Expanding Clinical Assessment for Traumatic Brain Injury and Comorbid Post-Traumatic Stress Disorder: A Retrospective Analysis of Virtual Environment Tasks in the Computer-Assisted Rehabilitation Environment

Abstract

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.

The Effect of Walking on Auditory Localization, Visual Discrimination, and Aurally Aided Visual Search

“…They were outfitted with a full body harness and tethered to the system's safety stand. Once secured, they were taken through a series of preliminary VE tasks specifically developed to acclimate to the CAREN (Onakomaiya et al, 2017). These included the balance balls, balance cubes, and continuous road VEs.…”

“…These VEs allowed participants to become comfortable moving in the harness. The continuous road VE was completed to acclimate participants to flat walking on the system's treadmill; the platform remained flat, and the treadmill speed was synced to a visual representation of a road on the screen to maintain congruence and optical flow (Onakomaiya et al, 2017). The visual display for this VE is shown in Panel A of Figure 1.…”

The use of the computer assisted rehabilitation environment in assessment and rehabilitation

“…Twenty-two articles used the computer-assisted rehabilitation environment system for biomechanical analysis , 15 articles used the computerassisted rehabilitation environment system for rehabilitation [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57], 4 articles were reviews [19,20,58,59] and 9 articles addressed the computerassisted rehabilitation environment system in other ways [60][61][62][63][64][65][66][67][68]. A flow chart summarizing study selection is shown in figure 1.…”

Overground and Virtual Reality Gait Speed Are Associated With Atypical Symptom Reporting in Active Duty Service Members With a History of Mild to Moderate Traumatic Brain Injury

“…To acclimate to walking on the CAREN system, service members completed the CAREN Continuous Road (CR) virtual environment 44. The treadmill speed was synced to the optical flow of the virtual path to maintain congruence and increase immersion.…”