Differential sensitivity between a virtual reality balance module and clinically used concussion balance modalities

Objective: Balance assessments are part of the recommended clinical concussion evaluation, along with computerized neuropsychological testing and self-reported symptoms checklists. New technology has allowed for the creation of virtual reality (VR) balance assessments to be used in concussion care, but there is little information on the sensitivity and specificity of these evaluations. The purpose of this study is to establish the sensitivity and specificity of a VR balance module for detecting lingering balance deficits clinical concussion care. Design: Retrospective case-control study. Setting: Institutional research laboratory. Participants: Normal controls (n = 94) and concussed participants (n = 27). Interventions: All participants completed a VR balance assessment paradigm. Concussed participants were diagnosed by a Certi-fied Athletic Trainer or physician (with 48 hours postinjury) and tested in the laboratory between 7 and 10 days postinjury. Receiver operating characteristic curves were performed to establish the VR module's sensitivity and specificity for detecting lingering balance deficits. Main Outcome Measures: Final balance score. Results: For the VR balance module, a cutoff score of 8.25 was established to maximize sensitivity at 85.7% and specificity at 87.8%. Conclusions: The VR balance module has high sensitivity and specificity for detecting subacute balance deficits after concussive injury. Clinical Relevance: The VR balance has a high subacute sensitivity and specificity as a stand-alone balance assessment tool and may detect ongoing balance deficits not readily detectable by the Balance Error Scoring System or Sensory Organization Test. Virtual reality balance modules may be a beneficial addition to the current clinical concussion diagnostic battery.