Development of a Portable Tool for Screening Neuromotor Sequelae From Repetitive Low-Level Blast Exposure.

Blast exposure is a prevalent cause of mild traumatic brain injury (mTBI) in military personnel in combat. However, it is more common for a service member to be exposed to a low-level blast (LLB) that does not result in a clinically diagnosable mTBI. Recent research suggests that repetitive LLB exposure can result in symptomology similar to symptoms observed after mTBI. This manuscript reports on the use of an Android-based smartphone application (AccWalker app) to capture changes in neuromotor functioning after blast exposure. Active duty U.S. Navy personnel (N = 59) performed a stepping-in-place task before repetitive LLB exposure (heavy weapons training), and again immediately after, 24 hours after, and 72 to 96 hours after the completion of the training. The AccWalker app revealed that there are changes in neuromotor functioning after LLB exposure (slower self-selected movement pace and increased stride time variability) in participants who experienced neurocognitive decline. These data suggest that neurocognitive and neuromotor decline can occur after repeated LLB exposure.

Sensitivity of the Balance Error Scoring System and the Sensory Organization Test in the Combat Environment.

This study evaluated the utility of the Balance Error Scoring System (BESS) and the Sensory Organization Test (SOT) as tools for the screening and monitoring of Service members (SMs) with mild traumatic brain injury (mTBI) in a deployed setting during the acute and subacute phases of recovery. Patient records (N = 699) were reviewed for a cohort of SMs who sustained a blast-related mTBI while deployed to Afghanistan and were treated at the Concussion Restoration Care Center (CRCC) at Camp Leatherneck. On initial intake into the CRCC, participants completed two assessments of postural control, the BESS, and SOT. SMs with mTBI performed significantly worse on the BESS and SOT when compared with comparative samples. When the SOT data were further examined using sensory ratios, the results indicated that postural instability was primarily a result of vestibular and visual integration dysfunction (r > 0.62). The main finding of this study was that the sensitivity of the SOT composite score (50-58%) during the acute phase was higher than previous sensitivities found in the sports medicine literature for impact-related trauma.