Exploring persistent complaints of imbalance after mTBI: Oculomotor, peripheral vestibular and central sensory integration function

Article type: Research Article

Authors: Campbell, Kody R.^{a; *} | Parrington, Lucy^a | Peterka, Robert J.^b | Martini, Douglas N.^c | Hullar, Timothy E.^{b; d} | Horak, Fay B.^a | Chesnutt, James C.^e | Fino, Peter C.^f | King, Laurie A.^a

Affiliations: [a] Department of Neurology, Oregon Health and Science University, Portland, OR, USA | [b] National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, OR, USA | [c] Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA | [d] Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA | [e] Departments of Family Medicine, Neurology, and Orthopedics & Rehabilitation, Oregon Health and Science University, Portland, OR, USA | [f] Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA

Correspondence: [*] Corresponding author: Kody R. Campbell, PhD, Department of Neurology, School of Medicine, Oregon Health and Science University, 3222 SW Research Dr, Portland, OR 97239, USA. Tel.: +503 418 2602; Fax: +503 346 8195; E-mail: campbeko@ohsu.edu.

Abstract: BACKGROUND:Little is known on the peripheral and central sensory contributions to persistent dizziness and imbalance following mild traumatic brain injury (mTBI). OBJECTIVE:To identify peripheral vestibular, central integrative, and oculomotor causes for chronic symptoms following mTBI. METHODS:Individuals with chronic mTBI symptoms and healthy controls (HC) completed a battery of oculomotor, peripheral vestibular and instrumented posturography evaluations and rated subjective symptoms on validated questionnaires. We defined abnormal oculomotor, peripheral vestibular, and central sensory integration for balance measures among mTBI participants as falling outside a 10-percentile cutoff determined from HC data. A X-squared test associated the proportion of normal and abnormal responses in each group. Partial Spearman’s rank correlations evaluated the relationships between chronic symptoms and measures of oculomotor, peripheral vestibular, and central function for balance control. RESULTS:The mTBI group (n = 58) had more abnormal measures of central sensory integration for balance than the HC (n = 61) group (mTBI: 41% –61%; HC: 10%, p’s < 0.001), but no differences on oculomotor and peripheral vestibular function (p > 0.113). Symptom severities were negatively correlated with central sensory integration for balance scores (p’s < 0.048). CONCLUSIONS:Ongoing balance complaints in people with chronic mTBI are explained more by central sensory integration dysfunction rather than peripheral vestibular or oculomotor dysfunction.

Keywords: Peripheral vestibular function, oculomotor function, central sensory integration, postural control, mild traumatic brain injury

DOI: 10.3233/VES-201590

Journal: Journal of Vestibular Research, vol. 31, no. 6, pp. 519-530, 2021