A “virtually minimal” visuo-haptic training of attention in severe traumatic brain injury

Abstract

BackgroundAlthough common during the early stages of recovery from severe traumatic brain injury (TBI), attention deficits have been scarcely investigated. Encouraging evidence suggests beneficial effects of attention training in more chronic and higher functioning patients. Interactive technology may provide new opportunities for rehabilitation in inpatients who are earlier in their recovery.MethodsWe designed a “virtually minimal” approach using robot-rendered haptics in a virtual environment to train severely injured inpatients in the early stages of recovery to sustain attention to a visuo-motor task. 21 inpatients with severe TBI completed repetitive reaching toward targets that were both seen and felt. Patients were tested over two consecutive days, experiencing 3 conditions (no haptic feedback, a break-through force, and haptic nudge) in 12 successive, 4-minute blocks.ResultsThe interactive visuo-haptic environments were well-tolerated and engaging. Patients typically remained attentive to the task. However, patients exhibited attention loss both before (prolonged initiation) and during (pauses during motion) a movement. Compared to no haptic feedback, patients benefited from haptic nudge cues but not break-through forces. As training progressed, patients increased the number of targets acquired and spontaneously improved from one day to the next.ConclusionsInteractive visuo-haptic environments could be beneficial for attention training for severe TBI patients in the early stages of recovery and warrants further and more prolonged clinical testing.

The Effectiveness of Virtual Reality Interventions for Improvement of Neurocognitive Performance After Traumatic Brain Injury: A Systematic Review

“…Another study 33 used a novel VR system with a robotic arm providing haptic cues in a target acquisition task, which was received well by users and a reduction in frequency of problematic behaviour was noticed during treatment. The same group 13 corroborated these findings and demonstrated potential benefits to attention in patients with severe TBI.…”

“…Subsequently, case studies were also included to illustrate a more detailed account of current advances. VR interventions are diverse, ranging from simple game console based tasks 23 to the use of robotics 13,33 . Thus, rapid advances over the years means that the use of technology across included studies is not truly uniform.…”

“…Essentially, VR technology is proving to be a discernible tool in the assessment, diagnosis, and treatment of chronic neurological and psychiatric disorders. It is well suited to this purpose as it provides: (i) a safe environment to practise activities of daily living (ADLs); (ii) the opportunity to tailor treatment modalities to the individual; (iii) tasks can be subjectively entertaining 13 , thereby circumventing issues associated with demotivation. The aim of this article is to provide a systematic review of the evidence available on effectiveness of VR technology in improving cognitive performance in patients with TBI, and translation into real-life situations.…”

Clinical Efficacy of Attentional Bias Modification Procedures: An Updated Meta-Analysis

“…The following criteria were applied for inclusion in the meta‐analysis: (a) the study was designed to manipulate AB to reduce symptoms and lower emotional vulnerability (in the latter case, to be included a study should have included at least one measure of distress); (b) the study assessed clinically relevant symptoms; (c) participants were randomized to training conditions; (d) a control condition (defined as sham training) existed; (e) the study was written in English and published/accepted for publication in a peer‐reviewed journal; (f) sufficient data to compute effect size were available. We did not include studies that investigated the effect of other types of cognitive bias modification (e.g., interpretation bias; see Amir, Bomyea, & Beard, ; Brosan, Hoppitt, Shelfer, Sillence, & Mackintosh, ) or used attention (re)training to improve attention functioning and not for modifying AB (Dvorkin et al., ) or symptoms (e.g., Van Bockstaele, Koster, Verschuere, Crombez, & De Houwer, ).…”

Tablet technology during stroke recovery: a survivor’s perspective

“…There are data to suggest these devices may be effective in improving: memory, an individual's sense of control, communication and overall independence [4,15,16]. There is very little evidence, if any, concerning the use of tablet technology use by stroke survivors [17,18].…”