INTRODUCTION:The Vestibular/Ocular Motor Screening (VOMS) was created as a brief clinical screening tool for identifying vestibular and ocular motor symptoms and impairments post-concussion. It was found to have predictive validity in correctly identifying concussed athletes from healthy controls. In 2018, the Military Acute Concussion Evaluation 2 (MACE2) replaced the original Military Acute Concussion Evaluation (MACE); the most prominent change between the MACE and MACE2 was the addition of the VOMS. Despite its adoption into military medicine, it is not known if the addition of the VOMS to the MACE2 is acutely helpful, and if it provides additional information for diagnosis, prognosis, and/or management. The purposes of this systematic review were: (1) to determine the utility of the VOMS in correctly identifying concussed individuals, particularly as it pertains to military medicine; (2) to explore the extent to which the VOMS can inform concussion prognosis; and (3) to establish the value of the VOMS as a measure for monitoring the evolution of symptoms throughout a service member's course of care. MATERIALS AND METHODS:A comprehensive search of PubMed was performed from January 1, 2014 through August 16, 2023. Articles were included if they researched concussion or a related health condition or healthy controls and administered the VOMS. Articles were excluded if they discussed health conditions other than concussion; did not administer the VOMS; or were written in languages other than English. The tools used to assess methodological quality and risk of bias varied according to study design. Articles were classified into three primary domains: diagnosis, prognosis, and/or rehabilitation/recovery over time. RESULTS:A total of 231 articles were retrieved and 3 were duplicates, leaving 228 articles for review. Of the 228 articles screened, 100 relevant full-text articles were assessed for eligibility. Fifty-nine articles met our inclusion and exclusion criteria while the other 41 articles were rejected. Thirty-two articles helped to inform diagnosis, 15 prognosis, and 16 rehabilitation/recovery over time. CONCLUSIONS:The VOMS had excellent internal consistency and moderate to good test-retest reliability; however, a false-positive rate of 21.9% was found. Most studies indicated that a positive VOMS was associated with a delayed recovery. Several studies indicated that VOMS scores improved with targeted, active interventions and/or a symptom-guided progressive return to activity. The greatest limitation was the paucity of published evidence in the military population. More research is needed on the use of the VOMS in service members.

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.

BACKGROUND:Gait impairments are common in individuals with mild traumatic brain injury (mTBI), presenting in the acute phase and often persisting in subtle ways over time. Despite the prominence of laboratory gait evaluations, a comprehensive understanding of gait deficits post-mTBI necessitates the examination of various gait domains in real-world environments. Assessing gait during a community ambulation task (CAT) may capture real-world challenges and influence focused interventions or rehabilitation in individuals with mTBI. RESEARCH QUESTION:The aim of the study was to compare gait performance across independent gait domains in individuals with and without mTBI using wearable sensors during both the CAT and laboratory tasks (i.e., 1-minute walk test). Additionally, associations between the CAT and single- and dual-task walking were investigated. METHODS:In this cross-sectional study, 107 participants, including individuals with mTBI (n = 52) and healthy controls (n = 55), underwent gait assessments during the CAT and 1-minute walk tests (single- and dual-task) using wearable sensors. Four independent gait domains (i.e., gait variability, pace, rhythm, and turning), consisting of thirteen gait variables, were analyzed. Statistical methods included t-tests and partial correlations, adjusted for covariates. RESULTS:Individuals with mTBI exhibited gait deficits across multiple gait domains. Specifically, increased gait variability, decreased gait pace and turns post mTBI were seen in the CAT and 1-minute walk tests. Notably, the CAT task exhibited greater gait differences in terms of gait variability and pace compared to the laboratory tasks. Across gait domains, the CAT revealed greater number of correlated measures with dual-task walking compared to single-task walking. SIGNIFICANCE:The community ambulation walking task showed more abnormalities across gait domains compared to laboratory walking tests, highlighting the potential importance of incorporating real-life, community ambulatory tasks into post-mTBI evaluation of mobility.

