Motion-based virtual reality cognitive training targeting executive functions in acquired brain injury community-dwelling individuals: A feasibility and initial efficacy pilot

Abstract

Acquired brain injury (ABI) is a leading cause of long-term cognitive disability, often involving deficits in executive functions (EF). ABI patients usually stop receiving cognitive treatment when leaving the rehabilitation facility or shortly thereafter, due to the high cost of therapy sessions and the mobility requirement to access therapy. Software solutions offer a promising tool for accessible and affordable cognitive rehabilitation in the home environment. However, research provides limited evidence for effective transfer of benefits from computerized cognitive training to real-life functions. Virtual reality (VR) exergames using motion-interaction offer a more realistic and natural training environment, and are therefore expected to facilitate a more effective transfer. Although commercial exergames may bring about some cognitive gains, they usually do not target cognitive functions directly. Here we describe a novel exergames platform, the Active Brain Trainer (ABT), designed to directly target EF, using games in multiple realistic contexts. The software adapts in real-time to the patient's behavior, providing feedback and rewards, and hence may enhance usability and compliance. The primary goal of the current study is to assess the feasibly and acceptability of this platform for community-dwelling ABI patients during the chronic phase. A secondary goal is to assess the initial efficacy on EF and functional benefits from program training. Participants were instructed to use the games for 15-20 sessions. Neuropsychological assessments of EF and daily life functions were performed before and after training. Participants also filled a satisfaction questionnaire following training. All training and assessments were conducted in the participants' homes. Game performance was recorded throughout training sessions. Preliminary results from the six ABI patients who successfully completed the program so far show no adverse effects. Participants reported enjoyment and satisfaction from training. Participants performed increasingly more challenging EF tasks within game environments. Initial results show improvements in functional tasks and most executive neuropsychological assessments following training. Additional participants are currently being trained to increase the power of the results. These preliminary findings support the feasibility and potential efficacy of the motion-based cognitive training of EF for community-dwelling individuals with ABI.

Available Virtual Reality-Based Tools for Executive Functions: A Systematic Review

“…Interestingly, participants reported enjoyment and satisfaction from training without adverse effects, declaring interest in including it in their treatment. Indeed, subjects supported that this training allowed them to be engaged in increasingly challenging EF activities, with a high impact on their motivation and adherence (Shochat et al, 2017 ). These findings are crucial because patients with ABI usually stop receiving cognitive treatment when they leave the rehabilitation due to the high cost of therapy sessions and mobility to access therapy.…”

“…To work on EFs through games in multiple realistic contexts, Shochat et al decided to implement a novel exergames platform, the Active Brain Trainer (ABT) (Intendu Ltd., Herzliya, Israel) (Shochat et al, 2017 ). This software adapts to the patient's behaviour in real-time and provides feedback and rewards, improving usability and compliance.…”

“…Shochat et al showed the feasibility, potential efficacy and acceptability (good satisfaction and absence of adverse effects) of this new exergames platform for the treatment at home of executive functioning in patients with ABI (Shochat et al, 2017 ). Interestingly, participants reported enjoyment and satisfaction from training without adverse effects, declaring interest in including it in their treatment.…”

A Review on Serious Games for Exercise Rehabilitation

“…The most common assessment method used by researchers is the existing clinical scale. Before the execution of SGER, [27] used the Montreal Cognitive Assessment(MoCA) to assess the patient's level of cognitive impairment. After the execution of SGER, [24] used Cognitive Abilities Screening Instrument Chinese version (CASI C-2.0) and Berg Balance Scale (BBS) to assess the status of patients' cognitive rehabilitation; [31] used subtests of the Illinois Test for Psycholinguistic Aptitudes (ITPA) to evaluate the patient's visual comprehension, visual association, visual integration, and visual-motor sequential memory; [27] used Executive Function Performance Test (EFPT), Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research (NIH-EXAMINER), and Dysexecutive Questionnaire (DEX) to assess the patient's executive functions.…”

“…VR and AR environments are suitable for players to perform SGER for cognitive rehabilitation. Active Brain Trainer (ABT) [27] was a platform based on VR. Shochat et al used the platform's games to treat patients with acquired brain injury.…”