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Postural Stability Assessment in Patients with Mild Traumatic Brain Injury Complaining of Dizziness

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Abstract

We compared subjective and objective measurements of symptoms of dizziness and postural stability in patients with mild traumatic brain injury (mTBI) during the first week following the injury. We recruited 244 patients with mTBI and 105 controls. The Dizziness Handicap Inventory (DHI) and modified Clinical Test of Sensory Integration and Balance were used as the subjective and objective measures of dizziness and ability to perform daily activities, respectively. All four DHI subscores significantly differed among the three mTBI subgroups (low, middle, and high; P = 0.00). The predictor of postural stability and sensory integration in all three DHI subgroups was the eyes closed while standing on a firm surface (ECFIS) condition (P = 0.03). A significant relationship was observed between the emotional (r = 0.14, P = 0.028) and total (r = 0.13, P = 0.048) aspects of the DHI and sensory integration indices (ECFIS). Compared with the healthy controls, balance, postural stability, and sensory integration were considerably impaired in the patients with mTBIs. However, a low correlation was observed between subjective (DHI) and objective balance measurements.

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References

  1. Hyder, A. A., Wunderlich, C. A., Puvanachandra, P., Gururaj, G., & Kobusingye, O. C. (2007). The impact of traumatic brain injuries: A global perspective. NeuroRehabilitation, 22(5), 341–353.

    Google Scholar 

  2. Holm, L., Cassidy, J. D., Carroll, L. J., & Borg, J. (2005). Summary of the WHO Collaborating Centre for Neurotrauma Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine, 37(3), 137–141.

    Article  Google Scholar 

  3. Barsky, A. J., & Borus, J. F. (1999). Functional somatic syndromes. Annals of Internal Medicine, 130(11), 910–921.

    Article  Google Scholar 

  4. Iverson, G. L., & McCracken, L. M. (1997). ‘Postconcussive’ symptoms in persons with chronic pain. Brain Injury, 11(11), 783–790.

    Article  Google Scholar 

  5. Wessely, S., Nimnuan, C., & Sharpe, M. (1999). Functional somatic syndromes: One or many? Lancet, 354(9182), 936–939.

    Article  Google Scholar 

  6. Alexander, M. P. (1995). Mild traumatic brain injury: Pathophysiology, natural history, and clinical management. Neurology, 45(7), 1253–1260.

    Article  Google Scholar 

  7. Swift, T. L., & Wilson, S. L. (2001). Misconceptions about brain injury among the general public and non-expert health professionals: An exploratory study. Brain Injury, 15(2), 149–165.

    Article  Google Scholar 

  8. Kushner D. Mild traumatic brain injury: Toward understanding manifestations and treatment. Arch Intern Med. 1998 Aug 10-24;158(15):1617-24.

  9. Chiu, W. T., Huang, S. J., Tsai, S. H., Lin, J. W., Tsai, M. D., Lin, T. J., et al. (2007). The impact of time, legislation, and geography on the epidemiology of traumatic brain injury. Journal of Clinical Neuroscience, 14(10), 930–935.

    Article  Google Scholar 

  10. Crooks, C. Y., Zumsteg, J. M., & Bell, K. R. (2007). Traumatic brain injury: A review of practice management and recent advances. Physical Medicine and Rehabilitation Clinics of North America, 18(4), 681–710.

    Article  Google Scholar 

  11. Roe, C., Sveen, U., Alvsaker, K., & Bautz-Holter, E. (2009). Post-concussion symptoms after mild traumatic brain injury: Influence of demographic factors and injury severity in a 1-year cohort study. Disability and Rehabilitation, 31(15), 1235–1243.

    Article  Google Scholar 

  12. Ruff, R. (2005). Two decades of advances in understanding of mild traumatic brain injury. The Journal of Head Trauma Rehabilitation, 20(1), 5–18.

    Article  Google Scholar 

  13. Alsalaheen, B. A., Mucha, A., Morris, L. O., Whitney, S. L., Furman, J. M., Camiolo-Reddy, C. E., et al. (2010). Vestibular rehabilitation for dizziness and balance disorders after concussion. Journal of Neurologic Physical Therapy, 34(2), 87–93.

    Article  Google Scholar 

  14. Alsalaheen, B. A., Mucha, A., Morris, L. O., Whitney, S. L., Furman, J. M., Camiolo-Reddy, C. E., et al. (2013). Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther., 34(2), 87–93.

    Article  Google Scholar 

  15. Kaufman, K. R., Brey, R. H., Chou, L. S., Rabatin, A., Brown, A. W., & Basford, J. R. (2006). Comparison of subjective and objective measurements of balance disorders following traumatic brain injury. Medical Engineering & Physics, 28(3), 234–239.

    Article  Google Scholar 

  16. Brewin, C. R. (2005). Systematic review of screening instruments for adults at risk of PTSD. Journal of Traumatic Stress, 18(1), 53–62.

    Article  Google Scholar 

  17. Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345.

    Article  Google Scholar 

  18. Yardley, L., & Redfern, M. S. (2001). Psychological factors influencing recovery from balance disorders. Journal of Anxiety Disorders, 15(1–2), 107–119.

    Article  Google Scholar 

  19. Fong, E., Li, C., Aslakson, R., & Agrawal, Y. (2015). Systematic review of patient-reported outcome measures in clinical vestibular research. Archives of Physical Medicine and Rehabilitation, 96(2), 357–365.

