Assessing balance through the use of a low-cost head-mounted display in older adults: a pilot study

Accuracy to identify young adults with chronic ankle instability using a virtual reality - Balance error scoring system: A cross-sectional study

INTRODUCTION

The Balance Error Scoring System (BESS) assesses the ability to control postural stability by performing 3 different stances on two-type surfaces during closed eyes. Virtual reality technology combined with the BESS test (VR-BESS) may be used to disrupt visual inputs instead of closing the eyes, which may improve the sensitivity of diagnosing patients with chronic ankle instability (CAI).

OBJECTIVE

This study aimed to evaluate the accuracy to identify individuals with CAI of the VR-BESS test comparing with the original BESS test.

METHODS

The BESS and VR-BESS tests were administered to 68 young adults (34 participants with CAI and 34 without CAI). Frontal and lateral video views were used to measure the participant's performance errors. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was computed to determine the diagnostic test's overall accuracy.

RESULTS

The total score of the BESS test and the VR-BESS test were statistically significant in comparison to the AUC of no discrimination at 0.5, with AUC values of 0.63 and 0.64, respectively. The cut-off scores for the BESS and VR-BESS tests were 12 and 15, respectively. There was no significant difference between the ROC curves of the BESS and the VR-BESS test for identifying individuals with CAI.

CONCLUSION

The BESS and VR-BESS tests may be utilized interchangeably to identify individuals with CAI.

Portable technology for postural control measurement: Comparing head position with center of pressure data

BACKGROUND

Standing is a basic human function that healthy adults take for granted, yet it is a complex perceptual-motor process that requires sensation of position and motion from the sensory systems.

OBJECTIVE

We assessed agreement between center of pressure data from a laboratory force-platform and head position data from an HTC Vive head-mounted display (HMD) for the evaluation of standing postural control. We investigated the impact of different statistical choices when assessing the relationship between two measurements. Specifically: 1) How does correlation and agreement statistics relate before and after logarithmic transformation? 2) Is there systemic or proportional bias between the force-platform and HMD measurements?

METHODS

We tested 37 adults (26 controls, 11 with unilateral vestibular hypofunction) standing on foam, observing a static or dynamic visual scene projected from the HMD. We quantified anterior-posterior and medio-lateral sway via Directional Path, Root Mean Square Velocity, Variance, and Power Spectral Density (PSD) from a force-platform and the HMD.

RESULTS

Intra-class correlations (ICCs) were moderate-to-good for the non-transformed data and good-to-excellent after logarithmic transformation for all outcomes except for PSD above 1 Hz. Correlations were higher than ICCs. Bland-Altman plots indicated proportional bias but not after logarithmic transformation.

CONCLUSIONS

Both devices correlated linearly, and measure people's postural responses but cannot be used interchangeably, mostly because they appear to diverge with larger sway as evident on Bland-Altman plots of non-transformed data. Agreement between devices was excellent for low frequency movement but poor for high frequency small corrective movements.

In too deep? A systematic literature review of fully-immersive virtual reality and cybersickness among older adults

BACKGROUND

Virtual reality technology holds great promise in improving the health and well-being of older adults; however, this technology is associated with potential risks that may outweigh the benefits. The purpose of this systematic review is to synthesize and critique the existing literature on fully-immersive virtual reality interventions for older adults and the associated risk of cybersickness.

METHODS

We searched eight databases for studies that utilized fully-immersive virtual reality, stated the population as older adults, provided outcomes related to cybersickness, and were written or translated into the English language. Our search generated 332 articles, 39 of which were selected for inclusion in this systematic synthesis and appraisal.

RESULTS

We found that the majority of studies utilized a one-time session. The studies generally had weak sample generalizability and methodological design, but strong data collection and participant retention. The studies nearly all used the Simulator Sickness Questionnaire to measure cybersickness, but the scoring for the Simulator Sickness Questionnaire varied or was not mentioned. Most included studies reported only minor cybersickness among older adult participants.

CONCLUSION

Researchers might conclude that the benefits of virtual reality interventions outweigh the risk of cybersickness in this population. Going forward, researchers should concentrate on the efficacy of virtual reality interventions among older adults, using larger samples and randomized controlled study design, along with measuring dosage effects.

Differing postural control patterns in individuals with bilateral and unilateral hearing loss

OBJECTIVES

Hearing loss (HL) is associated with imbalance and increased fall risk. The mechanism underlying this relationship and differences across types of hearing loss remains unclear. Head mounted displays (HMD) can shed light on postural control mechanisms via an analysis of head sway.

