Characterization of Balance Control After Moderate to Severe Traumatic Brain Injury: A Longitudinal Recovery Study
Characterization of Balance Control After Moderate to Severe Traumatic Brain Injury: A Longitudinal Recovery Study
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DOI：
10.1093/ptj/pzy065
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发表时间：
2018-09-01
期刊：
影响因子：
3.2
通讯作者：
Mochizuki, George
中科院分区：
文献类型：
--
作者：
Perez, Olinda Habib;Green, Robin E.;Mochizuki, George
背景。创伤性脑损伤（TBI）后的平衡障碍是常见的，并且在损伤后持续存在。在恢复过程中，平衡姿势不对称已被报道，但未被量化。本研究的目的是描述中度至重度TBI后的平衡恢复，重点是姿势不对称。本研究对前瞻性收集的资料进行了二次分析。数据来自45名中度至重度TBI患者。在受伤后大约2个月、5个月和12个月，用力板评估参与者两足和单足站立的平衡情况。收集年龄匹配且作为健康对照的参与者的单次就诊数据，使用95%置信区间进行视觉比较。从正位（AP）和中外侧（ML）方向的力板计算空间和时间的压力中心（COP）测量。尽管损伤后2至5个月净ML COP姿势摇摆有所改善，但AP姿势摇摆在恢复过程中没有变化。在所有时间点上，脑外伤患者的姿势摇摆在两个方向上都高于正常值。在康复过程中，肢间同步在任何方向上都没有改变。TBI负重不对称性在所有时间点都低于正常值，并且在恢复过程中没有变化。单脚站立的特点在四肢之间是不同的。由于纳入和排除标准，样本量减少；未来的研究将受益于更大的样本量。ML - COP的姿势摇摆、肢间同步和负重对称性没有恢复，表明ML控制的减少可能导致TBI后的平衡障碍。这些损伤可能扩展到动态平衡任务，也可能使TBI患者摔倒的风险更高。
Background. Balance impairments after traumatic brain injury (TBI) are common and persist after injury. Postural asymmetries in balance have been reported, but not quantified, across recovery.Objective. The objective of this study was to characterize balance recovery after moderate to severe TBI, with a focus on postural asymmetry.Design. A secondary analysis of prospectively collected data was used in this study.Methods. Data were from 45 participants with moderate to severe TBI. Participants' balance in 2 bipedal stances and 2 unipedal stances was assessed with force plates at approximately 2, 5, and 12 months after injury. Single-visit data from participants who were matched for age and served as healthy controls were collected for visual comparison using 95% confidence intervals. Spatial and temporal center-of-pressure (COP) measures were calculated from force plates in the anteroposterior (AP) and mediolateral (ML) directions.Results. Despite improvements in net ML COP postural sway from 2 to 5 months after injury, there were no changes in AP postural sway across recovery. Postural sway in individuals with TBI was higher than normative values at all time points in both directions. Interlimb synchrony did not change across recovery in either direction. TBI weight-bearing asymmetry was lower than normative values at all time points and did not change across recovery. The characteristics of unipedal stance differed between limbs.Limitations. Sample size was reduced as a result of the inclusion and exclusion criteria; future studies will benefit from a larger sample size.Conclusions. The absence of recovery in ML COP postural sway, interlimb synchrony, and weight-bearing symmetry indicated that reduced ML control may contribute to balance impairments after TBI. These impairments may extend to dynamic balance tasks and may also place individuals with TBI at a higher risk for falls.