Does Non-Immersive Virtual Reality Improve Attention Processes in Severe Traumatic Brain Injury? Encouraging Data from a Pilot Study

Abstract

Traumatic brain injury (TBI) is a sudden injury that causes damage to the brain. Rehabilitation therapies include specific training, such as attention process training (APT) programs using either standard or innovative approaches. The aim of this study is to evaluate the effects of a non-immersive virtual reality-based attention training to stimulate attention processes and mood in TBI patients. Thirty subjects with TBI were enrolled at the Neurorehabilitation Unit of the IRCCS Neurolesi Center and divided into either the Conventional Attention Process Training Group (C_APT: n = 15) or the Virtual-Based Attention Processes Training Group (VB_APT: n = 15), treated with the Virtual Reality Rehabilitation System (VRRS-Evo). All of the patients were evaluated with a specific psychometric battery before (T0) and after the end (T1) of each program. We found statistically significant differences between the two groups, in particular concerning global cognitive status (p < 0.02), attention processes (p < 0.03), depression symptoms (p < 0.04) and visual attention (p < 0.01). Experimental intragroup analysis showed great statistical significances in all psychometric tests, i.e., the Montreal Cognitive Assessment (p < 0.0006), Attention Matrices (p < 0.0007), the Hamilton Rating Scale-Depression (p < 0.004), the Trail Making Test-A (p < 0.0007), the Trail Making Test-B (p < 0.0007), and the Trail Making test-BA (p < 0.007). Our results suggest that non-immersive virtual reality may be a useful and effective approach for the attention processes recovery and mood of TBI patients, leading to better cognitive and behavioral outcomes.

Innovative Technologies in the Neurorehabilitation of Traumatic Brain Injury: A Systematic Review

“…Five clinical studies [ 32 , 33 , 36 , 37 ] and two systematic reviews [ 34 , 35 ] on the cognitive effects of VR systems in TBI Neurorehabilitation were included. In particular, VR was used in two pilot studies [ 32 , 33 ] for the training of attention processes: a visuo-haptic virtual environment and a virtual touch modality by means of the Virtual Reality Rehabilitation System (VRRS) were used to improve cognitive function.…”

“…Five clinical studies [ 32 , 33 , 36 , 37 ] and two systematic reviews [ 34 , 35 ] on the cognitive effects of VR systems in TBI Neurorehabilitation were included. In particular, VR was used in two pilot studies [ 32 , 33 ] for the training of attention processes: a visuo-haptic virtual environment and a virtual touch modality by means of the Virtual Reality Rehabilitation System (VRRS) were used to improve cognitive function. The two systematic reviews investigated VR gaming for cognitive treatment of moderate TBI, demonstrating that VR tools may improve memory and executive function in patients with TBI, while for attention training, weak evidence still exists [ 34 , 35 ].…”

“…To the best of our knowledge, this is the first systematic review that investigates the use of robotics and other technologies in moderate to severe TBI rehabilitation. Indeed, most existing reviews are focused only/mainly on VR approaches and cognitive telerehabilitation [ 33 , 34 , 40 ] and do not offer an overview of the most innovative approaches for both motor and cognitive rehabilitation in this patient population.…”

“… On the other hand, the C-BT, as well as VR systems, are widely used in severe and moderate TBI patients to train cognitive functions. VRRS allows a specific subdomain training and, thanks to its big screen, provides a wider view of space and facilitates the execution of cognitive tasks [ 33 , 38 ], whereas moderate TBI could take advantage of C-BT, which requires more control in the upper limb [ 39 , 40 ]. Another useful innovative approach is TR; despite the poor evidence in the TBI population, it can be useful in ensuring continuity of care between discharge from the hospital and return to home [ 42 ], avoiding travelling costs and geographical barriers for patients living far from metropolitan areas [ 65 , 66 ].…”

“…Rehabilitation System [33] Il Khymeia VRRS-Virtual Reality Rehabilitation System-is the most widely used for VR training and teletraining in clinical practice. The VRRS, in fact, is conceptualised with a "central HUB" that can be connected via USB, a series of specialised peripherals fully synchronised and integrated with the system.…”