The Use of a Virtual Reality Platform for Standardization of the Vestibular Ocular-Motor Screen
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Authors
Pavilionis, Philip K.
Issue Date
2024
Type
Dissertation
Language
Keywords
Concussion , Sport , Standardization , Virtual Reality
Alternative Title
Abstract
Public awareness of sport-related concussion (SRC) has risen in recent history. This is evident through a couple of factors. One is the increased self-reporting of SRC. It has been estimated that 2.5 million American High School students reported having at least one SRC within the previous year. Of that same group, 1 million reported having more than one SRC.1 The second factor is the development of various sports injury surveillance systems that have been implemented to track this data over the past decade. The Vestibular Ocular Motor Screen (VOMS) is a standard clinical tool for the assessment, diagnosis, and management of SRC. The VOMS consists of seven subtests that challenge the subject's oculomotor and vestibular function. The subtests are designed to elicit symptomology consistent with SRC. The current clinical protocol involves hand-held use of targets and administrator interpretation of the distances the targets are held in front of the subject. Variability among raters with this process may alter the symptom reporting from the subject and near-point convergence (NPC) measurements. This creates the potential for misdiagnosis, management, and treatment of SRC. The objective of this study is to explore a means of standardization of the VOMS among clinicians such that subjective symptomology recording is reliable in the diagnosis and management of SRC. This study consists of three experiments. Experiment one is an examination of the current clinical protocol compared to a novel prototype (PRO) and a virtual reality (VR) stimulus to determine if the latter two platforms are suitable means of standardization of the VOMS with a healthy population. The results indicate the PRO and VR elicit less symptoms but the VR had higher NPC measurements. Experiment two compares the Total Symptom Provocation Change Score (TSPCS) and Near Point Convergence (NPC) between the PRO and the VR stimuli at baseline and post-injury. Post-injury comparison data indicate no significant difference with TSPCS and NPC measurements and VR may be used with post-injury assessments. Experiment three is a direct comparison of the current clinical manual method of VOMS administration to the VR method that includes baseline and post-injury data. This experiment also examined self-reported motion sickness. The results indicate that VR can be used to administer the VOMS despite any history of motion sickness. The goal of this study is to provide proof of concept that leads to the development of a standardized, mobile VOMS VR stimuli that can record symptoms, eye movement, measure near-point convergence (NPC), and is completely automated such that the field healthcare professional can use this platform for a quick digital relay of this information to a physician for diagnosis and management of SRC.