INTRODUCTION:Vestibular/Ocular Motor Screening (VOMS) is often part of a comprehensive evaluation to identify acute mild traumatic brain injury. Most of the reports describe the use of the VOMS in adolescents/young adults and not in older adults or military service members. The purpose of this study was to describe VOMS findings in healthy civilians and active duty military service members up to the age of 50 years. MATERIALS AND METHODS:Seventy-seven healthy civilians between 18 and 50 years of age (22 males, age 31.8 [9.0] years) participated across three sites in addition to 40 healthy active duty service members (25 males, age 27.5 [4.9] years) from one site. Demographics, Neurobehavioral Symptom Inventory scores, mean near point convergence (NPC) distance, and Total Symptom Change (TSS) scores from the VOMS were evaluated. RESULTS:For civilians, the group mean NPC distance was 4.98 (3.8) cm. For military service members, the group mean NPC distance was 6.17 (4.57) cm. For civilians, the mean TSS was 1.2 (2.3) with 53.2% reporting 0 TSS, 27.3% reporting one TSS, and 19.5% reporting two or more TSS. For military service members, the mean TSS was 0.20 (0.72) with 92.5% reporting 0 TSS, 0% reporting one TSS, and 7.5% reporting two or more TSS. Age did not correlate with the mean NPC distance and TSS in healthy civilians and active duty military service members. CONCLUSIONS:Reconsideration of the Military Acute Concussion Evaluation, Version 2 cutoff value for abnormal mean NPC distance may be warranted to improve diagnostic accuracy in both civilian and military adult populations. Similarly, re-evaluating criteria for interpreting the TSS results of the VOMS, specifically in civilians, may be warranted.

OBJECTIVES:To investigate the relation between cognitive and motor performance in individuals with mild traumatic brain injury (mTBI) and examine differences in both cognitive and motor performance between adults after mTBI and healthy controls. DESIGN:Multi-center, cross-sectional study. SETTING:Three institutional sites (Courage Kenny Research Center, Minneapolis, MN, Oregon Health & Science University, Portland, OR, and University of Utah, Salt Lake City, UT). PARTICIPANTS:Data were collected from 110 participants (N=110), including those with mTBI and healthy controls, who completed cognitive and physical performance assessments. INTERVENTIONS:Not applicable. OUTCOME MEASURES:Cognitive assessments involved the Automated Neuropsychological Assessment Metrics to evaluate domains of attention, memory, reaction time, processing speed, and executive function. Physical performance was evaluated through clinical performance assessments, such as the 1-min walk test, the modified Illinois Agility Test, the Functional Gait Assessment Tool, the High-Level Mobility Assessment Tool, a complex turning course, and a 4-Item Hybrid Assessment of Mobility for mTBI. Participants also completed additional trials of the 1-min walk test, modified Illinois Agility Test, and complex turning course with a simultaneous cognitive task. RESULTS:Individuals with mTBI performed worse on cognitive assessments, as well as several of the physical performance assessments compared with healthy controls. Complex tasks were more strongly related to cognitive assessments compared with simple walking tasks. CONCLUSIONS:Combining complex motor tasks with cognitive demands may better demonstrate functional performance in individuals recovering from mTBI. By understanding the relation between cognitive and physical performance in individuals recovering from mTBI, clinicians may be able to improve clinical care and assist in return to activity decision-making.