PURPOSE

The purpose of this study was to evaluate head sway in response to sensory perturbations in individuals with bilateral (BHL) or unilateral hearing loss (UHL) and compare them to controls.

MATERIALS AND METHODS

We recruited 36 controls, 23 individuals with UHL and 14 with BHL. An HMD (HTC Vive) measured head sway while participants stood on the floor, hips-width apart. Stimuli included two levels of visuals and sound. Root Mean Square Velocity (RMSV) and Power Spectral Density (PSD) were used to quantify head sway.

RESULTS

Adjusting for age, individuals with BHL had significantly higher anterior-posterior and medio-lateral RMSV than controls and individuals with UHL. Individuals with UHL demonstrated significantly lower response to visual perturbations in RMSV AP and in all 3 frequency segments of PSD compared to controls. Individuals with UHL showed significantly lower movements at high frequencies compared to controls. Sounds or severity of HL did not impact head sway.

CONCLUSIONS

Individuals with BHL demonstrated increased sway with visual perturbations and should be clinically assessed for balance performance and fall risk. Individuals with UHL exhibited reduced responses to visual stimuli compared with controls, which may reflect conscious movement processing. Additional studies are needed to further understand the mechanistic relationship between hearing loss and imbalance.

Acceptability, Feasibility, and Effectiveness of Immersive Virtual Technologies to Promote Exercise in Older Adults: A Systematic Review and Meta-Analysis

CONTEXT

This review aimed to synthesize the literature on the acceptability, feasibility, and effectiveness of immersive virtual technologies to promote physical exercise in older people.

METHOD

We performed a literature review, based on four databases (PubMed, CINAHL, Embase, and Scopus; last search: 30 January 2023). Eligible studies had to use immersive technology with participants aged 60 years and over. The results regarding acceptability, feasibility, and effectiveness of immersive technology-based interventions in older people were extracted. The standardized mean differences were then computed using a random model effect.

RESULTS

In total, 54 relevant studies (1853 participants) were identified through search strategies. Concerning the acceptability, most participants reported a pleasant experience and a desire to use the technology again. The average increase in the pre/post Simulator Sickness Questionnaire score was 0.43 in healthy subjects and 3.23 in subjects with neurological disorders, demonstrating this technology's feasibility. Regarding the effectiveness, our meta-analysis showed a positive effect of the use of virtual reality technology on balance (SMD = 1.05; 95% CI: 0.75-1.36; p < 0.001) and gait outcomes (SMD = 0.7; 95% CI: 0.14-0.80; p < 0.001). However, these results suffered from inconsistency and the number of trials dealing with these outcomes remains low, calling for further studies.

CONCLUSIONS

Virtual reality seems to be well accepted by older people and its use with this population is feasible. However, more studies are needed to conclude its effectiveness in promoting exercise in older people.

Decrease in head sway as a measure of sensory integration following vestibular rehabilitation: A randomized controlled trial

OBJECTIVE

The purpose of this study was to determine the extent to which sensory integration strategies via head sway, derived from a Head-Mounted Display (HMD), change in people with vestibular disorders following vestibular rehabilitation.

DESIGN

Randomized Controlled TrialSetting:Vestibular Rehabilitation ClinicParticipants:Thirty participants with vestibular dysfunction and 21 age-matched controls.

MAIN OUTCOME MEASURES

Participants experienced two levels of visual surround (static or moving 'stars', front to back at 0.2 Hz, 32 mm) and white noise (none or rhythmic) while their head sway was recorded via the HTC Vive. We quantified head sway via Directional Path (DP) and Root Mean Square Velocity (RMSV) in 5 directions: anterior-posterior, medio-lateral, pitch, yaw, and roll and Power Spectral Density in low (PSD 1), medium (PSD 2) and high (PSD 3) frequencies in the anterior-posterior direction.

INTERVENTIONS

Participants performed the assessment prior to being randomized into 8-weeks of contextual sensory integration training in virtual reality or traditional vestibular rehabilitation and once again following completion of the intervention. Controls performed the assessment once. Twelve participants dropped out, half due to covid lock-down. We applied an intention to treat analysis.

RESULTS

We observed significant increases in AP DP, RMSV and all PSDs with change in visual level. Both intervention groups significantly decreased medio-lateral, pitch and roll DP and RMSV and anterior-posterior PSD 2 with no group differences. Vestibular participants were significantly higher than controls on all outcomes pre rehabilitation. Post rehabilitation they were only significantly higher on PSD 2. Sound was not a significant predictor of head sway in this protocol.

