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Recovery of Ambulation During Inpatient Rehabilitation: Physical Therapist Prognosis for Children and Adolescents With Traumatic Brain Injury

HM Dumas, PT, MS, is Manager, Research Center for Children with Special Health Care Needs, Franciscan Children's Hospital and Rehabilitation Center, 30 Warren St, Boston, MA 02135 (USA) (hdumas{at}fchrc.org).
SM Haley, PT, PhD, is Director, Center for Rehabilitation Effectiveness, and Associate Professor of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Mass
LH Ludlow, PhD, is Professor and Chair, Department of Educational Research, Measurement, and Evaluation, Lynch School of Education, Boston College, Boston, Mass
TM Carey, PT, MSPT, was a Research Assistant, Research Center for Children With Special Health Care Needs, Franciscan Children's Hospital and Rehabilitation Center, at the time of the study

Address all correspondence to Ms Dumas

Background and Purpose. Evidence to guide physical therapist prognosis for recovery of the ability to ambulate in children and adolescents with traumatic brain injury (TBI) is limited. The aim of this study was to delineate a predictive model and determine the value of key demographic and clinical variables in establishing a prognosis for ambulation without the assistance of a device or person over 15.24 m on a flat, level surface following inpatient rehabilitation. Subjects and Methods. For this retrospective study, a consecutive series of 95 children and adolescents with TBI (aged 2–18 years) admitted to an inpatient rehabilitation program was assessed using information from medical records. A multiple logistic regression analysis was conducted to identify predictors for ambulation at the time of discharge from the rehabilitation setting. Results. Fifty-six percent of the children achieved ambulation at discharge. Lower-extremity hypertonicity (measured on physical therapist examination as resistance to passive stretch), brain injury severity, and lower-extremity injury together were predictors of the ability to ambulate. Discussion and Conclusion. Impairment and injury-related variables were important in predicting a minimal level of unassisted ambulation after discharge from inpatient rehabilitation. Awareness of predictors of recovery of the ability to ambulate that are gathered as part of a physical therapist's examination may assist in developing a prognosis for ambulation and in establishment of an appropriate plan of care.

Key Words: Brain injuries • Child • Prognosis • Rehabilitation • Walking

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				D. J Smyntek, H. Dumas, S. M Haley, D. Aldrich, and D. P Hunt Use Evidence Cautiously Physical Therapy, July 1, 2004; 84(7): 665 - 667. [Full Text]