Top

Neurological Sciences

Published in:

01-07-2020 | Central Nervous System Trauma | Original Article

Long-term impact of mild traumatic brain injury on postural stability and executive function

Authors: Katrina Kunker, Denise M. Peters, Sambit Mohapatra

Published in: Neurological Sciences | Issue 7/2020

Abstract

Objective

A substantial number of individuals present with prolonged symptoms after a mild traumatic brain injury (mTBI) or concussion. This has warranted the development of assessment tools that can reliably detect prolonged symptoms after an mTBI. At present, a gold standard diagnostic tool for accurately identifying such prolonged symptoms is not available. The purpose of this study is to utilize specific measures of standing balance, cognitive function, and bimanual coordination to examine persisting long-term deficits in individuals with mTBI.

Methods

A total of 18 (medically diagnosed with an mTBI within the last year) and 14 (healthy age-matched controls) individuals participated in the study. Assessment tools included NIH Toolbox Cognition Battery (NIHTB-CB), TEMPA, and Purdue pegboard (bimanual coordination) and standing balance on a force platform.

Results

Individuals with mTBI demonstrated lower scores in all measures of cognition with statistically significant difference (p = 0.03) in executive function. The clinical tests of bimanual coordination did not show any statistically significant differences between groups. Postural stability was significantly reduced (p = 0.039) in the mTBI group.

Conclusion

Our results show long-term performance deficits (cognition and postural stability) that persist in individuals with mTBI. In addition, to the best of our knowledge, this is the first study to identify cognitive deficits in individuals with mTBI by utilizing NIHTB-CB. Knowledge gained from this study might affect decisions of return-to-play or return-to-learn in individuals with a history of mTBI(s).

Carroll LJ, Cassidy JD, Holm L, Kraus J, Coronado VG, WCCTF on MTBI (2004) Methodological issues and research recommendations for mild traumatic brain injury: the WHO collaborating centre task force on mild traumatic brain injury. J Rehabil Med:113–125

Gerberding JL BS (2003) Report to congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Centers dis control Prev 9–11

Alexander MP (1995) Mild traumatic brain injury: pathophysiology, natural history, and clinical management. Neurology. https://doi.org/10.1212/WNL.45.7.1253

Lange RT, Brickell TA, Iverson GL, Parkinson G, Bhagwat A, FLM (2011) 12-month outcome of mild traumatic brain injury and polytrauma in U.S. military service members. In: Coping with Blast-Related Traumatic Brain Injury in Returning Troops, pp 171–186

Caplain S, Blancho S, Marque S et al (2017) Early detection of poor outcome after mild traumatic brain injury: predictive factors using a multidimensional approach a pilot study. Front Neurol. https://doi.org/10.3389/fneur.2017.00666

(2015) Traumatic Brain Injury Hope Through Research. NIH Publ. No. 15–2478

Halstead ME, Walter KD (2010) Sport-related concussion in children and adolescents. Pediatrics. https://doi.org/10.1542/peds.2010-2005

Buckley TA, Baugh CM, Meehan WP, Difabio MS (2017) Concussion management plan compliance a study of NCAA power 5 conference schools. Orthop J Sport Med. https://doi.org/10.1177/2325967117702606

jcoleman@ncaa.org (2014) Concussion diagnosis and management best practices. In: NCAA.org - Off. Site NCAA

10.

Okie S (2005) Traumatic brain injury in the war zone. N Engl J Med. https://doi.org/10.1056/NEJMp058102

11.

(2016) DoD Worldwide Numbers for TBI. In: DVBIC

12.

(2016) VA/DoD Clinical practice guideline for the management of concussion-mild traumatic brain injury

13.

Belanger HG, Vanderploeg RD, Curtiss G, Warden DL (2007) Recent neuroimaging techniques in mild traumatic brain injury. J Neuropsychiatr Clin Neurosci 19:5–20. https://doi.org/10.1176/appi.neuropsych.19.1.5CrossRef

14.

Kinnunen KM, Greenwood R, Powell JH et al (2011) White matter damage and cognitive impairment after traumatic brain injury. Brain. https://doi.org/10.1093/brain/awq347

15.

Berman RA, Colby CL, Genovese CR, Voyvodic JT, Luna B, Thulborn KR, Sweeney JA (1999) Cortical networks subserving pursuit and saccadic eye movements in humans: an FMRI study. Hum Brain Mapp 8:209–225. https://doi.org/10.1002/(SICI)1097-0193(1999)8:4<209::AID-HBM5>3.0.CO;2-0CrossRefPubMedPubMedCentral

16.

