A virtual reality approach to the study of visually driven postural control in developing and aging humans

Maintaining upright stance is essential for the accomplishment of several goal-directed behaviors, such as walking. Humans use three distinct sensory systems to regulate their posture: the somatosensory, the vestibular and the visual systems. The role of vision in postural regulation remains poorly understood, notably its variability across the life-span, developmental type and neurological insult. Hence, visually-driven postural regulation was examined in typically developing and aging participants (5-85 years-old), as well as in atypically developing individuals with autism (12-33 years-old) and in children having sustained mTBI (9-18 years-old). In order to do so, participants' postural reactivity was assessed in response to a fully immersive virtual tunnel moving at 3 different velocities; control conditions were also included wherein the tunnel was either static or absent.    Results show that visually-induced postural reactivity was strongest in young children, then attenuated to become adult-like between 16-19 years of age, and started increasing again linearly with age after 45 years until becoming strong again around 60 years. Moreover, at the highest tunnel velocity, younger autistic participants showed significantly less postural reactivity compared to age-matched controls and young adults (16-33 years-old). Finally, children having sustained mTBI, who were initially moderately symptomatic, exhibited increased visually-induced instability compared to their matched controls up to 12 weeks post-injury, although most of them (89%) were no longer highly symptomatic. Altogether, this suggests the presence of an important transition period for the maturation of the systems underlying sensorimotor integration in postural control at around 16 years of age, and further sensorimotor changes after 60 years of age; this over-reliance on vision for postural regulation in childhood and late adulthood could guide the design of age-appropriate facilities/ activities. Furthermore, the fact that postural hypo-reactivity to visual information present in autism is contingent on both the visual environment and on chronological age, enhances our understanding of autism-specific sensory anomalies. Additionally, the fact that children with mTBI show balance anomalies up to 3 months post-injury, even when they are no longer highly symptomatic may be related to altered processing of dynamic visual information and could have implications for the clinical management of mTBI patients, since symptoms resolution is commonly used as a criterion for return to activities. Finally, results stemming from populations with atypical development (autism) and with so-called transient neurological insult (mild TBI) not only contribute to enhance our understanding of sensorimotor integration mechanisms underlying postural control, but could also consist of sensitive and specific markers of dysfunction in these populations.   Keywords : posture, balance, vision, sensorimotor development/ aging, autism, symptomatic mTBI, virtual reality.

Keyphrases: Posture, Balance, Vision, Sensorimotor development, Sensorimotor aging, Autism, TBI, Virtual reality