OBJECTIVE:The aim of this study was to establish the test-retest reliability of metrics obtained from wearable inertial sensors that reflect turning performance during tasks designed to imitate various turns in daily activity. METHODS:Seventy-one adults who were healthy completed 3 turning tasks: a 1-minute walk along a 6-m walkway, a modified Illinois Agility Test (mIAT), and a complex turning course (CTC). Peak axial turning and rotational velocity (yaw angular velocity) were extracted from wearable inertial sensors on the head, trunk, and lumbar spine. Intraclass correlation coefficients (ICCs) were established to assess the test-retest reliability of average peak turning speed for each task. Lap time was collected for reliability analysis as well. RESULTS:Turning speed across all tasks demonstrated good to excellent reliability, with the highest reliability noted for the CTC (45-degree turns: ICC = 0.73-0.81; 90-degree turns: ICC = 0.71-0.83; and 135-degree turns: ICC = 0.72-0.80). The reliability of turning speed during 180-degree turns from the 1-minute walk was consistent across all body segments (ICC = 0.74-0.76). mIAT reliability ranged from fair to excellent (end turns: ICC = 0.52-0.72; mid turns: ICC = 0.50-0.56; and slalom turns: ICC = 0.66-0.84). The CTC average lap time demonstrated good test-retest reliability (ICC = 0.69), and the mIAT average lap time test-retest reliability was excellent (ICC = 0.91). CONCLUSION:Turning speed measured by inertial sensors is a reliable outcome across a variety of ecologically valid turning tasks that can be easily tested in a clinical environment. IMPACT:Turning performance is a reliable and important measure that should be included in clinical assessments and clinical trials.

BACKGROUND AND PURPOSE:The Functional Gait Assessment (FGA) and High Level Mobility Assessment Tool (HiMAT) are clinical batteries used to assess people with mild traumatic brain injury (mTBI). However, neither assessment was specifically developed for people with mTBI; the FGA was developed to evaluate vestibular deficits, and the HiMAT was developed for individuals with more severe TBI. To maximize the sensitivity and reduce the time burden of these assessments, the purpose of this study was to determine the combination of FGA and HiMAT items that best discriminates persons with persistent symptoms from mTBI from healthy controls.METHODS:Fifty-three symptomatic civilians with persistent symptoms from mTBI (21% male, aged 31 (9.5) years, 328 [267] days since concussion) and 57 healthy adults (28% male, aged 32 (9.6) years) participated across 3 sites. The FGA and HiMAT were evaluated sequentially as part of a larger study. To determine the best combination of items, a lasso-based generalized linear model (glm) was fit to all data.RESULTS:The area under the curve (AUC) for FGA and HiMAT total scores was 0.68 and 0.66, respectively. Lasso regression selected 4 items, including FGA Gait with Horizontal Head Turns and with Pivot Turn, and HiMAT Fast Forward and Backward Walk, and yielded an AUC (95% confidence interval) of 0.71 (0.61-0.79) using standard scoring.DISCUSSION AND CONCLUSIONS:The results provide initial evidence supporting a reduced, 4-Item Hybrid Assessment of Mobility for mTBI (HAM-4-mTBI) for monitoring individuals with mTBI. Future work should validate the HAM-4-mTBI and investigate its utility for tracking progression throughout rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A409 ).

Objective: Unconstrained head motion is necessary to scan for visual cues during navigation, for minimizing threats, and to allow regulation of balance. Following mild traumatic brain injury (mTBI) people may experience alterations in head movement kinematics, which may be pronounced during gait tasks. Gait speed may also be impacted by the need to turn the head while walking in these individuals. The aim of this study was to examine head kinematics during dynamic gait tasks and the interaction between kinematics and gait speed in people with persistent symptoms after mTBI. Setting: A clinical assessment laboratory. Design: A cross-sectional, matched-cohort study. Participants: Forty-five individuals with a history of mTBI and 46 age-matched control individuals. Main Measures: All participants were tested at a single time point and completed the Functional Gait Assessment (FGA) while wearing a suite of body-mounted inertial measurement units (IMUs). Data collected from the IMUs were gait speed, and peak head rotation speed and amplitude in the yaw and pitch planes during the FGA-1, -3, and -4 tasks. Results: Participants with mTBI demonstrated significantly slower head rotations in the yaw (P = .0008) and pitch (P = .002) planes. They also demonstrated significantly reduced amplitude of yaw plane head rotations (P < .0001), but not pitch plane head rotations (P = .84). Participants with mTBI had significantly slower gait speed during normal gait (FGA-1) (P < .001) and experienced a significantly greater percent decrease in gait speed than healthy controls when walking with yaw plane head rotations (FGA-3) (P = .02), but not pitch plane head rotations (FGA-4) (P = .11). Conclusions: Participants with mTBI demonstrated smaller amplitudes and slower speeds of yaw plane head rotations and slower speeds of pitch plane head rotations during gait. Additionally, people with mTBI walked slower during normal gait and demonstrated a greater reduction in gait speed while walking with yaw plane head rotations compared with healthy controls.

