Original Research ARTICLE
Comprehensive evaluation of healthy volunteers using multi-modality brain injury assessments: an exploratory, observational study
- 1Intermountain Healthcare, United States
- 2Emmes Corporation, United States
- 3Evans Army Community Hospital, United States
- 4Lovelace Respiratory Research Institute, United States
Introduction: Even though mild traumatic brain injury is common and can result in persistent symptoms, traditional measurement tools can be insensitive in detecting functional deficits after injury. Some newer assessments do not have well-established norms, and little is known about how these measures perform over time or how cross-domain assessments correlate with one another. We conducted an exploratory pilot study to measure the distribution, stability, and correlation of results from assessments used in mild traumatic brain injury in healthy, community-dwelling adults.
Materials and Methods: In this prospective cohort study, healthy adult men and women without a history of brain injury underwent a comprehensive brain injury evaluation that included self-report questionnaires and neurological, electroencephalography, sleep, audiology/vestibular, autonomic, visual, neuroimaging, and laboratory testing. Most testing was performed at 3 intervals over 6 months.
Results: The study enrolled 83 participants, and 75 were included in the primary analysis. Mean age was 38 years, 58 were male, and 53 were civilians. Participants did not endorse symptoms of post-concussive syndrome, PTSD, or depression. Abnormal neurological examination findings were rare, and 6 had generalized slowing on electroencephalography. Actigraphy and sleep diary showed good sleep maintenance efficiency, but 21 reported poor sleep quality. Heart rate variability was most stable over time in the sleep segment. Dynavision performance was normal, but 41 participants had abnormal ocular torsion. On eye tracking, circular, horizontal ramp, and reading tasks were more likely to be abnormal than other tasks. Most participants had normal hearing, videonystagmography, and rotational chair testing, but computerized dynamic posturography was abnormal in up to 21% of participants. Twenty-two participants had greater than expected white matter changes for age by MRI. Most abnormal findings were dispersed across the population, though a few participants had clusters of abnormalities.
Conclusions: Despite our efforts to enroll normal, healthy volunteers, abnormalities on some measures were surprisingly common.
Keywords: concussion, mild traumatic brain injury, healthy control subjects, neurological examination, Electroencephaloagraphy (EEG), eye tracking, Neuroimaging, Heart rate variability, balance, Hearing, Actigraphy
Received: 24 Aug 2018;
Accepted: 15 Nov 2018.
Edited by:Tracey Weiland, The University of Melbourne, Australia
Reviewed by:Tom M. McMillan, University of Glasgow, United Kingdom
George A. Jelinek, The University of Melbourne, Australia
Copyright: © 2018 Weaver, Wilson, Lindblad, Churchill, Deru, Price, Williams, Orrison, Patel, Walker, Meehan and Mirow. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr. Lindell K. Weaver, Intermountain Healthcare, Salt Lake City, United States, firstname.lastname@example.org