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Improving Balance in TBI Using Virtual Reality

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02298231
Recruitment Status : Unknown
Verified October 2016 by Kessler Foundation.
Recruitment status was:  Recruiting
First Posted : November 21, 2014
Last Update Posted : October 14, 2016
Fort Belvoir Community Hospital
University of Southern California
VA Office of Research and Development
Kessler Institute for Rehabilitation
Information provided by (Responsible Party):
Kessler Foundation

Brief Summary:
This research study evaluates the effectiveness of a low-cost Virtual Reality-based (VR) training system in providing a customized balance treatment in a skilled clinical setting. Participants will be assigned to one of three treatment groups.

Condition or disease Intervention/treatment Phase
Traumatic Brain Injury Other: Standard of Care Balance Intervention Other: Mystic Isle Balance Intervention Other: Mystic Isle Balance Intervention with Dual Task Not Applicable

Detailed Description:

Traumatic Brain injury (TBI) is a major health concern for the U.S. military and civilian populations, resulting in more than 5.3 million people who require rehabilitation and assistance for the short and long-term consequences of TBI. TBI impairs the integration and organization of the visual, auditory and somatosensory inputs that permit body position awareness, in relation to self and the environment. Even minor impairments in any of these systems can cause balance dysfunction (BDF), which is one of the most disabling aspects of TBI. BDF affects over 65% of all individuals with TBI. When cognitive deficits are present, BDF may become more pronounced, particularly when attempting to engage in more than one task at a time (i.e., dual task). Treating BDF in patients with TBI can be challenging, as traditional treatments do not consistently replicate everyday life environments. Virtual reality (VR) interventions enable clinicians to systematically deliver and control dynamic, interactive, multisensory stimuli. The proposed study will implement and evaluate a novel, low-cost, VR rehabilitation tool (Mystic Isle; MI) targeting somatosensory, vestibular, and vision systems through a double-blind RCT. Given the importance of dual-task skills for real-world functioning, the investigators will also evaluate the relative effectiveness of dual task (balance and cognitive) VR training to improve balance.

Preliminary case, feasibility and efficacy studies have been conducted using MI with rehabilitation populations. Findings demonstrate that customized VR using full-body movement tracking is motivating, feasible for balance training in neurorehabilitation populations, and results in improved balance and motor action planning. The proposed study will directly evaluate the effectiveness of a low-cost, interactive, multisensory, VR training using MI to improve balance and global functioning. The investigators will evaluate the relative effectiveness of dual task (balance and cognitive) VR training to improve balance, the long-term effectiveness of such training, and the utility of a balance maintenance program for facilitating longer-term treatment effects.

A total of 180 participants (Service Members, Veterans, civilians) with mild to severe TBI and documented balance impairments will be randomly assigned into one of three balance treatment groups: 1) Standard of care (control condition); 2) MI; 3) MI dual task (balance plus cognitive). All groups will undergo 2 treatment sessions/week x 6 weeks (i.e. 12 sessions). Following completion of the treatment protocol, participants in the MI training group will be randomly assigned to a maintenance training group (2 sessions/month x 4 months) or a non-maintenance group. All participants will undergo baseline, immediate (6 weeks), and long-term (4 months) follow-up assessments of: 1) static and dynamic balance and 2) community integration, self-efficacy, quality of life, and cognitive function. This design will allow us to assess the efficacy of MI as a customizable balance treatment in TBI, and to evaluate the impact of this remediation program on overall functioning.

The following hypotheses are proposed: 1) Participants completing both MI training conditions will exhibit significantly improved balance relative to the control group; 2) Participants completing both MI training conditions will demonstrate significantly greater improvements in global functioning relative to the control group; 3) Participants receiving the MI dual task training (balance and cognitive) will exhibit significantly greater improvements in balance relative to those in the single task MI training; 4) Participants completing both MI training conditions will sustain treatment gains for up to 4 months following treatment relative to baseline performance; the control group will maintain or decrease balance between follow-up sessions; and 5) Participants receiving maintenance training will maintain better balance over the 4 month follow-up period compared to the non-maintenance group.

