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Dual-Task Training for Balance and Mobility in a Person With Severe Traumatic Brain Injury: A Case Study

Fritz, Nora E. PT, DPT; Basso, D. Michele PT, EdD

Journal of Neurologic Physical Therapy: March 2013 - Volume 37 - Issue 1 - p 37–43
doi: 10.1097/NPT.0b013e318282a20d
Case Studies
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Background and Purpose: Attentional impairments following severe traumatic brain injury (TBI) are common and can lead to decreased functional mobility and balance, as well as deficits in previously automatic movements such as walking and stair climbing. The purpose of this case study was to determine the feasibility and potential value of incorporating a cognitive-motor dual-task training program into physical therapy for a patient with a severe TBI.

Case Description: The patient was a 26-year-old woman who sustained a severe TBI during a motor vehicle accident 46 days prior to physical therapy evaluation. On the 8-level Rancho Los Amigos Cognitive Function Scale, her functioning was classified as level IV. She had impairments in attention, functional mobility, and balance, all of which limited her ability to participate in activities of daily living.

Intervention: Physical therapy was provided over 26 days within the inpatient rehabilitation setting. Interventions included mobility tasks such as walking, balancing, and stair climbing. Mobility training was paired with specific secondary cognitive and motor tasks.

Outcomes: Dual-task training may have contributed to improvements on outcome measures designed to test divided attention including the Walking While Talking Test and Trail Making Test and a greater rate of improvement in walking speed and time to descend stairs when compared to the baseline phase.

Discussion: Addition of cognitive-motor dual-task training to standard physical therapy in the inpatient rehabilitation setting appears to be feasible and may have value for improving function in individuals with severe TBI.

Video Abstract available: (see Video, Supplemental Digital Content 1, for more insights from the authors.

School Health & Rehabilitation Sciences, The Ohio State University, Columbus.

Correspondence: Nora E. Fritz, PT, DPT, School Health & Rehabilitation Sciences, The Ohio State University, 453 W. 10th Avenue, Columbus OH 43210 (

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors have declared no conflict of interest.

This research was supported in part by a Florence P. Kendall Doctoral Scholarship from the Foundation for Physical Therapy.

© 2013 Neurology Section, APTA