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Characterizing high-velocity angular vestibulo-ocular reflex function in service members post-blast exposure

机译：爆炸后服务成员中高速角前庭眼反射功能的特征

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Blasts (explosions) are the most common mechanism of injury in modern warfare. Traumatic brain injury (TBI) and dizziness are common sequelae associated with blasts, and many service members (SMs) report symptoms worsen with activity. The purpose of this study was to measure angular vestibulo-ocular reflex gain (aVOR) of blast-exposed SMs with TBI during head impulse testing. We also assessed their symptoms during exertion. Twenty-four SMs recovering from TBI were prospectively assigned to one of two groups based on the presence or absence of dizziness. Wireless monocular scleral search coil and rate sensor were used to characterize active and passive yaw and pitch head and eye rotations. Visual analog scale (VAS) was used to monitor symptoms during fast walking/running. For active yaw head impulses, aVOR gains were significantly lower in the symptomatic group (0.79 ± 0.15) versus asymptomatic (0.87 ± 0.18), but not for passive head rotation. For pitch head rotation, the symptomatic group had both active (0.915 ± 0.24) and passive (0.878 ± 0.22) aVOR gains lower than the asymptomatic group (active 1.03 ± 0.27, passive 0.97 ± 0.23). Some SMs had elevated aVOR gain. VAS scores for all symptoms were highest during exertion. Our data suggest symptomatic SMs with TBI as a result of blast have varied aVOR gain during high-velocity head impulses and provide compelling evidence of pathology affecting the vestibular system. Potential loci of injury in this population include the following: disruption of pathways relaying vestibular efference signals, differential destruction of type I vestibular hair cells, or selective damage to irregular afferent pathways—any of which may explain the common discrepancy between reports of vestibular-like symptoms and laboratory testing results. Significantly reduced pitch aVOR in symptomatic SMs and peak symptom severity during exertional testing support earlier findings in the chronic blast-exposed active duty SMs.
机译：爆炸（爆炸）是现代战争中最常见的伤害机制。创伤性脑损伤（TBI）和头晕是爆炸相关的常见后遗症，许多服务人员（SM）均报告其症状因活动而加重。这项研究的目的是在头部冲动测试中测量暴露于TBI的爆炸性SM的角前庭眼反射增益（aVOR）。我们还评估了他们在运动过程中的症状。根据头晕的存在或不存在，将24名从TBI康复的SM分为两组之一。无线单眼巩膜搜索线圈和速率传感器用于表征主动和被动偏航以及俯仰头部和眼睛的旋转。视觉模拟量表（VAS）用于监测快速步行/跑步过程中的症状。对于主动偏航头脉冲，有症状组的aVOR增益（0.79±0.15）明显低于无症状组（0.87±0.18），但对于被动头旋转则没有。对于俯仰头旋转，有症状组的主动（0.915±0.24）和被动（0.878±0.22）的aVOR增益均低于无症状组（主动1.03±0.27，被动的0.97±0.23）。一些SM提高了AVOR增益。劳累期间，所有症状的VAS评分最高。我们的数据表明，爆炸引起的TBI症状性SM在高速头部冲动过程中具有不同的aVOR增加，并提供了令人信服的病理学证据，影响前庭系统。该人群的潜在伤害位点包括：传递前庭效应信号的途径的破坏，I型前庭毛细胞的不同破坏或对不规则传入途径的选择性损伤，这些都可以解释前庭样报告之间的常见差异。症状和实验室检查结果。在运动测试期间，症状性SM的音高aVOR显着降低和症状严重性峰值，支持了在长期爆炸暴露的现役SM中早期发现。

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