Sensory Integration Balance Deficits in Complex mTBI: Can Early Initiation of Rehabilitation With Wearable Sensor Technology Improve Outcomes?
Abstract
Objectives and Rationale: Mild traumatic brain injury (mTBI) is common both in civilian and military populations and can be debilitating if symptoms do not resolve after injury. Balance problems are one of the most common complaints after sustaining a mTBI and often prevent people from returning to their previous quality of life. However, we currently lack clear guidelines on when to initiate physical therapy rehabilitation, and it is unclear if early physical therapy is beneficial. We believe that the underlying problem of imbalance results from damage to parts of the brain responsible for interpreting sensory information for balance control. We hypothesize that retraining the brain early, as opposed to months after injury, to correctly interpret sensory information will improve recovery. We also believe this retraining is limited when rehabilitation exercises are performed incorrectly and that performance feedback from wearable sensors can improve balance rehabilitation. The researchers in this project are experts at understanding and treating complex balance problems and have developed novel and portable ways to measure balance using new technology. There are three objectives of this proposal: (1) To determine how the timing of rehabilitation affects outcomes after mTBI. (2) To determine if home monitoring of balance exercises using wearable sensors improves outcomes. (3) To develop a novel feedback system using wearable sensors to provide the physical therapist information, in real-time during training, about quality of head and trunk movements during prescribed exercises. Ultimate Applicability and Impact of the Research: Types of Patients to Benefit: While the focus of this project is on mTBI, people with balance problems stemming from any other cause, will benefit from this project. In the case of mTBI, the timing for the first physical therapy visit is extremely varied, and there is not a clear protocol for clinicians to follow with regard to rehabilitation referrals. It is believed that symptoms will resolve on their own by 2-3 weeks, but in 20%-30% of people, this recovery does not occur. During this time, some strategies may develop that lead to poor compensation for balance control. Our first goal of this project is to determine if early rehabilitation, within the first 2 weeks of their physician visit, will help improve outcomes for people after mTBI. While home exercise programs are an important part of rehabilitation care after mTBI, there is no current way to monitor if patients are performing exercises correctly, or at all, in the home setting. A second goal of this study is to use wearable sensors to provide physical therapists with objective information on compliance and quality of exercise performance at home. A third goal of this project is to develop a portable biofeedback system to provide important information on head movements during training for balance problems. We currently have no way to easily provide this feedback to physical therapists during walking and dynamic balance tasks. Potential Clinical Applications, Benefits and Risks: Patients with mTBI often have poor outcomes with traditional rehabilitation. Our proposed rehabilitation approaches offer new and simple ways to test and improve their control of balance. The technology we propose in this project is portable and is becoming increasingly available and inexpensive. There are few potential risks to this study. These may include making symptoms worse during testing and rehabilitation, emotional anxiety, and a slight fall risk. Initiating early rehabilitation may make symptoms worse, but we will monitor this and will not progress patients until symptoms subside. The potential benefits to subjects include compensation for their participation and rehabilitation for their balance deficit. An indirect benefit is that our study will provide information on what types of balance deficits are common after mTBI, whi
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1710424
Entities
People
- Laurie A King
Organizations
- Oregon Health & Science University
- United States Army