Parrington L, Jehu DA, Fino PC, Stuart S, Wilhelm J, Pettigrew N, Murchison CF, El-Gohary M, VanDerwalker J, Pearson S, Hullar T, Chesnutt JC, Peterka RJ, Horak FB, King LA. Phys. Ther. 2020; ePub(ePub): ePub.
Affiliation
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.
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: Academic hospital; Oregon Health & Science University, Portland Veterans Affairs 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. 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 DHI 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.