Assessing subacute mild traumatic brain injury with a portable virtual reality balance device

Wright, W. Geoffrey; McDevitt, Jane; Tierney, Ryan; Haran, F. Jay; Appiah-Kubi, Kwadwo Osei; Dumont, Alex

doi:10.1080/09638288.2016.1226432

Cited by 31 publications

(36 citation statements)

References 36 publications

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“…Leveraging the wide availability of COTS hardware to develop objective clinical assessments and rehabilitative strategies has motivated research into not just smartphones. The Nintendo Wii Balance Board [ 54 - 57 ] and Microsoft Kinect [ 58 - 60 ] are also being used in physical medicine. Indeed, there are now several FDA-cleared Kinect applications suitable for use in the clinic or at home that provide exercise guidance and remotely accessible patient performance metrics [ 61 , 62 ].…”

Section: Discussionmentioning

confidence: 99%

Concussion Assessment With Smartglasses: Validation Study of Balance Measurement Toward a Lightweight, Multimodal, Field-Ready Platform

Salisbury¹,

Keshav²,

Sossong³

et al. 2018

JMIR Mhealth Uhealth

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BackgroundLightweight and portable devices that objectively measure concussion-related impairments could improve injury detection and critical decision-making in contact sports and the military, where brain injuries commonly occur but remain underreported. Current standard assessments often rely heavily on subjective methods such as symptom self-reporting. Head-mounted wearables, such as smartglasses, provide an emerging platform for consideration that could deliver the range of assessments necessary to develop a rapid and objective screen for brain injury. Standing balance assessment, one parameter that may inform a concussion diagnosis, could theoretically be performed quantitatively using current off-the-shelf smartglasses with an internal accelerometer. However, the validity of balance measurement using smartglasses has not been investigated.ObjectiveThis study aimed to perform preliminary validation of a smartglasses-based balance accelerometer measure (BAM) compared with the well-described and characterized waist-based BAM.MethodsForty-two healthy individuals (26 male, 16 female; mean age 23.8 [SD 5.2] years) participated in the study. Following the BAM protocol, each subject performed 2 trials of 6 balance stances while accelerometer and gyroscope data were recorded from smartglasses (Glass Explorer Edition). Test-retest reliability and correlation were determined relative to waist-based BAM as used in the National Institutes of Health’s Standing Balance Toolbox.ResultsBalance measurements obtained using a head-mounted wearable were highly correlated with those obtained through a waist-mounted accelerometer (Spearman rho, ρ=.85). Test-retest reliability was high (intraclass correlation coefficient, ICC2,1=0.85, 95% CI 0.81-0.88) and in good agreement with waist balance measurements (ICC2,1=0.84, 95% CI 0.80-0.88). Considering the normalized path length magnitude across all 3 axes improved interdevice correlation (ρ=.90) while maintaining test-retest reliability (ICC2,1=0.87, 95% CI 0.83-0.90). All subjects successfully completed the study, demonstrating the feasibility of using a head-mounted wearable to assess balance in a healthy population.ConclusionsBalance measurements derived from the smartglasses-based accelerometer were consistent with those obtained using a waist-mounted accelerometer. Additional research is necessary to determine to what extent smartglasses-based accelerometry measures can detect balance dysfunction associated with concussion. However, given the potential for smartglasses to perform additional concussion-related assessments in an integrated, wearable platform, continued development and validation of a smartglasses-based balance assessment is warranted. This approach could lead to a wearable platform for real-time assessment of concussion-related impairments that could be further augmented with telemedicine capabilities to integrate professional clinical guidance. Smartglasses may be superior to fully immersive virtual reality headsets for this application, given their lighter wei...

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Section: Discussionmentioning

confidence: 99%

Concussion Assessment With Smartglasses: Validation Study of Balance Measurement Toward a Lightweight, Multimodal, Field-Ready Platform

Salisbury¹,

Keshav²,

Sossong³

et al. 2018

JMIR Mhealth Uhealth

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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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“…Traditional vestibular rehabilitation is commonly applied for athletes with concussions to reduce returnto-play time [17,20], but no studies applied this technique in combination with virtual reality in this population. There is limited research regarding virtual reality in vestibular rehabilitation [19,[20][21][22][23]. Studies presented that rugby and snowboarding athletes had their sensorimotor skills, and dynamic posture improved using vestibular exercises combined with virtual reality technology [13,14], but any study evaluate this tool to recover balance after a concussion.…”

Section: Discussionmentioning

confidence: 99%

Virtual reality as a vestibular rehabilitation tool for athletes after concussion: a literature review

Felipe¹,

Hunnicutt²

2020

areh

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Virtual Reality is cogitated as one of the most favorable and challenging technologies applied in health sciences. Its use has been integrated in vestibular rehabilitation for the management of balance conditions, founded on mechanisms related to neuronal plasticity of the central nervous system. Dizziness is one of the most common symptoms after a concussion in sports and can be an issue related to a long return to play. Virtual reality may be a beneficial method for rehabilitation for athletes with dizziness after concussion. However, no studies have critically reviewed the scientific evidence in this regard. The objective was to conduct a systematic review on the effectiveness of virtual reality as a rehabilitation strategy for athletes after a concussion. A systematic review of the electronic databases Cochrane Collection, Consumer Health Complete, Oxford Journals, PubMed, Science Direct, and SPORTDiscus was conducted to identify studies related to the effect of virtual reality after a concussion in athletes. The search timeframe ranged from January 1990 to December 2019. The search resulted in the identification of 3 randomized controlled trials (RCTs) and 7 non-RCT studies. None of the studies were specific associated with athletes with dizziness after a concussion. Specific studies are necessary to establish the application that may respond optimally to the treatment of concussions associated with balance problems.

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Assessing subacute mild traumatic brain injury with a portable virtual reality balance device

Cited by 31 publications

References 36 publications

Concussion Assessment With Smartglasses: Validation Study of Balance Measurement Toward a Lightweight, Multimodal, Field-Ready Platform

Concussion Assessment With Smartglasses: Validation Study of Balance Measurement Toward a Lightweight, Multimodal, Field-Ready Platform

Concussion Recovery Phase Affects Vestibular and Oculomotor Symptom Provocation

Virtual reality as a vestibular rehabilitation tool for athletes after concussion: a literature review

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