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Antonellis P, Weightman MM, Fino PC, Chen S, Lester ME, Hoppes CW, Dibble LE, King LA. Relation Between Cognitive Assessment and Clinical Physical Performance Measures After Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2024; 105:868-875. [PMID: 37931890 DOI: 10.1016/j.apmr.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To investigate the relation between cognitive and motor performance in individuals with mild traumatic brain injury (mTBI) and examine differences in both cognitive and motor performance between adults after mTBI and healthy controls. DESIGN Multi-center, cross-sectional study. SETTING Three institutional sites (Courage Kenny Research Center, Minneapolis, MN, Oregon Health & Science University, Portland, OR, and University of Utah, Salt Lake City, UT). PARTICIPANTS Data were collected from 110 participants (N=110), including those with mTBI and healthy controls, who completed cognitive and physical performance assessments. INTERVENTIONS Not applicable. OUTCOME MEASURES Cognitive assessments involved the Automated Neuropsychological Assessment Metrics to evaluate domains of attention, memory, reaction time, processing speed, and executive function. Physical performance was evaluated through clinical performance assessments, such as the 1-min walk test, the modified Illinois Agility Test, the Functional Gait Assessment Tool, the High-Level Mobility Assessment Tool, a complex turning course, and a 4-Item Hybrid Assessment of Mobility for mTBI. Participants also completed additional trials of the 1-min walk test, modified Illinois Agility Test, and complex turning course with a simultaneous cognitive task. RESULTS Individuals with mTBI performed worse on cognitive assessments, as well as several of the physical performance assessments compared with healthy controls. Complex tasks were more strongly related to cognitive assessments compared with simple walking tasks. CONCLUSIONS Combining complex motor tasks with cognitive demands may better demonstrate functional performance in individuals recovering from mTBI. By understanding the relation between cognitive and physical performance in individuals recovering from mTBI, clinicians may be able to improve clinical care and assist in return to activity decision-making.
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Affiliation(s)
| | | | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT
| | - Siting Chen
- School of Public Health, Oregon Health & Science University, Portland, OR
| | - Mark E Lester
- Department of Physical Therapy, University of Texas Rio Grande Valley, Harlingen, TX
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR
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Zampieri C, Leary JB, Shahim P, Damiano D, Ho PS, Pham DL, Chan L. Associations between white matter integrity and postural control in adults with traumatic brain injury. PLoS One 2023; 18:e0288727. [PMID: 38011096 PMCID: PMC10681193 DOI: 10.1371/journal.pone.0288727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/03/2023] [Indexed: 11/29/2023] Open
Abstract
Abnormalities of postural sway have been extensively reported in traumatic brain injury (TBI). However, the underlying neural correlates of balance disturbances in TBI remain to be elucidated. Studies in children with TBI have reported associations between the Sensory Organization Test (SOT) and measures of white matter (WM) integrity with diffusion tensor imaging (DTI) in brain areas responsible for multisensory integration. This study seeks to replicate those associations in adults as well as explore relationships between DTI and the Limits of Stability (LOS) Test. Fifty-six participants (43±17 years old) with a history of TBI were tested 30 days to 5 years post-TBI. This study confirmed results in children for associations between the SOT and the medial lemniscus as well as middle cerebellar peduncle, and revealed additional associations with the posterior thalamic radiation. Additionally, this study found significant correlations between abnormal LOS scores and impaired WM integrity in the cingulum, corpus callosum, corticopontine and corticospinal tracts, fronto-occipital fasciculi, longitudinal fasciculi, medial lemniscus, optic tracts and thalamic radiations. Our findings indicate the involvement of a broad range of WM tracts in the control of posture, and demonstrate the impact of TBI on balance via disruptions to WM integrity.
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Affiliation(s)
- Cris Zampieri
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jacob B. Leary
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Pashtun Shahim
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Diane Damiano
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Pei-Shu Ho
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Dzung L. Pham
- Center for Neuroscience and Regenerative Medicine, The Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland, United States of America
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Martini DN, Gera G, Brumbach BH, Campbell KR, Parrington L, Chesnutt J, King LA. Symptoms and Central Sensory Integration in People With Chronic mTBI: Clinical Implications. Mil Med 2023; 188:3553-3560. [PMID: 35657326 PMCID: PMC10629982 DOI: 10.1093/milmed/usac157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/27/2022] [Accepted: 05/18/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Balance deficits in people with chronic mild traumatic brain injury (mTBI; ≥3 months post-mTBI), thought to relate to central sensory integration deficits, are subtle and often difficult to detect. The purpose of this study was to determine the sensitivity of the instrumented modified clinical test of sensory integration for balance (mCTSIB) in identifying such balance deficits in people with symptomatic, chronic mTBI and to establish the associations between balance and mTBI symptom scores in the chronic mTBI group. METHODS The Institutional Review Board approved these study methods. Forty-one people with chronic mTBI and balance complaints and 53 healthy controls performed the mCTSIB (eyes open/closed on firm/foam surfaces; EoFi, EcFi, EoFo, and EcFo) with a wearable sensor on their waist to quantify sway area (m2/s4). Sensory reweighting variables were calculated for the firm and foam stance conditions. A stopwatch provided the clinical outcome for the mCTSIB (time). Each participant completed the Neurobehavioral Symptom Inventory (NSI), which quantifies mTBI-related symptoms and provides a total score, as well as sub-scores on affective, cognitive, somatic, and vestibular domains. RESULTS The mTBI group reported significantly higher symptom scores across each NSI sub-score (all Ps < .001). The mTBI group had a significantly larger sway area than the control group across all mCTSIB conditions and the mTBI group had significantly higher sensory reweighting scores compared to the control group on both the firm (P = .01) and foam (P = .04) surfaces. Within the mTBI group, the NSI vestibular score significantly related to the mCTSIB sway area EcFi (r = 0.38; P = .02), sway area EcFo (r = 0.43; P = .006), sensory reweighting firm (r = 0.33; P = .04), and sensory reweighting foam (r = 0.38; P = .02). The average sway area across the 4 mCTSIB conditions was significantly (area under the curve: 0.77; P < .001) better at differentiating groups than the mCTSIB clinical total score. The average sway area across the 4 mCTSIB conditions had a sensitivity of 73% and a specificity of 71%. The clinical mCTSIB outcome scores were not different between groups. CONCLUSION People with chronic mTBI appear to have central sensory integration deficits detectable by instrumented measures of postural assessment. These findings suggest that central sensory integration should be targeted in rehabilitation for people with chronic mTBI.
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Affiliation(s)
- Douglas N Martini
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA 01003, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Geetanjali Gera
- Department of Physical Therapy, University of Kentucky, Lexington, KY 40536, USA
| | - Barbara H Brumbach
- Biostatistics and Design Program, Oregon Health & Science University, Portland, OR 97239, USA
| | - Kody R Campbell
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Healthcare System, Portland, OR 97239, USA
| | - Lucy Parrington
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Healthcare System, Portland, OR 97239, USA
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Bundoora, VIC 3086, Australia
| | - James Chesnutt
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Family Medicine and Orthopedics & Rehabilitation, Oregon Health & Science University, Portland, OR 97239, USA
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Healthcare System, Portland, OR 97239, USA
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Kleffelgård I, Andelic N, Bruusgaard KA, Langhammer B, Tamber AL, Soberg HL. Dizziness-Related Disability One Year after a Mild-to-Moderate TBI-A Follow-Up Study. J Clin Med 2023; 12:5192. [PMID: 37629234 PMCID: PMC10455561 DOI: 10.3390/jcm12165192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/29/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Persisting dizziness and balance problems after mild-to-moderate traumatic brain injury (mmTBI) may result in considerable disability. The primary aim of this study was to explore the factors associated with dizziness-related disability one year post-injury. Data from 64 participants (mean age 39.4 [SD 13.0] years; 45 [70.3%] women) with mmTBI from a previous randomised controlled trial were analysed using simple and multiple regression analyses (Clinical Trials Registry #NCT01695577). The Dizziness Handicap Inventory one year (12.1, [SD1.6] months) post-injury was the dependent variable. Demographic and injury-related variables, clinical findings, and measures of post-injury symptoms and functioning (Rivermead Post-Concussion Symptoms Questionnaire, RPQ; Vertigo Symptom Scale-short form, VSS-SF; Hospital Anxiety and Depression Scale; Balance Error Scoring System; and High-Level Mobility Assessment Tool, HiMAT) at baseline (3.5 [SD 2.1] months post-injury) were the independent variables. Dizziness-related disability at one year was associated with pre-injury comorbidity, neck pain, higher RPQ, higher VSS-SF, and lower HiMAT scores (adjusted R2 = 0.370, F = 6.52 p < 0.001). In conclusion, the factors associated with dizziness-related disability one year post-injury, such as pre-injury comorbidity, neck pain, increased post-concussion symptom burden, increased dizziness symptom severity, and reduced balance and mobility, should be addressed early in the rehabilitation process to reduce patient burden.
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Affiliation(s)
- Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (N.A.); (H.L.S.)
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (N.A.); (H.L.S.)
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Kari Anette Bruusgaard
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (K.A.B.); (B.L.); (A.-L.T.)
| | - Birgitta Langhammer
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (K.A.B.); (B.L.); (A.-L.T.)
| | - Anne-Lise Tamber
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (K.A.B.); (B.L.); (A.-L.T.)
| | - Helene Lundgaard Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (N.A.); (H.L.S.)
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (K.A.B.); (B.L.); (A.-L.T.)
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Campbell KR, Scanlan KT, Wilhelm JL, Brumbach BH, Pettigrew NC, Neilson A, Parrington L, King LA. Assessment of balance in people with mild traumatic brain injury using a balance systems model approach. Gait Posture 2023; 100:107-113. [PMID: 36516644 DOI: 10.1016/j.gaitpost.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/27/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Measuring persistent imbalance after mTBI is challenging and may include subjective symptom-reporting as well as clinical scales. Clinical assessments for quantifying balance following mTBI have focused on sensory orientation. It is theorized that balance control goes beyond sensory orientation and also includes subdomains of anticipatory postural adjustments, reactive postural control, and dynamic gait. The Mini Balance Evaluation Systems Test (Mini-BESTest) is a validated balance test that measures balance according to these subdomains for a more comprehensive assessment. The purpose of this study was to compare Mini-BESTest total and subdomain scores after subacute mTBI with healthy controls. METHODS Symptomatic mTBI (n = 90, 20 % male, age=36.0 ± 12.0, 46.3.4 ± 22.1 days since injury) and healthy control (n = 45, 20 % male, age=35.4 ± 12.5) participants completed the Mini-BESTest for balance. Mini-BESTest between-group differences were evaluated using Wilcoxon rank-sum tests. RESULTS The mTBI group (Median[minimum,maximum]) had a significantly worse Mini-BESTest total score than the healthy controls (24[18,28] vs 27[23-28], p < 0.001). The mTBI group performed significantly worse in 3 of the 4 subdomains compared to the healthy controls: reactive postural control: 5[2-6] vs 6[3-6], p = 0.003; sensory orientation: 6[5,6] vs 6[6], p = 0.005; dynamic gait: 8[5-10] vs 9[8-10], p < 0.001. There was no significance difference between groups in the anticipatory postural adjustments domain (5[3-6] vs 5[3-6], p = 0.12). CONCLUSIONS The Mini-BESTest identified deficits in people with subacute mTBI in the total score and 3 out of 4 subdomains, suggesting it may be helpful to use in the clinic to identify balance subdomain deficits in the subacute mTBI population. In combination with self-reported assessments, the mini-BESTest may identify balance domain deficits in the subacute mTBI population and help guide treatment for this population.
