02 | Towards defining biomarkers to evaluate concussions using virtual reality and a moving platform (BioVRSea)

Concussion diagnosis still depends largely on self-reported symptoms and clinical history, underscoring the need for objective biomarkers.1 This study introduces BioVRSea, an innovative framework combining virtual reality with a moving platform to probe postural control through multimodal measurements, including electroencephalography (EEG), electromyography (EMG), heart rate, and center of pressure (CoP). Fifty-four professional athletes, classified by self-reported concussion history, underwent both a standardized symptom questionnaire (SCAT5) and BioVRSea testing. Neurophysiological and biomechanical responses were compared before and after platform perturbations. Distinct patterns emerged: concussed individuals showed altered EEG spectral activity (notably in delta and theta bands),2,3 a discriminative Soleus median frequency in EMG among those with balance issues,4 and frequency-based CoP differences in the anterior–posterior axis.5 Integrating these multimodal features with SCAT5 via machine learning yielded classification accuracies up to 95.5%. These findings highlight the potential of BioVRSea as a quantitative tool for identifying concussion-related alterations and move toward the development of objective, data-driven biomarkers for concussion assessment. Ethics statement: All participants received detailed written information about the study and provided their signed informed consent. The research was conducted in accordance with the principles embodied in the Declaration of Helsinki and Icelandic statutory requirements. The study protocol was approved by the Icelandic National Bioethics Committee (no: VSN-20–101).