Head impact biomechanics studies have provided valuable insights into understanding collision sports and for informing evidence-based rule and policy changes. These have included changing the football kickoff, ice hockey body checking ages, and head-to-head hits in both sports. Given soccer's global popularity, and the growing public concern for the potential long-term neurological implications of collision and contact sports, studying soccer has the potential to impact many athletes and the sports medicine professionals caring for them.

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There is evidence from EEG studies that unexpected perturbations to standing posture induce a differential modulation of cortical activity compared to self-initiated and/or predictable conditions. However, the neural correlates of whole body postural response to visually-induced perturbations on standing posture have not been examined. Here we employ a novel experimental paradigm via combined Virtual Reality (VR) and EEG measures to examine the effects of visually induced perturbations on the dynamics of postural responses. Twelve Penn State student-athletes without prior history of neurologic disorders and/or orthopaedic injuries participated in this study. There were no differences in response/reaction time measures between both spatially and temporally unpredictable and fully predictable conditions (p>.05). However, significantly stronger modulation of frontal-central EEG theta activity was present prior to onset of unpredictable postural perturbations (p<. 05). It is postulated that enhanced EEG theta in unpredictable conditions reflects increased effort to recruit additional brain resources to meet the demands of the postural tasks.

Context: Clinicians sometimes treat concussed individuals who have amnesia, loss of consciousness (LOC), a concussion history, or certain symptom types more conservatively, but it is unclear whether recovery patterns differ in individuals with these characteristics. Objective: To determine whether (1) amnesia, LOC, and concussion history influence the acute recovery of symptoms, cognition, and balance; and (2) cognition and balance are influenced by acute symptom type. Design: Cohort study. Setting: Seven sports at 26 colleges and 210 high schools. Patients or Other Participants: A total of 8905 collegiate (n = 1392) and high school (n = 7513) athletes. Main Outcome Measure(s): The Graded Symptom Checklist, Standardized Assessment of Concussion, and Balance Error Scoring System were administered to all athletes during the preseason. To allow us to track recovery patterns, athletes diagnosed with a concussion (n = 375) repeated these assessments immediately after the injury, 3 hours postinjury, 1 day postinjury, and at 2, 3, 5, 7, and 90 days after injury. Results: Athletes who experienced amnesia had markedly greater deficits in and a slower recovery trajectory on measures of symptoms, cognition, and balance. Athletes with 2 or more prior concussions demonstrated poorer balance than those with no previous history. Otherwise, LOC and concussion history largely did not affect symptoms, cognition, or balance. Greater deficits in balance scores were observed in athletes with all symptom types. Regardless of these characteristics, most athletes recovered within 7 to 10 days. Conclusions: Athletes who experienced amnesia had more symptoms and greater deficits in cognition and balance. Symptoms and cognitive or balance deficits were not consistently associated with LOC or concussion history. Acute symptoms had a strong influence on balance scores and, to a lesser extent, on cognition. However, we found no evidence to support more cautious return-to-play decisions for athletes with these characteristics, as group recovery occurred within normal timelines. Our study supports current clinical practice: recommending that athletes be withheld from activity until they are asymptomatic, followed by a graduated return-to-play progression.

Objective To determine the criterion and content validity of a virtual reality (VR) balance module for use in clinical practice. Design Retrospective, VR balance module completed by participants during concussion baseline or assessment testing session. Setting A Pennsylvania State University research laboratory Participants A total of 60 control and 28 concussed students and athletes from the Pennsylvania State University Interventions None Main Outcome Measures This study examined: (1) the relationship between VR composite balance scores (final, stationary, yaw, pitch, and roll) and area of the center-of-pressure (eyes open and closed) scores and (2) group differences (normal volunteers and concussed student-athletes) on VR composite balance scores. Results With the exception of the stationary composite score, all other VR balance composite scores were significantly correlated with the center of pressure (COP) data obtained from a force platform. Significant correlations for the eyes open conditions ranged from r= −.273 to −.704 and from r= −.353 to −.876 for the eyes closed condition. When examining group differences on the VR balance composite modules, the concussed group did significantly (p<.01) worse on all measures compared to the control group. Conclusions The VR balance module met or exceeded the criterion and content validity standard set by current balance tools and may be appropriate for use in a clinical concussion setting.

Objective Balance assessments are part of the recommended clinical concussion evaluation, along with computerized neuropsychological testing and self-reported symptoms checklists. New technology has allowed for the creation of virtual reality (VR) balance assessments to be used in concussion care, but there is little information on the sensitivity and specificity of these evaluations. The purpose of this study is to establish the sensitivity and specificity of a VR balance module for detecting lingering balance deficits clinical concussion care. Design Retrospective, case-control study Setting Institutional research laboratory Participants Normal controls (n=94) and concussed participants (n=27) Interventions All participants completed a VR balance assessment paradigm. Concussed participants were diagnosed by a Certified Athletic Trainer or physician (with 48 hours post-injury) and tested in the lab between 7-10 days post-injury. ROC curves were performed in order to establish the VR module’s sensitivity and specificity for detecting lingering balance deficits. Main Outcome Measures Final balance score Results For the VR balance module, a cutoff score of 8.25 was established to maximize sensitivity at 85.7% and specificity at 87.8%. Conclusions The VR balance module has high sensitivity and specificity for detecting sub-acute balance deficits after concussive injury.

Use of a virtual reality-based NP platform can detect lingering cognitive abnormalities resulting from concussion in clinically asymptomatic participants. Virtual reality NP platforms may compliment the traditional concussion assessment battery by providing novel information. (PsycINFO Database Record