Application of a mild traumatic brain injury rehabilitation program in a virtual realty environment:  a case study.
OBJECTIVE
Mild traumatic brain injury (mTBI) can compromise reaction time, visual perception, memory, attention, balance, and gait. These deficits, especially if persistent, can restrict participation in daily activities and the resumption of personal and profession roles. The purpose of this case study is to describe an mTBI-specific clinical assessment and rehabilitation intervention administered in a virtual reality environment.


METHODS
The case involved a 31-year-old male service member who had sustained an mTBI (concussion) during a recreational softball game 36 days prior to physical therapist evaluation. He had complaints of severe visual and physical motion intolerance. He demonstrated impaired static balance and was restricted from full military duty.


METHODS
The assessment included measurements of postural and gait balance during cognitive, visual, and vestibular challenges within a Computer-Assisted Rehabilitation Environment. Phase 1 of the intervention consisted of clinical techniques (ie, optokinetic stimulation/habituation, visual/physical perturbations, and postural stability exercises) targeting specific impairments. Phase 2 training consisted of weapon handling and target recognition tasks to simulate the requirements of his military occupation.


RESULTS
At the conclusion of 6 treatments, the patient demonstrated significant increases in postural and gait balance with a near complete resolution of all postconcussion symptoms. He successfully returned to full duty and training for combat deployment.


CONCLUSIONS
Service members and civilians exhibit similar impairments, limitations, and restrictions following mTBI. A rehabilitation program delivered in a virtual-reality environment can be structured to manage complex mTBI symptoms through the integration of multiple treatment modalities specific to a patient's personal and professional roles.
Center for the Intrepid, Department of Orthopedics and Rehabilitation, Brooke Army Medical Center, Fort Sam Houston, Texas 78234, USA. Christopher.Rabago@amedd.army.mil
Christopher A
CA
Rábago
Jason M
JM
Wilken
D001288:Attention / Q000502:physiology; D001924:Brain Concussion / Q000503:physiopathology / Q000534:rehabilitation*; D004777:Environment; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology*; D011930:Reaction Time / Q000502:physiology; D014584:User-Computer Interface