Approximately 352,612 diagnoses of traumatic brain injury were made in the U.S. military from 2000-2016, with the 75-90% categorized as concussion, and 14% caused by blast exposure (Swanson 2017; VA/DoD CPG 2009). Concussion causes significant and often lasting impairments in vestibular function affecting balance (Haran 2016) and dynamic visual acuity (Kelley 2015; Gottshall 2007). Vestibular rehabilitation (i.e. gaze stabilization exercises, GSE) improves impairments but only if done intensely, 2-3 times per day for up to 20 minutes (Hall 2016). Currently, GSE are completed with the service men and women (SMW) focusing on a stationary letter while turning the head quickly (> 2Hz or 120deg/sec) but maintaining visual focus for 1-2 minutes (Hall 2016). The problem with this method is that it is not engaging and there is no way to control whether the SMW are turning the head quickly enough to induce recovery. SMW are often in the field or away from a skilled clinician. Therefore, there is a need for a portable device to deliver skilled vestibular rehabilitation in the field. The device must be durable, accurately measure activity and enable a clinician to remotely adjust parameters. The exercises must engage SMW and be challenging to induce meaningful change.
