Balance disorder after traumatic brain injury : A multifactorial observational study.

This research was undertaken to improve the assessment and treatment of balance disorder after Traumatic Brain Injury (TBI). It had three aims: to identify factors that have shaped healthcare practice concerning balance disorder and describe barriers to improved practice•; to develop understanding of the nature of TBI balance disorder; to establish proposals for an improved healthcare response for those with balance disorder following TBI. TBI is a significant cause of disability in the young adult population and problems with balance are consistently reported. A mixed methods approach was employed to address the aims within a common framework. This comprised a series of subject reviews, an observational study and a systematic analysis of emergent findings. Topics for the subject reviews were chosen for their relevance to TBI physiotherapy practice. The observational study involved 27 participants in the recovery and rehabilitation phase after TBI and was structured using a new comprehensive assessment protocol developed from first principles. Findings were explored using frequency analysis and thematic analysis generated from the development of individual participant narratives. Emergent topics were then considered with reference to the literature, existing theories and concepts of postural control. Different conceptualisations of balance were identified, influenced by discipline tradition, their evidence base, the evolution of ideas, and past and current purpose. Practice development was constrained by the lack of a comprehensive conceptualisation of human balance, inconsistent and fragmented service response and limited knowledge concerning the nature and prevalence of impairments affecting balance function after TBI. Balance disorder was found to be highly prevalent and multifactorial in nature. New sensorimotor characteristics of TBI balance disorder were identified, including observations of importance to the contentious debate concerning symptomatic minor TBI. Issues of key importance in the structure and process of assessment were also identified. Balance disorder is prevalent in the rehabilitation and recovery phase following TBI and is multifactorial in nature. Assessment and treatment of suspected balance disorder could be enhanced by the adoption of a single comprehensive conceptualisation of human balance, a systematic approach to assessment and formulation of causal hypotheses and a service process focused on the functional requirements of individuals. Research for the enhanced development of assessment and intervention strategies should also be pursued in the same context.