CONCLUSIONS

Head sway decreased following vestibular rehabilitation regardless of visual load or type of intervention applied. This change was measured via head kinematics derived from a portable HMD which can serve as a sensitive in-clinic assessment for tracking improvement over time.

Performance and Characteristics of Wearable Sensor Systems Discriminating and Classifying Older Adults According to Fall Risk: A Systematic Review

Sensor-based fall risk assessment (SFRA) utilizes wearable sensors for monitoring individuals’ motions in fall risk assessment tasks. Previous SFRA reviews recommend methodological improvements to better support the use of SFRA in clinical practice. This systematic review aimed to investigate the existing evidence of SFRA (discriminative capability, classification performance) and methodological factors (study design, samples, sensor features, and model validation) contributing to the risk of bias. The review was conducted according to recommended guidelines and 33 of 389 screened records were eligible for inclusion. Evidence of SFRA was identified: several sensor features and three classification models differed significantly between groups with different fall risk (mostly fallers/non-fallers). Moreover, classification performance corresponding the AUCs of at least 0.74 and/or accuracies of at least 84% were obtained from sensor features in six studies and from classification models in seven studies. Specificity was at least as high as sensitivity among studies reporting both values. Insufficient use of prospective design, small sample size, low in-sample inclusion of participants with elevated fall risk, high amounts and low degree of consensus in used features, and limited use of recommended model validation methods were identified in the included studies. Hence, future SFRA research should further reduce risk of bias by continuously improving methodology.

The Influence of Virtual Reality Head-Mounted Displays on Balance Outcomes and Training Paradigms: A Systematic Review

Background: Falls are the leading causes of (non)fatal injuries in older adults. Recent research has developed interventions that aim to improve balance in older adults using virtual reality (VR).

Purpose: We aimed to investigate the validity, reliability, safety, feasibility, and efficacy of head mounted display (HMD) systems for assessing and training balance in older adults.

Methods: We searched EBSCOhost, Scopus, Web of Science, and PubMed databases until 1 September 2020 to find studies that used HMD systems for assessing or training balance. The methodological quality was assessed using a modified version of Downs and Black. We also appraised the risk of bias using Risk of Bias Assessment tool for Non-randomized Studies (RoBANS).

Results: A total of 19 articles (637 participants) were included for review. Despite heterogenous age ranges and clinical conditions across studies, VR HMD systems were valid to assess balance and could be useful for fall prevention and for improving postural control and gait patterns. These systems also have the capacity to differentiate healthy and balance-impaired individuals. During VR versions of traditional balance tests, older adults generally acquire a cautious behavior and take more time to complete the tasks.

Conclusion: VR HMD systems can offer ecologically valid scenarios to assess and train functional balance and can be used alone or in addition to other interventions. New norms and protocols should be defined according to participants' age, health status, and severity of their illness when using VR HMD systems for balance assessment and training. For safe and feasible training, attention must be given to display type, VR elements and scenarios, duration of exposure, and system usability. Due to high risk of bias and overall poor quality of the studies, further research is needed on the effectiveness of HMD VR training in older adults.

Use of Virtual Reality to Assess Dynamic Posturography and Sensory Organization: Instrument Validation Study

Background

The Equitest system (Neurocom) is a computerized dynamic posturography device used by health care providers and clinical researchers to safely test an individual’s postural control. While the Equitest system has evaluative and rehabilitative value, it may be limited owing to its cost, lack of portability, and reliance on only sagittal plane movements. Virtual reality (VR) provides an opportunity to reduce these limitations by providing more mobile and cost-effective tools while also observing a wider array of postural characteristics.

Objective

This study aimed to test the plausibility of using VR as a feasible alternative to the Equitest system for conducting a sensory organization test.

Methods

A convenience sample of 20 college-aged healthy individuals participated in the study. Participants completed the sensory organization test using the Equitest system as well as using a VR environment while standing atop a force plate (Bertec Inc). The Equitest system measures the equilibrium index. During VR trials, the estimated equilibrium index, 95% ellipse area, path length, and anterior-posterior detrended fluctuation analysis scaling exponent alpha were calculated from center of pressure data. Pearson correlation coefficients were used to assess the relationship between the equilibrium index and center of pressure–derived balance measures. Intraclass correlations for absolute agreement and consistency were calculated to compare the equilibrium index and estimated equilibrium index.

