Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury

Campbell, Kody R.; King, Laurie A.; Parrington, Lucy; Fino, Peter C.; Antonellis, Prokopios; Peterka, Robert J.

doi:10.3389/fneur.2022.897454

Cited by 13 publications

(7 citation statements)

References 71 publications

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“…The motor activation parameters characterize the transformation from the internal sensory-derived estimate of body orientation and motion to the corrective ankle torque needed to resist gravity and stabilize upright stance. These parameters can affect the sensitivity of sway responses to internal and external perturbations to balance ( 25 ). For both parameters, post-hoc comparisons showed significant differences between the VS /EO and SS/EO condition as well as between the VS /EO and SS/EC ones.…”

Section: Resultsmentioning

confidence: 99%

“…A recent study investigating postural deficits in people with chronic mild traumatic brain injury ( 25 ) showed that sensitivity was affected by both sensory weights and by the stiffness factor Kp . In the current study, although mean Kp did not differ between groups there was still variation in Kp within each group that would be expected to influence an individual’s stimulus-evoked sway.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, to test the effect of both the sensory weight and the stiffness factor Kp on the stimulus sensitivity we plotted the stimulus-evoked sway against W*( Kp /( Kp - mgh )) value which includes the contribution of the sensory weight and the influence of the stiffness Kp on overall sensitivity ( 25 ).…”

Section: Methodsmentioning

confidence: 99%

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Postural impairments in unilateral and bilateral vestibulopathy

Corre,

Cugnot,

Boutabla

et al. 2024

Front. Neurol.

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Chronic imbalance is a major complaint of patients suffering from bilateral vestibulopathy (BV) and is often reported by patients with chronic unilateral vestibulopathy (UV), leading to increased risk of falling. We used the Central SensoriMotor Integration (CSMI) test, which evaluates sensory integration, time delay, and motor activation contributions to standing balance control, to determine whether CSMI measures could distinguish between healthy control (HC), UV, and BV subjects and to characterize vestibular, proprioceptive, and visual contributions expressed as sensory weights. We also hypothesized that sensory weight values would be associated with the results of vestibular assessments (vestibulo ocular reflex tests and Dizziness Handicap Inventory scores). Twenty HCs, 15 UVs and 17 BVs performed three CSMI conditions evoking sway in response to pseudorandom (1) surface tilts with eyes open or, (2) surface tilts with eyes closed, and (3) visual surround tilts. Proprioceptive weights were identified in surface tilt conditions and visual weights were identified in the visual tilt condition. BVs relied significantly more on proprioception. There was no overlap in proprioceptive weights between BV and HC subjects and minimal overlap between UV and BV subjects in the eyes-closed surface-tilt condition. Additionally, visual sensory weights were greater in BVs and were similarly able to distinguish BV from HC and UV subjects. We found no significant correlations between sensory weights and the results of vestibular assessments. Sensory weights from CSMI testing could provide a useful measure for diagnosing and for objectively evaluating the effectiveness of rehabilitation efforts and future treatments designed to restore vestibular function such as hair cell regeneration and vestibular implants.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Postural impairments in unilateral and bilateral vestibulopathy

Corre,

Cugnot,

Boutabla

et al. 2024

Front. Neurol.

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“…Altered long-latency trans-cortical responses may be influenced by an inability to appropriately prime a stepping response before the release 31 or an inappropriate motor responses, driven by altered sensory integration and state estimation, after a loss of balance. 14,32 However, such conclusions remain speculative and further research is needed to uncover the mechanisms underlying concussion-related reactive balance impairments.…”

Section: Discussionmentioning

confidence: 99%

Acute and Longitudinal Effects of Sport-related Concussion on Reactive Balance

Monoli,

Morris,

Crofts

et al. 2024

Preprint

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Postural instability is a common observation after concussions, with balance assessments playing a crucial role in clinical evaluations. Widely used post-concussion balance tests focus primarily on static and dynamic balance, excluding the critical aspect of reactive balance. This study investigated the acute and longitudinal effects of concussion on reactive balance in collegiate athletes. The assessments were conducted at pre-season baseline and 4 post-concussion timepoints: acute, pre-return-to-play, post-return-to-play, and six months post-concussion. The instrumented-modified Push and Release test measured reactive balance. Longitudinal effects of concussions on time to stability and step latency metrics were investigated applying Generalized Estimating Equations. Acutely after concussion, athletes demonstrated impaired reactive balance, indicated by longer times to stability, in dual-task conditions (p= 0.004). These acute impairments were transient and recovered over time. Exploratory analyses revealed that athletes who sustained their first lifetime concussion exhibited both acute (p = 0.037) and longitudinal (p = 0.004 at post-return-to-play) impairments in single- and dual-task compared to controls with no lifetime concussion. This comprehensive evaluation provides insights into the multifaceted nature of post-concussion impairments and emphasizes the importance of considering cognitive demand and history of concussions in assessing athletes' balance.

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“…By analogy to standing balance control, body sway variability can arise from sensory, motor, and central processing noise sources but is also influenced by the dynamic properties of the overall control system ( 84 , 85 ). While spontaneous sway variability during stance provides some indication of overall balance system behavior, the application of external perturbations and the use of system identification methods that are appropriate for control systems where feedback plays a major role ( 86 ) can enhance our ability to identify which components of the system are responsible for balance deficits ( 87 ).…”

Section: Discussionmentioning

confidence: 99%

Asymmetry measures for quantification of mechanisms contributing to dynamic stability during stepping-in-place gait

2023

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The goal of this study is to introduce and to motivate the use of new quantitative methods to improve our understanding of mechanisms that contribute to the control of dynamic balance during gait. Dynamic balance refers to the ability to maintain a continuous, oscillating center-of-mass (CoM) motion of the body during gait even though the CoM frequently moves outside of the base of support. We focus on dynamic balance control in the frontal plane or medial–lateral (ML) direction because it is known that active, neurally-mediated control mechanisms are necessary to maintain ML stability. Mechanisms that regulate foot placement on each step and that generate corrective ankle torque during the stance phase of gait are both known to contribute to the generation of corrective actions that contribute to ML stability. Less appreciated is the potential role played by adjustments in step timing when the duration of the stance and/or swing phases of gait can be shortened or lengthened to allow torque due to gravity to act on the body CoM over a shorter or longer time to generate corrective actions. We introduce and define four asymmetry measures that provide normalized indications of the contribution of these different mechanisms to gait stability. These measures are ‘step width asymmetry’, ‘ankle torque asymmetry’, ‘stance duration asymmetry’, and ‘swing duration asymmetry’. Asymmetry values are calculated by comparing corresponding biomechanical or temporal gait parameters from adjacent steps. A time of occurrence is assigned to each asymmetry value. An indication that a mechanism is contributing to ML control is obtained by comparing asymmetry values to the ML body motion (CoM angular position and velocity) at the time points associated with the asymmetry measures. Example results are demonstrated with measures obtained during a stepping-in-place (SiP) gait performed on a stance surface that either remained fixed and level or was pseudorandomly tilted to disturb balance in the ML direction. We also demonstrate that the variability of asymmetry measures obtained from 40 individuals during unperturbed, self-paced SiP were highly correlated with corresponding coefficient of variation measures that have previously been shown to be associated with poor balance and fall risk.

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Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury

Cited by 13 publications

References 71 publications

Postural impairments in unilateral and bilateral vestibulopathy

Postural impairments in unilateral and bilateral vestibulopathy

Acute and Longitudinal Effects of Sport-related Concussion on Reactive Balance

Asymmetry measures for quantification of mechanisms contributing to dynamic stability during stepping-in-place gait

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