Distribution and severity of lower limb spasticity does not influence mobility outcome following traumatic brain injury: An observational study.

Abstract

Objectives: To examine the effect of lower limb spasticity on mobility limitations following traumatic brain injury (TBI) and determine the influence of spasticity distribution on mobility outcomes following TBI. To determine whether the severity of lower limb spasticity had a differential effect on mobility following traumatic brain injury (TBI) and to investigate whether the distribution of lower limb spasticity influenced compensation strategies when walking. Methods: A large metropolitan rehabilitation hospital. Participants: Ninety-three ambulant people with TBI who were attending physiotherapy for mobility limitations. Design: Cross-sectional cohort study. Main measures: The High-Level Mobility Assessment Tool (HiMAT), gait velocity, modified Tardieu scale and three dimensional gait analysis was used to measure power generation. Results: Lower limb spasticity was common following TBI, with a distal distribution being the most prevalent. Participants with spasticity had significantly greater mobility limitations compared to participants without spasticity. However, the distribution of lower limb spasticity and the presence of unilateral or bilateral spasticity had no additional impact on mobility outcomes. There was no significant difference in mobility outcomes at the 6-month follow-up for people with spasticity, indicating that individuals have equivalent ability to improve their mobility over time despite the presence of spasticity. No significant relationship was found between the severity of lower limb spasticity and mobility limitations. There was a strong relationship between ankle power generation and mobility performance. Proximal compensation strategies did not vary significantly between groups with different distributions of lower limb spasticity. No significant relationship was found between the severity of lower limb spasticity and mobility limitations. There was a strong relationship between ankle power generation and mobility performance. Proximal compensation strategies did not vary significantly between groups with different distributions of lower limb spasticity. Conclusions: Following TBI, people with lower limb spasticity have significantly greater mobility limitations than those without spasticity, yet the distribution of spasticity does not appear to impact mobility outcomes. Although spasticity was prevalent, the severity and distribution did not appear to impact mobility outcomes. Proximal compensation strategies were not influenced by the distribution of lower limb spasticity following TBI. There is long-term potential to improve mobility, despite the presence of spasticity.