HIGH INTENSITY GAIT TRAINING FOLLOWING ACUTE TRAUMATIC BRAIN INJURY IN A PEDIATRIC PATIENT: A CASE STUDY

Background & Purpose: The current literature and clinical practice guidelines support high intensity gait training (HIGT) to help in the recovery of individuals post stroke, brain injury and spinal cord injury. Much of the literature focuses on the implementation of these interventions with adults, with little to no published literature in pediatrics. The purpose of this platform is to review the existing research, discuss application of the principles of high intensity gait training to the pediatric population, and demonstrate the feasibility of high intensity gait training (HIGT) intervention in a case report of a pediatric patient following acute traumatic brain injury.

Case Description: The patient is a 15-year-old male with traumatic brain injury following gunshot wound to the head who was seen in pediatric acute inpatient rehabilitation. High intensity gait training consisting of treadmill training, over ground training and stair training was implemented at least 4x/wk for 30-60 minutes per day for 10 weeks. HIGT was unable to be performed for target frequency 2 weeks of the admission due to serial casting intervention. Body weight support via the ZeroG and harness support at 0% body weight was provided as needed to ensure safety. Heart rate was monitored via continuous monitoring with the Polar H10 monitor with the goal of achieving 75-85% heart rate maximum. When the heart rate monitor was not available the RPE (rate of perceived exertion) scale was utilized with the goal of a 15-17. Target heart rates were achieved by varying speed, incline, resistance, and added ankle weights, and by incorporating retro ambulation, side-stepping, and obstacle negotiation.

Outcomes: Functional outcomes included the Ten Meter Walk Test (10MWT), Berg Balance Scale (BBS), Timed up and Go (TUG), and the Six Minute Walk Test (6MWT). Minimal detectable change (MDC) or minimally clinical important difference (MCID) for traumatic brain injury was used to evaluate meaningful improvement when possible. The patient increased his TUG from 38 seconds initially to 14.8 seconds and increased his overall gait speed on the 10MWT by 0.27m/s. He improved from a 7/56 on the BERG to a 33/56 and improved two standard deviations on the Six Minute Walk Test.

Discussion: HIGT is a promising and feasible intervention to promote meaningful recovery in pediatric patients with traumatic brain injury, with no adverse events occurring for this patient. The patient improved with his overall endurance, gait speed, independence and balance. Further research is indicated to compare effectiveness of HIGT versus traditional physical therapy in pediatric patients. In addition to discussing the results of this specific patient, presenters will briefly discuss equipment and sample interventions with videos and patient care anecdotes from a variety of pediatric patients with acquired brain injury.