Assessing motor impairment of the trunk in patients with traumatic brain injury: reliability and validity of the Trunk Impairment Scale

Verheyden, G., Hughes, J., Jelsma, J., Nieuwboer, A. and De Weerdt, W. (2006) Assessing motor impairment of the trunk in patients with traumatic brain injury: reliability and validity of the Trunk Impairment Scale. South African Journal of Physiotherapy, 62 (2), 23-28.

Abstract

Traumatic Brain Injury (TBI) is a significant cause of morbidity in the South African context (Reed and Welsh, 2002). Although statistics regarding TBI in South Africa are limited, a study in Johannesburg in 1991 recorded an incidence of 316 TBI patients per 100,000 inhabitants annually (Nell and Brown, 1991).
Following TBI, there is often an associated loss of trunk control and balance (Davies, 1994) which are considered as some of the most disabling aspects following TBI (Black et al, 1999). Selective trunk control isrequired ffor balance, limb function, gait, respiration and speech (Davies, 1990). Furthermore, sitting balance has been cited as an important predictor of functional outcome following TBI (Black et al, 1991).
The condition of TBI patients is often characterized by poor concentration, attention and memory. These patients are also frequently confused, disoriented and agitated (Sohlberg and Mateer, 1989, Quinn and Sullivan, 2000). It is therefore important that evaluation instrumentw should be brief and not complex. Although an accurate and reliable instrument of trunk function is required to define appropriate aims of rehabilitation (Mazaux, M.L. et al, 2001) there are few instruments that have been developed for measuring this in the TBI population. The Clinical Outcome Scale is a scale which consists of 13 items, one of which assesses sitting balance using a 7-point ordinal scale. In a study of 16 TBI patients, the sitting-balance item was found to be reliable (Low-Choy et al, 2002). The results should be interpreted with caution however, due to the small sample size and the use of intraclass correlation coefficients which may not be the appropriate statistical analysis to evaluate rater-agreement for an ordinal item. The validity of the instrument was not examined.The Trunk Impairment Scale (TIS) was developed by Verheyden et al (2004) as a comprehensive tool to assess impairments in trunk control after a stroke. The TIS contains 3 subsections, which assess static, sitting balance, dynamic sitting balance and trunk co-ordination.

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