Serrien DJ, Nirkko AC, Wiesendanger M (2001) Role of the corpus callosum in bimanual coordination: a comparison of patients with congenital and acquired callosal damage. Eur J Neurosci 14:1897–1905. https://doi.org/10.1046/j.0953-816X.2001.01798.xCrossRefPubMed

17.

Degani AM, Santos MM, Leonard CT, Rau TF, Patel SA, Mohapatra S, Danna-Dos-Santos A (2017) The effects of mild traumatic brain injury on postural control. Brain Inj 31:49–56. https://doi.org/10.1080/02699052.2016.1225982CrossRefPubMed

18.

Dash PK, Zhao J, Hergenroeder G, Moore AN (2010) Biomarkers for the diagnosis, prognosis, and evaluation of treatment efficacy for traumatic brain injury. Neurotherapeutics 7:100–114. https://doi.org/10.1016/j.nurt.2009.10.019CrossRefPubMedPubMedCentral

19.

Prince C, Bruhns ME (2017) Evaluation and treatment of mild traumatic brain injury: the role of neuropsychology. Brain Sci

20.

Iverson GL, Lovell MR, Collins MW (2003) Interpreting change on ImPACT following sport concussion. Clin Neuropsychol (neuropsychology, Dev Cogn sect D). https://doi.org/10.1076/clin.17.4.460.27934

21.

Buzzini SRR, Guskiewicz KM (2006) Sport-related concussion in the young athlete. Curr Opin Pediatr

22.

Tulsky DS, Carlozzi NE, Holdnack J, Heaton RK, Wong A, Goldsmith A, Heinemann AW (2017) Using the NIH toolbox cognition battery (NIHTB-CB) in individuals with traumatic brain injury. Rehabil Psychol 62:413–424. https://doi.org/10.1037/rep0000174CrossRefPubMedPubMedCentral

23.

Korman C (USA T (2017) The NFL’s concussion protocol failed Cam Newton

24.

Michael Hurley CB (2017) Hurley: tom savage becomes latest glaring failure of NFL’s concussion protocol

25.

McCrory P, Meeuwisse W, Dvořák J et al (2017) Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. https://doi.org/10.1136/bjsports-2017-097699

26.

McAllister TW, Ford JC, Ji S et al (2012) Maximum principal strain and strain rate associated with concussion diagnosis correlates with changes in corpus callosum white matter indices. Ann Biomed Eng. https://doi.org/10.1007/s10439-011-0402-6

27.

Wortzel HS, Arciniegas DB (2012) Treatment of post-traumatic cognitive impairments. Curr Treat Options Neurol 14:493–508. https://doi.org/10.1007/s11940-012-0193-6CrossRefPubMedPubMedCentral

28.

Weintraub S, Dikmen SS, Heaton RK, Tulsky DS, Zelazo PD, Bauer PJ, Carlozzi NE, Slotkin J, Blitz D, Wallner-Allen K, Fox NA, Beaumont JL, Mungas D, Nowinski CJ, Richler J, Deocampo JA, Anderson JE, Manly JJ, Borosh B, Havlik R, Conway K, Edwards E, Freund L, King JW, Moy C, Witt E, Gershon RC (2013) Cognition assessment using the NIH toolbox. Neurology 80:S54–S64. https://doi.org/10.1212/WNL.0b013e3182872dedCrossRefPubMedPubMedCentral

29.

Moseley AM, Yap MC (2003) Interrater reliability of the TEMPA for the measurement of upper limb function in adults with traumatic brain injury. J Head Trauma Rehabil 18:526–531CrossRefPubMed

30.

Desrosiers J, Hébert R, Bravo G, Dutil E (1995) The Purdue Pegboard Test: normative data for people aged 60 and over. Disabil Rehabil 17:217–224. https://doi.org/10.3109/09638289509166638CrossRefPubMed

31.

Ghawami H, Sadeghi S, Raghibi M, Rahimi-Movaghar V (2017) Executive functioning of complicated-mild to moderate traumatic brain injury patients with frontal contusions. Appl Neuropsychol. https://doi.org/10.1080/23279095.2016.1157078

32.

Kumar S, Rao SL, Chandramouli BA, Pillai S (2013) Reduced contribution of executive functions in impaired working memory performance in mild traumatic brain injury patients. Clin Neurol Neurosurg. https://doi.org/10.1016/j.clineuro.2012.12.038

33.

