Moving Sounds Increase Postural Visual Dependence in Adults With Chronic Traumatic Brain Injury

This cross-sectional study aimed to (1) establish the safety and tolerability of head-mounted display (HMD) assessment of sensory integration for postural control in participants with chronic traumatic brain injury (TBI); (2) investigate whether responses to visual and auditory cues differ between persons with TBI and healthy controls; and (3) evaluate the relationship between postural responses, postural visual dependence, and self-reported perception of disability.

20 healthy adults and 19 participants with TBI completed an HMD assessment of with visual and auditory perturbations. Head sway was quantified as a directional path in the anteroposterior and mediolateral directions. Participants also completed the Simulator Sickness Questionnaire (SSQ) and the Dizziness Handicap Inventory (DHI).

All participants completed testing. The average change in SSQ scores from pre to post postural control assessment was 0.8 points for healthy controls and 3.2 points for participants with TBI. Head sway in the TBI group was consistently higher in both directions, especially with dynamic visuals. In addition, a significant sound by visual by group interaction in the mediolateral direction indicates that participants with TBI responded more to the visual perturbations when sounds were present. Under the most challenging conditions, people with mild-to-moderate dizziness handicap showed little head sway, while those with severe symptoms were more variable.

HMD assessment of participants with TBI is feasible and provides a clinic-based assessment of postural visual dependence in this population. This assessment carries the potential to evaluate postural control and monitor progress of participants with TBI.