title: Assessment and rehabilitation of central sensory impairments for balance in mTBI using auditory biofeedback: a randomized clinical trial.
abstract: BACKGROUND
  Complaints of imbalance are common non-resolving signs in individuals with post-concussive syndrome. Yet, there is no consensus rehabilitation for non-resolving balance complaints following mild traumatic brain injury (mTBI). The heterogeneity of balance deficits and varied rates of recovery suggest varied etiologies and a need for interventions that address the underlying causes of poor balance function. Our central hypothesis is that most chronic balance deficits after mTBI result from impairments in central sensorimotor integration that may be helped by rehabilitation. Two studies are described to 1) characterize balance deficits in people with mTBI who have chronic, non-resolving balance deficits compared to healthy control subjects, and 2) determine the efficacy of an augmented vestibular rehabilitation program using auditory biofeedback to improve central sensorimotor integration, static and dynamic balance, and functional activity in patients with chronic mTBI.
  
  
  METHODS
  Two studies are described. Study 1 is a cross-sectional study to take place jointly at Oregon Health and Science University and the VA Portland Health Care System. The study participants will be individuals with non-resolving complaints of balance following mTBI and age- and gender-matched controls who meet all inclusion criteria. The primary outcome will be measures of central sensorimotor integration derived from a novel central sensorimotor integration test. Study 2 is a randomized controlled intervention to take place at Oregon Health & Science University. In this study, participants from Study 1 with mTBI and abnormal central sensorimotor integration will be randomized into two rehabilitation interventions. The interventions will be 6 weeks of vestibular rehabilitation 1) with or 2) without the use of an auditory biofeedback device. The primary outcome measure is the daily activity of the participants measured using an inertial sensor.
  
  
  CONCLUSIONS
  The results of these two studies will improve our understanding of the nature of balance deficits in people with mTBI by providing quantitative metrics of central sensorimotor integration, balance, and vestibular and ocular motor function. Study 2 will examine the potential for augmented rehabilitation interventions to improve central sensorimotor integration.
  
  
  BACKGROUND
  This trial is registered at clinicaltrials.gov ( NCT02748109 ).
authors.affiliation: Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L226, Portland, OR, 97239-3098, USA.|Veterans Affairs Portland Health Care System, Portland, Oregon, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Fino
authors.affiliation: Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA.|National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, Oregon, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Peterka
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Hullar
authors.affiliation: Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L226, Portland, OR, 97239-3098, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Murchison
authors.affiliation: Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L226, Portland, OR, 97239-3098, USA.|Veterans Affairs Portland Health Care System, Portland, Oregon, USA.
authors.forename: Fay B
authors.initials: FB
authors.lastname: Horak
authors.affiliation: Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Chesnutt
authors.affiliation: Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L226, Portland, OR, 97239-3098, USA. kingla@ohsu.edu.|National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, Oregon, USA. kingla@ohsu.edu.
authors.forename: Laurie A
authors.initials: LA
authors.lastname: King
mesh_terms: D000293:Adolescent; D000328:Adult; D001676:Biofeedback, Psychology / Q000379:methods*; D001924:Brain Concussion / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation*; D016022:Case-Control Studies; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D004856:Postural Balance; D012678:Sensation Disorders / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation*; D055815:Young Adult
keywords: Balance; Biofeedback; Concussion; Gait; Sensorimotor integration; mTBI