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CAREN (Computer Assisted Rehabilitation Environment) protocol --is a versatile, multi-sensory virtual reality system used for treatment and rehabilitation of human locomotion, or walking, as well as pain, posture, balance spinal stability and motor control integration.(10,11,12) History MOTEK was founded in 1993 (X) as a privately held motion capture, animation and visualization studio.

The early mission of MOTEK focused on the development and implementation of innovative animation and visualization techniques focusing or real time generation of realistic animations (X).

The company managed project work to ensure growth without the need for venture capital or going public untill 1998. In 1997, MOTEK had applied for a research grant to the European commission in order to develop the system now known as CAREN. This grant was received in 1998 and enabled the development of CAREN's 1st prototype.

The company also received external funding through TWINNING and NPM capital, both Dutch based investment companies.

The 1st production grade CAREN system was sold to the University of Groningen in 2000. Usage of CAREN before the day it has been brought to common people Within the annals of CAREN’s beginnings, the technology was being used primarily by scientific and military organizations because of the sheer complexity of its modern intricacies and somewhat complicated testing.(13,14,15) About CAREN From a general public point of view, one of the first glimpses of the CAREN was seen in Peter Berg's sci-fi alien thriller Battleship. In the action-packed film based on the legendary board game, a scene depicting a real life ex-soldier who has lost both his legs walking in a virtual reality simulator hints at the incredible possibilities for this technology. The promise of a new dawn in technologies for the medical markets is at the core of what makes the CAREN platform so intriguing, yet it also goes further to encompass early diagnostics, rehabilitation, motor training and research.

The CAREN system is the brainchild of Motek Medical, and remains the company’s flagship product as an immersive virtual reality entity that uses motion capture elements for clinical and research settings. The system consists of a motion base, the aforementioned motion capture element, a projection screen and Motek’s D-flow software, with three default models available – all of which can be tailored for specific needs. In its most basic form, CAREN is fully tailored for posture and balance-related applications, containing components including a hydraulic six-DOF motion base, two-millimeter diameter platform top with integrated dual force plates, eight-camera real-time motion capture system, large flat-screen projection system, surround sound system and the D-flow software package.

The CAREN Extended system represents a significant upgrade from the CAREN Base, with the major differences being the additions of a dual-belt instrumented treadmill mounted on the motion base and a wider peripheral vision scope. Bespoke for both balance and all gait applications, the CAREN Extended contains a cylindrical projection system that allows for peripheral vision up to 180 degrees. The system’s components are a six-DOF motion base, three-millimeter diameter platform top with aforementioned dual-belt instrumented treadmill, 10-camera real-time motion capture system, the aforementioned projection system with 120 to 180-degree cylindrical screen, surround sound system and the D-flow software.

The range-topping CAREN High-End model represents the most advanced setup, boasting a 360-degree dome for a “full-immersion virtual reality experience.” Additional components of this product include a six-DOF motion base with 1,000-kg payload, three-millimeter diameter platform top with dual-belt instrumented treadmill, 18-camera real-time motion capture system, spherical dome projection, surround sound system and, of course, the D-flow software architecture. Amongst the facilities utilizing this advanced CAREN system are the Brooke Army Medical Center in Texas and the SHEBA Medical Center in Tel Aviv, Israel.

Supplementing all CAREN configurations are Motek Medical-provided integrated components designed to further enhance the use of the systems. These consist of EMG (Electro-Myography), video capture, tailored motion capture suits, data gloves, haptic systems, energy consumption system, pressure measurement systems, heart rate measurement systems and head mount displays. Usage of CAREN before the day it has been brought to common people Within the annals of CAREN’s beginnings, the technology was being used primarily by scientific and military organizations because of the sheer complexity of its modern intricacies and somewhat complicated testing. Usage of CAREN nowadays Today, there has been a great use for Motek Medical’s CAREN in the medical practitioners area, with the first private clinic to use the system for a civilian demographic being New York’s Dynamic Neuromuscular Rehabilitation & Physical Therapy, founded by Dr. Lev Kalika. The Cleveland Clinic was the next facility to look into CAREN for more personal, rehabilitative and medical applications, and as of now – the close of 2014 – these two clinics are the only ones of their kind using the CAREN system in the U.S.


