Simple Low-Cost Virtual Reality to Improve the Responsiveness of Clinical Balance Assessment

Abstract

Concussions commonly affect postural stability, which incorporates the visual, vestibular, and somatosensory system. Postural stability post-concussion is commonly quantified via the Balance Error Scoring System (BESS). However, the BESS may not sufficiently challenge postural stability in an athletic population allowing potential deficits to go unquantified. Virtual reality (VR) devices may be capable of providing an increased visual-vestibular integration challenge to improve BESS responsiveness. PURPOSE: Determine if a low cost and clinically applicable VR modification to the standard BESS can provide a superior challenge to postural stability than the traditional BESS. METHODS: Twenty-eight adults (mean age 23.36 ± 2.38 years, mean height 1.74 m ± 0.13, mean weight 77.95 kg ± 16.63) were recruited. All individuals performed the standard BESS test and a VR modified BESS (VR-BESS) on a force plate. All participants completed a familiarization session to practice the traditional BESS and VR-BESS. Participants then performed two trials of the traditional BESS or VR-BESS in a counter-balanced randomized order. The VR-BESS used a headset (Google Cardboard) and phone (LG V10) to display a rollercoaster ride (FIBRUM) to induce a visual and vestibular challenge to postural stability. BESS postural control errors and center of pressure (CoP) velocity were averaged for the two trials and used for analyses. Separate repeated measures ANOVAs were conducted for the BESS errors and CoP velocity. Post hoc testing was conducted for the condition by stance by surface interaction with an alpha level set at p<0.05 with a Bonferroni correction for multiple comparison analyses. RESULTS: The overall repeated measures ANOVA was significant for BESS errors (F(2,26)=6.37, p=.003) and CoP velocity (F(2,26)=5.19, p=.008).The VR-BESS significantly increased total errors (20.93 vs. 11.42, p<0.05) and CoP velocity summed across all stances and surfaces (52.96 cm/s vs. 37.73 cm/s, p<0.05) beyond the traditional BESS. CONCLUSION: VR-BESS provides a standardized, efficient, and effective way to challenge postural stability to a greater extent than the traditional BESS. With technology quickly advancing and becoming less expensive, this modification may be immediately incorporated into balance training and assessment.