Effects of wearing a head-mounted display during a standard clinical test of dynamic balance

Background: The use of virtual reality (VR) in clinical settings has increased with the introduction of affordable, easy-to-use head-mounted displays (HMDs). However, some have raised concerns about the effects that HMDs have on posture and locomotion, even without the projection of a virtual scene, which may be different across ages. Research question: How does HMD wear impact the kinematic measures in younger and older adults? Methods: Twelve healthy young and sixteen older adults participated in two testing conditions: 1) TUG with no HMD and 2) TUG with an HMD displaying a scene of the actual environment (TUG_HMD). The dependent variables were the pitch, yaw, and roll peak trunk velocities (PTVs) in each TUG component, turning cadence, and the time to complete the TUG and its components – SIT-TO-STAND, TURN, WALK, and STAND-TO-SIT. Results: Wearing the HMD decreased turning cadence and pitch and yaw PTVs in all TUG components, decreased roll PTV in SIT-TO-STAND and TURN, and increased the time taken to complete all TUG components in all participants. Wearing the HMD decreased the pitch PTV in SIT-TO-STAND in older relative to younger adults. Wearing an HMD affected TUG performance in younger and older adults, which should be considered when an HMD is used for VR applications in rehabilitation. Significance: Our findings highlight the importance of considering the physical effect of HMD wear in clinical testing, which may not be present with non-wearable VR technologies.