Relating Self‐Reported Balance Problems to Sensory Organization and Dual‐Tasking in Chronic Traumatic Brain Injury

Abstract

Background Individuals who have experienced a traumatic brain injury (TBI) often have residual balance problems. It remains unclear whether these balance problems are driven by vestibular dysfunction or gait automaticity deficits, particularly in the chronic stages of TBI recovery, because most studies include only acute/subacute cases. Objectives Compare performance on the Sensory Organization Test vestibular score and Dual‐Task test in individuals with and without subjective balance problems at least 1 year after a TBI. Investigate the ability of each test to predict perceived balance problems. Design Prospective cohort study. Setting Rehabilitation department within a single institution. Participants Fifty adults (21‐71 years) with a history of mild, moderate, or severe TBI 1 to 5 years following nonpenetrating TBI. Interventions N/A. Methods Measures included the Dual‐Task test, Sensory Organization Test, Neurobehavioral Symptom Inventory, Dizziness Handicap Inventory, and assessments of four cognitive domains and depression. Participants who endorsed “feeling dizzy” and “loss of balance” on the Neurobehavioral Symptom Inventory were classified as symptomatic (n = 26) and others as asymptomatic (n = 24). T‐tests, chi‐square, and regression analyses predicting the Dizziness Handicap Inventory total score were performed. Results Dual‐task gait cost was negatively associated with the Dizziness Handicap Inventory (P = .044), controlling for depression and gender, whereas vestibular scores failed to predict balance‐related disability. Symptomatic individuals endorsed more balance problems (P < .001) and depression symptoms (P = .007), had poorer dual‐task cognitive output (P = .036), and slower dual‐task gait velocity (P = .036) than asymptomatic participants. Groups did not differ on Sensory Organization Test scores. Conclusions The nature of balance problems in chronic TBI may be related to automaticity of gait. These findings suggest that patients in the chronic stages of TBI may benefit from dual‐task assessments and interventions. Balance rehabilitation should be tailored to patient needs and assess cognition and affect.

Understanding and Managing Trauma-Induced Vestibular Deficits

“…25 Although gait ataxia has been well related to vestibular dysfunction in patients with moderate-to-severe TBI, the nature of balance problems in chronic mild TBI may be related to impairment of the "automatic gait" pathways. 26 It has been shown in chronic mild TBI patients who voiced complaints of "feeling dizzy" and "loss of balance" on the NSI that dual-task gait cost was negatively associated with the Dizziness Handicap Inventory, whereas the Sensory Organization Test vestibular score failed to predict balance-related disability. 26 Vestibular Trauma and Electroencephalography Concussion can of course affect the brain but, as discussed previously, can also impact the ear; this can be mediated through pressure in the vestibular aqueduct affecting the membranous labyrinth.…”

“…26 It has been shown in chronic mild TBI patients who voiced complaints of "feeling dizzy" and "loss of balance" on the NSI that dual-task gait cost was negatively associated with the Dizziness Handicap Inventory, whereas the Sensory Organization Test vestibular score failed to predict balance-related disability. 26 Vestibular Trauma and Electroencephalography Concussion can of course affect the brain but, as discussed previously, can also impact the ear; this can be mediated through pressure in the vestibular aqueduct affecting the membranous labyrinth. Although it is rare to have purely vestibular symptoms, patients' complaints can range from mild disequilibrium to rotational vertigo in any plane.…”