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Effects of Traumatic Brain Injury on Locomotor Adaptation

Vasudevan, Erin V. L. PhD; Glass, Rebecca N. BS; Packel, Andrew T. PT, NCS

Journal of Neurologic Physical Therapy: July 2014 - Volume 38 - Issue 3 - p 172–182
doi: 10.1097/NPT.0000000000000049
Research Articles
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Background and Purpose: Locomotor adaptation is a form of short-term learning that enables gait modifications and reduces movement errors when the environment changes. This adaptation is critical for community ambulation for example, when walking on different surfaces. While many individuals with traumatic brain injury (TBI) recover basic ambulation, less is known about recovery of more complex locomotor skills, like adaptation. The purpose of this study was to investigate how TBI affects locomotor adaptation.

Methods: Fourteen adults with TBI and 11 nondisabled comparison participants walked for 15 minutes on a split-belt treadmill with 1 belt moving at 0.7 m/s, and the other at 1.4 m/s. Subsequently, aftereffects were assessed and de-adapted during 15 minutes of tied-belt walking (both belts at 0.7 m/s).

Results: Participants with TBI showed greater asymmetry in interlimb coordination on split-belts than the comparison group. Those with TBI did not adapt back to baseline symmetry, and some individuals did not store significant aftereffects. Greater asymmetry on split-belts and smaller aftereffects were associated with greater ataxia.

Discussion: Participants with TBI were more perturbed by walking on split-belts and showed some impairment in adaptation. This suggests a reduced ability to learn a new form of coordination to compensate for environmental changes. Multiple interacting factors, including cerebellar damage and impairments in higher-level cognitive processes, may influence adaptation post-TBI.

Conclusions: Gait adaptation to novel environment demands is impaired in persons with chronic TBI and may be an important skill to target in rehabilitation.

Video Abstract Available (See Video, Supplemental Digital Content 1, for more insights from the authors.

Supplemental Digital Content is Available in the Text.

Motor Learning Lab, Moss Rehabilitation Research Institute, Albert Einstein Healthcare Network, Elkins Park, Pennsylvania.

Correspondence: Erin V. L. Vasudevan, PhD, Moss Rehabilitation Research Institute, 50 Township Line Road, Elkins Park, PA 19027 (

Portions of this work have been presented at the Society for Neuroscience Annual Meeting, October 2012, New Orleans, Louisiana.

This work has been supported by seed funding from the Moss Rehabilitation Research Institute Peer Review Committee.

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

The authors have no conflicts of interest to declare.

© 2014 Neurology Section, APTA