{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:40:46Z","timestamp":1780393246221,"version":"3.54.1"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T00:00:00Z","timestamp":1664841600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>Complaints of non-resolving imbalance are common in individuals with chronic mild traumatic brain injury (mTBI). Vestibular rehabilitation therapy may be beneficial for this population. Additionally, wearable sensors can enable biofeedback, specifically audio biofeedback (ABF), and aid in retraining balance control mechanisms in people with balance impairments. In this study, we described the effectiveness of vestibular rehabilitation therapy with and without ABF to improve balance in people with chronic mTBI. Participants (<jats:italic>n<\/jats:italic> = 31; females = 22; mean age = 40.9 \u00b1 11 y) with chronic (&amp;gt;3 months) mTBI symptoms of self-reported imbalance were randomized into vestibular rehabilitation with ABF (<jats:italic>n<\/jats:italic> = 16) or without ABF (<jats:italic>n<\/jats:italic> = 15). The intervention was a standard vestibular rehabilitation, with or without ABF, for 45 min biweekly for 6 weeks. The ABF intervention involved a smartphone that provided auditory feedback when postural sway was outside of predetermined equilibrium parameters. Participant's completed the Post-Concussion Symptom Scale (PCSS). Balance was assessed with the sensory organization test (SOT) and the Central Sensorimotor Integration test which measured sensory weighting, motor activation, and time delay with sway evoked by surface and\/or visual surround tilts. Effect sizes (Hedge's G) were calculated on the change between pre-and post-rehabilitation scores. Both groups demonstrated similar medium effect-sized decreases in PCSS and large increases in SOT composite scores after rehabilitation. Effect sizes were minimal for increasing sensory weighting for both groups. The with ABF group showed a trend of larger effect sizes in increasing motor activation (with ABF = 0.75, without ABF = 0.22) and in decreasing time delay (with ABF = \u22120.77, without ABF = \u22120.52) relative to the without ABF group. Current clinical practice focuses primarily on sensory weighting. However, the evaluation and utilization of motor activation factors in vestibular rehabilitation, potentially with ABF, may provide a more complete assessment of recovery and improve outcomes.<\/jats:p>","DOI":"10.3389\/fneur.2022.926691","type":"journal-article","created":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T05:51:46Z","timestamp":1664862706000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["The effects of augmenting traditional rehabilitation with audio biofeedback in people with persistent imbalance following mild traumatic brain injury"],"prefix":"10.3389","volume":"13","author":[{"given":"Kody R.","family":"Campbell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Peterka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Fino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Parrington","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Wilhelm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie C.","family":"Pettigrew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie A.","family":"King","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","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 Inj."},{"key":"B2","doi-asserted-by":"publisher","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":"B3","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1001\/jamaneurol.2019.1313","article-title":"Recovery after mild traumatic brain injury in patients presenting to US level I trauma centers: a transforming research and clinical knowledge in traumatic brain injury (TRACK-TBI) study","volume":"76","author":"Nelson","year":"2019","journal-title":"JAMA Neurol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"S73","DOI":"10.1016\/j.apmr.2003.08.107","article-title":"Population-based estimates of outcomes after hospitalization for traumatic brain injury in Colorado","volume":"85","author":"Whiteneck","year":"2004","journal-title":"Arch Phys Med Rehabil"},{"key":"B5","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s40945-020-00081-z","article-title":"Clinical examination factors that predict delayed recovery in individuals with concussion","volume":"10","author":"Martinez","year":"2020","journal-title":"Arch Physiotherapy."},{"key":"B6","doi-asserted-by":"publisher","first-page":"139ed","DOI":"10.1097\/JSM.0000000000000507","article-title":"Vision and vestibular system dysfunction predicts prolonged concussion recovery in children","volume":"28","author":"Master","year":"2018","journal-title":"Clin J Sport Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"E34","DOI":"10.1097\/HTR.0000000000000042","article-title":"Factor analysis of persistent postconcussive symptoms within a military sample with blast exposure","volume":"30","author":"Franke","year":"2015","journal-title":"J Head Trauma Rehabil."},{"key":"B8","doi-asserted-by":"publisher","first-page":"519","DOI":"10.3233\/VES-201590","article-title":"Exploring persistent complaints of imbalance after mTBI: oculomotor, peripheral vestibular and central sensory integration function","volume":"31","author":"Campbell","year":"2021","journal-title":"J Vestib Res."