SITIS Archives - Topic Details
Program:  SBIR
Topic Num:  AF071-044 (AirForce)
Title:  Virtual Reality Spatial Rehabilitation for Traumatic Brain Injury
Research & Technical Areas:  Biomedical, Human Systems

  Objective:  Develop a virtual reality-based system to that allows brain injured warfighters to return to service by providing cognitive training in spatial exploration.
  Description:  Traumatic brain injury has emerged as a leading cause of disability among warfighters currently deployed with Operation Iraqi Freedom; in fact, over 60% of injured soldiers sent to Walter Reed Medical Center with combat-related injuries are found to have suffered a traumatic brain injury. Extensive research using environmental enrichment (EE) in animals indicates that voluntary exploration of complex three-dimensional space promotes recovery from traumatic brain injury (Manosevitz M. 1975). EE consists of enhanced opportunities to explore a complex multi-sensory three-dimensional space (Rosenzweig M.R. 1978; Chapillon P. 2001). Research indicates that EE induces morphological, neurobiological and behavioral changes (Greenough M.T. 1973; Will B.E. 1977; Rosenzweig M.R. 1996; Van Praag H. 2000; Larsson F. 2002), and not only protects against but also reverses negative effects of the psychogenic and neurogenic stresses that predispose the individual to PTSD and TBI (Escorihuela R.M. 1994; Klein S.L. 1994; Francis D.D. 2002; Benaroya-Milshtein N. 2004). Enriched environments in the animal literature promote voluntary exploration of a complex and multi-sensory environment, stimulate learning and memory of reward areas of the explored space, and provide for self-regulation of stress by providing areas of varying stimulation or shelter in the space. The implications of the enriched environment research for rehabilitation of brain injured warfighters is clear. Spatial exploration stimulates hippocampal activation in humans as well as animals. The actions simulated in a virtual reality environment incur the same brain responses that actually performing the action causes (Morganti F. 2003). Virtual reality has also shown to assist in the performance of activities of daily living, and treatment of persons with mental trouble (Anderson P.L. 2001; Lee J.H. 2003). However, individuals suffering combat casualties differ greatly in their physical abilities. Because of differing levels of physical ability, it is difficult to develop a standard rehabilitation involving exploration of three dimensional space that can benefit all mobility levels and that will not cause stress to individuals of lower capability. Virtual reality has the potential to overcome these challenges. However, although virtual reality environments have been investigated for military training and stress inoculation applications, there are presently no systems designed specifically to stimulate neurological and functional recovery after brain injury.

  PHASE I: Develop design concept and produce prototype virtual reality application to stimulate the neural substrates of memory, attention, and spatial awareness. Perform preliminary evaluation of potential effectiveness and implementability of the application.
  PHASE II: Construct an implementation of the virtual reality application. Conduct a trial to demonstrate effectiveness of the application in brain injury rehabilitation.

  PHASE III DUAL USE APPLICATIONS: This system will be effective not only in returning troops to service after a combat casualty brain injury, but will also improve the level of function among discharged brain injured troops, improving their lives and reducing the health care burden currently carried by the Veterans Administration. The system can also be incorporated into civilian brain injury rehabilitation programs to help the over 1.5 million Americans who suffer a traumatic brain injury each year.

  References:  1. Anderson P.L., R. B. O., Hodges L. (2001). "Virtual Reality: using the virtual world to improve quality of life in the real world." Bulletin Menninger Clinic 65(1): 78-91. 2. Benaroya-Milshtein N., H. N., Apter A., Kukulansky T., Raz N., Wilf A., Yaniv I., Pick C.G. (2004). "Environmental enrichment in mice decreases anxiety, attenuates stress responses and enhances natural killer cell activity." European Journal of Neuroscience 20: 1341-1347. 3. Chapillon P., P. V., Roy V., Vincent A., Caston J. (2001). "Effects of pre- and postnatal stimulation on developmental, emotional, and cognitive aspects in rodents: a review." Developmental psychobiology 41: 373-387. 4. Escorihuela R.M., T. A., Fernandez-Teruel A. (1994). "Environmental enrichment reverses the detrimental action of early inconsistent stimulation and increases the beneficial effects of postnatal handling on shuttlebox learning in adult rats." Behavioural Brain Research 61: 169-173. 5. Francis D.D., D. J., Plotsky P.M., Meaney M. (2002). "Environmental enrichment reverses the effects of maternal separation on stress reactivity." The Journal of Neuroscience 22(18): 7840-7843. 6. Greenough M.T., V. F. R. (1973). "Pattern of dendritic branching in occipital cortex of rats reared in complex environments." Experimental Neurology 40: 491-504. 7. Klein S.L., L. K. G., Durr D., Schaefer T., Waring R.E. (1994). "Influence of environmental enrichment and sex on predator stress response in rats." Physiology and Behavior 56: 291-297. 8. Larsson F., W. B., Mohammed A.H. (2002). "Psychological stress and environmental adaptation in enriched vs. impoverished housed rats." Pharmacology, Biochemistry and Behavior 73: 193-207. 9. Lee J.H., K. J., Cho W., Hahn W.Y., Kim I.Y., Lee S.M., Kang Y., Kim D.Y., Yu T., Wiederhold B.K., Weiderhold M.D., Kim S.I. (2003). "A virtual reality system for the assessment and rehabilitation of the activities of daily living." Cyberpsychol Behav. 6(4): 383-388. 10. Manosevitz M., P. B. (1975). "Cage size as a factor in environmental enrichment." Journal of Comparative and Physiological Psychology 89(6): 648-654. 11. Morganti F., G. A., Castelnuevo G., Bulla D., Vettorello M., Riva G. (2003). "The use of technology-supported mental imagery in neurological rehabilitation." Cyberpsychol Behav. 6(4): 421-427. 12. Rosenzweig M.R., B. E. L. (1996). "Psychobiology of plasticity: effects of training and experience on brain and behavior." Behavioral Brain Research 78: 57-65. 13. Rosenzweig M.R., B. E. L., Hebert M., Morimoto H. (1978). "Social grouping cannot account for cerebral effects of enriched environments." Brain Research 153: 563-576. 14. Van Praag H., K. G., Gage F.H. (2000). "Neuronal consequences of environmental enrichment." Nature Reviews: Neuroscience 1: 191-198. 15. Will B.E., R. M. R., Bennett E.L., Hebert M., Morimoto H. (1977). "Relatively brief environmental enrichment aids recovery of learning capacity and alters brain measures after postweaning brain lesions in rats." Journal of Comparative and Physiological Psychology 91: 33-50.

Keywords:  virtual reality, traumatic brain injury, TBI, training, rehabilitation

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