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Smith E, Houtchens K, Pearson M, Dolbeer JA, Kneller S, Fitzgerald SM, Lambert KH, Hoppes CW. Post-concussion Return to Shooting Progression for Military Service Members: A Scoping Review and Conceptual Framework. Mil Med 2024; 189:e1336-e1342. [PMID: 37837212 DOI: 10.1093/milmed/usad399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION There are established protocols for staged return to physical activity in sport and military settings following concussion. Currently, there is no evidence-based staged return to shooting protocol in use by the U.S. military despite the unique challenges and stresses shooting places on the vestibular-ocular and cognitive systems often disrupted by a concussion. The primary purpose of this scoping review was to summarize available evidence and current practices on return to shooting post-concussion, with the goal of optimizing an evidence-based return to shooting protocol for military service members. Our secondary aim was to identify individuals who may benefit from a return to shooting progression. MATERIALS AND METHODS A comprehensive search of PubMed, SPORTDiscus, and Google Scholar was performed from the earliest dates to April 2023. A gray literature (Google) search was also performed. Articles were included if they studied a population with concussion, addressed return to shooting, and were written in English. Articles were excluded if they discussed health conditions other than concussion, focused on non-shooting interventions, did not use human subjects, or were written in a language other than English. RESULTS Our search strategy yielded 134 articles: 1 article met our inclusion and exclusion criteria, whereas the other 133 articles were rejected. The gray literature search yielded one item. CONCLUSIONS Based on our results, there is insufficient evidence to inform current practices on return to shooting post-concussion. In the absence of a published return to shooting protocol, we offer recommendations for identifying individuals who may benefit from a return to shooting progression and a revised version of a U.S. Army Special Operations Command Return to Range Progression. This protocol follows a conceptual framework for progression for variables such as environment, weapon type/caliber, and shooter position/movement. Further research is needed on identifying individuals who may benefit from a return to shooting protocol and safely and effectively progressing these individuals through a return to shooting protocol post-concussion.
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Affiliation(s)
- Erin Smith
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
| | - Kristina Houtchens
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
| | - Maria Pearson
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
| | | | | | - Scott M Fitzgerald
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Karen H Lambert
- Hearing Center of Excellence, Lackland Air Force Base, TX 78236, USA
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
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LeMarshall SJ, Stevens LM, Ragg NP, Barnes L, Foster J, Canetti EFD. Virtual reality-based interventions for the rehabilitation of vestibular and balance impairments post-concussion: a scoping review. J Neuroeng Rehabil 2023; 20:31. [PMID: 36869367 PMCID: PMC9985280 DOI: 10.1186/s12984-023-01145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 01/27/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Concussions and mild traumatic brain injuries are the most common causes of physical and cognitive disability worldwide. Concussion can result in post-injury vestibular and balance impairments that can present up to five years post initial concussion event, ultimately affecting many daily and functional activities. While current clinical treatment aims to reduce symptoms, the developing use of technology in everyday life has seen the emergence of virtual reality. Current literature has failed to identify substantial evidence regarding the use of virtual reality in rehabilitation. The primary aim of this scoping review is to identify, synthesise, and assess the quality of studies reporting on the effectiveness of virtual reality for the rehabilitation of vestibular and balance impairments post-concussion. Additionally, this review aims to summarise the volume of scientific literature and identify the knowledge gaps in current research pertaining to this topic. METHODS A scoping review of six databases (PubMed, Embase, CINAHL, ProQuest, SportDiscus, Scopus) and a grey literature (Google Scholar) was conducted using three key concepts (virtual reality, vestibular symptoms, and post-concussion). Data was charted from studies and outcomes were categorised into one of three categories: (1) balance; (2) gait; or (3) functional outcome measures. Critical appraisal of each study was conducted using the Joanna Briggs Institute checklists. A critical appraisal of each outcome measure was also completed utilising a modified GRADE appraisal tool to summarise the quality of evidence. Effectiveness was assessed using calculations of change in performance and change per exposure time. RESULTS Three randomised controlled trials, three quasi-experimental studies, three case studies, and one retrospective cohort study were ultimately included, using a thorough eligibility criteria. All studies were inclusive of different virtual reality interventions. The ten studies had a 10-year range and identified 19 different outcome measures. CONCLUSION The findings from this review suggests that virtual reality is an effective tool for the rehabilitation of vestibular and balance impairments post-concussion. Current literature shows sufficient but low level of evidence, and more research is necessary to develop a quantitative standard and to better understand appropriate dosage of virtual reality intervention.
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Affiliation(s)
- Soraya J LeMarshall
- Doctor of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Lachlan M Stevens
- Doctor of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Nicholas P Ragg
- Doctor of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Leia Barnes
- Integrated Specialist ENT Service, Logan Hospital, Meadowbrook, Australia
| | - Jacinta Foster
- Integrated Specialist ENT Service, Logan Hospital, Meadowbrook, Australia
| | - Elisa F D Canetti
- Doctor of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia. .,Tactical Research Unit, Bond University, Gold Coast, Australia.
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Hoppes CW, Lambert KH, Klatt BN, Harvard OD, Whitney SL. Vestibular Physical Therapy Treatment of Individuals Exposed to Directed Energy. Mil Med 2023; 188:e198-e204. [PMID: 34027970 DOI: 10.1093/milmed/usab202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Following suspected sonic attacks on U.S. Embassies, a subset of individuals presented with a unique cluster of symptoms believed to have resulted from exposure to directed energy. Directed energy has been described as exposure to a unique sound/pressure phenomenon such as infrasonic or ultrasonic acoustic or electromagnetic energy. The Joint Force does not have an established protocol to guide vestibular physical therapy for individuals exposed to directed energy. Therefore, we have provided evidence-based guidance for the treatment of oculomotor- and vestibular-related impairments from similar populations. MATERIALS AND METHODS Published evidence was used to inform suggestions for clinical best practice. We offer resources for the management of non-oculomotor- and non-vestibular-related impairments, before discussing physical therapy interventions for dizziness and imbalance. RESULTS The physical therapist should design a treatment program that addresses the individual's health condition(s), body structure and function impairments, activity limitations, and participation restrictions after suspected directed energy exposure. This treatment program may include static standing, compliant surface standing, weight shifting, modified center of gravity, gait, and gaze stabilization or vestibular-ocular reflex training. Habituation may also be prescribed. Interventions were selected that require little to no specialized equipment, as such equipment may not be available in all settings (i.e., operational environments). CONCLUSIONS Evidence-based guidance for prescribing a comprehensive vestibular physical therapy regimen for individuals exposed to directed energy may aid in their rehabilitation and return to duty. This standardized approach can help physical therapists to treat complaints that do not match any previously known medical conditions but resemble brain injury or vestibular pathology.
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Affiliation(s)
- Carrie W Hoppes
- U.S. Army Medical Center of Excellence, Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX 78234, USA
| | | | - Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Orlando D Harvard
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
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DuPlessis D, Lam E, Xie L, Reed N, Wright FV, Biddiss E, Scratch SE. Multi-domain assessment of sports-related and military concussion recovery: A scoping review. Phys Ther Sport 2023; 59:103-114. [PMID: 36528003 DOI: 10.1016/j.ptsp.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This review explores the literature on multi-domain assessments used in concussion recovery, to inform evidence-based and ecologically valid return-to-play. It asks: What simultaneous, dynamic multi-domain paradigms are used to assess recovery of youth and adults following concussion? METHODS Five databases were searched (CINAHL, EMBASE, MEDLINE, PsycInfo, SPORTDiscus) until September 30, 2021. Records were limited to those published in peer-reviewed journals, in English, between 2002 and 2021. Included studies were required to describe the assessment of concussion recovery using dynamic paradigms (i.e., requiring sport-like coordination) spanning multiple domains (i.e., physical, cognitive, socio-emotional functioning) simultaneously. RESULTS 7098 unique articles were identified. 64 were included for analysis, describing 36 unique assessments of 1938 concussed participants. These assessments were deconstructed into their constituent tasks: 13 physical, 17 cognitive, and one socio-emotional. Combinations of these "building blocks" formed the multi-domain assessments. Forty-six studies implemented level walking with a concurrent cognitive task. The most frequently implemented cognitive tasks were 'Q&A' paradigms requiring participants to answer questions aloud during a physical task. CONCLUSIONS A preference emerged for dual-task assessments, specifically combinations of level walking and Q&A tasks. Future research should balance ecological validity and clinical feasibility in multi-domain assessments, and work to validate these assessments for practice.
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Affiliation(s)
- Danielle DuPlessis
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Emily Lam
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Lucy Xie
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada; Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - F Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada; Department of Physical Therapy, University of Toronto, Toronto, Canada; School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Shannon E Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada.
