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Citation
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Joseph ALC, Lippa SM, Moore B, Bagri M, Row J, Chan L, Zampieri C. PM R 2020; ePub(ePub): ePub. |
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Abstract
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INTRODUCTION: 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, since most studies include only acute/sub-acute cases.
OBJECTIVES: (1) Compare performance on the Sensory Organization Test vestibular score and Dual-Task test in individuals with and without subjective balance problems at least one year after a TBI. (2) 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 one to five years following non-penetrating 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 sex, 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. This article is protected by copyright. All rights reserved.
Language: en |