Lucy Parrington1, Deborah A Jehu2, Peter C Fino3, Samuel Stuart4, Jennifer Wilhelm5, Natalie Pettigrew5, Charles F Murchison6, Mahmoud El-Gohary7, Jess VanDerwalker8, Sean Pearson8, Timothy Hullar9, James C Chesnutt10, Robert J Peterka11, Fay B Horak12, Laurie A King13. 1. Department of Neurology, Oregon Health & Science University, Portland, Oregon; and Veterans Affairs Portland Health Care System, Portland, Oregon. 2. Department of Neurology, Oregon Health & Science University; Djavad Mowafaghian Centre for Brain Health, Centre for Hip Health and Mobility, and Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada. 3. Department of Neurology, Oregon Health & Science University; Veterans Affairs Portland Health Care System; and Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah. 4. Department of Neurology, Oregon Health & Science University; and Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom. 5. Department of Neurology, Oregon Health & Science University. 6. Department of Neurology, Oregon Health & Science University; and Department of Biostatistics at the University of Alabama, Birmingham, Alabama. 7. ADPM Inc, Portland, Oregon. 8. ADPM Inc. 9. Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University. 10. Departments of Family Medicine, Neurology, and Orthopedics & Rehabilitation, Oregon Health & Science University. 11. National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System. 12. Department of Neurology, Oregon Health & Science University; Veterans Affairs Portland Health Care System; and APDM Inc. 13. Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (USA); Veterans Affairs Portland Health Care System; and National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System.
Abstract
BACKGROUND: Clinical practice for rehabilitation after mild traumatic brain injury (mTBI) is variable, and guidance on when to initiate physical therapy is lacking. Wearable sensor technology may aid clinical assessment, performance monitoring, and exercise adherence, potentially improving rehabilitation outcomes during unsupervised home exercise programs. OBJECTIVE: The objectives of this study were to: (1) determine whether initiating rehabilitation earlier than typical will improve outcomes after mTBI, and (2) examine whether using wearable sensors during a home-exercise program will improve outcomes in participants with mTBI. DESIGN: This was a randomized controlled trial. SETTING: This study will take place within an academic hospital setting at Oregon Health & Science University and Veterans Affairs Portland Health Care System, and in the home environment. PARTICIPANTS: This study will include 160 individuals with mTBI. INTERVENTION: The early intervention group (n = 80) will receive one-on-one physical therapy 8 times over 6 weeks and complete daily home exercises. The standard care group (n = 80) will complete the same intervention after a 6- to 8-week wait period. One-half of each group will receive wearable sensors for therapist monitoring of patient adherence and quality of movements during their home exercise program. MEASUREMENTS: The primary outcome measure will be the Dizziness Handicap Inventory score. Secondary outcome measures will include symptomatology, static and dynamic postural control, central sensorimotor integration posturography, and vestibular-ocular-motor function. LIMITATIONS: Potential limitations include variable onset of care, a wide range of ages, possible low adherence and/or withdrawal from the study in the standard of care group, and low Dizziness Handicap Inventory scores effecting ceiling for change after rehabilitation. CONCLUSIONS: If initiating rehabilitation earlier improves primary and secondary outcomes post-mTBI, this could help shape current clinical care guidelines for rehabilitation. Additionally, using wearable sensors to monitor performance and adherence may improve home exercise outcomes.
RCT Entities:
BACKGROUND: Clinical practice for rehabilitation after mild traumatic brain injury (mTBI) is variable, and guidance on when to initiate physical therapy is lacking. Wearable sensor technology may aid clinical assessment, performance monitoring, and exercise adherence, potentially improving rehabilitation outcomes during unsupervised home exercise programs. OBJECTIVE: The objectives of this study were to: (1) determine whether initiating rehabilitation earlier than typical will improve outcomes after mTBI, and (2) examine whether using wearable sensors during a home-exercise program will improve outcomes in participants with mTBI. DESIGN: This was a randomized controlled trial. SETTING: This study will take place within an academic hospital setting at Oregon Health & Science University and Veterans Affairs Portland Health Care System, and in the home environment. PARTICIPANTS: This study will include 160 individuals with mTBI. INTERVENTION: The early intervention group (n = 80) will receive one-on-one physical therapy 8 times over 6 weeks and complete daily home exercises. The standard care group (n = 80) will complete the same intervention after a 6- to 8-week wait period. One-half of each group will receive wearable sensors for therapist monitoring of patient adherence and quality of movements during their home exercise program. MEASUREMENTS: The primary outcome measure will be the Dizziness Handicap Inventory score. Secondary outcome measures will include symptomatology, static and dynamic postural control, central sensorimotor integration posturography, and vestibular-ocular-motor function. LIMITATIONS: Potential limitations include variable onset of care, a wide range of ages, possible low adherence and/or withdrawal from the study in the standard of care group, and low Dizziness Handicap Inventory scores effecting ceiling for change after rehabilitation. CONCLUSIONS: If initiating rehabilitation earlier improves primary and secondary outcomes post-mTBI, this could help shape current clinical care guidelines for rehabilitation. Additionally, using wearable sensors to monitor performance and adherence may improve home exercise outcomes.
Authors: Lisa R Treviño; Peter Roberge; Michael E Auer; Angela Morales; Annelyn Torres-Reveron Journal: Front Neurorobot Date: 2021-06-10 Impact factor: 2.650