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Affiliation(s)
- Kody R Campbell
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA.
| | - Kathleen T Scanlan
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA
| | - Jennifer L Wilhelm
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA
| | - Barbara H Brumbach
- Biostatistics & Design Program, Oregon Health & Science University, Portland, USA
| | - Natalie C Pettigrew
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA; Department of Neurology, Center for Regenerative Medicine, Oregon Health & Science University, Portland, USA
| | - Akira Neilson
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA
| | - Lucy Parrington
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; Department of Dietetics, Human Nutrition and Sport, School of Sport and Exercise Science, La Trobe University, Melbourne, Australia
| | - Laurie A King
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA
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Sheeba S, Cavaleri R, Summers S, Browne C. Effectiveness of non-pharmacological treatments for vestibular and oculomotor dysfunction in patients with persistent post-concussive symptoms: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e066634. [PMID: 36609322 PMCID: PMC9827270 DOI: 10.1136/bmjopen-2022-066634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Concussion is a form of mild traumatic brain injury that disrupts brain function. Although symptoms are mostly transient, recovery can be delayed and result in persistent postconcussive symptoms (PPCS). Vestibular and oculomotor dysfunction are among the most debilitating impairments associated with PPCS. However, pharmacological interventions for these impairments are associated with deleterious side effects. Accordingly, increasing research has examined the utility of non-pharmacological interventions for PPCS. The aim of this review is to synthesise and evaluate the effectiveness of non-pharmacological interventions for the treatment of vestibular and oculomotor dysfunction for patients with PPCS. METHODS AND ANALYSIS Systematic searches of MEDLINE, PubMed, Web of Science and Scopus will identify randomised controlled trials employing non-pharmacological treatments for vestibular and/or oculomotor dysfunction for PPCS. Such interventions may include, but are not limited to, vestibular rehabilitation, optokinetic stimulation and vestibulo-ocular reflex exercises. Assessments of oculomotor function will include versional eye movements, vergence eye movements, visual-fixation movements and accommodation response. Assessments of vestibular function will include the Fukuda Step test, functional balance tests, force displacement tests, and subjective reports of balance disruption or vertigo. Where appropriate, meta-analyses of standardised mean differences will be conducted using a random effects model for continuous outcomes. For dichotomous outcomes (improved vs not improved following treatment), effects will be expressed as relative risk. The impact of heterogeneity will be calculated using the I2 statistic. The Physiotherapy Evidence Database scale will be used to determine the methodological quality of individual studies and Grading of Recommendations, Assessment, Development and Evaluations used to assess the certainty and quality of evidence for each outcome. ETHICS AND DISSEMINATION Ethical approval is not required for this review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021254720.
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Affiliation(s)
- Stella Sheeba
- School of Science, Western Sydney University, Sydney, New South Wales, Australia
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Rocco Cavaleri
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Simon Summers
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Cherylea Browne
- School of Science, Western Sydney University, Sydney, New South Wales, Australia
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Translational Neuroscience Facility, UNSW Sydney, Sydney, New South Wales, Australia
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Coelho-Júnior HJ, Calvani R, Tosato M, Landi F, Picca A, Marzetti E. Protein intake and physical function in older adults: A systematic review and meta-analysis. Ageing Res Rev 2022; 81:101731. [PMID: 36087703 DOI: 10.1016/j.arr.2022.101731] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The present study explored cross-sectional and longitudinal associations between protein intake and physical function in older adults. METHODS We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated the association between protein intake and measures of physical function in older adults. Cross-sectional, case-control, and longitudinal cohort studies that investigated the association between protein intake and physical function as a primary or secondary outcome in people aged 60 + years were included. Studies published in languages other than English, Italian, Portuguese, or Spanish were excluded. Studies were retrieved from MEDLINE, SCOPUS, EMBASE, CINAHL, AgeLine, and Food Science Source databases through January 31, 2022. A pooled effect size was calculated based on standard mean differences (SMD), MD, log odds ratio (OR) and Z-score.. RESULTS Twenty-two cross-sectional studies examined a total of 11,332 community-dwellers, hospitalized older adults, and elite senior athletes with a mean age of approximately 75 years. The pooled analysis indicated that a protein intake higher than the recommended dietary allowance (RDA) was significantly associated with higher Short Physical Performance Battery (SPPB) scores (SMD: 0.63, 95% CI: 0.27, 0.99, P-value: 0.0006), faster walking speed, greater lower-limb (SMD: 0.22, 95% CI: 0.04, 0.40, P-value: 0.02) and isometric handgrip strength (Z-score: 0.087, 95% CI: 0.046-0.128, P-value: 0.0001), and better balance (SMD: 0.33, 95% CI: 0.05, 0.62, P-value: 0.02). Nine longitudinal studies investigated 12,424 community-dwelling and native older adults with a mean age of approximately 85 years. A protein intake higher than the current RDA was not associated with lower decline in either isometric handgrip strength (logOR: 0.99, 95% CI: 0.97-1.02, P-value= 0.67) or walking speed (logOR: 0.92, 95% CI: 0.77-1.10, P-value= 0.35). CONCLUSIONS A protein intake higher than the RDA is cross-sectionally associated with better physical performance and greater muscle strength in older adults. However, a high consumption of proteins does not seem to prevent physical function decline over time.
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Affiliation(s)
- Hélio José Coelho-Júnior
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.
| | - Riccardo Calvani
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.
| | - Matteo Tosato
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Francesco Landi
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Anna Picca
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Emanuele Marzetti
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
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Campbell KR, Wilhelm JL, Pettigrew NC, Scanlan KT, Chesnutt JC, King LA. Implementation and Adoption of Telerehabilitation for Treating Mild Traumatic Brain Injury. J Neurol Phys Ther 2022; 46:E1-E10. [PMID: 35666882 DOI: 10.1097/npt.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Multimodal physical therapy for mild traumatic brain injury (mTBI) has been shown to improve recovery. Due to the coronavirus disease-2019 (COVID-19) pandemic, a clinical trial assessing the timing of multimodal intervention was adapted for telerehabilitation. This pilot study explored feasibility and adoption of an in-person rehabilitation program for subacute mTBI delivered through telerehabilitation. METHODS Fifty-six in-person participants-9 males; mean (SD) age 34.3 (12.2); 67 (31) days post-injury-and 17 telerehabilitation participants-8 males; age 38.3 (12.7); 61 (37) days post-injury-with subacute mTBI (between 2 and 12 weeks from injury) were enrolled. Intervention included 8, 60-minute visits over 6 weeks and included subcategories that targeted cervical spine, cardiovascular, static balance, and dynamic balance impairments. Telerehabilitation was modified to be safely performed at home with minimal equipment. Outcome measures included feasibility (the number that withdrew from the study, session attendance, home exercise program adherence, adverse events, telerehabilitation satisfaction, and progression of exercises performed), and changes in mTBI symptoms pre- and post-rehabilitation were estimated with Hedges' g effect sizes. RESULTS In-person and telerehabilitation had a similar study withdrawal rate (13% vs 12%), high session attendance (92% vs 97%), and no adverse events. The telerehabilitation group found the program easy to use (4.2/5), were satisfied with care (4.7/5), and thought it helped recovery (4.7/5). The telerehabilitation intervention was adapted by removing manual therapy and cardiovascular portions and decreasing dynamic balance exercises compared with the in-person group. The in-person group had a large effect size (-0.94) in decreases in symptoms following rehabilitation, while the telerehabilitation group had a moderate effect size (-0.73). DISCUSSION AND CONCLUSIONS Telerehabilitation may be feasible for subacute mTBI. Limited ability to address cervical spine, cardiovascular, and dynamic balance domains along with underdosage of exercise progression may explain group differences in symptom resolution.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A392 ).
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Affiliation(s)
- Kody R Campbell
- Departments of Neurology (K.R.C., J.L.W., N.C.P., K.T.S., L.A.K.) and Family Medicine, Neurology, and Orthopedics and Rehabilitation (J.C.C.), Oregon Health and Science University, Portland; Veterans Affairs Portland Health Care System, Portland, Oregon (K.R.C., J.L.W., N.C.P., K.T.S., J.C.C., L.A.K.); and Center for Regenerative Medicine, Oregon Health and Science University, Portland
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D'Silva L, Chalise P, Rippee M, Devos H. Challenging the Vestibular System Affects Gait Speed and Cognitive Workload in Chronic Mild Traumatic Brain Injury and Healthy Adults. Front Neurol 2022; 13:819169. [PMID: 35812099 PMCID: PMC9259866 DOI: 10.3389/fneur.2022.819169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
People with persistent symptoms after mild traumatic brain injury (mTBI) report imbalance during walking with head movements. The purpose of this study was (1) to compare usual walk gait speed to walking with head turns (HT) between people with mTBI and controls, (2) to compare the cognitive workload from usual walk to HT walk between groups, and (3) to examine if gaze stability deficits and mTBI symptoms influence gait speed. Twenty-three individuals (mean age 55.7 ± 9.3 years) with persistent symptoms after mTBI (between 3 months to 2 years post-injury) were compared with 23 age and sex-matched controls. Participants walked a 12-inch wide, 60-foot walkway when looking ahead and when walking with HT to identify letters and their colors. Gait speed during usual walk and HT walk were calculated. Pupillary responses during both walks were converted to the Index of Cognitive Activity (ICA) as a measure of cognitive workload. Gaze stability was examined by the dynamic visual acuity (DVA) test in the yaw plane. The post-concussion symptom scale (PCSS) was used to collect symptom severity. Within group analysis showed that gait speed was lower during HT walk compared to usual walk in the people with mTBI (p < 0.001) as well as in controls (p < 0.001). ICA was higher with HT compared to usual walk in the mTBI group in the right eye (p = 0.01) and left eye (p = 0.001), and in controls in the right eye (p = 0.01) and left eye (p = 0.01). Participants in the mTBI group had slower usual (p < 0.001), and HT gait speed (p < 0.001) compared to controls. No differences were noted in ICA in the right or left eye during usual walk and HT walk between groups (p > 0.05). DVA loss in the yaw plane to the right and left was not different between groups (p > 0.05) and were not correlated with gait speed. PCSS scores were correlated with usual walk (r = −0.50, p < 0.001) and HT gait speed (r = −0.44, p = 0.002). Slower gait speed, poorer stability, and higher cognitive workload during walking with head turns may reduce community participation in people with mTBI and persistent symptoms.
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Affiliation(s)
- Linda D'Silva
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
- *Correspondence: Linda D'Silva
| | - Prabhakar Chalise
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, MO, United States
| | - Michael Rippee
- Department of Neurology, University of Kansas Medical Center, Kansas City, MO, United States
| | - Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
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10
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Powell D, Godfrey A, Parrington L, Campbell KR, King LA, Stuart S. Free-living gait does not differentiate chronic mTBI patients compared to healthy controls. J Neuroeng Rehabil 2022; 19:49. [PMID: 35619112 PMCID: PMC9137158 DOI: 10.1186/s12984-022-01030-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Physical function remains a crucial component of mild traumatic brain injury (mTBI) assessment and recovery. Traditional approaches to assess mTBI lack sensitivity to detect subtle deficits post-injury, which can impact a patient’s quality of life, daily function and can lead to chronic issues. Inertial measurement units (IMU) provide an opportunity for objective assessment of physical function and can be used in any environment. A single waist worn IMU has the potential to provide broad/macro quantity characteristics to estimate gait mobility, as well as more high-resolution micro spatial or temporal gait characteristics (herein, we refer to these as measures of quality). Our recent work showed that quantity measures of mobility were less sensitive than measures of turning quality when comparing the free-living physical function of chronic mTBI patients and healthy controls. However, no studies have examined whether measures of gait quality in free-living conditions can differentiate chronic mTBI patients and healthy controls. This study aimed to determine whether measures of free-living gait quality can differentiate chronic mTBI patients from controls. Methods Thirty-two patients with chronic self-reported balance symptoms after mTBI (age: 40.88 ± 11.78 years, median days post-injury: 440.68 days) and 23 healthy controls (age: 48.56 ± 22.56 years) were assessed for ~ 7 days using a single IMU at the waist on a belt. Free-living gait quality metrics were evaluated for chronic mTBI patients and controls using multi-variate analysis. Receiver operating characteristics (ROC) and Area Under the Curve (AUC) analysis were used to determine outcome sensitivity to chronic mTBI. Results Free-living gait quality metrics were not different between chronic mTBI patients and controls (all p > 0.05) whilst controlling for age and sex. ROC and AUC analysis showed stride length (0.63) was the most sensitive measure for differentiating chronic mTBI patients from controls. Conclusions Our results show that gait quality metrics determined through a free-living assessment were not significantly different between chronic mTBI patients and controls. These results suggest that measures of free-living gait quality were not impaired in our chronic mTBI patients, and/or, that the metrics chosen were not sensitive enough to detect subtle impairments in our sample.
