Beyond the sensory organization test: A portable scalable virtual reality platform for precision assessment of postural control

Balance depends on the continuous integration and reweighting of visual, vestibular, and somatosensory information. Although computerized dynamic posturography has long served as the gold standard for evaluating sensory contributions to balance, widespread adoption has been limited by cost, portability, and accessibility constraints. Recent advances in virtual reality (VR) technology provide an opportunity to transform balance assessment by delivering standardized sensory perturbations using affordable, portable hardware. An overview of the development and validation of the Virtual Reality Sensory Integration in Balance (VRSIB) assessment will be presented, together with a summary of findings from a growing body of research spanning healthy individuals and multiple clinical populations. Initial validation studies demonstrated that VRSIB is comparable to the NeuroCom Sensory Organization Test in detecting age-related differences in postural control while offering substantially greater portability and accessibility. Subsequent investigations have extended the application of VRSIB to large community samples across the lifespan, revealing distinct developmental and aging trajectories in sensory reweighting and identifying digital biomarkers associated with fall risk. Clinical studies further demonstrate the utility of VRSIB for detecting balance impairments in populations with neurological and neurodevelopmental disorders, including veterans with mild traumatic brain injury and post-traumatic stress disorder, individuals recovering from stroke, and children with autism spectrum disorder. Across these populations, VR-based measures have shown sensitivity to subtle deficits in sensory integration that are often difficult to identify using conventional clinical assessments. The potential of immersive VR environments to quantify visual-vestibular conflict, sensory weighting strategies, and postural stability through objective digital biomarkers derived from head-mounted displays will be highlighted. Particular emphasis will be placed on the translation of laboratory-based sensory integration paradigms into scalable clinical and community-based tools that support precision assessment, fall-risk identification, rehabilitation planning, and longitudinal monitoring. Together, these findings illustrate how VR technologies are redefining the assessment of human balance, moving the field beyond traditional posturography toward accessible, data-driven approaches capable of characterizing sensorimotor health across the lifespan and across diverse clinical populations.