Video Head Impulse Test in Survivors From Severe Traumatic Brain Injury: New Perspectives for Implementation of Assessment in Rehabilitation

Objective: This study aims to evaluate vestibular function by instrumental assessment of the angular vestibulo-ocular reflex (aVOR) in survivors from severe traumatic brain injury (sTBI) and analyze related clinical characteristics and functional balance scales. Setting: This study was conducted on inpatients accepted at Santa Lucia Foundation-Neurorehabilitation Hospital for Research and Healthcare (Rome, Italy), from January to September 2023. Participants: Twenty-one survivors from sTBI with a median age of 48 years (IQR = 27) were included in this study, recruited through the neurorehabilitation services. Participants were included if they had a Glasgow Coma Scale Score ≤ 8 at the time of injury, Level of Cognitive Functioning ≥ 7, static and dynamic balance impairments, ability to understand verbal commands, and Functional Ambulation Classification > 3. Design: Cross-sectional study. Main measures: Two expert physiotherapists performed an aVOR assessment using the video Head ImpulseTest by both head impulse and suppression paradigms. Furthermore, all participants completed a balance assessment using the Berg Balance Scale and the Mini-Balance Evaluation Systems Test (Mini-BESTest) scale. Descriptive statistical analyses were performed, and the relationship between aVOR function and balance outcomes was investigated. Results: Nineteen participants (90%) displayed aVOR with an abnormal gain at least in 1 canal. Thirty percent of all canals analyzed had abnormal gains, with a clear prevalence of the right posterior canal (71%), which presents aVOR gain lower than the functional threshold on average (mean 0.70; CI, 0.62-0.78). No correlations were found between the aVOR gain and the clinical outcome measure scores. Conclusion: Low aVOR gains were evident in people who experienced sTBI. A comprehensive evaluation of the vestibular peripheral system may detect vestibular impairments in these patients that may otherwise be unrecognized.