    Article  Google Scholar 

  20. Gottshall, K., Drake, A., Gray, N., McDonald, E., & Hoffer, M. E. (2003). Objective vestibular tests as outcome measures in head injury patients. Laryngoscope, 113(10), 1746–1750.

    Article  Google Scholar 

  21. Lin, L. F., Liou, T. H., Hu, C. J., Ma, H. P., Ou, J. C., Chiang, Y. H., et al. (2015). Balance function and sensory integration after mild traumatic brain injury. Brain Injury, 29(1), 41–46.

    Article  Google Scholar 

  22. Arciniegas, D. B., & Silver, J. M. (2001). Regarding the search for a unified definition of mild traumatic brain injury. Brain Injury, 15(7), 649–652.

    Article  Google Scholar 

  23. Whitney, S. L., Wrisley, D. M., Brown, K. E., & Furman, J. M. (2004). Is perception of handicap related to functional performance in persons with vestibular dysfunction? Otology & Neurotology, 25(2), 139–143.

    Article  Google Scholar 

  24. Jacobson, G. P., & Newman, C. W. (1990). The development of the dizziness handicap inventory. Archives of Otolaryngology - Head and Neck Surgery, 116(4), 424–427.

    Article  Google Scholar 

  25. Arnold, B. L., & Schmitz, R. J. (1998). Examination of balance measures produced by the biodex stability system. Journal of Athletic Training, 33(4), 323–327.

    Google Scholar 

  26. Pape, M. M., Williams, K., Kodosky, P. N., & Dretsch, M. (2015). The community balance and mobility scale: A pilot study detecting impairments in military service members with comorbid mild TBI and psychological health conditions. The Journal of Head Trauma Rehabilitation, 31(5), 339–345.

    Article  Google Scholar 

  27. Loughran, S., Gatehouse, S., Kishore, A., & Swan, I. R. (2006). Does patient-perceived handicap correspond to the modified clinical test for the sensory interaction on balance? Otology & Neurotology, 27(1), 86–91.

    Article  Google Scholar 

  28. Vereeck, L., Truijen, S., Wuyts, F. L., & Van de Heyning, P. H. (2007). The dizziness handicap inventory and its relationship with functional balance performance. Otology & Neurotology, 28(1), 87–93.

    Article  Google Scholar 

  29. Lehmann, J. F., Boswell, S., Price, R., Burleigh, A., deLateur, B. J., Jaffe, K. M., et al. (1990). Quantitative evaluation of sway as an indicator of functional balance in post-traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 71(12), 955–962.

    Google Scholar 

  30. Rubin, A. M., Woolley, S. M., Dailey, V. M., & Goebel, J. A. (1995). Postural stability following mild head or whiplash injuries. The American Journal of Otology, 16(2), 216–221.

    Google Scholar 

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Acknowledgements

We thank the Neural Regenerative Medicine Center of Taipei Medical University Institute of Biomedical Engineering, National Taiwan University of Science and Technology for their assistance during the study.

Funding Disclosure

This study was supported by research grants from Ministry of Health and Welfare Grant (MOHW105-TDU-B-212-133018), Taipei Medical University Grant (TMU102-AE1-B27), Taipei Medical University -National Taiwan University of Science and Technology Joint Research Program (TMU-NTUST-104-03), Shuang Ho Hospital, Taipei Medical University (105-SHH-HCP-06).

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Author notes

  1. Wei-Chun Hsu and Li-Fong Lin have contributed equally to this study.

Authors and Affiliations

  1. Graduate Institute of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei City, 110, Taiwan, ROC

    Kai-Yun Chen & Yung-Hsiao Chiang

  2. Center for Neurotrauma and Neuroregeneration, Taipei Medical University, Taipei City, 110, Taiwan, ROC

    Kai-Yun Chen & Yung-Hsiao Chiang

  3. Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 23561, Taiwan, ROC

    Shih-Wei Huang, Chun-De Liao, Tsan-Hon Liou & Li-Fong Lin

  4. Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 110, Taiwan, ROC

    Shih-Wei Huang, Wen-Hsuan Hou & Tsan-Hon Liou

  5. Department of Physical Medicine and Rehabilitation, Wan Fang Medical Center, Taipei Medical University, Taipei City, 110, Taiwan, ROC

    Yen-Nung Lin

  6. Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei City, 110, Taiwan, ROC

    Yen-Nung Lin, Tsan-Hon Liou, Shin-Han Tsai & Wen-Ta Chiu

  7. School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, 110, Taiwan, ROC

    Chun-De Liao

  8. Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taipei City, 110, Taiwan, ROC

    Wen-Hsuan Hou

  9. Department of Neurosurgery, Taipei Medical University Hospital, Taipei City, 110, Taiwan, ROC

    Yung-Hsiao Chiang

  10. Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, ROC

    Wei-Chun Hsu

  11. School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei City, 110, Taiwan, ROC

    Wen-Hsuan Hou & Li-Fong Lin

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  1. Kai-Yun Chen
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  3. Yen-Nung Lin
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  4. Chun-De Liao
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  8. Shin-Han Tsai
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  9. Wen-Ta Chiu
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  11. Li-Fong Lin
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Correspondence to Li-Fong Lin.

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Chen, KY., Huang, SW., Lin, YN. et al. Postural Stability Assessment in Patients with Mild Traumatic Brain Injury Complaining of Dizziness. J. Med. Biol. Eng. 37, 730–738 (2017). https://doi.org/10.1007/s40846-017-0285-6

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  • DOI: https://doi.org/10.1007/s40846-017-0285-6

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