Figure 44.5

Summary of results of Dynamic Gait Index for four subjects with nonpenetrating TBI.

44.9.1.1.2. Single tbi Subject Electromyelogram Results

Additional quantitative gait analysis using electromyography was performed on one of these subjects (D). At baseline, it revealed desynchronization of muscular activity—early activation of the left soleus during stance, and delayed activation of the left vastus lateralis, creating an abnormal gait pattern. This is shown in Figure 44.6. After 1 week of CN-NINM rehabilitation, much more normal phasing of both these muscles is present when the subject walked at the same speed. The medial hamstrings and medial gastrocnemius were not substantially affected, exhibiting similar phasing both before and after treatment.

Figure 44.6

Muscle activation pattern was recorded before (pre) and after (post) training. (a) Head stabilogram of a subject with bilateral vestibular loss, standing with closed eyes test during 100 seconds. Subject could not stand in test position before stimulation. (more...)

44.9.1.1.3. Stroke Subject dgi Results

Careful analysis of gait improvement in a stroke subject revealed a very important feature of CN-NINM training. The training protocol included balance, gait, and movement training (see previous section) during the initial 2 weeks in the laboratory, and an additional 5-day retraining and adjustment every month. In between the laboratory training sessions, the subject was instructed to continue the training at home. In this particular case, measurements of gait performance were conducted before and after every in-laboratory training period. Results are presented in Figure 44.7, which shows that the subject’s gait performance improved 48% over 6 months. However, development of such performance was not smooth and continuous, but looks stepwise. Maximum improvement shift was achieved during in-laboratory training (initial 2 weeks and two sequential follow-up periods). At home, however, the subject only maintained achieved performance without noticeable improvement. Most likely, this reflects the difference in level of “challenge” and effort that was applied during balance and gait exercises at home versus in the laboratory (in this particular case, subject used regular walking at home instead of specialized treadmill exercises in the laboratory). After the third training period, when gait performance was near maximal (23/24 of DGI score), the additional in-laboratory training did not change gait performance further and the subject successfully maintained this level of function by training at home. After 6 months, subject was asked to stop any training for 1 month (washout period). As a result, we noticed minimal performance drop, which was easily reversed when subject returned back to regular in-home exercises.

Figure 44.7

DGI recovery timeline. Stroke subject, 81 years of age, 4 years after cerebrovascular accident. Note: The major improvements occurred during in-laboratory training (blue stripes) and slight decrease of performance during “washout” period (more...)