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O’Neil J, Barnes K, Morgan Donnelly E, Sheehy L, Sveistrup H. Identification and description of telerehabilitation assessments for individuals with neurological conditions: A scoping review. Digit Health 2023; 9:20552076231183233. [PMID: 37377560 PMCID: PMC10291871 DOI: 10.1177/20552076231183233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Background The clinical adoption of telerehabilitation accelerated rapidly over the last few years, creating opportunities for clinicians and researchers to explore the use of digital technologies and telerehabilitation in the assessment of deficits related to neurological conditions. The objectives of this scoping review were to identify outcome measures used to remotely assess the motor function and participation in people with neurological conditions and report, when available, the psychometric data of these remote outcome measures. Methods MEDLINE (Ovid), CINAHL, PubMed, PsychINFO, EMBASE, and Cochrane databases were searched between December 13, 2020, and January 4, 2021, for studies investigating the use of remote assessments to evaluate motor function and participation in people with neurological conditions. An updated search was completed on May 9, 2022, using the same databases and search terms. Two reviewers independently screened each title and abstract, followed by full-text screening. Data extraction was completed using a pre-piloted data extraction sheet where outcome measures were reported as per the International Classification of Functioning, Disability and Health. Results Fifty studies were included in this review. Eighteen studies targeted outcomes related to body structures and 32 targeted those related to activity limitation and participation restriction. Seventeen studies reported psychometric data; of these, most included reliability and validity data. Conclusion Clinical assessments of motor function of people living with neurological conditions can be completed in a telerehabilitation or remote context using validated and reliable remote assessment measures.
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Affiliation(s)
- Jennifer O’Neil
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Keely Barnes
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Lisa Sheehy
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Heidi Sveistrup
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
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Fusco A, Galluccio C, Castelli L, Pazzaglia C, Pastorino R, Pires Marafon D, Bernabei R, Giovannini S, Padua L. Severe Acquired Brain Injury: Prognostic Factors of Discharge Outcome in Older Adults. Brain Sci 2022; 12:brainsci12091232. [PMID: 36138968 PMCID: PMC9496921 DOI: 10.3390/brainsci12091232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Severe Acquired Brain Injury (sABI) is a leading cause of disability and requires intensive rehabilitation treatment. Discharge from the rehabilitation ward is a key moment in patient management. Delays in patient discharge can adversely affect hospital productivity and increase healthcare costs. The discharge should be structured from the hospital admission toward the most appropriate environment. The purpose of our study is to investigate early predictors of outcome for discharge in older adults with sABI. A retrospective study was performed on 22 patients who were admitted to an intensive neurorehabilitation unit between June 2019 and December 2021. Patients were divided into two outcome categories, good outcome (GO) or poor outcome (PO), based on discharge destination, and the possible prognostic factors were analyzed at one and two months after admission. Among the factors analyzed, changes in the Disability Rating Scale (DRS) and Level of Cognitive Functioning (LCF) at the first and second month of hospitalization were predictive of GO at discharge (DRS, p = 0.025; LCF, p = 0.011). The presence of percutaneous endoscopic gastrostomy at two months after admission was also significantly associated with PO (p = 0.038). High Body Mass Index (BMI) and the presence of sepsis at one month after admission were possible predictors of PO (BMI p = 0.048; sepsis p = 0.014). An analysis of dynamic predictors could be useful to guarantee an early evaluation of hospital discharge in frail patients with sABI.
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Affiliation(s)
- Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Caterina Galluccio
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Letizia Castelli
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Costanza Pazzaglia
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Denise Pires Marafon
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOS Neuroriabilitazione Post-acuzie, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-3015-4382
| | - Luca Padua
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Xiang L, Bansal S, Wu AY, Roberts TL. Pathway of care for visual and vestibular rehabilitation after mild traumatic brain injury: a critical review. Brain Inj 2022; 36:911-920. [PMID: 35918848 PMCID: PMC10134507 DOI: 10.1080/02699052.2022.2105399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PRIMARY OBJECTIVE To review the pathway to care for treatment and management of patients receiving visual and vestibular rehabilitation after mild traumatic brain injury (mTBI). METHODS & PROCEDURES English scientific peer-reviewed articles from PubMed, CINAHL, Embase, and PsycINFO between 2000 and 2020 were first screened by title and abstract, then those selected underwent full-text review and analysis. MAIN OUTCOMES & RESULTS The database search yielded 1640 results and after title and abstract review, 75 articles were selected for full-text screening, from which 8 were included in the qualitative synthesis. Current evidence includes a limited number of retrospective cohort studies and case studies. CONCLUSIONS Many patients with visual and vestibular deficits following mTBI do not receive rehabilitation services until months following their injury as there is no standardized pathway to care for patients for visual and vestibular rehabilitation. Barriers to establishing a standardized pathway are the lack of natural history data for visual and vestibular function following mTBI and the lack of randomized clinical trials establishing the efficacy of rehabilitation in patients following mTBI.
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Affiliation(s)
- Lucille Xiang
- School of Physical and Occupational Therapy, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada.,School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Surbhi Bansal
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, USA
| | - Albert Y Wu
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, USA
| | - Tawna L Roberts
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, USA
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Schuermans J, Van Hootegem A, Van den Bossche M, Van Gendt M, Witvrouw E, Wezenbeek E. Extended reality in musculoskeletal rehabilitation and injury prevention - A systematic review. Phys Ther Sport 2022; 55:229-240. [DOI: 10.1016/j.ptsp.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
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Wright WG, Handy JD, Haskell A, Servatius L, Servatius R. History of Mild Traumatic Brain Injury Affects Static Balance Under Complex Multisensory Manipulations. J Neurotrauma 2022; 39:821-828. [PMID: 35229645 DOI: 10.1089/neu.2020.7600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A recent study in active duty military in the Coast Guard suggested lifetime experience with mTBI was associated with subtle deficits in postural control when exposed to multisensory discordance (i.e. rotating visual stimulation). The present study extended postural assessments to veterans recruited from the community. Service veterans completed the Defense Veteran Brain Injury Center (DVBIC) TBI Screening Tool, PTSD Checklist (PCL-5), and neurobehavioral symptom inventory (NSI). Postural control was assessed using a custom designed virtual reality based device, which assessed center of pressure (COP) sway in response to six conditions designed to test sensory integration by systematically combining three visual conditions (eyes open, eyes closed, and rotating scene) with two somatosensory conditions (firm or foam surface). Veterans screening positive for lifetime experience of mTBI (mTBI+) displayed similar postural sway to veterans without lifetime experience of mTBI (mTBI-) on basic assessment of eyes open or closed on firm and foam surface. mTBI+ veterans displayed greater sway than mTBI- veterans in response to the rotating visual stimuli while on a foam surface. Similar to previous research the degree of sway was affected by the number of lifetime experiences of mTBI. Increased postural sway was not related to PTSD, NSI, or, balance-specific symptom expression. In summary, veterans who experienced mTBI over their lifetime exhibited dysfunction in balance control as revealed by challenging conditions with multisensory discordance. These balance-related signs were independent of self-reported balance-related symptoms or other symptom domains measured by the NSI, which can provide a method for exposing otherwise covert dysfunction long after experience of mTBI.
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Affiliation(s)
- W Geoffrey Wright
- Temple University College of Public Health, 16043, Health and Rehabilitation Sciences, Philadelphia, Pennsylvania, United States;
| | - Justin D Handy
- Central New York Research Corporation, Research and Development, Syracuse, New York, United States;
| | - Amanda Haskell
- Syracuse VAMC, 20078, Research, Syracuse, New York, United States.,Central New York Research Corporation, Research and Development, Syracuse, New York, United States;
| | - Labeeby Servatius
- Syracuse VAMC, 20078, Research, Syracuse, New York, United States.,Central New York Research Corporation, Research and Development, Syracuse, New York, United States;
| | - Richard Servatius
- Syracuse VAMC, 20078, Research, Syracuse, New York, United States.,SUNY Upstate Medical University, 12302, Psychiatry, Syracuse, New York, United States;
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Brassel S, Power E, Campbell A, Brunner M, Togher L. Recommendations for the Design and Implementation of Virtual Reality for Acquired Brain Injury Rehabilitation: Systematic Review. J Med Internet Res 2021; 23:e26344. [PMID: 34328434 PMCID: PMC8367177 DOI: 10.2196/26344] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/25/2021] [Accepted: 05/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Virtual reality (VR) is increasingly being used for the assessment and treatment of impairments arising from acquired brain injuries (ABIs) due to perceived benefits over traditional methods. However, no tailored options exist for the design and implementation of VR for ABI rehabilitation and, more specifically, traumatic brain injury (TBI) rehabilitation. In addition, the evidence base lacks systematic reviews of immersive VR use for TBI rehabilitation. Recommendations for this population are important because of the many complex and diverse impairments that individuals can experience. OBJECTIVE This study aims to conduct a two-part systematic review to identify and synthesize existing recommendations for designing and implementing therapeutic VR for ABI rehabilitation, including TBI, and to identify current evidence for using immersive VR for TBI assessment and treatment and to map the degree to which this literature includes recommendations for VR design and implementation. METHODS This review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive search of 11 databases and gray literature was conducted in August 2019 and repeated in June 2020. Studies were included if they met relevant search terms, were peer-reviewed, were written in English, and were published between 2009 and 2020. Studies were reviewed to determine the level of evidence and methodological quality. For the first part, qualitative data were synthesized and categorized via meta-synthesis. For the second part, findings were analyzed and synthesized descriptively owing to the heterogeneity of data extracted from the included studies. RESULTS In the first part, a total of 14 papers met the inclusion criteria. Recommendations for VR design and implementation were not specific to TBI but rather to stroke or ABI rehabilitation more broadly. The synthesis and analysis of data resulted in three key phases and nine categories of recommendations for designing and implementing VR for ABI rehabilitation. In the second part, 5 studies met the inclusion criteria. A total of 2 studies reported on VR for assessment and three for treatment. Studies were varied in terms of therapeutic targets, VR tasks, and outcome measures. VR was used to assess or treat impairments in cognition, balance, and anxiety, with positive outcomes. However, the levels of evidence, methodological quality, and inclusion of recommendations for VR design and implementation were poor. CONCLUSIONS There is limited research on the use of immersive VR for TBI rehabilitation. Few studies have been conducted, and there is limited inclusion of recommendations for therapeutic VR design and implementation. Future research in ABI rehabilitation should consider a stepwise approach to VR development, from early co-design studies with end users to larger controlled trials. A list of recommendations is offered to provide guidance and a more consistent model to advance clinical research in this area.