OBJECTIVE:The purpose of this study was to (1) explore differences in vestibular ocular motor screening (VOMS) symptoms between healthy adults and adults with persistent symptoms after mild traumatic brain injury (mTBI), and (2) explore the relationships between VOMS symptoms and other measures (self-reported vestibular symptoms, clinical measures of balance and gait, and higher-level motor ability tasks). SETTING:Research laboratory setting. PARTICIPANTS:Fifty-three persons with persistent symptoms (>3 weeks) following mTBI and 57 healthy controls were recruited. Eligibility for participation included being 18 to 50 years of age and free of medical conditions that may affect balance, with the exception of recent mTBI for the mTBI group. DESIGN:Cross-sectional. MAIN MEASURES:The primary outcomes were the VOMS symptom scores and near point of convergence (NPC) distance. Secondary outcomes included the Dizziness Handicap Inventory (DHI) total and subdomain scores, sway area, Functional Gait Analysis total score, gait speed, and modified Illinois Agility Task completion time, and Revised High-Level Mobility Assessment Tool total score. RESULTS:The mTBI group reported more VOMS symptoms ( z range, -7.28 to -7.89) and a further NPC ( t = -4.16) than healthy controls (all P s < .001). DHI self-reported symptoms (total and all subdomain scores) were strongly associated with the VOMS symptom scores (rho range, 0.53-0.68; all P s < .001). No significant relationships existed between VOMS symptoms and other measures. CONCLUSION:Significant group differences support the relevance of the VOMS for mTBI in an age-diverse sample with persistent symptoms. Furthermore, strong association with DHI symptoms supports the ability of the VOMS to capture vestibular complaints in this population.

Background: Turning is a component of gait that requires planning for movement of multiple body segments and the sophisticated integration of sensory information from the vestibular, visual, and somatosensory systems. These aspects of turning have led to growing interest to quantify turning in clinical populations to characterize deficits or identify disease progression. However, turning may be affected by environmental differences, and the degree to which turning assessments are comparable across research or clinical sites has not yet been evaluated. Research question: The aim of this study was to determine the extent to which peak turning speeds are equivalent between two sites for a variety of mobility tasks. Methods: Data were collected at two different sites using separate healthy young adult participants (n = 47 participants total), but recruited using identical inclusion and exclusion criteria. Participants at each site completed three turning tasks: a one-minute walk (1 MW) along a six-meter walkway, a modified Illinois Agility Test (mIAT), and a custom clinical turning course (CCTC). Peak yaw turning speeds were extracted from wearable inertial sensors on the head, trunk, and pelvis. Between-site differences and two one-sided tests (TOST) were used to determine equivalence between sites, based on a minimum effect size reported between individuals with mild traumatic brain injury and healthy control subjects. Results: No outcomes were different between sites, and equivalence was determined for 6/21 of the outcomes. These findings suggest that some turning tasks and outcome measures may be better suited for multi-site studies. The equivalence results are also dependent on the minimum effect size of interest; nearly all outcomes were equivalent across sites when larger minimum effect sizes of interest were used. Significance: Together, these results suggest some tasks and outcome measures may be better suited for multi-site studies and literature-based comparisons.

