{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:26:18Z","timestamp":1791231978242,"version":"4.1.0"},"reference-count":55,"publisher":"SAGE Publications","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["VES"],"published-print":{"date-parts":[[2021,10,16]]},"abstract":"<jats:p>BACKGROUND: Little is known on the peripheral and central sensory contributions to persistent dizziness and imbalance following mild traumatic brain injury (mTBI). OBJECTIVE: To identify peripheral vestibular, central integrative, and oculomotor causes for chronic symptoms following mTBI. METHODS: Individuals with chronic mTBI symptoms and healthy controls (HC) completed a battery of oculomotor, peripheral vestibular and instrumented posturography evaluations and rated subjective symptoms on validated questionnaires. We defined abnormal oculomotor, peripheral vestibular, and central sensory integration for balance measures among mTBI participants as falling outside a 10-percentile cutoff determined from HC data. A X-squared test associated the proportion of normal and abnormal responses in each group. Partial Spearman\u2019s rank correlations evaluated the relationships between chronic symptoms and measures of oculomotor, peripheral vestibular, and central function for balance control. RESULTS: The mTBI group (n\u200a=\u200a58) had more abnormal measures of central sensory integration for balance than the HC (n\u200a=\u200a61) group (mTBI: 41% \u201361%; HC: 10%, p\u2019s\u200a&lt;\u200a0.001), but no differences on oculomotor and peripheral vestibular function (p\u200a&gt;\u200a0.113). Symptom severities were negatively correlated with central sensory integration for balance scores (p\u2019s\u200a&lt;\u200a0.048). CONCLUSIONS: Ongoing balance complaints in people with chronic mTBI are explained more by central sensory integration dysfunction rather than peripheral vestibular or oculomotor dysfunction.<\/jats:p>","DOI":"10.3233\/ves-201590","type":"journal-article","created":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T14:01:58Z","timestamp":1621346518000},"page":"519-530","source":"Crossref","is-referenced-by-count":31,"title":["Exploring persistent complaints of imbalance after mTBI: Oculomotor, peripheral vestibular and central sensory integration function"],"prefix":"10.1177","volume":"31","author":[{"given":"Kody R.","family":"Campbell","sequence":"first","affiliation":[{"name":"Department of Neurology, Oregon Health and Science University, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Parrington","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oregon Health and Science University, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Peterka","sequence":"additional","affiliation":[{"name":"National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas N.","family":"Martini","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy E.","family":"Hullar","sequence":"additional","affiliation":[{"name":"National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, OR, USA"},{"name":"Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fay B.","family":"Horak","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oregon Health and Science University, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C.","family":"Chesnutt","sequence":"additional","affiliation":[{"name":"Departments of Family Medicine, Neurology, and Orthopedics & Rehabilitation, Oregon Health and Science University, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Fino","sequence":"additional","affiliation":[{"name":"Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie A.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oregon Health and Science University, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"key":"10.3233\/VES-201590_ref1","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1111\/j.1526-4610.2008.01256.x","article-title":"Is balance normal in migraineurs without history of vertigo?","volume":"49","author":"Akdal","year":"2009","journal-title":"Headache"},{"key":"10.3233\/VES-201590_ref2","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.otc.2011.01.005","article-title":"Head injury and blast exposure: vestibular consequences","volume":"44","author":"Akin","year":"2011","journal-title":"Otolaryngol Clin North Am"},{"key":"10.3233\/VES-201590_ref3","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1080\/02699052.2017.1288928","article-title":"Vestibular consequences of mild traumatic brain injury and blast exposure: a review","volume":"31","author":"Akin","year":"2017","journal-title":"Brain Inj"},{"key":"10.3233\/VES-201590_ref4","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1177\/1941738119865262","article-title":"Vestibulo-Ocular Reflex Function in Adolescents With Sport-Related Concussion: Preliminary Results","volume":"11","author":"Alkathiry","year":"2019","journal-title":"Sports Health"},{"key":"10.3233\/VES-201590_ref5","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/NPT.0b013e3181dde568","article-title":"Vestibular rehabilitation for dizziness and balance disorders after concussion","volume":"34","author":"Alsalaheen","year":"2010","journal-title":"Journal of neurologic