2024 American Academy of Neurology Abstract Website

Logan Kugathasan¹, Jose Joaquin Casado³, Jeremy Smith², Mason Salmon⁴, Julia Hurtado⁵, Rachael Frank⁵, Jason Allen⁶, Russell Gore⁵
¹Emory University School of Medicine, ²Department of Radiology and Imaging Sciences, Emory University School of Medicine, ³Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, ⁴Georgia Institute of Technology, ⁵Shepherd Center, ⁶Department of Radiology and Imaging Sciences, Indiana University School of Medicine

Objective:

To assess postural dynamics in post-concussive vestibular dysfunction (PCVD) in the subacute and chronic phases post injury utilizing data from Sensory Organization Testing (SOT) run through Discreet Wavelet Transform (DWT) decomposition analysis.

Background:

The coordination of postural control (PC) requires a complex integration of multiple sensory modalities. Patients suffering from PCVD may have impairments in the integration of these modalities leading to postural deficits.

Design/Methods:

Postural sway data was collected from a Subacute Vestibular Dysfunction (SCVD) group (22 patients, 12 Female, Age: 23.33 ± 4.94 with positive Vestibular Ocular Motor Screening >30 days post-concussion), Chronic Vestibular Dysfunction (CVD) group (23 patients, 0 Female, Age: 39.78 ± 6.78), and Healthy Control (HC) group (34 patients, 21 Female, Age: 27.62 ± 4.39). Data underwent DWT decomposition into frequency bands associated with visual, vestibular, cerebellar, and proprioceptive integration. Percentage energy content (EC) of each band was compared across groups in each SOT condition to determine weighting of sensory systems in PC coordination.

Results:

SCVD demonstrated decreased percentage EC in high-frequency bands (proprioception) compared to HC during condition 2 (absent vision: p = 0.006) and condition 3 (sway-referenced vision: p = 0.016). CVD demonstrated decreased percentage EC in high-frequency bands in all conditions (no intervention: p = 0.001, absent vision: p < 0.001, sway-referenced vision: p = 0.001) and medium-frequency bands (vestibular/cerebellar) in condition 2 (p = 0.015) and 3 (p = 0.006) compared to HC.

Conclusions:

The SCVD and CVD groups demonstrated decreased proprioceptive strategy during conditions of absent/unreliable vision compared to HC. Furthermore, the CVD group demonstrated decreased proprioceptive strategy at baseline along with decreased vestibular/cerebellar strategy with absent/unreliable vision. This study demonstrates altered sensory integration for PC in PCVD and suggests an inability to properly compensate for compromised visual feedback. Sensory re-weighting that targets sensory integration may be helpful in treating those with PCVD.