Rehabilitation Therapies in a Concussion Clinic Cohort: Range, Rate, Reasons and Risk Factors

Abstract

Objective: To evaluate the efficacy of a personalized rehabilitation treatment for balance disorders based on visual, proprioceptive and vestibular deficits evaluated by CDP versus a traditional rehabilitation program. Design: Randomized, controlled study. Setting: Outpatient. Personalized balance disorders rehabilitation. Participants: The study involves the recruitment of 240 MS patients with balance disorders. Patients are evaluated with computerized dynamic posturography to identify subjects with prevalent visual or proprioceptive or vestibular deficits. Patients are randomly assigned to the control group (traditional rehabilitation program [TRG]) or study groups (visual [VRG], proprioceptive [PRG] or vestibular [VSRG] rehabilitation group). Each group is composed with 60 subjects. Interventions: Personalized rehabilitation treatments for balance disorders based on visual, proprioceptive and vestibular deficits evaluated by computerized dynamic posturography versus a traditional rehabilitation program. Each group received rehabilitation treatment for 20 sessions, 3 sessions/week, 1 hour/session. Main Outcome Measures: Clinical and instrumental evaluations are: BBS, TUGT, Mini best test, ABC scale, MFIS, T25W, TWT 6min, SOT Composite score and Subscores (Equitest), falls diary, FES-I and VAS. All participants are evaluated at T0 (start of rehabilitation treatments), T1 (end of rehabilitation treatments), T2 (one month follow up), T3 (three month follow up) and T4 (six month follow up). Results or Clinical Course: Preliminary results: 105 patients reached the end of rehabilitation treatments (T1) until now. 26 were assigned to VRG group, 25 to PRG group, 39 to VSRG group and 15 to TRG group. We performed multivariate analysis with RM ANOVA model. Preliminary results show marked improvement of BBS (P<.02). VSRG group shows greater improvement in BBS than the other groups. SOT Composite Score Equitest shows greater improvement in treatment groups without even enhancement of the statistical data. Conclusion: Personalized rehabilitation treatment for balance disorders have greater impact on both clinical outcomes (BBS) and instrumental (SOT Composite Score Equitest) compared to traditional treatment.