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Application of a Mild Traumatic Brain Injury Rehabilitation Program in a Virtual Realty Environment: A Case Study

Rábago, Christopher A. PT, PhD; Wilken, Jason M. PT, PhD

Journal of Neurologic Physical Therapy: December 2011 - Volume 35 - Issue 4 - p 185–193
doi: 10.1097/NPT.0b013e318235d7e6
Case Studies

Background and Purpose: 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.

Case Description: 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.

Interventions: 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.

Outcomes: 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.

Discussion: 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.

Center for the Intrepid, Department of Orthopedics and Rehabilitation, Brooke Army Medical Center, Fort Sam Houston, Texas.

Correspondence: Christopher A. Rábago, PT, PhD, Department of Orthopedics and Rehabilitation, Brooke Army Medical Center, 3851 Roger Brooke Drv, Fort Sam Houston, TX 78234 (

Support provided by Medical Research and Material Command's Military Operational Medicine Research Program (to J.M.W.).

The authors declare no conflict of interest.

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© 2011 Neurology Section, APTA