A hybrid assessment of clinical mobility test items for evaluating individuals with mild traumatic brain injury

Background and Purpose: The Functional Gait Assessment (FGA) and High Level Mobility Assessment Tool (HiMAT) are clinical batteries used to assess people with mild traumatic brain injury (mTBI). However, neither assessment was specifically developed for people with mTBI; the FGA was developed to evaluate vestibular deficits, and the HiMAT was developed for individuals with more severe TBI. To maximize the sensitivity and reduce the time burden of these assessments, the purpose of this study was to determine the combination of FGA and HiMAT items that best discriminates persons with persistent symptoms from mTBI from healthy controls. Methods: Fifty-three symptomatic civilians with persistent symptoms from mTBI (21% male, age 31(9.5) years, 328 (267) days since concussion and 57 healthy adults (28% male, age 32(9.6) years) participated across three sites. The FGA and HiMAT were evaluated sequentially as part of a larger study. To determine the best combination of items, a lasso-based generalized linear model (glm) was fit to all data. Results: The area under the curve (AUC) for FGA and HiMAT total scores were 0.68 and 0.66, respectively. Lasso regression selected four items including FGA Gait with Horizontal Head Turns and with Pivot Turn, and HiMAT Fast Forward and Backward Walk, and yielded an AUC (95% CI) of 0.71 (0.61, 0.79) using standard scoring. Discussion and Conclusions: The results provide initial evidence supporting a reduced, hybrid assessment of mobility (HAM-4-mTBI) for monitoring individuals with mTBI. Future work should validate the HAM-4-mTBI and investigate its utility for tracking progression throughout rehabilitation

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

Objective: The purpose of this study was to (1) explore differences in vestibular ocular motor screening (VOMS) symptoms between healthy adults and adults with persistent symptoms after mild traumatic brain injury (mTBI), and (2) explore the relationships between VOMS symptoms and other measures (self-reported vestibular symptoms, clinical measures of balance and gait, and higher-level motor ability tasks). Setting: Research laboratory setting. Participants: Fifty-three persons with persistent symptoms (\u3e3 weeks) following mTBI and 57 healthy controls were recruited. Eligibility for participation included being 18 to 50 years of age and free of medical conditions that may affect balance, with the exception of recent mTBI for the mTBI group. Design: Cross-sectional. Main Measures: The primary outcomes were the VOMS symptom scores and near point of convergence (NPC) distance. Secondary outcomes included the Dizziness Handicap Inventory (DHI) total and subdomain scores, sway area, Functional Gait Analysis total score, gait speed, and modified Illinois Agility Task completion time, and Revised High-Level Mobility Assessment Tool total score. Results: The mTBI group reported more VOMS symptoms (z range, −7.28 to −7.89) and a further NPC (t = −4.16) than healthy controls (all Ps \u3c .001). DHI self-reported symptoms (total and all subdomain scores) were strongly associated with the VOMS symptom scores (rho range, 0.53-0.68; all Ps \u3c .001). No significant relationships existed between VOMS symptoms and other measures. Conclusion: Significant group differences support the relevance of the VOMS for mTBI in an age-diverse sample with persistent symptoms. Furthermore, strong association with DHI symptoms supports the ability of the VOMS to capture vestibular complaints in this population. ClinicalTrials.gov Identifier: NCT0389229

Quantifying Turning Tasks With Wearable Sensors: A Reliability Assessment

Objective The aim of this study was to establish the test–retest reliability of metrics obtained from wearable inertial sensors that reflect turning performance during tasks designed to imitate various turns in daily activity. Methods Seventy-one adults who were healthy completed 3 turning tasks: a 1-minute walk along a 6-m walkway, a modified Illinois Agility Test (mIAT), and a complex turning course (CTC). Peak axial turning and rotational velocity (yaw angular velocity) were extracted from wearable inertial sensors on the head, trunk, and lumbar spine. ICCs were established to assess the test–retest reliability of average peak turning speed for each task. Lap time was collected for reliability analysis as well. Results Turning speed across all tasks demonstrated good to excellent reliability, with the highest reliability noted for the CTC (45-degree turns: ICC = 0.73–0.81; 90-degree turns: ICC = 0.71–0.83; and 135-degree turns: ICC = 0.72–0.80). The reliability of turning speed during 180-degree turns from the 1-minute walk was consistent across all body segments (ICC = 0.74–0.76). mIAT reliability ranged from fair to excellent (end turns: ICC = 0.52–0.72; mid turns: ICC = 0.50–0.56; and slalom turns: ICC = 0.66–0.84). The CTC average lap time demonstrated good test–retest reliability (ICC = 0.69), and the mIAT average lap time test–retest reliability was excellent (ICC = 0.91). Conclusions Turning speed measured by inertial sensors is a reliable outcome across a variety of ecologically valid turning tasks that can be easily tested in a clinical environment

Delaying Mobility Disability in People With Parkinson Disease Using a Sensorimotor Agility Exercise Program

This article introduces a new framework for therapists to develop an exercise program to delay mobility disability in people with Parkinson disease (PD). Mobility, or the ability to efficiently navigate and function in a variety of environments, requires balance, agility, and flexibility, all of which are affected by PD. This article summarizes recent research identifying how constraints on mobility specific to PD, such as rigidity, bradykinesia, freezing, poor sensory integration, inflexible program selection, and impaired cognitive processing, limit mobility in people with PD. Based on these constraints, a conceptual framework for exercises to maintain and improve mobility is presented. An example of a constraint-focused agility exercise program, incorporating movement principles from tai chi, kayaking, boxing, lunges, agility training, and Pilates exercises, is presented. This new constraint-focused agility exercise program is based on a strong scientific framework and includes progressive levels of sensorimotor, resistance, and coordination challenges that can be customized for each patient while maintaining fidelity. Principles for improving mobility presented here can be incorporated into an ongoing or long-term exercise program for people with PD