Vestibular Test Patterns in the NICoE Intensive Outpatient Program Patient Population

The National Intrepid Center of Excellence (NICoE), on the campus of Walter Reed National Military Medical Center, was developed to help improve the lives of active duty service members (SMs) with traumatic brain injury (TBI) and comorbid behavioral health (BH) conditions. During the NICoE intensive outpatient program, SM who have all been identified as having some degree of TBI, undergo extensive interdisciplinary evaluations, including comprehensive vestibular assessment. These SMs sometimes present with vestibular symptoms ranging from lightheadedness to vertigo associated with the dual TBI/BH diagnoses, and vestibular testing results reported elsewhere have varied among this population. The study's purpose was to collate the vestibular test results obtained from a sample of the NICoE patients to determine if specific tests have a tendency to be abnormal in these SMs. Results indicate that oculomotor tests, particularly pursuit and saccade, were most often abnormal. The vertical subtests of the pursuit and saccade tests were abnormal more frequently than the horizontal subtests, suggesting that the vertical subtests should be utilized when evaluating the TBI population. Overall, oculomotor tests of vertical pursuit and saccades, as well as tests of central vestibular function, appear useful for detecting neurologic changes in active duty SMs with chronic symptoms after TBI.