Brain Balance Study

A moderate traumatic brain injury (TBI) occurring in early or middle adulthood might have long-lasting effects on the brain that can accelerate the decline of physical and cognitive function in older age. The proposed study seeks to better understand the implications of aging with a TBI, in order to help Veterans maintain their health and independence. The overarching hypothesis of this new line of research is that participants who experienced a moderate TBI in early or middle adulthood (at least 15 years prior to study enrollment) will have poorer performance on balance and cognitive tests, despite self-reporting no persistent motor or cognitive impairment from the TBI. The investigators also seek to evaluate the potential for practice-based learning and improvement of complex balance tasks in this population, to gain experience for conducting future rehabilitation studies. The long term goal of this line of research is to design rehabilitative and lifestyle interventions to preserve brain health and function in Veterans who have previously experienced a TBI.

Inclusion Criteria:Enrollment Criteria for Participant with TBI (TBI+ group) Inclusion criteriaAge 50-65. People of this age normally do not exhibit substantial balance or cognitive impairments, so observing a clear deficit between groups will provide compelling evidence of a TBI-related effect. This "younger old" age group will also help to avoid other comorbid health conditions of older age that would increase variability (uncertainty) in the data set.Prior history of moderate closed-head TBI at least 15 years prior to study enrollment. Single or multiple TBIs are acceptable. All participants who self-report a prior TBI will complete a standardized interview called the Ohio State University TBI Identification Method (OSU TBI-ID) to characterize and confirm the occurrence of a prior moderate TBI. Moderate TBI will be defined as any of the following:loss of consciousness from 30 minutes to 24 hoursand/or alteration of consciousness/mental state for greater than 24 hoursand/or post-traumatic amnesia for >1 to <7 daysand/or abnormal structural imaging confirmed by medical recordsAffirmative response to the question: "At the present time, do you consider yourself to be fully recovered from the TBI?"Score on the Activities Specific Balance Confidence Scale of 90 or higher (out of 100 possible points), which indicates absence of self-reported balance/mobility deficits.Score of 19 or higher on the telephone version of the Montreal Cognitive Assessment, which indicates absence of major cognitive impairment.living in the community and able to travel to the research siteExclusion Criteria:Enrollment Criteria for Participant with TBI (TBI+ group) Exclusion criteriaNeurological injury or disease other than prior history of moderate TBICurrent clinically significant post-traumatic stress disorder (PCL score >30)severe arthritis, such as awaiting joint replacement, that would interfere with participation balance/mobility tasksCurrent substance abuseCurrent uncontrolled major depressive episode, history of severe psychiatric illness unrelated to TBI (e.g., bipolar 1 or schizophrenia).severe obesity (body mass index > 35)unstable cardiovascular disease (for example, recent angina or uncontrolled high blood pressure)lung disease requiring use of supplemental oxygenrenal disease requiring dialysisserious uncontrolled diabetesterminal illnessmyocardial infarction or major heart surgery in the previous yearcancer treatment in the past year, except for nonmelanoma skin cancers and cancers having an excellent prognosis (e.g., early stage breast or prostate cancer)uncontrolled hypertension at rest (systolic > 180 mmHg and/or diastolic > 100 mmHg)bone fracture in the previous yearhip joint replacement or metal implants that would preclude accurate assessment of lean mass or hip bone mineral densityUse of any pharmacologic agents (within past 180-days) that are known to influence BMD, including anti-resorptive or bone anabolic therapies, any compounded or over-the-counter androgenic hormone or androgen precursor, clomiphene, aromatase inhibitors, anti-estrogen or estrogen treatment, or growth hormone?Chronic use of systemic glucocorticoids >7.5 mg/d prednisone equivalent (e.g., hydrocortisone 30 mg, methylprednisolone 6 mg, or dexamethasone 1.2 mg)current participation in physical therapy for lower extremity functioncurrent enrollment in a clinical trial that might jeopardize safety or scientific integrity of either trialunable to communicate sufficiently with study personnel, and/or non-English speakingother medical conditions other that would adversely affect balance, cognition, or oculomotor function.clinical judgment of investigative team regarding safety or non-compliance.