Aerospace & Defense Technology - April 2021 - 28

Tech Briefs

Sensory Integration Balance Deficits in Complex mTBI:
Can Early Initiation of Rehabilitation with Wearable Sensor
Technology Improve Outcomes?
Developing a novel feedback system using wearable sensors to provide physical therapists with realtime information about quality of head and trunk movement during exercise could improve patient
rehabilitation practices.
Army Medical Research and Materiel Command, Fort Detrick, Maryland

M

ild traumatic brain injury (mTBI) is
common both in civilian and military populations and can be debilitating
if symptoms do not resolve after injury.
Balance problems are one of the most
common complaints after sustaining an
mTBI and often prevent people from returning to their previous quality of life.
However, clear guidelines are currently
lacking on when to initiate physical
therapy rehabilitation and it is unclear if
early physical therapy is beneficial.
It is believed that the underlying problem of imbalance results from damage to
parts of the brain responsible for interpreting sensory information for balance
control. It is hypothesized that retraining
the brain early, as opposed to months

Baseline error
score
mean (SD)

Post
rehabilitation
error score

Baseline error
score
mean (SD)

Post
rehabilitation
error score

Baseline
error score
mean (SD)

Post
rehabilitation
error score

0(1)

0(0)

3(3)

2(2)

4(4)

4(3)

0.20

Mediolateral sway (RMS, m/s2)

quality of head and trunk movements during prescribed exercises.
A total of 83 participants were recruited
and screened with 53 meeting inclusion
criteria. At the project's conclusion, 29
subjects had completed the rehabilitation
intervention with 9 still receiving rehabilitation. Seven completed a 6-month follow up test after their rehabilitation with
19 subjects still waiting for 6-month follow up testing. In terms of outcomes, the
following was learned.
Balance: Balance impairments are a
common complaint after mTBI. Preliminary analysis of postural sway data indicated that sway in the mediolateral plane
while performing the modified Balance
Error Scoring System (mBESS; Figure 1) be-

after injury, to correctly interpret sensory
information will improve recovery. It is
also believed this retraining is limited
when rehabilitation exercises are performed incorrectly, and that performance
feedback from wearable sensors, can improve balance rehabilitation.
There are three of objectives of this
research:
1) To determine how the timing of rehabilitation affects outcomes after mTBI;
2) To determine if home monitoring of
balance exercises using wearable sensors improves outcomes;
3) To develop a novel feedback system
using wearable sensors to provide the
physical therapist with information,
in real-time during training, about

mBESS Double leg, firm

1.0

mBESS Tandem, firm

0.8

0.15

2.0

mBESS Single leg, firm

1.5

0.6
1.0

0.10
0.4

0.5

0.05
0.2

0

0

0
Baseline

Post rehabilitation

Baseline

Post rehabilitation

Baseline

Post rehabilitation

Figure 1. Modified Balance Error Scoring System (mBESS) scores at baseline and post rehabilitation across 3 different stance positions (double leg feet together, double
leg tandem stance, and single leg stance). Inertial sensors worn on the head, sternum, lumbar spine, and feet recorded the mediolateral sway during each stance for
baseline and post-rehabilitation sessions. Sensors were able to detect balance changes from baseline to post rehabilitation that the mBESS scores could not.

28

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Aerospace & Defense Technology - April 2021

Table of Contents for the Digital Edition of Aerospace & Defense Technology - April 2021

Aerospace & Defense Technology - April 2021 - Intro
Aerospace & Defense Technology - April 2021 - Sponsor
Aerospace & Defense Technology - April 2021 - Cov1
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