Persistent Visual and Vestibular Impairments for Postural Control Following Concussion: A Cross-Sectional Study in University Students.

Abstract

To examine how concussion may impair sensory processing for control of upright stance. Participants were recruited from a single university into 3 groups: 13 participants (8 women, 21 ± 3years) between 2weeks and 6months post-injury who initiated a return-to-play progression (under physician management) by the time of testing (recent concussion group), 12 participants (7 women, 21 ± 1years) with a history of concussion (concussion history group, > 1year post-injury), and 26 participants (8 women, 22 ± 3years) with no concussion history (control group). We assessed sensory reweighting by simultaneously perturbing participants' visual, vestibular, and proprioceptive systems and computed center of mass gain relative to each modality. The visual stimulus was a sinusoidal translation of the visual scene at 0.2Hz, the vestibular stimulus was ± 1mA binaural monopolar galvanic vestibular stimulation (GVS) at 0.36Hz, the proprioceptive stimulus was Achilles' tendon vibration at 0.28Hz. The recent concussion (95% confidence interval 0.078-0.115, p = 0.001) and the concussion history (95% confidence interval 0.056-0.094, p = 0.038) groups had higher gains to the vestibular stimulus than the control group (95% confidence interval 0.040-0.066). The recent concussion (95% confidence interval 0.795-1.159, p = 0.002) and the concussion history (95% confidence interval 0.633-1.012, p = 0.018) groups had higher gains to the visual stimulus than the control group (95% confidence interval 0.494-0.752). There were no group differences in gains to the proprioceptive stimulus or in sensory reweighting. Following concussion, participants responded more strongly to visual and vestibular stimuli during upright stance, suggesting they may have abnormal dependence on visual and vestibular feedback. These findings may indicate an area for targeted rehabilitation interventions.