Written by Emily Sinitski, Canadian Forces Health Services CAREN Coordinator
Recap from Part 1 post: The Computer Assisted Rehabilitation Environment (CAREN) is located in The Ottawa, Ontario and Edmonton, Alberta Centres of Excellence. The CAREN is a virtual reality environment that allows clinicians and researchers to systematically manipulate the walking surface and/or visual field to address patients’ treatment needs for physical, cognitive and mental health rehabilitation. Get all the information from last weeks post here. Part 2 can be found here.
Current CAREN research areas
Several research studies have been completed since the opening of the CAREN facilities in 2011, which were led by teams from Defence Research & Development Canada, Canadian Forces Health Services, The Ottawa Hospital Rehabilitation Centre, Glenrose Rehabilitation Hospital, and Center for Interdisciplinary Research in Rehabilitation and Social Integration in Quebec. Current research areas include non-level gait biomechanics, assistive device evaluation, and use of the CAREN system for chronic low back pain, and lower limb amputee gait training. Results from our research studies will be instrumental in directing future research to the efficacy of the CAREN in rehabilitation programmes and optimising therapeutic protocols, making informed decisions related to the future use of the CAREN, and providing a scientific basis for moving forward with the possible use of this system for other disorders.
Simulator sickness and postural stability after immersion in the CAREN
Although the CAREN is a valuable tool for rehabilitation, simulator sickness can cause feelings of discomfort and unwanted side effects that limit the effectiveness of training. The purpose of this research was to establish a baseline of simulator sickness symptoms and postural stability after immersion in the CAREN system, for a non-injured military population (n=30). Results from this research demonstrated participants experienced “slight” symptoms of simulator sickness and greater postural instability after moderate activity in the CAREN. The data reported support our current guidelines to assess simulator sickness during CAREN sessions, even for a non-injured population. This information will be used as a comparative dataset for CAREN-based clinical assessments and future studies with CAF patient populations.
Evaluation of a CAREN-based gait training protocol for lower limb amputees
This research evaluated a structured CAREN gait training protocol used to improve gait performance for individuals with a lower limb amputation (n=8). Participants’ walking performance was assessed on days 1 and 8, and 20 minute training sessions were provided on days 2-7. A matched control group was also used for comparisons (n=8). The functional training sessions were individualized to participant’s needs by establishing a Lower Extremity Prosthetic Training Consideration framework to ensure therapeutic education and activities were delivered consistently to participants in the CAREN system. The largest improvements in walking performance were observed in symmetry of standing balance, step length, toe load and arm swing; upper body gait variability; and self-report measures of confidence and perceived exertion. The findings in this research suggested that the therapeutic education and functional strengthening throughout the six gait training sessions resulted in gait patterns closer to able-bodied.
Upcoming research areas
A preliminary investigation of a Motion-Assisted, Multi-Modal Memory Desensitization and Reconsolidation virtual reality based treatment for individuals with chronic combat-related post traumatic stress disorder will commence in early 2016. This treatment incorporates elements of Virtual Reality Exposure therapy and Eye Movement Desensitization and Reprocessing, while adding a motion-based component (e.g, walking). In this combination, members are challenged to optimally approach their traumatic memories for exposure.
CAREN scientific literature for 2015
Summary of scientific literature using the CAREN system for 2015:
- Collins JD et al. A systematic literature review of the use and effectiveness of the Computer Assisted Rehabilitation Environment for research and rehabilitation as it relates to the wounded warrior. Work 2015; 50(1):121-129.
- Hebert JS et al. Use of the CAREN system as a treatment adjunct for Canadian Armed Forces members with chronic non-specific low back pain: a pilot study. Journal of Military, Veteran and Family Health 2015; 1(1):47-58.
- Plotnik M et al. Self-selected gait speed – over ground versus self-paced treadmill walking, a solution for a paradox. Journal of NeuroEngineering and Rehabilitation 2015;12:20.
- Roosink M et al. Assessing the Perception of Trunk Movements in Military Personnel with Chronic Non-Specific Low Back Pain Using a Virtual Mirror. PloS One 2015; 10(3):e0120251.
- Sessoms PH et al., 2015. Head stabilization measurements as a potential evaluation tool for comparison of persons with TBI and vestibular dysfunction with healthy controls. Military Medicine 2015; 180(3):135-142.
- Sessoms PH et al. Improvements in gait speed and weight shift of persons with traumatic brain injury and vestibular dysfunction using a virtual reality Computer-Assisted Rehabilitation Environment. Military Medicine 2015; 180(3):143-149.
- Sheehan RC et al. Mediolateral angular momentum changes in persons with amputation during perturbed walking. Gait & Posture 2015; 41:795–800.
- Sinitski EH et al. Fixed and self-paced treadmill walking for able-bodied and transtibial amputees in a multi-terrain virtual environment Gait & Posture 2015; 41:568–573.
So how are you using technology in your everyday practice? Have you ever participated in research within the military or veteran populations? We would love to hear and share your story.