Physical Performance and Fall Risk in Persons With Traumatic Brain Injury

Abstract

Injuries sustained from traumatic brain injury (TBI) culminate in both cognitive and neuromuscular deficits. Patients often progress to higher functioning on the Rancho continuum even while mobility deficits persist. Although prior studies have examined physical performance among persons with chronic symptoms of TBI, less is known about the relatively acute phase of TBI as patients prepare for rehabilitation discharge. The aims of this cross-sectional study were to (a) compare balance and gait performance in 20 ambulant persons with moderate to severe TBI who were nearing rehabilitation discharge with their age-matched controls and (b) describe performance with thresholds for fall risk and community navigation. During a designed task circuit, 40 participants (20 persons with TBI and 20 controls) performed the Timed Up and Go (TUG), gait velocity, and Walking and Remembering tests. Balance testing included the Fullerton Advanced Balance Scale (FABS) and instrumented Modified Clinical Test for Sensory Interaction in Balance (MCTSIB). Statistical analyses included analysis of covariance for group comparisons and a multivariate analysis of covariance for MCTSIB sway velocities with anthropometric controls. The TBI group (mean [ M] age = 42, standard deviation [ SD] =19.5 years; 70% males) performed significantly more poorly on all mobility tests ( p < .05) and their scores reflected a potential fall risk. Gait velocity was significantly slower for the TBI versus control group ( M = .96, SD = 2.6 vs. M = 1.5, SD = 2.2 m/s; p < .001), including TUG times ( M = 13.5, SD = 4.9 vs. M = 7.7, SD = 1.4; p < .001). TBI participants also demonstrated significantly greater sway velocity on all MCTSIB conditions ( p < .01) and lower performance on the FABS ( p < .001). Performance indices indicate potential fall risk and community navigation compromise for individuals with moderate to severe TBI. Physical performance scores support the need for continued interventions to optimize functional mobility upon discharge.

Vestibular agnosia in traumatic brain injury and its link to imbalance

“…One reason for a relative lack of understanding of imbalance in TBI is that there are no acute prospective studies (mechanistic or otherwise) assessing vestibular dysfunction in acute TBI. There has been one cross-sectional study assessing instrumented measures of balance, in the subacute stage ( Klima et al , 2019 ) confirming manifest imbalance in subacute TBI. We also recently reported two separate cross-sectional clinical studies in ambulant acute TBI patients; one showing that 62% were unbalanced ( Marcus et al , 2019 ) of whom half did not report feeling unbalanced, and the other ( Sargeant et al , 2018 ), confirming the lack of correlation between objective signs of imbalance and vestibular symptom scores.…”

Dynamic balance recovery in chronic Acquired Brain Injury participants following a perturbation training

“…Both etiologies lead to dynamic balance impairments (McCulloch et al, 2010; Lord et al, 2004). Dynamic balance impairment is a risk factor for falls post-ABI, and has a significant impact on physical function, activity, community participation and quality of life years after the injury (McCulloch et al, 2010; Lord et al, 2004; Peterson et al, 2015; Klima et al, 2019; Medley et al, 2006). About 30% to 65% of TBI survivors and 73% of community-dwelling stroke survivors, report continual problems in dynamic balance control and gait (Klima et al, 2019, Forster et al, 1999) and a fall within 6 months post-stroke (Yates et al, 2002).…”

“…Dynamic balance impairment is a risk factor for falls post-ABI, and has a significant impact on physical function, activity, community participation and quality of life years after the injury (McCulloch et al, 2010; Lord et al, 2004; Peterson et al, 2015; Klima et al, 2019; Medley et al, 2006). About 30% to 65% of TBI survivors and 73% of community-dwelling stroke survivors, report continual problems in dynamic balance control and gait (Klima et al, 2019, Forster et al, 1999) and a fall within 6 months post-stroke (Yates et al, 2002). ABI survivors demonstrate also reduced gait stability and adjustments of gait patterns when faced with environmental challenges, such as avoiding obstacles (Hyndman et al, 2006; Van Swigchem et al, 2013).…”

The Functional and Structural Neural Correlates of Dynamic Balance Impairment and Recovery in Persons with Acquired Brain Injury

“…Longitudinal studies indicated an association between brain atrophy post-stroke and gait control decline [7,8] and increased risk of motor-related neurodegenerative disorders such as Parkinson disease post-TBI [9] . Subjects post-ABI at the chronic phase frequently suffer from a dynamic balance control impairment which restricts their mobility, limits their community integration and their locomotor abilities [10][11][12] . Dynamic balance control is a complex function that is achieved by both feedback and feedforward control mechanisms and mediated by both central pattern generation at the spinal level and subcortical and cortical brain areas [13][14][15] .…”