AD AWARD NUMBER: W81XWH-08-2-0188 TITLE: Disequilibrium after Traumatic Brain Injury: Vestibular Mechanisms PRINCIPAL INVESTIGATOR: Mark Walker, M.D. CONTRACTING ORGANIZATION: Case Western Reserve University Cleveland, OH 44106 REPORT DATE: September 2009 TYPE OF REPORT: Annual PREPARED FOR: U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland 21702-5012 DISTRIBUTION STATEMENT: Approved for Public Release; Distribution Unlimited The views, opinions and/or findings contained in this report are those of the author(s) and should not be construed as an official Department of the Army position, policy or decision unless so designated by other documentation.
REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE 2. REPORT TYPE 1 September 2009 Annual 3. DATES COVERED 1 Sep 2008 31 Aug 2009 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Disequilibrium after Traumatic Brain Injury: Vestibular Mechanisms 5b. GRANT NUMBER W81XWH-08-2-0188 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER Mark Walker, M.D. 5e. TASK NUMBER E-Mail: mark.walker@case.edu 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER Case Western Reserve University Cleveland, OH 44106 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR S ACRONYM(S) U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland 21702-5012 11. SPONSOR/MONITOR S REPORT NUMBER(S) 12. DISTRIBUTION / AVAILABILITY STATEMENT Approved for Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT The purpose of this study is to investigate mechanisms of disequilibrium and imbalance in veterans of Operation Enduring Freedom / Operation Iraqi Freedom who have experienced mild traumatic brain injury (mtbi). Chronic dizziness is a common symptom in these veterans and also in civilians after head injury, but the cause is not known. Our hypothesis is that damage to vestibular reflexes involving inner ear otolith organs (sensors of gravity and linear motion) and/or their brain connections are involved. To test this hypothesis, we are measuring vestibular and balance function in veterans with mtbi and comparing them to control subjects. In the first year of this study, we have set up our experimental protocols and have recruited and tested several subjects. Each of the two mtbi subjects that we have tested so far demonstrated otolith vestibulo-ocular reflexes that were lower than we have found in prior studies of normal subjects without vestibular problems. This finding is supportive of our hypothesis, but there are not yet sufficient data to make definitive conclusions. 15. SUBJECT TERMS Traumatic brain injury, balance, locomotion, vestibular, eye movements 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT a. REPORT U b. ABSTRACT U 18. NUMBER OF PAGES c. THIS PAGE U UU 10 19a. NAME OF RESPONSIBLE PERSON USAMRMC 19b. TELEPHONE NUMBER (include area code) Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std. Z39.18
! #! # # % &!! (
)! # % &! ( # ) ++,. ++,.. ++/ % ( ( &! # 00 1! &! # (!! 0 2# ) 34 5 ) 6 7 )852% ( ( 4!! (!!. 1 &(
)+ 4.9 : 3 2 5 &. 4 : 4 #! ; 1! # 5 5 2 0 0 (! ( & # ( 3 2! <! (! 3 2 = ++>! #!! & (! 1 3 2 (!! & 0! # +? +? 3 2( &! (!! # % & & ( )! # % & + & %, + % %, + +?
4.9 : Α # 5 &! &!! (!! # 6 & 3 2(! ( & < ( &! # (!! & & (! ( & # & ( + + & %, % & % % + & (!! #! & <! & 4 Β!!? &! #!! &! (!! # (!!!! # &!. &! ( & #! #! # +! # %, +! #
/ & +!0# %, +!,# % (. ( % & & & & & (! ( & # 1 2 + & %, + & 0 3 & %, + + Χ
4.9?: 3 2 4 5 = & (. 1 & +,, 1 ( & 4 ( & : 1 4! &!(! # (! 1 (! 1! 0 ( ( &!! &!! # %! 5 7 2 ( 4?.?( ++/( 9 ) ( 5 4!! # 4 & (! ( (! Β ( ( (
. / )01 # :!, :,:,,?+( ++, / 0 2 / 3 / 2 31 3 >Χ: : ΧΧ? Χ ( ++> / 4,/ 2 1 ) 0 00 :, :,:,?,?,( ++, 1 >/: /: />+ // ( ++/,
) 5, 667/ / 8 % % 9 5 & 1 & ) 1 2 6 2 9. : 8 # ( &! (! (! % Ε ΧΕ!! 00. ( ( ++, ) ( ( ++, ( (! Φ! & 7 ( ( ++! # (! & # ( ( ++? (! 9 ( ( ++ 8 # ( &! 1 ( ( : 3! # # ( 3! # (? 3! # (! 3! ( : (!! 3 2(! (!! ( (!! ( ( & 5Α & 1! (! (!!! 3 2! :!! # 1!!! &! 6. 4 5 2 5 ) 1> Γ17 +> + >> 8 3 4 >