Results From a Randomized Controlled Trial to Address Balance Deficits After Traumatic Brain Injury

Tefertiller, Candace; Hays, Kaitlin; Natale, Audrey; O'Dell, Denise R; Ketchum, Jessica M.; Sevigny, Mitch; Eagye, C.B.; Philippus, Angela; Harrison-Felix, Cynthia

doi:10.1016/j.apmr.2019.03.015

Cited by 28 publications

(52 citation statements)

References 49 publications

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“…Similarly, our participants showed CB&M score improvement post-perturbation training of Δ=7.02. When examining the proportion of participants that showed greater CB&M improvement than the suggested MDC (MDC=8), 48% of participants met or exceeded MDC in the previously mentioned study and 45.7% of the participants in our study met or exceeded the MDC (Tefertiller et al, 2019). The fact that the CB&M changes following our intervention were comparable to those seen both in the experimental and in the control group in the previously mentioned study (Tefertiller et al, 2019), suggesting that the additive contribution of the applied perturbations is limited.…”

Section: Discussionmentioning

confidence: 52%

“…Tefertiller et al, (2019) presented an improvement in CB&M score post an in-home 12-week physical therapy (virtual reality or conventional balance training) of 7.7 and 7.8 respectively in subjects post-TBI at the chronic phase. Similarly, our participants showed CB&M score improvement post-perturbation training of Δ=7.02.…”

Section: Discussionmentioning

confidence: 96%

“…However, the MDC of the CB&M measure in participant post-ABI at the chronic phase is not established yet. A recent published study addressing balance deficits following TBI at the chronic phase suggested using an MDC value of 8 as a change in the CB&M score that the therapist can interpret as a true change in balance and not related to a measurement error (Tefertiller et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Effect size was calculated based on the following hypothesis: H 0 =0, the H 1 =8. Effect size was based on a previous study in TBI population (MDC=8) (Tefertiller et al, 2019), and standard deviation (16) was based on another study (Inness et al, 2011). Alpha of 0.05.…”

Section: Methodsmentioning

confidence: 99%

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

Joubran

Bar-Haim

Shmuelof

2021

Preprint

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BackgroundAcquired Brain Injury (ABI) is defined as a damage to the brain that occurs after birth. Subjects post-ABI suffer from dynamic balance impairments that persist years after the injury.ObjectiveTo explore the effect of a perturbation method which is consisted of unexpected balance perturbations using Re-Step™ technology on the recovery of dynamic balance and gait velocity in chronic ABI participants.MethodsIn a clinical trial, 35 chronic ABI participants (stroke and traumatic brain injury) participated in 22 sessions of perturbation-training, twice a week for 3 months. Dynamic balance was assessed pre and post-training using Community Balance and Mobility Scale (CB&M). Gait velocity was also assessed in the stroke participants using the 10-meter walk test (10MWT).ResultsDynamic balance improved significantly post-training (p=0.001). This improvement was greater than the improvement that was observed in a sub-group that was tested twice before training (p=0.04). 16 participants (45.7%) out of 35 met or exceeded minimal detectable change (MDC) of the CB&M Scale. Self-paced velocity also improved significantly (p=0.02) but only 2 participants (9.5%) out of 21 exceeded the MDC of 10MWT post-stroke.ConclusionsUnexpected balance perturbation-training using Re-Step™ technology led to an improvement in dynamic balance and gait velocity in chronic ABI participants. The advantage of Re-Step™ technology training compared to conventional balance training should be further examined.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Joubran

Bar-Haim

Shmuelof

2021

Preprint

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“…Lesions in the previously mentioned areas are associated with gait and balance impairments [20][21][22] . Dynamic balance and mobility at the chronic phase of ABI have been shown to respond to rehabilitation treatments such as virtual reality training, multi-disciplinary rehabilitation and conventional balance training [23][24][25][26] . Furthermore, facing unpredictable perturbations, coming from mechatronic shoes, has been recently shown to be associated with improvement in dynamic balance [26] .…”

Section: Introductionmentioning

confidence: 99%

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

Joubran¹,

Bar-Haim²,

Shmuelof³

2021

Preprint

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Dynamic balance depends on the interaction between multiple brain networks and is impaired following Acquired Brain Injury (ABI). This study aims to characterize the brain functional and structural correlates of ABI-induced dynamic balance impairment and recovery at the chronic-phase following a rehabilitation treatment. 31 participants participated in a novel rehabilitation treatment composed of 22 sessions of perturbation training. Dynamic balance was assessed using the Community Balance and Mobility scale (CB&M) and the 10-Meter Walking Test (10MWT). Brain function was assessed based on resting-state fMRI scans which were analysed using independent component analysis (ICA), and regions of interest analyses. Brain volume was assessed using structural MRI and compared to age-matched and elderly participants. ICA revealed a reduction in component-related activation within the sensorimotor and cerebellar networks post-intervention (p < 0.035). Improvement in CB&M scale was associated with a reduction in FC within the cerebellar network (p = 0.023) and with baseline FC within the cerebellar-putamen (p = 0.002) and cerebellar-thalamic networks (p = 0.026). Improvement in 10MWT was associated with baseline FC within the cerebellar-putamen (p = 0.012) and cerebellar-cortical networks (p = 0.017, p = 0.004, p < 0.001and p = 0.005). A global brain volume reduction was found in the ABI-group when compared to the age-matched controls (p < 0.001), which was negatively associated with ABI chronicity, but not associated with CB&M scale. Our results show that dynamic balance recovery is associated with FC changes within and between the cerebellar and sensorimotor networks that are consistent with the contribution of modularity to balance control and recovery. The diffused atrophy post-ABI indicates that ABI led to a degenerative process.

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Dizziness and Balance Disorders in a Traumatic Brain Injury Population: Current Clinical Approaches

Harrell

Manetta

Gorgacz

2021

Curr Phys Med Rehabil Rep

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Results From a Randomized Controlled Trial to Address Balance Deficits After Traumatic Brain Injury

Cited by 28 publications

References 49 publications

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

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

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

Dizziness and Balance Disorders in a Traumatic Brain Injury Population: Current Clinical Approaches

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