Virtual reality (VR) may be useful during rehabilitation of service members with persistent vestibular impairment following concussion. Thirty-eight active duty US military service members with persistent balance impairment resulting from concussion were randomized into three groups [Conventional Vestibular Physical Therapy (CVPT, n = 13), Virtual Reality Vestibular Physical Therapy (VRVPT, n = 12), and Hybrid Virtual Reality and Conventional Vestibular Physical Therapy (HybridVPT, n = 13)] and were treated twice weekly for 6 weeks. Changes in clinical measures such as Activities-specific Balance Confidence (ABC) Scale, Dizziness Handicap Inventory (DHI), Functional Gait Assessment (FGA), and Sensory Organization Test (SOT) were assessed from pre-, mid-, and post-treatment scores. A significant main time effect was observed demonstrating clinical improvement over time (ABC: p < .001, η2p = .54; DHI: p < .001, η2p = .57; FGA: p < .001, η2p = .74; SOT: p < .001, η2p = .35). Both CVPT and HybridVPT groups demonstrated significant improvements in patient-reported confidence and function earlier in the treatment course (p < .005). FGA significantly and incrementally improved at each assessment time point in all treatment groups. The SOT significantly improved early in treatment in the CVPT group only and pre-to-post-treatment in the CVPT and VRVPT groups only. The HybridVPT group did not demonstrate any significant improvement with time in the instrumented SOT measure. In the comparison of pre-to-post-effects of VRVPT and HybridVPT effects compared to CVPT, there was no clear superiority or inferiority observed in either of the experimental treatments. This preliminary work shows initial efficacy of using VR-based therapy for concussed individuals allowing future work to personalize treatment that may improve adherence and engagement to therapy.

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Background: Vestibular deficit is common following concussion and may affect gait. The purpose of this study was to investigate differences in head and pelvic center of mass (COM) movement during gait in military tactical athletes with and without concussion-related central vestibular impairment.Material and Methods: 24 patients with post-concussion vestibular impairment (20 males, 4 females; age: 31.7 ± 7.9 years; BMI: 27.3 ± 3.3) and 24 matched controls (20 males, 4 females; age: 31.8 ± 6.4 years; BMI: 27.2 ± 2.6) were included in the analyses. Three-dimensional head and pelvic displacement and velocities were collected at a 1.0 m/s standardized treadmill walking speed and assessed using Statistical Parametric Mapping t-tests. Maximum differences (dmax) between groups were reported for all significant kinematic findings.Results: The Vestibular group demonstrated significantly diminished anteroposterior head excursions (dmax = 2.3 cm, p = 0.02) and slower anteroposterior (dmax = 0.37 m/s, p = 0.01), mediolateral (dmax = 0.47 m/s, p = 0.02) and vertical (dmax = 0.26 m/s, p &lt; 0.001) velocities during terminal stance into pre-swing phases compared to the Control group. Vertical pelvic excursion was significantly increased in midstance (dmax = 2.4 cm, p = 0.03) and mediolaterally during pre- to initial-swing phases (dmax = 7.5 cm, p &lt; 0.001) in the Vestibular group. In addition, pelvic velocities of the Vestibular group were higher mediolaterally during midstance (dmax = 0.19 m/s, p = 0.02) and vertically during post-initial contact (dmax = 0.14 m/s, p &lt; 0.001) and pre-swing (dmax = 0.16 m/s, p &lt; 0.001) compared to the Control group.Significance: The Vestibular group demonstrated a more constrained head movement strategy during gait compared with Controls, a finding that is likely attributed to a neurological impairment of visual-vestibular-somatosensory integration.