Enhancing participation in a home based virtual reality balance program by using balance assessment scores to guide game choices in adults with TBI

Special Interest Report
Population: Adult

Kaitlin Hays, PT, DPT, NCS, Physical Therapist, Craig Hospital khays@craighospital.org

Denise O’Dell, PT, DSc, NCS, Physical Therapist, Craig Hospital dodell@craighospital.org

Jeffery Cuthbert, PhD, MPH, MS, OT, Principle Investigator, Craig Hospital jcuthbert@craighospital.org

Candace Tefertiller, PT, DPT, ATP, NCS, Director of Physical Therapy, Craig Hospital ctefertiller@craighospital.org

Audrey Natale, PT, DPT, Physical Therapist, Craig Hospital anatale@craighospital.org

Keywords: Participation, Balance, Brain Injury, Virtual Reality

Purpose: Chronic balance deficits are commonly reported after traumatic brain injury (TBI), yet there is limited evidence for the treatment of diminished balance in this population, especially in regards to achieving engagement and participation in the home setting. Research in similar populations has shown that virtual reality (VR) can be an effective modality to improve balance. A pilot randomized controlled trial (RCT) conducted at Craig Hospital demonstrated the use of a commercially available VR gaming system for inpatients with TBI. In comparison to individuals receiving a matched-dose of traditional balance training, individuals participating in VR training reported greater enjoyment. The intervention was found to be safe, as effective as additional standard balance care, and enjoyed by participants more than traditional balance activities. Based on this information, a large scale RCT was initiated to assess the efficacy of a home-based VR Physical Therapy (PT) program for community dwelling individuals with TBI reporting balance deficits. The purpose of this poster is to explore the rationale for the use of outcome measure scores to guide the development of specific VR balance programs used in this RCT.

Description: Thirty six protocols were developed as part of the current trial. Eighteen use a commercially available VR system, and eighteen are non-VR home balance programs (similar to home programs routinely given to patients leaving inpatient rehabilitation). Each protocol is designed to address system deficits (measured by the Balance Evaluation Systems Test (BEST)) and functional balance (measured by the Community Balance and Mobility Scale (CBAM)). BEST subscale scores are used to select activities that will challenge the system with the greatest underlying deficits, while CBAM scores are utilized to determine the difficulty of the program. This poster will emphasize the clinical rationale used in the development of these protocols and potential translation to a clinical setting.

Summary of Use: The concept of using balance assessment scores to select VR-based balance rehabilitation games is generalizable to the clinic setting. Off-the-shelf VR games target various underlying balance systems and require different skill sets for successful participation. By having a working knowledge of the balance systems most impaired in an individual and the available game options, clinicians can tailor a specific program for the clinic or home setting. This program can target specific impairments and accommodate an individual’s personal preferences and interests.

Importance to Members: The use of commercially available VR systems in rehabilitation is growing rapidly. Selecting appropriate games to treat specific balance deficits can be an overwhelming task for clinicians. The concept of using scores on standardized balance tests to guide game choices based on difficulty and affected balance systems can assist clinicians in optimal game selection to promote maximum balance recovery while also creating an enjoyable treatment environment which may improve compliance.

Hays, Kaitlin , PT, DPT, NCS; O’Dell, Denise , PT, DSc, NCS; Cuthbert, Jeffery , PhD, MPH, MS, OT; Tefertiller, Candace , PT, DPT, ATP, NCS; Natale, Audrey , PT, DPT. Enhancing participation in a home based virtual reality balance program by using balance assessment scores to guide game choices in adults with TBI. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/009_hays-et-al/