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Updated: Feb 10, 2026

The use of Biofeedback in Clinical Virtual Reality: The INTREPID Project
Published on: November 12, 2009
Smartphone virtual reality to increase clinical balance assessment responsiveness
Matthew Rausch1, Janet E Simon1, Chad Starkey1
1Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.
Objective:
To determine if a low cost smartphone based, clinically applicable virtual reality (VR) modification to the standard Balance Error Scoring System (BESS) can challenge postural stability beyond the traditional BESS.
Design:
Cross-sectional study.
Setting:
University research laboratory.
Participants:
28 adults (mean age 23.36 ± 2.38 years, mean height 1.74 m ± 0.13, mean weight 77.95 kg ± 16.63).
Main Outcome Measures:
BESS postural control errors and center of pressure (CoP) velocity were recorded during the BESS test and a VR modified BESS (VR-BESS). The VR-BESS used a headset and phone to display a rollercoaster ride to induce a visual and vestibular challenge to postural stability.
Results:
The VR-BESS significantly increased total errors (20.93 vs. 11.42, p < 0.05) and CoP velocity summed across all stances and surfaces (52.96 cm/s vs. 37.73 cm/s, p < 0.05) beyond the traditional BESS.
Conclusion:
The VR-BESS provides a standardized, and effective way to increase postural stability challenge in the clinical setting. The VR-BESS can use any smartphone technology to induce postural stability deficits that may otherwise normalize with traditional testing. Thus, providing a unique relatively inexpensive and simple to operate clinical assessment tool and∖or training stimulus.
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