Application of a Novel Integrated Interdisciplinary Habituation Training Program to Address mTBI-Associated Vestibular, Visual, and Auditory System Disturbances

Research Objectives: To describe a novel interdisciplinary habituation program and application in rehabilitation from symptoms of chronic mild traumatic brain injury (mTBI).

Design: Descriptive

Setting: Shepherd Center’s SHARE Military Initiative (SHARE) in Atlanta, Georgia, USA, a comprehensive rehabilitation program for service members and veterans with symptoms of traumatic brain injury.

Participants: Twenty-two military service members and veterans, ages 31–61, with chronic mTBI who participated in a novel, integrated interdisciplinary habituation training program as part of their treatment at SHARE.

Interventions: An interdisciplinary habituation training program collaboratively created by physical therapists, occupational therapists, and speech-language pathologists to offer an integrated approach to addressing symptoms associated with hypersensitivity to stimuli following TBI.

Main Outcome Measures: Changes in symptoms were measured pre/post intervention using the Habituation Rating Scale (HRS), an outcome measure created by SHARE clinicians to assess changes in a variety of symptoms SHARE participants report as commonly occurring during community activities. Changes in dizziness, headache, and balance pre/post intervention were also evaluated via the Dizziness Handicap Inventory (DHI), Visual Vertigo Analog Scale (VVAS), Headache Impact Test (HIT-6), Functional Gait Assessment (FGA), and Sensory Organization Test (SOT).

Results: The most frequently reported symptoms pre-intervention were headache and feeling irritated. Feeling anxiety, overwhelmed, and irritated received the highest average severity ratings pre-intervention and demonstrated the greatest reduction post-intervention. Activities identified as most symptom provoking pre-intervention were being a passenger in a car, being at a social gathering with lots of background noise, and being in a crowded environment in the community, which along with walking through a supermarket, demonstrated the greatest reduction post-intervention. Post-intervention improvements in symptoms and function were also demonstrated on standardized clinical measures of dizziness, visual vertigo, headache, functional gait, and sensory organization.

Conclusions: Interdisciplinary habituation training is feasible and may lead to reduced activity-based symptom provocation in people with a history of mTBI. Future research should include a larger, controlled trial to establish efficacy as well as validation of the HRS.

Author(s) Disclosures: The authors have nothing to disclose.