Virtual reality as a screening tool for sports concussion in adolescents

Primary objective: There is controversy surrounding the cognitive effects of sports concussion. This study aimed to verify whether the technique of virtual reality could aid in the identification of attention and inhibition deficits in adolescents. Study design: A prospective design was used to assess 25 sports-concussed and 25 non-sports-concussed adolescents enrolled in a sport and education programme. Methods and procedures: Participants were evaluated in immersive virtual reality via ClinicaVR: Classroom-CPT and in real life via the traditional VIGIL-CPT. Main outcomes and results: The neuropsychological assessment using virtual reality showed greater sensitivity to the subtle effects of sports concussion compared to the traditional test, which showed no difference between groups. The results also demonstrated that the sports concussion group reported more symptoms of cybersickness and more intense cybersickness than the control group. Conclusions: Sports concussion was associated with subtle deficits in attention and inhibition. However, further studies are needed to support these results.

[1]  Lili Liu,et al.  Concurrent Validity of a Virtual Reality Driving Assessment for Persons with Brain Injury , 2000, Cyberpsychology Behav. Soc. Netw..

[2]  Joan Machamer,et al.  Neuropsychological outcome at 1-year post head injury. , 1995 .

[3]  Albert A. Rizzo,et al.  Methylphenidate Effect in Children With ADHD Can Be Measured by an Ecologically Valid Continuous Performance Test Embedded in Virtual Reality , 2010, CNS Spectrums.

[4]  B. Giordani,et al.  Disability caused by minor head injury. , 1981, Neurosurgery.

[5]  Philip Schatz.  Computerized Neuropsychological Assessment in Sport , 2011 .

[6]  Karl M. Newell,et al.  Application of Virtual Reality Graphics in Assessment of Concussion , 2006, Cyberpsychology Behav. Soc. Netw..

[7]  Hwee-Ling Yen,et al.  Rehabilitation for traumatic brain injury in children and adolescents. , 2007, Annals of the Academy of Medicine, Singapore.

[8]  F. D. Rose,et al.  Virtual enriched environments in paediatric neuropsychological rehabilitation following traumatic brain injury: Feasibility, benefits and challenges , 2009, Developmental neurorehabilitation.

[9]  Ben C B Yip,et al.  Virtual reality (VR)-based community living skills training for people with acquired brain injury: A pilot study , 2009, Brain injury.

[10]  W. Alves,et al.  Postconcussive symptoms after uncomplicated mild head injury , 1993 .

[11]  Jian-Wei Zhang,et al.  How Do Learners Utilize the Course Package and Learning Support Services in Distance Learning: A Su , 2003 .

[12]  Pierre Jolicoeur,et al.  Cumulative effects of concussions in athletes revealed by electrophysiological abnormalities on visual working memory , 2011, Journal of clinical and experimental neuropsychology.

[13]  Gene E. Alexander,et al.  Factors Related to Patient Report of Cognitive Difficulties Following Head Injury , 1992 .

[14]  Albert A. Rizzo,et al.  Virtual Reality in Brain Damage Rehabilitation: Review , 2005, Cyberpsychology Behav. Soc. Netw..

[15]  Jens Egeland,et al.  Measuring Several Aspects of Attention in One Test , 2010, Journal of attention disorders.

[16]  Glenn Curtiss,et al.  Factors moderating neuropsychological outcomes following mild traumatic brain injury: A meta-analysis , 2005, Journal of the International Neuropsychological Society.

[17]  B. Giordani,et al.  Neuropsychological sequelae of minor head injury. , 1983, Neurosurgery.

[18]  S. Dikmen,et al.  Neuropsychological and psychosocial consequences of minor head injury. , 1986, Journal of neurology, neurosurgery, and psychiatry.

[19]  R. Adams,et al.  Distractibility in Attention/Deficit/ Hyperactivity Disorder (ADHD): The Virtual Reality Classroom , 2009, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[20]  F Lepore,et al.  Concussions in athletes produce brain dysfunction as revealed by event‐related potentials , 2000, Neuroreport.

[21]  Shawn Marshall,et al.  Experimental Studies of Virtual Reality-Delivered Compared to Conventional Exercise Programs for Rehabilitation , 2003, Cyberpsychology Behav. Soc. Netw..