Determining readiness for duty after mild traumatic brain injury (mTBI) is essential for the safety of service members and their unit. Currently, these decisions are primarily based on self-reported symptoms, objective measures that assess a single system, or standardized physical or cognitive tests that may be insensitive or lack ecological validity for warrior tasks. While significant technological advancements have been made in a variety of assessments of these individual systems, assessments of isolated tasks are neither diagnostically accurate nor representative of the demands imposed by daily life and military activities. Emerging evidence suggests that complex tasks, such as dual-task paradigms or turning, have utility in probing functional deficits after mTBI. Objective measures from turning tasks in single- or dual-task conditions, therefore, may be highly valuable for clinical assessments and return-to-duty decisions after mTBI. The goals of this study are to assess the diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation of objective, dual-task turning measures within an mTBI population. These goals will be accomplished over two phases. Phase 1 will enroll civilians at three sites and active-duty service members at one site to examine the diagnostic accuracy and predictive capacity of dual-task turning outcomes. Phase 1 participants will complete a series of turning tasks while wearing inertial sensors and a battery of clinical questionnaires, neurocognitive testing, and standard clinical assessments of function. Phase 2 will enroll active-duty service members referred for rehabilitation from two military medical treatment facilities to investigate the responsiveness to rehabilitation of objective dual-task turning measures. Phase 2 participants will complete two assessments of turning while wearing inertial sensors: a baseline assessment prior to the first rehabilitation session and a post-rehabilitation assessment after the physical therapist determines the participant has completed his/her rehabilitation course. A variable selection procedure will then be implemented to determine the best task and outcome measure for return-to-duty decisions based on diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation. Overall, the results of this study will provide guidance and potential new tools for clinical decisions in individuals with mTBI. Clinical Trial Registration: clinicaltrials.gov, Identifier NCT03892291.

OBJECTIVE:To use clinically available inertial measurement units to quantify the control of linear accelerations at the head and trunk during gait in different sensory conditions in individuals with unilateral vestibular loss.DESIGN:Observational study.SETTING:Outpatient research laboratory.PARTICIPANTS:Individuals (n=13; mean age, 47.6±13.7y; 69% women) 6 weeks after vestibular schwannoma resection surgery and vestibular healthy participants (n=16; mean age, 29.7±5.9y; 56% women).INTERVENTION:Not applicable.MAIN OUTCOME MEASURES:Walking speed normalized, root mean square values of cranial-caudal, medial-lateral, and anterior-posterior directed linear accelerations at the head and the trunk while walking in 2 visual sensory conditions (eyes open and eyes closed).RESULTS:Linear mixed models for each root mean square value were fit on the effects of group, condition, and group by condition. The group by condition effect was used to examine the primary hypothesis that individuals with vestibular loss would experience greater change in triplanar root mean square values at the head and trunk from the eyes open to eyes closed condition compared with the vestibular healthy group. The group by condition effect was found to be significant at the head in the cranial-caudal (β=0.39; P=.002), medial-lateral (β=0.41; P<.001), and anterior-posterior (β=0.43; P<.001) directions. The group by condition effect was also significant in the cranial-caudal (β=0.39; P=.002), medial-lateral (β=0.39; P<.001), and anterior-posterior (β=0.23; P=.002) directions at the trunk.CONCLUSIONS:Participants who underwent vestibular schwannoma resection were more impaired in their ability to control accelerations at the head and trunk without visual sensory information than vestibular healthy participants. These impairments were detectable using clinically available inertial measurement units.

BACKGROUND:A standard, reliable, objective measure is needed for identifying individuals with mild to moderate traumatic brain injury (TBI).OBJECTIVE:The purpose of this study was to examine balance using an AMTI OR6-7 force platform (FP), neurocognition and mood using the Automated Neuropsychological Assessment Metric4 (ANAM4), blood flow comparisons using a Brain Acoustic Monitor (BAM), and voice using Voice Analysis software (VA) for screening service members for a mild to moderate TBI.METHODS:Active duty and retired service member volunteers (n = 88, 35 with a diagnosis of mild to moderate TBI and 53 who never had a TBI) completed an informed consent document, and evaluations using the four technologies.RESULTS:Development of a clinical prediction rule yielded two FP variables and one ANAM4 Mood Scale variable (vigor) as helpful in predicting the presence of a TBI. Assuming a 15% pre-test probability, these predictors yield a post-test probability of 75.7% for a positive result with any two or more measures being positive, and a post-test probability of 2.3% for a negative result with zero measures being positive.CONCLUSIONS:This study demonstrated the usefulness of a force platform and a self-reported mood scale for predicting presence of mild to moderate TBI.