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Affiliation(s)
- Dylan Powell
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Alan Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Lucy Parrington
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA.,Department of Dietetics, Human Nutrition and Sport, La Trobe University, Victoria, Australia
| | - Kody R Campbell
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Laurie A King
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Sam Stuart
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA. .,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, UK. .,North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
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11
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Wood NI, Hentig J, Hager M, Hill-Pearson C, Hershaw JN, Souvignier AR, Bobula SA. The Non-Concordance of Self-Reported and Performance-Based Measures of Vestibular Dysfunction in Military and Civilian Populations Following TBI. J Clin Med 2022; 11:jcm11112959. [PMID: 35683348 PMCID: PMC9181197 DOI: 10.3390/jcm11112959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
As a predominately young, physically active, and generally healthy population, service members (SMs) with vestibular dysfunction (VD) following a TBI may not be accurately represented by the current civilian reference ranges on assessments of VD. This study enrolled SMs who were referred for vestibular rehabilitation following a mild/moderate TBI. The participants self-reported VD using the Activities-specific Balance Confidence (ABC) scale and the Dizziness Handicap Inventory (DHI) followed by evaluation of vestibular performance using computerized dynamic posturography sensory organizational test (CDP−SOT). Retrospective analysis of these outcomes comparing the study sample of SMs to the reported civilian samples revealed SMs self-reported lower VD with significantly higher balance confidence (ABC: 77.11 ± 14.61, p < 0.05) and lower dizziness (DHI: 37.75 ± 11.74, p < 0.05) than civilians. However, the SMs underperformed in performance-based evaluations compared to civilians with significantly lower CDP−SOT composite and ratio scores (COMP: 68.46 ± 13.46, p < 0.05; VIS: 81.36 ± 14.03, p < 0.01; VEST: 55.63 ± 22.28, p < 0.05; SOM: 90.46 ± 10.17, p < 0.05). Correlational analyses identified significant relationships between the ABC and CDP−SOT composite (r = 0.380, p < 0.01) and ratio scores (VIS: r = 0.266, p < 0.05; VEST: r = 0.352, p < 0.01). These results highlight the importance of recognizing and understanding nuances in assessing VD in SMs to ensure they have access to adequate care and rehabilitation prior to returning to duty.
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Affiliation(s)
- Nicholas I. Wood
- Evans Army Community Hospital, Fort Carson, CO 80913, USA; (N.I.W.); (C.H.-P.); (J.N.H.); (A.R.S.); (S.A.B.)
- Traumatic Brain Injury Center of Excellence, Fort Carson, CO 80913, USA;
- General Dynamics Information Technology, Falls Church, VA 22042, USA
| | - James Hentig
- Evans Army Community Hospital, Fort Carson, CO 80913, USA; (N.I.W.); (C.H.-P.); (J.N.H.); (A.R.S.); (S.A.B.)
- Traumatic Brain Injury Center of Excellence, Fort Carson, CO 80913, USA;
- General Dynamics Information Technology, Falls Church, VA 22042, USA
- Correspondence: ; Tel.: +1-(719)-258-0695
| | - Madison Hager
- Traumatic Brain Injury Center of Excellence, Fort Carson, CO 80913, USA;
| | - Candace Hill-Pearson
- Evans Army Community Hospital, Fort Carson, CO 80913, USA; (N.I.W.); (C.H.-P.); (J.N.H.); (A.R.S.); (S.A.B.)
- Traumatic Brain Injury Center of Excellence, Fort Carson, CO 80913, USA;
- General Dynamics Information Technology, Falls Church, VA 22042, USA
| | - Jamie N. Hershaw
- Evans Army Community Hospital, Fort Carson, CO 80913, USA; (N.I.W.); (C.H.-P.); (J.N.H.); (A.R.S.); (S.A.B.)
- Traumatic Brain Injury Center of Excellence, Fort Carson, CO 80913, USA;
- General Dynamics Information Technology, Falls Church, VA 22042, USA
| | - Alicia R. Souvignier
- Evans Army Community Hospital, Fort Carson, CO 80913, USA; (N.I.W.); (C.H.-P.); (J.N.H.); (A.R.S.); (S.A.B.)
| | - Selena A. Bobula
- Evans Army Community Hospital, Fort Carson, CO 80913, USA; (N.I.W.); (C.H.-P.); (J.N.H.); (A.R.S.); (S.A.B.)
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12
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Powell D, Stuart S, Godfrey A. Exploring Inertial-Based Wearable Technologies for Objective Monitoring in Sports-Related Concussion: A Single-Participant Report. Phys Ther 2022; 102:6534728. [PMID: 35196371 PMCID: PMC9155164 DOI: 10.1093/ptj/pzac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/29/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Challenges remain in sports-related concussion (SRC) assessment to better inform return to play. Reliance on self-reported symptoms within the Sports Concussion Assessment Tool means that there are limited data on the effectiveness of novel methods to assess a player's readiness to return to play. Digital methods such as wearable technologies may augment traditional SRC assessment and improve objectivity in making decisions regarding return to play. METHODS The participant was a male university athlete who had a recent history of SRC. The single-participant design consisted of baseline laboratory testing immediately after SRC, free-living monitoring, and follow-up supervised testing after 2 months. The primary outcome measures were from traditional assessment (eg, Sports Concussion Assessment Tool and 2-minute instrumented walk/gait test; secondary outcome measures were from remote (free-living) assessment with a single wearable inertial measurement unit (eg, for gait and sleep). RESULTS The university athlete (age = 20 years, height = 175 cm, weight = 77 kg [176.37 lb]) recovered and returned to play 20 days after SRC. Primary measures returned to baseline levels after 12 days. However, supervised (laboratory-based) wearable device assessment showed that gait impairments (increased step time) remained even after the athlete was cleared for return to play (2 months). Similarly, a 24-hour remote gait assessment showed changes in step time, step time variability, and step time asymmetry immediately after SRC and at return to play (1 month after SRC). Remote sleep analysis showed differences in sleep quality and disturbance (increased movement between immediately after SRC and once the athlete had returned to play [1 month after SRC]). CONCLUSION The concern about missed or delayed SRC diagnosis is growing, but methods to objectively monitor return to play after concussion are still lacking. This report showed that wearable device assessment offers additional objective data for use in monitoring players who have SRC. This work could better inform SRC assessment and return-to-play protocols. IMPACT Digital technologies such as wearable technologies can yield additional data that traditional self-report approaches cannot. Combining data from nondigital (traditional) and digital (wearable) methods may augment SRC assessment for improved return-to-play decisions. LAY SUMMARY Inertia-based wearable technologies (eg, accelerometers) may be useful to help augment traditional, self-report approaches to sports-related concussion assessment and management by better informing return-to-play protocols.
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Affiliation(s)
- Dylan Powell
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Alan Godfrey
- Address all correspondence to Dr Godfrey to: ; Follow the author(s): @godfreybiomed; @PhysioPowell; @samstuart87
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13
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Gait Impairment in Traumatic Brain Injury: A Systematic Review. SENSORS 2022; 22:s22041480. [PMID: 35214382 PMCID: PMC8875145 DOI: 10.3390/s22041480] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/24/2022] [Accepted: 02/10/2022] [Indexed: 02/06/2023]
Abstract
Introduction: Gait impairment occurs across the spectrum of traumatic brain injury (TBI); from mild (mTBI) to moderate (modTBI), to severe (sevTBI). Recent evidence suggests that objective gait assessment may be a surrogate marker for neurological impairment such as TBI. However, the most optimal method of objective gait assessment is still not well understood due to previous reliance on subjective assessment approaches. The purpose of this review was to examine objective assessment of gait impairments across the spectrum of TBI. Methods: PubMed, AMED, OVID and CINAHL databases were searched with a search strategy containing key search terms for TBI and gait. Original research articles reporting gait outcomes in adults with TBI (mTBI, modTBI, sevTBI) were included. Results: 156 citations were identified from the search, of these, 13 studies met the initial criteria and were included into the review. The findings from the reviewed studies suggest that gait is impaired in mTBI, modTBI and sevTBI (in acute and chronic stages), but methodological limitations were evident within all studies. Inertial measurement units were most used to assess gait, with single-task, dual-task and obstacle crossing conditions used. No studies examined gait across the full spectrum of TBI and all studies differed in their gait assessment protocols. Recommendations for future studies are provided. Conclusion: Gait was found to be impaired in TBI within the reviewed studies regardless of severity level (mTBI, modTBI, sevTBI), but methodological limitations of studies (transparency and reproducibility) limit clinical application. Further research is required to establish a standardised gait assessment procedure to fully determine gait impairment across the spectrum of TBI with comprehensive outcomes and consistent protocols.
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14
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Cogan AM, Pape TLB, Yeaw J, DeKoven M, Anupindi R, Jordan N. Health Care Resource Utilization and Costs for Adults With Mild Traumatic Brain Injury With Chronic Vestibular Impairment. Arch Phys Med Rehabil 2021; 103:90-97.e8. [PMID: 34634230 DOI: 10.1016/j.apmr.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/25/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To quantify the economic burden of all-cause health care resource utilization (HCRU) among adults with and without chronic vestibular impairment (CVI) after a mild traumatic brain injury (mTBI). DESIGN Retrospective matched cohort study. SETTING IQVIA Integrated Data Warehouse. PARTICIPANTS People with mTBI+CVI (n=20,441) matched on baseline age, sex, year of mTBI event, and Charlson Comorbidity Index (CCI) score to people with mTBI only (n=20,441) (N=40,882). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES All-cause health HCRU and costs at 12 and 24 months post mTBI diagnosis. RESULTS People with mTBI+CVI had significantly higher all-cause HCRU and costs at both time points than those with mTBI only. Multivariable regression analysis showed that, when controlling for baseline variables, costs of care were 1.5 times higher for mTBI+CVI than mTBI only. CONCLUSIONS People who developed CVI after mTBI had greater overall HCRU and costs for up to 2 years after the injury event compared with people who did not develop CVI after controlling for age, sex, region, and CCI score. Further research on access to follow-up services and effectiveness of interventions to address CVI is warranted.
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Affiliation(s)
- Alison M Cogan
- Washington DC VA Medical Center, Physical Medicine and Rehabilitation Service, Washington, DC.
| | - Theresa L Bender Pape
- Department of Veterans Affairs, Center for Innovation in Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Neil Jordan
- Department of Veterans Affairs, Center for Innovation in Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois; Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Behavioral Sciences and Preventive Medicine, Chicago, Illinois
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15
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Joseph ALC, Lippa SM, Moore B, Bagri M, Row J, Chan L, Zampieri C. Relating Self-Reported Balance Problems to Sensory Organization and Dual-Tasking in Chronic Traumatic Brain Injury. PM R 2021; 13:870-879. [PMID: 32844594 PMCID: PMC10440855 DOI: 10.1002/pmrj.12478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Individuals who have experienced a traumatic brain injury (TBI) often have residual balance problems. It remains unclear whether these balance problems are driven by vestibular dysfunction or gait automaticity deficits, particularly in the chronic stages of TBI recovery, because most studies include only acute/subacute cases. OBJECTIVES Compare performance on the Sensory Organization Test vestibular score and Dual-Task test in individuals with and without subjective balance problems at least 1 year after a TBI. Investigate the ability of each test to predict perceived balance problems. DESIGN Prospective cohort study. SETTING Rehabilitation department within a single institution. PARTICIPANTS Fifty adults (21-71 years) with a history of mild, moderate, or severe TBI 1 to 5 years following nonpenetrating TBI. INTERVENTIONS N/A. METHODS Measures included the Dual-Task test, Sensory Organization Test, Neurobehavioral Symptom Inventory, Dizziness Handicap Inventory, and assessments of four cognitive domains and depression. Participants who endorsed "feeling dizzy" and "loss of balance" on the Neurobehavioral Symptom Inventory were classified as symptomatic (n = 26) and others as asymptomatic (n = 24). T-tests, chi-square, and regression analyses predicting the Dizziness Handicap Inventory total score were performed. RESULTS Dual-task gait cost was negatively associated with the Dizziness Handicap Inventory (P = .044), controlling for depression and gender, whereas vestibular scores failed to predict balance-related disability. Symptomatic individuals endorsed more balance problems (P < .001) and depression symptoms (P = .007), had poorer dual-task cognitive output (P = .036), and slower dual-task gait velocity (P = .036) than asymptomatic participants. Groups did not differ on Sensory Organization Test scores. CONCLUSIONS The nature of balance problems in chronic TBI may be related to automaticity of gait. These findings suggest that patients in the chronic stages of TBI may benefit from dual-task assessments and interventions. Balance rehabilitation should be tailored to patient needs and assess cognition and affect.
