RehabXR: A Mixed-Reality System for Delivery of Battlefield-Focused Vestibular Rehabilitation

While most individuals recover from mild traumatic brain injury (mTBI) within 3 months, 10–20% continue to experience chronic post-concussive symptoms such as headaches, dizziness, and imbalance. These individuals may benefit from vestibular rehabilitation, but military medicine needs a device that can standardize key elements of vestibular rehabilitation while allowing customization and targeting military-relevant tasks. We designed RehabXR, a portable mixed-reality-based platform for assessment and rehabilitation of multisensory and cognitive impairments after mTBI. RehabXR includes a virtual reality headset, controller, custom 3D-printed replica M4 rifle, and three first-person shooter games targeting common impairments post-mTBI. To assess usability, facilitated group discussions were conducted with ten military clinicians with post-mTBI rehabilitation experience and ten individuals with a history of mTBI. Clinicians and individuals with a history of mTBI rated RehabXR prototype usability favorably, with average System Usability Scale scores of 84.5 (range 55.0–97.5) and 85.2 (range 77.5–95.0), respectively. Clinicians liked the realism, engagement, interactivity, applicability, portability, and transparency (availability of quantitative outcome metrics). Individuals with a history of mTBI liked the ease of use and reported the games were realistic, fun, and engaging. After four weeks of use, patients rated RehabXR usability favorably (although somewhat lower than the prototype) with an average System Usability Scale score of 70.89 (range 55.0–87.5). These findings support RehabXR’s feasibility and acceptability and provide a foundation for studies of clinical effectiveness and return-to-duty applications.