BACKGROUND:Individuals with unilateral vestibular hypofunction (UVH) alter their movement and reduce mobility to try to stabilize their gaze and avoid symptoms of dizziness and vertigo. OBJECTIVE:To determine if individuals with UVH 6 weeks after surgery demonstrate altered head and trunk kinematics during community ambulation. METHODS:A total of 15 vestibular schwannoma patients with documented postoperative unilateral vestibular loss and 9 healthy controls with symmetrical vestibulo-ocular reflexes participated in this cross-sectional study. Head kinematics (head turn frequency, amplitude, and velocity) and head-trunk coordination during community ambulation were obtained from inertial measurement units for all head movements and within specific amplitudes of head movement. RESULTS:Individuals with UVH made smaller (mean 26° [SD = 3°] vs 32° [SD = 6°]), fewer (mean 133 [SD = 59] vs 221 [SD = 64]), and slower (mean 75°/s [SD = 8°/s] vs 103°/s [SD = 23°/s]) head turns than healthy individuals ( P < .05) but did not demonstrate significantly increased head-trunk coupling (mean 38% [SD = 18%] vs 31% [SD = 11%], P = .22). When small (≤45°) and large (>45°) head turns were considered separately, individuals with UVH demonstrated increased head-trunk coupling compared with healthy individuals for large head turns (mean 54% [SD = 23%] vs 33% [SD = 10%], P = .005). CONCLUSIONS:This study demonstrated that although walking at an adequate speed, individuals with UVH made fewer, smaller, and slower head movements symmetrically in both directions compared with healthy individuals and did not decouple their head movement relative to their trunk when required to make larger purposeful head turns during community ambulation.

Importance Individuals with vestibular hypofunction acutely restrict head motion to reduce symptoms of dizziness and nausea. This restriction results in abnormal decoupling of head motion from trunk motion, but the character, magnitude, and persistence of these deficits are unclear. Objective To use wearable inertial sensors to quantify the extent of head and trunk kinematic abnormalities in the subacute stage after resection of vestibular schwannoma (VS) and the particular areas of deficit in head-trunk motion. Design, Setting, and Participants This cross-sectional observational study included a convenience sample of 20 healthy adults without vestibular impairment and a referred sample of 14 adults 4 to 8 weeks after resection of a unilateral VS at a university and a university hospital outpatient clinic. Data were collected from November 12, 2015, through November 17, 2016. Exposures Functional gait activities requiring angular head movements, including items from the Functional Gait Assessment (FGA; range, 1-30, with higher scores indicating better performance), the Timed Up & Go test (TUG; measured in seconds), and a 2-minute walk test (2MWT; measured in meters). Main Outcomes and Measures Primary outcomes included peak head rotation amplitude (in degrees), peak head rotation velocity (in degrees per second), and percentage of head-trunk coupling. Secondary outcomes were activity and participation measures including gait speed, FGA score, TUG time, 2MWT distance, and the Dizziness Handicap Inventory score (range, 0-100, with higher scores indicating worse performance). Results A total of 34 participants (14 men and 20 women; mean [SD] age, 39.3 [13.6] years) were included. Compared with the 20 healthy participants, the 14 individuals with vestibular hypofunction demonstrated mean (SD) reduced head turn amplitude (84.1° [15.5°] vs 113.2° [24.4°] for FGA-3), reduced head turn velocities (195.0°/s [75.9°/s] vs 358.9°/s [112.5°/s] for FGA-3), and increased head-trunk coupling (15.1% [6.5%] vs 5.9% [5.8%] for FGA-3) during gait tasks requiring angular head movements. Secondary outcomes were also worse in individuals after VS resection compared with healthy individuals, including gait speed (1.09 [0.27] m/s vs 1.47 [0.22] m/s), FGA score (20.5 [3.6] vs 30.0 [0.2]), TUG time (10.9 [1.7] s vs 7.1 [0.8] s), 2MWT (164.8 [37.6] m vs 222.6 [26.8] m), and Dizziness Handicap Inventory score (35.4 [20.7] vs 0.1 [0.4]). Conclusions and Relevance With use of wearable sensors, deficits in head-trunk kinematics were characterized along with a spectrum of disability in individuals in the subacute stage after VS surgery compared with healthy individuals. Future research is needed to fully understand how patterns of exposure to head-on-trunk movements influence the trajectory of recovery of head-trunk coordination during community mobility.

