Improving Balance in TBI Using a Low-Cost Customized Virtual Reality Rehabilitation Tool

The proposed study will implement and evaluate a novel, low-cost, Virtual Reality (VR) rehabilitation tool (Island Quest; IQ) targeting somatosensory, vestibular, and vision systems through a double-blind RCT. Given the importance of dual-task skills for real-world functioning, we will also evaluate the relative effectiveness of dual task (balance and cognitive) VR training to improve balance. 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) IQ; 3) IQ dual task (balance plus cognitive). All groups will undergo 2 treatment sessions/week x 6 weeks. Following completion of the treatment protocol, participants in the IQ 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 IQ as a customizable balance treatment in TBI, and to evaluate the impact of this remediation program on overall functioning.