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. 2020 Dec 17;10(12):1003.
doi: 10.3390/brainsci10121003.

Head Position and Posturography: A Novel Biomarker to Identify Concussion Sufferers

Frederick Robert Carrick  1   2   3   4 , Guido Pagnacco  4   5 , Melissa Hunfalvay  4 , Sergio Azzolino  4 , Elena Oggero  4   5
Affiliations

Head Position and Posturography: A Novel Biomarker to Identify Concussion Sufferers

Frederick Robert Carrick et al. Brain Sci. .

Abstract

Balance control systems involve complex systems directing muscle activity to prevent internal and external influences that destabilize posture, especially when body positions change. The computerized dynamic posturography stability score has been established to be the most repeatable posturographic measure using variations of the modified Clinical Test of Sensory Integration in Balance (mCTSIB). However, the mCTSIB is a standard group of tests relying largely on eyes-open and -closed standing positions with the head in a neutral position, associated with probability of missing postural instabilities associated with head positions off the neutral plane. Postural stability scores are compromised with changes in head positions after concussion. The position of the head and neck induced by statically maintained head turns is associated with significantly lower stability scores than the standardized head neutral position of the mCTSIB in Post-Concussion Syndrome (PCS) subjects but not in normal healthy controls. This phenomenon may serve as a diagnostic biomarker to differentiate PCS subjects from normal ones as well as serving as a measurement with which to quantify function or the success or failure of a treatment. Head positions off the neutral plane provide novel biomarkers that identify and differentiate subjects suffering from PCS from healthy normal subjects.

Keywords: brain; concussion; eye; head; neck; posturography; proprioception; vestibular.

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Conflict of interest statement

Guido Pagnacco and Elena Oggero are principals in Vestibular Technologies, the company that manufactured the force plate used in this study. They were not involved in testing or data collection. All other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Adjusted predictions of right head turn stability scores in concussion subjects.
Figure 2
Figure 2
Adjusted predictions of right head turn stability scores in healthy normal controls.
Figure 3
Figure 3
Adjusted predictions of left head turn stability scores in concussion subjects.
Figure 4
Figure 4
Adjusted predictions of left head turn stability scores in healthy normal controls.
Figure 5
Figure 5
Adjusted predictions of head flexion stability scores in concussion subjects.
Figure 6
Figure 6
Adjusted predictions of head flexion stability scores in healthy normal controls.
Figure 7
Figure 7
Adjusted predictions of head extension stability scores in concussion subjects.
Figure 8
Figure 8
Adjusted predictions of head extension stability scores in healthy normal controls.
Figure 9
Figure 9
Receiver operating characteristic (ROC) curve for head neutral, eyes closed perturbed testing in concussion determination.
Figure 10
Figure 10
ROC curve for right head turn, eyes closed perturbed testing in concussion determination.
Figure 11
Figure 11
ROC curve for left head turn, eyes closed perturbed testing in concussion determination.
Figure 12
Figure 12
ROC curve for head extension, eyes closed perturbed testing in concussion determination.
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