Skip to main content

Military Health System

Test of Sitewide Banner

This is a test of the sitewide banner capability. In the case of an emergency, site visitors would be able to visit the news page for addition information.

NICoE, NHRC Team Up To Make CAREN Technology Portable

Image of A person walks in front of a large virtual reality screen. The Computer Assisted Rehabilitation Environment (CAREN) at the National Intrepid Center of Excellence (NICoE) offers clinicians a VR-based tool to assess and treat patients with TBI and PTSD. (Photo by Linsey Pizzulo, National Intrepid Center of Excellence)

Since the National Intrepid Center of Excellence opened in 2010, Biomedical Engineer Sarah Kruger has operated the center’s Computer Assisted Rehabilitation Environment (CAREN).

The CAREN is a large-scale virtual-reality system used to evaluate and treat NICoE patients with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD).

Now, her team is collaborating with researchers at the Naval Health Research Center (NHRC) to scale the technology down to a mobile system, with the long-term goal of making the novel therapy more attainable throughout both the Military Health System and the Defense Intrepid Network for TBI and Brain Health.

“Head-mounted display technology has become more affordable and accessible over the past couple of years,” said Kruger. “It’s also portable. So we want to leverage what we’ve learned about the [CAREN] system and see if we can make it possible to use similar treatments without committing the space or funding to a CAREN.”

In the CAREN, the patient stands or walks on a treadmill in the middle of a circular platform while interacting with virtual environments projected in front of them onto a 9-foot-tall, 180-degree screen. The platform can tilt in all directions to mimic a rocking boat, an uphill climb, or other scenarios as a ring of motion-capture cameras track movement, allowing for real-time modifications to the environment.

Monitoring the patient’s behavior, physical therapists can assess and treat conditions such as vestibular dysfunction - one of the most common complaints following a TBI - and PTSD.

In initial discussions about using head-mounted displays for treatment, NICoE physical therapists expressed concern that the devices might be too heavy for their many patients with neck pain. So the NICoE and NHRC teams evaluated several different headsets and, after positive feedback from clinicians, chose an augmented-reality (AR) based head-mounted display which has a lightweight visor that allows digital content to be layered over the existing real-world environment.

A person wearing a virtual reality headset
Researchers at the National Intrepid Center of Excellence (NICoE) and the Naval Health Research Center (NHRC) are using their CARENs to test similar technology on an AR headset, which would be more accessible and less costly for military medical treatment facilities than a CAREN. (Photo by Sarah Kruger, National Intrepid Center of Excellence)

Application developers then worked to transition some of the CAREN’s most frequently utilized virtual environments over to a cross-platform game engine that allows for improved graphics, physics, and user control. The new environments are compatible on both the CAREN and AR headset.

These systems are currently being evaluated in two IRB-approved research protocols for a multisite vestibular physical therapy project, where data is being collected at both NICoE and NHRC.

Last month, the research team provided an overview of the development process in a symposium presentation at the International Conference on Virtual Rehabilitation. Kruger, physical therapist Kathleen Delpy, and research scientist Kerry Rosen represented the NICoE; with NHRC physical therapist Dawn Bodell and biomedical engineers Pinata Sessoms, Vrajeshri Ordek, and Jacob Van Dehy. 

While there are some clear differences between the CAREN and the head-mounted display - for instance, the CAREN makes it easier for patients to find real-world anchors and use their peripheral vision - Kruger does not consider them to be dealbreakers.

“There are obviously limitations to using [the mobile system],” she said, “but if I can get a 75% solution that clinicians will use, I’ll take it.”

The key to this health innovation is that the head-mounted displays are portable and can potentially be used at multiple locations without requiring a full-size CAREN. There are pros and cons to the new technology, but in the end, they may help make TBI and PTSD care more accessible to MHS patients.

You also may be interested in...

TBI Caregiver Support Forms

Form/Template
6/29/2021

This is a fillable and printer-friendly version of the forms available in the "Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans."

Patient Global Impression Change Scale

Form/Template
5/1/2015

Form filled out by patients to rate their changes in activity, symptoms, emotions and quality of life.

Neurobehavioral Symptom Inventory Form

Form/Template
4/30/2015

Form used by providers to question patients about their symptoms

Military Acute Concussion Evaluation 2012

Form/Template
4/30/2015

Use this form to screen for concussions

Neuroimaging following TBI in non deployed setting

Form/Template
7/8/2013

The guidance contained in this CR represents a review of currently published literature and expert contributions obtained by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) in collaboration with clinical subject matter experts representing the Services, Department of Veterans Affairs (VA), academic, research and civilian sectors.

DCoE Concussion Management Algorithm Cards

Form/Template
10/8/2012

Combat Medic/Corpsman Algorithm Card to diagnose a concussion in a deployed setting

Page 1 of 1 , showing items 1 - 6
Refine your search
Last Updated: September 01, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery