Assessing Physical Function and Mobility following Pediatric Traumatic Brain Injury with the NIH Toolbox Motor Battery: A Feasibility Study

Emily A. Evansa Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA;b Center for Gerontology and Healthcare Research, Brown University, Rhode Island, USACorrespondence[email protected]
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Nathan E. Cookc Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA;d MassGeneral Hospital for Children™ Sports Concussion Program, Massachusetts General Hospital, Boston, Massachusetts, USA;e Spaulding Rehabilitation Hospital, Boston, Massachusetts, USAView further author information

Grant L. Iversonc Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA;d MassGeneral Hospital for Children™ Sports Concussion Program, Massachusetts General Hospital, Boston, Massachusetts, USA;f Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, Massachusetts, USA;g Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts, USA

https://orcid.org/0000-0001-7348-9570 View further author information

Elise L. Townsendh Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USAView further author information

Ann-Christine Duhaimei Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USAView further author information

& The TRACK-TBI Investigators

Abstract

Aims

Traumatic brain injury (TBI) can impair physical function in children. The NIH Toolbox Motor Battery (NIHTB-M) was designed to be a brief assessment of physical function, but no studies have examined its use in children with TBI. This study aims to describe the feasibility of using the NIHTB-M to assess children with TBI.

Methods

The NIHTB-M was administered to children with TBI 2 weeks (n = 22) and/or 6 months (n = 23) following injury. This descriptive study summarizes participant performance, administration challenges, and the association between NIHTB-M scores, participant characteristics, and subjective report of physical function.

Results

Of the NIHTB-M domains, deficits in endurance and balance were most prevalent. Children aged 5 to 16 years could complete the assessment per administration guidelines, except for a few cases (n = 3) where orthopedic injuries limited participation. Younger children (aged 3 to 4) had difficulty following the NIHTB-M directions. Technological issues impacted balance assessment in several cases (n = 6).

Conclusion

The NIHTB-M is brief to administer, generally well tolerated by school-aged children and, despite occasional technological challenges, is a feasible performance-based battery for assessment of children with TBI for clinical and research purposes. Additional investigation of psychometric properties and ceiling and floor effects is needed.

Keywords:

Acknowledgements

The TRACK-TBI Investigators: Opeolu Adeoye, MD, University of Cincinnati; Neeraj Badjatia, MD, University of Maryland; Kim Boase, University of Washington; Yelena Bodien, PhD, Massachusetts General Hospital; M. Ross Bullock, MD PhD, University of Miami; Randall Chesnut, MD, University of Washington; John D. Corrigan, PhD, ABPP, Ohio State University; Karen Crawford, University of Southern California; Ramon Diaz-Arrastia, MD PhD, University of Pennsylvania; Sureyya Dikmen, PhD, University of Washington; Richard Ellenbogen, MD, University of Washington; V Ramana Feeser, MD, Virginia Commonwealth University; Adam R. Ferguson, PhD, University of California, San Francisco; Brandon Foreman, MD, University of Cincinnati; Raquel Gardner, University of California, San Francisco; Etienne Gaudette, PhD, University of Southern California; Joseph Giacino, PhD, Spaulding Rehabilitation Hospital; Dana Goldman, PhD, University of Southern California; Luis Gonzalez, TIRR Memorial Hermann; Shankar Gopinath, MD, Baylor College of Medicine; Rao Gullapalli, PhD, University of Maryland; J Claude Hemphill, MD, University of California, San Francisco; Gillian Hotz, PhD, University of Miami; Sonia Jain, PhD, University of California, San Diego; Frederick K. Korley, MD, PhD, University of Michigan; Joel Kramer, PsyD, University of California, San Francisco; Natalie Kreitzer, MD, University of Cincinnati; Harvey Levin, MD, Baylor College of Medicine; Chris Lindsell, PhD, Vanderbilt University; Joan Machamer, MA, University of Washington; Christopher Madden, MD, UT Southwestern; Geoffrey T Manley, MD PhD, University of California, San Francisco; Alastair Martin, PhD, University of California, San Francisco; Thomas McAllister, MD, Indiana University; Michael McCrea, PhD, Medical College of Wisconsin; Randall Merchant, PhD, Virginia Commonwealth University; Pratik Mukherjee, MD PhD, University of California, San Francisco; Lindsay Nelson, PhD, Medical College of Wisconsin; Laura B. Ngwenya, MD, PhD, University of Cincinnati, Florence Noel, PhD, Baylor College of Medicine; David Okonkwo, MD PhD, University of Pittsburgh; Eva Palacios, PhD, University of California, San Francisco; Daniel Perl, MD, Uniformed Services University; Ava Puccio, PhD, University of Pittsburgh; Miri Rabinowitz, PhD, University of Pittsburgh; Claudia Robertson, MD, Baylor College of Medicine; Jonathan Rosand, MD, MSc, Massachusetts General Hospital; Angelle Sander, PhD, Baylor College of Medicine; Gabriella Satris, University of California, San Francisco; David Schnyer, PhD, UT Austin; Seth Seabury, PhD, University of Southern California; Sabrina Taylor, PhD, University of California, San Francisco; Nancy Temkin, PhD, University of Washington; Arthur Toga, PhD, University of Southern California; Alex Valadka, MD, Virginia Commonwealth University; Mary Vassar, RN MS, University of California, San Francisco; Paul Vespa, MD, University of California, Los Angeles; Kevin Wang, PhD, University of Florida; John K. Yue, CCRC, PMP, University of California, San Francisco; Esther Yuh, MD PhD, University of California, San Francisco; Ross Zafonte, Harvard Medical School

The authors also thank Research Coordinators, Scott Haire and Carla Fortes-Monteiro and lab members: Beth Costine-Bartell, Eleanor Crawford, George Price, John Shen, Madeline Perlewitz, Natalie Escobar, Jacqueline Andrews, Scott Henderson, Zoe Silsby, Andrew Bourque, and Madeline Karsten for their invaluable contributions.

Disclosure statement

General Disclosure: Grant Iverson has received research support from test publishing companies including Psychological Assessment Resources, Inc. and CNS Vital Signs in the past (not in the past 5 years). He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc., the Mooney-Reed Charitable Foundation, Heinz Family Foundation, and the Spaulding Research Institute. He receives royalties for one neuropsychological test (Wisconsin Card Sorting Test-64 Card Version).

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This project was supported by the National Institutes of Health (NIH), National Institute of Neurological Disorders and Stroke (NINDS), and Department of Health and Human Services, through U01NS086090. NIH had no role in the design, or conduct of the study including collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. Emily Evans receives funding through the Center on Health Services Training and Research (CoHSTAR).