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Affiliation(s)
- Annie-Lori C Joseph
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Sara M Lippa
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Defense and Veterans Brain Injury Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Brian Moore
- Center for Neuroscience and Regenerative Medicine, The Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Manjot Bagri
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Jessica Row
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Center for Neuroscience and Regenerative Medicine, The Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cris Zampieri
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
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16
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D'Silva LJ, Chalise P, Obaidat S, Rippee M, Devos H. Oculomotor Deficits and Symptom Severity Are Associated With Poorer Dynamic Mobility in Chronic Mild Traumatic Brain Injury. Front Neurol 2021; 12:642457. [PMID: 34381408 PMCID: PMC8350131 DOI: 10.3389/fneur.2021.642457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/25/2021] [Indexed: 12/02/2022] Open
Abstract
Oculomotor deficits, vestibular impairments, and persistent symptoms are common after a mild traumatic brain injury (mTBI); however, the relationship between visual-vestibular deficits, symptom severity, and dynamic mobility tasks is unclear. Twenty-three individuals (mean age 55.7 ± 9.3 years) with persistent symptoms after mTBI, who were between 3 months to 2 years post-injury were compared with 23 age and sex-matched controls. Oculomotor deficits [depth perception, near-point convergence, baseline visual acuity (BLVA), perception time], vestibular deficits (dynamic visual acuity in the pitch and yaw planes), dynamic mobility measured by the Functional Gait Assessment (FGA), and symptoms measured by the Post-Concussion Symptom Scale (PCSS) and Dizziness Handicap Inventory (DHI) were compared between groups. Participants with mTBI had poorer performance on the FGA (p < 0.001), higher symptom severity on the PCSS (p < 0.001), and higher DHI scores (p < 0.001) compared to controls. Significant differences were seen on specific items of the FGA between individuals with mTBI and controls during walking with horizontal head turns (p = 0.002), walking with vertical head tilts (p < 0.001), walking with eyes closed (p = 0.003), and stair climbing (p = 0.001). FGA performance was correlated with weeks since concussion (r = −0.67, p < 0.001), depth perception (r = −0.5348, p < 0.001), near point convergence (r = −0.4717, p = 0.001), baseline visual acuity (r = −0.4435, p = 0.002); as well as with symptoms on the PCSS (r = −0.668, p < 0.001), and DHI (r = −0.811, p < 0.001). Dynamic balance deficits persist in chronic mTBI and may be addressed using multifaceted rehabilitation strategies to address oculomotor dysfunction, post-concussion symptoms, and perception of handicap due to dizziness.
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Affiliation(s)
- Linda J D'Silva
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
| | - Prabhakar Chalise
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, MO, United States
| | - Sakher Obaidat
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
| | - Michael Rippee
- Department of Neurology, University of Kansas Health System, Kansas City, MO, United States
| | - Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
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17
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Sweeny M, Habib Perez O, Inness EL, Danells C, Chandra T, Foster E, Comper P, Bayley M, Mochizuki G. The Toronto concussion study: a cross-sectional analysis of balance deficits following acute concussion in community-dwelling adults. Brain Inj 2021; 35:587-595. [PMID: 33734923 DOI: 10.1080/02699052.2021.1891288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To characterize balance deficits in community-dwelling adults following acute concussion.Design: Cross-sectional observational study.Methods: Individuals with acute concussion (n=100) and healthy controls (n=20) completed the BESS (Balance Error Scoring System) and quiet standing trials on forceplates with the eyes open, closed, or during a cognitive dual task. BESS score and centre-of-pressure root mean square and high-frequency power (0.4-3Hz) were used to characterize group differences. In a secondary analysis, participants were subdivided based on self-reported symptoms of balance problems and dizziness using the SCAT-3 (Sport Concussion Assessment Tool - Third Edition) Symptom Checklist.Results: In comparing individuals with concussion and controls, BESS score (16.0 ± 6.0 vs 12.6 ± 3.8; F(1,116) = 5.814, p = .017) and anteroposterior [F(1.78, 204.2) = 11.93, p < .001] and mediolateral [F(1, 114) = 10.05, p = .002] high-frequency power revealed significant group differences. Dividing individuals based on self-reported symptoms revealed significant differences in mediolateral high frequency power, such that participants reporting balance and dizziness problems as well as those participants not reporting balance or dizziness symptoms following concussion were less stable than controls.Conclusions: Deficits in clinical and posturographic measures of balance occur in community-dwelling adults with concussion. These measures do not align with self-reported balance symptoms. Future research and clinical practice aimed at careful selection of optimized balance assessment is recommended.
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Affiliation(s)
- Michelle Sweeny
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Olinda Habib Perez
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute,Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Cynthia Danells
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tharshini Chandra
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada
| | - Evan Foster
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada
| | - Paul Comper
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute,Faculty of Medicine, University of Toronto, Toronto, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - George Mochizuki
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute,Faculty of Medicine, University of Toronto, Toronto, Canada.,School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
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18
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Fino PC, Weightman MM, Dibble LE, Lester ME, Hoppes CW, Parrington L, Arango J, Souvignier A, Roberts H, King LA. Objective Dual-Task Turning Measures for Return-to-Duty Assessment After Mild Traumatic Brain Injury: The ReTURN Study Protocol. Front Neurol 2021; 11:544812. [PMID: 33519659 PMCID: PMC7844093 DOI: 10.3389/fneur.2020.544812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 12/07/2020] [Indexed: 02/05/2023] Open
Abstract
Determining readiness for duty after mild traumatic brain injury (mTBI) is essential for the safety of service members and their unit. Currently, these decisions are primarily based on self-reported symptoms, objective measures that assess a single system, or standardized physical or cognitive tests that may be insensitive or lack ecological validity for warrior tasks. While significant technological advancements have been made in a variety of assessments of these individual systems, assessments of isolated tasks are neither diagnostically accurate nor representative of the demands imposed by daily life and military activities. Emerging evidence suggests that complex tasks, such as dual-task paradigms or turning, have utility in probing functional deficits after mTBI. Objective measures from turning tasks in single- or dual-task conditions, therefore, may be highly valuable for clinical assessments and return-to-duty decisions after mTBI. The goals of this study are to assess the diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation of objective, dual-task turning measures within an mTBI population. These goals will be accomplished over two phases. Phase 1 will enroll civilians at three sites and active-duty service members at one site to examine the diagnostic accuracy and predictive capacity of dual-task turning outcomes. Phase 1 participants will complete a series of turning tasks while wearing inertial sensors and a battery of clinical questionnaires, neurocognitive testing, and standard clinical assessments of function. Phase 2 will enroll active-duty service members referred for rehabilitation from two military medical treatment facilities to investigate the responsiveness to rehabilitation of objective dual-task turning measures. Phase 2 participants will complete two assessments of turning while wearing inertial sensors: a baseline assessment prior to the first rehabilitation session and a post-rehabilitation assessment after the physical therapist determines the participant has completed his/her rehabilitation course. A variable selection procedure will then be implemented to determine the best task and outcome measure for return-to-duty decisions based on diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation. Overall, the results of this study will provide guidance and potential new tools for clinical decisions in individuals with mTBI. Clinical Trial Registration: clinicaltrials.gov, Identifier NCT03892291.
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Affiliation(s)
- Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | | | - Leland E Dibble
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Mark E Lester
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, United States.,Department of Physical Therapy, Texas State University, Round Rock, TX, United States
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, United States
| | - Lucy Parrington
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Jorge Arango
- Traumatic Brain Injury Center of Excellence, Fort Carson, CO, United States
| | | | - Holly Roberts
- Madigan Army Medical Center, Joint Base Lewis-McChord, WA, United States
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
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19
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Mang CS, Whitten TA, Cosh MS, Dukelow SP, Benson BW. Assessment of Postural Stability During an Upper Extremity Rapid, Bimanual Motor Task After Sport-Related Concussion. J Athl Train 2020; 55:1160-1173. [PMID: 33064821 DOI: 10.4085/1062-6050-378-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Sport-related concussion (SRC) often presents with multidimensional and subtle neurologic deficits that are difficult to detect with standard clinical tests. New assessment approaches that efficiently quantify deficits across multiple neurologic domains are needed. OBJECTIVE To quantify impairments in postural movements during an assessment of rapid, bimanual motor ability in athletes within 10 days of experiencing an SRC and evaluate relationships between impairments in upper extremity and postural performance. DESIGN Cohort study. SETTING Sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS Initial baseline assessments were completed for 711 athletes. Seventy-five athletes (age = 15.8 ± 3.3 years at baseline) sustained SRCs and were reassessed within 10 days. Seventy-eight athletes (age = 15.5 ± 2.0 years) completed 2 assessments in a healthy state. MAIN OUTCOME MEASURE(S) Athletes stood on force plates and performed a rapid, bimanual motor task, termed the object-hit task, delivered using a Kinesiological Instrument for Normal and Altered Reaching Movements endpoint robot. Measures of postural stability that quantified center-of-pressure movements and measures of upper extremity performance were used to characterize task performance. RESULTS Performance changes across assessments were converted to reliable change indices. We observed a difference in reliable change indices values between athletes with SRC and healthy control athletes on the combined postural measures (P = .01). Using measures to evaluate the change in postural movements from the early, easier portion of the task to the later, more difficult portion, we identified the highest levels of impairment (19%-25% of the sample impaired). We also noted a difference between individuals with concussion and healthy individuals on the combined upper extremity measures (P = .003), but these impairments were largely unrelated to those identified in the postural movements. CONCLUSIONS Measurement of postural movements during the object-hit task revealed impairments in postural stability that were not related to impairments in upper extremity performance. The findings demonstrated the benefits of using assessments that simultaneously evaluate multiple domains of neurologic function (eg, upper extremity and postural control) after SRC.
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Affiliation(s)
- Cameron S Mang
- Faculty of Kinesiology and Health Studies, University of Regina, SK, Canada
| | - Tara A Whitten
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Madeline S Cosh
- Benson Concussion Institute, Group23 Sports Medicine Clinic, Calgary, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Brian W Benson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
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Lavrick SY, Borisov AS, Shprakh VV, Mikhalevich IM. [Cytoflavin in patients with vertigo and dizziness in a distant period of mild traumatic brain injury]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:46-50. [PMID: 32490618 DOI: 10.17116/jnevro202012004146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the efficacy and safety of the complex metabolic neuroprotective medicine cytoflavin in tablet form in patients with vertigo and dizziness in a distant period of mild traumatic brain injury. MATERIAL AND METHODS Forty patients, aged 20-55 years, with a mild traumatic brain injury were studied for 3 months to 1 year. Cytoflavin was used as monotherapy in a dose of 2 tablets 2 times a day for 25 days. Otoneurological and stabilometric examinations were performed before and after treatment. The Dizziness Handicap Inventory, a visual-analogous scale and HADS were administered. RESULTS AND CONCLUSION Cytoflavin decreases the severity of vertigo and dizziness, improves stabilometric indicators and reduces emotional disorders in patients with vertigo in the distant period of mild traumatic brain injury. No significant adverse reactions are observed.
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Affiliation(s)
- S Yu Lavrick
- Irkutsk State Medical Academy of Postgraduate Education - Branch of Russian Medical Academy of Continuing Professional Education, Irkutsk, Russia
| | - A S Borisov
- Irkutsk State Medical University, Irkutsk, Russia
| | - V V Shprakh
- Irkutsk State Medical Academy of Postgraduate Education - Branch of Russian Medical Academy of Continuing Professional Education, Irkutsk, Russia
| | - I M Mikhalevich
- Irkutsk State Medical Academy of Postgraduate Education - Branch of Russian Medical Academy of Continuing Professional Education, Irkutsk, Russia
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Jafarzadeh S, Pourbakht A, Bahrami E. Vestibular Assessment in Patients with Persistent Symptoms of Mild Traumatic Brain Injury. Indian J Otolaryngol Head Neck Surg 2020; 74:272-280. [PMID: 36032895 PMCID: PMC9411379 DOI: 10.1007/s12070-020-02043-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/08/2020] [Indexed: 12/26/2022] Open
Abstract
Aim The estimated worldwide incidence of TBI is 10 million cases per year. Dizziness and imbalance are two common symptoms in mild TBI (mTBI). In about 10-15% of TBI patients, these symptoms remain for a long time and may show no recovery. These persistent symptoms may relate to different factors including vestibular abnormalities. The aim of this study is a vestibular assessment of patients with persistent symptoms of mTBI by different tests including computerized dynamic posturography. Materials and Methods 21 patients with mTBI evaluated in this study. Patients were civilians with persistent symptoms. TBI did cause by blunt force trauma (mainly from falling) in the past 6 months. They had normal neurologic and musculoskeletal assessments and no temporal bone fracture. Several auditory and vestibular evaluations were performed for each patient. They included: case history, otoscopy, pure tone and speech audiometry, tympanometry, vestibular bedside examination (spontaneous nystagmus, gaze, saccade, pursuit, Dix-Hallpike maneuver, side-lying maneuver, roll, and Romberg test), cervical Vestibular Myogenic Evoked Potential (c-VEMP), Computerized Dynamic Posturography (CDP) and Dizziness Handicap Inventory (DHI). Results Patients showed hearing loss in 10 (47.6%) and tinnitus in 4 (19.0%) cases. In ocular motor tests, patients had the most abnormal results in the pursuit test. 6 patients also had Benign Paroxysmal Positional Vertigo (BPPV) in the posterior canal. c-VEMP showed abnormal saccular function in 14 patients. In CDP, the composite scores were decreased relative to normal populations. Conclusion vestibular tests showed abnormal results in most patients. Vestibular abnormality could relate to persisting symptoms of mTBI patients.
