Background In recent years, the delivery of evidence-based therapies targeting posttraumatic stress disorder (PTSD) has been the focus of the Departments of Defense in countries such as Canada, the Netherlands, and the United States. More than 66% of military members continue to experience symptoms of PTSD that significantly impact their daily functioning and quality of life after completing evidence-based treatments. Innovative, engaging, and effective treatments for PTSD are needed. Multimodal motion-assisted memory desensitization and reconsolidation (3MDR) is an exposure-based, virtual reality–supported therapy used to treat military members and veterans with treatment-resistant PTSD. Given the demonstrated efficacy of 3MDR in recently published randomized control trials, there is both an interest in and a need to adapt the intervention to other populations affected by trauma and to improve accessibility to the treatment. Objective We aimed to further innovate, develop, and validate new and existing hardware and software components of 3MDR to enhance its mobility, accessibility, feasibility, and applicability to other populations affected by trauma, including public safety personnel (PSP), via international collaboration. Methods This study used a modified Delphi expert consultation method and mixed methods quasi-experimental validation with the purpose of software validation among PSP (first responders, health care providers) participants (N=35). A team of international experts from the Netherlands, the United States, and Canada met on the web on a weekly basis since September 2020 to discuss the adoption of 3MDR in real-world contexts, hardware and software development, and software validation. The evolution of 3MDR hardware and software was undertaken followed by a mixed methods software validation study with triangulation of results to inform the further development of 3MDR. Results This study resulted in the identification, description, and evolution of hardware and software components and the development of new 3MDR software. Within the software validation, PSP participants widely acknowledged that the newly developed 3MDR software would be applicable and feasible for PSP affected by trauma within their professions. The key themes that emerged from the thematic analysis among the PSP included the desire for occupationally tailored environments, individually tailored immersion, and the applicability of 3MDR beyond military populations. Conclusions Within the modified Delphi consultation and software validation study, support for 3MDR as an intervention was communicated. PSP participants perceived that 3MDR was relevant for populations affected by trauma beyond military members and veterans. The resulting hardware and software evolution addressed the recommendations and themes that arose from PSP participants. 3MDR is a novel, structured, exposure-based, virtual reality–supported therapy that is currently used to treat military members and veterans with PTSD. Going forward, it is necessary to innovate and adapt 3MDR, as well as other trauma interventions, to increase effectiveness, accessibility, cost-effectiveness, and efficacy among other populations affected by trauma.

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 < 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 < 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 < 0.001) and pre-swing (dmax = 0.16 m/s, p < 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.

BackgroundVestibular 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 tactical athletes with and without concussion-related central vestibular impairment.Methods25 patients with post-concussion vestibular impairment (20 males, 4 females; age: 31.7±7.9 years; BMI: 27.3±3.3) and 25 matched controls (21 males, 4 females; age: 31.8±6.4 years; BMI: 27.2±2.6) participated. Three-dimensional head and pelvic COM 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.ResultsThe 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<0.001) velocities during terminal stance into pre-swing phases compared to the Control group. Vertical pelvic COM 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<0.001) in the Vestibular group. In addition, Pelvic COM 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<0.001) and pre-swing (dmax=0.16 m/s, p<0.001) compared to the Control group.SignificanceThe 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.

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