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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.

This study describes concussions and concussion-related outcomes sustained by high school soccer players by head impact location, sex, and injury mechanism. Data were obtained for the 2012/13-2015/16 school years from the National High School Sports-Related Injury Surveillance System, High School RIO™. This Internet-based sports injury surveillance system captures data reported by athletic trainers from an annual average of 162 US high schools. Data were analyzed to describe circumstances of soccer concussion (e.g., symptomology, symptom resolution and return-to-play time) by impact location [i.e., front- (face included), back-, side-, and top-of-the-head] and sex. Most concussions were from front-of-the-head impacts (boys: 30.5%; girls: 34.0%). Overall, 4.1±2.2 and 4.6±2.3 symptoms were reported in boys and girls, respectively. In boys, symptom frequency was not associated with head impact location (P=0.66); an association was found in girls (p=0.02), with the highest symptom frequency reported in top-of-the-head impacts (5.4±2.2). Head impact location was not associated with symptom resolution time (boys P=0.21; girls P=0.19) or return-to-play time (boys P=0.18; girls P=0.07). Heading was associated with 28.0% and 26.5% of concussions in boys and girls, respectively. Most player-player contact concussions during heading occurred from side-of-the-head impacts (boys: 49.4%; girls: 43.2%); most heading-related ball contact concussions occurred from front-of-the-head (boys: 41.4%; girls: 42.6%) and top-of-the-head (boys: 34.5%; girls: 36.9%) impacts. Head impact location was generally independent of symptom resolution time, return-to-play time, and recurrence among high school soccer concussions. However, impact location may be associated with reported symptom frequency. Further, many of these clinical concussion descriptors were associated with sex.