An assessment of gait and balance deficits after traumatic brain injury.

OBJECTIVE To assess the sensations of instability that many patients report after traumatic brain injury (TBI). DESIGN A controlled study. SETTING A motion analysis and vestibular and balance laboratory. PARTICIPANTS Twenty subjects, 10 with TBI and complaints of instability, and 10 without TBI. INTERVENTIONS Balance and gait analysis. MAIN OUTCOME MEASURES Dizziness Handicap Inventory (DHI), caloric irrigation, optokinetic testing, Dix-Hallpike Test, posturography, and center of mass (COM) movement. RESULTS Subjects were well matched in terms of age, height, weight, and gender. DHI scores of those with and without TBI differed significantly (32.2+/-23.0 vs 0.2+/-0.63, P<.001). Caloric and optokinetic circularvection testing were abnormal only in subjects with TBI (8/10 and 4/10, respectively). Benign paroxysmal positioning vertigo was present in only 3 subjects with TBI, and this either resolved spontaneously (n=1) or was successfully treated (n=2). Composite posturography scores of those with and without TBI differed significantly (69.6+/-35.8 vs 79.5+/-40.5, P=.02). Gait parameters also differed significantly between the groups (P=.05), with the subjects with TBI having lower anterior and posterior and higher medial and lateral COM displacements and velocities. CONCLUSIONS Patients' complaints of instability after TBI may have objective correlates and may be rectifiable. Balance and gait testing in these patients is warranted.

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