title: A systematic literature review of the use and effectiveness of the Computer Assisted Rehabilitation Environment for research and rehabilitation as it relates to the wounded warrior.
abstract: BACKGROUND
  Several U.S. military treatment and research facilities employ a Computer Assisted Rehabilitation Environment (CAREN) [Motek Medical BV, Amsterdam, The Netherlands] for research and rehabilitation of complex injuries exhibited by Wounded Warriors. There has been little scientific evidence of the effectiveness of this type of system for rehabilitation.
  
  
  OBJECTIVE
  A systematic review of the literature was completed to determine what type of work has been performed on the CAREN and report findings of clinical significance.
  
  
  METHODS
  Specific terms were searched on electronic databases to include journal articles, abstracts, and peer-reviewed conference proceedings related to the CAREN.
  
  
  RESULTS
  Twenty-six publications were elicited that met our criteria. These were divided by their primary focus: rehabilitation, clinical research, and technical reports.
  
  
  CONCLUSIONS
  Results from published articles have determined that the system is a capable tool for both assessment and rehabilitation, but little has currently been published, particularly on patient populations.
  
  
  CONCLUSIONS
  More research needs to be performed to evaluate its effectiveness as a rehabilitation tool compared to other rehabilitation methods. It is expected that a system, such as the CAREN, will challenge patients multifactorially (e.g. physically and cognitively) and provide biofeedback while decreasing rehabilitation time and increasing effectiveness of treatment.
authors.affiliation: Naval Health Research Center, San Diego, CA, USA.
authors.forename: John-David
authors.initials: JD
authors.lastname: Collins
authors.affiliation: Naval Health Research Center, San Diego, CA, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Markham
authors.affiliation: Naval Health Research Center, San Diego, CA, USA.
authors.forename: Kathrine
authors.initials: K
authors.lastname: Service
authors.affiliation: Naval Health Research Center, San Diego, CA, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Reini
authors.affiliation: Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Wolf
authors.affiliation: Naval Health Research Center, San Diego, CA, USA.
authors.forename: Pinata
authors.initials: P
authors.lastname: Sessoms
mesh_terms: D006801:Humans; D008889:Military Personnel; D009426:Netherlands; D015397:Program Evaluation; D012046:Rehabilitation / Q000592:standards*; D013813:Therapy, Computer-Assisted / Q000592:standards*; D063367:Virtual Reality Exposure Therapy / Q000379:methods* / Q000592:standards*
keywords: CAREN; immersive virtual environment; therapy; warfighter