Validation of a Virtual Reality Balance Module for Use in Clinical Concussion Assessment and Management

Teel, Elizabeth; Slobounov, Semyon

doi:10.1097/jsm.0000000000000109

Cited by 41 publications

(29 citation statements)

References 16 publications

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“…The VR balance module used in this study has previously been shown as a valid postural stability assessment tool. 22 In two studies using D-1 college football players, it was shown that there are no differences between VR final balance scores over three separate testing sessions as well as scores before and following a full practice. 18 More formal reliability statistics, such as intraclass correlation coefficients, have yet to be established for this technology.…”

Section: Discussionmentioning

confidence: 99%

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

Teel

Arnett

Slobounov

2016

Clinical Journal of Sport Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

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

Teel

Arnett

Slobounov

2016

Clinical Journal of Sport Medicine

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“…Many diagnostic tests have been shown to reliably detect deficits in postural control in a concussed population [14,25,29]. Common tests include the Balance Error Scoring System (BESS) and the Sensory Organization Test (SOT) [6], while others include advanced technology such as the use of virtual reality [32,33,35,36]. Objective outcome measures with high sensitivity and specificity often require costly instruments such as high-resolution cameras and force plates that are not readily available on the sideline.…”

Section: Introductionmentioning

confidence: 99%

Concussion Recovery Phase Affects Vestibular and Oculomotor Symptom Provocation

et al. 2017

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Vestibular and oculomotor testing is emerging as a valuable assessment in sport-related concussion (SRC). However, their usefulness for tracking recovery and guiding return-to-play decisions remains unclear. Therefore the purpose of this study was to evaluate their clinical usefulness for tracking SRC recovery. Vestibular and oculomotor assessments were used to measure symptom provocation in an acute group (n=21) concussed≤10 days, prolonged symptoms group (n=10) concussed ≥16 days (median=84 days), healthy group (n=58) no concussions in >6 months. Known-groups approach was used with three groups at three time points (initial, 2-week and 6-week follow-up). Provoked symptoms for Gaze-Stabilization (GST), Rapid Eye Horizontal (REH), Optokinetic Stimulation (OKS), Smooth-Pursuit Slow (SPS) and Fast (SPF) tests, total combined symptoms scores and near point convergence (NPC) distance were significantly greater at initial assessment in both injury groups compared to controls. Injury groups improved on the King-Devick test and combined symptom provocation scores across time. The acute group improved over time on REH and SPF tests, while the prolonged symptoms group improved on OKS. A regression model (REH, OKS, GST) was 90% accurate discriminating concussed from healthy. Vestibular and ocular motor tests give valuable insight during recovery. They can prove beneficial in concussion evaluation given the modest equipment, training and time requirements. The current study demonstrates that when combined, vestibular and oculomotor clinical tests aid in the detection of deficits following a SRC. Additionally, tests such as NPC, GST, REH, SPS, SPF OKS and KD provide valuable information to clinicians throughout the recovery process and may aid in return to play decisions.

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“…Instrumented balance platforms that measure center of pressure (COP) excursions during static stance are commonly utilized to identify adaptations in balance and postural control that occur following injury and rehabilitation. [1][2][3] For clinical purposes, it is essential that balance platforms demonstrate reliability and validity to detect changes in postural control due to losses of visual input, vestibular input, and/or somatosensory input.…”

mentioning

confidence: 99%

“…[3][4][5] Force-plates calculate COP excursions using load cells and measuring the 3-dimensional (x, y, z) forces and moments generated between the foot and platform during stance.…”

mentioning

confidence: 99%

Validating Center-of-Pressure Balance Measurements Using the MatScan® Pressure Mat

Goetschius¹,

Feger²,

Hertel³

et al. 2018

Journal of Sport Rehabilitation

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Context: Measurements of center-of-pressure (COP) excursions during balance are common practice in clinical and research settings to evaluate adaptations in postural control due to pathological or environmental conditions. Traditionally measured using laboratory force plates, pressure-mat devices may be a suitable option for clinicians and scientist to measure COP excursions. Objective: Compare COP measures and changes during balance between MatScan® pressure mat and force plate. Design: Validation study. Setting: Laboratory. Participants: 30 healthy, young adults (19 female, 11 male, 22.7 ± 3.4 y, 70.3 ± SD kg, 1.71 ± 0.09 m). Main Outcomes: COP excursions were simultaneously measured using pressure-mat and forceplate devices. Participants completed 3 eyes-open and 3 eyes-closed single-leg balance trials (10 s). Mean of the 3 trials was used to calculate 4 COP variables: medial-lateral and anterior-posterior excursion, total distance, and area with eyes open and eyes closed. Percent change and effect sizes were calculated between eyes-open to eyes-closed conditions for each variable and for both devices. Results: All COP variables were highly correlated between devices for eyes-open and eyes-closed conditions (all r > .92, P < .001). BlandAltman plots suggest the pressure-mat COP measurements were smaller than those of the force-plate, and the differences between devices appeared to increase as the measurement magnitude increased. Percent change in COP variables was highly correlated between devices (r > .85, P < .001). Cohen d effect sizes between eyesopen and eyes-closed were all large (d > 2.25) and similar in magnitude between devices. Conclusion: COP measures were correlated between devices, but values tended to be smaller using the pressure mat. The pressure mat and force plate detected comparable magnitude changes in COP measurements between eyesopen and eyes-closed. Pressure mats may provide a viable option for detecting large magnitude changes in postural control during short-duration testing.

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Validation of a Virtual Reality Balance Module for Use in Clinical Concussion Assessment and Management

Cited by 41 publications

References 16 publications

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

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

Concussion Recovery Phase Affects Vestibular and Oculomotor Symptom Provocation

Validating Center-of-Pressure Balance Measurements Using the MatScan® Pressure Mat

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