Objectively assessing balance deficits after TBI: Role of computerized posturography

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.