CHANGES IN FUNCTIONAL AND PHYSICAL STATUS INDICATORS IN MILITARY PERSONNEL WITH ASTHENIC AND AUTONOMIC DYSFUNCTION FOLLOWING TRAUMATIC BRAIN INJURY AFTER A PHYSICAL THERAPY PROGRAM
DOI:
https://doi.org/10.67034/2786-8354.2026.20.2.03Keywords:
physical therapy; asthenia; traumatic brain injury; brain pathology; military personnel; combat-related injury; balance disordersAbstract
Introduction. To evaluate changes in functional status indicators in military personnel with asthenic and autonomic dysfunction following traumatic brain injury under the influence of a physical therapy program.
Materials and Methods. The study involved 96 male servicemen of the Armed Forces of Ukraine. The comparison group consisted of 33 apparently healthy individuals. The main group included 63 military personnel with mild traumatic brain injury in the recovery period, who were randomly assigned to two groups. Participants in the first main group underwent physical therapy according to standard rehabilitation approaches for traumatic brain injury. For participants in the second main group, a comprehensive physical therapy program was developed, including functional training, balance exercises, oculomotor training, vestibular stimulation, proprioceptive training elements, psychophysical relaxation, and the use of a visual biofeedback system. Functional status was assessed using the Functional Movement Screen, Modified Clinical Test of Sensory Interaction on Balance, Y-Balance Test, Upper Quarter Y-Balance Test, Rivermead Post-Concussion Symptoms Questionnaire, and Dizziness Handicap Inventory.
Results. Military personnel with traumatic brain injury demonstrated impairments in functional movement control, sensory integration, postural stability, and dynamic balance accompanied by pronounced post-concussion and vestibular symptoms. The total Functional Movement Screen score in the main groups was more than twofold lower than that of apparently healthy individuals, amounting to 9 [8; 10] and 9 [8; 9] points, respectively. The most pronounced balance impairments were observed during the Modified Clinical Test of Sensory Interaction on Balance performed under conditions of an unstable support surface and visual deprivation. Following completion of physical therapy, positive changes in functional indicators were observed in both main groups; however, greater improvements were identified in participants of the second main group. In this group, the total Functional Movement Screen score increased by 100%, performance in the Modified Clinical Test of Sensory Interaction on Balance under the most challenging sensory conditions improved by 55.6%, whereas the reduction in the total Rivermead Post-Concussion Symptoms Questionnaire score and Dizziness Handicap Inventory scores exceeded 50% of baseline values. Statistically significant correlations were identified between indicators of functional movement control, sensory integration, dynamic balance, and the severity of post-concussion and vestibular manifestations.
Conclusions. Asthenic and autonomic dysfunction following traumatic brain injury in military personnel is associated with complex impairments in sensory integration, postural control, and functional movement control. The implementation of a comprehensive physical therapy program provides greater improvements in functional status and dynamic balance, as well as a more pronounced reduction in post-concussion and vestibular manifestations, compared with standard physical therapy approaches.
References
1. Aljabri, A., Halawani, A., Ashqar, A., Alageely, O., & Alhazzani, A. (2024). The Efficacy of Vestibular Rehabilitation Therapy for Mild Traumatic Brain Injury: A Systematic Review and Meta-analysis. The Journal of head trauma rehabilitation. 39(2): E59–E69. https://doi.org/10.1097/HTR.0000000000000882
2. Alsalaheen, B. A., Mucha, A., Morris, L. O., Whitney, S. L., Furman, J. M., Camiolo-Reddy, C. E., Collins, M. W., Lovell, M. R., & Sparto, P. J. (2010). Vestibular rehabilitation for dizziness and balance disorders after concussion. Journal of neurologic physical therapy. 34(2): 87–93. https://doi.org/10.1097/NPT.0b013e3181dde568
3. Campbell, K. R., Wilhelm, J. L., Antonellis, P., Scanlan, K. T., Pettigrew, N. C., Martini, D. N., Chesnutt, J. C., & King, L. A. (2023). Assessing the Effects of Mild Traumatic Brain Injury on Vestibular Home Exercise Performance with Wearable Sensors. Sensors (Basel, Switzerland). 23(24): 9860. https://doi.org/10.3390/s23249860
4. Eapen, B. C., Bowles, A. O., Sall, J., Lang, A. E., Hoppes, C. W., Stout, K. C., Kretzmer, T., & Cifu, D. X. (2022). The management and rehabilitation of post-acute mild traumatic brain injury. Brain injury. 36(5): 693–702. https://doi.org/10.1080/02699052.2022.2033848
5. Guskiewicz, K. M., Ross, S. E., & Marshall, S. W. (2001). Postural Stability and Neuropsychological Deficits After Concussion in Collegiate Athletes. Journal of athletic training. 36(3): 263–273.
