Virtual reality game-based therapy for treatment of postural and co-ordination abnormalities secondary to TBI: a pilot study.

PRIMARY OBJECTIVE: The study objective was to test the efficacy of game-based virtual reality (VR) therapy as a mean of correcting postural and co-ordination abnormalities in individuals with traumatic brain injury (TBI). Therapy was done with interactive customized VR games and scenarios, utilizing an Xbox Kinect sensor. RESEARCH DESIGN: The study was a pilot project using the structure of a phase II clinical trial. METHODS AND PROCEDURES: Fifteen participants with mild-to-moderate chronic TBI-related balance and motor co-ordination impairments participated in 15 sessions, each lasting ∼50-55 minutes, scheduled 2-3 times a week over 5-6 consecutive weeks. Participants were evaluated at baseline, immediately after the final session and in a 1-month follow-up with a battery of clinical tests (measuring postural stability, gait and co-ordination) and movement performance parameters. Movement parameters included arm-leg co-ordination, dynamic stability and arm precision, calculated from kinematic data recorded with Xbox Kinect sensor. RESULTS: Following therapy, most participants improved their static and dynamic postural stability, gait and arm movements. These effects persisted over the retention interval. CONCLUSIONS: Results will be used to improve the VR program, with the goal of producing a cost-effective, accessible and easy to individualize therapeutic approach. The pilot data will be used for designing a larger scale clinical trial.

The effect of additional hand contact on postural stability perturbed by a moving environment.

Additional hand contact of external objects has been shown to reduce postural instability caused by a deficiency of one or more senses. Little is known, however, if additional contact can help in an environment where the senses are available but conflicting. This question was investigated by analyzing the effect of different types of hand contact on postural stability perturbed by the moving visual scene. While standing for 1min on a rocker board in front of a screen, eight healthy young subjects observed a projection of a virtual ship rocking on water to simulate standing on the ship's deck. In randomly assigned trials subjects were asked (a) to stand with arms at sides (with no contact); (b) to hold a standard cane parallel to the ground; (c) to lightly touch a rocker cane handle with their index finger; or (d) touch a standard quad cane handle with their index finger. Based on the kinematic data collected, the displacement of the center of mass (COM) and angular displacements in the hip and ankle joints were computed. Results showed that the moving visual scene perturbed body stability. However, additional contact with support of varying stability reduced the destabilizing effect. The results can be potentially used for practical purposes; when in an environment with visual perturbations simply holding an object in hand may help stabilize the body when at risk for a fall.