Preliminary Evidence for Improvement in Symptoms, Cognitive, Vestibular, and Oculomotor Outcomes Following Targeted Intervention with Chronic mTBI Patients

Introduction: To determine if targeted, active interventions would improve symptoms and impairment in previously intractable patients with chronic mild traumatic brain injury (mTBI). Materials and Methods: Twenty-six (20 males; 6 females) out of 51 (51%) former military and civilian patients with chronic (1-3 yr) mTBI enrolled in the TEAM traumatic brain injury (TBI) study completed both an initial and 6-mo post-intervention comprehensive mTBI assessment including symptoms (Post-concussion Symptom Scale [PCSS], Dizziness Handicap Inventory [DHI]), cognitive (Immediate Post-concussion Assessment and Cognitive Testing [ImPACT]), vestibular/oculomotor (Vestibular/Ocular Motor Screening [VOMS]), balance (Activities-specific Balance Confidence [ABC] scale, Balance Error Scoring System [BESS]), and cervical (Neck Disability Index [NDI]). Patients were prescribed progressive, targeted interventions and therapies (e.g., behavioral, vestibular, vision, and exertion) that matched their mTBI clinical profile. A series of paired t-tests adjusted for multiple corrections were used to compare pre- and post-intervention assessment scores. Results: Patients demonstrated significant improvement from pre-to post-intervention on total symptoms (t = 2.69, p = 0.01), verbal memory (t = -1.96, p = 0.05), ABC balance score (t = -2.05, p = 0.05), smooth pursuits (t = 2.32, p = 0.04), near-point convergence distance (t = -3.58, p = 0.01), vestibular ocular reflex (t = 2.31, p = 0.03), and visual motion sensitivity (t = 2.43, p = 0.03). Conclusions: Previously recalcitrant patients with chronic complex mTBI demonstrated significant improvement in symptoms, cognitive, vestibular, oculomotor, and balance function following targeted interventions.