Publication Date

Spring 2015

Document Type

Project Summary

Degree Name

Doctor of Physical Therapy


Physical Therapy

First Advisor

Russell E. Carter, PT, Ed.D.

Second Advisor

Mary K. Jones, PT, MPT, CLT, NCS

Third Advisor

Roberta O'Shea, PT, DPT, Ph.D.


Background and Purpose: The purpose of this retrospective case report is to describe physical therapy interventions provided to improve the balance and ambulation of a 20-year-old patient with apparent lower extremity foot drop and fatigue 20 months post severe traumatic brain injury secondary to a motor vehicle accident.

Case Description: The patient initially had decreased active and passive range of motion in bilateral ankles, decreased BERG balance test scores, and decreased ambulation distance without the use of an assistive device. Treatment interventions included balance and ambulation training program that incorporated stretching and joint mobilizations, balance exercises, and endurance training.

Outcomes: Following 13 sessions of skilled physical therapy over a 19-day period, the patient exhibited mild improvement with ankle dorsiflexion, improved ambulation speed by 900%, improved Six-Minute Walk test ambulation distance by 250 feet, and improved BERG balance test score by 7 points. The patient was also capable of ambulating 295 feet in a crowded, public area with moderate assistance.

Discussion: More research is needed to determine how mental fatigue impacts patients with acquired brain injury and impairments related to hypertonicity, balance, and ambulation distance beyond household distance (>150 feet).