Postural Motor Activation Deficits After mTBI; Translating Laboratory Findings to Clinical Care
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Laurie A King, PhD
- Phone Number: 503-418-2602
- Email: kingla@ohsu.edu
Study Contact Backup
- Name: Maggie E Stojak, MS
- Phone Number: 971-420-4351
- Email: concussionresearch@ohsu.edu
Study Locations
-
-
Oregon
-
Portland, Oregon, United States, 97239
- OHSU Balance Disorders Laboratory
-
Contact:
- Maggie Stojak, MS
- Phone Number: 971-420-4351
- Email: stojak@ohsu.edu
-
Contact:
- Laurie King, PhD, PT, MCR
- Phone Number: 503-418-2602
- Email: kingla@ohsu.edu
-
Principal Investigator:
- Laurie King, PhD, PT, MCR
-
-
Utah
-
Salt Lake City, Utah, United States, 84106
- University of Utah Neuromechanics and Applied Locomotion Laboratory
-
Contact:
- Chloe Adler
- Email: chloe.adler@utah.edu
-
Contact:
- Peter Fino, PhD
- Phone Number: (801) 410-0875
- Email: peter.fino@utah.edu
-
Sub-Investigator:
- Peter Fino, PhD
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Diagnosed mTBI (concussion)
- 18-60 years of age
- More than 2 weeks from the date of the most recent mTBI
- Less than 6 months from the most recent mTBI
- Persisting symptoms from the mTBI
Exclusion Criteria:
- Injury, medical, or neurological illness that could explain balance issues
- Moderate to severe substance abuse in the past month
- Display behavior that would interfere with safety during data collection
- Significant pain during the study period (> 7/10)
- Pregnancy
- Persistent use of medications that cause balance impairment during the study
- Active in physical therapy services for mTBI symptoms
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Participants with motor physical therapy for mTBI
Participants in this arm of the study will receive physical therapy focused on reactive and dynamic balance exercises to improve motor activation for stability.
|
The motor activation program will complete approximately 12 rehabilitation sessions involving a novel physical therapy program with exercises targeted to improve dynamic and reactive balance.
|
|
Active Comparator: Standard of care physical therapy treatment for mTBI
This arm of the study will receive physical therapy in accordance with current clinical practice guidelines for mTBI treatment.
|
This arm of the study will complete approximately 12 rehabilitation sessions involving the the current clinical practice guidelines for mTBI treatment including exercises for aerobic tolerance, neck pain, balance, and movement.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Instrumented, Modified Push & Release Test (I-mP&R) - Time to Stability
Time Frame: Weeks 0 and 7 of study
|
The Instrumented, Modified Push & Release (I-mP&R) test quantifies reactive balance and motor activation by measuring the time required to regain stability following a controlled loss of balance.
Participants are leaned just beyond their limit of stability, instructed to close their eyes, and then released unexpectedly.
Wearable inertial sensors placed on the lumbar spine and bilateral feet are used to determine the instant of release and the first instant of stability, defined as lumbar acceleration magnitude less than 1.07 times gravity and angular velocity magnitude less than 14 degrees per second.
The test is performed in four directions (forward, backward, left, right), and the median Time to Stability across all directions is retained as the primary outcome.
|
Weeks 0 and 7 of study
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Patient Global Impression of Change (PGIC)
Time Frame: Week 7 only
|
A single-item, seven-point Likert scale in which participants rate their perceived overall change in health status following intervention.
Scores range from 1 (no change) to 7 (a great deal of change).
|
Week 7 only
|
|
Dizziness Handicap Inventory (DHI)
Time Frame: Weeks 0 and 7
|
A 25-item self-report questionnaire assessing the self-perceived dizziness-related problems.
Items are scored from 0 to 4, where 0 indicates no problems, and 4 indicates problems occurring always.
Total scores range from 0-100, with higher scores indicating greater perceived dizziness-related problems.
|
Weeks 0 and 7
|
|
Neurobehavioral Symptom Inventory (NSI)
Time Frame: Weeks 0 and 7
|
A 22-item self-report questionnaire assessing the severity of post-concussive symptoms.
Each item is rated from 0 (none) to 4 (very severe), with higher total scores indicating greater symptom burden.
|
Weeks 0 and 7
|
|
Quality of Life after Brain Injury (QOLIBRI)
Time Frame: Weeks 0 and 7
|
A 37-item questionnaire assessing quality of life across six domains including cognition, emotions, daily life and autonomy, social relationships, feelings, and physical problems.
