New tools make previously impossible research and treatment a (virtual) reality

The CAREN gives researchers a tool in understanding how lower foot and leg trauma can impact service members, and help patients to return to active duty or the civilian community. (Image credit: National Intrepid Center of Excellence)

By Christopher Austin

Our nation’s wounded warriors often face a long road of rehabilitation as they return home with life-altering injuries. But in the face of these challenges, they will have the help of clinicians and researchers who are breaking new ground to help ease their adjustment, and provide a new understanding of the potential for using advanced technology in rehabilitation.

A photo from behind a patient as they wear headphones and hold a controller in their right hand while looking at a screen. In front of the screen is a motion tracker.
A patient uses the BrightBrainer to play one of a variety of 
games that use motion controls to allow them to test a variety 
of factors like dexterity and cognition. 
(Image credit: courtesy photo)
At Walter Reed National Military Medical Center (WRNMMC), faculty of the Uniformed Services University of the Health Sciences Department of Physical Medicine and Rehabilitation (PMR) are working with the Occupational Therapy (OT), Physical Therapy (PT) divisions and the Extremity Trauma and Amputation Center of Excellence (EACE) to use a variety of virtual reality (VR) systems to better understand and treat the injuries of Service members.

The Computer Assisted Rehabilitation Environment (CAREN), a VR experience that consists of a multi-directional treadmill in front of a large curved display, is one such system and one of only a dozen in the U.S. (the nearby National Intrepid Center of Excellence also has one).  Users are secured to the treadmill with harnesses and given scenarios within a virtual environment that are projected onto the screen in front of them, which they maneuver through by walking on the treadmill. The treadmill can change orientation as the environment dips, rises, and swivel to challenge users with uncertain footing.

In addition to allowing patients to safely test themselves in a controlled environment as a part of their therapy, the CAREN also allows therapists and physicians to gather unique data on the users thanks to motion-capture cameras stationed around the treadmill platform. This information gives researchers a tool in understanding how lower foot and leg trauma can impact service members, and help patients to return to active duty or the civilian community.

A screenshot of a wire frame for human motion
To gather movement data, reflective markers are placed at key points on a patient, including legs, arms and hips. Encircling the room are eight specialized cameras with light-emitting diodes, known as LEDs, that flash at 120 times per second and record in true three-dimensional volume reflections of the markers in various positions as the patient walks. The angle and position of every joint -- ankles, hips, arms, pelvis, etc. -- is recorded in real time and expressed as stick-figure renditions of the patient walking. (Image credit: Defense Dept., Fred W. Baker III)

Researchers are using the BrightBrainer system for injury-related issues that service members are having with cognition and upper limbs. Through the use of an interface not too different from most motion-controlled video games, patients are able to use two hand-held controllers to interact with a virtual environment and test not only their dexterity, but other skills like reaction time, special awareness and memory. Participants can be presented with a variety of challenges at once due to the virtual nature of the exercises, and their performance can be recorded to allow researchers to examine their progress and look for potential applications for rehabilitation.

Another system that faculty are using is the Gait Lab.  Service members with lower limb injuries or amputations use it to analyze how their body moves through the placement of multiple sensors on their bodies.  The sensors are picked up by motion capture cameras stationed around the wide, open room of the lab. While not at the same level of interactivity as the other systems, it is still a highly advanced tool in analyzing the movement capabilities of patients. Faculty are able to construct a virtual, 3-D wire-frame recording of the service member in motion by having them perform simple exercises like walking in a straight line. This can be used by the patients and their therapists to see how their injuries have impacted how they get around. With this information, they can begin working on therapies that will allow the patient to further regain their mobility in a safe and productive way.


The classic therapist/patient relationship will never go out of style, but new technology and research are working to help restore a better quality of life to injured service members.