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Affiliation(s)
- Sophie Brassel
- Discipline of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Power
- Speech Pathology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Andrew Campbell
- Cyberpsychology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Melissa Brunner
- Discipline of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Leanne Togher
- Discipline of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Sheehan RC, Fain AC, Wilson JB, Wilken JM, Rábago CA. Inclusion of a Military-specific, Virtual Reality-based Rehabilitation Intervention Improved Measured Function, but Not Perceived Function, in Individuals with Lower Limb Trauma. Mil Med 2021; 186:e777-e783. [PMID: 33201245 DOI: 10.1093/milmed/usaa483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/12/2020] [Accepted: 10/28/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Lower extremity injury is common in the military and can lead to instability, pain, and decreased function. Military service also places high physical demands on service members (SMs). Standard treatment interventions often fail to align with these unique demands. Thus, the goal of the study was to evaluate the effectiveness of a military-specific virtual reality-based rehabilitation (VR) intervention supplemental to standard care (SC) in improving military performance in SMs with lower extremity injuries. MATERIALS AND METHODS As part of an institutional review board-approved randomized control trial, SMs receiving care at an advanced rehabilitation center were randomized to receive either SC or VR in addition to SC (VR+SC). Participants were evaluated before treatment and ∼3 weeks later using a previously developed and validated military-specific assessment. Perceived improvement in physical function was measured using a Global Rating of Change (GROC) questionnaire. A repeated measures ANOVA was used to evaluate the effects of adding VR on the military-specific assessment measures. Linear regression was used to determine the relationship between perceived improvement, measured improvement, and VR volume. RESULTS The VR+SC group was able to traverse a greater distance in the assessment following the VR intervention. There was no significant difference in GROC between groups. For the VR+SC group, change in distance completed was not correlated with GROC, but GROC was correlated with VR volume. CONCLUSION VR improved the distance that participants were able to traverse in the assessment. However, the VR+SC group demonstrated a disconnect between their perceived functional improvement as measured by the GROC and functional improvement as measured by the change in the distance completed. Rather, the perceived improvement appears to be more correlated with the volume of VR received. The way in which the treatment progression is structured and communicated may influence how patients perceive their change in physical function.
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Affiliation(s)
- Riley C Sheehan
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - AuraLea C Fain
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Extremity Trauma and Amputation Center of Excellence, Sam Houston, TX 78234, USA
| | - Jonathan B Wilson
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Jason M Wilken
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Extremity Trauma and Amputation Center of Excellence, Sam Houston, TX 78234, USA
| | - Christopher A Rábago
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- Extremity Trauma and Amputation Center of Excellence, Sam Houston, TX 78234, USA
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12
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Cook NE, Huebschmann NA, Iverson GL. Safety and Tolerability of an Innovative Virtual Reality-Based Deep Breathing Exercise in Concussion Rehabilitation: A Pilot Study. Dev Neurorehabil 2021; 24:222-229. [PMID: 33126815 DOI: 10.1080/17518423.2020.1839981] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To examine the safety and tolerability of a virtual reality-based deep breathing exercise for children and adolescents who are slow to recover from concussion. Methods: Fifteen participants (ages 11 to 22; mean = 16.9 years) were recruited from a specialty concussion clinic within a tertiary care medical center. Participants completed a 5-min paced deep breathing exercise administered via a virtual reality headset. Results: Nearly all participants (93.3%) reported the experience was either positive or extremely positive. No participants reported significant discomfort or discontinued the exercise. Three participants reported a mild increase in headache, dizziness, or nausea. Participants reported significant decreases in stress (r =.57), tension (r =.73), fatigue (r =.73), and confusion (r =.67), with large effect sizes, following the deep breathing exercise. Conclusion: A brief, virtual reality-based deep breathing exercise is worthy of additional study as a rehabilitation component for children and adolescents with prolonged concussion recoveries.
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Affiliation(s)
- Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Spaulding Research Institute, Charlestown, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, USA
| | - Nathan A Huebschmann
- Spaulding Rehabilitation Hospital, Spaulding Research Institute, Charlestown, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Spaulding Research Institute, Charlestown, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, USA.,Center for Health and Rehabilitation Research, Charlestown, MA, USA
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13
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Technology and concussion: A scoping review. JOURNAL OF CONCUSSION 2021. [DOI: 10.1177/2059700221992952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Technology for concussion identification and management is rapidly expanding across the continuum of care. Although many technologies offer a range of services around concussion, there is an absence of a non-commercial online location for medical providers to access regarding the functionality of the various technologies used in concussion identification and management. Objective The purpose of this review is to present research findings on technology for concussion identification and management. Methods Searches for eligible studies were conducted using the PubMed, EMBASE, and Scopus databases with specific search criteria. Through a stepwise process, full-text articles were selected for inclusion if they described clinically useful electronic technologies (i.e. electronics able to be used in standard clinical environments including telehealth) by healthcare providers or end users (i.e. parents or athletes). Results A total of 29 articles were included in this review and described technology used to measure symptoms (3), neurocognitive performance (7), the visual system (4), and balance or dual task performance (18). Within the results, various technologies demonstrated increased utility for concussion identification, often detecting subtle deficits not possible with current low-tech clinical methods, differentiating those with concussion from those without concussion, with strong reliability and validity. Conclusion Innovative technologies included in this review demonstrate enhanced ability to identify and manage symptoms of concussion, neurocognitive deficits, visual deficits, and balance and dual-task deficits.
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14
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Heslot C, Cogné M, Guillouët E, Perdrieau V, Lefevre-Dognin C, Glize B, Bonan I, Azouvi P. Management of unfavorable outcome after mild traumatic brain injury: Review of physical and cognitive rehabilitation and of psychological care in post-concussive syndrome. Neurochirurgie 2020; 67:283-289. [PMID: 33049290 DOI: 10.1016/j.neuchi.2020.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 08/26/2020] [Accepted: 09/13/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Mild Traumatic Brain Injury (mTBI) is a public health issue with approximately 42 million people worldwide affected yearly. Most patients have a favorable short-term recovery but 10-20% are likely to develop post-concussive syndrome (association of physical, cognitive, and psychological difficulties after injury). Post-concussive syndrome can be associated with Post-Traumatic Stress Disorder (PTSD). There is to date no recommendation on the interventions that could be done to reduce post-concussive syndrome. The present review aims at summarizing the effect of therapeutic education, physical and cognitive rehabilitation and of psychological care in mTBI patients with post-concussive syndrome. METHODS In the current international literature, we investigated the effects of therapeutic education, physical and cognitive rehabilitation and of psychological care in this population using the Medline database and we discussed the results of these studies. RESULTS The application of a therapeutic education intervention within 3 months after mTBI has been found appropriate and effective to prevent post-concussion syndrome in several studies but the timeline of this intervention differs among the existing studies. Concerning physical disabilities, several pharmacological, rehabilitative and non-pharmacological techniques have shown some efficacy in reducing headache and vertigo; rTMS seems also promising in this context. The management of fatigue is also crucial and requires a multidisciplinary approach. We did not find any intervention in mTBI patients with post-concussive syndrome suffering from dysosmia and/or dysgueusia. No pharmacological treatment is currently recommended to reduce the cognitive symptoms of post-concussive syndrome after mTBI. Rehabilitation and brain-stimulation techniques have already proven their efficacy to reduce the cognitive impairment in this population. Even if the use of Virtual Reality software seems well tolerated in this population, its efficacy and additional value needs to be demonstrated in larger studies. Concerning the psychological care after mTBI, Cognitive and Behavioral Therapy interventions are the most frequently reported in this population, followed by psychoeducational interventions. PTSD management seems crucial in overall recovery of patients with post-concussive syndrome. CONCLUSION Many studies have sought to demonstrate the effectiveness of various rehabilitation techniques, including different cognitive rehabilitation programs, technology-assisted rehabilitation, different types of brain stimulation and some pharmacological treatments. However, most of these studies are of a low level of scientific evidence and it would be necessary to carry out well-conducted prospective randomized trials in order to offer an appropriate and effective multidisciplinary management for patients with post-concussive syndrome after mTBI.
