1. Project Objective: To develop an open source 3D virtual rehabilitation tool to help improve working memory function of mild TBI patients. Goals: Create a virtual rehabilitation interface accompanied by an equivalent hardware model. Analyze the patient’s strengths and weaknesses by providing feedback. Erwin Yap 1, David Weinberg 1 Dr. Joseph Cheng 2, Vanderbilt Medical Center 2, Department of Neurosurgery, Nashville, TN, USA Department of Biomedical Engineering 1, Vanderbilt University, Nashville, TN, USA Rehabilitation Tool for Traumatic Brain Injury Patients TESTINGTESTING CONCLUSIONCONCLUSION PROPOSED SOLUTION Problem: Traumatic Brain Injury (TBI) is one of the major cause of disabilities worldwide. Traumatic Brain injury is defined as damage to the brain resulting from external mechanical forces. The most common causes of TBI is from falls (28%), car accidents (20%), assaults (11%), and struck by events (19%). 1.4 million are affected in the US; 50,000 die; 235,000 are hospitalized; 1.1 million go through extensive rehabilitation therapy. 5.3 million Americans currently have a long-term or lifelong need for traumatic brain injury care. TBI patients often lose track of their careers since their working memory function is impaired to different degrees. Focus group: Soldiers coming back with brain injury, specifically the ones with working memory impairments. 6 out of 10 soldiers returning from the “Global War on Terror” are diagnosed with TBI. 10-20% of Iraq veterans, or about 150,000-300,000 have suffered TBI during the war. In war, most of the brain injury is caused by bullets or shrapnel shells hitting the head and the neck. It can also be caused by mortar or roadside blasts. The main problems war veterans with mild TBI deal with are navigation and sequencing. BACKGROUNDBACKGROUND In conclusion, our rehabilitation tool showed no significant improvements at sequencing skills associated with working memory function for healthy college students. FUTURE RECOMMENDATIONS Perform clinical trails using patients with mild traumatic brain injury and increase sample size. Create a method to help patients improve navigation skills (i.e using a map to find an object in a 3D environment). ACKNOWLEDGEMENTSACKNOWLEDGEMENTS REFERENCESREFERENCES 1. "Facts about Traumatic Brain Injury." Facts About TBI. Web. 8 Nov. 2009. (http://www.brainandspinalcord.org/blog/category/tbi/treatment-tbi/) 2. Christiansen C, Abrau B. “Task Performance in Virtual Environments Used for Cognitive Rehabilitation After Traumatic Brain Injury.” Arch Phys Med Rehabil 79(1999) 3. Finkelstein E, Corso P, Miller T and associates. The Incidence and Economic Burden of Injuries in the United States. New York (NY): Oxford University Press; 2006. Four volunteer groups: 2x2 factorial design (Virtual rehab vs. Facebook & setting the table vs. preparing a cheeseburger) Both groups contained patients without disabilities. Training time of 2 minutes was given to the subjects. Control group was asked to look at Facebook while treatment group was tasked to use the Alice program for 2 minutes. The subjects were tasked to construct the similar object in proper sequence using the materials provided. They will be evaluated using a point system scale which measures the performance indicators stated above. In theory, there will be multiple tasks which they can do so they don’t remember doing the task using muscle memory. RESULTSRESULTS We want to thank Dr. Pamela Drury, neuropsychologist of the VA hospital, for helping us determine the needs of war veterans with mild traumatic brain injury. We also want to thank Ms. Christy Hagewood, research nurse of the Vanderbilt Department of Neurosurgery/Spine for helping us develop an IRB proposal for a clinical trial of our project. METHODSMETHODS Prototypes: Cheeseburger prototype: Involves making a cheeseburger using buns, lettuce, tomatoes, burger and cheese in a particular sequencing order. Table setting prototype: Involves setting up a table using a plate, salad fork, salad plate, cup, regular fork, spoon, knife, napkin in a particular sequencing order. Design Criteria: Use of Alice 3D Engine, an open source software to show the instructional video regarding the task. Created a hardware equivalent of the prototype. Performance Indicators: Time required for total completion Number of mistakes in sequencing Number of mistakes in completing the task ConsentPre-test Virtual Component Post-test Evaluation Survey Figure 3: Factorial Anova with two between-subjects factors Figure 2: Flowchart of the testing procedure, 2x2 factorial design There was a significant difference decrease (p 0.4) in completion time for the experimental virtual training versus the Facebook control group. Figure 1: Screenshots of the Alice interface