Scores are transformed to a 0-100 scale, with higher scores indicating better quality of life.
|
Weeks 0 and 7
|
|
Activities-specific Balance Confidence Scale (ABC)
Time Frame: Weeks 0 and 7
|
A self-report questionnaire that assesses an individual's confidence in performing 16 everyday activities without losing balance or becoming unsteady.
Each item is rated from 0% (no confidence) to 100% (complete confidence).
The total score is calculated as the mean of all items, with lower scores indicating reduced balance confidence.
|
Weeks 0 and 7
|
|
PROMIS - Satisfaction with Participation in Social Roles
Time Frame: Weeks 0 and 7
|
A self-report questionnaire assessing participants' perceived satisfaction with their ability to engage in usual social roles and activities over the past 7 days.
Items are rated on a Likert scale, with higher scores indicating greater satisfaction with participation.
|
Weeks 0 and 7
|
|
Generalized Anxiety Disorder-7 (GAD-7)
Time Frame: Weeks 0 and 7
|
A 7-item self-report questionnaire used to assess the severity of anxiety symptoms over the past two weeks.
Each item is scored on a 4-point Likert scale from 0 (not at all) to 3 (nearly every day), with total scores ranging from 0 to 21.
Higher scores indicate greater severity of anxiety symptoms.
|
Weeks 0 and 7
|
|
Modified Clinical Test of Sensory Integration on Balance (mCTSIB)
Time Frame: Weeks 0 and 7
|
This test assesses the relative contributions of visual, vestibular, and somatosensory inputs to postural control during standing.
Participants stand with feet together under four conditions: eyes open on a firm surface, eyes closed on a firm surface, eyes open on a foam surface, and eyes closed on a foam surface.
Performance is evaluated based on the ability to maintain balance for up to 30 seconds per condition.
When wearable sensors are used, postural sway measures may also be derived.Total time across all conditions is recorded, with longer durations indicating better balance performance.
|
Weeks 0 and 7
|
|
Complex Turning Course (CTC)
Time Frame: Weeks 0 and 7
|
Evaluates walking performance along a prescribed path involving multiple turns of 135, 90, and 45 degree angles.
When wearable sensors are used, spatiotemporal gait, and/or postural sway measures may also be derived.Lap completion time and total completion time are recorded.
|
Weeks 0 and 7
|
|
Complex Uneven Turning Course (CUTC)
Time Frame: Weeks 0 and 7
|
A clinical mobility assessment designed to evaluate walking and turning performance under increased balance demands.
Participants walk a prescribed path involving multiple turns of 45, 90, 135 degree angles on an uneven walking surface.
When wearable sensors are used, spatiotemporal gait, and/or postural sway measures may also be derived.Performance is quantified using completion time, with faster times indicating better mobility and balance performance.
|
Weeks 0 and 7
|
|
10-Meter Walk Test (10MWT)
Time Frame: Weeks 0 and 7
|
A clinical assessment of gait speed measured over a 10-meter level walkway at a self-selected pace.
Time is recorded after the participants foot crosses two meters and is recording is stopped after the participant crosses 8 meters.
When wearable sensors are used, spatiotemporal gait, and/or postural sway measures may also be derived.
Three trials are completed
|
Weeks 0 and 7
|
|
Timed Tandem Gait
Time Frame: Weeks 0 and 7
|
A clinical assessment requiring heel-to-toe walking along a 3-meter line with the goal of keeping heel and toe together and not stepping off the line as accurately and quickly as possible.
Once the participant crosses the end of the 3 m line, they quickly turn 180° and return to the starting point using the same gait.
When wearable sensors are used, spatiotemporal gait, and/or postural sway measures may also be derived.
Time to completion is recorded, with shorter times indicating better performance.
|
Weeks 0 and 7
|
|
Dynamic Visual Acuity (DVA)
Time Frame: Weeks 0 and 7
|
This test assesses gaze stability during active head movements by measuring the loss of visual acuity relative to static visual acuity.
Participants read an eye chart (ETDRS in this study) while performing horizontal head rotations at a standardized frequency.
The change in the number of lines read compared to static visual acuity is recorded, with a loss of three or more lines considered clinically significant.