A consequence of vestibular loss is increased coupling of head-on-trunk motion, particularly in the yaw plane, which adversely affects community mobility in these patients. Inertial sensors may provide a means of better understanding normal decoupling behaviors in community environments, but demonstration of their validity and responsiveness is needed. This paper examined the validity and measurement sensitivity of inertial sensors in quantifying yaw plane head-trunk decoupling during unrestricted and restricted cervical motion conditions in healthy adults. Peak head turn amplitude and velocity, head-trunk coupling, and trunk turn lag were simultaneously measured using wearable inertial sensors and a motion capture system. Agreement between motion capture and the inertial sensors was excellent (intraclass correlation coefficients(2,1) >.75) for all measured outcomes during a static head turn task and for peak head turn velocity and trunk turn lag during a walking task. Cervical collar use significantly reduced head turn amplitude and velocity, and increased coupling of head-on-trunk motion (p<;.02). Measurement of head and trunk coordination during gait activities using inertial sensors is valid and feasible. Amplitude and velocity outcomes were most reliable and responsive to experimental alterations in head motion. Using inertial sensors to quantify abnormal kinematics following vestibular loss may provide insights into recovery of head-trunk coordination in these individuals.

BACKGROUND:The ability to adapt postural responses to sensory illusions diminishes with age and is further impaired by Parkinson disease. However, limited information exists regarding training-related adaptions of sensory reweighting in these populations.METHODS:This study sought to determine whether Parkinson disease or age would differentially affect acute postural recovery or adaptive postural responses to novel or repeated exposure to sensory illusions using galvanic vestibular stimulation during quiet stance.FINDINGS:Acutely, individuals with Parkinson disease demonstrated larger center of pressure coefficient of variation compared to controls. Unlike individuals with Parkinson disease and asymptomatic older adults, healthy young adults acutely demonstrated a reduction in Sample Entropy to the sensory illusion. Following a period of consolidation Sample Entropy increased in the healthy young group, which coincided with a decreased center of pressure coefficient of variation. Similar changes were not observed in the Parkinson disease or older adult groups.INTERPRETATION:Taken together, these results suggest that young adults learn to adapt to vestibular illusion in a more robust manner than older adults or those with Parkinson disease. Further investigation into the nature of this adaptive difference is warranted.

