citation in 2011 by Rabago CA and Wilken JM: J Neurol Phys Ther. 2011 Dec;35(4):185-93. doi: 10.1097/NPT.0b013e318235d7e6. Application of a mild traumatic brain injury rehabilitation program in a virtual realty environment: a case study. Rábago CA , Wilken JM. Abstract Mild traumatic brain injury (mTBI) can compromise reaction time, visual perception, memory, attention, balance, and gait. These deficits, especially if persistent, can restrict participation in daily activities and the resumption of personal and profession roles. The purpose of this case study is to describe an mTBI-specific clinical assessment and rehabilitation intervention administered in a virtual reality environment. The case involved a 31-year-old male service member who had sustained an mTBI (concussion) during a recreational softball game 36 days prior to physical therapist evaluation. He had complaints of severe visual and physical motion intolerance. He demonstrated impaired static balance and was restricted from full military duty. The assessment included measurements of postural and gait balance during cognitive, visual, and vestibular challenges within a Computer-Assisted Rehabilitation Environment. Phase 1 of the intervention consisted of clinical techniques (ie, optokinetic stimulation/habituation, visual/physical perturbations, and postural stability exercises) targeting specific impairments. Phase 2 training consisted of weapon handling and target recognition tasks to simulate the requirements of his military occupation. At the conclusion of 6 treatments, the patient demonstrated significant increases in postural and gait balance with a near complete resolution of all postconcussion symptoms. He successfully returned to full duty and training for combat deployment. Service members and civilians exhibit similar impairments, limitations, and restrictions following mTBI. A rehabilitation program delivered in a virtual-reality environment can be structured to manage complex mTBI symptoms through the integration of multiple treatment modalities specific to a patient's personal and professional roles. PMID: 22027473 [PubMed - indexed for MEDLINE] Display Settings: Abstract 1 Author information Publication Types, MeSH Terms Full text links PubMed Rábago, C. A., & Wilken, J. M. (2011) INTRODUCTION: PURPOSE: METHODS: RESULTS: CONCLUSION: See 1 citation in 2006 by Chou LS and Osternig LR and Parker TM and Van Donkelaar P: Med Sci Sports Exerc. 2006 Jun;38(6):1032-40. Gait stability following concussion. Parker TM , Osternig LR, VAN Donkelaar P, Chou LS. Abstract The need to identify functional impairment following a brain injury is critical to prevent reinjury during the period of recovery. However, little is known about the effect of concussion on dynamic motor function. The purpose of this study was to examine the effect of concussion on a dynamic motor task under conditions of divided and undivided attention over the course of 28 d. Fifteen subjects with concussions (CONC) and 15 uninjured controls (NORM) were observed while walking with undivided attention and while concurrently completing simple mental tasks. The CONC were assessed within 48 h of injury and again at 5, 14, and 28 d postinjury. The NORM were evaluated at the same time intervals. Whole-body motion data were collected to examine displacement and velocity of the center of mass (COM) and the maximum separation between the COM and center of pressure (COP). Three-way repeated-measures mixed-design ANOVA and Tukey post hoc tests were completed to determine differences between group, task, and testing day (P<0.05). Several aspects of gait stability were compromised in the CONC group for up to 4 wk after injury. CONC were found to walk significantly slower during dual tasks on all testing days when compared with the uninjured controls. The injured subjects were also found to have greater sway and sway velocity than controls when attention was divided for up to 28 d postinjury. The findings of this study suggest that concussion may have long-term observable and measurable effects on the control of gait stability. PMID: 16775541 [PubMed - indexed for MEDLINE] Display Settings: Abstract 1 Author information Publication Types, MeSH Terms LinkOut - more resources Full text links PubMed Parker, T. M., Osternig, L. R., Van Donkelaar, P., & Chou, L.-S. (2006) See 1 citation in 2008 by Broglio SP and Puetz TW: Sports Med. 2008;38(1):53-67. The effect of sport concussion on neurocognitive function, self-report symptoms and postural control : a meta-analysis. Broglio SP , Puetz TW. Abstract Sport concussion is commonly assessed using a battery of tests that evaluate neurocognitive functioning, postural control and self-report symptoms. The degree to which concussion affects each of these measures is unclear. Thus, the purpose of this meta-analysis is to systematically review and quantify the effect of sport concussion on each assessment measure when administered immediately post-injury and in the 2 weeks following injury. PubMed and PsychINFO databases were searched from January 1970 to June 2006, from which 39 were included for review. Studies were selected for review if they included concussed athletes who were evaluated using one of the three assessment measures. One post-morbid assessment must have been completed within 14 days of injury and compared with a baseline measure or control group. Study design, type of neurocognitive assessment, timing of assessment following injury and number of post-concussion assessments were extracted as potential moderators. Sport-related concussion had a large negative effect (mean Delta; 95% confidence interval) on neurocognitive functioning (-0.81; -1.01, -0.60), self-report symptoms (-3.31; -6.35, -0.27) and postural control (-2.56; -6.44, 1.32) in the initial assessment following injury. A reduced, but large effect, was also seen in the 14 days following the initial assessment for neurocognitive functioning (-0.26; -0.46, -0.06), self-report symptoms (-1.09; -2.07, -0.11) and postural control (-1.16; -2.59, 0.27). Our findings demonstrated large effects for each aspect of the assessment battery. These findings support the use of the multifaceted concussion evaluation. Comment in The value of various assessment techniques in detecting the effects of concussion on cognition, symptoms, and postural control. [J Athl Train. 2009] PMID: 18081367 [PubMed - indexed for MEDLINE] Display Settings: Abstract 1 Author information Publication Types, MeSH Terms LinkOut - more resources Full text links PubMed Broglio, S. P., & Puetz, T. W. (2008) 1. 2. 3. 4.
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