Effectiveness of exercise for improving balance and gait in patients with traumatic brain injury – literature review

Uvod: Nezgodna poškodba možganov je pridobljena poškodba, ki ima lahko za posledice okvare kognitivne funkcije, senzorike in motorike. Z izvajanjem vadbe za ravnotežje in hojo naj bi pripomogli k izboljšanju ravnotežja in premičnosti. Poleg standardne vadbe za ravnotežje in hojo se lahko uporabi tudi navidezno resničnost, tekoči trak z razbremenitvijo telesne teže ali robote za hojo. Namen: Namen diplomskega dela je bil pregledati izsledke randomiziranih kontroliranih poskusov o učinkovitosti vadbe za izboljšanje ravnotežja in hoje pri pacientih z nezgodno poškodbo možganov. Metode dela: Literaturo smo iskali v podatkovnih zbirkah PubMed, PEDro, Cochrane in CINAHL. Vključeni so bili le randomizirani kontrolirani poskusi v angleškem jeziku, ki so bili objavljeni do septembra 2020. Rezultati: V pregled literature smo vključili pet raziskav o učinkovitosti vadbe za ravnotežje in štiri raziskave o učinkovitosti vadbe hoje. V raziskavah je skupno sodelovalo 292 preiskovancev, v različnih fazah po poškodbi in z različno stopnjo resnosti poškodbe. Primerjavo med raziskavami so oteževale različne izvedbe in primerjave vadbenih programov ter različna ocenjevalna orodja. V pregledanih raziskavah ni bilo prisotne razlike v učinkovitosti med standardno vadbo hoje in vadbo hoje na tekočem traku z razbremenitvijo telesne teže, med vadbo hoje z roboti in vadbo hoje na tekočem traku z razbremenitvijo telesne teže ter med standardno vadbo za ravnotežje in vadbo z uporabo navidezne resničnosti. V dveh raziskavah o učinkovitosti vadbe za ravnotežje so poročali o (večjem) izboljšanju ravnotežja, premičnosti in vrtoglavice po vadbi v primerjavi s skupino brez vadbe in po vadbi z navidezno resničnostjo v primerjavi z vadbo na ravnotežni plošči Biodex. Zaključek: V pregledanih raziskavah so poročali o vadbah za ravnotežje in hojo, ki so bile učinkovite za izboljšanje ravnotežja in premičnosti, vendar v večini raziskav (z izjemo dveh) niso ugotovili superiornosti določene vrste vadbe. Zaradi nizkega števila raziskav, majhnega in nehomogenega vzorca ter različnih merilnih orodij ne moremo z gotovostjo trditi, da nobena od vrst vadbe za ravnotežje in hojo ni superiorna za izboljšanje ravnotežja in premičnosti. Potrebno je izvesti raziskave z večjimi in bolj homogenimi vzorci preiskovancev, poenotiti merilna orodja in natančno opisati vadbene programe.Introduction: Traumatic brain injury is an acquired brain injury that can result in impairment of cognitive, sensory, and motor function. Performing balance and gait training should improve balance and mobility. In addition to standard balance and gait training, virtual reality, partial body weight-supported and robotic gait training can also be used. Purpose: The purpose of this diploma thesis was to review the results of randomized controlled trials on the effectiveness of exercise for improving balance and gait in patients with traumatic brain injury. Methods: We searched for literature in PubMed, PEDro, Cochrane and CINAHL. Only randomized controlled trials in English published up to September 2020 were included. Results: We included five randomized controlled trials on the effectiveness of balance training and four randomized controlled trials on the effectiveness of gait training in the literature review. The total number of 292 subjects participated in the study, with different time after the injury and with varying severity of the injury. Comparisons between surveys were hampered by different implementations and comparisons of exercise programs and different assessment tools. In the reviewed studies, there was no difference in effectiveness between standard gait training and body weight-supported training, between robotic gait training and body weight-supported training, and between standard balance training and virtual reality based balance training. Two studies of the effectiveness of balance training reported (greater) improvements of balance, mobility, and dizziness after exercise compared to the non-exercise group and after virtual reality training compared to training on Biodex balance platform. Conclusion: Balance and gait trainings that were effective in improving balance and mobility were reported in the reviewed studies, but the superiority of a particular type of training was not found in most studies (except two). Due to the low number of studies, the small and inhomogeneous sample, and the various measurement tools, it cannot be said with certainty that none of the types of balance and gait trainings are superior to improve balance and mobility. It is necessary to conduct research with larger and more homogeneous samples of subjects, to unify measurement tools and to describe training programs in detail