Balance impairment in patients with moderate-to-severe traumatic brain injury: Which measures are appropriate for assessment?

Abstract

Left untreated, balance impairment following moderate-to-severe traumatic brain injury (TBI) can be highly debilitating and hinder activities of daily life. To detect impairments, clinicians need appropriate assessment tools. The objective of this study was to evaluate the feasibility and utility of a battery of clinical balance assessments in adults with moderate-to-severe TBI within 6-months of injury. Thirty-seven adults with TBI [Glasgow Coma Scale score ≤ 12 (33 M/4 F) age 18-50 years] participated in balance testing. Assessments included the Balance Error Scoring System (BESS), National Institutes of Health Standing Balance Test (NIH-SBT), Functional Gait Assessment (FGA), Advanced Functional Gait Assessment (FGA-A), Tandem Gait Test (TGT), Berg Balance Scale (BBS), and Walking While Talking Test (WWTT). We identified pronounced ceiling effects on the BBS and FGA, two widely used clinical balance assessments. The NIH-SBT, WWTT, and FGA used in conjunction with the FGA-A, offered versatility in their capacity to assess patients across the balance severity spectrum. This study provides evidence to support a stepwise approach to balance assessment that can be adapted to the broad range of balance ability found in moderate-to-severe TBI.

Keywords: balance; dual-task; gait; postural stability; traumatic brain injury.

Figure 1

Histograms presenting score distributions of all balance measures included in the SiMPly Rehab testing battery. One extreme outlier (> 3*IQR from Q1 or Q3) was excluded on the NIH-SBT_ratio1 and TGT. Two extreme outliers were excluded on the WWTT-simple and WWTT-complex. NC: Assessment not completed; Q1: first quartile; Q3: third quartile.