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 studentathletes) 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 = 20.273 to 20.704 for the eyes open conditions and from r = 20.353 to 20.876 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.