Novel virtual reality balance training program improves persisting symptoms after concussion in multiple domains
By Zoe Marquis. This article was initially published in the 11/20/25 Edition of our Concussion Update newsletter; please consider subscribing.
A recent case report published in Journal of Clinical Medicine suggests that virtual-reality-based balance training may be effective for resolving persisting symptoms after concussion. Lead researcher (and Concussion Alliance Internship Alum!) Zach Napora and his colleagues developed a virtual reality (VR) balance training program in which patients move a virtual “hockey puck” through a series of VR courses that increase in difficulty. This balance training program was designed to address persisting vestibular dysfunction after concussion, including “dizziness and balance-related deficits.” During the VR tasks, patients stand on a multi-axis force plate platform (a platform that measures the amount of force being exerted at a given time), which allows them to control the puck’s movement by shifting their weight. The tasks require patients to maintain their balance while moving their body and shifting their weight, which helps engage and rehabilitate the vestibular and ocular processing systems.
This case study followed a 20-year-old National Collegiate Athletic Association (NCAA) Division I football player who had sustained multiple concussions in a three-month period. The training program led to a reduction in the player’s self-reported balance-related symptoms and an objective increase in accuracy in his performance on the VR balance tasks. To the researchers’ surprise, the player’s self-reported cognitive- and mood-related symptoms also improved. The authors say that “[the program’s] objective measurement, engaging format, and ease of use suggest potential for broader application in concussion rehabilitation.”
The program consisted of 10 sessions over the course of 10 weeks. During each session, the player completed the VR balance training battery and a clinical interview about his symptoms. By the end of the program, the player’s accuracy in each of the VR courses had increased. Averaged across all courses, the player’s accuracy increased from 75.87% in the first session to 91.67% in the final session. In addition to self-reported and objective balance improvements, the authors were also interested in the player’s self-reported symptom improvement in non-balance-related domains (cognitive and mood). The researchers suggest that this improvement might occur through modulation of cerebello-prefrontal pathways or through stimulation of the hippocampus and parietal cortex via pathways connecting these areas to the vestibular system. Essentially, balance training might help “rewire” regions of the brain that support aspects of cognition and mood in addition to balance and proprioception. Limitations of this study include the possibility of a practice effect (the patient improving on the VR tasks due to practice rather than rehabilitation) and the limited information available on the player’s baseline symptom levels. The researchers say that a practice effect is unlikely, given the lack of a plateau in improvement.
