Characterizing Behavioral Biomarkers of Sports-Related Concussion Using Mobile Mixed Reality

Diagnosing concussions is challenging due to the absence of accessible, reliable, and interpretable biomarkers of neurocognitive impairment (NCI) that is subject to variability of symptoms throughout recovery. FlightPath is the mobile mixed-reality application in which users continuously follow a virtual agent by engaging visuomotor and cognitive functions. As a sideline screening tool, FlightPath was deployed with university athletes before and after sports-related brain injury. Using FlightPath performance data from 187 participants, this manuscript aimed to characterize behavioral biomarkers that distinguish concussed from non-concussed individuals. A simple three-dimensional object-following error (TE₃ᴰ) proved insufficient to capture behavioral dynamics under NCI. We therefore introduce TRACE (Temporal Reaction and Correction Evaluation), a demand–response framework that quantifies the effectiveness of corrective actions to task demands over time. Diagnostic testing shows that TRACE, particularly during adaptive agent sessions, provides greater discriminative power than TE₃ᴰ alone, supporting reliable concussion identification with interpretable connection to NCI symptoms.