ABSTRACT Frequently, clinical balance outcome measures are limited by floor or ceiling effects and provide insufficient resolution to determine subtle deficits. Detailed assessment of postural control obtained through posturography may be cost‐prohibitive or logistically infeasible in some clinical settings. Two‐dimensional (2D) motion analysis may provide a clinically feasible means of obtaining detailed quantification of balance deficits. Forty‐five participants aged 18–80 years, with and without Parkinson disease, performed the Push and Release (PR) test, sit‐to‐stand (STS), and timed single leg stance (SLS). Performance was captured simultaneously using a three‐dimensional (3D) (10‐camera laboratory‐based 3D motion capture system and 3D motion analysis software) and 2D (two commercially available video cameras and 2D motion analysis software) system. Agreement was excellent between 2D and 3D systems for all outcomes of the PR and SLS (intraclass correlation coefficients [ICC 2,1 ] 0.96–0.99, 95% CIs 0.92–0.98 to 0.99–1.0), and ranged from fair to excellent for STS outcomes (ICC 2,1 0.59–0.93, 95% CIs 0.36–0.75 to 0.87–0.96). Test–retest reliability (ICC 3,1 0.89–1.0, 95% CIs 0.76–0.96 to 1.0–1.0) and inter‐rater reliability (ICC 2,1 0.77–1.0, 95% CIs 0.61–0.87 to 1.0–1.0) of the 2D obtained outcomes were excellent. A technology package of commonly available video cameras and 2D motion analysis software was a valid and reliable method for quantifying outcomes of postural control tasks in people with a range of balance abilities. Two‐dimensional analysis can be used in clinical practice to provide balance assessments as a cost‐effective alternative to 3D motion capture. Anat Rec, 299:1165–1173, 2016. © 2016 Wiley Periodicals, Inc.

Physical training programs that enhance battlefield-related fitness needs have been increasingly advocated as operational demands on the US military have increased, but few studies have evaluated program effectiveness. The purpose of this study was to compare a novel 7-week physical training program with traditional army physical fitness training in improving the selected measures of physical fitness and military task performance. One hundred and eighty subjects performed a 30-m rush wearing a fighting load, a simulated casualty recovery wearing a fighting load, a 1-repetition maximum bench press, a maximum repetition pull-up test, a medicine ball put, a vertical jump, and a T-test agility drill to establish test-retest reliability and normative reference values. One hundred thirty-three subjects were assigned by block randomization to either traditional Army physical training (TT) of calisthenics and running or a novel program (NT) of calisthenics, resistance, aerobic, speed, power, and agility training. The results indicated that between-day reliability was high (intraclass correlation coefficients [ICCs] 3,1; 0.87-0.98) for all measures except for the casualty recovery (ICC 3,1; 0.67). Reliability improved for all the measures that were averaged over 3 trials (ICC 3,3; 0.93-0.95). The NT was superior to TT in improving bench press (8 vs. 3%; p < 0.01), medicine ball put (7 vs. 1%; p < 0.01), 30-m rush times (5 vs. 1%; p < 0.01), and casualty recovery times (17 vs. -15%; p < 0.01). These findings suggest that a short-term physical training program is effective in improving strength, power, and speed among previously conditioned men. Future studies should determine if similar training programs mitigate the injury risk in this population.

Loss of upper extremity motion caused by axillary burn scar contracture is a major complication of burn injury. Positioning acutely injured patients with axillary burns in positions above 90° of shoulder abduction may improve shoulder motion and minimize scar contracture. However, these positions may increase injury risk to the nerves of the brachial plexus. This study evaluated the occurrence of paresthesias, pain, and positional intolerance in four shoulder abduction positions in healthy adults. Sixty men and women were placed in four randomly assigned shoulder abduction positions for up to 2 hours: 1) 90° with elbow extension (90 ABD); 2) 130° with elbow flexion at 110° (130 ABD); 3) 150° with elbow extension (150 ABD); and 4) 170° with elbow extension (170 ABD). Outcome measures were assessed at baseline and every 30 minutes and included the occurrence of upper extremity paresthesias, position comfort/tolerance, and pain. Transient paresthesias, lasting less than 3 minutes, occurred in all test positions in 10 to 37% of the cases. Significantly fewer subjects reported paresthesias in the 90 ABD position compared with the other positions (P < .01). Pain was reported more frequently in the 170° position (68%) compared with the other positions (P < .01). Positioning with the elbow flexed or in terminal extension is not recommended, regardless of the degree of shoulder abduction. Positioning patients in a position of 150° of shoulder abduction was shown to be safe and well tolerated. Consideration of positions above this range should be undertaken cautiously and only with strict monitoring in alert and oriented patients for short time periods.