The objective of this study was to determine whether physical performance during virtual environment (VE) tasks in the Computer-Assisted Rehabilitation Environment (CAREN) could differentiate between service members (SMs) with a history of traumatic brain injury (TBI) with and without comorbid post-traumatic stress disorder (PTSD). Data were obtained by independent review of clinical notes, objective outcomes, and validated questionnaires from 214 SMs (208 males) with a history of TBI assessed in the CAREN from 2010 to 2015. Three preliminary VEs acclimatized patients to the CAREN: Balance Balls, weight shifting on a static platform (timed); Balance Cubes, step shifting with and without platform motion (timed); and Continuous Road, flat ambulation (self-selected speed). Multiple regression analyses revealed that patients with comorbid TBI-PTSD were significantly slower in completing the VE tasks than patients without PTSD. Logistic regression showed that the Balance Cubes VE without platform motion significantly predicted diagnostic category (i.e., no PTSD vs. comorbid PTSD). In conclusion, in SMs with a history of TBI, physical performance on the CAREN effectively distinguished those with comorbid PTSD, as their performance was significantly slower than SMs without PTSD. These results portray the potential of the CAREN as a novel assessment tool in SMs with a history of TBI.
Gait training is an essential part of the rehabilitation process for those with lower extremity (LE) amputations. For service members at Walter Reed Army Medical Center, the Computer Assisted Rehabilitation Environment (CAREN) allows virtual reality to be incorporated into gait training as an adjunct to conventional therapies. This retrospective case series examines the self-selected velocities achieved in two different virtual environments (VE) by 11 service members with LE amputations. These VEs allowed participants to progress from level walking to more challenging terrain. Over periods of four to eight weeks, all participants were found to increase their self-selected velocities; progression appears to be individual. The preliminary results obtained indicate that further investigation is warranted.
Objective: The present study was designed to examine the impact that walking has on performance in auditory localization, visual discrimination, and aurally aided visual search tasks. Background: Auditory localization and visual search are critical skills that are frequently conducted by moving observers, but most laboratory studies of these tasks have been conducted on stationary listeners who were either seated or standing during stimulus presentation. Method: Thirty participants completed three different tasks while either standing still or while walking at a comfortable self-selected pace on a treadmill: (1) an auditory localization task, where they identified the perceived location of a target sound; (2) a visual discrimination task, where they identified a visual target presented at a known location directly in front of the listener; and (3) an aurally aided visual search task, where they identified a visual target that was presented in the presence of multiple visual distracters either in isolation or in conjunction with a spatially colocated auditory cue. Results: Participants who were walking performed auditory localization and aurally aided visual search tasks significantly faster than those who were standing, with no loss in accuracy. Conclusion: The improved aurally aided visual search performance found in this experiment may be related to enhanced overall activation caused by walking. It is also possible that the slight head movements required may have provided auditory cues that enhanced localization accuracy. Application: The results have potential applications in virtual and augmented reality displays where audio cues might be presented to listeners while walking.
To review the outcomes of rehabilitation for a service member with bilateral lower extremity amputations. A 25 yearold marine suffered a right knee disarticulation and a left transtibial amputation during military service. For two years, the patient underwent a comprehensive rehabilitation program at Walter Reed Army Medical Center. During the course of his rehabilitation, this patient took part in conventional physical therapy and at 16.5 months post-injury added clinical sessions in the Computer Assisted Rehabilitation Environment (CAREN) Laboratory to his therapy regimen for approximately six months. Gait analyses were conducted at three different points in his rehabilitation program: 5.5, 18, and 23.5 months post-injury.Temporal spatial parameters of self-selected velocities, cadence, and step length increased while his stance support time and step width decreased, becoming closer to asymptomatic populations. During the CAREN clinical sessions, the patient showed an increase in overall speed in the Road with Overhead Targets application. With the Boat application, the patient was able to improve the application time at increased levels of difficulty. The use of virtual reality as an adjunct to conventional rehabilitation for individuals with amputations provides a novel approach for maximizing function.
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