The present protocol evaluates the relative impact of visual and vestibular inputs during roll plane rotations using optokinetic, vestibular, and combined visuovestibular stimulations. Subjects underwent isolated visual rotations, whole-body vestibular rotations in darkness, and visuovestibular stimulations combining static visual scenes with head rotations. Dynamic and static eye movement gains, absolute amplitudes, velocities, and accelerations were measured alongside perceptual responses. Trials included a baseline rest period before and after movement to stabilize oculomotor fixation. Precise eye- and head-tracking were achieved using the Chronos Eye-Tracking Device (C-ETD), which recorded ocular torsion and head movements across three translational and three rotational dimensions. Eye movements were analyzed for slow-phase velocities and nystagmus frequency, with data quality ensured by averaging torsional outputs from both eyes and excluding frames with artefacts. Real-time gaze alignment monitoring allowed trial repetition as needed, and post-hoc analysis excluded confounding movements. Optokinetic stimulation involved projected visual elements rotating around a fixation point, while vestibular trials employed motorized whole-body rotations in darkness. Visuovestibular trials combined both stimuli, creating relative retinal motion. Data synchronization between eye and head trackers ensured accurate frame-by-frame analysis recorded at 100 Hz. Sensory-specific contributions to gaze stabilization were quantified by comparing slow-phase velocities across trial types. Sensory-specific gains were indexed by dividing visual and vestibular responses by visuovestibular outcomes and validated through comparisons with summed individual responses. Results revealed robust sensory integration, with the relative contributions of visual and vestibular inputs quantified. This protocol offers a detailed framework for evaluating multisensory integration during roll plane rotations. The protocol may therefore serve to elucidate sensory deficits in motion processing, as well as present novel oculomotor biomarkers. It has previously been employed to evaluate how visual clutter and motion accelerations impact motion processing and has highlighted an increased reliance on visual input in concussed patients.

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, characterized by brief episodes of vertigo triggered by changes in head position. While idiopathic cases are frequent, post-traumatic BPPV has been increasingly recognized, particularly in individuals who have experienced traumatic brain injury (TBI). TBI, ranging from mild concussions to severe head trauma, is a significant cause of neurological morbidity and is often associated with vestibular dysfunction. The pathophysiology of post-traumatic BPPV is thought to involve direct mechanical disruption of the otolithic organs, alterations in endolymph dynamics, or vascular compromise affecting inner ear structures. Compared to idiopathic BPPV, post-traumatic cases tend to have a more prolonged and refractory course, often requiring multiple repositioning maneuvers for symptom resolution. Additionally, concurrent vestibular pathologies, such as vestibular migraine, post-concussive dizziness, or central vestibular dysfunction, may complicate diagnosis and treatment. Early identification and appropriate management of post-traumatic BPPV are crucial in reducing disability and improving the quality of life in affected patients. This review explores the epidemiology, pathophysiology, clinical characteristics, and treatment considerations of post-traumatic BPPV, emphasizing the importance of a multidisciplinary approach. Understanding the relationship between TBI and BPPV can enhance clinical decision-making and optimize rehabilitation strategies for individuals with vestibular dysfunction following head trauma.

Objective Vestibular/ocular deficits occur with mild traumatic brain injury (mTBI). The vestibular/ocular motor screening (VOMS) tool is used to assess individuals post-mTBI, which primarily relies upon subjective self-reported symptoms. Instrumenting the VOMS (iVOMS) with technology may allow for more objective assessment post-mTBI, which reflects actual task performance. This study aimed to validate the iVOMS analytically and clinically in mTBI and controls. Methods Seventy-nine people with sub-acute mTBI (<12 weeks post-injury) and forty-four healthy control participants performed the VOMS whilst wearing a mobile eye-tracking on a one-off visit. People with mTBI were included if they were within 12 weeks of a physician diagnosis. Participants were excluded if they had any musculoskeletal, neurological or sensory deficits which could explain dysfunction. A series of custom-made eye tracking algorithms were used to assess recorded eye-movements. Results The iVOMS was analytically valid compared to the reference (ICC2,1 0.85-0.99) in mTBI and controls. The iVOMS outcomes were clinically valid as there were significant differences between groups for convergence, vertical saccades, smooth pursuit, vestibular ocular reflex and visual motion sensitivity outcomes. However, there was no significant relationship between iVOMS outcomes and self-reported symptoms. Conclusion The iVOMS is analytically and clinically valid in mTBI and controls, but further work is required to examine the sensitivity of iVOMS outcomes across the mTBI spectrum. Findings also highlighted that symptom and physiological issue resolution post-mTBI may not coincide and relationships need further examination.

