Walking and Balance Post-TBI

Inclusion criteria

• greater than 3 months post-TBI (as defined by INTRuST criteria) and no longer receiving care as an inpatient in a rehabilitation facility.
• the ability to follow simple three-step commands;
• the ability to communicate presence and location of pain;
• the ability to sit independently without back or arm support for five minutes;
• the ability to stand with support of a straight cane, quad cane, or walker for 2 minutes;
• the ability to walk 10 meters with maximum 1 person assisting;
• presence of motor deficits (determined by clinical assessment of paresis);
• age ≥ 18;
• ability to give consent or have a acceptable surrogate capable of giving consent on subject's behalf

Exclusion criteria

• unable to ambulate 500 feet prior to TBI;
• history of serious chronic obstructive pulmonary disease or oxygen dependence;
• severe weight bearing pain;
• lower-extremity amputation;
• non-healing ulcers on the lower-extremity;
• renal dialysis or end stage liver disease;
• legal blindness or severe visual impairment;
• severe arthritis or orthopedic problems that limit passive ranges of motion of lower extremity (knee flexion contracture of -10°, knee flexion Range of Motion < 90°, hip flexion contracture > 25°, and ankle plantar flexion contracture > 15°);
• history of deep venous thrombosis or pulmonary embolism within 6 months
• uncontrollable diabetes with recent weight loss, diabetic coma, or frequent insulin reactions;
• severe hypertension with systolic greater than 200 mmHg and diastolic greater than 110 mmHg at rest;
• intracranial hemorrhage related to aneurysm rupture or an arteriovenous malformation (hemorrhagic infarctions will not be excluded);
• history of severe uncontrolled seizure disorder;
• other neurological conditions such as multiple sclerosis or Parkinson's Disease;
• pain that is scored greater than 5 out of 10 on a visual analog scale;
• any factor contraindicative to MRI examination (e.g., cardiac pacemaker/ defibrillator, pregnancy, aneurysm clips, insulin pump, metal fragments in the body).
• any other health problems judged by their screening physician to put the client at significant risk of harm during the study