Smaller losses indicate better vestibulo-ocular function.
|
Weeks 0 and 7
|
|
Vestibular Ocular Motor Screening (VOMS)
Time Frame: Weeks 0 and 7
|
A clinician-administered screening tool that evaluates symptom provocation associated with vestibular and ocular motor function.
Baseline symptoms (headache, dizziness, nausea, fogginess) are rated on a 0-10 scale.
After each task (smooth pursuits, saccades, near point of convergence, vestibulo-ocular reflex, and visual motion sensitivity), participants re-rate symptoms on the same scale.
Total and change scores are calculated, with higher scores indicating greater symptom provocation.
|
Weeks 0 and 7
|
|
Hybrid Assessment of Mobility (HAM-4)
Time Frame: Weeks 0 and 7
|
A performance-based mobility assessment that combines multiple challenging gait and balance tasks, including fast walking, backward walking, pivot turn, and walking with head turns.
Performance is scored across four components, with a maximum total score of 14.
When wearable sensors are used, spatiotemporal gait, and/or postural sway measures may also be derived.Higher scores indicate better overall mobility and balance performance.
|
Weeks 0 and 7
|
|
Automated Neuropsychological Assessment Metric (ANAM)
Time Frame: Weeks 0 and 7
|
A computerized neurocognitive assessment battery used to evaluate cognitive domains commonly affected following mild traumatic brain injury, including attention, processing speed, working memory, and reaction time.
The assessment is administered on a computer or tablet, and performance metrics are automatically recorded.
Higher scores and faster reaction times generally indicate better cognitive performance, depending on the specific subtest.
|
Weeks 0 and 7
|
|
Gold-Standard Laboratory Assessments: Central Sensorimotor Integration Test (CSMI)
Time Frame: Weeks 0 and 7
|
A laboratory-based balance assessment using pseudorandom stimuli including surface and/or visual tilt to quantify sensory weighting, motor activation parameters (stiffness and damping), and feedback time delay during standing balance.
|
Weeks 0 and 7
|
|
Patient Health Questionnaire-2 (PHQ-2)
Time Frame: Weeks 0 and 7
|
A 2-item self-report questionnaire used to assess the severity of depressive symptoms over the past two weeks.
Each item is scored on a 3-point Likert scale from 0 (not at all) to 3 (nearly every day), yielding a total score range of 0 to 6. Higher scores indicate greater severity of depressive symptoms.
|
Weeks 0 and 7
|
|
Brief Resilience Scale (BRS)
Time Frame: Weeks 0 and 7
|
A 6-item self-report questionnaire designed to assess an individual's ability to recover or "bounce back" from stress.
Items are rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).
Scores are averaged across items, with higher scores indicating greater resilience.
|
Weeks 0 and 7
|
|
Neck Disability Index (NDI)
Time Frame: Weeks 0 and 7
|
A 10-item self-report questionnaire that assesses neck-related disability during daily activities.
Each item is scored from 0 (no disability) to 5 (complete disability), resulting in a total score ranging from 0 to 50.
Higher scores indicate greater neck-related disability.
Scores may also be expressed as a percentage of the maximum score.
|
Weeks 0 and 7
|
|
Convergence Insufficiency Symptom Survey (CISS)
Time Frame: Weeks 0 and 7
|
A 15-item self-report questionnaire assessing symptoms associated with convergence insufficiency during near-vision activities.
Each item is rated on a 5-point Likert scale from 0 (never) to 4 (always), with total scores ranging from 0 to 60. Higher scores indicate greater symptom severity, and scores of 21 or higher are suggestive of convergence insufficiency.
|
Weeks 0 and 7
|
|
Fear Avoidance after Concussion Tool (FACT)
Time Frame: Weeks 0 and 7
|
A 28-item self-report questionnaire that assesses fear-avoidance beliefs and behaviors related to physical activity, symptom exacerbation, and return to activity following concussion.
The measure evaluates the extent to which individuals avoid movement or activities due to fear of worsening symptoms or re-injury.
Higher scores indicate greater fear-avoidance.
|
Weeks 0 and 7
|
|
Modified Fatigue Impact Scale (MFIS)
Time Frame: Weeks 0 and 7
|
A self-report questionnaire that assesses the perceived impact of fatigue on physical, cognitive, and psychosocial functioning over the past 4 weeks.
