Tele-Rehabilitation to Improve Mild Traumatic Brain Injury Recovery and Reduce Subsequent Injury Risk

Tele-Rehabilitation to Improve Mild Traumatic Brain Injury Recovery and Reduce Subsequent Injury Risk

Tele-Rehabilitation to Improve Mild Traumatic Brain Injury Recovery and Reduce Subsequent Injury Risk

The goal of this clinical trial is to examine the feasibility, utility, and efficacy of a smartphone-based assessment battery and remotely administered virtual Neuromuscular/Dual-Task (vNDT) intervention among healthy U.S. military service members and physically active young adults with a recent concussion.

Aim 1. Determine the baseline neuromuscular/dual-task performance characteristics among a sample of active-duty military service members compared to physically active young adult civilians. The investigators hypothesize that active-duty military service members will have similar baseline gait and dual-task abilities as civilians, demonstrating translation potential between populations. The investigators also hypothesize that baseline gait and dual-task abilities will be influenced by history of prior mTBI injuries among military Service Members. Aim 2. Examine the efficacy of a smartphone-based vNDTT intervention to reduce musculoskeletal injury and improve neuromuscular/dual-task performance after a recent mTBI. The investigators hypothesize that those randomized to the intervention within three weeks of mTBI will have a lower risk of MSK injury in the 3-month period following mTBI, relative to standard-of-care. The investigators also hypothesize that those randomized to the intervention within three weeks of mTBI will have better post-intervention gait and dual-task performance than those assigned to standard-of-care, despite similar baseline performance.

Participants will enroll and undergo initial testing within three weeks of mTBI, be randomized to an 8-week vNDTT or standard-of-care intervention, return for post-intervention testing, and be monitored for subsequent MSK injuries in the three months after mTBI

The study PI, Co-Is, and the biostatistician will not know group assignments until after the primary analyses are complete.

The vNDTT strategy incorporates lower body strength exercises with landing stabilization focus. Exercises will begin after the initial study visit and last for 8 weeks.

Participants will be provided routine instructions related to physical activity and rehabilitation exercises

The vNDTT strategy incorporates lower body strength exercises with landing stabilization focus. Exercises will begin after the initial study visit and last for 8 weeks.

Virtually logging a training session on the smartphone application (# of sessions logged/planned sessions

During the initial (post-injury) evaluation and again at the follow-up (8 weeks after initial evaluation) test

During the initial (post-injury) evaluation and again at the follow-up (8 weeks after initial evaluation) test

During the initial (post-injury) evaluation and again at the follow-up (8 weeks after initial evaluation) test

During the initial (post-injury) evaluation and again at the follow-up (8 weeks after initial evaluation) test

During the initial (post-injury) evaluation and again at the follow-up (8 weeks after initial evaluation) test

Inclusion Criteria: 18-40 years of age at the time of enrollment Mild TBI or concussion diagnosis by a physician Confirmed MTBI diagnosis via VA/DOD guidelines at time of enrollment Participation in regular physical activity prior to injury (confirmed via the Global Physical Activity Questionnaire [GPAQ]) (Cleland et al., 2014; Keating et al., 2019) Access to a smartphone for app download Exclusion Criteria: Moderate or severe TBI Pre-injury neurological disorder Abnormal brain imaging findings (if performed as a part of routine care) Previous TBI (mild/moderate/severe) <12 months prior to enrollment other than the current injury for which they are being seen