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The Community Balance and Mobility Scale: Detecting Impairments in Military Service Members With Mild Traumatic Brain
Marcy M Pape1, Paula N Kodosky1, Peter Hoover1
1National Intrepid Center of Excellence, Walter Reed National Military Medical Center, 4860 South Palmer Road, Bethesda MD 20889.
Military Medicine
|October 18, 2019
Summary
The Community Balance and Mobility scale (CB&M) effectively identifies balance deficits in service members with mild traumatic brain injury (mTBI). A new cut score of 81.5 enhances diagnostic accuracy for mTBI-related balance issues.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Military Health
Background:
- Mild traumatic brain injury (mTBI) is prevalent in service members.
- Balance and mobility impairments are common sequelae of mTBI.
- Existing balance assessments may not fully capture mTBI-specific deficits in military populations.
Purpose of the Study:
- To evaluate the utility of the Community Balance and Mobility scale (CB&M) in service members with mTBI.
- To compare CB&M performance against established balance measures.
- To establish a military-specific CB&M cut score for mTBI identification.
Main Methods:
- A cross-sectional study compared active duty service members with (n=45) and without (n=45) mTBI.
- Participants underwent assessments including the CB&M, Activities-Specific Balance Confidence Scale, gait speed, and Functional Gait Assessment.
- Data were collected within an intensive-outpatient, interdisciplinary mTBI program.
Main Results:
- Service members with mTBI performed significantly worse across all balance and mobility measures (P ≤ 0.01).
- The CB&M demonstrated superior sensitivity (78%) and specificity (91%) compared to other measures.
- A CB&M cut score of 81.5 showed the largest effect size and area under the curve (0.92).
Conclusions:
- Objective measures, including the CB&M, effectively differentiate service members with mTBI from controls.
- The proposed CB&M cut score of 81.5 offers good diagnostic utility and minimizes ceiling/floor effects.
- Further validation of the 81.5 CB&M cut score in civilian mTBI populations is recommended.
