Differential Sensitivity Between a Virtual Reality Balance Module and Clinically Used Concussion Balance Modalities

Abstract

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.

<p>Physiological Vibration Acceleration (Phybrata) Sensor Assessment of Multi-System Physiological Impairments and Sensory Reweighting Following Concussion</p>

“…The results presented above demonstrate the ability of data from a phybrata sensor worn on the mastoid to confirm clinical diagnosis of concussion, provide independent measures that confirm the presence of accompanying neurological and vestibular impairments, and quantify the progression of multi-system physiological impairments and sensory reweighting following concussion. ROC results have been previously reported for a variety of concussion diagnostics tools and biomarkers, including symptoms inventories, 146,147 neurocognitive testing, [148][149][150][151][152][153][154] analyses of head impact kinematics, [155][156][157][158] postural stability assessments, 39,159,160 gait analysis, 161 eye movement tracking, [162][163][164][165][166] vestibular and oculomotor screening, 167,168 visually evoked potentials, 169 electrovestibulography, 45 robotic assessment of neuromotor performance, 170 blood-based biomarkers, [171][172][173][174] salivary biomarkers, 175 EEG, 176 and MRI assessments of alterations in cerebral blood flow. 177 Many components of traditional neurocognitive testing have been shown to have limited predictive value, 151 and the use of reduced variable subsets (including balance and eye tracking) has recently been recommended.…”

Technology and concussion: A scoping review

“…Standing balance is quick and easy to assess, can be examined almost anywhere, and if advanced sensor measurements can demonstrate high diagnostic utility, balance could be an ideal biologic marker of concussion. According to the results presented here, although technology's ability to measure balance is superior to human measurement, produces good to excellent validity and reliability, and provides an enhanced ability to identify balance impairments, there are still 13-19% false positives and false negatives in differentiating concussed from non-concussed, 14,15 making these technologies very useful, but not stand-alone tools in concussion identification.…”

“…VR balance module was found to have high sensitivity and specificity. 14 Another study examined the Virtual Environment TBI scan (VETS) which uses a Wii Balance Board, compared to the Neurocom Sensory Organization Test (SOT). The VETS was found to have high sensitivity and specificity.…”

Effect of subconcussive impacts on functional outcomes over a single collegiate football season

“…Data were collected before season (baseline) and after the season. Three different modules were used: balance, reaction time, and spatial memory (see [36][37][38] for reliability and validity of all modules for use in detecting sport-related concussion. Briefly: spatial memory (sensitivity 95.8%/specificity 91.4%); reaction time (sensitivity 95.2%/specificity 89.1%); balance (sensitivity 85.7%/specificity 87.8%)).…”