Recommendations for the Design and Implementation of Virtual Reality for Acquired Brain Injury Rehabilitation: Systematic Review

Abstract

Background Virtual reality (VR) is increasingly being used for the assessment and treatment of impairments arising from acquired brain injuries (ABIs) due to perceived benefits over traditional methods. However, no tailored options exist for the design and implementation of VR for ABI rehabilitation and, more specifically, traumatic brain injury (TBI) rehabilitation. In addition, the evidence base lacks systematic reviews of immersive VR use for TBI rehabilitation. Recommendations for this population are important because of the many complex and diverse impairments that individuals can experience. Objective This study aims to conduct a two-part systematic review to identify and synthesize existing recommendations for designing and implementing therapeutic VR for ABI rehabilitation, including TBI, and to identify current evidence for using immersive VR for TBI assessment and treatment and to map the degree to which this literature includes recommendations for VR design and implementation. Methods This review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive search of 11 databases and gray literature was conducted in August 2019 and repeated in June 2020. Studies were included if they met relevant search terms, were peer-reviewed, were written in English, and were published between 2009 and 2020. Studies were reviewed to determine the level of evidence and methodological quality. For the first part, qualitative data were synthesized and categorized via meta-synthesis. For the second part, findings were analyzed and synthesized descriptively owing to the heterogeneity of data extracted from the included studies. Results In the first part, a total of 14 papers met the inclusion criteria. Recommendations for VR design and implementation were not specific to TBI but rather to stroke or ABI rehabilitation more broadly. The synthesis and analysis of data resulted in three key phases and nine categories of recommendations for designing and implementing VR for ABI rehabilitation. In the second part, 5 studies met the inclusion criteria. A total of 2 studies reported on VR for assessment and three for treatment. Studies were varied in terms of therapeutic targets, VR tasks, and outcome measures. VR was used to assess or treat impairments in cognition, balance, and anxiety, with positive outcomes. However, the levels of evidence, methodological quality, and inclusion of recommendations for VR design and implementation were poor. Conclusions There is limited research on the use of immersive VR for TBI rehabilitation. Few studies have been conducted, and there is limited inclusion of recommendations for therapeutic VR design and implementation. Future research in ABI rehabilitation should consider a stepwise approach to VR development, from early co-design studies with end users to larger controlled trials. A list of recommendations is offered to provide guidance and a more consistent model to advance clinical research in this area.

The sentiment of a virtual rock concert

“…Dietrich et al ( 2021 ) describe two case studies on VR applications for alcohol abuse prevention, and compare different co-design methodologies. Brassel et al ( 2021 ) provide a review of design principles for VR applications in the field of brain injury rehabilitation, and conclude that co-design is an important component.…”

Improving Care for Veterans with Traumatic Brain Injury Across the Lifespan

“…Likewise, three systematic reviews assessed the effects of physical rehabilitation on cognition, and one demonstrated positive effects in the general adult population (Fritz, Cheek, and Nichols-Larsen, 2015). Of the other two systematic reviews, one exclusively examined populations of veterans (Wilson et al, 2016), and one drew uncertain conclusions (Brassel et al, 2021). Four systematic reviews assessed the effects of occupational rehabilitation interventions on cognition.…”

“…Fourteen of those reviews demonstrated effectiveness (Bogdanova et al, 2016;Cicerone et al, 2005;Cicerone et al, 2011;Elliott and Parente, 2014;Fritz, Cheek, and Nichols-Larsen, 2015;Hallock et al, 2016;Kennedy et al, 2008;Lambez and Vakil, 2021;Little, Byrne, and Coetzer, 2021;O'Neil-Pirozzi, Kennedy, and Sohlberg, 2016;Park, Maitra, and Martinez, 2015;Radomski et al, 2016;Rodríguez-Rajo et al, 2018;Rohling et al, 2009), and two demonstrated no effect Virk et al, 2015). Additionally, three reviews had mixed findings (Cicerone et al, 2019;Roitsch et al, 2019;Steel, Elbourn, and Togher, 2021), and four characterized the evidence as uncertain (Ali, Viczko, and Smart, 2020;Brassel et al, 2021;Geraldo et al, 2018;Schrijnemaekers et al, 2014). Two systematic reviews assessed the effect of behavioral rehabilitation on cognitive outcomes, demonstrating effectiveness in the general adult population (Little, Byrne, and Coetzer, 2021) and uncertain conclusions in populations restricted to veterans (Wilson et al, 2016).…”

“…Eight studies assessed the effectiveness of virtual care in the general adult population. Five of the reviews demonstrated positive effects (Alashram et al, 2019;Betts et al, 2018;Bogdanova et al, 2016;Leopold et al, 2015;Voinescu, Sui, and Fraser, 2021), one found mixed effects (Manivannan et al, 2019), and two drew uncertain conclusions (Brassel et al, 2021;Buhagiar et al, 2020). Physical exercise was tested for cognitive effects in four systematic reviews.…”

Experiences of Patients Undergoing Chemotherapy With Virtual Reality: Mixed Methods Feasibility Study

“…This would enable a more personalized “prescription” of VR interventions to patients for whom it would be most useful. More recent research has noted the importance of considering patient characteristics such as motor, visual, or vestibular impairments in the design and implementation of VR for patients with acquired brain injuries, as lack of such consideration could be a barrier to the use of VR by this group [ 33 ].…”