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Sensory Phenotypes for Balance Dysfunction After Mild Traumatic Brain Injury
Peter C Fino1, Leland E Dibble2, Elisabeth A Wilde2
1From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA. peter.fino@utah.edu.
Chronic mild traumatic brain injury (mTBI) causes diverse balance issues. Specific sensory phenotypes, not just vestibular deficits, characterize mTBI-related imbalance and guide treatment.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Clinical Neurology
Background:
- Current treatments for chronic mild traumatic brain injury (mTBI) utilize symptom subtypes, but these may be too broad for accurate diagnosis.
- Balance deficits in mTBI patients are complex and may involve multiple sensory systems, not solely vestibular impairments.
- Understanding specific sensory phenotypes is crucial for refining treatment strategies for mTBI-related chronic effects.
Purpose of the Study:
- To investigate the existence of dominant sensory phenotypes in individuals with chronic mTBI.
- To identify clinical characteristics, symptom clusters, functional measures, and injury mechanisms associated with sensory phenotypes for balance control in mTBI.
- To compare sensory phenotype presentations between individuals with and without a history of mTBI.
Main Methods:
- Secondary analysis of the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium dataset.
- Calculation of sensory ratios from the Sensory Organization Test to categorize individuals into one of eight sensory phenotypes.
- Comparison of demographic, clinical, injury characteristics, symptoms, cognition, and physical function across phenotypes and groups.
Main Results:
- Abnormal visual, vestibular, and proprioception ratios were prevalent in the mTBI group, with many exhibiting multiple sensory deficits.
- Significant differences in global outcomes, symptom severity, and physical/cognitive functioning were observed across sensory phenotypes within the mTBI group.
- While mTBI patients generally reported worse symptoms, those in the vestibular-deficient phenotype paradoxically reported lower symptom burdens compared to non-mTBI counterparts.
Conclusions:
- Chronic mTBI leads to varied balance deficits stemming from complex sensory integration problems.
- Classifying mTBI-related balance dysfunction solely under a vestibular umbrella is an oversimplification.
- Future research should focus on precise classification of balance deficits using specific sensory phenotypes for improved clinical management.
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