Perception and Performance on a Virtual Reality Cognitive Stimulation for Use in the Intensive Care Unit: A Non-randomized Trial in Critically Ill Patients

Abstract

Background: Newly acquired long-term cognitive impairments are common among survivors of critical illness. They have been linked to the stressful situation that patients experience in the intensive care unit (ICU). In this paper we use virtual reality (VR) technology to comfort critically ill patients and reduce stress during their ICU stay. We investigate the acceptance, comfort, recollection, and visual perception of VR stimulation and how it affects physiological parameters. Methods: A VR head-mounted display was used to present immersive nature scenes to 33 critically ill cardiac surgery patients [mean age 63 years (range 32-83)]. Data was collected with an eye tracker fitted inside the VR head-mounted display to measure eye movements (250 Hz) and sensors to record physiological parameters (240 Hz). Patients received VR stimulation (for 5 min.) prior to ICU admission, during ICU stay, and 3 months after discharge. Acceptance, recollection and comfort were assessed with validated questionnaires. Results: The number of gazed meaningful objects per minute was significantly lower during the ICU session compared to pre-and follow-up sessions, whereas mean duration of fixation on meaningful moving objects did not differ between the sessions. While respiratory rate decreased significantly during VR stimulation, heart rate and blood pressure remained constant. Post-ICU rating of VR acceptance during ICU stay was moderate to high and discomfort low. Recollection of VR was high [28/33 patients (84.8%)], while recollection of ICU stay was low [10/33 patients (30.3%)]. Conclusion: Eye movements indicate that patients were able to perceive and process cognitive stimulation during their ICU stay. VR was recalled better than the rest of the ICU stay and well accepted. Decreased respiratory rate during stimulation indicate a relaxing effect of VR.

Virtual Reality Tailored to the Needs of Post-ICU Patients: A Safety and Immersiveness Study in Healthy Volunteers

“…In line with previous findings on VR modalities in the intensive care, our results show that this newly designed ICU-VR module is safe ( 31 – 33 ). As noted previously, a VR meditative intervention can be implemented during an ICU stay ( 17 ).…”

“…This 29-item self-report tool measures volunteers’ involvement in many different daily activities such as watching television, reading books, or enjoying movies. Those who have the ability to become more involved or engrossed in these activities will also have greater immersive tendencies and will more easily feel present in virtual environments ( 30 ).…”

Immersive 3D Virtual Reality Cancellation Task for Visual Neglect Assessment: A Pilot Study

“…Firstly, the ratings of acceptance and usability were very high and close to the maximum score. Gerber et al (2019a) found similar values, using a comparable technical setup with critically ill patients in the intensive care unit (ICU). Secondly, the ratings in the SSQ showed very low values, thus reflecting a safe device regarding cybersickness.…”

“…After having finished the task, all participants were asked to fill out a questionnaire on usability, negative effects, and general demographic data. The questionnaire was slightly adapted, for our study, from Gerber et al (2019a). The content regarding usability was based on the System Usability Scale (SUS; Brooke, 1996), the content regarding side effects on the Simulator Sickness Questionnaire (SSQ; Kennedy et al, 1993).…”

Head-Mounted Display-Based Application for Cognitive Training

“…These systems can be used to avoid bad habits, addictions or aggressive behavioral responses [ 30 , 31 , 32 ]. Cognitive stimulation is a fundamental strategy for the improvement and rehabilitation of mental capacities and executive functions, such as memory, attention, processing speed, and contextual learning [ 33 , 34 ], evaluating in this way the behavior of the participants and improving the conditions that unbalance their state of mental well-being [ 35 ]. Although the literature does not allow establishing the full effectiveness of IVR to counteract disorders such as dementia, potential distractors are reduced and the experience of people with mild cognitive impairment is improved [ 36 ].…”