Aging with a Traumatic Brain Injury: Implications for Balance Deficits and Fall Risk

越来越多的研究表明，在成年早期或中期持续的TBI有可能 影响衰老过程的轨迹，无论是在大脑功能还是全身健康的背景下。 认为自己在脑损伤多年后完全康复且无症状的人 实际上可能比没有经历过头部受伤的同龄人表现出更差的功能。TBI文献 揭示了令人信服的证据表明，TBI可以引起神经内分泌的长期异常级联反应， 神经炎性过程，改变大脑网络的结构和功能的完整性。但 几乎没有直接证据来确定“正常”的与年龄相关的神经变性和身体机能的下降 和认知功能会因多年前发生的TBI而恶化。通过了解 我们可以更好地确定潜在的干预措施，以减少负面影响 影响整个生命周期。这是一个重要的调查领域，考虑到有大量的 为经历过TBI的退伍军人提供参与康复干预的机会， 生活方式的改变，可能会保留功能，因为他们过渡到老年。最重要的假设是 这项新的研究是，在成年早期或中期经历过中度TBI的参与者（ 研究入组前至少15年）在平衡和认知测试中的表现较差， 自我报告没有持续的运动或认知障碍的创伤性脑损伤。我们还试图评估 为实践为基础的学习和改善复杂的平衡任务，在这一人口，以获得 为今后开展康复研究提供经验。将比较既往TBI的退伍军人（TBI+组） 无TBI病史的对照组（TBI组）。我们建议招收退伍军人谁是 过渡到老年（即，年龄在50-65岁之间）。本研究将侧重于平衡功能，因为 它与跌倒风险的密切联系。福尔斯和由此产生的伤害是老年退伍军人残疾的主要原因 这给个人和社会带来了巨大的康复需求和成本。的 平衡赤字和福尔斯下降的重要性在未来几年只会增加，因为超过50%的退伍军人 到2050年将达到65岁或以上。此外，平衡的丧失在急性期的恢复中是非常常见的。 TBI，表明神经控制通路/网络受损，可能易受慢性效应影响。作为 次要结局，我们将进行与平衡功能相关的评估（包括认知和 眼功能），并增加因跌倒而受伤的风险（骨矿物质密度）。TBI文献 表明这些次要结果也容易受到TBI的慢性影响。的首要目标 这项研究是为了确定TBI+参与者是否有平衡，认知和视力表现受损 与TBI参与者相比。研究的第二个目的是评估基于实践的 学习需要视觉空间认知参与的平衡任务。除了拟议的小组外， 分析，我们还将在TBI+参与者中进行探索性回归分析， 损伤的严重程度与运动和认知表现的连续测量之间的关系。的 从这项研究中获得的知识和经验将为我们进行更大规模的研究做好准备， 老化与TBI的慢性影响，以及准备我们测试康复干预措施，以促进 健康的老龄化

Accumulating research indicates that a TBI sustained in early or middle adulthood has the potential to influence the trajectory of the aging process, both in the context of brain function and whole-body health. People who consider themselves to be fully recovered and asymptomatic many years following a brain injury might actually exhibit poorer function than peers who did not experience a head injury. The TBI literature reveals compelling evidence that TBI can elicit long-term abnormal cascades of neuroendocrine and neuroinflammatory processes that alter the structural and functional integrity of brain networks. However, there is little direct evidence to establish whether “normal” age-related neurodegeneration and decline of physical and cognitive function are made worse by a TBI that occurred many years earlier. By understanding the chronic effects of “aging with a TBI” we can better identify potential interventions to reduce negative repercussions across the lifespan. This is an important area of investigation, considering there is a substantial window of opportunity for Veterans who have experienced a TBI to engage in rehabilitative interventions and lifestyle modifications that may preserve function as they transition to older age. The overarching hypothesis of this new line of research is that participants who experienced a moderate TBI in early or middle adulthood (at least 15 years prior to study enrollment) will have poorer performance on balance and cognitive tests, despite self-reporting no persistent motor or cognitive impairment from the TBI. We also seek to evaluate the potential for practice-based learning and improvement of complex balance tasks in this population, in order to gain experience for conducting future rehabilitation studies. Veterans with prior TBI (TBI+ group) will be compared to a control group who report no history of TBI (TBI- group). We propose to enroll Veterans who are transitioning into older age (i.e., age between 50-65 years). This study will focus on balance function because of its close association with fall risk. Falls and resultant injuries are a major cause of disability in older Veterans and civilians, which poses a substantial rehabilitation demand and cost to individuals and society. The significance of balance deficits and falls will only grow in the coming years, as more than 50% of all Veterans will be 65 years or older by 2050. Further, loss of balance is very common in the acute stage of recovery from TBI, suggesting damage to neural control pathways/networks that might be susceptible to chronic effects. As secondary outcomes, we will conduct assessments that are related to balance function (including cognitive and oculomotor function) and that increase the risk of injuries due to a fall (bone mineral density). The TBI literature suggests that these secondary outcomes are also susceptible to the chronic effects of a TBI. The first aim of the study is to determine if TBI+ participants have impaired balance, cognition, and oculomotor performance compared to TBI- participants. The second aim of the study is to evaluate the potential for practice-based learning of balance tasks requiring visuospatial cognitive engagement. In addition to the proposed group analyses, we will also conduct exploratory regression analysis within the TBI+ participants to examine potential relationships between the severity of injury and continuous measures of motor and cognitive performance. The knowledge and experience gained from this study will prepare us to conduct larger studies to better understand the chronic effects of aging with a TBI, as well as prepare us to test rehabilitation interventions to promote healthy aging in this population.