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Affiliation(s)
- C Heslot
- Rehabilitation Medicine Unit, Rennes University Hospital, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - M Cogné
- Rehabilitation Medicine Unit, Raymond Poincaré Hospital, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France.
| | - E Guillouët
- Rehabilitation Medicine Unit, Raymond Poincaré Hospital, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - V Perdrieau
- Rehabilitation Medicine Unit, Raymond Poincaré Hospital, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - C Lefevre-Dognin
- Rehabilitation Medicine Unit, Raymond Poincaré Hospital, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - B Glize
- Rehabilitation Medicine Unit, Bordeaux University Hospital, place Amélie-Raba-Léon, 33000 Bordeaux, France; EA4136, Bordeaux University, 146, rue Léo-Saignat, 33000 Bordeaux, France
| | - I Bonan
- Rehabilitation Medicine Unit, Rennes University Hospital, 2, rue Henri-le-Guilloux, 35000 Rennes, France; Unit Empenn-U1228, INSERM, INRIA, University of Rennes 1, Rennes, France
| | - P Azouvi
- Rehabilitation Medicine Unit, Raymond Poincaré Hospital, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; EA 4047 HANDIReSP, Versailles-Saint Quentin University, France
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15
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Hurtado JE, Heusel-Gillig L, Risk BB, Trofimova A, Abidi SA, Allen JW, Gore RK. Technology-enhanced visual desensitization home exercise program for post-concussive visually induced dizziness: a case series. Physiother Theory Pract 2020; 38:985-994. [PMID: 32955968 DOI: 10.1080/09593985.2020.1815259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Purpose: Post-concussive visually induced dizziness (VID), in which symptoms are provoked by exposure to complex visual motion, is associated with protracted recovery. Although vestibular rehabilitation therapy (VRT) is recommended to treat post-concussive dizziness, there is sparse literature reporting on specific VRT interventions treating VID. Methods: A consecutive series of 26 individuals referred for VRT post-concussion were retrospectively assessed for inclusion in this case series. Each participant underwent a combination of conventional VRT and a technology-enhanced visual desensitization home exercise program (HEP). Self-report and objective measures were recorded from initial and discharge therapy evaluations. Twenty-three individuals (mean age 23.1 ± 12.4) with post-concussive dizziness (mean 109 ± 56 days post-injury) and no evidence for peripheral vestibular dysfunction were included. Treatment duration averaged 6.9 ± 2.5 weeks. Results: There were significant improvements in post-intervention on subjective and objective measures of dizziness and gait (p < .05). The response to intervention was independent of pre-injury migraine history but pre-injury depression/anxiety increased self-report of post-treatment anxiety. Concurrent treatment with medications did not influence response to treatment. Conclusions: The combination therapy intervention improved outcome measures consistent with VRT treatment outcomes in both concussion and non-traumatic vestibular conditions. Individuals referred for VRT post-concussion warrant assessment for VID and may benefit from the addition of technology-enhanced visual desensitization.
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Affiliation(s)
- Julia E Hurtado
- Shepherd Center, Complex Concussion Clinic , Atlanta, GA, USA
| | - Lisa Heusel-Gillig
- Department of Rehabilitation Medicine, Emory Dizziness and Balance Center , Atlanta, GA, USA
| | - Benjamin B Risk
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University , Atlanta, GA, USA
| | - Anna Trofimova
- Diagnostic Radiology, Department of Radiology and Imaging Sciences, Neuroradiology Division, Emory University School of Medicine , Atlanta, GA, USA
| | - Syed A Abidi
- School of Medicine, Emory University , Atlanta, GA, USA
| | - Jason W Allen
- Diagnostic Radiology, Department of Radiology and Imaging Sciences, Neuroradiology Division, Emory University School of Medicine , Atlanta, GA, USA.,Department of Neurology, Emory University School of Medicine, Emory University School of Medicine , Atlanta, GA, USA
| | - Russell K Gore
- Shepherd Center, Complex Concussion Clinic , Atlanta, GA, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University , Atlanta, GA, USA
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16
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Sensorimotor conflict tests in an immersive virtual environment reveal subclinical impairments in mild traumatic brain injury. Sci Rep 2020; 10:14773. [PMID: 32901067 PMCID: PMC7479615 DOI: 10.1038/s41598-020-71611-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 08/11/2020] [Indexed: 11/08/2022] Open
Abstract
Current clinical tests lack the sensitivity needed for detecting subtle balance impairments associated with mild traumatic brain injury (mTBI). Patient-reported symptoms can be significant and have a huge impact on daily life, but impairments may remain undetected or poorly quantified using clinical measures. Our central hypothesis was that provocative sensorimotor perturbations, delivered in a highly instrumented, immersive virtual environment, would challenge sensory subsystems recruited for balance through conflicting multi-sensory evidence, and therefore reveal that not all subsystems are performing optimally. The results show that, as compared to standard clinical tests, the provocative perturbations illuminate balance impairments in subjects who have had mild traumatic brain injuries. Perturbations delivered while subjects were walking provided greater discriminability (average accuracy ≈ 0.90) than those delivered during standing (average accuracy ≈ 0.65) between mTBI subjects and healthy controls. Of the categories of features extracted to characterize balance, the lower limb accelerometry-based metrics proved to be most informative. Further, in response to perturbations, subjects with an mTBI utilized hip strategies more than ankle strategies to prevent loss of balance and also showed less variability in gait patterns. We have shown that sensorimotor conflicts illuminate otherwise-hidden balance impairments, which can be used to increase the sensitivity of current clinical procedures. This augmentation is vital in order to robustly detect the presence of balance impairments after mTBI and potentially define a phenotype of balance dysfunction that enhances risk of injury.
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17
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Reneker JC, Pannell WC, Babl RM, Zhang Y, Lirette ST, Adah F, Reneker MR. Virtual immersive sensorimotor training (VIST) in collegiate soccer athletes: A quasi-experimental study. Heliyon 2020; 6:e04527. [PMID: 32743105 PMCID: PMC7385459 DOI: 10.1016/j.heliyon.2020.e04527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/01/2020] [Accepted: 07/17/2020] [Indexed: 12/18/2022] Open
Abstract
A burgeoning area of innovation in sports is the use of extended realities to provide athletes with novel training environments. Evidence has demonstrated that virtual environments can be useful therapeutic tools with demonstrated positive outcomes. The purpose of this pilot investigation was to determine the effects of virtual immersive sensorimotor training intervention by quantifying 1) the training effect measured via change in performance pre-to post-intervention on the virtual reality exercises, 2) the difference in the in clinical measures of functional sensorimotor control, 3) the injury incidence rate, and 4) on-field performance during soccer competitions. Statistical analyses were used to describe differences between an experimental and a control group. Participants were recruited from the men and women's soccer teams at two universities in the United States. Participants at one university were in the experimental group (n = 78) and received virtual immersive sensorimotor training, consisting of nine novel exercises in headset virtual reality, twice each week for six weeks. Participants at the second university were in the control group (n = 52). The virtual exercises were developed with reference to the rehabilitative principles of neuroplasticity to train various neurologic processes, contributing to overall sensorimotor control. This includes vestibular, visual and oculomotor activities, cervical neuromotor control training, movement coordination, and postural/balance exercises. The results indicate significant positive training effects pre-to post-intervention in seven of the nine training exercises (p ≤ 0.005) and improvement in clinical tests of cervical neuromotor control, balance, and inspection time (p ≤ 0.009) in the experimental group compared to the control. One of the virtual training exercises was positively associated with on-field performance (p = 0.022). No differences in injury rate or overall on-field performance metrics between the experimental and control were detected. This research study provides evidence of training and positive transfer from virtual to real-world environments, supporting the use of these novel virtual exercises to improve measures of sensorimotor control in healthy soccer athletes.