The scale consists of 21 items rated on a Likert scale from 0 (never) to 4 (almost always).
Total scores range from 0 to 84, with higher scores indicating greater fatigue impact.
|
Weeks 0 and 7
|
|
Lower Extremity Functional Scale (LEFS)
Time Frame: Weeks 0 and 7
|
A self-report questionnaire assessing perceived difficulty performing everyday activities that require lower extremity function.
The scale consists of 20 items; each scored from 0 (extreme difficulty or unable to perform activity) to 4 (no difficulty).
Total scores range from 0 to 80, with higher scores indicating better lower extremity function.
|
Weeks 0 and 7
|
|
Dual-Task Questionnaire (DTQ)
Time Frame: Weeks 0 and 7
|
A self-report measure with 10 items assessing participants' perceived difficulty performing activities that require simultaneous motor and cognitive demands (dual-tasking) in daily life.
Items are scored from 0 (never) to 4 (very often and there is also the ability to select no applicable (N/A).
Participants are asked to rate how challenging it is to walk, balance, or move while performing an additional cognitive task (e.g., talking, thinking, or concentrating).
Higher scores indicate greater perceived dual-task difficulty.
|
Weeks 0 and 7
|
|
Balance Recovery Confidence (BRC) Scale
Time Frame: Weeks 0 and 7
|
A self-report questionnaire that assesses an individual's confidence in their ability to recover balance to prevent a fall across a range of everyday situations.
The scale consists of 19 scenario-based items, each describing a potential loss-of-balance situation (e.g., slips, trips, perturbations during walking or standing).
Participants rate their confidence in recovering balance for each scenario on an 11-point numeric scale from 0 to 10, where 0 indicates cannot do at all, and 10 indicates highly certain can do.
Total and average scores are calculated, with higher scores indicating greater balance recovery confidence.
|
Weeks 0 and 7
|
|
Uneven 10-Meter Walk Test (U10MWT)
Time Frame: Weeks 0 and 7
|
Evaluates walking performance over a 10-meter uneven walking surface.
Participants are instructed to walk at a self-selected comfortable pace.
Performance is quantified using the time required to complete the walkway, with shorter times indicating better gait performance under increased balance demands.
Time is recorded after the participants foot crosses two meters and is recording is stopped after the participant crosses 8 meters.
When wearable sensors are used, spatiotemporal gait, and/or postural sway measures may also be derived.
Three trials are completed.
|
Weeks 0 and 7
|
|
1-Minute Walk Test (1MWT)
Time Frame: Weeks 0 and 7
|
An over-ground walking performance and functional mobility; Participants are instructed to walk continuously for one minute at a self-selected comfortable pace along a defined walking course.
Performance is quantified using distance walked during the one-minute period.
When wearable sensors are used, spatiotemporal gait, and/or postural sway measures may also be derived.
Greater distance indicates better walking performance.
|
Weeks 0 and 7
|
|
1-Minute Walk Dual-Task (Serial 3s)
Time Frame: Weeks 0 and 7
|
Assesses walking performance under divided attention.
Participants are instructed to walk continuously for one minute at a self-selected comfortable pace while simultaneously performing a cognitive task consisting of serial subtraction by 3's.
Walking performance is quantified using distance covered during the one-minute period.
When wearable sensors are used, spatiotemporal gait, and/or postural sway measures may also be derived.
Reduced walking distance and/or altered gait parameters reflect greater dual-task interference.
|
Weeks 0 and 7
|
|
The Visual Vertigo Analogue Scale-6 (VVAS-6)
Time Frame: Week 0 and Week 7
|
A self-report questionnaire that assesses how dizzy a person would feel in different situations.
The participant is asked to rate how dizzy they would feel from 0-10.
This questionnaire is six items and there is also an option to select that the situation would not apply to the participant as well.
A higher score indicates more impairment with total score ranging from 0-60, those that score 37 and above are considered to have vestibular impairment.
|
Week 0 and Week 7
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Laurie A King, PhD, PT, MCR, Oregon Health and Science University
- Principal Investigator: Peter Fino, PhD, University of Utah
Study record dates
Study Major Dates
Study Start (Estimated)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- IRB#28652
- HT9425-25-1-0748 (Other Grant/Funding Number: Department of the Army)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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