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The Effectiveness of Virtual Reality for Treating Concussions

Lisa Fabien, Oluwatobi Fadugba, Tiffany Gonzalez, and Kayla Parker

Over 300,000 athletes in the United States suffer from concussions each year. Aside from the immediate consequences such as headache, nausea, vomiting, and blurred vision, post-concussion syndrome can cause these symptoms to linger for weeks or even months. With proper treatment, these symptoms can be alleviated in a shortened period of time. We propose a study to investigate the effectiveness of virtual reality for treating concussions. This study will evaluate the difference in lengths of recovery for high school to college-aged athletes suffering from a concussion and undergoing physical therapy, virtual reality therapy, or a combination of the two.

Abstract

Concussions

Lauren Raguette

Katharine Wilcheck, PT, DPT

CSTEP: Dr. Christine Veloso, Dorys Johnson,�Edwina Branch-Smith, Liz Gonzalez, Michelle Riley

URECA: Karen Kernan

In memory of Dr. David Ferguson

Introduction

Acknowledgements

Type of traumatic brain injury (TBI)
Result of a bump, blow, or jolt to the head, or hit to the body
Causes the head and brain to move rapidly back and forth.
Brain can begin to bounce around or twist in the skull due to the sudden movement
Chemical changes and stretching and damage to brain cells can occur as a result of the brain’s sudden movement

Virtual Reality

Symptoms Include

Nausea
Loss of Consciousness
Ringing in the Ear
Headache
Dizziness

	Clinical Description	Treatment
Grade I	Transient confusion,�no LOC�Concussive symptoms last < 15 min	Athlete may return to action once no symptoms for 15 min
Grade II	Transient confusion,�no LOC Concussive symptoms last > 15 min	Athlete removed from game, may return to contact if no symptoms for 1 week
Grade III	LOC of any duration	Requires ED evaluation LOC < 1 min: return to contact if no symptoms for 1 week LOC > 1 min: must wait 2 weeks without symptoms before return to contact

Clinical Trajectories

Cognitive/Fatigue
Vestibular
Ocular
Post-Traumatic Migraine
Cervical
Anxiety/Mood

Methods

A simulated, three-dimensional, immersive, artificial environment created with software and presented to the user in such a way that the user suspends belief and accepts it as a real environment

Uses of Virtual Reality

Stroke Rehab

Pain Management

Treatment of PTSD

Managing and Treating Anxiety

Relaxation and Meditation

Participants

300 high school and college athletes who have taken an ImPACT baseline test
Ages 13-23
Diagnosed with a Grade III concussion within 24 hours of injury
Randomized block design: 50 females and 50 males in each subgroup

Procedure

Experimental Groups

Physical therapy and virtual reality (Group 1)
Virtual reality only (Group 2)

Control Group

Physical therapy only (Group 3)

One hour of therapy every other day

	Day A	Day B	Day C	Day D
Group 1	PT		VR
Group 2	VR		VR
Group 3	PT		PT

Physical therapy will follow a Zurich Return to Play Protocol

Virtual reality treatment will use the Computer Assisted Rehabilitation Environment {CAREN} system

Platform surrounded by a six meter semicircular screen
Immerses patient in a virtual reality environment with six degrees of freedom
Can promote various brain activities while the patient feels, acts, and thinks in real time without fear of further injury
Each action or reaction is evaluated and transcribed as feedback for further treatment

Measures

ImPACT test will be taken every 3 days and the number of days until the patient returns to baseline will be recorded and compared
Independent t-test to compare the three groups and identify statistically significant differences in recovery time based on the treatment methods

References

Cantu, R. (2010). Immediate Post-Concussion Assessment and Cognitive �Testing (ImPACT) Practices of Sports Medicine Professionals. Yearbook of Sports Medicine,2010, 37-38.
Hoffman, Hunter G. (2004, June 7th). Modulation of thermal pain-related brain activity with virtual reality: evidence from fMRI.
Laver K. (2012, June 20th). Cochrane review: virtual reality for stroke rehabilitation.
McComas, J., PhD, PT, & Sveistrup, H., PhD, PT. (2002). Virtual Reality Applications for Prevention, Disability... : Journal of Neurologic Physical Therapy. NYDNRehab.com. (n.d.). Concussion Treatment in NYC.
Virtual Reality Society. (2017). What is Virtual Reality?
Wright, W. Geoffrey (2016, October 10). Assessing subacute mild traumatic brain injury with a portable virtual reality balance device.
Wright, W. (2016, December 1). Virtual Environment TBI Screen (VETS).

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