Is ballistic strength training more effective than usual care for improving mobility following traumatic brain injury (TBI)?

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Traumatic brain injury (TBI) is the leading cause of death and disability amongst adolescents and young adults. The incidence of TBI in Australia is 300 per 100,000, of which 20% are classified moderate to severe. The prevalence of TBI in the community is high because of the survival rate and the demographic groups at most risk are adolescents and young adults. Although a minority of people who sustain a moderate to severe TBI can expect to make a full recovery, over 75% of victims never return to full independence and function. In contrast to the vast literature on neuropsychological impairments following TBI, surprisingly little information is known about the effect of the brain injury on gait. My recent systematic review found the key biomechanical abnormalities of gait were yet to be determined. Further, the key physical impairments contributing to mobility limitations have not been established. Several studies have suggested balance may be primarily responsible. Although balance, spasticity, contracture, muscle weakness and inco-ordination may all contribute to mobility limitations, my research has identified that balance and strength deficits are most prevalent, but the primary cause of mobility limitations was muscle weakness. Physiotherapy is routinely provided to treat the physical impairments that contribute to mobility limitations in order to optimize rehabilitation outcomes for people with TBI. Balance training and muscle strengthening programs are widely used. Strong evidence exists indicating balance training improves balance disorders and strength training improves muscle weakness in neurological populations, yet little evidence exists supporting the impact of either intervention on mobility limitations. Further, a recent international symposium on research priorities for TBI highlighted the urgent need for rehabilitative therapy research as virtually no level 1 evidence exists. The primary aim of this research program is to investigate whether ballistic strength training is more effective than usual carer for improving mobility following TBI. The research program constitutes a randomised controlled trial (RCT) comparing ballistic strength training and usual care for improving mobility following TBI.