physical therapy: JNPT"},{"key":"10.3233\/VES-201590_ref6","doi-asserted-by":"crossref","first-page":"439","DOI":"10.3233\/VES-160598","article-title":"The usefulness of the video head impulse test in children and adults post-concussion","volume":"26","author":"Alshehri","year":"2016","journal-title":"J Vestib Res"},{"key":"10.3233\/VES-201590_ref7","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1044\/2019_PERS-SIG6-2019-0004","article-title":"Vestibular and Balance Dysfunction Following Sport-Related Concussion","volume":"4","author":"Bogle","year":"2019","journal-title":"Perspectives of the ASHA Special Interest Groups"},{"key":"10.3233\/VES-201590_ref8","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1111\/head.14024","article-title":"The prevalence and impact of migraine and severe headache in the United States: Updated age, sex, and socioeconomic-specific estimates from government health surveys","volume":"61","author":"Burch","year":"2021","journal-title":"Headache"},{"key":"10.3233\/VES-201590_ref9","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1093\/brain\/awaa386","article-title":"Vestibular agnosia in traumatic brain injury and its link to imbalance","volume":"144","author":"Calzolari","year":"2021","journal-title":"Brain"},{"key":"10.3233\/VES-201590_ref10","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1177\/000348949710600302","article-title":"Migraine-related vestibulopathy","volume":"106","author":"Cass","year":"1997","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"10.3233\/VES-201590_ref11","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1080\/02699052.2017.1332783","article-title":"Quality of return to work in patients with mild traumatic brain injury: a prospective investigation of associations among post-concussion symptoms, neuropsychological functions, working status and stability","volume":"31","author":"Chu","year":"2017","journal-title":"Brain Injury"},{"key":"10.3233\/VES-201590_ref13","doi-asserted-by":"crossref","unstructured":"Cohen J. , Statistical Power Analysis for the Behavioral Sciences, Academic Press, 2013.","DOI":"10.4324\/9780203771587"},{"key":"10.3233\/VES-201590_ref14","doi-asserted-by":"crossref","first-page":"258","DOI":"10.3758\/s13428-015-0693-x","article-title":"Quantification and analysis of saccadic and smooth pursuit eye movements and fixations to detect oculomotor deficits","volume":"49","author":"DiCesare","year":"2017","journal-title":"Behav Res Methods"},{"key":"10.3233\/VES-201590_ref15","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1177\/003591575204500604","article-title":"The pathology symptomatology and diagnosis of certain common disorders of the vestibular system","volume":"45","author":"Dix","year":"1952","journal-title":"Proceedings of the Royal Society of Medicine"},{"key":"10.3233\/VES-201590_ref16","doi-asserted-by":"crossref","first-page":"46","DOI":"10.3389\/fnhum.2015.00046","article-title":"Effects of aging on eye movements in the real world","volume":"9","author":"Dowiasch","year":"2015","journal-title":"Frontiers in Human Neuroscience"},{"key":"10.3233\/VES-201590_ref17","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1089\/neu.2017.5231","article-title":"Abnormal Turning and Its Association with Self-Reported Symptoms in Chronic Mild Traumatic Brain Injury","volume":"35","author":"Fino","year":"2018","journal-title":"J Neurotrauma"},{"key":"10.3233\/VES-201590_ref18","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12883-017-0812-7","article-title":"Assessment and rehabilitation of central sensory impairments for balance in mTBI using auditory biofeedback: a randomized clinical trial","volume":"17","author":"Fino","year":"2017","journal-title":"BMC Neurol"},{"key":"10.3233\/VES-201590_ref19","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1089\/neu.2015.4060","article-title":"Sensitivity of the Balance Error Scoring System and the Sensory Organization Test in the Combat Environment","volume":"33","author":"Haran","year":"2016","journal-title":"J Neurotrauma"},{"key":"10.3233\/VES-201590_ref20","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: Building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"Journal of Biomedical Informatics"},{"key":"10.3233\/VES-201590_ref21","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014A metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"Journal of Biomedical Informatics"},{"key":"10.3233\/VES-201590_ref22","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1097\/HTR.0000000000000385","article-title":"Persistent Symptoms and Objectively Measured Balance Performance Among OEF\/OIF Veterans With Remote Mild Traumatic Brain Injury","volume":"33","author":"Hebert","year":"2018","journal-title":"J Head Trauma Rehabil"},{"key":"10.3233\/VES-201590_ref23","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1093\/brain\/awh066","article-title":"Eye movement and visuomotor arm movement deficits following mild closed head injury","volume":"127","author":"Heitger","year":"2004","journal-title":"Brain"},{"key":"10.3233\/VES-201590_ref24","doi-asserted-by":"crossref","first-page":"2850","DOI":"10.1093\/brain\/awp181","article-title":"Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression, malingering