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Affiliation(s)
- Jennifer C Reneker
- Department of Population Health Sciences, School of Population Health, University of Mississippi Medical Center, USA
| | - W Cody Pannell
- Department of Physical Therapy, School of Health Related Professions, University of Mississippi Medical Center, USA
| | - Ryan M Babl
- Department of Physical Therapy, School of Health Related Professions, University of Mississippi Medical Center, USA
| | - Yunxi Zhang
- Department of Data Science, School of Population Health, University of Mississippi Medical Center, USA
| | - Seth T Lirette
- Department of Data Science, School of Population Health, University of Mississippi Medical Center, USA
| | - Felix Adah
- Department of Physical Therapy, School of Health Related Professions, University of Mississippi Medical Center, USA
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18
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A novel assessment for Readiness Evaluation during Simulated Dismounted Operations: A reliability study. PLoS One 2019; 14:e0226386. [PMID: 31887147 PMCID: PMC6936885 DOI: 10.1371/journal.pone.0226386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022] Open
Abstract
Objective To determine the intersession reliability of the Readiness Evaluation during Simulated Dismounted Operations (REDOp), a novel ecologically-based assessment for injured Service Members, provide minimal detectable change values, and normative reference range values. To evaluate the ability to differentiate performance limitations between able-bodied and injured individuals using the REDOp. Design Repeated measures design and between group comparison. Setting Outpatient rehabilitative care setting. Participants Service Members who were able-bodied (n = 32) or sustained a traumatic lower extremity injury (n = 22). Interventions During the REDOp, individuals walked over variable terrain as speed and incline progressively increased; they engaged targets; and carried military gear. Main outcome measures Endurance measured using total distance traveled; walking stability measured using range of full-body angular momentum; and shooting accuracy, precision, reaction time and acquisition time. Results Intersession reliability analyses were conducted on a sub-group of 18 able-bodied Service Members. Interclass correlation coefficient values were calculated for distance traveled (0.91), range of angular momentum about three axes (0.78–0.93), shooting accuracy (0.61), precision (0.47), reaction time (0.21), and acquisition time (0.77). Service Members with lower extremity injury demonstrated significantly less distance traveled with a median distance of 0.89 km compared to 2.73 km for the able-bodied group (p < 0.001). Service Members with lower extremity injury demonstrated significantly less stability in the frontal and sagittal planes than the able-bodied group (p < 0.001). The primary performance limiter was endurance followed by pain for both groups. There was no evidence of ceiling effects. Conclusions The REDOp is a highly reliable, military-relevant assessment that can be used to measure performance and identify deficits across the domains of activity tolerance, gait stability, and shooting performance.
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19
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Hoppes CW, Sparto PJ, Whitney SL, Furman JM, Huppert TJ. Changes in cerebral activation in individuals with and without visual vertigo during optic flow: A functional near-infrared spectroscopy study. NEUROIMAGE-CLINICAL 2018; 20:655-663. [PMID: 30211002 PMCID: PMC6129736 DOI: 10.1016/j.nicl.2018.08.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/15/2018] [Accepted: 08/31/2018] [Indexed: 02/06/2023]
Abstract
Background and purpose Individuals with visual vertigo (VV) describe symptoms of dizziness, disorientation, and/or impaired balance in environments with conflicting visual and vestibular information or complex visual stimuli. Physical therapists often prescribe habituation exercises using optic flow to treat these symptoms, but it is not known how individuals with VV process the visual stimuli. The primary purpose of this study was to use functional near-infrared spectroscopy (fNIRS) to determine if individuals with VV have different cerebral activation during optic flow compared with control subjects. Methods Fifteen individuals (5 males and 10 females in each group) with VV seeking care for dizziness and 15 healthy controls (CON) stood in a virtual reality environment and viewed anterior-posterior optic flow. The support surface was either fixed or sway-referenced. Changes in cerebral activation were recorded using fNIRS during periods of optic flow relative to a stationary visual environment. Postural sway of the head and center of mass was recorded using an electromagnetic tracker. Results Compared with CON, the VV group displayed decreased activation in the bilateral middle frontal regions when viewing optic flow while standing on a fixed platform. Despite both groups having significantly increased activation in most regions while viewing optic flow on a sway-referenced surface, the VV group did not have as much of an increase in the right middle frontal region when viewing unpredictable optic flow in comparison with the CON group. Discussion and conclusions Individuals with VV produced a pattern of reduced middle frontal cerebral activation when viewing optic flow compared with CON. Decreased activation in the middle frontal regions of the cerebral cortex may represent an alteration in control over the normal reciprocal inhibitory visual-vestibular interaction in visually dependent individuals. Although preliminary, these findings add to a growing body of literature using functional brain imaging to explore changes in cerebral activation in individuals with complaints of dizziness, disorientation, and unsteadiness. Future studies in larger samples should explore if this decreased activation is modified following a rehabilitation regimen consisting of visual habituation exercises. Visual vertigo and healthy controls process optic flow information differently. Visual vertigo had reduced bilateral middle frontal activation on a fixed platform. Visual vertigo had reduced right middle frontal activation on a moving platform.
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Affiliation(s)
- Carrie W Hoppes
- Army-Baylor Doctoral Program in Physical Therapy, Fort Sam Houston, TX, United States.
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20
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Ray NT, Knarr BA, Higginson JS. Walking speed changes in response to novel user-driven treadmill control. J Biomech 2018; 78:143-149. [PMID: 30078637 DOI: 10.1016/j.jbiomech.2018.07.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 05/29/2018] [Accepted: 07/20/2018] [Indexed: 11/28/2022]
Abstract
Implementing user-driven treadmill control in gait training programs for rehabilitation may be an effective means of enhancing motor learning and improving functional performance. This study aimed to determine the effect of a user-driven treadmill control scheme on walking speeds, anterior ground reaction forces (AGRF), and trailing limb angles (TLA) of healthy adults. Twenty-three participants completed a 10-m overground walking task to measure their overground self-selected (SS) walking speeds. Then, they walked at their SS and fastest comfortable walking speeds on an instrumented split-belt treadmill in its fixed speed and user-driven control modes. The user-driven treadmill controller combined inertial-force, gait parameter, and position based control to adjust the treadmill belt speed in real time. Walking speeds, peak AGRF, and TLA were compared among test conditions using paired t-tests (α = 0.05). Participants chose significantly faster SS and fast walking speeds in the user-driven mode than the fixed speed mode (p > 0.05). There was no significant difference between the overground SS walking speed and the SS speed from the user-driven trials (p < 0.05). Changes in AGRF and TLA were caused primarily by changes in walking speed, not the treadmill controller. Our findings show the user-driven treadmill controller allowed participants to select walking speeds faster than their chosen speeds on the fixed speed treadmill and similar to their overground speeds. Since user-driven treadmill walking increases cognitive activity and natural mobility, these results suggest user-driven treadmill control would be a beneficial addition to current gait training programs for rehabilitation.
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Affiliation(s)
- Nicole T Ray
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States.
| | - Brian A Knarr
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, United States
| | - Jill S Higginson
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States
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21
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Aida J, Chau B, Dunn J. Immersive virtual reality in traumatic brain injury rehabilitation: A literature review. NeuroRehabilitation 2018; 42:441-448. [DOI: 10.3233/nre-172361] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jared Aida
- Department of Physical Medicine and Rehabilitation, Loma Linda University Health, Loma Linda, CA, USA
| | - Brian Chau
- Department of Veteran Affairs, Loma Linda Healthcare System, Department of Physical Medicine and Rehabilitation, Redlands, CA, USA
| | - Justin Dunn
- Loma Linda University School of Medicine, Loma Linda, CA, USA
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22
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Hoppes CW, Sparto PJ, Whitney SL, Furman JM, Huppert TJ. Functional near-infrared spectroscopy during optic flow with and without fixation. PLoS One 2018. [PMID: 29513720 PMCID: PMC5841770 DOI: 10.1371/journal.pone.0193710] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Individuals with visual vertigo describe symptoms of dizziness, disorientation, and/or impaired balance in environments with conflicting visual and vestibular information or complex visual stimuli. Physical therapists often prescribe habituation exercises using optic flow to treat these symptoms, but there are no evidence-based guidelines for delivering optic flow and it is unclear how the brain processes such stimuli. The purposes of this study were to use functional near-infrared spectroscopy (fNIRS) to explore cerebral activation during optic flow, and determine if visual fixation had a modulating effect on brain activity. METHODS Fifteen healthy participants (7 males and 8 females; mean age 41 years old) stood in a virtual reality environment and viewed optic flow moving unidirectionally in the yaw plane with and without fixation. Changes in cerebral activation were recorded from the bilateral fronto-temporo-parietal and occipital lobes using fNIRS. RESULTS Cerebral activation was greater with visual motion than while viewing a stationary scene. Greater cerebral activation in the bilateral fronto-temporo-parietal lobes was observed when optic flow was viewed with fixation. DISCUSSION AND CONCLUSIONS Optic flow activates the bilateral fronto-temporo-parietal regions of the cerebral cortex. This activation is greater while viewing optic flow and a fixation target, providing preliminary evidence supporting the use of a fixation target during habituation exercises.
