Wearable Technology to Characterize and Treat mTBI Subtypes: Biofeedback-Based Precision Rehabilitation
Abstract
Objective and Rationale: Mild traumatic brain injury (mTBI) is common and can cause long-term problems. Balance problems are one of the most common problems and can prevent people from returning to their previous quality of life. People with mTBI can have many symptoms that present differently (i.e., ‘subtypes’), making it difficult to evaluate and treat. Subtypes include cognitive, ocular-motor (vision problems), headache, vestibular (balance and dizziness) and mood. Correct detection of subtype is important for patients to get the best and most specific (to their subtype) care, as quickly as possible. Our group has expertise in the subtypes that most commonly affect balance and gait (vestibular and ocular-motor) and we plan to use wearable sensors and objective measures to improve detection and treatment of the problems that commonly occur in these subtypes. Our group has developed wearable sensors that can measure how people move overall and can provide immediate feedback on how multiple body segments move during rehabilitation. These sensors can give feedback on head and body movement and speed but also measure how stable balance and walking are during an exercise. We believe real-time feedback during exercises will improve the quality of physical therapy, specifically for those patients with vestibular and ocular-motor subtypes. We also want to see whether people with vestibular and ocular-motor subtypes move differently in the real world. We will do this by measuring daily life mobility over 7 days using wearable sensors. Objectives: To determine whether (1) real-time biofeedback using wearable sensors improves outcomes after mTBI, (2) certain subtypes of mTBI respond better to physical therapy, and (3) measuring daily life mobility can identify subtypes who will benefit from physical therapy. Focus Area: Our primary focus area under FY22 TBIPHRP CTA for mTBI is treatment. We will test a new treatment approach using wearable sensors for feedback during physical therapy that focuses on sensory and motor dysfunction after mTBI. It also aligns with the goal of personalizing medicine since we believe better measures of mTBI subtype will lead to better and more targeted interventions. We will also focus on objective measures of how people move (quality of movement) in daily life to better measure recovery after mTBI to ultimately facilitate safe return to work/duty. In a small study, we found that while people with vestibular and ocular-motor subtypes had the same daily life quantity of movement (i.e., number of steps per day), they had abnormal quality (i.e., impaired turning during daily life), compared to people with other subtypes, like mood or cognitive. This finding has important implications for return to work/duty. Our Team and Approach: We are a multidisciplinary team and believe the challenge of assessing and treating people with mTBI requires a multi-pronged approach. Specifically, our team includes neuroscientists, concussion physicians, physical therapists, biomedical engineers, and a community-based collaborative approach that includes a person with lived experience to guide decision-making. Problem/Question to Be Addressed and Ultimate Applicability and Impact of the Research: Current clinical assessment tools are not sensitive enough to detect and treat some subtle (yet troubling) problems after mTBI. The wearable sensors we will test measure and provide immediate feedback on movement quality during physical therapy. This immediate feedback on performance will improve outcomes. Currently, there are no other systems able to easily measure multiple body segments, simultaneously with balance and walking. Such complex movements are needed for safe return to high level activity and military duty. Another goal is to study how daily movement changes after mTBI. This will inform whether people with vision/dizziness/balance subtypes are more limited in daily life than people wit
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310845
Entities
People
- Laurie A King
Organizations
- Oregon Health & Science University
- United States Army