Fino Peter C, Antonellis Prokopios, Parrington Lucy, Weightman Margaret M, Dibble Leland E, Lester Mark E, Hoppes Carrie W, King Laurie A
Department of Health & Kinesiology, University of Utah, Salt Lake City, Utah, USA.
Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.
J Neurotrauma. 2025 Jun;42(11-12):929-943. doi: 10.1089/neu.2024.0127. Epub 2025 Mar 26.
Balance and mobility problems are common consequences after mild traumatic brain injury (mTBI). However, turning and nonstraight gait, which are required for daily living, are rarely assessed in clinical tests of function after mTBI. Therefore, the primary goals of this study were to assess (1) the added value of clinic-based turning task variables, obtained using wearable sensors, over standard general assessments of mobility, and (2) assess the associations between general assessments of mobility, objective variables from clinic-based turning tasks, and ecologically relevant functional tasks. Fifty-three civilians with mTBI, 57 healthy civilian controls, and 36 healthy active-duty military controls participated across three sites. Participants were tested in a single session that encompassed self-reported questionnaires including demographic information and balance and mobility testing including the use of wearable sensors. Lasso regression models and the area under the receiver-operator characteristic curve (AUC) assessed diagnostic accuracy. Partial correlation coefficients assessed the relationship between each variable with ecologically relevant functional tasks. Multivariate models revealed high diagnostic accuracy, with an AUC of 0.92, using multiple variables from instrumented clinic-based turning tasks. The complex turning course (CTC) yielded the highest multivariate AUC (95% confidence interval [CI]) of 0.90 (0.84, 0.95) for a single task, and the average lap time from the CTC had the highest univariate AUC (95% CI) of 0.70 (0.58, 0.78). Turning variables provided added value, indicated by higher AUCs, over standard general assessments of mobility. Turning variables had strong associations with ecologically relevant functional tasks and outperformed general assessments of mobility, though there were slight differences in the relationship based on civilian versus military population. Clinic-based turning tasks, especially the CTC and modified Illinois Agility Test (mIAT), have high diagnostic accuracy, strong associations with ecologically relevant functional tasks, and require relatively short time(s) to complete. Compared to general assessments of mobility, clinic-based turning tasks may be more ecologically relevant to daily function. Future work should continue to examine the CTC and mIAT alongside other promising tools for return-to-activity assessments.
平衡和行动能力问题是轻度创伤性脑损伤（mTBI）后的常见后果。然而，日常生活所需的转身和非直线步态在mTBI后的临床功能测试中很少被评估。因此，本研究的主要目标是评估：（1）使用可穿戴传感器获得的基于临床的转身任务变量相对于标准的一般行动能力评估的附加价值；（2）评估一般行动能力评估、基于临床的转身任务的客观变量与生态相关功能任务之间的关联。53名患有mTBI的平民、57名健康平民对照和36名健康现役军人对照在三个地点参与研究。参与者在一次测试中接受了包括人口统计学信息的自我报告问卷以及包括使用可穿戴传感器的平衡和行动能力测试。套索回归模型和受试者工作特征曲线下面积（AUC）评估诊断准确性。偏相关系数评估每个变量与生态相关功能任务之间的关系。多变量模型显示出较高的诊断准确性，使用基于仪器的临床转身任务中的多个变量时AUC为0.92。对于单个任务，复杂转身过程（CTC）产生的多变量AUC最高（95%置信区间[CI]），为0.90（0.84，0.95），而CTC的平均圈时单变量AUC最高（95%CI），为0.70（0.58，0.78）。与标准的一般行动能力评估相比，转身变量通过更高的AUC显示出附加价值。转身变量与生态相关功能任务有很强的关联，并且在行动能力评估方面表现优于一般评估，尽管根据平民与军人人群，关系存在细微差异。基于临床的转身任务，特别是CTC和改良的伊利诺伊敏捷性测试（mIAT），具有较高的诊断准确性，与生态相关功能任务有很强的关联，并且完成所需时间相对较短。与一般行动能力评估相比，基于临床的转身任务可能在生态上与日常功能更相关。未来的工作应继续研究CTC和mIAT以及其他用于恢复活动评估的有前景的工具。
