title: 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.
authors.affiliation: National Intrepid Center of Excellence, Walter Reed National Military Medical Center, 4860 S. Palmer Road, Bethesda, MD 20889.
authors.forename: Marie M
authors.initials: MM
authors.lastname: Onakomaiya
authors.affiliation: National Intrepid Center of Excellence, Walter Reed National Military Medical Center, 4860 S. Palmer Road, Bethesda, MD 20889.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Kruger
authors.affiliation: Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Krista B
authors.initials: KB
authors.lastname: Highland
authors.affiliation: National Intrepid Center of Excellence, Walter Reed National Military Medical Center, 4860 S. Palmer Road, Bethesda, MD 20889.
authors.forename: Paula N
authors.initials: PN
authors.lastname: Kodosky
authors.affiliation: National Intrepid Center of Excellence, Walter Reed National Military Medical Center, 4860 S. Palmer Road, Bethesda, MD 20889.
authors.forename: Marcy M
authors.initials: MM
authors.lastname: Pape
authors.affiliation: Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Roy
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000534:rehabilitation; D003863:Depression / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000534:rehabilitation; D011795:Surveys and Questionnaires; D000076142:Virtual Reality