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Post Traumatic Stress Disorder Recovery for soldiers wounded in Afghanistan and Iraq isn't always as simple as treating a physical injury. For a lot of the service men and women, dealing with Post Traumatic Stress Disorder (PTSD) can be the real battle.

PTSD is a term for severe consequences of exposure to stressful experiences. Such as threatened death, serious physical injury, or a threat to physical and/or psychological integrity, to the extent that the usual defences are incapable of coping.

Typical symptoms include restlessness, insomnia, aggression, depression, dissociation, emotional detachment and nightmares. Sufferers can also experience memory loss regarding the traumatic event, which sometimes causes other underlying psychological conditions to appear.

The presence of a PTSD response is influenced by the intensity of the experience, its duration, and the individual person involved. PTSD may also have a delayed onset of months, years or even decades.

In the UK, the armed forces are not always warmly received when they return home. It's frequently in the news - getting turned away from hotels, receiving inadequate medical treatment and being unable to wear their uniform with pride. However, treatment for injured soldiers is improving. Dealing with PTSD issues quickly allows the solider to get on with life and back to where they want to be – whether that's back to their family and friends, or re-joining their squadron.

Human Body Modeling data being compared in real time with EMG data from the same muscle group

CAREN
A medical team in The Netherlands has found a creative way to utilize cutting edge technology to create a training environment that dramatically reduces the recovery time for PTSD sufferers and allows the patient greater control over their treatment.

MOTEK Medical, the research team behind the virtual training environment, creates, develops, integrates and implements revolutionary technologies for the medical industry. It is widely recognized for its innovative rehabilitation technology and achievements in shortening rehabilitation processes for orthopaedic and neurological patients.

The virtual environment – the CAREN System – creates a real-time virtual world, where the patient can interact and move seamlessly thanks to Vicon motion capture technology. The patient's movements are captured by the 13 Vicon MX40+ cameras situated around the studio. This data is then transferred in real-time to the virtual environment, where the patient can see themselves moving in the animated world.

Oshri Even-Zohar, head researcher at MOTEK Medical said: "The CAREN System can create any environment that is necessary. The most popular of these, a crowded street scene, allows the patient to interact with a situation in a completely controlled environment.

"Previously, the best a soldier could hope for would be one-to-one counseling, which can take months, even years, to be effective. Within CAREN, soldiers can face their fears directly and overcome them at a much faster pace, without the fear of actually being in that situation – they are completely in control."

The rehabilitation time is shortened thanks to the software behind the system - D-Flow™. It works by enabling the realtime integration of multisensory input and output devices; a pioneering set of tools that can take over some balance functions from the human brain.

The future for MOTEK
MOTEK is leading the way for virtual reality research and development. At the moment, the majority of its VR patients are injured soldiers, but as the treatment develops and becomes more widely available, the CAREN system will revolutionize the way we think about treating all psychological disorders; from a fear of flying to claustrophobia.

The Technology
MOTEK started off in 1994 with an aim of creating realistic real-time animation using motion capture technology, mainly for the entertainment industry. Then, 10 years ago, MOTEK received funding from the European Commission to develop the CAREN System, which was the first ever multi sensory real-time feedback system using immersive integrated reality technology.

MOTEK bought its first Vicon motion capture system 16 years ago, and today has a total of 13 cameras.

CAREN software editor interface

The system works in real-time and enables the creation of a variety of experiments in a controlled and repeatable environment by using different virtual reality principles. It enables the researchers to analyse balance behaviour, latency, response times and the relations between different sensory inputs that affect human decision protocols, human balance, posture and locomotion behaviours.

Even-Zohar continued: "For the soldiers we're treating, the virtual environments utilise the multi sensory inputs available inside the system to apply a type of exposure therapy; a cognitive behavioural therapy technique for reducing fear and anxiety responses. It is similar to systematic desensitisation, though it works more quickly and produces more robust results. It is also very closely related to exposure and response prevention, a method widely used for the treatment of obsessive-compulsive disorder – it's based on the principles of habituation and cognitive dissonance."

However, PTSD isn't the only beneficiary of this technology.

Even-Zohar explains: "As well as our work with soldiers suffering from PTSD, we're also developing a Human Body Model (HBM), which is a software tool enabling, for the first time, researchers to be able to view muscle forces and joint torques in the body in real-time. Hopefully in the future, this will have applications for sports performance enhancement – perhaps even developing our next Olympic winners!"

Muscle Modeling
An understanding of how the muscles in the body work hasn't been possible – until recently. MOTEK has developed a system which allows researchers to analyse the force of the muscle that you can't see in operation in the human body.

Even-Zohar comments: "The patient wears the Vicon motion capture suit and their muscular skeleton is represented in real-time on a digital display. The DFlow ™ software analyses which muscles are in use and highlights them in green – the harder the muscle is working the greener it will be. The inactive muscles are highlighted in red.

"This data can then be compared to a healthy patient, to see where the discrepancies lie. We then advise the patient on how to use their muscles correctly to achieve optimum performance."

With more work into this area, Even-Zohar is hoping to isolate the cause behind the ‘Parkinson's tremors', which some Parkinson's sufferers report. At the moment, it is not known where this problem originates.