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Basic Retraining


For those with balance and coordination issues stemming from TBI, the TOP program uses perhaps the most unconventional biofeedback tool, a Nintendo Wii. The popular video game console markets a surprisingly effective biofeedback training device in the form of the Wii Fit.

The Wii Fit is a combination of an exercise video game and Nintendo’s Balance Board peripheral. It is intended to help gamers stay active and physically fit through game versions of aerobics, strength training, and yoga.

But where the Wii Fit really shines as a biofeedback device is in its balance games. The Balance Board contains sensors that accurately measure a person’s center of gravity and displays it on the screen in the form of a game. The game requires the player to alter his or her balance to achieve a goal. For Marines with TBI suffering from balance issues, the Wii Fit can help them achieve balance, even if it no longer feels the way it did before their injury. With practice, the soldier can actually relearn how to balance.


Virtual reality is an important component to the TOP program at ECU's Psychophysiology Lab and Biofeedback Clinic

With each of the different biofeedback modalities, the TOP program uses the concept of graded exposure. Graded exposure not only increases the Marines tolerance to stress, it provides repetitions of the process that allows them to control it. With practice comes better control and faster reaction.

“As they learn to control their reactions to a stressor, we increase the stress a little bit. It progressively gets harder and harder,” said Russoniello. “We start off with talk stressors and math stressors, things of that nature, and they learn how to control those. Eventually, we start to talk with them about their experience in the war, and finally we move them into virtual reality where they become immersed into a software program which is very much like Iraq. They then maneuver through this virtual world and we utilize the same techniques from the other exercises to help them control themselves.”

For Marines with PTSD, flashbacks can be very distressing. They can be brought on by many things, from the sound of a child crying, to the sound of gunfire or an explosion in a movie. They can be debilitating and difficult to recover from.

“They get to the point where they don’t connect any emotion to the memories they have from the war. So they can talk about terrible things without ever having to emotionally deal with them," said Russoniello. "So what happens I think, and this is really the crux of what we are trying to do with this program, is to let these guys touch the emotion to that experience, because it’s scary as hell. Most guys don’t want to go there because then they have to deal with it and they aren’t sure they can. It’s easier to shut it off, or drink it silent, or whatever. So now in the VR when a Marine has a flashback and looses control, we can take 10 or 15 minutes to talk about it and look at the skills he has acquired to combat it.”

Many Marines who have worked with virtual reality say they can feel the difference.

“I actually had a flashback episode during the last VR session that Dr. R. and I went through. And surprisingly enough, it wasn’t as bad as I expected it to be, and I was actually able to recover from it quite fast,” said Sergeant Christopher Soldano. “If that’s any indication of how I may be able to handle and deal with future flashbacks, I’m very happy with the way things are going.”

Most, if not all, of the Marines in the program have been happy with the results. They feel the difference in their daily lives, and they see it in the reactions of others. Sgt. Soldano has had people tell him that he seems like a completely different person from when he started the program last year.

“My PTSD is classified as pretty severe,” he said. “Since I started the program, I’ve noticed that, you know, my counseling sessions are a lot less intense. My medications—I don’t necessarily need them as much. I notice things decrease on the other side, and I have more control on my side. This is helping me a lot.”



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