title: Targeted rehabilitation reduces visual dependency and improves balance in severe traumatic brain injury: a case study.
abstract: OBJECTIVE
  To further understand the mechanisms underlying gait impairment following traumatic brain injury.
  
  
  METHODS
  A 58-year-old man presented with marked unsteadiness and motion sensitivity following a severe traumatic brain injury. He underwent a 6-week inpatient rehabilitation program focused on re-weighting and subsequently re-integrating ascending interoceptive information, by gradual reduction of maladaptive visual fixation techniques. We report clinical neurological outcomes and measures of functional outcome, as well as an objective assessment of visual dependency (the rod and disk test) at baseline and after the rehabilitation.
  
  
  RESULTS
  Clinically, the patient had gait unsteadiness exacerbated by visual motion. A significant reduction in visual dependency occurred with tailored multi-disciplinary rehabilitation via gradual removal of visual fixation strategies that the patient had developed to maintain balance (t-test; p < 0.01), as well as clinical improvements in gait, balance, and functional outcome.
  
  
  CONCLUSIONS
  We highlight the importance of visual dependency in the generation of maladaptive gait strategies following brain injury. Our data suggest assessing and treating visual dependency to be an important component of gait rehabilitation after traumatic brain injury. Implications for rehabilitation Whilst gait disturbance in TBI is multifactorial, abnormal visual dependency may be important but under-recognised component of the disorder. Visual dependency can be easily and objectively assessed by the bedside in patients using a dynamic rod and disc test. Tailored rehabilitation with gradual reduction of maladaptive visual fixation can reduce visual dependency and contribute to improved gait and balance following TBI.
authors.affiliation: a Institute of Neurology, University College London , London , UK.
authors.forename: Diego
authors.initials: D
authors.lastname: Kaski
authors.affiliation: b Regional Neurological Rehabilitation Unit , Homerton University Hospital , London , UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Buttell
authors.affiliation: a Institute of Neurology, University College London , London , UK.|b Regional Neurological Rehabilitation Unit , Homerton University Hospital , London , UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Greenwood
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology; D000070642:Brain Injuries, Traumatic / Q000503:physiopathology / Q000534:rehabilitation*; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology*
keywords: BPPV; Visual dependency; balance; gait; rehabilitation; traumatic brain injury