Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury
Imbalance is common following mild Traumatic Brain Injury (mTBI) and can persist months after the initial injury. To determine if mTBI subjects with chronic imbalance differed from healthy age- and sex-matched controls (HCs) we used both the Central SensoriMotor Integration (CSMI) test, which evalua...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.897454/full |
| _version_ | 1797990760171175936 |
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| author | Kody R. Campbell Kody R. Campbell Laurie A. King Laurie A. King Lucy Parrington Lucy Parrington Lucy Parrington Peter C. Fino Peter C. Fino Prokopios Antonellis Robert J. Peterka Robert J. Peterka |
| author_facet | Kody R. Campbell Kody R. Campbell Laurie A. King Laurie A. King Lucy Parrington Lucy Parrington Lucy Parrington Peter C. Fino Peter C. Fino Prokopios Antonellis Robert J. Peterka Robert J. Peterka |
| author_sort | Kody R. Campbell |
| collection | DOAJ |
| description | Imbalance is common following mild Traumatic Brain Injury (mTBI) and can persist months after the initial injury. To determine if mTBI subjects with chronic imbalance differed from healthy age- and sex-matched controls (HCs) we used both the Central SensoriMotor Integration (CSMI) test, which evaluates sensory integration, time delay, and motor activation properties and the standard Sensory Organization Test (SOT). Four CSMI conditions evoked center-of-mass sway in response to: surface tilts with eyes closed (SS/EC), surface tilts with eyes open viewing a fixed visual surround (SS/EO), visual surround tilts with eyes open standing on a fixed surface (VS/EO), and combined surface and visual tilts with eyes open (SS+VS/EO). The mTBI participants relied significantly more on visual cues during the VS/EO condition compared to HCs but had similar reliance on combinations of vestibular, visual, and proprioceptive cues for balance during SS/EC, SS/EO, and SS+VS/EO conditions. The mTBI participants had significantly longer time delays across all conditions and significantly decreased motor activation relative to HCs across conditions that included surface-tilt stimuli with a sizeable subgroup having a prominent increase in time delay coupled with reduced motor activation while demonstrating no vestibular sensory weighting deficits. Decreased motor activation compensates for increased time delay to maintain stability of the balance system but has the adverse consequence that sensitivity to both internal (e.g., sensory noise) and external disturbances is increased. Consistent with this increased sensitivity, SOT results for mTBI subjects showed increased sway across all SOT conditions relative to HCs with about 45% of mTBI subjects classified as having an “Aphysiologic” pattern based on published criteria. Thus, CSMI results provided a plausible physiological explanation for the aphysiologic SOT pattern. Overall results suggest that rehabilitation that focuses solely on sensory systems may be incomplete and may benefit from therapy aimed at enhancing rapid and vigorous responses to balance perturbations. |
| first_indexed | 2024-04-11T08:41:36Z |
| format | Article |
| id | doaj.art-ffa3ae596cff4977b9a6de0c638277a2 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-11T08:41:36Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-ffa3ae596cff4977b9a6de0c638277a22022-12-22T04:34:12ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-10-011310.3389/fneur.2022.897454897454Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injuryKody R. Campbell0Kody R. Campbell1Laurie A. King2Laurie A. King3Lucy Parrington4Lucy Parrington5Lucy Parrington6Peter C. Fino7Peter C. Fino8Prokopios Antonellis9Robert J. Peterka10Robert J. Peterka11Department of Neurology, Oregon Health and Science University, Portland, OR, United StatesNational Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, OR, United StatesDepartment of Neurology, Oregon Health and Science University, Portland, OR, United StatesNational Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, OR, United StatesDepartment of Neurology, Oregon Health and Science University, Portland, OR, United StatesNational Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, OR, United StatesDepartment of Dietetics, Human Nutrition and Sport, La Trobe University, Melbourne, VIC, AustraliaDepartment of Neurology, Oregon Health and Science University, Portland, OR, United StatesDepartment of Health and Kinesiology, University of Utah, Salt Lake City, UT, United StatesDepartment of Neurology, Oregon Health and Science University, Portland, OR, United StatesDepartment of Neurology, Oregon Health and Science University, Portland, OR, United StatesNational Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, OR, United StatesImbalance is common following mild Traumatic Brain Injury (mTBI) and can persist months after the initial injury. To determine if mTBI subjects with chronic imbalance differed from healthy age- and sex-matched controls (HCs) we used both the Central SensoriMotor Integration (CSMI) test, which evaluates sensory integration, time delay, and motor activation properties and the standard Sensory Organization Test (SOT). Four CSMI conditions evoked center-of-mass sway in response to: surface tilts with eyes closed (SS/EC), surface tilts with eyes open viewing a fixed visual surround (SS/EO), visual surround tilts with eyes open standing on a fixed surface (VS/EO), and combined surface and visual tilts with eyes open (SS+VS/EO). The mTBI participants relied significantly more on visual cues during the VS/EO condition compared to HCs but had similar reliance on combinations of vestibular, visual, and proprioceptive cues for balance during SS/EC, SS/EO, and SS+VS/EO conditions. The mTBI participants had significantly longer time delays across all conditions and significantly decreased motor activation relative to HCs across conditions that included surface-tilt stimuli with a sizeable subgroup having a prominent increase in time delay coupled with reduced motor activation while demonstrating no vestibular sensory weighting deficits. Decreased motor activation compensates for increased time delay to maintain stability of the balance system but has the adverse consequence that sensitivity to both internal (e.g., sensory noise) and external disturbances is increased. Consistent with this increased sensitivity, SOT results for mTBI subjects showed increased sway across all SOT conditions relative to HCs with about 45% of mTBI subjects classified as having an “Aphysiologic” pattern based on published criteria. Thus, CSMI results provided a plausible physiological explanation for the aphysiologic SOT pattern. Overall results suggest that rehabilitation that focuses solely on sensory systems may be incomplete and may benefit from therapy aimed at enhancing rapid and vigorous responses to balance perturbations.https://www.frontiersin.org/articles/10.3389/fneur.2022.897454/fullmTBIconcussionsensory integrationbalancevestibularvision |
| spellingShingle | Kody R. Campbell Kody R. Campbell Laurie A. King Laurie A. King Lucy Parrington Lucy Parrington Lucy Parrington Peter C. Fino Peter C. Fino Prokopios Antonellis Robert J. Peterka Robert J. Peterka Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury Frontiers in Neurology mTBI concussion sensory integration balance vestibular vision |
| title | Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury |
| title_full | Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury |
| title_fullStr | Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury |
| title_full_unstemmed | Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury |
| title_short | Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury |
| title_sort | central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury |
| topic | mTBI concussion sensory integration balance vestibular vision |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.897454/full |
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