The nature and extent of upper limb associated reactions during walking in people with acquired brain injury.
Michelle B Kahn, Ross A Clark, Gavin Williams and 4 others
PMID 31881975WHAT IT FOUND
During walking, people with acquired brain injury and associated reactions held the affected arm further from the body and bent the elbow more than healthy adults.
Shoulder, forearm and wrist patterns also varied, so assess the whole arm.
Key findings
01During walking, the acquired brain injury group showed more shoulder abduction and more elbow flexion than healthy controls.
02Group differences were broad, affecting 18 of 30 upper limb variables, with all shoulder abduction and elbow flexion outcomes different.
03Individual patterns varied: about half had fixed elbow flexion, a third had increased shoulder abduction variability, and half had increased forearm rotation range of motion.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
People could walk 10 m without aids, so findings may not apply to more severely affected patients. The ABI group mixed stroke, traumatic brain injury and neurosurgical conditions, so patterns could not be separated by diagnosis. Associated reactions were identified by visual observation before testing, not by a validated objective measure. The study only looked at walking, so it does not show how the arm behaves in sit-to-stand, standing or daily tasks. The motion analysis model did not capture fingers and had known shoulder modelling and soft tissue error. This was a descriptive comparison, not a trial of any treatment.
Declared interests
Funding was provided by Royal Automobile Club of Victoria, Physiotherapy Research Foundation, Epworth Research Institute, National Health and Medical Research Council, and an R.D. Wright Biomedical Fellowship. The supplied text does not report additional conflicts of interest.
The easy way to misread this
Do not read the group differences as one arm posture for every patient with acquired brain injury. Many participants were abnormal in opposite directions, and the study did not test whether treating those patterns changes walking or arm function.