Virtual reality in concussion management: from lab to clinic
Background: The use of virtual reality (VR) technology continues to grow in the areas of clinical assessment and rehabilitation. Both researchers and health care providers are exploring ways to incorporate VR in clinical practice as an emerging technology. VR postural control and neuropsychological testing represents a promising next step in SRC management.
Aim: This article reviews the current literature on VR applications for SRC assessment.
Relevance for patients: VR-based postural control assessments suggest that visual motion is destabilizing following SRC perhaps indicating persistent perceptual-motion disintegration when clinical postural control tests suggest complete recovery. VR can also provide functional neuropsychological assessments using real-life scenarios or virtual environments, which may be more sensitive than traditional pencil-and-paper or computerized neuropsychological assessments.
[1] Mann S, Havens JC, Iorio J, Yuan Y, Furness T. All Reality: Values, Taxonomy, and Continuum, for Virtual, Augmented, eXtended/MiXed (X), Mediated (X, Y), and Multimediated Reality/Intelligence. Presented at the AWE; 2018. Available from: http://www.wearcam.org/all.pdf. [Last accessed on 2020 Apr 23].
[2] Howard MC. A Meta-analysis and Systematic Literature Review of Virtual Reality Rehabilitation Programs. Comput Hum Behav 2017;70:317-27.
[3] Chuah SH. Why and who will Adopt Extended Reality Technology? Literature Review, Synthesis, and Future Research Agenda. Malaysia: Universiti Sains Malaysia; 2018.
[4] Hiraga CY, Tonello MG, Pellegrini AM. Contribution of Virtual Reality (Nintendo Wii) for Exercise Training and Rehabilitation. In: Locomotion and Posture in Older Adults. Berlin: Springer; 2017. p. 371-84.
[5] Man D. Common Issues of Virtual Reality in Neurorehabilitation. London: IntechOpen; 2010.
[6] Ro YK, Brem A, Rauschnabel PA. Augmented Reality Smart Glasses: Definition, Concepts and Impact on Firm Value Creation. In: Augmented Reality and Virtual Reality. Berlin: Springer; 2018. p. 169-81.
[7] Rizzo AA. Virtual Reality in Psychology and Rehabilitation: The Last Ten Years and the Next. Proceeding 7th ICDVRAT with Art Abilitation; 2008.
[8] Knight RG, Titov N, Crawford M. The Effects of Distraction on Prospective Remembering Following Traumatic Brain Injury Assessed in a Simulated Naturalistic Environment. J Int Neuropsych Soc 2006;12:8-16.
[9] Gamito P, Oliveira J, Pacheco J, Morais D, Saraiva T, Lacerda R, et al. Traumatic brain injury memory training: A virtual reality online solution. Int J Disabil Hum Dev 2011;10:309-12.
[10] Larson EB, Ramaiya M, Zollman FS, Pacini S, Hsu N, Patton JL, et al. Tolerance of a Virtual Reality Intervention for Attention Remediation in Persons with Severe TBI. Brain Inj 2011;25:274-81.
[11] Dvorkin AY, Ramaiya M, Larson EB, Zollman FS, Hsu N, Pacini S, et al. A “Virtually Minimal” Visuo-haptic Training of Attention in Severe Traumatic Brain Injury. J Neuroeng Rehabil 2013;10:92.
[12] Biffi E, Beretta E, Cesareo A, Maghini C, Turconi AC, Reni G, et al. An Immersive Virtual Reality Platform to Enhance Walking Ability of Children with Acquired Brain Injuries. Methods Inf Med 2017;56:119-26.
[13] Sessoms PH, Gottshall KR, Collins J, Markham AE, Service KA, Reini SA. Improvements in Gait Speed and Weight Shift of Persons with Traumatic Brain Injury and Vestibular Dysfunction Using a Virtual Reality Computerassisted Rehabilitation Environment. Mil Med 2015;180 Suppl 3:143-9.
[14] Cox DJ, Davis M, Singh H, Barbour B, Nidiffer FD, Trudel T, et al. Driving Rehabilitation for Military Personnel Recovering from Traumatic Brain Injury Using Virtual Reality Driving Simulation: A Feasibility Study. Mil Med 2010;175:411-6.
[15] Broglio SP, Harezlak J, Katz B, Zhao S, McAllister T, McCrea M, et al. Acute Sport Concussion Assessment Optimization: A Prospective Assessment from the CARE Consortium. Sports Med 2019;49:1977-87.
[16] Dalecki M, Gorbet DJ, Macpherson A, Sergio LE. Sport Experience is Correlated with Complex Motor Skill Recovery in Youth Following Concussion. Eur J Sport Sci 2019;19:1-10.
[17] Slobounov S, Slobounov E, Newell K. Application of Virtual Reality Graphics in Assessment of Concussion. Cyberpsychol Behav 2006;9:188-91.
[18] Lee DN, Lishman JR. Visual Proprioceptive Control of Stance. J Hum Mov Stud 1975;18:83-94.
[19] Lee DN, Aronson E. Visual Proprioceptive Control of Standing in Human Infants. Percept Psychophys 1974;15:529-32.
[20] Lestienne F, Soechting J, Berthoz A. Postural Readjustments Induced by Linear Motion of Visual Scenes. Exp Brain Res 1977;28:363-84.
[21] Dichgans J, Brandt T. Visual-vestibular Interaction: Effects on Self-motion Perception and Postural Control. Berlin: Springer; 1978. p. 755-804.