or intellectual ability","volume":"132","author":"Heitger","year":"2009","journal-title":"Brain"},{"key":"10.3233\/VES-201590_ref25","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1002\/lio2.74","article-title":"The use of oculomotor, vestibular, and reaction time tests to assess mild traumatic brain injury (mTBI) over time","volume":"2","author":"Hoffer","year":"2017","journal-title":"Laryngoscope Investigative Otolaryngology"},{"key":"10.3233\/VES-201590_ref26","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1038\/nrn2699","article-title":"Experience-dependent structural synaptic plasticity in the mammalian brain","volume":"10","author":"Holtmaat","year":"2009","journal-title":"Nat Rev Neurosci"},{"issue":"Suppl 2","key":"10.3233\/VES-201590_ref27","doi-asserted-by":"crossref","first-page":"ii7","DOI":"10.1093\/ageing\/afl077","article-title":"Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?","volume":"35","author":"Horak","year":"2006","journal-title":"Age and Ageing"},{"key":"10.3233\/VES-201590_ref28","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1001\/archotol.134.10.1099","article-title":"Physiological and morphological assessment of the saccule in Guinea pigs after noise exposure","volume":"134","author":"Hsu","year":"2008","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"10.3233\/VES-201590_ref29","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1001\/archotol.1990.01870040046011","article-title":"The development of the Dizziness Handicap Inventory","volume":"116","author":"Jacobson","year":"1990","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"10.3233\/VES-201590_ref30","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1682\/JRRD.2011.03.0051","article-title":"Psychometric study of the Neurobehavioral Symptom Inventory","volume":"49","author":"King","year":"2012","journal-title":"J Rehabil Res Dev"},{"key":"10.3233\/VES-201590_ref31","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.msksp.2018.12.007","article-title":"Vestibulo-ocular dysfunction in adolescent rugby union players with and without a history of concussion","volume":"39","author":"Leung","year":"2019","journal-title":"Musculoskeletal Science & Practice"},{"key":"10.3233\/VES-201590_ref32","unstructured":"T.B.I.W.G. Management of Concussion\/m, VA\/DoD Clinical PracticeGuideline forManagement of Concussion\/Mild Traumatic Brain Injury, (2016)."},{"key":"10.3233\/VES-201590_ref33","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1159\/000362780","article-title":"Quantifying the vestibulo-ocular reflex with video-oculography: nature and frequency of artifacts","volume":"20","author":"Mantokoudis","year":"2015","journal-title":"Audiol Neurootol"},{"key":"10.3233\/VES-201590_ref34","doi-asserted-by":"crossref","first-page":"2430","DOI":"10.1007\/s00415-019-09403-z","article-title":"Vestibular dysfunction in acute traumatic brain injury","volume":"266","author":"Marcus","year":"2019","journal-title":"Journal of Neurology"},{"key":"10.3233\/VES-201590_ref35","doi-asserted-by":"crossref","first-page":"265","DOI":"10.3233\/NRE-2002-17402","article-title":"Evaluation and treatment of postconcussive symptoms","volume":"17","author":"McAllister","year":"2002","journal-title":"NeuroRehabilitation"},{"key":"10.3233\/VES-201590_ref36","doi-asserted-by":"crossref","first-page":"021008","DOI":"10.1115\/1.4026364","article-title":"The mechanics of traumatic brain injury: a review of what we know and what we need to know for reducing its societal burden","volume":"136","author":"Meaney","year":"2014","journal-title":"J Biomech Eng"},{"key":"10.3233\/VES-201590_ref37","first-page":"271","article-title":"Prospective study of anxiety, post-traumatic stress and depression on postural control, gait, otolith and visuospatial function in military service members with persistent post-concussive symptoms","volume":"46","author":"Meehan","year":"2019","journal-title":"Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc"},{"key":"10.3233\/VES-201590_ref38","first-page":"567","article-title":"Baseline vestibular and auditory findings in a trial of post-concussive syndrome","volume":"43","author":"Meehan","year":"2016","journal-title":"Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc"},{"key":"10.3233\/VES-201590_ref39","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1089\/neu.2019.6595","article-title":"Smooth Pursuit and Saccades after Sport-Related Concussion","volume":"37","author":"Murray","year":"2020","journal-title":"J Neurotrauma"},{"key":"10.3233\/VES-201590_ref40","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1523\/JNEUROSCI.02-05-00536.1982","article-title":"Adaptation to altered support and visual conditions during stance: patients with vestibular deficits","volume":"2","author":"Nashner","year":"1982","journal-title":"The Journal of Neuroscience"},{"key":"10.3233\/VES-201590_ref42","unstructured":"I. NeuroCom International, Balance Manager Systems Clinical Interpretation Guide: Computerized Dynamic Posturography., 2008."