Validation of a Virtual Reality Balance Module for Use in Clinical Concussion Assessment and Management

Objective:To determine the criterion and content validity of a virtual reality (VR) balance module for use in clinical practice. Design:Retrospective, VR balance module completed by participants during concussion baseline or assessment testing session. Setting:A Pennsylvania State University research laboratory. Participants:A total of 60 control and 28 concussed students and athletes from the Pennsylvania State University. Interventions:None. Main Outcome Measures:This study examined: (1) the relationship between VR composite balance scores (final, stationary, yaw, pitch, and roll) and area of the center-of-pressure (eyes open and closed) scores and (2) group differences (normal volunteers and concussed student–athletes) on VR composite balance scores. Results:With the exception of the stationary composite score, all other VR balance composite scores were significantly correlated with the center of pressure data obtained from a force platform. Significant correlations ranged from r = −0.273 to −0.704 for the eyes open conditions and from r = −0.353 to −0.876 for the eyes closed condition. When examining group differences on the VR balance composite modules, the concussed group did significantly (P < 0.01) worse on all measures compared with the control group. Conclusions:The VR balance module met or exceeded the criterion and content validity standard set by the current balance tools and may be appropriate for use in a clinical concussion setting. Clinical Relevance:Virtual reality balance module is a valid tool for concussion assessment in clinical settings. This novel type of balance assessment may be more sensitive to concussion diagnoses, especially later (7-10 days) in the recovery phase than current clinical balance tools.