[22]  Jane Dywan,et al.  Retest reliability in adolescents of a computerized neuropsychological battery used to assess recovery from concussion. , 2007, NeuroRehabilitation.

[23]  Michael W Collins,et al.  The relation between post concussion symptoms and neurocognitive performance in concussed athletes. , 2007, NeuroRehabilitation.

[24]  J. Middleton,et al.  Thinking about head injuries in children. , 1989, Journal of child psychology and psychiatry, and allied disciplines.

[25]  A. Rizzo,et al.  The virtual classroom: An ecological version of the Continuous Performance Test - A pilot study: (695432011-008) , 2013 .

[26]  Cheryl Trepagnier,et al.  Virtual environments for the investigation and rehabilitation of cognitive and perceptual impairments , 1999 .

[27]  Robert S. Kennedy,et al.  Simulator Sickness Questionnaire: An enhanced method for quantifying simulator sickness. , 1993 .

[28]  D. Carmody,et al.  Electroencephalogram biofeedback for reading disability and traumatic brain injury. , 2005, Child and adolescent psychiatric clinics of North America.

[29]  Jiri Dvorak,et al.  Summary and agreement statement of the 1st International Symposium on Concussion in Sport, Vienna 2001. , 2002, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[30]  Peter H. Wilson,et al.  Virtual reality in acquired brain injury upper limb rehabilitation: Evidence-based evaluation of clinical research , 2009, Brain injury.

[31]  S. Chapman,et al.  Effects of traumatic brain injury on a virtual reality social problem solving task and relations to cortical thickness in adolescence , 2011, Neuropsychologia.

[32]  Maria V. Sanchez-Vives,et al.  From presence to consciousness through virtual reality , 2005, Nature Reviews Neuroscience.

[33]  K A Dunn,et al.  Traumatic brain injury in the United States: A public health perspective. , 1999, The Journal of head trauma rehabilitation.

[34]  Todd Bowerly,et al.  A Virtual Reality Scenario for All Seasons: The Virtual Classroom , 2009, CNS Spectrums.

[35]  Charles H Hillman,et al.  A history of sport-related concussion on event-related brain potential correlates of cognition. , 2011, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[36]  Luke M Gessel,et al.  Concussions among United States high school and collegiate athletes. , 2007, Journal of athletic training.

[37]  G. Gioia,et al.  Ecological Assessment of Executive Function in Traumatic Brain Injury , 2004, Developmental neuropsychology.

[38]  D. Gronwall,et al.  Delayed recovery of intellectual function after minor head injury. , 1974, Lancet.

[39]  D. E. Mcallister,et al.  Recovery of conditioned fear by a single postextinction shock: Effect of similarity of shock contexts and of time following extinction , 2006, Learning & behavior.

[40]  N. Gosselin,et al.  Comparison of functional outcome following acute care in young, middle-aged and elderly patients with traumatic brain injury , 2006, Brain injury.

[41]  Robert C. Cantu,et al.  Posttraumatic Retrograde and Anterograde Amnesia: Pathophysiology and Implications in Grading and Safe Return to Play. , 2001, Journal of athletic training.

[42]  L. Hartlage,et al.  Persistent neurobehavioral problems following mild traumatic brain injury. , 2001, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[43]  Albert A. Rizzo,et al.  Analysis of assets for virtual reality applications in neuropsychology , 2004 .

[44]  A. Saykin,et al.  Neuroimaging Findings in Mild Traumatic Brain Injury * , 2001, Journal of clinical and experimental neuropsychology.

[45]  N R Temkin,et al.  One year psychosocial outcome in head injury , 1995, Journal of the International Neuropsychological Society.

[46]  James L Patton,et al.  Tolerance of a virtual reality intervention for attention remediation in persons with severe TBI , 2011, Brain injury.

[47]  K P Krages,et al.  Rehabilitation for traumatic brain injury in children and adolescents. , 1999, Evidence report/technology assessment.

[48]  J. McComas,et al.  Benefits of activity and virtual reality based balance exercise programmes for adults with traumatic brain injury: Perceptions of participants and their caregivers , 2005, Brain injury.

[49]  C. Collin,et al.  A follow-up study of patients hospitalized after minor head injury. , 1996, Disability and rehabilitation.

[50]  J E Sniezek,et al.  Incidence of mild and moderate brain injury in the United States, 1991. , 1996, Brain injury.