},{"key":"10.3233\/VES-201590_ref43","first-page":"295","article-title":"Combat wounds in operation Iraqi Freedom and operation Enduring Freedom","volume":"64","author":"Owens","year":"2008","journal-title":"J Trauma"},{"key":"10.3233\/VES-201590_ref44","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1152\/jn.2002.88.3.1097","article-title":"Sensorimotor integration in human postural control","volume":"88","author":"Peterka","year":"2002","journal-title":"J Neurophysiol"},{"key":"10.3233\/VES-201590_ref45","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.3389\/fneur.2018.01045","article-title":"Implementation of a Central Sensorimotor Integration Test for Characterization of Human Balance Control During Stance","volume":"9","author":"Peterka","year":"2018","journal-title":"Front Neurol"},{"key":"10.3233\/VES-201590_ref46","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.3389\/fneur.2018.01113","article-title":"A Multidimensional Approach to Post-concussion Symptoms in Mild Traumatic Brain Injury","volume":"9","author":"Polinder","year":"2018","journal-title":"Front Neurol"},{"key":"10.3233\/VES-201590_ref47","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1089\/neu.2010.1516","article-title":"Long-term outcomes after uncomplicated mild traumatic brain injury: a comparison with trauma controls","volume":"28","author":"Ponsford","year":"2011","journal-title":"J Neurotrauma"},{"key":"10.3233\/VES-201590_ref48","first-page":"19","article-title":"Effects of mild head injury on postural stability as measured through clinical balance testing","volume":"35","author":"Riemann","year":"2000","journal-title":"J Athl Train"},{"key":"10.3233\/VES-201590_ref49","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1089\/neu.2014.3687","article-title":"Eye tracking detects disconjugate eye movements associated with structural traumatic brain injury and concussion","volume":"32","author":"Samadani","year":"2015","journal-title":"J Neurotrauma"},{"key":"10.3233\/VES-201590_ref50","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1080\/02699050701553189","article-title":"Community integration, social support and life satisfaction in relation to symptoms 3 years after mild traumatic brain injury","volume":"21","author":"Staalnacke","year":"2007","journal-title":"Brain Injury"},{"key":"10.3233\/VES-201590_ref51","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/1477-7525-7-101","article-title":"Measurement properties of the Dizziness Handicap Inventory by cross-sectional and longitudinal designs","volume":"7","author":"Tamber","year":"2009","journal-title":"Health and Quality of Life Outcomes"},{"key":"10.3233\/VES-201590_ref52","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.3399\/bjgp16X683161","article-title":"Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand","volume":"66","author":"Theadom","year":"2016","journal-title":"The British Journal of General Practice: The Journal of the Royal College of General Practitioners"},{"key":"10.3233\/VES-201590_ref53","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1682\/JRRD.2014.08.0197","article-title":"Characterizing effects of mild traumatic brain injury and posttraumatic stress disorder on balance impairments in blast-exposed servicemembers and Veterans using computerized posturography","volume":"52","author":"Wares","year":"2015","journal-title":"J Rehabil Res Dev"},{"key":"10.3233\/VES-201590_ref54","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.apmr.2003.08.107","article-title":"Population-based estimates of outcomes after hospitalization for traumatic brain injury in Colorado,S","volume":"85","author":"Whiteneck","year":"2004","journal-title":"Arch Phys Med Rehabil"},{"key":"10.3233\/VES-201590_ref55","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1002\/da.20837","article-title":"Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions","volume":"28","author":"Wilkins","year":"2011","journal-title":"Depress Anxiety"},{"key":"10.3233\/VES-201590_ref56","doi-asserted-by":"crossref","first-page":"e781","DOI":"10.1212\/WNL.0000000000009930","article-title":"Longitudinal white-matter abnormalities in sports-related concussion: A diffusion MRI study","volume":"95","author":"Wu","year":"2020","journal-title":"Neurology"},{"key":"10.3233\/VES-201590_ref57","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/s10194-020-01128-z","article-title":"Subdiagnosis, but not presence of vestibular symptoms, predicts balance impairment in migraine patients - a cross sectional study","volume":"21","author":"Zorzin","year":"2020","journal-title":"J Headache Pain"}],"container-title":["Journal of Vestibular Research"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/VES-201590","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:26:20Z","timestamp":1777613180000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.3233\/VES-201590"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,16]]},"references-count":55,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3233\/ves-201590","relation":{},"ISSN":["0957-4271","1878-6464"],"issn-type":[{"value":"0957-4271","type":"print"},{"value":"1878-6464","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,16]]}}}