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Affiliation(s)
- Carrie W. Hoppes
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| | - Patrick J. Sparto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Susan L. Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Joseph M. Furman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Theodore J. Huppert
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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23
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Wright WG, Tierney RT, McDevitt J. Visual-vestibular processing deficits in mild traumatic brain injury. J Vestib Res 2018; 27:27-37. [PMID: 28387693 DOI: 10.3233/ves-170607] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The search for reliable and valid signs and symptoms of mild traumatic brain injury (mTBI), commonly synonymous with concussion, has lead to a growing body of evidence that individuals with long-lasting, unremitting impairments often experience visual and vestibular symptoms, such as dizziness, postural and gait disturbances. OBJECTIVE Investigate the role of visual-vestibular processing deficits following concussion. METHODS A number of clinically accepted vestibular, oculomotor, and balance assessments as well as a novel virtual reality (VR)-based balance assessment device were used to assess adults with post-acute concussion (n = 14) in comparison to a healthy age-matched cohort (n = 58). RESULTS Significant between-group differences were found with the VR-based balance device (p = 0.001), with dynamic visual motion emerging as the most discriminating balance condition. The symptom reports collected after performing the oculomotor and vestibular tests: rapid alternating horizontal eye saccades, optokinetic stimulation, and gaze stabilization, were all sensitive to health status (p < 0.05), despite the absence of oculomotor abnormalities being observed, except for near-point convergence. The BESS, King-Devick, and Dynamic Visual Acuity tests did not detect between-group differences. CONCLUSION Postural and visual-vestibular tasks most closely linked to spatial and self-motion perception had the greatest discriminatory outcomes. The current findings suggest that mesencephalic and parieto-occipital centers and pathways may be involved in concussion.
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Affiliation(s)
- W G Wright
- Department of Physical Therapy, Neuromotor Sciences Program, Temple University, Philadelphia, PA, USA.,Department of Bioengineering, Temple University, Philadelphia, PA, USA
| | - R T Tierney
- Department of Kinesiology, Temple University, Philadelphia, PA, USA
| | - J McDevitt
- Department of Physical Therapy, Neuromotor Sciences Program, Temple University, Philadelphia, PA, USA.,Department of Athletic Training, East Stroudsburg University, East Stroudsburg, PA, USA
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Use of Perturbation-Based Gait Training in a Virtual Environment to Address Mediolateral Instability in an Individual With Unilateral Transfemoral Amputation. Phys Ther 2016; 96:1896-1904. [PMID: 27277497 PMCID: PMC5131184 DOI: 10.2522/ptj.20150566] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 05/30/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Roughly 50% of individuals with lower limb amputation report a fear of falling and fall at least once a year. Perturbation-based gait training and the use of virtual environments have been shown independently to be effective at improving walking stability in patient populations. An intervention was developed combining the strengths of the 2 paradigms utilizing continuous, walking surface angle oscillations within a virtual environment. This case report describes walking function and mediolateral stability outcomes of an individual with a unilateral transfemoral amputation following a novel perturbation-based gait training intervention in a virtual environment. CASE DESCRIPTION The patient was a 43-year-old male veteran who underwent a right transfemoral amputation 7+ years previously as a result of a traumatic blast injury. He used a microprocessor-controlled knee and an energy storage and return foot. OUTCOMES Following the intervention, multiple measures indicated improved function and stability, including faster self-selected walking speed and reduced functional stepping time, mean step width, and step width variability. These changes were seen during normal level walking and mediolateral visual field or platform perturbations. In addition, benefits were retained at least 5 weeks after the final training session. DISCUSSION The perturbation-based gait training program in the virtual environment resulted in the patient's improved walking function and mediolateral stability. Although the patient had completed intensive rehabilitation following injury and was fully independent, the intervention still induced notable improvements to mediolateral stability. Thus, perturbation-based gait training in challenging simulated environments shows promise for improving walking stability and may be beneficial when integrated into a rehabilitation program.
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Wright WG, McDevitt J, Tierney R, Haran FJ, Appiah-Kubi KO, Dumont A. Assessing subacute mild traumatic brain injury with a portable virtual reality balance device. Disabil Rehabil 2016; 39:1564-1572. [PMID: 27718642 DOI: 10.1080/09638288.2016.1226432] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Balance impairment is a common sensorimotor symptom in mild traumatic brain injury (mTBI). We designed an affordable, portable virtual reality (VR)-based balance screening device (Virtual Environment TBI Screen [VETS]), which will be validated relative to the Neurocom Sensory Organization Test (SOT) to determine if it can replace commonly used postural assessments. METHODS This preliminary study examines healthy adults (n = 56) and adults with mTBI (n = 11). Participants performed six upright postural tasks on the VETS and the SOT. Analysis of variance was used to determine between-group differences. Pearson's correlations were used to establish construct validity. Known-groups approach was used to establish classification accuracy. RESULTS The mTBI cohort performed significantly worse than the healthy cohort on the new device (p = 0.001). The new device has 91.0% accuracy and an ROC curve with a significant area-under-the-curve (AUC = 0.865, p < 0.001). Conditions with dynamic visual stimulation were the most sensitive to health status. The SOT had an 84.8% accuracy and AUC =0.703 (p = 0.034). CONCLUSIONS The new VR-based device is a valid measure for detecting balance impairment following mTBI and can potentially replace more expensive and cumbersome equipment. Assessments that test visual-vestibular processing, such as VETS, increase sensitivity to mTBI-related balance deficits, which can be used to guide rehabilitation. Implications for rehabilitation Emerging technology using virtual reality can be economically integrated into the clinical setting for easy testing of postural control in neurologically impaired populations. Tailoring postural assessments to include tasks that rely on visual and vestibular integration will increase the accuracy of detecting balance impairment following mild traumatic brain injury.
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Affiliation(s)
- W Geoffrey Wright
- a Department of Physical Therapy , Temple University , Philadelphia , PA , USA.,e Department of Bioengineering , Temple University , Philadelphia , PA , USA
| | - Jane McDevitt
- b Department of Athletic Training , East Stroudsburg University , East Stroudsburg , PA , USA.,c Department of Kinesiology , Temple University , Philadelphia , PA , USA
| | - Ryan Tierney
- c Department of Kinesiology , Temple University , Philadelphia , PA , USA
| | - F Jay Haran
- d Department of Kinesiology , University of North Carolina-Greensboro , Greensboro , NC , USA
| | | | - Alex Dumont
- e Department of Bioengineering , Temple University , Philadelphia , PA , USA
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Murray DA, Meldrum D, Lennon O. Can vestibular rehabilitation exercises help patients with concussion? A systematic review of efficacy, prescription and progression patterns. Br J Sports Med 2016; 51:442-451. [DOI: 10.1136/bjsports-2016-096081] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 11/04/2022]
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Chang PFJ, Baxter MF, Rissky J. Effectiveness of Interventions Within the Scope of Occupational Therapy Practice to Improve Motor Function of People With Traumatic Brain Injury: A Systematic Review. Am J Occup Ther 2016; 70:7003180020p1-5. [PMID: 27089286 DOI: 10.5014/ajot.2016.020867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
After traumatic brain injury (TBI), many people experience significant motor function impairments. To help occupational therapy practitioners make informed decisions in choosing treatment strategies to improve clients' motor function, we undertook a systematic review and synthesized applicable findings of intervention studies. Of 2,306 articles identified in the literature search, we reviewed 47 full-text articles, of which 16 met approved criteria. We found moderate evidence that various exercise programs increase motor function and limited evidence that people with TBI can benefit from rehabilitation and computer-based programs. We offer implications for practice, education, and research.
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Affiliation(s)
- Pei-Fen J Chang
- Pei-Fen J. Chang, PhD, OTR, is Associate Professor, School of Occupational Therapy, Texas Woman's University, Houston;
| | - Mary Frances Baxter
- Mary Frances Baxter, PhD, OT, FAOTA, is Associate Professor, School of Occupational Therapy, Texas Woman's University, Houston
| | - Jenna Rissky
- Jenna Rissky, MOT, was Graduate Student, Texas Woman's University, Houston, at the time of the study
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Salisbury DB, Dahdah M, Driver S, Parsons TD, Richter KM. Virtual reality and brain computer interface in neurorehabilitation. Proc (Bayl Univ Med Cent) 2016; 29:124-7. [PMID: 27034541 DOI: 10.1080/08998280.2016.11929386] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The potential benefit of technology to enhance recovery after central nervous system injuries is an area of increasing interest and exploration. The primary emphasis to date has been motor recovery/augmentation and communication. This paper introduces two original studies to demonstrate how advanced technology may be integrated into subacute rehabilitation. The first study addresses the feasibility of brain computer interface with patients on an inpatient spinal cord injury unit. The second study explores the validity of two virtual environments with acquired brain injury as part of an intensive outpatient neurorehabilitation program. These preliminary studies support the feasibility of advanced technologies in the subacute stage of neurorehabilitation. These modalities were well tolerated by participants and could be incorporated into patients' inpatient and outpatient rehabilitation regimens without schedule disruptions. This paper expands the limited literature base regarding the use of advanced technologies in the early stages of recovery for neurorehabilitation populations and speaks favorably to the potential integration of brain computer interface and virtual reality technologies as part of a multidisciplinary treatment program.