[51]  Albert A. Rizzo,et al.  The Virtual Classroom: A Virtual Reality Environment for the Assessment and Rehabilitation of Attention Deficits , 2000, Cyberpsychology Behav. Soc. Netw..

[52]  M. Levin.  Can virtual reality offer enriched environments for rehabilitation? , 2011, Expert review of neurotherapeutics.

[53]  Stéphane Bouchard,et al.  Assessment of Inhibition Deficits with the Virtual Classroom in Children with Traumatic Brain Injury: A Pilot-Study , 2009, Annual Review of Cybertherapy and Telemedicine.

[54]  Gavin Williams,et al.  Upper limb virtual rehabilitation for traumatic brain injury: Initial evaluation of the elements system , 2010, Brain injury.

[55]  F. Newcombe,et al.  The psychological effects of concussion D. M. A. Gronwall & H. Sampson, Auckland University Press/Oxford University Press (1974). 118 pp , 1976, Neuroscience.

[56]  D. Pennell,et al.  Functional abnormalities in normally appearing athletes following mild traumatic brain injury: a functional MRI study , 2010, Experimental Brain Research.

[57]  S. Deb,et al.  Neurobehavioural symptoms one year after a head injury , 1999, British Journal of Psychiatry.

[58]  T. McMillan,et al.  Neuropsychological evaluation of mild head injury. , 1985, Journal of neurology, neurosurgery, and psychiatry.

[59]  M. Tarr,et al.  Virtual reality in behavioral neuroscience and beyond , 2002, Nature Neuroscience.

[60]  Sheilagh Hodgins,et al.  Structural Neuroimaging and the Antisocial Brain , 2009 .

[61]  Steven P Broglio,et al.  The Effect of Sport Concussion on Neurocognitive Function, Self-Report Symptoms and Postural Control , 2008, Sports medicine.

[62]  David J. Schretlen,et al.  A quantitative review of the effects of traumatic brain injury on cognitive functioning , 2003, International review of psychiatry.

[63]  Craig K. Enders,et al.  Comparison of the Lees-Haley Fake Bad Scale, Henry-Heilbronner Index, and Restructured Clinical Scale 1 in Identifying Noncredible Symptom Reporting , 2008, Clinical Neuropsychologist.

[64]  Michael Zyda,et al.  Virtual Reality: In the Mind of the Beholder - Guest Editors' Introduction , 1995, Computer.

[65]  Alain Ptito,et al.  Contributions of functional magnetic resonance imaging (fMRI) to sport concussion evaluation. , 2007, NeuroRehabilitation.

[66]  Paul McCrory,et al.  Preparticipation Assessment for Head Injury , 2004, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[67]  J Dvorak,et al.  Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. , 2005, British journal of sports medicine.

[68]  Glenn Curtiss,et al.  Recent neuroimaging techniques in mild traumatic brain injury. , 2007, The Journal of neuropsychiatry and clinical neurosciences.

[69]  Michael J. Singer,et al.  Measuring Presence in Virtual Environments: A Presence Questionnaire , 1998, Presence.

[70]  C. Martin,et al.  La réalité virtuelle comme nouvelle approche évaluative en neuropsychologie: l'exemple de la classe virtuelle avec des enfants ayant subi un traumatisme cranio-cérébral , 2009 .

[71]  Robert L. Mapou.  Neurobehavioral Recovery From Head Injury , 1989 .

[72]  J. Galen Buckwalter,et al.  A Controlled Clinical Comparison of Attention Performance in Children with ADHD in a Virtual Reality Classroom Compared to Standard Neuropsychological Methods , 2007, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[73]  Chwen Jen Chen,et al.  The Theoretical Framework for Designing Desktop Virtual Reality-Based Learning Environments , 2004 .

[74]  G. Larrabee,et al.  A review of mild head trauma. Part I: Meta-analytic review of neuropsychological studies. , 1997, Journal of clinical and experimental neuropsychology.

[75]  H. Belanger,et al.  The neuropsychological impact of sports-related concussion: A meta-analysis , 2005, Journal of the International Neuropsychological Society.

[76]  Albert A Rizzo,et al.  The Utility of a Continuous Performance Test Embedded in Virtual Reality in Measuring ADHD-Related Deficits , 2009, Journal of developmental and behavioral pediatrics : JDBP.