Virtual enriched environments in paediatric neuropsychological rehabilitation following traumatic brain injury: Feasibility, benefits and challenges

Abstract

A frequent consequence of traumatic brain injury (TBI) is a significant reduction in patients' cerebral activation/arousal, which clinicians agree is not conducive to optimal rehabilitation outcomes. In the context of paediatric rehabilitation, sustained periods of inactivity are particularly undesirable, as contemporary research has increasingly called into question the Kennard principle that youth inherently promotes greater neural plasticity and functional recovery following TBI. Therefore, the onus to create rehabilitation conditions most conducive to harnessing plasticity falls squarely on the shoulders of clinicians. Having noted the efficacy of environmental enrichment in promoting neural plasticity and positive functional outcomes in the animal literature, some researchers have suggested that the emerging technology of Virtual Reality (VR) could provide the means to increase patients' cerebral activation levels via the use of enriched Virtual Environments (VEs). However, 10 years on, this intuitively appealing concept has received almost no attention from researchers and clinicians alike. This paper overviews recent research on the benefits of enriched environments in the injured brain and identifies the potential and challenges associated with implementing VR-based enrichment in paediatric neuropsychological rehabilitation.

Vascular Endothelial Growth Factor: Adaptive Changes in the Neuroglialvascular Unit

“…It also reduces BBB damage induced by surgical injury and diminishes apoptotic, neuronal death while also improving vascularisation in the same model [115]. In humans, successful assays show the benefits of enriched environments in the injured brain and identify the potential and challenges associated with implementing environmental enrichment in pediatric neuropsychological rehabilitation [116].…”

Staging Perspectives in Neurodevelopmental Aspects of Neuropsychiatry: Agents, Phases and Ages at Expression

“…In consequence of this and a multitude of other investigations, the period of adolescence, which is characterized by elevated rates of brain plasticity, presents an important neurodevelopmental staging interval under the course of which brain and behavior sensitivity to environmental influence, restricted to greater or lesser degrees by epigenetic factors, is considered substantial (Darnaudery and Maccari 2008;Law et al 2009;Leo et al 2009. Marco et al (2010 have reported that both chemical (e.g., methylphenidate) and environmental (e.g., physical or social enrichment) interventions have the propensity to counteract Adriani et al 2006;Nithianantharajah and Hannan 2006;Navailles et al 2008;Pereira et al 2008;Zaias et al 2008;Penn et al 2009;Zakharova et al 2009) the detrimental effects of developments insults of prior origin (see Marco et al 2010 , Tables 1 and 2).…”

“…The adolescence period consists also of marked brain development and maturation of the HPA axis during which glucocorticoids influence programming effects on neurocircuitry involved in learning and memory (McCormick and Mathews 2009). There is a plethora of evidence emphasizing the notion that the adolescent brain requires a great deal of further development to reach maturity with wide-ranging changes in the prefrontal cortex (PFC) and mesolimbic regions (Giedd et al 1999;Sowell et al 2001;Güroglu et al 2009;Johnson et al 2009;Stevens et al 2009). Sturman and Moghaddam (2010) have indicated that adolescent rats were more susceptible to the functional activation evoked by internal and external motivating factors (e.g., hunger, or, cue presence on perseveration) during the extinction of a previously rewarded operant behavior.…”

Neurocognitive and Psychophysiological Interfaces for Adaptive Virtual Environments

“…The application of VR to neurocognitive assessment is considered by a growing body of researchers to be distinctively important because it represents the potential for more than a simple linear extension of existing computer technology for human use (Campbell et al, 2009;Carelli et al, 2009;Riva et al, 2004). For such researchers, it is important that VR does more than simply automate the paradigms of the past (Penn et al, 2009). Instead, virtual environments should provide a paradigm shift for the future.…”