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Affiliation(s)
- David B Salisbury
- Baylor Institute for Rehabilitation, Dallas, Texas (Salisbury, Dahdah, Driver); Baylor Regional Medical Center at Plano, Plano, Texas (Dahdah); the Department of Psychology, the University of North Texas, Denton, Texas (Parsons); and the Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas (Richter)
| | - Marie Dahdah
- Baylor Institute for Rehabilitation, Dallas, Texas (Salisbury, Dahdah, Driver); Baylor Regional Medical Center at Plano, Plano, Texas (Dahdah); the Department of Psychology, the University of North Texas, Denton, Texas (Parsons); and the Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas (Richter)
| | - Simon Driver
- Baylor Institute for Rehabilitation, Dallas, Texas (Salisbury, Dahdah, Driver); Baylor Regional Medical Center at Plano, Plano, Texas (Dahdah); the Department of Psychology, the University of North Texas, Denton, Texas (Parsons); and the Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas (Richter)
| | - Thomas D Parsons
- Baylor Institute for Rehabilitation, Dallas, Texas (Salisbury, Dahdah, Driver); Baylor Regional Medical Center at Plano, Plano, Texas (Dahdah); the Department of Psychology, the University of North Texas, Denton, Texas (Parsons); and the Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas (Richter)
| | - Kathleen M Richter
- Baylor Institute for Rehabilitation, Dallas, Texas (Salisbury, Dahdah, Driver); Baylor Regional Medical Center at Plano, Plano, Texas (Dahdah); the Department of Psychology, the University of North Texas, Denton, Texas (Parsons); and the Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas (Richter)
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Motor-Cognitive Dual-Task Training in Persons With Neurologic Disorders: A Systematic Review. J Neurol Phys Ther 2016; 39:142-53. [PMID: 26079569 DOI: 10.1097/npt.0000000000000090] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Deficits in motor-cognitive dual tasks (eg, walking while talking) are common in individuals with neurologic conditions. This review was conducted to determine the effectiveness of motor-cognitive dual-task training (DTT) compared with usual care on mobility and cognition in individuals with neurologic disorders. METHODS Databases searched were Biosis, CINAHL, ERIC, PsychInfo, EBSCO Psychological & Behavioral, PubMed, Scopus, and Web of Knowledge. Eligibility criteria were studies of adults with neurologic disorders that included DTT, and outcomes of gait or balance were included. Fourteen studies met inclusion criteria. Participants were subjects with brain injury, Parkinson disease (PD), and Alzheimer disease (AD). Intervention protocols included cued walking, cognitive tasks paired with gait, balance, and strength training and virtual reality or gaming. Quality of the included trials was evaluated with a standardized rating scale of clinical relevance. RESULTS Results show that DTT improves single-task gait velocity and stride length in subjects with PD and AD, dual-task gait velocity and stride length in subjects with PD, AD, and brain injury, and may improve balance and cognition in those with PD and AD. The inclusion criteria of the studies reviewed limited the diagnostic groups included. DISCUSSION AND CONCLUSIONS While the range of training protocols and outcome assessments in available studies limited comparison of the results across studies motor-cognitive dual-task deficits in individuals with neurologic disorders appears to be amenable to training. Improvement of dual-task ability in individuals with neurologic disorders holds potential for improving gait, balance, and cognition.Video Abstract available for additional insights from the authors (Supplemental Digital Content, http://links.lww.com/JNPT/A104).
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Rábago CA, Dingwell JB, Wilken JM. Reliability and Minimum Detectable Change of Temporal-Spatial, Kinematic, and Dynamic Stability Measures during Perturbed Gait. PLoS One 2015; 10:e0142083. [PMID: 26535580 PMCID: PMC4633040 DOI: 10.1371/journal.pone.0142083] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 10/16/2015] [Indexed: 12/04/2022] Open
Abstract
Temporal-spatial, kinematic variability, and dynamic stability measures collected during perturbation-based assessment paradigms are often used to identify dysfunction associated with gait instability. However, it remains unclear which measures are most reliable for detecting and tracking responses to perturbations. This study systematically determined the between-session reliability and minimum detectable change values of temporal-spatial, kinematic variability, and dynamic stability measures during three types of perturbed gait. Twenty young healthy adults completed two identical testing sessions two weeks apart, comprised of an unperturbed and three perturbed (cognitive, physical, and visual) walking conditions in a virtual reality environment. Within each session, perturbation responses were compared to unperturbed walking using paired t-tests. Between-session reliability and minimum detectable change values were also calculated for each measure and condition. All temporal-spatial, kinematic variability and dynamic stability measures demonstrated fair to excellent between-session reliability. Minimal detectable change values, normalized to mean values ranged from 1–50%. Step width mean and variability measures demonstrated the greatest response to perturbations with excellent between-session reliability and low minimum detectable change values. Orbital stability measures demonstrated specificity to perturbation direction and sensitivity with excellent between-session reliability and low minimum detectable change values. We observed substantially greater between-session reliability and lower minimum detectable change values for local stability measures than previously described which may be the result of averaging across trials within a session and using velocity versus acceleration data for reconstruction of state spaces. Across all perturbation types, temporal-spatial, orbital and local measures were the most reliable measures with the lowest minimum detectable change values, supporting their use for tracking changes over multiple testing sessions. The between-session reliability and minimum detectable change values reported here provide an objective means for interpreting changes in temporal-spatial, kinematic variability, and dynamic stability measures during perturbed walking which may assist in identifying instability.
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Affiliation(s)
- Christopher A. Rábago
- Center for the Intrepid, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, United States of America
- Department of Defense and Veterans Affairs Extremity Trauma and Amputation Center of Excellence, JBSA Fort Sam Houston, Texas, United States of America
- * E-mail:
| | - Jonathan B. Dingwell
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas, United States of America
| | - Jason M. Wilken
- Center for the Intrepid, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, United States of America
- Department of Defense and Veterans Affairs Extremity Trauma and Amputation Center of Excellence, JBSA Fort Sam Houston, Texas, United States of America
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McFadyen BJ, Gagné MÈ, Cossette I, Ouellet MC. Using dual task walking as an aid to assess executive dysfunction ecologically in neurological populations: A narrative review. Neuropsychol Rehabil 2015; 27:722-743. [PMID: 26487095 DOI: 10.1080/09602011.2015.1100125] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Within rehabilitation, clinical assessment plays a crucial role in diagnosis, prognostication and making decisions about return to function. The ecological validity of the assessment of executive dysfunction has become a particular focus in neuropsychology and is gaining interest in mobility research and neurological rehabilitation of acquired brain injury or degenerative neurological diseases. In this narrative review, we look at how the task of walking and the inseparable cognitive demands and interference of the surrounding environment are exploited in dual task walking (DTW) paradigms to expose executive dysfunction. While quite a number of studies and reviews have recently focused on the utility of DTW for gait assessment, particularly to assess fall risk, very little consideration has been given to the level of ecological validity required. This paper directly addresses this issue with discussion of evidence and lacunas related to task, personal and technological factors that should be addressed in order to exploit fully DTW paradigms as an ecological assessment tool.
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Affiliation(s)
- Bradford J McFadyen
- a Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec City Rehabilitation Institute , Quebec , Canada.,b Faculty of Medicine, Department of Rehabilitation , Université Laval , Quebec , Canada
| | - Marie-Ève Gagné
- a Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec City Rehabilitation Institute , Quebec , Canada.,c Faculty of Social Sciences, School of Psychology , Université Laval , Quebec , Canada
| | - Isabelle Cossette
- a Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec City Rehabilitation Institute , Quebec , Canada.,b Faculty of Medicine, Department of Rehabilitation , Université Laval , Quebec , Canada
| | - Marie-Christine Ouellet
- a Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec City Rehabilitation Institute , Quebec , Canada.,c Faculty of Social Sciences, School of Psychology , Université Laval , Quebec , Canada
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Semple BD, Lee S, Sadjadi R, Fritz N, Carlson J, Griep C, Ho V, Jang P, Lamb A, Popolizio B, Saini S, Bazarian JJ, Prins ML, Ferriero DM, Basso DM, Noble-Haeusslein LJ. Repetitive concussions in adolescent athletes - translating clinical and experimental research into perspectives on rehabilitation strategies. Front Neurol 2015; 6:69. [PMID: 25883586 PMCID: PMC4382966 DOI: 10.3389/fneur.2015.00069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/13/2015] [Indexed: 12/23/2022] Open
Abstract
Sports-related concussions are particularly common during adolescence, a time when even mild brain injuries may disrupt ongoing brain maturation and result in long-term complications. A recent focus on the consequences of repetitive concussions among professional athletes has prompted the development of several new experimental models in rodents, as well as the revision of guidelines for best management of sports concussions. Here, we consider the utility of rodent models to understand the functional consequences and pathobiology of concussions in the developing brain, identifying the unique behavioral and pathological signatures of concussive brain injuries. The impact of repetitive concussions on behavioral consequences and injury progression is also addressed. In particular, we focus on the epidemiological, clinical, and experimental evidence underlying current recommendations for physical and cognitive rest after concussion, and highlight key areas in which further research is needed. Lastly, we consider how best to promote recovery after injury, recognizing that optimally timed, activity-based rehabilitative strategies may hold promise for the adolescent athlete who has sustained single or repetitive concussions. The purpose of this review is to inform the clinical research community as it strives to develop and optimize evidence-based guidelines for the concussed adolescent, in terms of both acute and long-term management.