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Zeldovich M, Wu YJ, Gorbunova A, Mikolic A, Polinder S, Plass AM, Covic A, Asendorf T, Andelic N, Voormolen DC, von Steinbüchel N. Influence of Sociodemographic, Premorbid, and Injury-Related Factors on Post-Concussion Symptoms after Traumatic Brain Injury. J Clin Med 2020; 9:jcm9061931. [PMID: 32575667 PMCID: PMC7356324 DOI: 10.3390/jcm9061931] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Post-concussion symptoms (PCS) are often reported as consequences of mild and moderate traumatic brain injury (TBI), but these symptoms are not well documented in severe TBI. There is a lack of agreement as to which factors and covariates affect the occurrence, frequency, and intensity of PCS among TBI severity groups. The present study therefore aims to examine the association between sociodemographic, premorbid, and injury-related factors and PCS. METHODS A total of 1391 individuals (65% male) from the CENTER-TBI study were included in the analyses. The occurrence, frequency (number of PCS), and intensity (severity) of PCS were assessed using the Rivermead Post-concussion Symptoms Questionnaire (RPQ) at six months after TBI. To examine the association between selected factors (age, sex, living situation, employment status, educational background, injury and TBI severity, and premorbid problems) and PCS, a zero-inflated negative binomial model (ZINB) for occurrence and frequency of PCS and a standard negative binomial regression (NB) for intensity were applied. RESULTS Of the total sample, 72% of individuals after TBI reported suffering from some form of PCS, with fatigue being the most frequent among all TBI severity groups, followed by forgetfulness, and poor concentration. Different factors contributed to the probability of occurrence, frequency, and intensity of PCS. While the occurrence of PCS seemed to be independent of the age and sex of the individuals, both the frequency and intensity of PCS are associated with them. Both injury and TBI severity influence the occurrence and frequency of PCS, but are associated less with its intensity (except "acute" symptoms such as nausea, vomiting, and headaches). Analyses focusing on the mTBI subgroup only yielded results comparable to those of the total sample. DISCUSSION In line with previous studies, the results support a multifactorial etiology of PCS and show the importance of differentiating between their occurrence, frequency, and intensity to better provide appropriate treatment for individual subgroups with different symptoms (e.g., multiple PCS or more intense PCS). Although PCS often occur in mild to moderate TBI, individuals after severe TBI also suffer from PCS or post-concussion-like symptoms that require appropriate treatment. The chosen statistical approaches (i.e., ZINB and NB models) permit an ameliorated differentiation between outcomes (occurrence, frequency, and intensity of PCS) and should be used more widely in TBI research.
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Affiliation(s)
- Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Yi-Jhen Wu
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Anastasia Gorbunova
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Ana Mikolic
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 Rotterdam, The Netherlands
| | - Anne Marie Plass
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0450 Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models, 0373 Oslo, Norway
| | - Daphne C Voormolen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 Rotterdam, The Netherlands
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
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Inertial Sensors Reveal Subtle Motor Deficits When Walking With Horizontal Head Turns After Concussion. J Head Trauma Rehabil 2020; 34:E74-E81. [PMID: 30045224 DOI: 10.1097/htr.0000000000000418] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine whether horizontal head turns while seated or while walking, when instrumented with inertial sensors, were sensitive to the acute effects of concussion and whether horizontal head turns had utility for concussion management. SETTING Applied field setting, athletic training room. PARTICIPANTS Twenty-four collegiate athletes with sports-related concussion and 25 healthy control athletes. DESIGN Case-control; longitudinal. MAIN MEASURES Peak head angular velocity and peak head angle (range of motion) when performing head turns toward an auditory cue while seated or walking. Gait speed when walking with and without head turns. RESULTS Athletes with acute sports-related concussion turned their head slower than healthy control subjects initially (group β = -49.47; SE = 16.33; P = .003) and gradually recovered to healthy control levels within 10 days postconcussion (group × time β = 4.80; SE = 1.41; P < .001). Peak head velocity had fair diagnostic accuracy in differentiating subjects with acute concussion compared with controls (areas under the receiver operating characteristic curve [AUC] = 0.71-0.73). Peak head angle (P = .17) and gait speed (P = .64) were not different between groups and showed poor diagnostic utility (AUC = 0.57-0.62). CONCLUSION Inertial sensors can improve traditional clinical assessments by quantifying subtle, nonobservable deficits in people following sports-related concussion.
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Ptito A, Papa L, Gregory K, Folmer RL, Walker WC, Prabhakaran V, Wardini R, Skinner K, Yochelson M. A Prospective, Multicenter Study to Assess the Safety and Efficacy of Translingual Neurostimulation Plus Physical Therapy for the Treatment of a Chronic Balance Deficit Due to
Mild‐to‐Moderate
Traumatic Brain Injury. Neuromodulation 2020; 24:1412-1421. [PMID: 32347591 PMCID: PMC9291157 DOI: 10.1111/ner.13159] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/28/2020] [Accepted: 03/23/2020] [Indexed: 12/22/2022]
Abstract
Objectives Materials and Methods Results Conclusions
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Affiliation(s)
- Alain Ptito
- Psychology Department McGill University Health Centre; Montreal Neurological Institute and Hospital Montreal QC Canada
| | - Linda Papa
- Department of Emergency Medicine Orlando Health Orlando FL USA
| | - Kenton Gregory
- Center for Regenerative Medicine Oregon Health and Science University Portland OR USA
| | - Robert L. Folmer
- Department of Otolaryngology Oregon Health and Science University Portland OR USA
- National Center for Rehabilitative Auditory Research VA Portland Health Care System Portland OR USA
| | - William C. Walker
- Department of Physical Medicine and Rehabilitation Virginia Commonwealth University Richmond VA USA
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin Hospitals and Clinics University of Wisconsin Madison WI USA
| | | | | | - Michael Yochelson
- Shepherd Center Atlanta GA USA
- MedStar National Rehabilitation Network Washington DC USA
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Manaseer TS, Gross DP, Dennett L, Schneider K, Whittaker JL. Gait Deviations Associated With Concussion: A Systematic Review. Clin J Sport Med 2020; 30 Suppl 1:S11-S28. [PMID: 32132473 DOI: 10.1097/jsm.0000000000000537] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait deviations resulting from concussion are important to consider in the diagnosis, treatment progression, and return to activity after a concussion. OBJECTIVE To identify quantifiable gait deviations associated with concussion across populations and time since injury. METHODS AND MATERIALS Six electronic databases were systematically searched from January 1974 to September 2016. Studies selected included original data, had an analytic design, and reported a quantifiable gait parameter in individuals who had sustained a concussion as defined by the American Congress of Rehabilitation Medicine or related definitions. Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were followed. Two independent authors assessed study quality [Downs and Black (DB) criteria] and level of evidence (Oxford Center of Evidence-Based Medicine Model). RESULTS Of 2650 potentially relevant articles, 21 level 4 studies were included. The median DB score was 12/33 (range 10-16). Heterogeneity in gait parameters and timing of postconcussion testing precluded meta-analysis. There is consistent level 4 evidence of increased medial-lateral center-of-mass displacement, and inconsistent level 4 evidence of decreased gait velocity after concussion. Further, there is preliminary level 4 evidence that gait deficits may exist beyond the typical 10-day recovery period and return to activity. CONCLUSION These findings suggest that individuals who have suffered a concussion may sway more in the frontal plane, and walk slower compared to healthy controls. Consensus about the most important gait parameters for concussion diagnosis and clinical management are lacking. Further, high-quality prospective cohort studies evaluating changes in gait from time of concussion to return to activity, sport, recreation and/or work are needed.
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Affiliation(s)
- Thaer S Manaseer
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Douglas P Gross
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Liz Dennett
- John Walter Scott Library, University of Alberta, Edmonton, AB, Canada
| | - Kathryn Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; and
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, AB, Canada
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Helmich I, Coenen J, Henckert S, Pardalis E, Schupp S, Lausberg H. Reduced frontopolar brain activation characterizes concussed athletes with balance deficits. NEUROIMAGE-CLINICAL 2020; 25:102164. [PMID: 31954336 PMCID: PMC6965737 DOI: 10.1016/j.nicl.2020.102164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/25/2022]
Abstract
Symptomatic athletes with balance deficits present reduced frontopolar oxygenation during postural control with closed eyes. Decreased brain oxygenation in the FPC of symptomatic individuals may characterize the deficit of shifting the focus from visual inputs towards proprioception.
Objectives Athletes with sport-related concussions (SRC) often demonstrate deficits in postural stability. Lower cerebral blood flow in frontal cortices has been documented in athletes with symptoms after SRC, however, it is unclear if functional brain oxygenation during postural control tasks is reduced in symptomatic athletes after SRC in the same manner. We therefore compared brain oxygenation patterns in frontal cortices of symptomatic and asymptomatic athletes with SRC during postural control tasks with the hypothesis that symptomatic athletes are characterized by reduced functional brain oxygenation during postural control. Methods 62 concussed athletes (n = 31 symptomatic, n = 31 asymptomatic) were investigated during four postural control tasks with eyes closed versus eyes opened conditions and stable vs. unstable surface conditions. Brain oxygenation was assessed using functional NearInfraRed Spectroscopy (fNIRS) on frontopolar cortices of each hemisphere. Postural sway was measured by the analysis of ground reaction forces. Results Symptomatic athletes showed greater postural sway when compared to asymptomatic athletes during postural control, particularly during closed eyes and/or unstable surface conditions. Changes of oxygenated hemoglobin (∆HbO2) within the left hemispheric frontopolar cortex were significantly reduced in symptomatic athletes when compared to asymptomatic athletes during the eyes closed condition. A stepwise linear regression analysis revealed that self-reported post-concussion symptoms such as headaches and sadness predict decreased brain oxygenation during postural control with closed eyes. Conclusion Symptomatic athletes with increased postural sway are characterized by decreased frontopolar brain oxygenation during postural control tasks, particularly during conditions with closed eyes. Because the frontopolar cortex showed to be involved in redistributing executive functions to novel task situations, we conclude that athletes with post-concussion symptoms suffer from a deficit in coordinating postural adjustments to balance control tasks with reduced sensory input.
