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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.
Insights
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.
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.
Abstract:
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.
