When is it safe to resume high-level mobility after traumatic brain injury? A systematic review.

Abstract

Background: Traumatic brain injury (TBI) is the leading cause of disability in people aged 15-45. Many people with TBI have goals of returning to an active lifestyle and resuming community participation including leisure, sport and employment. High-level mobility (HLM) limitations are common following TBI and are associated with reduced community participation and quality of life. Commencing HLM retraining early is important for secondary prevention of comorbidities such as cardiovascular disease, type-2 diabetes and psychosocial problems but has potential risks associated such as falls, re-bleeding and exacerbation of symptoms (e.g. headache, dizziness, visual disturbance). In the absence of clinical guidelines, this review aimed to determine the timeframe for safe resumption of HLM after TBI from the literature. Method: An electronic search of 10 databases was performed. Identification of relevant articles, data extraction and quality assessment was performed in accordance with the PRISMA guidelines. Results: Seventeen studies were included in the review. Fourteen studies had participants commence HLM before six-weeks post injury, with the earliest time to commencement being three days. Only one study reported adverse events and no studies monitored symptom exacerbation, making it difficult to draw conclusions regarding the safety of HLM exercise after TBI. Conclusion: A safe timeframe for return to HLM training after TBI could not be determined due to insufficient reporting of symptom exacerbation and adverse events. Further research into the safety of HLM in the early rehabilitative stage after TBI is required in order to better understand potential sequelae and adverse events in this population.