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Assessment of sensorimotor functions after traumatic brain injury (TBI) in childhood - Methodological aspects
K Jöhnk1, J P Kuhtz-Buschbeck, H Stolze
1Department of Physiology, Christian-Albrechts-Universität, Kiel, Germany.
Insights
Evaluating sensorimotor functions after Traumatic Brain Injury (TBI) requires diverse methods. Quantitative movement analysis is crucial for tracking recovery in children, highlighting the need for standardized, combined approaches.
Area of Science:
- Neuroscience
- Pediatric Rehabilitation
- Movement Science
Background:
- Traumatic Brain Injury (TBI) significantly impacts sensorimotor functions in children.
- Standardized evaluation methods are essential for assessing recovery and guiding rehabilitation.
Purpose of the Study:
- To introduce and discuss qualitative and quantitative methods for evaluating sensorimotor functions post-TBI.
- To illustrate methodological aspects using a case study of a child with severe TBI.
Main Methods:
- Neurological examination, clinical scales (Barthel-Index, Terver Numeric Score, Rappaport Disability Rating Scale), and developmental tests (KTK).
- Quantitative assessment of gait (spatiotemporal parameters) and hand motor functions (kinematics).
- Comparison of a child with severe TBI to an age-matched healthy control group (N=16) over 12 months.
Main Results:
- Quantitative analysis identified movement slowing and compensatory strategies as primary motor disorders.
- Significant deficits were observed in fine motor skills (hand movements) and gait.
- Initial improvement was noted in the first interval post-TBI, with minimal improvement in the second interval.
Conclusions:
- Clinical scores and developmental tests may not fully capture the recovery trajectory.
- Quantitative movement assessment and functional tests are valuable for documenting sensorimotor recovery.
- Effective evaluation necessitates procedural uniformity and a combination of qualitative and quantitative methods.
Abstract:
Various basic qualitative and quantitative methods for the evaluation of sensorimotor functions after Traumatic Brain Injury (TBI) are introduced and discussed. Methodological aspects are illustrated by a single case follow-up study of a child after severe TBI (age 11; 712;1 yrs; 6, 8 and 12 month post TBI) in comparison to an age-matched healthy control group (N=16). The evaluation consisted of neurological investigation, Barthel-Index, Terver Numeric Score for Functional Assessment, Rappaport Disability Rating Scale (modified version), a coordination-test for children (KTK), a pilot-tested Motor Function Score, quantitative evaluation of spatiotemporal gait parameters on a walkway and on a treadmill, and the kinematic assessment of hand motor functions. Quantitative movement analyses revealed two general types of motor disorder: Slowing of movements and compensatory motor strategies. Averaged z-scores showed deficits, which were pronounced in fine motor skills (hand movements: 1.86, gait: 1.3). During follow-up, a strong improvement rate during the first (-0.48 z-scores) and nearly no improvement rate (-0.03 z-scores) during the second time interval was seen. Clinical scores and developmental tests were not able to document the whole restitutional course, whereas motor tests with special emphasis on functional aspects and the quantitative movement assessment seemed to be suitable methods. We conclude that a sufficient evaluation of sensorimotor functions after TBI in childhood needs an increase in procedural uniformity on onehand and the combination of various qualitative and quantitative methods on the other hand. To connect both claims, further research is necessary.