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Affiliation(s)
- I Helmich
- Department of Neurology, Psychosomatic Medicine and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University (GSU) Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.
| | - J Coenen
- Department of Neurology, Psychosomatic Medicine and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University (GSU) Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany; Department of Sport and Health, Institute of Sport Medicine, Paderborn University, Warburger Str. 100, 33098 Paderborn, Germany
| | - S Henckert
- Department of Neurology, Psychosomatic Medicine and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University (GSU) Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - E Pardalis
- Department of Neurology, Psychosomatic Medicine and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University (GSU) Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - S Schupp
- Department of Neurology, Psychosomatic Medicine and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University (GSU) Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - H Lausberg
- Department of Neurology, Psychosomatic Medicine and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University (GSU) Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
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Stuart S, Parrington L, Martini DN, Kreter N, Chesnutt JC, Fino PC, King LA. Analysis of Free-Living Mobility in People with Mild Traumatic Brain Injury and Healthy Controls: Quality over Quantity. J Neurotrauma 2020; 37:139-145. [DOI: 10.1089/neu.2019.6450] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Samuel Stuart
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Lucy Parrington
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Douglas N. Martini
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Nicholas Kreter
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - James C. Chesnutt
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
| | - Peter C. Fino
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah
| | - Laurie A. King
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
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Wood TA, Hsieh KL, An R, Ballard RA, Sosnoff JJ. Balance and Gait Alterations Observed More Than 2 Weeks After Concussion: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil 2019; 98:566-576. [PMID: 31219809 DOI: 10.1097/phm.0000000000001152] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to systematically review and quantitatively synthesize the existing evidence of balance and gait alterations lasting more than 2 wks after concussion in adults. DESIGN A systematic review was conducted through PubMed, CINAHL, SPORTDiscus, and Web of Science. Investigations must include adult participants with at least one concussion, were measured for 14 days after injury, and reported balance or gait measures. Balance error scoring system scores, center of pressure sway area and displacement, and gait velocity were extracted for the meta-analysis. RESULTS Twenty-two studies were included. Balance alterations were observed for 2 wks after concussion when participants were tested with eyes closed, for longer durations of time, and with nonlinear regulatory statistics. The meta-analysis of center of pressure sway area with no visual feedback indicated that concussed individuals had greater sway area (P < 0.001). Various gait alterations were also observed, which may indicate that concussed individuals adopt a conservative gait strategy. The meta-analysis revealed that concussed participants walked 0.12 m/sec (P < 0.001) and 0.06 m/sec (P = 0.023) slower in single and dual-task conditions, respectively. CONCLUSIONS Subtle balance and gait alterations were observed after 2 wks after a concussion. Understanding these alterations may allow clinicians to improve concussion diagnosis and prevent subsequent injury.
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Affiliation(s)
- Tyler A Wood
- From the Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois (TAW, KLH, RA, JJS); Brown School, Washington University, St. Louis, Missouri (RA); and Division of Intercollegiate Athletics, University of Illinois at Urbana-Champaign, Champaign, Illinois (RAB)
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Rice V, Boykin G, Alfred P, Lindsay G, Overby C, Jeter A, Lester M, Allison S, Cooper D. The investigation of four technologies to assist in detecting mild to moderate traumatic brain injury of U.S. Military service members. Work 2019; 63:165-180. [PMID: 31156198 DOI: 10.3233/wor-192918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A standard, reliable, objective measure is needed for identifying individuals with mild to moderate traumatic brain injury (TBI). OBJECTIVE The purpose of this study was to examine balance using an AMTI OR6-7 force platform (FP), neurocognition and mood using the Automated Neuropsychological Assessment Metric4 (ANAM4), blood flow comparisons using a Brain Acoustic Monitor (BAM), and voice using Voice Analysis software (VA) for screening service members for a mild to moderate TBI. METHODS Active duty and retired service member volunteers (n = 88, 35 with a diagnosis of mild to moderate TBI and 53 who never had a TBI) completed an informed consent document, and evaluations using the four technologies. RESULTS Development of a clinical prediction rule yielded two FP variables and one ANAM4 Mood Scale variable (vigor) as helpful in predicting the presence of a TBI. Assuming a 15% pre-test probability, these predictors yield a post-test probability of 75.7% for a positive result with any two or more measures being positive, and a post-test probability of 2.3% for a negative result with zero measures being positive. CONCLUSIONS This study demonstrated the usefulness of a force platform and a self-reported mood scale for predicting presence of mild to moderate TBI.
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Affiliation(s)
- Valerie Rice
- U.S. Army Research Laboratory, JBSA Fort Sam Houston, TX, USA
| | - Gary Boykin
- U.S. Army Research Laboratory, JBSA Fort Sam Houston, TX, USA
| | - Petra Alfred
- U.S. Army Research Laboratory, JBSA Fort Sam Houston, TX, USA
| | | | - Cory Overby
- General Dynamics Corporation, Falls Church, VA, USA
| | - Angela Jeter
- General Dynamics Corporation, Falls Church, VA, USA
| | - Mark Lester
- Brooke Army Medical Center, Institute for Surgical Research Laboratory, JBSA Fort Sam Houston, TX, USA
| | - Stephen Allison
- U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Douglas Cooper
- San Antonio Area Medical Center, JBSA Fort Sam Houston, TX, USA
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30
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Gera G, Chesnutt J, Mancini M, Horak FB, King LA. Inertial Sensor-Based Assessment of Central Sensory Integration for Balance After Mild Traumatic Brain Injury. Mil Med 2019; 183:327-332. [PMID: 29635623 DOI: 10.1093/milmed/usx162] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Optimal balance control requires a complex integration of sensory information from the visual, vestibular, and proprioceptive systems. The goal of this study is to determine if the instrumented modified Clinical Test of Sensory Integration and Balance (mCTSIB) was impaired acutely after mild traumatic brain injury (mTBI) when postural sway under varying sensory conditions was measured with a wearable inertial sensor. Materials and Methods Postural sway was assessed in athletes who had sustained a mTBI within the past 2-3 d (n = 38) and control athletes (n = 81). Postural sway was quantified with a wearable inertial sensor (Opal; APDM, Inc.) during four varying sensory conditions of quiet stance: (1) eyes open (EO) firm surface, (2) eyes closed (EC) firm surface, (3) eyes open (EO) foam surface, and (4) eyes closed (EC) foam surface. Sensory reweighting deficits were computed by comparing the postural sway area in eyes closed versus eyes open conditions for firm and foam condition. Results Postural sway was higher for mTBI compared with the control group during three of the four conditions of instrumented mCTSIB (EO firm, EC firm, and EC foam; p < 0.05). Sensory reweighting deficits were evident for mTBI individuals compared with control group on foam surface (EC firm vs EO firm; p < 0.05) and not on firm surface (EC firm vs EO firm; p = 0.63). Conclusions The results from this study highlight the importance of detecting postural sway deficits during sensorimotor integration in mild TBI individuals.
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Affiliation(s)
- Geetanjali Gera
- Department of Rehabilitation Sciences, University of Kentucky, 900 South Limestone, Lexington, KY 40536
| | - Jim Chesnutt
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Martina Mancini
- Department of Rehabilitation Sciences, University of Kentucky, 900 South Limestone, Lexington, KY 40536
| | - Fay B Horak
- Department of Rehabilitation Sciences, University of Kentucky, 900 South Limestone, Lexington, KY 40536.,Veterans Affairs Portland Healthcare System, 3710 SW US Veterans Hospital Road, Portland, OR 97239
| | - Laurie A King
- Department of Rehabilitation Sciences, University of Kentucky, 900 South Limestone, Lexington, KY 40536
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Gagné MÈ, McFadyen BJ, Cossette I, Fait P, Gagnon I, Sirois K, Blanchet S, Le Sage N, Ouellet MC. Alterations in dual-task walking persist two months after mild traumatic brain injury in young adults. JOURNAL OF CONCUSSION 2019. [DOI: 10.1177/2059700219878291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives To compare dual-task performance involving different cognitive-locomotor combinations between healthy controls and participants with sub-acute mild traumatic brain injury (mTBI) and to correlate dual-task performances to history of prior head injuries. Methods Eighteen participants having recently sustained mTBI and 15 controls performed nine dual-tasks combining locomotor (level-walking, narrow obstacle, deep obstacle) and cognitive (Stroop task, Verbal fluency, Counting backwards) tasks. Previous history of concussion was also investigated. Results Slower gait speeds were observed in the mTBI group compared to controls during both single and dual-tasks. Longer response times to cognitive tasks in the mTBI group further suggested the presence of residual impairments two months following injury. No combination of dual-task was more sensitive. Correlations were observed between history of mTBI and several measures of dual-task performance, underlying the need to further consider the effects of multiple injuries in relation to dual-task walking. Conclusion Dual-tasks using simultaneously locomotor and cognitive functions represent an ecological way for clinicians to detect residual, but subtle, alterations post-mTBI. History of previous mTBI needs to be considered as a personal characteristic which may influence dual-task walking performance.
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Affiliation(s)
- Marie-Ève Gagné
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de santé et de Services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec City, Canada
- School of Psychology, Faculty of Social Sciences, Université Laval, Québec City, Canada
| | - Bradford J McFadyen
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de santé et de Services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Isabelle Cossette
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de santé et de Services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec City, Canada
| | - Philippe Fait
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
- Research Center in Neuropsychology and Cognition (CERNEC), Université de Montréal, Montréal, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montréal, Canada
| | - Katia Sirois
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de santé et de Services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec City, Canada
- School of Psychology, Faculty of Social Sciences, Université Laval, Québec City, Canada
| | - Sophie Blanchet
- Memory and Cognition Laboratory, Psychology Institute, INSERM U894, Psychiatry and Neurosciences Center, Université Paris Descartes, Paris, France
| | - Natalie Le Sage
- Centre Hospitalier Affilié Universitaire de Québec, Enfant-Jésus Hospital, Trauma Research Unit, Québec City, Canada
| | - Marie-Christine Ouellet
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de santé et de Services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec City, Canada
- School of Psychology, Faculty of Social Sciences, Université Laval, Québec City, Canada
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Tone-induced cervical and ocular vestibular-evoked myogenic potentials: comparing abnormalities in traumatic and non-traumatic vestibular disease. The Journal of Laryngology & Otology 2018; 132:906-910. [PMID: 30295212 DOI: 10.1017/s002221511800172x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Otolithic function is poorly understood, but vestibular-evoked myogenic potential testing has allowed the documentation of pathology in patients who complain of imbalance. METHODS Seventy-four patients with traumatic and non-traumatic vestibular disease were sequentially assessed at a tertiary referral neuro-otology unit in a teaching hospital. A detailed history of all patients was taken and standard vestibular assessment was conducted using the technique described in the companion paper. The results of both groups of patients were analysed and the rate of abnormalities was assessed. RESULTS There was a high rate of abnormalities, including bilateral pathology, in a significant number of patients. Many patients in both groups inexplicably failed to recover. CONCLUSION Vestibular-evoked myogenic potentials are helpful in documenting pathology, including bilateral pathology, which is outlined in the literature as being exceedingly difficult to compensate for.
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Fino PC, Parrington L, Walls M, Sippel E, Hullar TE, Chesnutt JC, King LA. Abnormal Turning and Its Association with Self-Reported Symptoms in Chronic Mild Traumatic Brain Injury. J Neurotrauma 2018; 35:1167-1177. [PMID: 29078732 DOI: 10.1089/neu.2017.5231] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Turning is common in daily activity and requires rapid, coordinated reorientation of the head, trunk, and pelvis toward the new direction of travel. Yet, turning gait has not been well explored in populations with mild traumatic brain injury (mTBI) who may alter their turning behavior according to self-perceived symptoms or motor dysfunction. The purpose of this study was to examine turning velocities and coordination in adults with chronic mTBI (>3 months post-injury and still reporting balance complaints) during a task simulating everyday ambulation. We hypothesized that individuals with chronic mTBI would reduce their angular velocity when turning and increase the variability of head-pelvis coordination compared with controls, and that the reduction in velocity and increased variability would be associated with their self-reported symptom score. Forty-two adults (14 chronic mTBI, 28 controls) completed the Neurobehavioral Symptom Inventory before walking 12 laps around a marked course containing two 45-degree turns, four 90-degree turns, and two 135-degree turns. Inertial sensors collected angular velocities of the head and pelvis. After adjusting for covariates, participants with chronic mTBI had significantly slower lap times and peak angular velocities of the pelvis (p < 0.01) compared with the control group. The peak velocity timing (PVT) between peak velocities of the head and pelvis, and the variability of that timing was significantly greater in participants with chronic mTBI (p < 0.01). Within the chronic mTBI group, somatosensory symptoms were associated with slower angular velocities of the head and pelvis (p = 0.03) and increased PVT variability (p < 0.01). The results suggest individuals with chronic mTBI with worse somatic symptoms have impaired head stabilization during turning in situations similar to everyday life. These results encourage future research on turning gait to examine the causal relationship between symptoms and daily locomotor function in adults with chronic mTBI.