Results

Intraclass correlations demonstrated moderate consistency and absolute agreement (0.5 < intraclass correlation coefficient < 0.75) between the equilibrium index and estimated equilibrium index from the Equitest and VR sensory organization test (SOT), respectively, in four of six tested conditions. Additionally, weak to moderate correlations between force plate measurements and the equilibrium index were noted in several of the conditions.

Conclusions

This research demonstrated the plausibility of using VR as an alternative method to conduct the SOT. Ongoing development and testing of virtual environments are necessary before employing the technology as a replacement to current clinical tests.

Applications of Head-Mounted Displays for Virtual Reality in Adult Physical Rehabilitation: A Scoping Review

IMPORTANCE

Head-mounted displays for virtual reality (HMD-VR) may be used as a therapeutic medium in physical rehabilitation because of their ability to immerse patients in safe, controlled, and engaging virtual worlds.

OBJECTIVE

To explore how HMD-VR has been used in adult physical rehabilitation.

DATA SOURCES

A systematic search of MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO, and ERIC produced 11,453 abstracts, of which 777 underwent full-text review.

STUDY SELECTION AND DATA COLLECTION

This scoping review includes 21 experimental studies that reported an assessment or intervention using HMD-VR in a physical rehabilitation context and within the scope of occupational therapy practice.

FINDINGS

HMD-VR was used for assessment and intervention for patients with a range of disorders, including stroke, multiple sclerosis, spinal cord injury, and Parkinson's disease.

CONCLUSIONS AND RELEVANCE

HMD-VR is an emerging technology with many uses in adult physical rehabilitation. Higher quality clinical implementation studies are needed to examine effects on patient outcomes.

WHAT THIS ARTICLE ADDS

We review existing research on how immersive virtual reality (e.g., using head-mounted displays) has been used for different clinical populations in adult physical rehabilitation and highlight emerging opportunities in this field for occupational therapists.

Effects of body visualization on performance in head-mounted display virtual reality

Although there are many virtual reality (VR) applications in sports, only a handful of studies visualized the whole body. There is still a lack of understanding, how much of the own body must be visualized in the head-mounted display (HMD) based VR, to ensure fidelity and similar performance outcome as in the real-world. In the current study, 20 young and healthy participants completed three tasks in a real and virtual environment: balance task, grasping task, and throwing task with a ball. The aim was to find out the meaning of the visualization of different body parts for the quality of movement execution and to derive future guidelines for virtual body presentation. In addition, a comparison of human performance between reality and VR, with whole-body visualization was made. Focusing on the main goal of the current study, there were differences within the measured parameters due to the visualization of different body parts. In the balance task, the differences within the VR body visualization consisted mainly through no-body visualization (NB) compared to the other visualization types defined as whole-body (WB), WB except feet (NF), as well as WB except feet and legs (NLF). In the grasping task, the different body visualization seemed to have no impact on the participants' performances. In the throwing task, the whole-body visualization led to higher accuracy compared to the other visualization types. Regarding the comparison between the conditions, we found significant differences between reality and VR, which had a large effect on the parameters time for completion in the balance and grasping task, the number of foot strikes on the beam in the balance task, as well as the subjective estimation of the difficulty for all tasks. However, the number of errors and the quality of the performances did not differ significantly. The current study was the first study comparing sports-related tasks in VR and reality with further manipulations (occlusions of body parts) of the virtual body. For studies analyzing perception and sports performance or for VR sports interventions, we recommend the visualization of the whole body in real-time.

The Use of Virtual Reality Through Head-Mounted Display on Balance and Gait in Older Adults: A Scoping Review

Introduction: Falls are the most prominent cause of injury and injury-related deaths among older adults (OAs). Virtual reality has been utilized as a method of improving balance and gait in OAs. However, the use of virtual reality through a head-mounted display (VR-HMD) in this area is limited. Objective: The objective of this scoping review was to identify research that used VR-HMD in relation to balance and gait in OAs and to evaluate how VR-HMD is being used with this population. Materials and Methods: A systematic search of the literature was carried out from June 2019 to July 2019 through the following databases: Scopus, Web of Science, PUBMED, and PsycInfo. Eligible studies involved the use of VR-HMD to assess or intervene in balance or gait outcomes of OAs (≥65 years). Articles were not limited to any specific study design or by the year of publication. Results: Our search identified 306 possible articles, of which eight citations met the eligibility criteria. Four studies utilized VR-HMD as an assessment tool or to perturb the balance, while the other four used VR-HMD in their interventions. Conclusions: Currently, it is not clear whether VR-HMD alone is an effective tool for improving balance and gait. However, this review suggests that it is feasible to use VR-HMD with OAs to affect balance and gait. More research is needed in this area, although there appears to be great potential in utilizing VR-HMD with OAs to improve balance outcomes.