1. David Jessop, Laurent Bouyer, McFadyen BJ Vestibulo-visual integration for postural stability during standing Presented at International Symposium on Posture and Gait, Bologna, Italy, July 2009; Submitted to J. Neurophysiology

2. Fung J, Malouin F, McFadyen BJ, Comeau F, Lamontagne A, Chapdelaine S, Beaudoin C, Laurendeau D, Hughey L, Richards CL. Locomotor rehabilitation in a complex virtual environment. Conf Proc IEEE Eng Med Biol Soc. 2004;7:4859-61. Jewish Rehabilitation Hospital, McGill University, Montreal, Quebec, Canada.

3.Viau A, Feldman AG, McFadyen BJ, Levin MF. Reaching in reality and virtual reality: a comparison of movement kinematics in healthy subjects and in adults with hemiparesis. J Neuroeng Rehabil. 2004 Dec 14;1(1):11. Center for Interdisciplinary Research in Rehabilitation (CRIR), 6300 Darlington, Montreal, Quebec, Canada.

4.Fung J, Richards CL, Malouin F, McFadyen BJ, Lamontagne A. A treadmill and Motion Coupled Virtual Reality System for Gait Training Post-Stroke. Cyberpsychol Behav. 2006 Apr;9(2):157-62. 2006 Apr;9(2):157-62. Jewish Rehabilitation Hospital (CRIR), McGill University, Montreal, Canada.

5. Bugnariu N, Fung J. Aging and selective sensorimotor strategies in the regulation of upright balance. J Neuroeng Rehabil. 2007 Jun 20;4:19. SourceSchool of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Room 3057, Ottawa, Ontario, K1H 8M5, Canada.

6.Antonie J. van den Bogert, Thomas Geijtenbeek, Oshri Even-Zohar Real-Time Biomechanical Analysis for Virtual Reality Based Rehabilitation

7.A.J. van den Bogert, T. Geijtenbeek, O. Even-Zohar Virtual Rehabilitation International Conference, 2009 Evaluation of a system for real-time analysis of muscle function: Shoulder and elbow muscles

8.J Biomech. 2012 Aug 9;45(12):2084-91. doi: 10.1016/j.jbiomech.2012.05.039. Epub 2012 Jun 29. Effects of perturbation magnitude on dynamic stability when walking in destabilizing environments. Sinitksi EH1, Terry K, Wilken JM, Dingwell JB. Author information 1Center for the Intrepid, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Ft. Sam Houston, TX 78234, USA.

9. Age Effects on Mediolateral Balance Control L. Eduardo Cofre ́ Lizama1, Mirjam Pijnappels1, Gert H. Faber1, Peter N. Reeves2, Sabine M. Verschueren3, Jaap H. van Diee ̈n1* 1MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands, 2College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States of America, 3 Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium

10. van der Eerden WJ, Otten E, May G, Even-Zohar O. Stud Health Technol Inform. 1999;62:373-8.

11.Antonie J. van den Bogert, Thomas Geijtenbeek, Oshri Even-Zohar, Frans Steenbrink and Elizabeth C. Hardin. Medical & Biological Engineering & Computing Open acces:

12. T. Geijtenbeek, F. Steenbrink, E. Otten, O. Even-Zohar VRCAI '11 Proceedings of the 10th International Conference on Virtual Reality Continuum and Its Applications in Industry D-flow: immersive virtual reality and real-time feedback for rehabilitation

13.Collins, J. D., Markham, A., Service, K., Reini, L. S., Wolf, E., & Sessoms, P. (2014). A systematic literature review of the use and effectiveness of the computer assisted rehabilitation environment for research and rehabilitation as it relates to the wounded warrior. Work: A Journal of Prevention, Assessment and Rehabilitation.

14.Clin Orthop Relat Res. 2014 Oct;472(10):3076-84. doi: 10.1007/s11999-014-3664-0. Task-specific fall prevention training is effective for warfighters with transtibial amputations. Kaufman KR1, Wyatt MP, Sessoms PH, Grabiner MD.

15.Isaacson, B. M., Swanson, T. M., & Pasquina, P. F. (2013). The use of a computer-assisted rehabilitation environment (CAREN) for enhancing wounded warrior rehabilitation regimens. The Journal of Spinal Cord Medicine, 36(4), 296–299. doi:10.1179/2045772313Y.0000000119