The purpose of this study is to evaluate the effectivenes of a home-based physical therapy program designed to improve balance following traumatic brain injury by incorporating the use of a virtual reality system.

Inclusion Criteria:

• Has sustained a documented TBI that required an inpatient rehabilitation program;
• is at least one year post TBI;
• is at least 18 and no more than 64 years of age at the time of enrollment;
• is English or Spanish speaking
• is at least three months beyond completion of formal PT, including acute inpatient rehabilitation, outpatient and home-based therapy;
• provides written medical clearance for participation in an in-home balance exercise program;
• ambulates independently within the home (with assistive devices and/or orthotics as needed);
• has active range of motion of bilateral upper extremities of at least 90 degrees of abduction to allow for control of the VR system;
• completes a 15 minute trial using a VR system in the absence of a negative physical or behavioral reaction;
• self-reports ongoing balance deficits and demonstrate such deficits by scoring at or below one standard deviation above the mean (75 or below) on the CB&M; and
• provides informed consent, or has a guardian available to provide consent.

Exclusion Criteria:

• has a history of another medical illness or neurological disorder which may affect balance;
• has experienced a seizure within the last year;
• has a history of psychiatric disorder requiring hospitalization;
• is currently participating in another RCT;
• is currently using VR technology to address specific balance goals;
• is unable to travel to Craig for assessments throughout the study period;
• is unable to communicate effectively to complete standardized assessments;
• has cognitive impairment that precludes completion of baseline testing;
• is unavailable to participate in 12 continuous weeks of therapy;
• has no access to television able to connect to VR-gaming system; and
• reports inadequate space required for VR-gaming system sensors.