Factors Associated With Virtual Reality Sickness in Head-Mounted Displays: A Systematic Review and Meta-Analysis

The use of head-mounted displays (HMD) for virtual reality (VR) application-based purposes including therapy, rehabilitation, and training is increasing. Despite advancements in VR technologies, many users still experience sickness symptoms. VR sickness may be influenced by technological differences within HMDs such as resolution and refresh rate, however, VR content also plays a significant role. The primary objective of this systematic review and meta-analysis was to examine the literature on HMDs that report Simulator Sickness Questionnaire (SSQ) scores to determine the impact of content. User factors associated with VR sickness were also examined. A systematic search was conducted according to PRISMA guidelines. Fifty-five articles met inclusion criteria, representing 3,016 participants (mean age range 19.5–80; 41% female). Findings show gaming content recorded the highest total SSQ mean 34.26 (95%CI 29.57–38.95). VR sickness profiles were also influenced by visual stimulation, locomotion and exposure times. Older samples (mean age ≥35 years) scored significantly lower total SSQ means than younger samples, however, these findings are based on a small evidence base as a limited number of studies included older users. No sex differences were found. Across all types of content, the pooled total SSQ mean was relatively high 28.00 (95%CI 24.66–31.35) compared with recommended SSQ cut-off scores. These findings are of relevance for informing future research and the application of VR in different contexts.

An Immersive Virtual Reality Platform for Assessing Spatial Navigation Memory in Predementia Screening: Feasibility and Usability Study

BACKGROUND

Traditional methods for assessing memory are expensive and have high administrative costs. Memory assessment is important for establishing cognitive impairment in cases such as detecting dementia in older adults. Virtual reality (VR) technology can assist in establishing better quality outcome in such crucial screening by supporting the well-being of individuals and offering them an engaging, cognitively challenging task that is not stressful. However, unmet user needs can compromise the validity of the outcome. Therefore, screening technology for older adults must address their specific design and usability requirements.

OBJECTIVE

This study aimed to design and evaluate the feasibility of an immersive VR platform to assess spatial navigation memory in older adults and establish its compatibility by comparing the outcome to a standard screening platform on a personal computer (PC).

METHODS

VR-CogAssess is a platform integrating an Oculus Rift head-mounted display and immersive photorealistic imagery. In a pilot study with healthy older adults (N=42; mean age 73.22 years, SD 9.26), a landmark recall test was conducted, and assessment on the VR-CogAssess was compared against a standard PC (SPC) setup.

RESULTS

Results showed that participants in VR were significantly more engaged (P=.003), achieved higher landmark recall scores (P=.004), made less navigational mistakes (P=.04), and reported a higher level of presence (P=.002) than those in SPC setup. In addition, participants in VR indicated no significantly higher stress than SPC setup (P=.87).

CONCLUSIONS

The study findings suggest immersive VR is feasible and compatible with SPC counterpart for spatial navigation memory assessment. The study provides a set of design guidelines for creating similar platforms in the future.

Virtual reality among the elderly: a usefulness and acceptance study from Taiwan

BACKGROUND

Virtual reality (VR) has several applications in the medical domain and also generates a secure environment to carry out activities. Evaluation of the effectiveness of VR among older populations revealed positive effects of VR as a tool to reduce risks of falls and also improve the social and emotional well-being of older adults. The decline in physical and mental health, the loss of functional capabilities, and a weakening of social ties represent obstacles towards active aging among older adults and indicate a need for support. Existing research focused on the effects of VR among older populations, and its uses and benefits. Our study investigated the acceptance and use of VR by the elderly.

METHODS

This pilot study was conducted on 30 older adults who voluntarily participated during March to May 2018. Nine VR applications that promote physical activities, motivate users, and provide entertainment were chosen for this study. Participants were asked to use any one of the applications of their choice for 15 min twice a week for 6 weeks. At the end of 6 weeks, participants were asked to fill out a questionnaire based on the Technology Acceptance Model and a literature review, to evaluate their acceptance of VR technology. Cronbach's alpha reliability analysis was used to test the internal consistency of the questionnaire items. Pearson's product moment correlation was used to examine the validity of the questionnaire. A linear regression and mediation analysis were utilized to identify relationships among the variables of the questionnaire.

