William C Walker1,2, Kayla J Nowak3, Kimbra Kenney4, Laura Manning Franke1, Blessen C Eapen5, Karen Skop6, Harvey Levin7,8, Amma A Agyemang1, David F Tate9, Elisabeth A Wilde7,8,10, Sidney Hinds11, Tracy L Nolen3. 1. a Dept. Physical Medicine & Rehabilitation , Virginia Commonwealth University , Richmond , VA , USA. 2. b Dept. Physical Medicine & Rehabilitation , Hunter Holmes McGuire VA Medical Center , Richmond , VA , USA. 3. c Clinical Research Network Center , RTI International, RTP , NC , USA. 4. d Dept. of Neurology , Uniformed Services University of the Health Sciences , Bethesda , MD , USA. 5. e South Texas Veterans Health Care System , San Antonio , TX , USA. 6. f Dept. of Physical Medicine & Rehabilitation Services , James A. Haley Veterans' Hospital , Tampa , FL , USA. 7. g Dept. of Physical Medicine & Rehabilitation , Michael E. DeBakey VA Medical Center , Houston , TX , USA. 8. h Baylor College of Medicine , Houston , TX , USA. 9. i Missouri Institute of Mental Health , University of Missouri- Saint Louis , St. Louis , MO , USA. 10. j University of Utah , Salt Lake City , UT , USA. 11. k US Army Medical Research and Materiel Command , Fort Detrick , MD , USA.
Abstract
OBJECTIVES: Determine if mild traumatic brain injury (mTBI) history is associated with balance disturbances. SETTING: Chronic Effects of Neurotrauma Consortium (CENC) centres. PARTICIPANTS: The CENC multi-centre study enrols post-9/11 era Service Members and Veterans with combat exposure. This sample (n = 322) consisted of enrolees completing initial evaluation by September 2016 at the three sites conducting computerized dynamic post-urography (CDP) testing. DESIGN: Observational study with cross-sectional analyses using structural equation modelling. MAIN MEASURES: Comprehensive structured interviews were used to diagnose all lifetime mild traumatic brain injuries (mTBIs). The outcome, Sensory Organization Test (SOT), was measured on CDP dual-plate force platform. Other studied variables were measured by structured interviews, record review and questionnaires. RESULTS: The overall positive/negative mTBI classification did not have a significant effect on the composite equilibrium score. However, the repetitive mTBI classification showed lower scores for participants with ≥ 3 mTBI versus 1-2 lifetime mTBIs. For repetitive mTBI, pain interference acted as a mediator for the indirect effect, and a direct effect was evident on some sensory condition equilibrium scores. CONCLUSION: These findings show that repeated mTBI, partially mediated by pain, may lead to later balance disturbances among military combatants. Further study of CDP outcomes within this accruing cohort is warranted.
OBJECTIVES: Determine if mild traumatic brain injury (mTBI) history is associated with balance disturbances. SETTING: Chronic Effects of Neurotrauma Consortium (CENC) centres. PARTICIPANTS: The CENC multi-centre study enrols post-9/11 era Service Members and Veterans with combat exposure. This sample (n = 322) consisted of enrolees completing initial evaluation by September 2016 at the three sites conducting computerized dynamic post-urography (CDP) testing. DESIGN: Observational study with cross-sectional analyses using structural equation modelling. MAIN MEASURES: Comprehensive structured interviews were used to diagnose all lifetime mild traumatic brain injuries (mTBIs). The outcome, Sensory Organization Test (SOT), was measured on CDP dual-plate force platform. Other studied variables were measured by structured interviews, record review and questionnaires. RESULTS: The overall positive/negative mTBI classification did not have a significant effect on the composite equilibrium score. However, the repetitive mTBI classification showed lower scores for participants with ≥ 3 mTBI versus 1-2 lifetime mTBIs. For repetitive mTBI, pain interference acted as a mediator for the indirect effect, and a direct effect was evident on some sensory condition equilibrium scores. CONCLUSION: These findings show that repeated mTBI, partially mediated by pain, may lead to later balance disturbances among military combatants. Further study of CDP outcomes within this accruing cohort is warranted.
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