Postural Motor Activation Deficits After mTBI; Translating Laboratory Findings to Clinical Care

This work will address an important gap in physical therapy rehabilitation after concussion. Physical therapy usually focuses on how the brain processes sensory information such as inner ear and vision for balance rehabilitation, but our recent research shows that people with imbalance more often have a problem with how they can respond to imbalance (i.e., motor activation). While there are complex laboratory tools to test motor activation for balance, these tests are not practical for the clinic. Our goal is to create both an exercise intervention focused on motor activation after concussion and simple, but objective and instrumented (wearable sensors), clinical measures of motor activation. Objectives: This research study has three aims. 1) We will develop an exercise program to improve the problems with how one's body responds to imbalance (i.e., improve motor activation) after a concussion. We will do this using a Community Based Participatory Research (CBPR) approach by collaborating with a team of people with a broad range of experience related to concussion. We will include patients who have had a concussion, healthcare professionals with expertise in concussion, and healthcare administrators. This group will contain people working in the military and civilians. 2) We will compare our new motor-focused physical therapy intervention to the standard sensory focused balance intervention. We will determine which intervention program is more effective in treating balance problems after a concussion. We hypothesize that the motor-focused program will help patients more compared to the sensory program. 3) We will create and test several balance tests that can be used in the clinical without expensive research equipment to our standard research-based motor activation tests. This aim will allow us to determine if the clinical tests perform as well as the research-grade tests. To make the test useful to clinicians, we will use simpler technology like smart-phone applications, wearable sensors, and virtual reality goggles that are both affordable and practical for healthcare providers.

Inclusion Criteria: To participate in the randomized controlled trial, participants may be either civilians, active-duty military, or Veterans, and must: 1) have a diagnosis of mTBI based upon VA/DoD criteria (Centers for Disease Control and Prevention, 2015; Woodson, 2015), 2) be between 18-60 years old, 3) be outside of the acute stage (\> 2 weeks post-mTBI) but within 6 months of their most recent mTBI and still reporting symptoms. Exclusion Criteria: * For all Aims: Participants must not: 1) have had or currently have any other injury, medical, or neurological illness that could potentially explain balance deficits (e.g., CNS disease, stroke, greater than mild TBI, lower extremity amputation, recent lower extremity or spine orthopedic injury) 2) meet criteria for moderate to severe substance-use disorder within the past month, as defined by DSM-V, 3) display behavior that would significantly interfere with validity of data collection or safety during study, 4) be in significant pain during the evaluation (\> 7/10 by patient subjective report), 5) be a pregnant female (balance considerations), 6) be unable to abstain in the use of medications that might impair their balance for 24 hours in advance of testing, or 7) be actively enrolled in ongoing physical therapy services for their mTBI.