Romeas Thomas, Greffou Selma, Allard Remy, Forget Robert, McKerral Michelle, Faubert Jocelyn, Gagnon Isabelle
Faubert Laboratory, École d'Optométrie, Université de Montréal, Montréal, QC, Canada.
Institut National du Sport du Québec, Montréal, QC, Canada.
Front Neurol. 2021 Nov 25;12:596615. doi: 10.3389/fneur.2021.596615. eCollection 2021.
Motor control deficits outlasting self-reported symptoms are often reported following mild traumatic brain injury (mTBI). The exact duration and nature of these deficits remains unknown. The current study aimed to compare postural responses to static or dynamic virtual visual inputs and during standard clinical tests of balance in 38 children between 9 and 18 years-of-age, at 2 weeks, 3 and 12 months post-concussion. Body sway amplitude (BSA) and postural instability (vRMS) were measured in a 3D virtual reality (VR) tunnel (i.e., optic flow) moving in the antero-posterior direction in different conditions. Measures derived from standard clinical balance evaluations (BOT-2, Timed tasks) and post-concussion symptoms (PCSS-R) were also assessed. Results were compared to those of 38 healthy non-injured children following a similar testing schedule and matched according to age, gender, and premorbid level of physical activity. Results highlighted greater postural response with BSA and vRMS measures at 3 months post-mTBI, but not at 12 months when compared to controls, whereas no differences were observed in post-concussion symptoms between mTBI and controls at 3 and 12 months. These deficits were specifically identified using measures of postural response in reaction to 3D dynamic visual inputs in the VR paradigm, while items from the BOT-2 and the 3 timed tasks did not reveal deficits at any of the test sessions. PCSS-R scores correlated between sessions and with the most challenging condition of the BOT-2 and as well as with the timed tasks, but not with BSA and vRMS. Scores obtained in the most challenging conditions of clinical balance tests also correlated weakly with BSA and vRMS measures in the dynamic conditions. These preliminary findings suggest that using 3D dynamic visual inputs such as optic flow in a controlled VR environment could help detect subtle postural impairments and inspire the development of clinical tools to guide rehabilitation and return to play recommendations.
轻度创伤性脑损伤（mTBI）后，常出现持续时间超过自我报告症状的运动控制缺陷。这些缺陷的确切持续时间和性质尚不清楚。本研究旨在比较38名9至18岁儿童在脑震荡后2周、3个月和12个月时，对静态或动态虚拟视觉输入以及在标准临床平衡测试中的姿势反应。在不同条件下，在前后方向移动的3D虚拟现实（VR）隧道（即视觉流）中测量身体摆动幅度（BSA）和姿势不稳定性（vRMS）。还评估了从标准临床平衡评估（BOT-2，定时任务）和脑震荡后症状（PCSS-R）得出的指标。将结果与38名健康未受伤儿童在类似测试计划下的结果进行比较，并根据年龄、性别和病前身体活动水平进行匹配。结果显示，与对照组相比，mTBI后3个月时，BSA和vRMS测量的姿势反应更大，但12个月时没有差异，而在3个月和12个月时，mTBI组和对照组的脑震荡后症状没有差异。这些缺陷是通过VR范式中对3D动态视觉输入的姿势反应测量专门确定的，而BOT-2和3项定时任务中的项目在任何测试环节都未显示出缺陷。PCSS-R分数在各测试环节之间以及与BOT-2最具挑战性的条件以及定时任务相关，但与BSA和vRMS无关。在临床平衡测试最具挑战性条件下获得的分数与动态条件下的BSA和vRMS测量也弱相关。这些初步研究结果表明，在受控的VR环境中使用3D动态视觉输入，如视觉流，可能有助于检测细微的姿势损伤，并激发临床工具的开发，以指导康复和重返比赛建议。
