Oculomotor rehabilitation after concussion in adults (ORCA): a feasibility study

Background Oculomotor deficits are reported in up to 85% of adults after concussion and may contribute to prolonged symptoms and delayed return to daily activities. Oculomotor rehabilitation has been successfully implemented in younger age groups, however evidence in adults is lacking. Virtual reality (VR)–based oculomotor rehabilitation (OMR) offers a standardized and scalable intervention model; however, feasibility in adults with persistent symptoms has not been established, and it remains important to understand whether sex influences response to rehabilitation. Aim The goal of this study was to assess the feasibility of a 6-week RCT on VR-based OMR in adults with persistent symptoms after concussion, using a sex and gender lens. Design Sex-stratified, two-arm randomized feasibility trial with 1:1 allocation. Methods Adults (24 female, 16 male; all identifying as cisgender) aged 18–42 years with persistent (≥30 days) post-concussion symptoms suggestive of oculomotor dysfunction were randomized to six sessions of VR–based OMR with mobile application homework or usual care (UC, education only). The primary objective was to assess feasibility of a future fully powered randomized controlled trial, including recruitment, retention, perceived benefit and harms. Feasibility progression criteria were defined a priori using a traffic-light framework. Proof-of-concept was operationalized as participant-rated perceived benefit (0–4) at study completion. Results Forty participants were randomized (OMR n = 20; usual care n = 20); 39 completed follow-up (95% retention). All participants allocated to OMR attended six sessions and 94.7% engaged in prescribed home-based exercises. VR-based assessment and training were well tolerated; symptoms were transient and no adverse events occurred. Participant-rated perceived benefit was higher in the OMR group (mean 3.4/4) compared with usual care (mean 2.3/4). Conclusion VR-based OMR with mobile reinforcement is feasible, acceptable, and well tolerated in adults with persistent post-concussion symptoms. Predefined feasibility benchmarks were met, supporting progression to a fully powered trial. Future adequately powered studies should evaluate clinical efficacy and consider sex and gender as interacting variables, in samples with greater gender diversity. Clinical trial registration Identifier, NCT07709936, https://clinicaltrials.gov/expert-search?term=NCT07709936 .