An Augmented Reality Rifle Qualification Test for Return-to-Duty Assessment in Service Members.

INTRODUCTION: Variability in return-to-duty (RTD) decision-making following mild traumatic brain injury (mTBI) is a threat to troop readiness. Current RTD assessments lack military-specific tasks and quantitative outcomes to inform stakeholders of a service member's (SM) capacity to successfully perform military duties. Augmented reality (AR), which places digital assets in a user's physical environment, provides a technological vehicle to deliver military-relevant tasks to a SM to be used in the RTD decision-making process. In addition to delivering digital content, AR headsets provide biomechanical data that can be used to assess the integrity of the central nervous system in movement control following mTBI. The objective of this study was to quantify cognitive and motor performance on an AR rifle qualification test (RQT) in a group of neurologically healthy military SMs. MATERIALS AND METHODS: Data were collected from 111 healthy SMs who completed a basic (single-task) and complex (dual-task) RQT with a simulated M4 rifle. The complex scenario required the SM to perform the RQT while simultaneously answering arithmetic problems. Position data from the AR headset were used to capture postural sway, and the built-in microphone gathered responses to the arithmetic problems. RESULTS: There were no differences in the number of targets hit, trigger pull reaction time, and transition time from kneeling to standing between the basic and complex scenarios. A significant worsening in postural sway following kneel-to-stand transition was observed in the complex scenario. The average reaction time to answer the arithmetic problems was nearly 2 times slower than the average reaction time to pull the trigger to a displayed target in the complex scenario. CONCLUSION: The complex scenario provoked dual-task interference in SMs as evidenced by worsening postural sway and reaction time differences between the cognitive and motor tasks. An AR RQT provides objective and quantitative outcomes during a military-specific task. Greater precision in evaluating cognitive and motor performance during a military-relevant task has the potential to aid in the detection and management of SMs and their RTD following MTBI.

The Immersive Cleveland Clinic Virtual Reality Shopping Platform for the Assessment of Instrumental Activities of Daily Living.

A decline in the performance of instrumental activities of daily living (IADLs) has been proposed as a prodromal marker of neurological disease. Existing clinical and performance-based IADL assessments are not feasible for integration into clinical medicine. Virtual reality (VR) is a powerful yet underutilized tool that could advance the diagnosis and treatment of neurological disease. An impediment to the adoption and scaling of VR in clinical neurology is VR-related sickness resulting from sensory inconsistencies between the visual and vestibular systems (i.e., locomotion problem). The Cleveland Clinic Virtual Reality Shopping (CC-VRS) platform attempts to solve the locomotion problem by coupling an omnidirectional treadmill with high-resolution VR content, enabling the user to physically navigate a virtual grocery store to simulate shopping. The CC-VRS consists of Basic and Complex shopping experiences; both require walking 150 m and retrieving five items. The Complex experience has additional scenarios that increase the cognitive and motor demands of the task to better represent the continuum of activities associated with real-world shopping. The CC-VRS platform provides objective and quantitative biomechanical and cognitive outcomes related to the user's IADL performance. Initial data indicate that the CC-VRS results in minimal VR-sickness and is feasible and tolerable for older adults and patients with Parkinson's disease (PD). The considerations underlying the development, design, and hardware and software technology are reviewed, and initial models of integration into primary care and neurology are provided.

Objective assessment of postural stability in Parkinson's disease using mobile technology.

BACKGROUND: A significant gap remains in the ability to effectively characterize postural instability in individuals with Parkinson's disease. Clinical evaluation of postural declines is largely subjective, whereas objective biomechanical approaches are expensive and time consuming, thus limiting clinical adoption. Recent advances in mobile devices present an opportunity to address the gap in the quantification of postural stability. The aim of this project was to determine whether kinematic data measured by hardware within a tablet device, a 3rd generation iPad, was of sufficient quantity and quality to characterize postural stability. METHODS: Seventeen patients and 17 age-matched controls completed six balance conditions under altered surface, stance, and vision. Simultaneous kinematic measurements were gathered from a three-dimensional motion capture system and tablet. RESULTS: The motion capture system and tablet provided similar measures of stability across groups. In particular, within the patient population, correlation between the two systems for peak-to-peak, normalized path length, root mean square, 95% volume, and total power values ranged from 0.66 to 1.00. Kinematic data from five balance conditions--double-leg stance with eyes open on a foam surface, double-leg stance with eyes closed on firm and foam surfaces, and tandem stance on firm and foam surfaces--were capable of discriminating patients from controls. CONCLUSIONS: The hardware within the tablet provides data of sufficient accuracy for the quantification of postural stability in patients with Parkinson's disease. The objectivity, portability, and ease of use of this device make it ideal for use in clinical environments lacking sophisticated biomechanical systems.