Alroumi Abdulmohsen M, Hoppes Carrie W, Whitney Susan L, Li Zhihao, Holt Lisa, Ramakrishnan Sridhar, Barnicott Shannon L, Logeais Meghan T, Richard Holly, Salter Shane R, Tiede Jeffrey M, Wirt Michael D, Hovareshti Pedram
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States.
Advanced Exposures, Diagnostics, Interventions, and Biosecurity (AEGIS) Program, Joint Base San Antonio-Lackland Air Force Base, San Antonio, TX, United States.
Front Neurol. 2025 May 21;16:1558795. doi: 10.3389/fneur.2025.1558795. eCollection 2025.
Mild traumatic brain injury (mTBI) is a prevalent issue among military service members, often resulting in persistent vestibular dysfunction that can impair operational performance. Vestibular, sensory, and cognitive deficits following mTBI hinder critical warrior tasks such as moving under fire and maintaining situational awareness. Despite advances in rehabilitation, there remains a need for interventions that replicate the complex demands of military environments. This study introduces Praxis, a novel virtual reality (VR) system designed to deliver multisensory vestibular rehabilitation to service members with persistent post-mTBI symptoms. Praxis integrates low-cost wearable sensors and VR environments to enhance gaze stability, balance, and cognitive-motor integration through military-relevant tasks. The primary goals of this pilot study are twofold: 1) to evaluate the feasibility of using the Praxis system to deliver VR, military-specific multisensory rehabilitation to a representative sample of 15 service members with vestibular-related complaints post-mTBI over a 4-week period, and 2) to evaluate objective measures, including advanced neuroimaging, to support return-to-duty (RTD) decisions by correlating functional performance improvements with neurophysiological changes. Patients will complete multisensory exercises using Praxis in conjunction with standard rehabilitation provided by the Special Operations Performance and Recovery (SPaR) Program at the Center for the Intrepid. A control group without vestibular-related complaints post-mTBI will receive the standard SPaR Program treatments. Outcome measures include Praxis scores, self-reported questionnaires, functional performance on military-specific tasks, self-reported symptom severity, and neurophysiological changes assessed through resting-state functional magnetic resonance imaging (rs-fMRI). Usability will be evaluated using the System Usability Scale (SUS), with success defined by a SUS score of 68 or higher. Secondary objectives explore the correlation between performance improvements, neurophysiological changes, and rehabilitation compliance. By capturing objective data through wearable sensors and advanced neuroimaging, this study aims to bridge the gap between clinical assessments and real-world functional performance. The findings will inform future large-scale trials and provide critical insights into the role of VR and multisensory rehabilitation in post-mTBI recovery, supporting improved RTD decisions and enhancing warfighter readiness. This protocol contributes to the advancement of neurorehabilitation by integrating technology-driven solutions tailored for military populations.
clinicaltrials.gov, identifier: NCT06314464.
轻度创伤性脑损伤（mTBI）在军人中是一个普遍问题，常导致持续的前庭功能障碍，进而影响作战表现。mTBI后的前庭、感觉和认知缺陷会妨碍诸如在火力下行动和保持态势感知等关键作战任务。尽管康复治疗取得了进展，但仍需要能够模拟军事环境复杂要求的干预措施。本研究引入了Praxis，这是一种新型虚拟现实（VR）系统，旨在为有持续性mTBI后症状的军人提供多感官前庭康复治疗。Praxis整合了低成本可穿戴传感器和VR环境，通过与军事相关的任务来增强注视稳定性、平衡能力以及认知 - 运动整合能力。这项初步研究的主要目标有两个：1）评估使用Praxis系统在4周内为15名有前庭相关主诉的mTBI后军人代表性样本提供VR、针对军事的多感官康复治疗的可行性；2）通过将功能表现改善与神经生理变化相关联，评估包括先进神经成像在内的客观指标，以支持重返岗位（RTD）决策。患者将使用Praxis完成多感官训练，并结合英勇中心特种作战表现与恢复（SPaR）计划提供的标准康复治疗。一个没有mTBI后前庭相关主诉的对照组将接受标准的SPaR计划治疗。结果指标包括Praxis评分、自我报告问卷、军事特定任务的功能表现、自我报告的症状严重程度以及通过静息态功能磁共振成像（rs - fMRI）评估的神经生理变化。将使用系统可用性量表（SUS）评估可用性，成功的定义是SUS评分为68分或更高。次要目标是探索表现改善、神经生理变化与康复依从性之间的相关性。通过可穿戴传感器和先进神经成像获取客观数据，本研究旨在弥合临床评估与现实世界功能表现之间的差距。研究结果将为未来的大规模试验提供信息，并为VR和多感官康复在mTBI后恢复中的作用提供关键见解，支持改进RTD决策并提高战士准备状态。本方案通过整合针对军事人群量身定制的技术驱动解决方案，为神经康复的发展做出贡献。
clinicaltrials.gov，标识符：NCT06314464。
