Subtle impairments of perceptual-motor function and well-being are detectable among military cadets and college athletes with self-reported history of concussion

Abstract

IntroductionA lack of obvious long-term effects of concussion on standard clinical measures of behavioral performance capabilities does not preclude the existence of subtle neural processing impairments that appear to be linked to elevated risk for subsequent concussion occurrence, and which may be associated with greater susceptibility to progressive neurodegenerative processes. The purpose of this observational cohort study was to assess virtual reality motor response variability and survey responses as possible indicators of suboptimal brain function among military cadets and college athletes with self-reported history of concussion (HxC).MethodsThe cohort comprised 75 college students (20.7 ± 2.1 years): 39 Reserve Officer Training Corp (ROTC) military cadets (10 female), 16 football players, and 20 wrestlers; HxC self-reported by 20 (29.2 ± 27.1 months prior, range: 3–96). A virtual reality (VR) test involving 40 lunging/reaching responses to horizontally moving dots (filled/congruent: same direction; open/incongruent: opposite direction) was administered, along with the Sport Fitness and Wellness Index (SFWI) survey. VR Dispersion (standard deviation of 12 T-scores for neck, upper extremity, and lower extremity responses to congruent vs. incongruent stimuli originating from central vs. peripheral locations) and SFWI response patterns were the primary outcomes of interest.ResultsLogistic regression modeling of VR Dispersion (range: 1.5–21.8), SFWI (range: 44–100), and an interaction between them provided 81% HxC classification accuracy (Model χ2[2] = 26.03, p < .001; Hosmer & Lemeshow χ2[8] = 1.86, p = .967; Nagelkerke R2 = .427; Area Under Curve = .841, 95% CI: .734, .948). Binary modeling that included VR Dispersion ≥3.2 and SFWI ≤86 demonstrated 75% sensitivity and 86% specificity with both factors positive (Odds Ratio = 17.6, 95% CI: 5.0, 62.1).Discussion/ConclusionDetection of subtle indicators of altered brain processes that might otherwise remain unrecognized is clearly important for both short-term and long-term clinical management of concussion. Inconsistency among neck, upper extremity, and lower extremity responses to different types of moving visual stimuli, along with survey responses suggesting suboptimal well-being, merit further investigation as possible clinical indicators of persisting effects of concussion that might prove to be modifiable.

Test-Retest Reliability of Immersive Virtual Reality Measures of Perceptual-Motor Performance

“…A unique aspect of our immersive VR test was simultaneous quantification of four different perceptual-motor responses (i.e., eye, neck, arm, and step) to eight different combinations of moving visual stimuli characteristics. Regarding test validity, our prior VR research demonstrated that a composite metric derived from multiple component measures had very good discriminatory power for distinguishing individuals with a remote history of concussion from those who denied ever having sustained such an injury (Wilkerson et al, 2023). Findings in this study further support clinical use of our VR test by documenting moderate to excellent test-retest reliability for numerous measurements.…”

“…In this study, we presented a VR test in which there were moving visual stimuli of two types that required respondents to select stimulus-matched directional responses over multiple successive trials, and to execute of a combination of eye movements, neck rotation, upper extremity reaching, and whole-body lateral lunging toward a virtual target; we then measured the duration of each displacement. Previous research has demonstrated that measures derived from this specific VR test have good predictive validity for the identification of college athletes and military cadets with a remote history of concussion (Wilkerson et al, 2023). Based on the findings reported by the only previous study that has assessed the test-retest reliability of RT values derived from an immersive VR test (Horan et al, 2020), we expected adequate statistical results to justify the clinical use of most, if not all, measures derived from this unique VR test.…”

“…Peripheral), and Movement Direction (Left-to-Right vs. Right-to-Left) that were Superimposed on the Virtual Reality Environment. (Figure reproduced with permission fromWilkerson, G. B., et al (2023). Subtle impairments of perceptual-motor function and wellbeing are detectable among military cadets and college athletes with self-reported history of concussion.…”

Concussion history and virtual reality metrics predict core or lower extremity injury occurrence among high school athletes

“…The 40-trial immersive VR test presented eight different combinations of stimulus initial position, stimulus type, and movement direction. The validity of the test for discrimination between individuals with and without a lifetime history of concussion has been established ( 47 ) and documentation of moderate to excellent test–retest reliability for the various measurements derived from the test ( 50 ).…”

Assessment and Training of Perceptual-Motor Function: Performance of College Wrestlers Associated with History of Concussion

“…An integrated multi-component VR assessment may identify individuals who would otherwise be exposed to an unrecognized elevation of injury risk [27], and participation in a training activity that incorporates a similar approach may yield beneficial improvements in perceptual-motor performance. Thus, the purposes of this study were: (1) to assess the potential for VR measurements of perceptual-motor performance to discriminate college wrestlers with a history of concussion from those who deny having ever sustained a concussion, and (2) to assess the potential for perceptual-motor performance improvements after six VR training sessions are completed over a 3-week period.…”