Okonkwo DO, Tempel ZJ, Maroon J (2014) Sideline assessment tools for the evaluation of concussion in athletes: a review. [miscellaneous article]. Neurosurgery. https://doi.org/10.1227/NEU.0000000000000493

34.

Alsalaheen B, Stockdale K, Pechumer D, Broglio SP (2016) Validity of the immediate post concussion assessment and cognitive testing (ImPACT). Sport. Med

35.

Caeyenberghs K, Leemans A, Coxon J, Leunissen I, Drijkoningen D, Geurts M, Gooijers J, Michiels K, Sunaert S, Swinnen SP (2011) Bimanual coordination and corpus callosum microstructure in young adults with traumatic brain injury: a diffusion tensor imaging study. J Neurotrauma 28:897–913. https://doi.org/10.1089/neu.2010.1721CrossRefPubMed

36.

Jantzen KJ, Anderson B, Steinberg FL, Kelso JAS (2004) A prospective functional MR imaging study of mild traumatic brain injury in college football players. Am J Neuroradiol

37.

Kuhtz-Buschbeck JP, Hoppe B, Gölge M, Dreesmann M, Damm-Stünitz U, Ritz A (2003) Sensorimotor recovery in children after traumatic brain injury: analyses of gait, gross motor, and fine motor skills. Dev Med Child Neurol 45:821–828. https://doi.org/10.1017/S001216220300152XCrossRefPubMed

38.

Platz T, Winter T, Muller N et al (2001) Arm ability training for stroke and traumatic brain injury patients with mild arm paresis: a single-blind, randomized, controlled trial. Arch Phys Med Rehabil 82:961–968. https://doi.org/10.1053/apmr.2001.23982CrossRefPubMed

39.

De Beaumont L, Mongeon D, Tremblay S et al (2011) Persistent motor system abnormalities in formerly concussed athletes. J Athl Train 46:234–240. https://doi.org/10.4085/1062-6050-46.3.234CrossRefPubMedPubMedCentral

40.

Thompson L, Badache M, Cale S et al (2017) Balance performance as observed by center-of-pressure parameter characteristics in male soccer athletes and non-athletes. Sports. https://doi.org/10.3390/sports5040086

41.

Cavanaugh JT, Guskiewicz KM, Giuliani C et al (2005) Detecting altered postural control after cerebral concussion in athletes with normal postural stability. Br J Sports Med. https://doi.org/10.1136/bjsm.2004.015909

42.

Baracks J, Casa DJ, Covassin T et al (2018) Acute sport-related concussion screening for collegiate athletes using an instrumented balance assessment. J Athl Train. https://doi.org/10.4085/1062-6050-174-17

43.

Quatman-Yates CC, Bonnette S, Hugentobler JA, et al (2015) Postconcussion postural sway variability changes in Youth: The Benefit of Structural Variability Analyses. Pediatr Phys Ther. https://doi.org/10.1097/PEP.0000000000000193

44.

Karr JE, Areshenkoff CN, Garcia-Barrera MA (2014) The neuropsychological outcomes of concussion: a systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury. Neuropsychology. https://doi.org/10.1037/neu0000037

45.

Belanger HG, Spiegel E, Vanderploeg RD (2010) Neuropsychological performance following a history of multiple self-reported concussions: a meta-analysis. J Int Neuropsychol Soc. https://doi.org/10.1017/S1355617709991287

Title: Long-term impact of mild traumatic brain injury on postural stability and executive function
Authors: Katrina Kunker
Denise M. Peters
Sambit Mohapatra
Publication date: 01-07-2020
Publisher: Springer International Publishing
Keywords: Central Nervous System Trauma
Traumatic Brain Injuries
Published in: Neurological Sciences / Issue 7/2020
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-020-04300-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Long-term impact of mild traumatic brain injury on postural stability and executive function

Abstract

Objective

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2020

Delayed and isolated abducens nerve palsy following minor head injury

Assessment of cutaneous axon-reflex responses to evaluate functional integrity of autonomic small nerve fibers

The role of clivus length and cranial base flexion angle in basilar invagination and Chiari malformation pathophysiology

The neurological manifestations of COVID-19: a review article

Unusual imaging appearance of a rare cortical ependymoma mimicking angiocentric glioma

Dysphasia is associated with diffusion-weighted MRI abnormalities in patients with transient neurological symptoms