Using Virtual-Reality to Assess Sensory Integration for Navigation and Balance Control in People with Chronic Symptoms after Concussion

Rehabilitation for people with persisting symptoms of imbalance and dizziness after concussion focuses on improving one’s ability to integrate sensory signals for balance control. However, daily life also requires a cognitive application of this sensory integration to remember one’s position and navigate through the surrounding environment, and these simultaneous cognitive demands of navigation may interfere with balance control. Understanding this dual-task interference caused by the simultaneous use of overlapping sensory information is essential to providing transformative rehabilitative care that improves daily life. This project will use state-of-the-art virtual reality technology and tests of dynamic sensory integration during navigation to determine the effects of concussion on spatial navigation, dynamic balance control, and their interference to guide targeted rehabilitation strategies. The long-term goal of the work is to improve rehabilitative care for people with persisting imbalance after concussion by directing patients to targeted treatments that improve their mobility and navigation in daily life. Overall, the results of this study will open a new significant line of research that can use virtual reality as an innovative and clinically-translatable assessment, and potentially future treatment, of sensory integration for spatial updating and sensory integration for balance in clinical settings for people with persisting symptoms after concussion.

Current Status

2024-02-09
This project, at its core, aims to develop a new paradigm to assess mobility-related impairments after concussion. Rehabilitation for people with persisting symptoms of imbalance and dizziness after concussion focuses on improving one’s ability to integrate sensory signals for balance control. However, daily life also requires a cognitive application of this sensory integration to remember one’s position and navigate through the environment. The project goal is to use state-of-the-art virtual reality (VR) technology and tests of dynamic sensory integration during navigation to determine the effects of concussion on spatial navigation, dynamic balance control, and their interference to guide targeted rehabilitation strategies. For our current progress towards this objective, we have 1) received IRB approval, 2) developed a testing protocol combining surveys, virtual reality tasks, and real-world mobility measurements, and 3) run healthy participants on the entire protocol. For the VR testing part of the protocol, we developed a virtual version of the Sensory Organization Test (SOT), designed to assess an individual’s ability to use different sensory cues (visual, proprioceptive, vestibular, and auditory) to maintain postural stability. In this task, the participant wears a head-mounted display (HMD) and balance is measured as they experience different sensory conditions while standing on the ground or on a foam surface. We analyzed preliminary data collected from the tracking system of the HMD to assess its reliability. We also analyzed and implemented a new trial structure of our existing VR homing/navigation task to adapt for testing people with concussion. In this task, participants are asked to walk to different waypoints in a virtual environment in the presence or absence of auditory landmarks and self-location cues experienced from walking. For the additional non-VR tasks, we completed experimenter trainings to administer the NIH toolbox cognitive testing, the Timed Tandem Gait task (walking heel to toe along a 3 m long line of tape while simultaneously completing a cognitive task such as counting down by sevens), and the Vestibular Ocular-Motor Screening (VOMS), that involves the participants moving their eyes, head, and/or body and reporting self-reported symptoms. We are beginning recruitment for participants who have experienced concussion and meet our inclusion and exclusion criteria. We plan to enroll the first concussion participant in the next month.