Search

Background/Objectives: Neural processes involved in visual detection, decision-making, and motor plan execution are believed to play a key role in the avoidance of sport-related injuries, but very little evidence exists to guide the development of training activities for the optimization of brain function. Immersive virtual reality provides a means to precisely measure the amount of time that elapses from visual stimulus presentation to the initiation of a motor response (i.e., perceptual latency) or its completion (i.e., response time). Methods: The median value of a metric quantifying both the speed and accuracy (i.e., the rate correct per second of response time) of 50 high school female soccer players was used to assign those who exhibited suboptimal performance to a training program. Training sessions required less than 5 min and the number of sessions completed over a 7-week period ranged from 3 to 13 (median = 5). Results: Among 42 players available for follow-up assessment at 8 weeks after the first practice session (training n = 19; comparison n = 23), the results of regression-discontinuity analyses demonstrated statistically significant differences (p < 0.05) for metrics representing fast/accurate movement initiation (i.e., the rate correct score for perceptual latency, p = 0.016) and across-trial consistency (i.e., perceptual latency variability, p = 0.027). From the first practice session to the end of the soccer season, 12 injuries were sustained by 10 players (four concussions and eight musculoskeletal injuries). A time-to-event analysis demonstrated strong associations with perceptual latency variability ≥ 0.143 (Hazard Ratio = 15.43, p = 0.011) and a lifetime history of at least one concussion (Hazard Ratio = 8.84, p = 0.008). Conclusions: The strong association of movement initiation consistency with the avoidance of concussion or musculoskeletal injury suggests that the training program may have a highly beneficial far-transfer effect.

Concussion may affect sport performance capabilities related to the visual perception of environmental events, rapid decision-making, and the generation of effective movement responses. Immersive virtual reality (VR) offers a means to quantify, and potentially enhance, the speed, accuracy, and consistency of responses generated by integrated neural processes. A cohort of 24 NCAA Division I male wrestlers completed VR assessments before and after a 3-week VR training program designed to improve their perceptual-motor performance. Prior to training, the intra-individual variability (IIV) among 40 successive task trials for perceptual latency (i.e., time elapsed between visual stimulus presentation and the initiation of movement response) demonstrated strong discrimination between 10 wrestlers who self-reported a history of concussion from 14 wrestlers who denied ever having sustained a concussion (Area Under Curve ≥ 0.750 for neck, arm, and step movements). Natural log transformation improved the distribution normality of the IIV values for both perceptual latency and response time (i.e., time elapsed between visual stimulus presentation and the completion of movement response). The repeated measures ANOVA results demonstrated statistically significant (p < 0.05) pre- and post-training differences between groups for the IIV in perceptual latency and the IIV in response time for neck, arm, and step movements. Five of the six IIV metrics demonstrated a statistically significant magnitude of change for both groups, with large effect sizes. We conclude that a VR assessment can detect impairments in perceptual-motor performance among college wrestlers with a history of concussion. Although significant post-training group differences were evident, VR training can yield significant performance improvements in both groups.

IntroductionA lack of obvious long-term effects of concussion on standard clinical measures of behavioral performance capabilities does not preclude the existence of subtle neural processing impairments that appear to be linked to elevated risk for subsequent concussion occurrence, and which may be associated with greater susceptibility to progressive neurodegenerative processes. The purpose of this observational cohort study was to assess virtual reality motor response variability and survey responses as possible indicators of suboptimal brain function among military cadets and college athletes with self-reported history of concussion (HxC).MethodsThe cohort comprised 75 college students (20.7 ± 2.1 years): 39 Reserve Officer Training Corp (ROTC) military cadets (10 female), 16 football players, and 20 wrestlers; HxC self-reported by 20 (29.2 ± 27.1 months prior, range: 3–96). A virtual reality (VR) test involving 40 lunging/reaching responses to horizontally moving dots (filled/congruent: same direction; open/incongruent: opposite direction) was administered, along with the Sport Fitness and Wellness Index (SFWI) survey. VR Dispersion (standard deviation of 12 T-scores for neck, upper extremity, and lower extremity responses to congruent vs. incongruent stimuli originating from central vs. peripheral locations) and SFWI response patterns were the primary outcomes of interest.ResultsLogistic regression modeling of VR Dispersion (range: 1.5–21.8), SFWI (range: 44–100), and an interaction between them provided 81% HxC classification accuracy (Model χ2[2] = 26.03, p

BackgroundIntegrated movement and cognitive load paradigms are used to expose impairments associated with concussion and musculoskeletal injury. There is currently little information on the discriminatory nature of dual-task complexity and the relative influence of physical exertion on cognitive outcomes.PurposeAssess cognitive performance while under motor conditions of increasing complexity before and after a standardized exercise protocol.Methods34 participants were recruited (17 male and 17 female; 24 ± 1.4 yrs). A modified Eriksen flanker test was used to assess cognitive performance under four conditions (seated, single-leg stance, walking, and lateral stepping) before and after a 20-min moderate-to vigorous intensity treadmill protocol. The flanker test consisted of 20 sets of 5-arrow configurations, appearing in random order. To complete the response to cognitive stimulus, participants held a smartphone horizontally and were instructed to respond as quickly and as accurately as possible by tilting the device in the direction corresponding to the orientation of the middle arrow. The metrics used for analysis included average reaction time (ms), inverse efficiency index (average reaction time penalized for incorrect responses), and conflict effect (the average time cost of responding to an incongruent repetition vs. a congruent repetition). Mixed effects (condition by time) RMANOVAs were conducted to examine the effects of motor task complexity and physical exertion on cognitive performance.ResultsThere was a condition by time interaction for inverse efficiency index (p < 0.001), in which participants displayed higher cognitive efficiency for the pre-activity lateral stepping condition compared to the other three conditions (Cohen's d = 1.3–1.6). For reaction time and conflict effect, there were main effects for condition (p = 0.004 and 0.006, respectively), in which performance during lateral stepping was improved in relation to the seated condition (reaction time Cohen's d = 0.68; conflict effect Cohen's d = 0.64).ConclusionParticipants tended to display better dual-task cognitive performance under more stimulating or complex motor tasks before physical exertion, likely associated with the inverted-U arousal-performance relationship. When using dual-task assessments, clinicians should be mindful of the accompanying motor task and baseline exertion levels and their potential to disrupt or optimize cognitive performance.