VESTIBULAR EVALUATION IN INDIVIDUALS WITH MILD BRAIN INJURY.

Abstract

Purpose/Hypothesis: Clients with mild brain injuries (MBI) are susceptible to vestibular dysfunction. The Dizziness Handicap Inventory (DHI), Sensory Organization Testing (SOT), Dynamic Gait Index (DGI), Dix-Hallpike Maneuver (DHM), and Head-Impulse Test (HIT) are objective vestibular examination measures that have been validated in subjects with vestibular pathologies. Research utilizing these tests to examine the prevalence of vestibular dysfunction post-MBI and assessing the validity of these measures in clients with MBI is lacking. The primary purpose of this descriptive study was to investigate the application of objective measures to examine the incidence of vestibular dysfunction in clients with MBI and secondly, to examine the concurrent validity of the DGI with SOT and DHI scores in clients with MBI. Number of Subjects: Fifteen subjects with diagnosis of MBI with onset < 6 months were recruited from MBI outpatient clinic. Mean age was 40 years (range 19–78) and mean time post-injury was 69 days (range 12–167). Subjects were excluded if they had spinal or extremity injuries that contraindicated test administration or previous neurologic diagnoses. Materials/Methods: The DHI, SOT, DGI, DHM, and HIT were administered in controlled order to subjects over two sessions. The DHI was used to quantify subjects' self report of dizziness. SOT was used to assess the use of sensory inputs for balance, specifically vestibular input. The DGI was used to evaluate subjects' functional balance during gait tasks. The DHM and HIT were administered to detect BPPV and vestibulo-ocular function, respectively. Descriptive statistics were used to examine the sample's score distribution for each test and Pearson correlation was used to examine the relationship between tests. Results: The mean score on the DHI was 50 (IQR 35–72), with 60% of scores being 50 or higher. The mean SOT composite balance score was 61.1 (IQR 54.5–71.0), with 73.3% of subjects falling below their normative age group scores. Forty-six percent of subjects were determined to have difficulty using vestibular input to maintain balance. The mean score on the DGI was 19 (IQR 16.5–22.0), with 53.3% of subjects in a fall risk category. Two subjects had positive DHM results and 3 subjects had positive HIT results. A significant good correlation (r = −0.795) was found between DHI and DGI scores, indicating that subjective vestibular symptoms were related to subjects' functional balance deficits. Conclusions: These findings demonstrate that vestibular dysfunction is prevalent in clients with MBI. The DHI, DGI, and SOT findings detected a large percentage of subjects with vestibular impairment, demonstrating the validity of vestibular testing in MBI. Clinical Relevance: Individuals who experience MBI should be screened for vestibular dysfunction. In this study the DHI demonstrated sensitivity in measuring self-reported vestibular symptoms, which correlated with subjects' functional balance scores. The DGI and SOT were valid measures for detecting balance dysfunction in MBI.