Acceptance and Commitment Therapy Integrated Vestibular Rehabilitation (ACTIVE) for mTBI: A Targeted, Randomized Controlled Trial


Evaluate a combination therapy for vestibular rehabilitation and psychological health following a mild traumatic brain injury. Determine whether it reduces vestibular symptoms and functional impairment more quickly and effectively than usual care. Look for predictors of treatment response that can guide future personalized care approaches.

STRONG STAR Consortium investigators are taking a synergistic approach as they try to improve patient recovery after a mild traumatic brain injury (mTBI), or concussion. Their innovative combination of therapies aims to address both vestibular and psychological health issues that commonly co-occur, increasing functional impairment and prolonging recovery.

About 380,000 post-9/11 military service members have experienced a TBI, and 60% of those report problems related to the vestibular system, a sensory system in the inner ear that creates a sense of balance and spatial orientation. Problems can include dizziness, vertigo (feeling of spinning or floating), blurred vision, and gait and balance issues. Meanwhile, about a third of those with a TBI also report psychological health issues including anxiety, depression, and posttraumatic stress.

Researchers believe vestibular and psychological health problems share some underlying mechanisms and that, by targeting both in a timely way, they can achieve greater symptom reductions more quickly and better prevent these problems from becoming chronic or causing additional complications.

The approach

Led by Anthony Kontos, PhD, of the University of Pittsburgh, the STRONG STAR team will evaluate a four-week program called ACTIVE in a military population at the Intrepid Spirit Center at Fort Cavazos, Texas, and a civilian population at the University of Pittsburgh’s UPMC Sports Medicine Concussion Program.

As part of usual care, all participants will receive targeted vestibular rehabilitation, which involves exercises that reduce vestibular symptoms, impairment, and recovery time following mTBI.

The ACTIVE arm will receive the standard-of-care services plus a psychological health intervention called Acceptance and Commitment Therapy, or ACT. ACT is a talk therapy associated with long-lasting improvements in psychological health and functional outcomes by enhancing psychological flexibility. That is the ability to persist in or change behaviors to pursue one’s personal values and goals, even in the presence of unwanted thoughts, emotions, and physiological sensations.

ACT and targeted vestibular rehabilitation have been studied separately but never together. The research team believes that their combination in this study will provide synergistic effects that lead to a greater reduction in symptoms, impairment, and functional limitations and accelerate return to regular activity compared to usual care.

Measuring success, guiding future treatment

To provide more objective markers of vestibular function and treatment efficacy, this study will utilize the I-Portal Portable Assessment System (I-PAS). This tool was developed through the group’s previous research and provides an objective, portable, noninvasive assessment of changes in vestibular function that correspond with treatment efficacy.

As part of the study, researchers also will consider how personal and injury characteristics are related to treatment response – knowledge that could guide future care to best meet patient needs.

If proven successful, the proposed ACTIVE intervention will provide an evidence-based, personalized medicine approach with which military and civilian TBI care providers can decrease the short- and long-term effects of mTBI and related psychological health issues. This would greatly increase the quality of life for TBI patients and their families, and for the military as a whole, enhance operational readiness.

Secured By miniOrange