Objectively assessing balance deficits after TBI: Role of computerized posturography

Abstract

Abstract-Balance impairment, or postural instability, is a common source of residual physical disability after severe traumatic brain injury (TBI). Standardized functional measures such as the Functional Independence Measure (FIM) do not specifically assess balance. Furthermore, no agreement exists as to the optimal way to objectively measure balance problems in the TBI population. Technological advances have led to force-plate balance measurement known as computerized posturography testing (CPT). Published CPT data for severe TBI are lacking, and the feasibility of using CPT during rehabilitation has not been described. This study described CPT findings in 21 ambulatory patients with severe TBI who were undergoing inpatient rehabilitation at a Defense and Veterans Brain Injury Center. Results demonstrated the utility of CPT in detecting and quantifying postural instability. Comparisons with the normative database indicate that the sample had a high degree of balance impairment despite some participants having reached the ceiling of the FIM ambulation scale at discharge from the acute rehabilitation setting. The quantitative CPT measures are a promising way to characterize postural instability in severe TBI populations.

Progression of posturographic findings after acquired brain injury

“…In this sense, the high number of posturographic studies reported here provides an overview of how ABI patients manage to achieve postural stability after their first attempt to stand unassisted. Our data confirm the deficit of these patients in managing vestibular afferents and the clear dominance of the visual afferents across the process of regaining postural balance [12][13][14]37]. This also suggests that, regardless of the intensity of balance impairment, in these patients there is a common mechanism of sensory processing.…”

“…The emergence of more technologically advanced systems has corroborated these data and has also demonstrated the patients' overreliance on visual compensatory strategies to maintain their balance [12][13][14]. Additionally, according to these studies, when standing quiet on a posturographic platform, persons with ABI tend to sway more in the sagittal and lateral directions and are slower in weight-shifting than controls.…”

Minimizing the effect of TBI-related physical sequelae on vocational return

“…CPT also provides data about the pattern of postural instability, which may be useful in guiding rehabilitation interventions [73]. More traditional quantitative balance tests include variations of the Romberg test [74], the test of sway [75], and the Berg Balance Scale [76].…”

Characterizing effects of mild traumatic brain injury and posttraumatic stress disorder on balance impairments in blast-exposed servicemembers and Veterans using computerized posturography

“…In moderate-tosevere TBI, objective impairment of early balance function is ubiquitous, can be measured on routine physical examination, and is predictive of rehabilitation outcome [12][13]. Objective balance impairments persisting months to years after moderate-to-severe TBI have also been documented on computerized posturography testing (CPT), a method of quantifying balance through body weight shifts on a force plate under normal and altered sensory conditions [14]. The Sensory Organization Test (SOT) is a component of CPT that measures information about the integration of the sensory components of standing balance (visual, proprioceptive, and vestibular) and generates an outcome measure called the equilibrium score that assesses the overall coordination of these systems to maintain standing posture [9].…”