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. Conclusion: Patients' complaints of instability after TBI may have objective correlates and may be rectifiable. Balance and gait testing in these patients is warranted.