Innovative technologies used for the assessment of concussion and TBI

Neuropsychologists measure the relationship between how the brain is functioning and how people think and act as a result. Although they have incorporated advances in brain imaging to improve our understanding of brain-behavior relationships, the field has been slow to embrace technology to improve our assessments of a patient’s ability to perform everyday activities like the ability to drive or predict performance in the classroom. Many of our paper-and-pencil tests have been computerized, but this has not done much more than automate the older tests without providing new information.

With concussion, the computerized testing we use (the ImPACT test) for return-to-play or return-to-school decisions with athletes and non-athletes can be complicated by many daily life factors such as stress or poor sleep.Virtual reality testing environments used to assess concussion

Although our testing does a good job of finding cognitive difficulties, it could be better at predicting what exactly those difficulties look like in the real world. Examples might include subtle swerving in a driving lane or an attentional delay in braking, all factors that make driving unsafe.

This is why I began working with my research collaborator, Thomas Parsons, Ph.D. He is an innovatortaking our cognitive tests and embedding them in virtual reality.

We still get all of our old cognitive data, but now it also comes with automated logging of behavioral responses synced with stimulus presentations like how stressed the person may be while testing (psychophysiology). It also tracks body movements like a head turn towards a distraction while testing.

Additionally, this testing occurs in a simulated dynamic real-world environment. This is an improvement over older testing environments that typically used a static stimulus presentation in a research lab. The virtual simulation allows for a more practical assessment for someone performing real-world tasks with real-world stressors and distractions.

This helps us better understand all of the sub-component processes that may lead to difficulties with attention while also better predicting how attention affects real world behaviors. The combination allows us to be more confident in deciding how safe it is to return to sport or driving, be it in the moment, or after another week of recovery for a concussed individual.

We are also beginning to conduct research using a virtual grocery store for teenagers and adults, and have been conducting research using a virtual classroom for youth. Additional hallway and playground scenarios (i.e., a virtual school) are in the process of being added.

Our findings so far show positive improvements to the practice of neuropsychology. My hope is to do further research to see how it can improve the testing and management of the concussion/TBI of the patients I work with in the OHSU Sports Medicine program.

If interested in participating in virtual reality research, please contact our research coordinator, Sarah Mastel, at 503-494-2442 or We are looking for children through young adults (29 or younger) to serve as research controls, as well as individuals with ASD, ADHD, and/or those have sustained a concussion/TBI.


Tyler Duffield, Ph.D. is a pediatric neuropsychology fellow with the OHSU Sports Medicine program who specializes in concussion.