Evaluation of the “RehabXR” virtual reality system for vestibular rehabilitation: evidence of changes in functional brain connectivity in warfighters with chronic mild traumatic brain injury

Introduction: Military service members (SMs) often experience vestibular dysfunction, including symptoms like dizziness and gaze instability, following mild traumatic brain injury (mTBI). These impairments compromise their ability to perform military duties, emphasizing the necessity for effective rehabilitation strategies. We previously developed a mixed reality-based system, called RehabXR, to deliver multisensory vestibular rehabilitation using low-cost wearable sensors and a virtual reality environment. Methods: This study evaluates RehabXR's rehabilitative impact both behaviorally and at neural level in 15 SMs with chronic vestibular complaints post-mTBI. Behavioral assessments were conducted via a Readiness Assessment Battery comprising mobility and agility tests, while neural impact was measured using resting-state functional MRI (rfMRI) to evaluate functional connectivity (FC) in the vestibular visual network (VVN) and default mode network (DMN). Results: After the rehabilitation, participants showed significant improvements in task completion times, as well as increased FC in the VVN and decreased FC in the DMN. Discussion: These findings suggest RehabXR as a promising rehabilitative tool for improving vestibular function and cognitive-motor integration post-mTBI.