},{"key":"B9","doi-asserted-by":"publisher","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":"B10","doi-asserted-by":"publisher","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":"B11","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1136\/bjsports-2016-096081","article-title":"Can vestibular rehabilitation exercises help patients with concussion? A systematic review of efficacy, prescription and progression patterns","volume":"51","author":"Murray","year":"2017","journal-title":"Br J Sports Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"256","DOI":"10.4085\/1062-6050-51.11.05","article-title":"Review of vestibular and oculomotor screening and concussion rehabilitation","volume":"52","author":"Kontos","year":"2017","journal-title":"J Athl Train."},{"key":"B13","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1097\/NPT.0000000000000230","article-title":"Prospective changes in vestibular and ocular motor impairment after concussion","volume":"42","author":"Elbin","year":"2018","journal-title":"J Neurol Phys Ther."},{"key":"B14","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/B978-0-444-63954-7.00014-8","article-title":"Vestibular dysfunction and concussion","volume":"158","author":"Mucha","year":"2018","journal-title":"Handb Clin Neurol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"193e","DOI":"10.1016\/j.jpeds.2021.08.032","article-title":"A randomized controlled trial of precision vestibular rehabilitation in adolescents following concussion: preliminary findings","volume":"239","author":"Kontos","year":"2021","journal-title":"J Pediatr."},{"key":"B16","doi-asserted-by":"publisher","first-page":"jrm00181","DOI":"10.2340\/16501977-2823","article-title":"Effect of vestibular rehabilitation on change in health-related quality of life in patients with dizziness and balance problems after traumatic brain injury: a randomized controlled trial","volume":"53","author":"S\u00f8berg","year":"2021","journal-title":"J Rehabil Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1136\/bjsports-2013-093267","article-title":"Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial","volume":"48","author":"Schneider","year":"2014","journal-title":"Bri J Sports Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"103470","DOI":"10.1136\/bjsports-2020-103470","article-title":"Do physical interventions improve outcomes following concussion: a systematic review and meta-analysis?","volume":"2021","author":"Reid","year":"2021","journal-title":"Bri J Sports Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"184","DOI":"10.3988\/jcn.2011.7.4.184","article-title":"Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises","volume":"7","author":"Han","year":"2011","journal-title":"J Clin Neurol."},{"key":"B20","first-page":"187urolo","article-title":"Chapter 13 - An overview of vestibular rehabilitation","volume-title":"Handbook of Clinical Neurology.","author":"Whitney","year":"2016"},{"key":"B21","doi-asserted-by":"publisher","first-page":"944","DOI":"10.3389\/fneur.2018.00944","article-title":"Potential mechanisms of sensory augmentation systems on human balance control","volume":"9","author":"Sienko","year":"2018","journal-title":"Front Neurol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"3444","DOI":"10.3390\/s21103444","article-title":"Wearable devices for biofeedback rehabilitation: a systematic review and meta-analysis to design application rules and estimate the effectiveness on balance and gait outcomes in neurological diseases","volume":"21","author":"Bowman","year":"2021","journal-title":"Sensors."},{"key":"B23","doi-asserted-by":"publisher","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":"B24","doi-asserted-by":"publisher","first-page":"77","DOI":"10.3233\/VES-170601","article-title":"Vibro-tactile and auditory balance biofeedback changes muscle activity patterns: Possible implications for vestibular implants","volume":"27","author":"Allum","year":"2017","journal-title":"J Vestib Res."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.1016\/j.apmr.2004.12.036","article-title":"Audio-biofeedback improves balance in patients with bilateral vestibular loss","volume":"86","author":"Dozza","year":"2005","journal-title":"Arch Phys Med Rehabil."},{"key":"B26","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s00221-006-0709-y","article-title":"Auditory biofeedback substitutes for loss of sensory information in maintaining stance","volume":"178","author":"Dozza","year":"2007","journal-title":"Exp Brain Res."},{"key":"B27","doi-asserted-by":"publisher","first-page":"433","DOI":"10.3233\/VES-160599","article-title":"Auditory contributions to maintaining balance","volume":"26","author":"Stevens","year":"2016","journal-title":"J Vestib Res."},{"key":"B28","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1002\/acn3.699","article-title":"in maintaining stance. cations for vestibular implants. mTBI using auditoAnn Clin Transl Neurol","volume":"6","author":"Fleszar","year":"2019"},{"key":"B29","doi-asserted-by":"publisher","first-page":"424l","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":"B30","doi-asserted-by":"publisher","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 Qual Life Outcomes."