Computerized Dynamic Posturography: A Historical ‘Concussion Predictor’

By Catherine Sassano and Denise Pouncey

This article is a part of the November/December 2020, Volume 32, Number 6,  Audiology Today issue.

History

A male patient in his early 30s, seen in the University of Mississippi Medical Center clinic in the summer of 2019, had sustained a head injury above his left eyebrow from a snowboarding accident in December 2017. He presented in our clinic with primary complaints of lightheadedness on a weekly basis, room-spinning vertigo every couple of days, presyncope and syncope every so often, floaters in his vision, and daily imbalance.

Formerly a monthly “migrainer,” he reported that his migraines had doubled since his snowboarding incident. He denied any hearing concerns, a fall within the past 12 months, or the use of a vitamin D supplement. The patient reported that competing speech signals that require “too much brain power” worsened his symptoms. He noted that something that provides him temporary relief is applying pressure to the base of his skull in the form of pressing his head into the back of a chair headrest.

Of note, it is important to mention that the patient’s medical history was also significant for a car accident in 2015. Based on symptomatology, the patient was diagnosed with concussion and referred for a balance assessment.

Results

Upon arrival to his balance assessment, the patient completed a case history packet including the Dizziness Handicap Inventory. He scored a total of 74 (Emotional = 20, Functional = 30, Physical = 24), which was consistent with a severe dizziness handicap. He then completed a balance evaluation including videonystagmography (VNG), video head impulse testing (vHIT), and computerized dynamic posturography (CDP).

Interestingly, the testing was largely within normal limits. There was no presence of spontaneous nystagmus, benign paroxysmal positional vertigo (BPPV), or gaze-evoked nystagmus. Some positional nystagmus was observed in vision-denied conditions, however, it was non-clinically significant in nature. Also interestingly, oculo-motor testing (tracking, random saccades, optokinetics, etc.) was normal.