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Going virtual to unravel sports concussions

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Our understanding of sports concussions and how to treat them has evolved dramatically over the past 20 years. And researchers like Ohio State’s Jaclyn Caccese are continuing that progress.

Caccese is an assistant professor in the School of Health and Rehabilitations Sciences and is part of Ohio State’s Chronic Brain Injury program. A major tool in her research arsenal is virtual reality (VR), which she uses to understand the short- and long-term effects of concussions and how to help athletes rehabilitate.

This past summer, Caccese installed a VR system, the Immersive Labs, in her lab. Recently, she explained the impact VR is having on her research and on the lives of athletes.

Is this an exciting time for this type of research?

I think it is. Probably the most exciting part is how rapidly the technology is improving. Five or 10 years ago, virtual reality was an option but there were many limitations, such as long lag times. It has been a laboratory research tool for some time now, but we are finally getting to the point where there is potential for it to be applied clinically.

What is the Immersive Labs?

It’s a 5-meter virtual reality dome with a 4K projector. It surrounds a treadmill so you can walk in the virtual reality scene. There are nine high-speed motion capture cameras that surround the dome.

As people walk or stand, we can see exactly how they’re moving. The goal is to understand how people use sensory information and, in the case of virtual reality, visual information to balance while they stand and walk after they sustain a brain injury.

What we are finding is that people move a lot more in response to a visual stimulus after they sustain a brain injury. Therefore, visual information is more perturbing to them than it would be otherwise.

Why does that matter?

There are implications in the short and in the long term.

In the short term, we see an increased risk of lower extremity injury following concussion. Visual and vestibular processing (how our bodies process sensory information) for balance may play a role. There is also some question about their capacity for dual tasking, doing two things at once.

You do not want an athlete to return to play from their concussion and two to three weeks later sustain an ACL tear that ends their season. It’s important to understand what those persistent impairments are and what we can do about it.

Would you say VR is a game-changer in understanding those impairments?

A lot of my work focuses on postural control, how our brain controls how our body moves in space. Virtual reality, in that context, can make things happen that you couldn’t otherwise make happen in the lab.

Right now we don’t have tools that can record someone’s movement during a football game. We’ll get there but we’re not there yet. What we can do is make real-life things happen in a virtual environment, and we can study how people respond to real-life events as opposed to just having them walk through a lab, which may not be as challenging and would not give us the level of detail virtual reality does.

What are people seeing in this cave?

The most basic is a field of pyramids that just move back and forth and we measure how much a person moves in response. That is the most basic up to walking through a park, but we can really put them anywhere.

What you do not want is too much going on in your scene; it may be overwhelming.

What we are finding is that people move a lot more in response to a visual stimulus after they sustain a brain injury. Therefore, visual information is more perturbing to them than it would be otherwise.

Jaclyn Caccese, Assistant Professor with Ohio State's Chronic Brain Injury program
So you couldn’t put them in a soccer match?

You could, but we’re not there yet.

Would that even be a good idea for someone recovering from a concussion?

From a training perspective, it’s a good idea, having them interact like they would in real life.

Other people who use virtual reality to study aging, for example, will put older adults in a grocery store and they will have them interact with the virtual reality scene. Therefore, you could do something similar for athletes returning to play.

The one challenge we have right now is that we have to understand more clearly specific impairments following concussion. Then we can design targeted rehabilitation interventions. If an athlete is having difficulties dual tasking, we may ask them to block opponents while running through a virtual environment. If an athlete is having difficulties with visual processing, we may have the scene move faster or slower as they run down the field.

There remains a lot to do to design an intervention like that, but that would be a long-term possibility.

Is the long-term goal just to return people to play or help them rehabilitate?

Right now, we are at a point where we are just trying to figure out what the problem is. However, the long-term goal would be to prevent subsequent injury and to prevent long-term impairments. Some of these individuals still have problems years after their concussion, so what happens as they age and systems naturally start to degrade? What can we do to prevent that?