[22] Berthoz A, Lacour M, Soechting JF, Vidal PP. The Role of Vision in the Control of Posture during Linear Motion. In: Progress in Brain Research. Amsterdam, Netherlands: Elsevier; 1979. p. 197-209.
[23] Van Asten W, Gielen C, Van Der Gon JJ. Postural Adjustments Induced by Simulated Motion of Differently Structured Environments. Exp Brain Res 1988;73:371-83.
[24] Slobounov S, Tutwiler R, Sebastianelli W, Slobounov E. Alteration of Postural Responses to Visual Field Motion in Mild Traumatic Brain Injury. Neurosurgery 2006;59:134-93.
[25] Slobounov S, Slobounov E, Sebastianelli W, Cao C, Newell K. Differential Rate of Recovery in Athletes after First and Second Concussion Episodes. Neurosurgery 2007;61:338-44.
[26] Teel EF, Slobounov SM. Validation of a Virtual Reality Balance Module for use in Clinical Concussion Assessment and Management. Clin J Sport Med 2015;25:144.
[27] Teel EF, Gay MR, Arnett PA, Slobounov SM. Differential Sensitivity between a Virtual Reality (VR) Balance Module and Clinically Used Concussion Balance Modalities. Clin J Sport Med 2016;26:162.
[28] Furman GR, Lin C, Bellanca JL, Marchetti GF, Collins MW, Whitney SL. Comparison of the Balance Accelerometer Measure and Balance Error Scoring System in Adolescent Concussions in Sports. Am J Sports Med 2013;41:1404-10.
[29] Wright WG, Tierney RT, McDevitt J. Visual-vestibular Processing Deficits in Mild Traumatic Brain Injury. J Vestibular Res 2017;27:27-37.
[30] Wright WG, McDevitt J, Tierney R, Haran FJ, AppiahKubi KO, Dumont A. Assessing Subacute Mild Traumatic Brain Injury with a Portable Virtual Reality Balance Device. Disabil Rehabil 2017;39:1564-72.
[31] Murray NG, Ambati VP, Contreras MM, Salvatore AP, Reed-Jones RJ. Assessment of Oculomotor Control and Balance Post-concussion: A Preliminary Study for a Novel Approach to Concussion Management. Brain Inj 2014;28:496-503.
[32] Murray NG, Fernandez E, Salvatore AP, Reed-Jones RJ. Assessment of the Wii Basic Balance Test in Measuring Postural Deficits Post-concussion. J Clin Transl Res 2017;2:123-8.
[33] DeMatteo C, Greenspoon D, Levac D, Harper JA, Rubinoff. Evaluating the Nintendo Wii for Assessing Return to Activity Readiness in Youth with Mild Traumatic Brain Injury. Phys Occup Ther Pediatr 2014;34:229-44.
[34] Nolin P, Stipanicic A, Henry M, Joyal CC, Allain P. Virtual Reality as a Screening Tool for Sports Concussion in Adolescents. Brain Inj 2012;26:1564-73.
[35] Teel E, Gay M, Johnson B, Slobounov S. Determining Sensitivity/Specificity of Virtual Reality-based Neuropsychological Tool for Detecting Residual Abnormalities Following Sport-related Concussion. Neuropsychology 2016;30:474.
[36] Keshner EA, Kenyon RV, Dhaher Y, Streepey JW. Employing a Virtual Environment in Postural Research and Rehabilitation to Reveal the Impact of Visual Information. Int J Disabil Hum Dev 2005;4:177-82.
[37] Keshner EA, Kenyon RV, Langston J. Postural Responses Exhibit Multisensory Dependencies with Discordant Visual and Support Surface Motion. J Vestib Res 2004;14:307-19.
[38] Keshner EA, Kenyon RV. Using Immersive Technology for Postural Research and Rehabilitation. Assist Technol 2004;16:54-62.
[39] Wade MG, Lindquist R, Taylor JR, Treat-Jacobson D. Optical Flow, Spatial Orientation, and the Control of Posture in the Elderly. J Gerontol B Psychol Sci Soc Sci 1995;50:P51-4.
[40] Ring C, Nayak US, Isaacs B. Balance Function in Elderly People who have and who have not Fallen. Arch Phys Med Rehabil 1988;69:261-4.
[41] Eagle SR, Kontos AP, Pepping G, Johnson CD, Sinnott A, LaGoy A, et al. Increased Risk of Musculoskeletal Injury Following Sport-related Concussion: A Perception Action Coupling Approach. Sports Med 2020;50:15-23.
[42] Porras DC, Siemonsma P, Inzelberg R, Zeilig G, Plotnik M. Advantages of Virtual Reality in the Rehabilitation of Balance and Gait: Systematic Review. Neurology 2018;90:1017-25.
[43] Burdea GC. Virtual Rehabilitation Benefits and Challenges. Methods Inf Med 2003;42:519-23.
[44] Schultheis MT, Rizzo AA. The Application of Virtual Reality Technology in Rehabilitation. Rehabil Psychol 2001;46:296.
[45] Morel M, Bideau B, Lardy J, Kulpa R. Advantages and Limitations of Virtual Reality for Balance Assessment and Rehabilitation. Neurophysiol Clin 2015;45:315-26.
[46] Rizzo A, Kim GJ. A SWOT Analysis of the Field of Virtual Reality Rehabilitation and Therapy. Presence 2005;14:119-46.
[47] Rizzo A. Virtual Reality and Disability: Emergence and Challenge. Disabil Rehabil 2002;24:11-2.