Objective Dual-Task Turning Measures for Return-to-Duty Assessment After Mild Traumatic Brain Injury: The ReTURN Study Protocol

Peter C Fino, Margaret M Weightman, Leland E Dibble, Mark E Lester, Carrie W Hoppes, Lucy Parrington, Jorge Arango, Alicia Souvignier, Holly Roberts, Laurie A King, Peter C Fino, Margaret M Weightman, Leland E Dibble, Mark E Lester, Carrie W Hoppes, Lucy Parrington, Jorge Arango, Alicia Souvignier, Holly Roberts, Laurie A King

Abstract

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.

Keywords: concussion; gait; inertial sensors; return to sport (RTS); wearable sensors.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Fino, Weightman, Dibble, Lester, Hoppes, Parrington, Arango, Souvignier, Roberts and King.

Figures

Figure 1
Figure 1
Overview of the three primary clinical turning tasks for this study protocol. Left: The 1-min walk (1MW) test is performed by walking at one's self-selected pace back and forth between two lines for 1 min; turns are assessed at the end of the walk, and all turns are 180°. Center: The modified Illinois Agility Test (mIAT) is a condensed version of the Illinois Agility Test and completed at one's maximum running speed; turns are assessed throughout the course and include 180° turns at the ends and shallower slalom turns in the middle. Right: The custom clinical turning course (CCTC) was designed to fit in a small hallway or large examination room and is completed at one's comfortable walking pace; turns are evaluated throughout the course and include 45°, 90°, and 135° turns representative of daily life.
Figure 2
Figure 2
Overview of the Simulated Urban Patrol (SUP) task. (A) Bird's-eye view of the compartmentalized rooms including one configuration of hostile (red) and friendly (blue) targets. Some targets were configured to require multiple shots to clear; these targets are denoted with three red ***. (B) Example image of a hostile target that required three shots to clear. With each shot, 1/3 of the target's LEDs turn off; participants are instructed to completely clear all LEDs on the hostile targets. (C) Example image of a friendly target turning white when tagged indicating an incorrect shot.

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