Skip to main content

Military Health System

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)

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | The 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...

TBICoE Brain Injury Awareness Month 2023 Events Flyer

Publication
1/29/2023

2023 Brain Injury Awareness Month training and education events hosted by the Traumatic Brain Injury Center of Excellence

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | TBI Educators | Education & Training Events | Vision Center of Excellence

Progressive Return to Activity: Primary Care for Acute Concussion Management

Publication
1/23/2023

The Progressive Return to Activity (PRA): Primary Care for Acute Concussion Management clinical recommendation is an evidence-based return to activity protocol for primary care managers and concussion/traumatic brain injury (TBI) clinic providers. The PRA is a six-step approach that begins after the provider performs the Military Acute Concussion Evaluation 2 (MACE 2) and diagnoses the patient with a concussion/TBI. The PRA stages start with relative rest and allow service members to gradually increase activities until they receive clearance for return to full duty or activity. In each stage, it offers general and military specific activities and options to help providers manage their patients’ primary symptom clusters. The PRA also offers recommendations on specialty referrals and handouts are available for providers to give patients and leadership.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | TBI Educators | Centers of Excellence

DOD TBI Worldwide Numbers At-A-Glance

Publication
8/24/2022

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. The "DOD TBI Numbers At-A-Glance" provide a high level overview of TBI's sustained since 2000 and also show the data by severity and service branch.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers

Neuroimaging Following Mild TBI Clinical Recommendation

Publication
5/16/2022

This TBICoE clinical recommendation allows primary care managers to make an informed, evidenced-based decision regarding whether or not imaging is indicated following a concussion/mild TBI.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Traumatic Brain Injury Center of Excellence

2021 Traumatic Brain Injury Center of Excellence Annual Report

Publication
4/26/2022

The 2021 Traumatic Brain Injury Center of Excellence (TBICoE) Annual Report provides a look at accomplishments and activities from calendar year 2021.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | TBI Educators | TBICoE Research | TBI Provider Resources

References and Acknowledgements: Neuroimaging Following Concussion Clinical Recommendation

Publication
4/6/2022

This document acknowledges those who participated in the expert working group with the Traumatic Brain Injury Center of Excellence and provides the resources and references used to develop the Neuroimaging Following Concussion/Mild Traumatic Brain Injury: Guidance for the Primary Care Manager.

Recommended Content:

Traumatic Brain Injury Center of Excellence

TBICoE 2021 Publications

Publication
3/16/2022

Master list of 2021 TBICoE articles published in research journals

Recommended Content:

Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBICoE Research | Traumatic Brain Injury Center of Excellence

Assessment and Management of Dizziness and Visual Disturbances Following Concussion/Mild Traumatic Brain Injury

Publication
10/22/2021

This clinical recommendation provides medical staff with a single, comprehensive reference for the assessment and management of dizziness and visual disturbances following mild TBI/concussion. Dizziness and visual disturbances often present with overlapping symptoms and should prompt a provider to perform a visual and dizziness—or vestibular—assessment.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Traumatic Brain Injury Center of Excellence | Centers of Excellence

Improving Relationships after TBI

Publication
10/21/2021

Flier for the Interactive Relationship Building Workshop for Active-Duty Military and Veteran TBI Caregivers and Families: This flier provides information on TBICoE's educational session for caregivers of active-duty service members and veterans who have sustained a TBI. In addition to sharing caregiver resources and current research initiatives, webinar topics will also include relationship building strategies, improving communication and addressing intimacy after TBI.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBI Provider Resources | Centers of Excellence | Traumatic Brain Injury Center of Excellence

2021 Q2 DOD Worldwide Numbers for TBI

Publication
10/14/2021

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in the second quarter of calendar year 2021. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | Traumatic Brain Injury Center of Excellence

2000-Q2 2021 DOD Worldwide Numbers for TBI

Publication
10/14/2021

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis from calendar year 2000 through the second quarter of 2021. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | Centers of Excellence | Traumatic Brain Injury Center of Excellence

2000-Q1 2021 DOD Worldwide Numbers for TBI

Publication
8/9/2021

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis from calendar year 2000 through the first quarter of 2021. The data is also broken down by each branch of the armed services.

Recommended Content:

DOD TBI Worldwide Numbers | Traumatic Brain Injury Center of Excellence

2021 Q1 DOD Worldwide Numbers for TBI

Publication
8/9/2021

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in the first quarter of calendar year 2021. The data is also broken down by each branch of the armed services.

Recommended Content:

DOD TBI Worldwide Numbers | Traumatic Brain Injury Center of Excellence

PRA Case Study Workbook

Publication
7/23/2021

This workbook, paired with corresponding PRA Training Video 8, is an interactive clinical case scenario to test your understanding in applying the Progressive Return to Activity. We hope this will help medical providers become more familiar with the PRA process when treating service members with concussion.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education | Traumatic Brain Injury Center of Excellence

2020 TBICoE Annual Report

Publication
7/9/2021

2020 Traumatic Brian Injury Center of Excellence (TBICoE) Annual Report.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 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