6. Khanyukova, I, Hondulenko, N, Sanina, N. (2024). Disability of military personnel in Ukraine for 2014-2022. Medical Perspectives. 29(4): 184–192. https://doi.org/10.26641/2307-0404.2024.4.319362
7. Kim, S. Y., Yeh, P. H., Ollinger, J. M., Morris, H. D., Hood, M. N., Ho, V. B., & Choi, K. H. (2023). Military-related mild traumatic brain injury: clinical characteristics, advanced neuroimaging, and molecular mechanisms. Translational psychiatry. 13(1): 289. https://doi.org/10.1038/s41398-023-02569-1
8. Kovalets, R.I., Aravitska, M.G, & Ilnytskyi, N.R. (2025). Correction of signs of astheno-vegetative syndrome, psycho-emotional state and sleep quality by means of physical therapy in military personnel with consequences of traumatic brain injury and complicated bruxism. Rehabilitation and Recreation. 19(4): 19-28. https://doi.org/10.32782/2522-1795.2025.19.4.2
9. Leddy, J. J., Baker, J. G., & Willer, B. (2016). Active Rehabilitation of Concussion and Post-concussion Syndrome. Physical medicine and rehabilitation clinics of North America. 27(2): 437–454. https://doi.org/10.1016/j.pmr.2015.12.003
10. Quatman-Yates, C. C., Hunter-Giordano, A., Shimamura, K. K., Landel, R., Alsalaheen, B. A., Hanke, T. A., & McCulloch, K. L. (2020). Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury. The Journal of orthopaedic and sports physical therapy. 50(4): CPG1–CPG73. https://doi.org/10.2519/jospt.2020.0301
11. Rakaieva, A.E., & Aravitska M.G. (2024) Study of the effectiveness of rehabilitation intervention for the correction of symptoms of asteno-vegetative syndrome in elderly persons with the consequences of coronavirus infection. Rehabilitation and Recreation. 18(3): 41-50. DOI: https://doi.org/10.32782/2522-1795.2024.18.3.4
12. Rakaieva, A.E., & Aravitska, M.G. (2024). Correction of the geriatric status associated with impaired muscle activity in the elderly with post-COVID-19 syndrome by physical therapy means. Ukraine. Nation's Health. 1: 172–178. https://doi.org/10.32782/2077-6594/2024.1/30
13. Reid, S. A., Farbenblum, J., & McLeod, S. (2022). Do physical interventions improve outcomes following concussion: a systematic review and meta-analysis?. British journal of sports medicine. 56(5): 292–298. https://doi.org/10.1136/bjsports-2020-103470
14. Silverberg, N. D., Iaccarino, M. A., Panenka, W. J., Iverson, G. L., McCulloch, K. L., Dams-O'Connor, K., Reed, N., McCrea, M., & American Congress of Rehabilitation Medicine Brain Injury Interdisciplinary Special Interest Group Mild TBI Task Force (2020). Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines. Archives of physical medicine and rehabilitation. 101(2): 382–393. https://doi.org/10.1016/j.apmr.2019.10.179
15. Teare-Ketter, A., LaForme Fiss, A., & Ebert, J. (2021). The Utility of Neuromotor Retraining to Augment Manual Therapy and Vestibular Rehabilitation in a Patient with Post-Concussion Syndrome: A Case Report. International journal of sports physical therapy. 16(1): 248–258. https://doi.org/10.26603/001c.18823