RESULTS

In total, six male and 24 female participants aged 60~95 years volunteered to participate in the study. Perceived usefulness, perceived ease of use, social norms, and perceived enjoyment were seen to have had significant effects on the intention to use VR. Participants agreed to a large extent regarding the perceived usefulness, perceived enjoyment, and their experience of using VR. Thus, VR was seen to have high acceptance among this elderly population.

CONCLUSIONS

Older people have positive perceptions towards accepting and using VR to support active aging. They perceived VR to be useful, easy to use, and an enjoyable experience, implying positive attitudes toward adopting this new technology.

Assessment of vestibular function in elderly patients

PURPOSE OF REVIEW

Individuals over the age of 60 are at an increased risk of falls, even if they do not have an isolated dysfunction of the vestibular system. The aim of this article is to review the various vestibular testing currently available and its usefulness in determining the presence of vestibular dysfunction in the elderly population. The primary vestibular tests to be reviewed include: balance function testing, vestibular evoked myogenic potentials (VEMPs), and video head impulse testing (vHIT).

RECENT FINDINGS

Balance function testing is important as it evaluates the integration of vestibular information along with sensory and visual information, which may also be impaired. VEMP testing provides a small diagnostic yield as most elderly patients have absent or reduced responses. vHIT gain is reduced in this population, but will still be within the normal range for individuals with normal balance function.

SUMMARY

The combination of various vestibular tests provides complimentary information instead of redundant information on the patient's balance function. Each test evaluates various aspects of the vestibular system which are all needed to determine stable balance in the elderly population.

Concussion Assessment With Smartglasses: Validation Study of Balance Measurement Toward a Lightweight, Multimodal, Field-Ready Platform

BACKGROUND

Lightweight and portable devices that objectively measure concussion-related impairments could improve injury detection and critical decision-making in contact sports and the military, where brain injuries commonly occur but remain underreported. Current standard assessments often rely heavily on subjective methods such as symptom self-reporting. Head-mounted wearables, such as smartglasses, provide an emerging platform for consideration that could deliver the range of assessments necessary to develop a rapid and objective screen for brain injury. Standing balance assessment, one parameter that may inform a concussion diagnosis, could theoretically be performed quantitatively using current off-the-shelf smartglasses with an internal accelerometer. However, the validity of balance measurement using smartglasses has not been investigated.

OBJECTIVE

This study aimed to perform preliminary validation of a smartglasses-based balance accelerometer measure (BAM) compared with the well-described and characterized waist-based BAM.

METHODS

Forty-two healthy individuals (26 male, 16 female; mean age 23.8 [SD 5.2] years) participated in the study. Following the BAM protocol, each subject performed 2 trials of 6 balance stances while accelerometer and gyroscope data were recorded from smartglasses (Glass Explorer Edition). Test-retest reliability and correlation were determined relative to waist-based BAM as used in the National Institutes of Health's Standing Balance Toolbox.

RESULTS

Balance measurements obtained using a head-mounted wearable were highly correlated with those obtained through a waist-mounted accelerometer (Spearman rho, ρ=.85). Test-retest reliability was high (intraclass correlation coefficient, ICC2,1=0.85, 95% CI 0.81-0.88) and in good agreement with waist balance measurements (ICC2,1=0.84, 95% CI 0.80-0.88). Considering the normalized path length magnitude across all 3 axes improved interdevice correlation (ρ=.90) while maintaining test-retest reliability (ICC2,1=0.87, 95% CI 0.83-0.90). All subjects successfully completed the study, demonstrating the feasibility of using a head-mounted wearable to assess balance in a healthy population.

CONCLUSIONS

Balance measurements derived from the smartglasses-based accelerometer were consistent with those obtained using a waist-mounted accelerometer. Additional research is necessary to determine to what extent smartglasses-based accelerometry measures can detect balance dysfunction associated with concussion. However, given the potential for smartglasses to perform additional concussion-related assessments in an integrated, wearable platform, continued development and validation of a smartglasses-based balance assessment is warranted. This approach could lead to a wearable platform for real-time assessment of concussion-related impairments that could be further augmented with telemedicine capabilities to integrate professional clinical guidance. Smartglasses may be superior to fully immersive virtual reality headsets for this application, given their lighter weight and reduced likelihood of potential safety concerns.