The acute and long-term consequences of mild traumatic brain injury (mTBI) are far reaching. Though it may often be overlooked due to the now expansive field of research dedicated to understanding the consequences of mTBI on the brain, recent work has revealed that substantial changes in the vestibulo-auditory system can also occur due to mTBI. These changes, termed "labyrinthine" or "cochlear concussion," include hearing loss, vertigo, and tinnitus that develop after mTBI in the setting of an intact bony labyrinthine capsule (as detected on imaging). In the review that follows, we focus our discussion on the effects of mTBI on the peripheral structures and pathways of the auditory and vestibular systems. Although the effects of indirect trauma (e.g., noise and blast trauma) have been well-investigated, there exists a profound need to improve our understanding of the effects of direct head injury (such as mTBI) on the auditory and vestibular systems. Our aim is to summarize the current evidentiary foundation upon which labyrinthine and/or cochlear concussion are based to shed light on the ways in which clinicians can refine the existing modalities used to diagnose and treat patients experiencing mTBI as it relates to hearing and balance.

Benign paroxysmal positional vertigo (BPPV) is a medical condition where patients develop symptoms of vertigo, "room spinning," associated with nausea and vomiting. BPPV is believed to be caused by a disturbance in the inner ear vestibular system. Trauma has been recognized as one of the risk factors for this condition. BPPV can be easily diagnosed and treated by bedside maneuvers. Due to a lack of awareness among some treating clinicians, patients may have to wait for a long time before the correct management is offered. We share two cases of BPPV in 15- and 16-year-old male school students who developed posterior canal BPPV following a head injury during a rugby game. Both patients continue to have vertigo symptoms for several weeks before the final diagnosis. BPPV symptoms completely resolved following the Epley maneuver. Frontline clinicians need to diagnose and treat BPPV early to prevent the persistence of these debilitating symptoms. As far as we are aware, no previous study has published the occurrence of BPPV in young adolescent rugby players.

The Vestibular/Ocular-Motor Screening (VOMS), an important component in acute (<72 h) sport-related concussion (SRC) assessment, is increasingly used alongside the Sport Concussion Assessment Tool (SCAT) and as part of the Military Acute Concussion Evaluation 2 (MACE2). VOMS demonstrates clinically useful diagnostic accuracy for acute SRC and improves the overall utility when added to the SCAT3. However, potential overlap among VOMS's vestibular and oculomotor items suggests the possibility of a more efficient version. VOMS and SCAT3 scores were analyzed for 3,958 preseason (47.8% female) and 496 acute-SRC (37.5% female) NCAA-DoD Concussion Assessment, Research, and Education (CARE) consortium collegiate athlete evaluations. Analyses revealed very large effect sizes (d = 2.39-2.45) and high correlations (rho = 0.95-0.99) among all VOMS items except near point of convergence distance (d = 0.79, rho ≤ 0.341). Receiver operating characteristic (ROC) curve analyses showed clinically useful discriminative utility for VOMS Total (AUC = 0.85) and the VOMS Total change score, where pretest symptoms were incorporated (AUC = 0.81). A modified VOMS (mVOMS) consisting of four items (smooth pursuits, horizontal saccades, horizontal vestibulo-ocular reflex, visual motion sensitivity) yielded identical AUCs to VOMS Total. Integer cutoff analyses suggest a score of ≥4 for VOMS Total and ≥4 for mVOMS Total optimizes concussion identification. Incorporating VOMS or mVOMS into SCAT3 (AUC = 0.79) significantly improved the combined tool's acute utility for acute concussion identification by a maximum of 4% (SCAT3+VOMS AUC = 0.84, SCAT3+mVOMS AUC = 0.83). Future versions of SCAT or MACE may want to consider incorporating a more parsimonious VOMS for the purpose of identifying acute concussion.