Dual-Tasking as Diagnostic and Rehabilitation Tool in Traumatic Brain Injury Patients

L A Zhavoronkova,E M Kushnir,A A Indeeva,E L Pogosbekyan,O A Maksakova,S I Moraresku

doi:10.4236/jbbs.2020.106015

Abstract

Objective: Purpose of this study was to investigate the behavioral and brain activity impairments in patients after moderate traumatic brain injury (mTBI) in comparison with the normal ranges while dual-tasks performing. We would like to evaluate dual-tasking as diagnostic and rehabilitation tool and to test hypothesis of brain aging after mTBI. Material and Methods: Electroencephalographic (EEG), stabilographic and clinical study was performed in 11 patients (mean age 28.8 ± 8.4 years) for up to 1 - 12 months after a mTBI in comparison with 17 healthy subjects (26.7 ± 5.1 years). All the participants performed two motor and two cognitive tasks presented separately, and simultaneously (dual-tasking). Results: Clinical examination revealed predominantly cognitive deficit in mTBI patients with intact postural control. EEG data demonstrated coherence decrease for slow (delta-theta) rhythms in frontal-temporal areas predominantly for left hemisphere during cognitive tasks performance. In contrast, EEG coherence for slow spectral bands increased in the same areas in healthy volunteers. EEG coherence increased for fast spectral bands—alpha2 and beta, predominantly in right hemisphere while both healthy adults and patients performed motor components of dual tasks. Rehabilitation course with dual tasks, led to a predominant reduction in cognitive deficits, and EEG coherence increases at the frontal-temporal areas of the left hemisphere. Conclusions: Dual-tasks may be used as diagnostic tool in patients after mTBI. This approach demonstrates predominant cognitive deficit, and left hemispheric dysfunction in patients similar to elderly persons and support the hypothesis of brain aging after TBI. Pilot studies also suggested rehabilitation effect of dual-tasking in mTBI patients.

Highlights

Traumatic brain injury (TBI) usually resulting from a blow to the head is most common in people of working age, it happens in the elderly too
It was shown an increase of EEG coherence (p < 0.01) for slow spectral bands with some shift at the left hemisphere for performance of cognitive task
An increase of EEG coherence for cognitive and motor component was observed as specific brain activation while dual-tasks execution

Summary

Introduction

Traumatic brain injury (TBI) usually resulting from a blow to the head is most common in people of working age, it happens in the elderly too. TBI is a result of falls, road accidents, sports injuries, etc. Some injuries classified as moderate (mTBI) are not accompanied by hemiparesis and other neurological deficiencies. There is growing evidence that even years after mTBI, cognitive, affective, and behavioral functions may change, which leads to insolvency in work, school, or in social relations. Diffuse axonal injury is frequent in TBI (including mTBI) and disintegration is a significant pathogenic factor in this form of the brain pathology [6]. Disintegrative processes including corpus callosum were described mostly in mTBI patients accompanied by disorders in different spheres [7]-[14]

Methods

Results

Discussion

Conclusion