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Affiliation(s)
- Peter C Fino
- 1 Department of Neurology, Oregon Health & Science University , Portland, Oregon
| | - Lucy Parrington
- 1 Department of Neurology, Oregon Health & Science University , Portland, Oregon
| | - Merissa Walls
- 1 Department of Neurology, Oregon Health & Science University , Portland, Oregon
| | - Emily Sippel
- 1 Department of Neurology, Oregon Health & Science University , Portland, Oregon
| | - Timothy E Hullar
- 2 Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University , Portland, Oregon
| | - James C Chesnutt
- 3 Department of Orthopedics & Rehabilitation, Neurology, and Family Medicine, Oregon Health & Science University , Portland, Oregon
| | - Laurie A King
- 1 Department of Neurology, Oregon Health & Science University , Portland, Oregon
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Lee H, Lee S, Salado L, Estrada J, White J, Muthukumar V, Lee SP, Mohapatra S. Proof-of-Concept Testing of a Real-Time mHealth Measure to Estimate Postural Control During Walking: A Potential Application for Mild Traumatic Brain Injuries. Asian Pac Isl Nurs J 2018; 3:177-189. [PMID: 31037266 PMCID: PMC6484150 DOI: 10.31372/20180304.1027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Most individuals with mild traumatic brain injury (mTBI) experience post-injury deficits in postural control. Currently available measures of postural control are lab-based or supervised, which may hinder timely symptom assessment for individuals with mTBI, including Asian populations, who do not seek initial screening post-injury. In this proof-of-concept testing study, we introduce a real-time mobile health (mHealth) system to measure postural control during walking. The proposed mHealth system can be used for home-based symptom assessment and management of mTBI. Methods: In our proposed mHealth system, a smartwatch, a smartphone, and a cloud server communicate to measure, collect, and store body balance data in real time. Specifically, we focus on the rotation vector data that have been reported to be the most effective in terms of differentiating balance control during walking across different participants. Results: Constant motion change in four participants (two females and two males; three healthy participants, and one individual with reduced physical mobility) was collected and analyzed. The results of our data analysis show that, compared to healthy participants, the individual was reduced physical mobility had a wider range of motion between right and left, up and down, and forward and backward while walking. We also found that female participants had narrower ranges of right-to-left and up-and-down motions than their male counterparts. Conclusions: Our results highlight the potential of the proposed real-time mHealth system for home-based symptom assessment and management of mTBI, which may benefit Asian and other nonwhite racial minority groups that appear to be more reluctant to access post-acute rehabilitation services.
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Affiliation(s)
- Hyunhwa Lee
- School of Nursing, University of Nevada, Las Vegas, NV, USA
| | - Sungchul Lee
- Department of Computer Science, University of Wisconsin-Whitewater, WI, USA
| | - Laura Salado
- College of Arts, Sciences, and Education, Florida International University, FL, USA
| | - Jonica Estrada
- School of Sciences, University of Nevada, Las Vegas, NV, USA
| | - Jacob White
- College of Liberal Arts, University of Nevada, Las Vegas, NV, USA
| | - Venkatesan Muthukumar
- Department of Electrical and Computer Engineering, University of Nevada, Las Vegas, NV, USA
| | - Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA
| | - Sambit Mohapatra
- Department of Rehabilitation & Movement Science, University of Vermont, VT, USA
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The Structure of the Rivermead Post-Concussion Symptoms Questionnaire in Australian Adults with Traumatic Brain Injury. BRAIN IMPAIR 2017. [DOI: 10.1017/brimp.2017.26] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background and aims: Many sustaining traumatic brain injury (TBI) suffer ongoing post-concussion symptoms (PCS). The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is widely used, although there is disagreement about its structure. This study compared the fit of published RPQ structures with a four-factor structure derived from a large adult sample with TBI in Tasmania.Method: 661 adults with TBI completed the RPQ at approximately one month post injury. Exploratory factor analysis (EFA), using the first half of the sample (n = 330), suggested a four-factor solution. This was compared with models reported in the literature with the second half of the sample (n = 331), using structural equation modelling. Trajectory of recovery across these factors was examined within subsamples at 1, 3, 6 and 12 months following TBI.Results: Inter-correlations between items were strongest for somatic, cognitive and emotional functioning items and the EFA identified a four-factor model. Fit was examined utilising bootstrapping for model comparison. The data at 1 month following TBI best fitted the four-factor model (CFI = .95, RMSEA = .060 (.049–.071) and factors had adequate internal consistency (r = .61–.89). This model appeared a good fit and clinically useful across time points to 12 months post injury.Conclusions: Data best fitted a four-factor model, identified using a rigorous statistical approach. Clinicians and clinical researchers may use this preferred model to provide more specific measurement of the severity of PCS. Future research could attempt replication within international samples.
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Dobney DM, Miller MB, Tufts E. Non-pharmacological rehabilitation interventions for concussion in children: a scoping review. Disabil Rehabil 2017; 41:727-739. [PMID: 29157025 DOI: 10.1080/09638288.2017.1400595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To summarise the extent, nature, and quality of current scholarly literature related to non-pharmacological, rehabilitation interventions following concussion, or mild traumatic brain injury in children. METHODS An electronic search was conducted from 1987 to 24 October 2017. Studies were included if they met the following criteria: (1) full text, peer reviewed, and written in English, (2) original research, (3) diagnosed concussion or mild traumatic brain injury, (4) described the evaluation of an intervention, (5) the outcome was a concussion impairment, and (6) the mean/median age was under 19. Quality assessment using the Down's and Black criteria was conducted. RESULTS Twenty-six studies published between 2001 and 2017 were identified. Interventions included rest, active rehabilitation, exercise, vestibular, oculomotor, cervicospinal therapy, education, early intervention, telephone counselling, mobile health application, Web-based Self-Management program, multimodal physical therapy, cognitive behavioural therapy, transcranial direct current stimulation, and acupuncture. The quality assessments ranged from poor to good. CONCLUSIONS The literature describing interventions following concussion in children is scarce. While both positive and negative results were obtained, there were methodological concerns in most studies limiting the ability to draw conclusions. Interventions incorporating aerobic exercise show promise as a concussion management strategy. Implications for rehabilitation Few studies have examined rehabilitation interventions for youth following concussion. Research ranging from rest to exercise highlights the uncertainty of the field. Low quality research limits the generalizability of results. The use of physical activity appears to be an emerging area of interest. Individualised, aerobic exercise should be used as part of clinical management.
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Affiliation(s)
- Danielle M Dobney
- a School of Physical and Occupational Therapy, Faculty of Medicine , McGill University , Montreal , Canada
| | - Matthew B Miller
- b Department of Exercise Science, Faculty of Arts and Science , Concordia University , Montreal , Canada
| | - Emily Tufts
- c Centennial College Libraries , Toronto , Canada
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Chanpimol S, Seamon B, Hernandez H, Harris-Love M, Blackman MR. Using Xbox kinect motion capture technology to improve clinical rehabilitation outcomes for balance and cardiovascular health in an individual with chronic TBI. Arch Physiother 2017; 7:6. [PMID: 28824816 PMCID: PMC5560163 DOI: 10.1186/s40945-017-0033-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/09/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Motion capture virtual reality-based rehabilitation has become more common. However, therapists face challenges to the implementation of virtual reality (VR) in clinical settings. Use of motion capture technology such as the Xbox Kinect may provide a useful rehabilitation tool for the treatment of postural instability and cardiovascular deconditioning in individuals with chronic severe traumatic brain injury (TBI). The primary purpose of this study was to evaluate the effects of a Kinect-based VR intervention using commercially available motion capture games on balance outcomes for an individual with chronic TBI. The secondary purpose was to assess the feasibility of this intervention for eliciting cardiovascular adaptations. METHODS A single system experimental design (n = 1) was utilized, which included baseline, intervention, and retention phases. Repeated measures were used to evaluate the effects of an 8-week supervised exercise intervention using two Xbox One Kinect games. Balance was characterized using the dynamic gait index (DGI), functional reach test (FRT), and Limits of Stability (LOS) test on the NeuroCom Balance Master. The LOS assesses end-point excursion (EPE), maximal excursion (MXE), and directional control (DCL) during weight-shifting tasks. Cardiovascular and activity measures were characterized by heart rate at the end of exercise (HRe), total gameplay time (TAT), and time spent in a therapeutic heart rate (TTR) during the Kinect intervention. Chi-square and ANOVA testing were used to analyze the data. RESULTS Dynamic balance, characterized by the DGI, increased during the intervention phase χ2 (1, N = 12) = 12, p = .001. Static balance, characterized by the FRT showed no significant changes. The EPE increased during the intervention phase in the backward direction χ2 (1, N = 12) = 5.6, p = .02, and notable improvements of DCL were demonstrated in all directions. HRe (F (2,174) = 29.65, p = < .001) and time in a TTR (F (2, 12) = 4.19, p = .04) decreased over the course of the intervention phase. CONCLUSIONS Use of a supervised Kinect-based program that incorporated commercial games improved dynamic balance for an individual post severe TBI. Additionally, moderate cardiovascular activity was achieved through motion capture gaming. Further studies appear warranted to determine the potential therapeutic utility of commercial VR games in this patient population. TRIAL REGISTRATION Clinicaltrial.gov ID - NCT02889289.
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Affiliation(s)
- Shane Chanpimol
- Neurology Service, Veterans Affairs Medical Center, Washington, DC USA
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center, Washington, DC USA
| | - Bryant Seamon
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center, Washington, DC USA
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center - Human Performance Research Unit, Veterans Affairs Medical Center, Washington, DC USA
| | - Haniel Hernandez
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center, Washington, DC USA
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center - Human Performance Research Unit, Veterans Affairs Medical Center, Washington, DC USA
| | - Michael Harris-Love
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center - Human Performance Research Unit, Veterans Affairs Medical Center, Washington, DC USA
- Geriatrics and Extended Care Service/Research Service, Veterans Affairs Medical Center, Washington, DC USA
- Department of Exercise and Nutritional Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC USA
| | - Marc R. Blackman
- Research Service, Veterans Affairs Medical Center, Washington, DC USA
- Departments of Medicine, Biochemistry and Molecular Medicine, George Washington University School of Medicine, Washington, DC USA
- Departments of Medicine and Rehabilitation Medicine, Georgetown University School of Medicine, Washington, DC USA
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Asken BM, DeKosky ST, Clugston JR, Jaffee MS, Bauer RM. Diffusion tensor imaging (DTI) findings in adult civilian, military, and sport-related mild traumatic brain injury (mTBI): a systematic critical review. Brain Imaging Behav 2017; 12:585-612. [DOI: 10.1007/s11682-017-9708-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Adams J, Moore B. Return to Meaningful Activities After a Multi-Modal Rehabilitation Programme among Individuals Who Experience Persistent Dizziness and Debility Longer Than 9 Months after Sustaining a Concussion: A Case Series. Physiother Can 2017; 69:249-259. [PMID: 30275641 DOI: 10.3138/ptc.2015-81ep] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The authors explored changes in outcome measures and return to meaningful life activities in six individuals who participated in a home-based multi-modal rehabilitation programme to address persistent dizziness and debility that had continued for more than 9 months since a documented concussion. Methods: In a case series using a repeated-measures design, changes from pre- to post-treatment assessments were assessed after a 6-month intervention. The outcome measures used were the Rivermead Post-Concussion Symptoms Questionnaire's subsidiary scales (RPQ-3, RPQ-13), Dizziness Handicap Inventory (DHI), Activities-specific Balance Confidence Scale, Functional Gait Assessment, return to work or study, and return to activity. Results: Six months after the multi-modal rehabilitation programme, statistically significant differences were found on the RPQ-3 (p=0.026), RPQ-13 (p=0.037), and DHI (p=0.033). In addition, four participants had returned to their previous work, and all six participants had been able to return to physical activity. Conclusion: A supervised home programme, provided in the context of a multi-modal rehabilitation programme, has the potential to improve outcomes even when rehabilitative services are delayed and persistent concussion-related symptoms continue for a significant amount of time after the onset of a concussion.
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Affiliation(s)
- Joseph Adams
- Department of Physical Therapy, Rusk Rehabilitation, New York University Langone Medical Center, New York, N.Y
| | - Brian Moore
- Department of Physical Therapy, California State University, Sacramento, Calif
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Vander Werff Kathy R. The Application of the International Classification of Functioning, Disability and Health to Functional Auditory Consequences of Mild Traumatic Brain Injury. Semin Hear 2016; 37:216-32. [PMID: 27489400 DOI: 10.1055/s-0036-1584409] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This article reviews the auditory consequences of mild traumatic brain injury (mTBI) within the context of the International Classification of Functioning, Disability and Health (ICF). Because of growing awareness of mTBI as a public health concern and the diverse and heterogeneous nature of the individual consequences, it is important to provide audiologists and other health care providers with a better understanding of potential implications in the assessment of levels of function and disability for individual interdisciplinary remediation planning. In consideration of body structures and function, the mechanisms of injury that may result in peripheral or central auditory dysfunction in mTBI are reviewed, along with a broader scope of effects of injury to the brain. The activity limitations and participation restrictions that may affect assessment and management in the context of an individual's personal factors and their environment are considered. Finally, a review of management strategies for mTBI from an audiological perspective as part of a multidisciplinary team is included.
