Virtual reality, machine learning, and statistical modeling reveal an association between multiple concussion history and impaired perceptual decision-making

Current clinical assessment methods are insufficiently sensitive for detection of subtle post-concussion impairments in perceptual-cognitive function. The purpose of this study was to search for any perceptual response metrics associated with concussion history that might increase understanding of altered brain-behavior relationships. Immersive virtual reality test data were aggregated for 202 healthy adolescents and young adults (116 males, 86 females) who participated in different studies over a 2-year period. Left- versus right-directed neck rotation, arm reach, and step-lunge responses to sequential presentations of 2 types of horizontally moving visual stimuli were measured in terms of time to initiation of body segment movement (perceptual latency [PL]), as well as response completion (response time [RT]). Speed-accuracy tradeoff was represented by rate correct per second for PL (RCS-PL) and RT (RCS-RT) of neck and arm movements, and across-trial inconsistency was represented by PL variability (PLV) and RT variability (RTV). Both supervised machine learning and theory-based statistical regression methods were used to identify metrics that best discriminated between participants who reported a history of no concussion (NC), single concussion (SC), NC + SC, or multiple concussions (MC). Additionally, statistical regression was used to assess a theoretical relationship between metrics believed to align with components of the drift-diffusion computational model of decision-making. The best metric for discrimination between NC + SC and MC was Neck RCS-PL. Neck PLV values demonstrated a strong inverse logarithmic correlation with Neck RCS-PL (r = –0.796, P < 0.001). The Neck RCS-PL and Neck PLV behavioral metrics may have relevance to the two components of the drift-diffusion computational model of perceptual decision-making, and their combination may be associated with a cumulative and persisting deficiency after having sustained more than one lifetime concussion.