The new VR-based device is a valid measure for detecting balance impairment following mTBI and can potentially replace more expensive and cumbersome equipment. Assessments that test visual-vestibular processing, such as VETS, increase sensitivity to mTBI-related balance deficits, which can be used to guide rehabilitation. Implications for rehabilitation Emerging technology using virtual reality can be economically integrated into the clinical setting for easy testing of postural control in neurologically impaired populations. Tailoring postural assessments to include tasks that rely on visual and vestibular integration will increase the accuracy of detecting balance impairment following mild traumatic brain injury.

In this study, we collected and analyzed preliminary data for the internal consistency of a new condensed model to assess vestibular and oculomotor impairments following a concussion. We also examined this model's ability to discriminate concussed athletes from healthy controls. Each participant was tested in a concussion assessment protocol that consisted of the Neurocom's Sensory Organization Test (SOT), Balance Error Scoring System exam, and a series of 8 vestibular and oculomotor assessments. Of these 10 assessments, only the SOT, near point convergence, and the signs and symptoms (S/S) scores collected following optokinetic stimulation, the horizontal eye saccades test, and the gaze stabilization test were significantly correlated with health status, and were used in further analyses. Multivariate logistic regression for binary outcomes was employed and these beta weights were used to calculate the area under the receiver operating characteristic curve ( area under the curve). The best model supported by our findings suggest that an exam consisting of the 4 SOT sensory ratios, near point convergence, and the optokinetic stimulation signs and symptoms score are sensitive in discriminating concussed athletes from healthy controls (accuracy=98.6%, AUC=0.983). However, an even more parsimonious model consisting of only the optokinetic stimulation and gaze stabilization test S/S scores and near point convergence was found to be a sensitive model for discriminating concussed athletes from healthy controls (accuracy=94.4%, AUC=0.951) without the need for expensive equipment. Although more investigation is needed, these findings will be helpful to health professionals potentially providing them with a sensitive and specific battery of simple vestibular and oculomotor assessments for concussion management.

This study indicated that treadmill and overground walking exercise training programmes, combined with conventional rehabilitation, improved walking function in an African group of adult stroke survivors. Therefore, professionals who conduct stroke rehabilitation programmes should utilize exercise training to optimize patient outcomes.

Mild traumatic brain injury (mTBI) following a head impact or blast exposure can cause diffuse injury to the brain, which can affect sensorimotor, cognitive, and emotional processes. Among the most common sensorimotor symptoms of mTBI is balance impairment. A commonly used assessments of balance following mTBI is the sensory organization test (SOT). This test has shown that postural deficits following head injury may be due to visual-vestibular processing issues, but it is less sensitive to unremitting symptoms that do not spontaneously resolve within a week. Our current project involves demonstrating validity and reliability of a novel low-cost, portable virtual reality-based balance screening device that employs established principles of sensorimotor reweighting and visual-vestibular integration. The goal is to determine if it can replace existing tools that are either prohibitively expensive or lack reliability or sensitivity. Methods: Healthy adults with no known musculoskeletal or neurological injury (n=27; 17 males, 10 females; 22.1+3.9 years) were tested to establish healthy norms. Individuals with mTBI (n=8; 4 males, 4 females; 20.0+1.7 years) were compared to the healthy norms. The new VR-based balance assessment system consists of a Wii balance board (WBB), a large screen television, and a custom-designed software user interface used to collect and process data. Subjects performed six upright postural tasks (three visual conditions either standing directly on the WBB or on foam placed on the WBB). Subjects viewed a virtual reality scene displayed on a 60" television. The three visual conditions were Static Scene, Dark Scene, and Dynamic Scene (Roll at 60 deg/s). The WBB recorded COP at 100Hz for 30 sec. Dependent variables included COP velocity, root mean square, and sway area. Subjects also performed the sensory organization test (SOT), which can be used as criterion-measures for intraclass correlations with the new device. Results: Preliminary data on healthy subjects validates effectiveness of the device to reduce postural stability as sensory input reliability and availability decreases. Additionally, our results reveal that individuals with mTBI have significantly worse balance scores on the new VR-device (p<0.001). This highlights its sensitivity to balance disturbance even if when testing a small sample. Comparison of the new device to SOT shows good criterion validity with ROC curves revealing sensitivity/specificity equal or higher than the SOT. COP sway area, velocity, and standard deviation of medial-lateral and 7KLV UHVHDUFK LV VXSSRUWHG E\ WKH &RQJUHVVLRQDOO\ 'LUHFWHG 0HGLFDO 5HVHDUFK 3URJUDP ± 5DSLG ,QQRYDWLRQ )XQG :;:+& :*: 72 978-1-4799-8984-3/15/$31.00 ©2015 IEEE