Self-report questionnaire.

Pediatric traumatic brain injury often leads to long-term disability. Unfortunately, while currently used standard clinical measures can effectively capture secondary functional impairments, they do not measure neurologic impairment directly. Therefore, the objective of this study was to evaluate the feasibility of walking dynamic motor control (walk-DMC) assessments to more directly measure neurological impairment and recovery for individuals post-traumatic brain injury. To accomplish this, we assessed the trajectory of walk-DMC (a single summary measure that reflects the overall complexity of muscle activation patterns during walking) and standard clinical measures of balance, mobility, and function in a small cohort of individuals post-traumatic brain injury at different time points post-injury (during acute rehabilitation, short- and long-term follow-up). At enrollment all participants demonstrated substantial neurological impairment. All clinical measures showed an initial deficit followed by recovery, with most returning to nondisabled ranges over the study period for all participants. In contrast, walk-DMC scores demonstrated an initial acute deficit and did not reach nondisabled ranges for two of the participants, indicating persistent neurologic impairment. The findings of our pilot study show the promise of Walk-DMC’s ability in identifying subtle ongoing neurologic impairment compared to traditionally used clinical assessments of balance, mobility, and function. Further work in a larger cohort of participants with traumatic brain injury will improve understanding of how walking dynamic motor control changes with injury severity and where such a measure can serve as a leading indicator of neurologic and functional recovery.

儿童创伤性脑损伤常导致长期残疾。遗憾的是，当前临床常用的标准评估手段虽可有效检出继发性功能障碍，却无法直接衡量神经功能损伤。为此，本研究旨在评估步行动态运动控制（walking dynamic motor control，walk-DMC）评估的可行性，以期更直接地检测创伤性脑损伤患者的神经功能损伤与恢复状态。为实现这一研究目标，我们针对小型创伤性脑损伤患者队列，在损伤后不同时间节点（急性康复期、短期及长期随访阶段）开展了两项评估：一是walk-DMC的变化轨迹——该指标为可反映步行过程中肌肉激活模式整体复杂度的单一汇总指标；二是平衡、活动能力与功能的标准临床评估指标。入组阶段所有参与者均表现出显著的神经功能损伤。所有临床评估指标均呈现初始缺损、后续恢复的变化趋势，多数参与者在研究周期内恢复至无残疾水平区间。与之形成鲜明对比的是，walk-DMC评分仅表现出初始急性缺损，且有2名参与者始终未达到无残疾水平区间，提示其存在持续性神经功能损伤。本预试验结果表明，相较于传统的平衡、活动能力与功能临床评估手段，walk-DMC在识别隐匿的持续性神经功能损伤方面颇具应用潜力。未来针对更大规模创伤性脑损伤患者队列的研究，将有助于进一步明确步行动态运动控制随损伤严重程度的变化规律，以及该指标可作为神经功能与功能恢复先导指标的适用场景。