44.9.2. Balance
The four TBI subjects were tested on the NeuroCom CDP Sensory Organization Test (SOT) before and after the week of twice-daily interventions. The SOT is an objective, automated measure of sensory-motor integration that evaluates the functional contribution of the somatosensory, visual, and vestibular components of balance. A composite score is calculated and compared with a database normalized for age and height. Sample pre- and postintervention scores are shown in Figure 44.8 for the latter two subjects in this cohort. The composite scores for all four subjects are summarized in Figure 44.9.
Figure 44.9
Summary of results from Computerized Dynamic Posturography SOT. Changes greater than 5 points are considered clinically significant improvement. SOT score below the age corrected norm marked in red color, SOT above the norm is marked in green color. Blue (more...)
44.9.3. Cognitive Functions
Additionally, TBI subjects C and D were tested for changes in cognitive function, memory, attention, and mood both before the 5-day intervention began, and within 24 hours of completing the training. Their primary indications and scores on the Brief Repeatable Battery of Neuropsychological Tests (Boringa et al., 2001; Portaccio et al., 2010; Strauss, 2006) are summarized in Tables 44.5 and 44.6, and the attendant lists below each indicate the symptoms and changes.
Table 44.5
Cognitive Tests, Subject C
Table 44.6
Cognitive Tests, Subject D
1. Subject given 12 words in 24 seconds, then must recall them in any order within 60 seconds.
2. Recall of original 12 words 15 minutes later.
3. Recall position of 10 checkers on 6 x 6 board after viewing for 10 seconds.
4. Number of correctly matched digits to unfamiliar systematic symbolic code in 90 seconds.
5. Paced arithmetic serial addition test; successive entry every 3 seconds.
6. Paced arithmetic serial addition test; successive entry every 2 seconds.
7. Spontaneous production of names of a given category within 90 seconds.
8. Beck Depression Inventory; self-report that measures symptoms of depression.
Symptoms: pre-CN-NINM intervention
Difficulties with concentration, emotions, and physical fatigue
Slow and stuttered speech (significant dysarthria and expressive aphasia)
Diplopia and blurred vision
Frequent vertigo and loss of balance in crowded places and between store aisles
Problems with attention span, sustained and divided attention (low scores on word span on Symbol-Digit and Paced Audio Serial Addition Tests)
Depression and emotional instability from chronic disability
Results: posttraining
Showed statistically and clinically relevant improvement on most of the tests after 1 month.
Verbal and visual were retrieval intact.
After almost 5 years staying at home unable to do anything but simple tasks, she was able to go shopping, go to appointments, cook meals, and participate in family conversations.
Symptoms: preintervention
Hypersensitivity to sounds, light, motion, or to objects or people moving in environment.
Felt very tired, constant muscle aches because of cocontraction and aberrant neuromotor pattern, frequently had to lie down in complete isolation for at least 30 minutes.
Showed significant attention impairment (low numbers on all tests).
Moderate depression on depression scale, frequent crying.
Both receptive and expressive aphasia, difficulty participating in conversations.
Dysarthria; difficulty pronouncing even single-syllable words, stutters.
Results: posttraining
After very first balance training with PoNS regained balance; after 5 days of intensive training was able to jog, walk, and stand with eyes closed.
Showed significant improvement on all tests, no signs of depression.
Now working again nearly full-time as a nurse-midwife, and is biking, jogging, singing, cooking, and traveling with her family.
All subjects anecdotally reported progressive improvements in eye movement, short-term memory, executive function, and mood elevation. Additionally, subjects C and D noted significant and progressive reductions in both expressive aphasia and social anxiety.