The proposed study is poised to make an important contribution to enhancing balance function in service members and civilians with TBI, thereby promoting recovery of physical and social functioning and overall quality of life.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 180 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Improving Balance in TBI Using a Low-Cost Customized Virtual Reality Rehabilitation Tool
Study Start Date : April 2016
Estimated Primary Completion Date : October 2018
Estimated Study Completion Date : October 2018

Arm Intervention/treatment
Experimental: Group 1
Standard of Care Balance (SCB) Treatment
Other: Standard of Care Balance Intervention
Standard balance therapy as performed by a physical therapist

Experimental: Group 2
Mystic Isle (MI) Balance Training
Other: Mystic Isle Balance Intervention
Balance therapy using virtual reality

Experimental: Group 3
Mystic Isle (MI) Dual Task Training
Other: Mystic Isle Balance Intervention with Dual Task
Balance therapy using virtual reality and performing cognitive tasks

Primary Outcome Measures :
  1. Balance Assessment [ Time Frame: 4 months ]
    Physical tasks scored based on performance, e.g., 10 Meter walk, Balance Tasks and Computerized Sensory Organization Test

Secondary Outcome Measures :
  1. Global Functioning evaluating the impact of the intervention on everyday life [ Time Frame: 4 months ]

  2. Neuropsychological Assessment examining changes in cognitive functioning [ Time Frame: 4 months ]

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Have been diagnosed with a mild to severe Traumatic Brain Injury (TBI). My TBI severity will be categorized by research study staff based on length of loss of consciousness (LOC), alteration of consciousness/mental state (AOC) or post-traumatic amnesia (PTA).
  • Must be out of PTA, as indicated by O-log score of > 24 on 2 consecutive days as determined by study staff.
  • Be at least 3 months post injury.
  • Speak English.
  • As determined by study personnel, have at least 20/60 acuity in worst eye according to the Snellen Eye Exam.
  • As determined by study personnel, receive an acceptable score on the Token Test.
  • Balance dysfunction as determined by impairment on standing balance measures (Sensory Organization Test)
  • Be able and willing to comply with study procedures, including follow-up requirements.
  • Be willing and able to give informed consent

Exclusion Criteria:

  • Have an unstable or uncontrolled seizure disorder.
  • Have a diagnosis of excessive fluid surrounding my brain.
  • Have severe cardiac disease (e.g. heart attack or heart failure).
  • Have uncontrolled or unstable orthostatic hypotension (blood pressure drops suddenly when one stands, causing one to feel light headed or dizzy).
  • Have had a lower limb injury in the past 90 days.
  • Have any other injury that affects one's ability to balance.
  • Have a pre-existing condition that significantly affects one's alignment or function of one's lower limb while standing.
  • Be on any medication that may affect one's balance, strength, or muscle coordination (e.g. Botox, Baclofen).
  • Have significant neurological history (e.g.epilepsy that began before TBI, multiple sclerosis) other than TBI.
  • Have significant psychiatric history (i.e. schizophrenia).
  • Have a history of significant drug abuse.
  • Have had physical or occupational therapy or treatment for balance disorder in the past 30 days.
  • Have difficulty following or responding to commands that would limit study participation.
  • Be currently enrolled in another research study that is likely to affect participation in this research study.
  • Have any underlying medical conditions that would limit study participation.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02298231

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Contact: Kathleen Goworek 973-324-3560 ext 3560
Contact: Lea Frank 973-324-3581 ext 3581

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United States, New Jersey
Kessler Foundation Recruiting
West Orange, New Jersey, United States, 07052
Contact: Kate Chervin    973-324-3560 ext 3560   
Sponsors and Collaborators
Kessler Foundation
Fort Belvoir Community Hospital
University of Southern California
VA Office of Research and Development
Kessler Institute for Rehabilitation
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Principal Investigator: Karen J Nolan, PhD Kessler Foundation
Principal Investigator: Denise Krch, PhD Kessler Foundation

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Responsible Party: Kessler Foundation Identifier: NCT02298231     History of Changes
Other Study ID Numbers: R-831-14
First Posted: November 21, 2014    Key Record Dates
Last Update Posted: October 14, 2016
Last Verified: October 2016
Keywords provided by Kessler Foundation:
Traumatic Brain Injury
Virtual Reality
Additional relevant MeSH terms:
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Brain Injuries
Brain Injuries, Traumatic
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Craniocerebral Trauma
Trauma, Nervous System
Wounds and Injuries