Factors associated with balance deficits on admission to rehabilitation after traumatic brain injury: A multicenter analysis

Objective: To evaluate how demographics, measures of injury severity, and a cute care complications relate to sitting and standing balance in patients with traumatic brain injury (TBI). Design: Multicenter analysis of consecut ive admissions to designated TBI Model Systems of Care (TBIMS). Setting: Te n National Institute for Disability and Rehabilitation Research TBI Model S ystem centers for coordinated acute and rehabilitation care. Participants: 908 adults with TBI were included in the study. Main Outcome Measures: Sitt ing and standing balance were assessed within 72 hours of admission to inpa tient rehabilitation. Results: Age less than 50 years had a significant ass ociation with normal sitting and standing balance (P = .001 and .05, respec tively). Measures of severity of traumatic brain injury, including admissio n Glasgow Coma Score, length of posttraumatic amnesia ( PTA), Length of com a, and acute care length of stay were each significantly related to impaire d sitting and standing balance ratings (P < .01). Initial abnormalities in pupillary response had a significant relationship with impairment of sittin g (P = .009) but not standing balance. Incidence of respiratory failure, pn eumonia, soft tissue infections, and urinary tract infections were all rela ted to impaired sitting balance (P < .01). Presence of intracranial hemorrh ages did not have a significant relationship with either sitting or standin g balance. Intracranial compression had a significant relationship with sta nding (P = .05) but not sitting balance. A discriminant function analysis, which included neuroradiological findings, injury severity, and medical com plications, could not accurately predict impaired balance ratings. Conclusi ons: This study demonstrated that rehabilitation admission balance ratings have a significant relationship with age, multiple measures of severity, an d acute care medical complications after TBI. Prospective studies are indic ated to evaluate the role balance at rehabilitation admission plays in the functional prognosis of patients with TBI.