Characterizing Clinical Presentations following Mild Traumatic Brain Injury: Mechanisms of Injury and Dizziness Subtypes
Date
2024-01-22
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Abstract
This MSc thesis explores clinical presentations following mild Traumatic Brain Injury (mTBI) and includes two studies. The first study evaluates the association between symptom severity score, Vestibular Ocular Motor Screen, vestibulo-ocular reflex (VOR), oculomotor, and cervical spine function and 1) mTBI mechanism and 2) sport type in 98 youth (6-17 years) presenting to acute mTBI clinics (Calgary and Montreal sites). Forty-six males and 55 females sustained a non-sport related concussion (nSRC; n= 18) or sport-related concussion (SRC; n= 80), in contact sport (n=62), or non-contact sport (n=18). No statistically significant differences were found in any outcome by mTBI mechanism. Athletes injured in non-contact sport had a 12.69 (95% CI: 2.38-78.79) times higher odds of abnormal VOR gain compared to those in contact sport. Future research is warranted, including comparison to pre-injury status, to better understand the mechanism driving the differences in VOR by sport type. The second study examines concurrent validity of dizziness subtype classification between a physiotherapist and physician specialist, and test-retest reliability by a physiotherapist in 21 youth and adults diagnosed with SRC. Dizziness subtypes included Benign Paroxysmal Positional Vertigo, Unilateral Peripheral Vestibular Hypofunction, cervicogenic dizziness, centrally mediated dizziness, vestibular migraine, and other. Substantial agreement (k= 0.67, 95% CI 0.35-1.00) was found between the physiotherapist and physician specialist and almost perfect agreement between physiotherapist classifications at the initial and 7-day assessments (k= 1.00, 95% CI 0.56-1.00). At the initial assessment, 71.43% and 35.71% of participants had at least one dizziness subtype categorized as “other” by the physiotherapist and physician specialist, respectively, and multiple dizziness subtypes were selected by both raters for 42.86% of participants. This work will inform the refinement of subtype classification processes, including the addition of potential subtypes to enable further classification. Future research is needed to evaluate a refined version of the subtype classification system in a larger prospective cohort study to further inform dizziness subtype management.
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Keywords
Dizziness, Mild Traumatic Brain Injury, Sport-Related Concussion, Vestibulo-ocular reflex, Cervical spine, Post-traumatic dizziness
Citation
Holte, K. E. (2024). Characterizing clinical presentations following mild traumatic brain injury: mechanisms of injury and dizziness subtypes (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.