The Community Balance and Mobility Scale: Detecting Impairments in Military Service Members With Mild Traumatic Brain Injury

Pape, Marcy M.; Kodosky, Paula N; Hoover, Peter

doi:10.1093/milmed/usz265

Cited by 10 publications

(13 citation statements)

References 40 publications

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“…Some of the Service members with mTBI demonstrate a variety of motor deficits measured by the Community Balance and Mobility Scale ( 77 ). This scale was designed based on the expertise of physical and occupational therapists to assess motor skills such as postural control during multitasking, crouching, walking sequences, dodging, running, and stopping control ( 78 ).…”

Section: Translational Considerations Of Behavioral Impairmentsmentioning

confidence: 99%

Perspectives on Primary Blast Injury of the Brain: Translational Insights Into Non-inertial Low-Intensity Blast Injury

et al. 2022

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Most traumatic brain injuries (TBIs) during military deployment or training are clinically “mild” and frequently caused by non-impact blast exposures. Experimental models were developed to reproduce the biological consequences of high-intensity blasts causing moderate to severe brain injuries. However, the pathophysiological mechanisms of low-intensity blast (LIB)-induced neurological deficits have been understudied. This review provides perspectives on primary blast-induced mild TBI models and discusses translational aspects of LIB exposures as defined by standardized physical parameters including overpressure, impulse, and shock wave velocity. Our mouse LIB-exposure model, which reproduces deployment-related scenarios of open-field blast (OFB), caused neurobehavioral changes, including reduced exploratory activities, elevated anxiety-like levels, impaired nesting behavior, and compromised spatial reference learning and memory. These functional impairments associate with subcellular and ultrastructural neuropathological changes, such as myelinated axonal damage, synaptic alterations, and mitochondrial abnormalities occurring in the absence of gross- or cellular damage. Biochemically, we observed dysfunctional mitochondrial pathways that led to elevated oxidative stress, impaired fission-fusion dynamics, diminished mitophagy, decreased oxidative phosphorylation, and compensated cell respiration-relevant enzyme activity. LIB also induced increased levels of total tau, phosphorylated tau, and amyloid β peptide, suggesting initiation of signaling cascades leading to neurodegeneration. We also compare translational aspects of OFB findings to alternative blast injury models. By scoping relevant recent research findings, we provide recommendations for future preclinical studies to better reflect military-operational and clinical realities. Overall, better alignment of preclinical models with clinical observations and experience related to military injuries will facilitate development of more precise diagnosis, clinical evaluation, treatment, and rehabilitation.

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Section: Translational Considerations Of Behavioral Impairmentsmentioning

confidence: 99%

Perspectives on Primary Blast Injury of the Brain: Translational Insights Into Non-inertial Low-Intensity Blast Injury

et al. 2022

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“…22 Most studies assess gait using gait speed; a simple protocol that measures gait during straight-ahead walking. 17,26 Other studies use increasing gait complexity (e.g. dual-task, obstacle avoidance, turning course) in an effort to uncover subtle gait dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Gait Performance in People with Symptomatic, Chronic Mild Traumatic Brain Injury

Martini

Parrington

Stuart

et al. 2020

Journal of Neurotrauma

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There is a dearth of knowledge about how symptom severity affects gait in the chronic (>3 months) mild traumatic brain injury (mTBI) population despite up to 53% of people reporting persisting symptoms following mTBI. The purpose of this investigation was to determine if gait is affected in a symptomatic, chronic mTBI group and to assess the relationship between gait performance and symptom severity on the Neurobehavioral Symptom Inventory (NSI). Gait was assessed under single-and dual-task conditions using five inertial sensors in 57 control subjects and 65 people with chronic mTBI (1.1 year from mTBI).The single-and dual-task gait domains of Pace, Rhythm, Variability, and Turning were calculated from individual gait characteristics. Dual-task cost (DTC) was calculated for each domain. The mTBI group walked (domain z-score mean difference: single-task = 0.70; dual-task = 0.71) and turned (z-score mean difference: single-task = 0.69; dual-task = 0.70) slower (p<0.001) under both gait conditions, with less rhythm under dual-task gait (z-score difference = 0.21, p=0.001). DTC was not different between groups.Higher NSI somatic sub-score was related to higher single-and dual-task gait variability as well as slower dual-task pace and turning (p<0.01). People with chronic mTBI and persistent symptoms exhibited altered gait, particularly under dual-task, and worse gait performance related to greater symptom severity. Future gait research in chronic mTBI should assess the possible underlying physiological mechanisms for persistent symptoms and gait deficits.

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“…Movement impairment is the most common long term problem reported by patients after traumatic brain injury (39%) ( 38 ). Impairments include issues with balance, coordination, ambulation, muscle tone (spasticity, paralysis, and weakness) and motor skills such as dexterity and writing ( 38 , 39 ). We tested whether our SBI animal model displays these common sequelae associated with chronic post-injury stages.…”

Section: Resultsmentioning

confidence: 99%

Dexmedetomidine-mediated sleep phase modulation ameliorates motor and cognitive performance in a chronic blast-injured mouse model

Bibineyshvili

Schiff²,

Calderon³

2022

Front. Neurol.

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Multiple studies have shown that blast injury is followed by sleep disruption linked to functional sequelae. It is well established that improving sleep ameliorates such functional deficits. However, little is known about longitudinal brain activity changes after blast injury. In addition, the effects of directly modulating the sleep/wake cycle on learning task performance after blast injury remain unclear. We hypothesized that modulation of the sleep phase cycle in our injured mice would improve post-injury task performance. Here, we have demonstrated that excessive sleep electroencephalographic (EEG) patterns are accompanied by prominent motor and cognitive impairment during acute stage after secondary blast injury (SBI) in a mouse model. Over time we observed a transition to more moderate and prolonged sleep/wake cycle disturbances, including changes in theta and alpha power. However, persistent disruptions of the non-rapid eye movement (NREM) spindle amplitude and intra-spindle frequency were associated with lasting motor and cognitive deficits. We, therefore, modulated the sleep phase of injured mice using subcutaneous (SC) dexmedetomidine (Dex), a common, clinically used sedative. Dex acutely improved intra-spindle frequency, theta and alpha power, and motor task execution in chronically injured mice. Moreover, dexmedetomidine ameliorated cognitive deficits a week after injection. Our results suggest that SC Dex might potentially improve impaired motor and cognitive behavior during daily tasks in patients that are chronically impaired by blast-induced injuries.

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The Community Balance and Mobility Scale: Detecting Impairments in Military Service Members With Mild Traumatic Brain Injury

Cited by 10 publications

References 40 publications

Perspectives on Primary Blast Injury of the Brain: Translational Insights Into Non-inertial Low-Intensity Blast Injury

Perspectives on Primary Blast Injury of the Brain: Translational Insights Into Non-inertial Low-Intensity Blast Injury

Gait Performance in People with Symptomatic, Chronic Mild Traumatic Brain Injury

Dexmedetomidine-mediated sleep phase modulation ameliorates motor and cognitive performance in a chronic blast-injured mouse model

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