Is balance performance reduced after mild traumatic brain injury?: Interim analysis from chronic effects of neurotrauma consortium (CENC) multi-centre study

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.

KEYWORDS:

• Traumatic brain injury
• concussion
• balance
• pain
• veteran
• military

Supplemental data

Supplemental data for this article can be accessed here

Acknowledgments

The CENC Observational Study Site PIs or co-PIs also include: Heather Belanger PhD (Tampa), Carlos Jaramillo MD (SanAntonio), Ajit Pai MD (Richmond), Heechin Chae MD (Fort Belvoir), Randall Scheibel PhD (Houston), Terri Pogoda PhD (Boston), Scott Sponheim PhD (Minneapolis) and Kathleen Carlson PhD (Portland). The authors also acknowledge the efforts of the entire CENC Observational Study Leadership Working Group and Core Team members who besides the authors also include: Justin Alicea, Jessica Berumen, Cody Blankenship, Jennifer Boyce, Linda Brunson, Katrina Burson, Julia Christensen, Margaret Clarke, Doreen Collins, Sureyya Dikmen, Esra Doud, Connie Duncan, Stephanie Edmunds, Robyn Endsley, Elizabeth Fogleman, Katelyn Gormley, Brenda Hair, Jim Henry, Nancy Hsu, Cheryl Ford-Smith, George Gitchel, Caitlin Jones, Sunchai Khemalaap, Valerie Larson, Tiffany Lewis, Scott McDonald, Tamara McKenzie-Hartman, Frank Mierzwa, Alison Molitor, Joe Montanari, Johnnie Mortenson, Nicholas Pastorek, Judy Pulliam, Risa Richardson, Callie Riggs, Rachel Rosenfield, Sara Salkind, James K. Sickinger, Taylor Swankie, Nancy Temkin, Doug Theriaque, Maya Troyanskaya, Rodney Vanderploeg and Carmen Vasquez.

This material is based upon work supported with resources and the use of facilities at: Hunter Holmes McGuire Veterans Affairs Medical Center (VAMC) in Richmond, VA; James A. Haley Veterans Hospital (VH), Tampa, FL; Audie L. Murphy Memorial VH, San Antonio, TX; and is based upon work supported in part by the Defense and Veterans Brain Injury Center, US Army Medical Research and Material Command (USAMRMC).

Conflicts of interest

The authors report no conflicts of interest. The views, opinions and/or findings contained in this article are those of the authors and should not be construed as an official Veterans Affairs or Department of Defense position, policy or decision, unless so designated by other official documentation.

Additional information

Funding

This work was supported by grant funding from: Department of Defense, Chronic Effects of Neurotrauma Consortium (CENC) Award W81XWH-13-2-0095 and Department of Veterans Affairs CENC Award I01 CX001135.