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Affiliation(s)
- Bridgette D. Semple
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Sangmi Lee
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Raha Sadjadi
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nora Fritz
- Kennedy Krieger Institute, John Hopkins University, Baltimore, MD, USA
| | - Jaclyn Carlson
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Carrie Griep
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Vanessa Ho
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Patrice Jang
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Annick Lamb
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Beth Popolizio
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Sonia Saini
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey J. Bazarian
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Mayumi L. Prins
- Department of Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Donna M. Ferriero
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - D. Michele Basso
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
| | - Linda J. Noble-Haeusslein
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Physical Therapy and Rehabilitation Sciences, University of California San Francisco, San Francisco, CA, USA
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Sinitski EH, Lemaire ED, Baddour N. Evaluation of motion platform embedded with dual belt treadmill instrumented with two force plates. ACTA ACUST UNITED AC 2015; 52:221-34. [PMID: 26230116 DOI: 10.1682/jrrd.2013.11.0244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/23/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Emily H. Sinitski
- The Ottawa Hospital Research Institute Centre for Research and Development, Ottawa, Canda
| | - Edward D. Lemaire
- The Ottawa Hospital Research Institute Centre for Research and Development, Ottawa, Canda;Faculty of Medicine, University of Ottowa, Ottowa, Canada
| | - Natalie Baddour
- Department of Mechanical Engineering, University of Ottawa, Ottowa, Canada
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Treatment of vertigo and postural instability using visual illusions. The Journal of Laryngology & Otology 2014; 128:1005-7. [DOI: 10.1017/s0022215114002254] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Ototoxicity caused by medication can lead to debilitating symptoms such as dizziness, vertigo and postural instability. There is no current ‘gold standard’ treatment available.Case report:A 79-year-old male, with bilateral loss of vestibular function caused by gentamicin toxicity after surgery for prosthetic valve endocarditis, complained of dizziness, difficulty in walking and an increased risk of falling. Physical examination showed a positive head thrust test suggesting bilateral loss of vestibular function.Results:The patient underwent a specific motion-based virtual reality enhanced protocol for peripheral vestibular disease. He showed a great improvement, with a 50 per cent reduction in his Dizziness Handicap Inventory score.Conclusion:Computer-aided rehabilitation programmes might represent an important advance in gait and posture training.
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Pietrzak E, Pullman S, McGuire A. Using Virtual Reality and Videogames for Traumatic Brain Injury Rehabilitation: A Structured Literature Review. Games Health J 2014; 3:202-14. [PMID: 26192369 DOI: 10.1089/g4h.2014.0013] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eva Pietrzak
- Centre for Australian Military and Veterans' Health, School of Population Health, The University of Queensland, Herston, Queensland, Australia
| | - Stephen Pullman
- Centre for Australian Military and Veterans' Health, School of Population Health, The University of Queensland, Herston, Queensland, Australia
| | - Annabel McGuire
- Centre for Australian Military and Veterans' Health, School of Population Health, The University of Queensland, Herston, Queensland, Australia
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Edwards J, Vess J, Reger G, Cernich A. The use of virtual reality in the military's assessment of service members with traumatic brain injury: recent developments and emerging opportunities. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 21:220-30. [PMID: 25084846 DOI: 10.1080/09084282.2013.796554] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Traumatic brain injury (TBI) is a common event in the current extended conflicts by American service members, with estimates that as many as 300,000 have sustained combat-related concussions during Operation Iraqi Freedom and Operation Enduring Freedom. The limited ecological validity of traditional neuropsychological assessment measures presents a challenge to effective postconcussion evaluation of service members in relation to fitness-for-duty decisions or rehabilitation needs. Virtual reality (VR) technology offers a promising opportunity to advance the field of functional assessment for TBI. This article reviews the current professional literature on VR applications for TBI assessment, with special emphasis on those that are particularly relevant to U.S. service members. VR affords several advantages for clinical use. These include assessment of complex sets of cognitive and behavioral functions rather than the isolated components assessed by traditional measures; more precise control over the standardized presentation of task stimuli and the recording of response data; and enhanced ecological validity that can lead to more useful assessment data in the applied contexts faced by the U.S. military.
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Affiliation(s)
- Joe Edwards
- a Department of Behavioral Health , TBI Clinic , Ft. Wainwright , Alaska
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Returning service members to duty following mild traumatic brain injury: exploring the use of dual-task and multitask assessment methods. Phys Ther 2013; 93:1254-67. [PMID: 23766395 DOI: 10.2522/ptj.20120143] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Within the last decade, more than 220,000 service members have sustained traumatic brain injury (TBI) in support of military operations in Iraq and Afghanistan. Mild TBI may result in subtle cognitive and sensorimotor deficits that adversely affect warfighter performance, creating significant challenges for service members, commanders, and clinicians. In recent conflicts, physical therapists and occupational therapists have played an important role in evaluating service member readiness to return to duty (RTD), incorporating research and best practices from the sports concussion literature. Because premorbid (baseline) performance metrics are not typically available for deployed service members as for athletes, clinicians commonly determine duty readiness based upon the absence of postconcussive symptoms and return to "normal" performance on clinical assessments not yet validated in the military population. Although practices described in the sports concussion literature guide "return-to-play" determinations, resolution of symptoms or improvement of isolated impairments may be inadequate to predict readiness in a military operational environment. Existing clinical metrics informing RTD decision making are limited because they fail to emphasize functional, warrior task demands and they lack versatility to assess the effects of comorbid deficits. Recently, a number of complex task-oriented RTD approaches have emerged from Department of Defense laboratory and clinical settings to address this gap. Immersive virtual reality environments, field-based scenario-driven assessment programs, and militarized dual-task and multitask-based approaches have all been proposed for the evaluation of sensorimotor and cognitive function following TBI. There remains a need for clinically feasible assessment methods that can be used to verify functional performance and operational competence in a variety of practice settings. Complex and ecologically valid assessment techniques incorporating dual-task and multitask methods may prove useful in validating return-to-activity requirements in civilian and military populations.
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Dual-task training for balance and mobility in a person with severe traumatic brain injury: a case study. J Neurol Phys Ther 2013; 37:37-43. [PMID: 23364169 DOI: 10.1097/npt.0b013e318282a20d] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Attentional impairments following severe traumatic brain injury (TBI) are common and can lead to decreased functional mobility and balance, as well as deficits in previously automatic movements such as walking and stair climbing. The purpose of this case study was to determine the feasibility and potential value of incorporating a cognitive-motor dual-task training program into physical therapy for a patient with a severe TBI. CASE DESCRIPTION The patient was a 26-year-old woman who sustained a severe TBI during a motor vehicle accident 46 days prior to physical therapy evaluation. On the 8-level Rancho Los Amigos Cognitive Function Scale, her functioning was classified as level IV. She had impairments in attention, functional mobility, and balance, all of which limited her ability to participate in activities of daily living. INTERVENTION : Physical therapy was provided over 26 days within the inpatient rehabilitation setting. Interventions included mobility tasks such as walking, balancing, and stair climbing. Mobility training was paired with specific secondary cognitive and motor tasks. OUTCOMES Dual-task training may have contributed to improvements on outcome measures designed to test divided attention including the Walking While Talking Test and Trail Making Test and a greater rate of improvement in walking speed and time to descend stairs when compared to the baseline phase. DISCUSSION Addition of cognitive-motor dual-task training to standard physical therapy in the inpatient rehabilitation setting appears to be feasible and may have value for improving function in individuals with severe TBI. VIDEO ABSTRACT AVAILABLE (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A41) for more insights from the authors.
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Gottshall KR, Sessoms PH, Bartlett JL. Vestibular physical therapy intervention: utilizing a computer assisted rehabilitation environment in lieu of traditional physical therapy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2012:6141-6144. [PMID: 23367330 DOI: 10.1109/embc.2012.6347395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Advanced technology such as virtual reality or immersive environments increases the complexities and challenges therapists can impose on their patients. In this study, four patients with mild traumatic brain injury utilized a Computer Assisted Rehabilitation Environment (CAREN) in place of traditional vestibular physical therapy. Patients visited the CAREN twice weekly for 6 weeks. Therapy sessions included a variety of applications that tasked the cognitive and physical capabilities of individual patients. After the 6 weeks, all patients showed improvement on balance, gait and visual measures. Virtual reality based therapy is an engaging and effective tool to treat patients with deficiencies related to a prior brain injury.
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