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Asken BM, Mihalik JP, Schmidt JD, Littleton AC, Guskiewicz KM, Hopfinger JB. Visual Performance Measures and Functional Implications in Healthy Participants: A Sports Concussion Perspective. ACTA ACUST UNITED AC 2016. [DOI: 10.3928/19425864-20160204-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lin LF, Liou TH, Hu CJ, Ma HP, Ou JC, Chiang YH, Chiu WT, Tsai SH, Chu WC. Balance function and sensory integration after mild traumatic brain injury. Brain Inj 2016; 29:41-6. [PMID: 25265292 DOI: 10.3109/02699052.2014.955881] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study examined the disparities in balance functions and sensory integration in patients with mild traumatic brain injuries (mTBIs) and healthy controls. PARTICIPANTS One hundred and seven patients with mTBI and 107 age- and sex-matched controls were recruaited for this study. PRIMARY MEASURES Symptoms of dizziness, balance functions and the ability to perform daily activities were assessed using the dizziness handicap inventory (DHI). This study also performed the postural-stability test and a modified clinical test of sensory integration by using the Biodex Stability System (BBS). RESULTS DHI scores (functional, emotional, physical and total self-reported scores) were substantially increased in patients following an mTBI compared with the scores of the controls (p < 0.000). The postural-stability test indices (anterior-posterior) (p = 0.045) and the sensory-integration test index (eyes-open-firm-surface index) (p = 0.006) were substantially lower in patients with mTBI than in the controls. However, indices of two other postural-stability test indices (overall and medial-lateral) and three other sensory-integration tests indices (eyes-closed-firm-surface, eyes-open-foam-surface and eyes-closed-foam-surface) measured for the mTBI group did not differ from those of the control group. CONCLUSION Activities of daily living, balance in postural stability and sensory integration were strongly impaired in patients with mTBI.
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Affiliation(s)
- Li-Fong Lin
- a Graduate Institute of Biomedical Engineering, National Yang-Ming University , Taiwan ROC
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Vestibular Rehabilitation After Traumatic Brain Injury: Case Series. Phys Ther 2016; 96:839-49. [PMID: 26586860 DOI: 10.2522/ptj.20150095] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 11/05/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE There has been an increasing focus on vestibular rehabilitation (VR) after traumatic brain injury (TBI) in recent years. However, detailed descriptions of the content of and patient responses to VR after TBI are limited. The purposes of this case series are (1) to describe a modified, group-based VR intervention and (2) to examine changes in self-reported and performance-based outcome measures. CASE DESCRIPTION Two women and 2 men (aged 24-45 years) with mild TBI, dizziness, and balance problems participated in an 8-week intervention consisting of group sessions with guidance, individually modified VR exercises, a home exercise program, and an exercise diary. Self-reported and performance-based outcome measures were applied to assess the impact of dizziness and balance problems on functions related to activity and participation. OUTCOMES The intervention caused no adverse effects. Three of the 4 patients reported reduced self-perceived disability because of dizziness, diminished frequency and severity of dizziness, improved health-related quality of life, reduced psychological distress, and improved performance-based balance. The change scores exceeded the minimal detectable change, indicating a clinically significant change or improvement in the direction of age-related norms. The fourth patient did not change or improve in most outcome measures. DISCUSSION A modified, group-based VR intervention was safe and appeared to be viable and beneficial when addressing dizziness and balance problems after TBI. However, concurrent physical and psychological symptoms, other neurological deficits, and musculoskeletal problems might influence the course of central nervous system compensation and recovery. The present case series may be useful for tailoring VR interventions to patients with TBI. Future randomized controlled trials are warranted to evaluate the short- and long-term effects of VR after TBI.
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Tapper A, Gonzalez D, Roy E, Niechwiej-Szwedo E. Executive function deficits in team sport athletes with a history of concussion revealed by a visual-auditory dual task paradigm. J Sports Sci 2016; 35:231-240. [DOI: 10.1080/02640414.2016.1161214] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Examining the relationship between medical diagnoses and patterns of performance on the modified Dynamic Gait Index. Phys Ther 2015; 95:854-63. [PMID: 25476719 DOI: 10.2522/ptj.20140297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 11/23/2014] [Indexed: 02/09/2023]
Abstract
BACKGROUND In the original and modified Dynamic Gait Index (mDGI), 8 tasks are used to measure mobility; however, disagreement exists regarding whether all tasks are necessary. The relationship between mDGI scores and Centers for Medicare & Medicaid Services (CMS) severity indicators in the mobility domain has not been explored. OBJECTIVE The study objectives were to examine the relationship between medical diagnoses and mDGI scores, to determine whether administration of the mDGI can be shortened on the basis of expected diagnostic patterns of performance, and to create a model in which mDGI scores are mapped to CMS severity modifiers. DESIGN This was a cross-sectional, descriptive study. METHODS The 794 participants included 140 people without impairments (control cohort) and 239 people with stroke, 140 with vestibular dysfunction, 100 with traumatic brain injury, 91 with gait abnormality, and 84 with Parkinson disease. Scores on the mDGI (total, performance facet, and task) for the control cohort were compared with those for the 5 diagnostic groups by use of an analysis of variance. For mapping mDGI scores to 7 CMS impairment categories, an underlying Rasch scale was used to convert raw scores to an interval scale. RESULTS There was a main effect of mDGI total, time, and gait pattern scores for the groups. Task-specific score patterns based on medical diagnosis were found, but the range of performance within each group was large. A framework for mapping mDGI total, performance facet, and task scores to 7 CMS impairment categories on the basis of Rasch analysis was created. LIMITATIONS Limitations included uneven sample sizes in the 6 groups. CONCLUSIONS Results supported retaining all 8 tasks for the assessment of mobility function in older people and people with neurologic conditions. Mapping mDGI scores to CMS severity indicators should assist clinicians in interpreting mobility performance, including changes in function over time.
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Fife TD, Kalra D. Persistent vertigo and dizziness after mild traumatic brain injury. Ann N Y Acad Sci 2015; 1343:97-105. [DOI: 10.1111/nyas.12678] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Terry D. Fife
- Barrow Neurological Institute; Phoenix Arizona
- Department of Neurology; University of Arizona College of Medicine; Phoenix Arizona
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Register-Mihalik JK, Littleton AC, Guskiewicz KM. Are divided attention tasks useful in the assessment and management of sport-related concussion? Neuropsychol Rev 2013; 23:300-13. [PMID: 24242888 DOI: 10.1007/s11065-013-9238-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 11/04/2013] [Indexed: 11/26/2022]
Abstract
This article is a systematic review of the literature on divided attention assessment inclusive of a cognitive and motor task (balance or gait) for use in concussion management. The systematic review drew from published papers listed in PubMed, MEDLINE, EMBASE and CINAHL databases. The search identified 19 empirical research papers meeting the inclusion criteria. Study results were considered for the psychometric properties of the paradigms, the influence of divided attention on measures of cognition and postural control and the comparison of divided attention task outcomes between individuals with concussion and healthy controls (all samples were age 17 years or older). The review highlights that the reliability of the tasks under a divided attention paradigm presented ranges from low to high (ICC: 0.1-0.9); however, only 3/19 articles included psychometric information. Response times are greater, gait strategies are less efficient, and postural control deficits are greater in concussed participants compared with healthy controls both immediately and for some period following concussive injury, specifically under divided attention conditions. Dual task assessments in some cases were more reliable than single task assessments and may be better able to detect lingering effects following concussion. Few of the studies have been replicated and applied across various age groups. A key limitation of these studies is that many include laboratory and time-intensive measures. Future research is needed to refine a time and cost efficient divided attention assessment paradigm, and more work is needed in younger (pre-teens) populations where the application may be of greatest utility.
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Affiliation(s)
- Johna K Register-Mihalik
- Clinical Research Unit, Emergency Services Institute, WakeMed Health and Hospitals, 3000 New Bern Ave., Raleigh, NC, 27610, USA,
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Selwyn R, Hockenbury N, Jaiswal S, Mathur S, Armstrong RC, Byrnes KR. Mild traumatic brain injury results in depressed cerebral glucose uptake: An (18)FDG PET study. J Neurotrauma 2013; 30:1943-53. [PMID: 23829400 DOI: 10.1089/neu.2013.2928] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Moderate to severe traumatic brain injury (TBI) in humans and rats induces measurable metabolic changes, including a sustained depression in cerebral glucose uptake. However, the effect of a mild TBI on brain glucose uptake is unclear, particularly in rodent models. This study aimed to determine the glucose uptake pattern in the brain after a mild lateral fluid percussion (LFP) TBI. Briefly, adult male rats were subjected to a mild LFP and positron emission tomography (PET) imaging with (18)F-fluorodeoxyglucose ((18)FDG), which was performed prior to injury and at 3 and 24 h and 5, 9, and 16 days post-injury. Locomotor function was assessed prior to injury and at 1, 3, 7, 14, and 21 days after injury using modified beam walk tasks to confirm injury severity. Histology was performed at either 10 or 21 days post-injury. Analysis of function revealed a transient impairment in locomotor ability, which corresponds to a mild TBI. Using reference region normalization, PET imaging revealed that mild LFP-induced TBI depresses glucose uptake in both the ipsilateral and contralateral hemispheres in comparison with sham-injured and naïve controls from 3 h to 5 days post-injury. Further, areas of depressed glucose uptake were associated with regions of glial activation and axonal damage, but no measurable change in neuronal loss or gross tissue damage was observed. In conclusion, we show that mild TBI, which is characterized by transient impairments in function, axonal damage, and glial activation, results in an observable depression in overall brain glucose uptake using (18)FDG-PET.
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Affiliation(s)
- Reed Selwyn
- 1 Department of Radiology, Uniformed Services University of the Health Sciences , Bethesda, Maryland
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Abstract
BACKGROUND The High-Level Mobility Assessment Tool (HiMAT) was developed to quantify balance and mobility problems after traumatic brain injury (TBI). Measurement properties of the HiMAT have not been tested in the mild TBI (MTBI) population. OBJECTIVE The aim of this study was to examine the reliability, validity, and responsiveness of the HiMAT in a sample of the MTBI population. DESIGN A cohort, pretest-posttest, comparison study was conducted. METHODS Ninety-two patients (69% men, 31% women) with a mean age of 37.1 years (SD=13.8) and a mean Glasgow Coma Scale score of 14.7 (SD=0.7) were recruited from Oslo University Hospital. All patients were tested with the HiMAT (range of scores=0 [worst] to 54 [best]) at 3 months postinjury. Fifty-one patients were retested at 6 months. A subgroup of 25 patients was selected for the reliability testing. Balance function reported on the Rivermead Post Concussion Symptoms Questionnaire was chosen as a criterion and anchor. Criterion-related validity was studied with correlation analysis. Intraclass correlation coefficients (ICCs) were used for assessing interrater and intrarater reliability. Minimal detectable change (MDC) for the HiMAT was estimated. Responsiveness was assessed with receiver operating characteristic curve analyses. RESULTS The mean HiMAT sum score was 46.2 (95% confidence interval=44.4 to 48.1). The HiMAT had a ceiling effect of 22.8%. The correlation between HiMAT scores and self-reported balance problems was large (r=-.63, P<.001). Interrater and intrarater reliability of the HiMAT sum score was high (interrater ICC=.99, intrarater ICC=.95). The MDC was -3 to +4 points. Responsiveness was good, and the HiMAT discriminated well between patients with self-perceived improved balance function versus unchanged balance function (area under the curve=0.86). LIMITATIONS The small sample size, a ceiling effect, and lack of a gold standard were limitations of the study. CONCLUSIONS The HiMAT demonstrated satisfactory measurement properties for patients with MTBI. The HiMAT can be used as an outcome measure of balance and mobility problems in patients with MTBI.
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Current world literature. Curr Opin Pediatr 2012; 24:770-9. [PMID: 23146873 DOI: 10.1097/mop.0b013e32835af8de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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