Charles E. Levy, M.D.; North Florida Foundation for Research and Education, Inc.; TBI Concept Award

The medical problem we are trying to address is mild traumatic brain injury and PTSD in returning combat vets. Returning combat vets often have problems with memory, concentration and controlling their frustration and anger. That's what we're hoping to help them with. Our research grant is to build virtual environments that could be therapeutic for returning combat vets. We have a basic paradigm, which is to build a virtual grocery store so that a therapist and a patient could enter this virtual store and work on doing cognitive tasks and emotional tasks. The veteran could put together a shopping list with the help of a therapist. They can go into the store, look for items, the items could be easy to find, hard to find or not available. They can follow a budget. They can purchase the items. They can check to see if they have enough money and check to make sure they have enough change. These things might seem pretty trivial, but actually if you have problems with memory and concentration, these tasks can be pretty vexing. On top of that, returning combat vets may have problems with crowds, may have problems in public places, may have problems with noise level, may have problems with tolerating the sounds of everyday life - like crying babies. Some veterans will wait till 1 a.m. or 2 a.m. when the stores are empty so they can shop with the least amount of interference. So in our virtual environment, the therapist can select the noise level. The therapist can select the amount of people who are in the store. The therapist can even select the appearance of the people in the store. This is an example of what's called a bot, a B-O-T. And in our store we have basically autonomous humans walking through the store and doing actions that look like they're shopping. They're not controlled by any specific person. We can increase the number or decrease the number. We can change the appearance to the therapeutic goals we're looking for. It could be that the first time we encounter the veteran we would start with a model of their empty store and slowly increase the number of people they encounter. And finally the therapist can select encounters that might be challenging. So we've got it set up so that the therapist can manufacture a collision with another shopper. That collision can be a minor collision or a major collision. So in a virtual environment they have a change to practice and explore things in a safe way that they couldn't do in the real world. Combat veterans are used to virtual reality in ways that perhaps people of my generation aren't. Combat veterans are used to playing computer games. Virtual reality is even used in combat training. There are certain veterans who would prefer to engage in a virtual world than a face-to-face encounter with a therapist, and we can provide that. The virtual world has the potential to meet the patient in their home. So we can bring the therapy right to the patient in their environment on their own time. The CDMRP made the mechanism of the concept award possible. So sometimes, it's difficult to get funds to allow you to explore a new technology without having to run patients through it first. Well, we're not ready to run patients through this. We need to build the application before we can test it on patients and CDMRP gave us the doorway to do that.