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Dynamic Visual Stimulations Produced in a Controlled Virtual Reality Environment Reveals Long-Lasting Postural

Thomas Romeas1,2, Selma Greffou1, Remy Allard1

  • 1Faubert Laboratory, École d'Optométrie, Université de Montréal, Montréal, QC, Canada.

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Summary

Children with mild traumatic brain injury (mTBI) show subtle postural control deficits for up to 3 months post-injury, detectable with virtual reality (VR) optic flow. These impairments resolve by 12 months, suggesting VR can identify issues missed by standard tests.

Keywords:
balancechildrenmild traumatic brain injury (mTBI)perception-action couplingpostural instabilitysensorimotor controlvirtual reality

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Area of Science:

  • Neuroscience
  • Biomechanics
  • Rehabilitation Medicine

Background:

  • Motor control deficits can persist after mild traumatic brain injury (mTBI), even when self-reported symptoms resolve.
  • The duration and specific nature of these post-mTBI motor deficits remain unclear, particularly in pediatric populations.
  • Standard clinical balance assessments may not fully capture subtle, lingering impairments following mTBI.

Purpose of the Study:

  • To compare postural responses to virtual reality (VR) visual stimuli and standard balance tests in children with mTBI.
  • To determine the time course of postural control deficits at 2 weeks, 3 months, and 12 months post-mTBI.
  • To investigate the utility of VR-based optic flow paradigms for detecting subtle balance impairments.

Main Methods:

  • Thirty-eight children (9-18 years) with mTBI and 38 age/gender-matched controls were assessed at multiple time points.
  • Postural responses were measured using body sway amplitude (BSA) and postural instability (vRMS) in a 3D VR optic flow tunnel.
  • Standard clinical balance tests (BOT-2, timed tasks) and post-concussion symptom scales (PCSS-R) were also administered.

Main Results:

  • Children with mTBI exhibited significantly greater postural sway (BSA, vRMS) at 3 months post-injury compared to controls.
  • These VR-detected postural deficits were not evident at 12 months post-mTBI, nor were differences in self-reported symptoms.
  • Standard clinical balance tests (BOT-2, timed tasks) did not reveal significant deficits at any assessment point.

Conclusions:

  • Dynamic 3D visual stimuli (optic flow) in VR can detect subtle, transient postural impairments following pediatric mTBI.
  • VR-based assessments may offer a more sensitive measure of motor recovery than standard clinical balance tests.
  • These findings suggest VR could aid in guiding rehabilitation and return-to-play decisions after mTBI.