Objective Dual-Task Turning Measures for Return-to-Duty Assessment After Mild Traumatic Brain Injury: The ReTURN Study Protocol

Abstract

Determining readiness for duty after mild traumatic brain injury (mTBI) is essential for the safety of service members and their unit. Currently, these decisions are primarily based on self-reported symptoms, objective measures that assess a single system, or standardized physical or cognitive tests that may be insensitive or lack ecological validity for warrior tasks. While significant technological advancements have been made in a variety of assessments of these individual systems, assessments of isolated tasks are neither diagnostically accurate nor representative of the demands imposed by daily life and military activities. Emerging evidence suggests that complex tasks, such as dual-task paradigms or turning, have utility in probing functional deficits after mTBI. Objective measures from turning tasks in single- or dual-task conditions, therefore, may be highly valuable for clinical assessments and return-to-duty decisions after mTBI. The goals of this study are to assess the diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation of objective, dual-task turning measures within an mTBI population. These goals will be accomplished over two phases. Phase 1 will enroll civilians at three sites and active-duty service members at one site to examine the diagnostic accuracy and predictive capacity of dual-task turning outcomes. Phase 1 participants will complete a series of turning tasks while wearing inertial sensors and a battery of clinical questionnaires, neurocognitive testing, and standard clinical assessments of function. Phase 2 will enroll active-duty service members referred for rehabilitation from two military medical treatment facilities to investigate the responsiveness to rehabilitation of objective dual-task turning measures. Phase 2 participants will complete two assessments of turning while wearing inertial sensors: a baseline assessment prior to the first rehabilitation session and a post-rehabilitation assessment after the physical therapist determines the participant has completed his/her rehabilitation course. A variable selection procedure will then be implemented to determine the best task and outcome measure for return-to-duty decisions based on diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation. Overall, the results of this study will provide guidance and potential new tools for clinical decisions in individuals with mTBI.Clinical Trial Registration: clinicaltrials.gov, Identifier NCT03892291.

Exploring Vestibular Ocular Motor Screening in Adults With Persistent Complaints After Mild Traumatic Brain Injury

“…We therefore recommend further investigation in elderly populations should clinicians wish to use the VOMS in this age group. The second is that the power and sample sizes were specific to the main study 27. As we found group differences and associations after α correction, we do not believe this to be a significant limitation and feel that the data herein may provide values that can be used for powering future investigations in adults.…”

“…This cross-sectional study was completed across 3 separate sites (Oregon Health & Science University, Portland, Oregon; Courage Kenny Research Center, Minneapolis, Minnesota; and University of Utah, Salt Lake City, Utah) between June 2019 and September 2020. Data were collected as part of a larger study relating to return-to-duty assessments and evaluating functional performance in civilian and military relevant tasks (NCT03892291, W81XWH1820049) 27. Participants completed a single testing session.…”

“…Detailed inclusion and exclusion criteria have been defined in the study protocol 27. Briefly, participants were included if they were 18 to 50 years of age and were free of medical conditions (eg, musculoskeletal disorder, psychological disorder, substance abuse, subjective reporting of significant pain) that may affect balance, with the exception of recent mTBI for the mTBI group.…”

Volitional Head Movement Deficits and Alterations in Gait Speed Following Mild Traumatic Brain Injury

“…Data for this report come from a larger multisite study examining mobility in individuals with persisting symptoms after mTBI. 18 The protocol for this study was approved by local Institutional Review Boards and the US Army Medical Research and Materiel Command, Office of Research Protections, Human Research Protection Office. Prospective study participants were screened for inclusion and exclusion criteria before scheduling their arrival at the clinic for testing.…”

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

“…A convenience sample of 53 individuals with persistent symptoms following mTBI (11 males/42 females; mean age: 32.0 [SD: 9.6] years; 328 [SD: 267] days since injury, symptoms lasting >3 weeks) and 57 healthy control volunteers (16 males/41 females; mean age: 31.1 [SD: 9.5] years) were recruited and tested across 3 separate sites (Oregon Health & Science University, Portland, Oregon; Courage Kenny Research Center, Minneapolis, Minnesota; and The University of Utah, Salt Lake City, Utah) between June 2019 and September 2020 as part of a larger study 19. Participants were recruited from the general population of the hospitals and local communities and through concussion/TBI clinics or medical records of individuals with an mTBI diagnosis.…”