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Fino PC, Dibble LE, Wilde EA, Fino NF, Johnson P, Cortez MM, Hansen CR, van der Veen SM, Skop KM, Werner JK, Tate DF, Levin HS, Pugh MJV, Walker WC. Sensory Phenotypes for Balance Dysfunction After Mild Traumatic Brain Injury. Neurology 2022; 99:e521-e535. [PMID: 35577572 PMCID: PMC9421603 DOI: 10.1212/wnl.0000000000200602] [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: 08/19/2021] [Accepted: 03/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Recent team-based models of care use symptom subtypes to guide treatments of individuals with chronic effects of mild traumatic brain injury (mTBI). However, these subtypes, or phenotypes, may be too broad, particularly for balance (e.g., vestibular subtype). To gain insight into mTBI-related imbalance, we (1) explored whether a dominant sensory phenotype (e.g., vestibular impaired) exists in the chronic mTBI population, (2) determined the clinical characteristics, symptomatic clusters, functional measures, and injury mechanisms that associate with sensory phenotypes for balance control in this population, and (3) compared the presentations of sensory phenotypes between individuals with and without previous mTBI. METHODS A secondary analysis was conducted on the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium. Sensory ratios were calculated from the sensory organization test, and individuals were categorized into 1 of the 8 possible sensory phenotypes. Demographic, clinical, and injury characteristics were compared across phenotypes. Symptoms, cognition, and physical function were compared across phenotypes, groups, and their interaction. RESULTS Data from 758 Service Members and Veterans with mTBI and 172 individuals with no lifetime history of mTBI were included. Abnormal visual, vestibular, and proprioception ratios were observed in 29%, 36%, and 38% of people with mTBI, respectively, with 32% exhibiting more than 1 abnormal sensory ratio. Within the mTBI group, global outcomes (p < 0.001), self-reported symptom severity (p < 0.027), and nearly all physical and cognitive functioning tests (p < 0.027) differed across sensory phenotypes. Individuals with mTBI generally reported worse symptoms than their non-mTBI counterparts within the same phenotype (p = 0.026), but participants with mTBI in the vestibular-deficient phenotype reported lower symptom burdens than their non-mTBI counterparts (e.g., mean [SD] Dizziness Handicap Inventory = 4.9 [8.1] for mTBI vs 12.8 [12.4] for non-mTBI, group × phenotype interaction p < 0.001). Physical and cognitive functioning did not differ between the groups after accounting for phenotype. DISCUSSION Individuals with mTBI exhibit a variety of chronic balance deficits involving heterogeneous sensory integration problems. While imbalance when relying on vestibular information is common, it is inaccurate to label all mTBI-related balance dysfunction under the vestibular umbrella. Future work should consider specific classification of balance deficits, including specific sensory phenotypes for balance control.
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Affiliation(s)
- Peter C Fino
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA.
| | - Leland E Dibble
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Elisabeth A Wilde
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Nora F Fino
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA.
| | - Paula Johnson
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Melissa M Cortez
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Colby R Hansen
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Susanne M van der Veen
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Karen M Skop
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - J Kent Werner
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - David F Tate
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Harvey S Levin
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Mary Jo V Pugh
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - William C Walker
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
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van der Veen SM, Perera RA, Manning-Franke L, Agyemang AA, Skop K, Sponheim SR, Wilde EA, Stamenkovic A, Thomas JS, Walker WC. Executive function and relation to static balance metrics in chronic mild TBI: A LIMBIC-CENC secondary analysis. Front Neurol 2022; 13:906661. [PMID: 36712459 PMCID: PMC9874327 DOI: 10.3389/fneur.2022.906661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/03/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Among patients with traumatic brain injury (TBI), postural instability often persists chronically with negative consequences such as higher fall risk. One explanation may be reduced executive function (EF) required to effectively process, interpret and combine, sensory information. In other populations, a decline in higher cognitive functions are associated with a decline in walking and balance skills. Considering the link between EF decline and reduction in functional capacity, we investigated whether specific tests of executive function could predict balance function in a cohort of individuals with a history of chronic mild TBI (mTBI) and compared to individuals with a negative history of mTBI. Methods Secondary analysis was performed on the local LIMBIC-CENC cohort (N = 338, 259 mTBI, mean 45 ± STD 10 age). Static balance was assessed with the sensory organization test (SOT). Hierarchical regression was used for each EF test outcome using the following blocks: (1) the number of TBIs sustained, age, and sex; (2) the separate Trail making test (TMT); (3) anti-saccade eye tracking items (error, latency, and accuracy); (4) Oddball distractor stimulus P300 and N200 at PZ and FZ response; and (5) Oddball target stimulus P300 and N200 at PZ and FZ response. Results The full model with all predictors accounted for between 15.2% and 21.5% of the variability in the balance measures. The number of TBI's) showed a negative association with the SOT2 score (p = 0.002). Additionally, longer times to complete TMT part B were shown to be related to a worse SOT1 score (p = 0.038). EEG distractors had the most influence on the SOT3 score (p = 0.019). Lastly, the SOT-composite and SOT5 scores were shown to be associated with longer inhibition latencies and errors (anti-saccade latency and error, p = 0.026 and p = 0.043 respectively). Conclusions These findings show that integration and re-weighting of sensory input when vision is occluded or corrupted is most related to EF. This indicates that combat-exposed Veterans and Service Members have greater problems when they need to differentiate between cues when vision is not a reliable input. In sum, these findings suggest that EF could be important for interpreting sensory information to identify balance challenges in chronic mTBI.
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Affiliation(s)
- Susanne M van der Veen
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States.,Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Robert A Perera
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States
| | - Laura Manning-Franke
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Amma A Agyemang
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Karen Skop
- Department of Physical Medicine and Rehabilitation Services, James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Scott R Sponheim
- Minneapolis VA Health Care System, Veterans Affairs Medical Center, Minneapolis, MN, United States.,Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Elisabeth A Wilde
- Department of Physical Medicine and Rehabilitation, Michael E. DeBakey VA Medical Center, Houston, TX, United States.,Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States.,Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Alexander Stamenkovic
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - James S Thomas
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - William C Walker
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States.,Richmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System, Richmond, VA, United States
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