Balance training using virtual reality as compared to an activity-based exercise program for adults with traumatic brain injury

Abstract

Exercise has been considered important in the management of functional balance problems although there are limited data supporting effectiveness after traumatic brain injury (TBI). This thesis compared two functional balance retraining programs: a virtual reality (VR) generated program and an activity-based (AB) program. Participants (n = 33, age 18--66) had sustained a moderate or severe TBI (initial Glasgow Coma Scale [GCS] <12) 6 months or more before the start of the study. Participants were quasi-randomly assigned to either an intervention group or a control group that received no intervention. Groups were matched on initial Berg Balance Scale scores (BBS), years since TBI, and age. Static standing balance (using a force plate), functional balance (using the Community Balance and Mobility Scale [CB&M]) and perceptions of balance and function (using the Activity-specific Balance Confidence Scale [ABC] and the Lower Extremity Functional Scale [LEFS]) were measured at baseline, after six weeks of intervention, and 3 months later. BBS and CB&M scores improved for the exercise groups after six weeks. Some of the improvements were still present at three months. Functional balance improvements were supported by increased scores on the ABC, the LEFS, and by participant focus group comments. The focus groups also indicated the multidimensional benefits of both types of exercise. While not statistically significant, the VR group reported higher scores of functional balance and mobility, balance confidence, and more positive comments from participants than the AB group. This supports the use of VR as a potentially effective method of delivering exercise.