A Hybrid Assessment of Clinical Mobility Test Items for Evaluating Individuals With Mild Traumatic Brain Injury

Abstract

Background and Purpose: The Functional Gait Assessment (FGA) and High Level Mobility Assessment Tool (HiMAT) are clinical batteries used to assess people with mild traumatic brain injury (mTBI). However, neither assessment was specifically developed for people with mTBI; the FGA was developed to evaluate vestibular deficits, and the HiMAT was developed for individuals with more severe TBI. To maximize the sensitivity and reduce the time burden of these assessments, the purpose of this study was to determine the combination of FGA and HiMAT items that best discriminates persons with persistent symptoms from mTBI from healthy controls. Methods: Fifty-three symptomatic civilians with persistent symptoms from mTBI (21% male, aged 31 (9.5) years, 328 [267] days since concussion) and 57 healthy adults (28% male, aged 32 (9.6) years) participated across 3 sites. The FGA and HiMAT were evaluated sequentially as part of a larger study. To determine the best combination of items, a lasso-based generalized linear model (glm) was fit to all data. Results: The area under the curve (AUC) for FGA and HiMAT total scores was 0.68 and 0.66, respectively. Lasso regression selected 4 items, including FGA Gait with Horizontal Head Turns and with Pivot Turn, and HiMAT Fast Forward and Backward Walk, and yielded an AUC (95% confidence interval) of 0.71 (0.61-0.79) using standard scoring. Discussion and Conclusions: The results provide initial evidence supporting a reduced, 4-Item Hybrid Assessment of Mobility for mTBI (HAM-4-mTBI) for monitoring individuals with mTBI. Future work should validate the HAM-4-mTBI and investigate its utility for tracking progression throughout rehabilitation. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A409).

Objective turning measures improve diagnostic accuracy and relate to real-world mobility/combat readiness in chronic mild traumatic brain injury

“…The copyright holder for this preprint this version posted March 13, 2024. ; https://doi.org/10.1101/2024.03.11.24304109 doi: medRxiv preprint use in populations with chronic mTBI (12). These studies suggest assessments of turning may have clinical value in populations with mTBI.…”

“…Clinical outcomes of FGA total score and HiMAT total score were calculated for each respective battery. The four-item HAM-4-mTBI was calculated from the FGA and HiMAT using the individual item scores of Walk with Pivot Turn, Walk with Horizontal Head Turns, Fast Forward Walk, and Fast Backward Walk (12). Additionally, to capture a traditional measure of self-selected walking speed, straight-path gait speed was extracted from the ST and DT 1MW tests using validated and automated Mobility Lab software (APDM, a Clario Company, Portland, OR, USA).…”

“…Other studies have reported abnormal balance control during turning in otherwise asymptomatic athletes recovering from mTBI (28). When selecting an optimized set of clinical items from the FGA and HiMAT, the Gait with Pivot Turn test item from the FGA was one of only four test items retained for use in populations with chronic mTBI (12). These studies suggest assessments of turning may have clinical value in populations with mTBI.…”

“…While extensive literature on dual-task (DT) gait, where mobility tasks are combined with a simultaneous cognitive task to mirror everyday life, demonstrates diagnostic utility in people with mTBI (3)(4)(5)(6)(7)(8), these tasks are often limited to straight-line walking and artificial, laboratory-based cognitive tasks such as serial 3 subtraction. Other multi-faceted clinical assessment batteries such as the Functional Gait Assessment (FGA) (9), High-level Mobility Assessment Tool (HiMAT) (10,11), 4-Item Hybrid Assessment of Mobility for mTBI (HAM-4-mTBI) (12), and mini Balance Evaluation Systems Test (mini-BESTest) (13) include a variety of mobility tasks, such as walking with horizontal head turns, running, bounding, and reactive stepping with varying motor demands. The majority of individual test items within these general measures of mobility similarly focus on straight-line walking.…”