},{"key":"B31","doi-asserted-by":"publisher","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":"J Neurosci."},{"key":"B32","doi-asserted-by":"publisher","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":"B33","doi-asserted-by":"crossref","DOI":"10.1002\/9781118287422","volume-title":"System Identification: A Frequency Domain Approach","author":"Pintelon","year":"2012"},{"key":"B34","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1007\/s10827-010-0291-y","article-title":"Non-linear stimulus-response behavior of the human stance control system is predicted by optimization of a system with sensory and motor noise","volume":"30","author":"van der Kooij","year":"2011","journal-title":"J Comput Neurosci."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1016\/j.apmr.2007.05.003","article-title":"Learning effects of repetitive administrations of the sensory organization test in healthy young adults","volume":"88","author":"Wrisley","year":"2007","journal-title":"Arch Phys Med Rehabil."},{"key":"B36","doi-asserted-by":"crossref","DOI":"10.4324\/9780203771587","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"2013"},{"key":"B37","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1016\/j.apmr.2019.10.179","article-title":"Dams-O'Connor K, et al. Management of concussion and mild traumatic brain injury. A synthesis of practice guidelines archives of physical","volume":"101","author":"Silverberg","year":"2020","journal-title":"Med Rehabil."},{"key":"B38","doi-asserted-by":"publisher","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":"J Neurol Phys Ther."},{"key":"B39","doi-asserted-by":"publisher","first-page":"2375","DOI":"10.1177\/0363546512455400","article-title":"A revised factor structure for the post-concussion symptom scale: baseline and postconcussion factors","volume":"40","author":"Kontos","year":"2012","journal-title":"Am J Sports Med."},{"key":"B40","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1093\/neuros\/nyz332","article-title":"Concussion guidelines step 2: evidence for subtype classification","volume":"86","author":"Lumba-Brown","year":"2020","journal-title":"Neurosurgery."},{"key":"B41","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1093\/neuros\/nyz545","article-title":"Concussion clinical profiles screening (CP Screen) tool: preliminary evidence to inform a multidisciplinary approach","volume":"87","author":"Kontos","year":"2020","journal-title":"Neurosurgery."},{"key":"B42","doi-asserted-by":"publisher","first-page":"57","DOI":"10.3389\/fneur.2011.00057","article-title":"Postural compensation for unilateral vestibular loss","volume":"2","author":"Peterka","year":"2011","journal-title":"Front Neurol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1080\/02699052.2020.1802665","article-title":"The toronto concussion study: a longitudinal analysis of balance deficits following concussion in community-dwelling adults","volume":"34","author":"Sweeny","year":"2020","journal-title":"Brain Inj."},{"key":"B44","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1097\/JSM.0b013e3181b625fe","article-title":"The relationship of athlete-reported concussion symptoms and objective measures of neurocognitive function and postural control","volume":"19","author":"Broglio","year":"2009","journal-title":"Clin J Sport Med."},{"key":"B45","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1249\/MSS.0000000000001789","article-title":"Baseline concussion clinical measures are related to sensory organization and balance","volume":"51","author":"Vander Vegt","year":"2019","journal-title":"Med Sci Sports Exerc."},{"key":"B46","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.gaitpost.2022.05.023","article-title":"Do sensorimotor control properties mediate sway in people with chronic balance complaints following mTBI?","volume":"96","author":"Parrington","year":"2022","journal-title":"Gait Posture."},{"key":"B47","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1080\/02699052.2018.1542507","article-title":"Sex differences in concussion: a review of brain anatomy, function, and biomechanical response to impact","volume":"33","author":"Solomito","year":"2019","journal-title":"Brain Inj."},{"key":"B48","doi-asserted-by":"publisher","first-page":"e213046","DOI":"10.1001\/jamanetworkopen.2021.3046","article-title":"Association of sex and age with mild traumatic brain injury-related symptoms: a TRACK-TBI study","volume":"4","author":"Levin","year":"2021","journal-title":"JAMA Netw Open."},{"key":"B49","doi-asserted-by":"publisher","first-page":"100183","DOI":"10.1016\/j.arrct.2022.100183","article-title":"Exploring age and sex patterns for rehabilitation referrals after a concussion: a retrospective analysis","volume":"2022","author":"Martini","year":"2022","journal-title":"Arch Rehabil Res Clin Transl."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.926691\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T05:51:52Z","timestamp":1664862712000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.926691\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,4]]},"references-count":49,"alternative-id":["10.3389\/fneur.2022.926691"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2022.926691","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,4]]},"article-number":"926691"}}