No abstract

Background Neurological rehabilitation is technologically evolving rapidly, resulting in new treatments for patients. Stroke, one of the most prevalent conditions in neurorehabilitation, has been a particular focus in recent years. However, patients often need help with physical and cognitive constraints, whereby the cognitive domain in neurorehabilitation does not technologically exploit existing potential. Usually, cognitive rehabilitation is performed with pen and paper or on a computer, which leads to limitations in preparation for activities of daily living. Technologies such as virtual reality (VR) can bridge this gap. Objective This pilot study investigated the use of immersive VR in cognitive rehabilitation for patients undergoing inpatient neurorehabilitation. The goal was to determine the difference in rehabilitation effectiveness between a VR serious game that combines everyday activities with cognitive paradigms and conventional computerized cognitive training. We hypothesized the superiority of the VR serious game regarding cognitive abilities and patient-reported outcomes as well as transfer to daily life. Methods We recruited 42 patients with acute brain affection from a German neurorehabilitation clinic in inpatient care with a Mini Mental Status Test score >20 to participate in this randomized controlled trial. Participants were randomly assigned to 2 groups, with 1 receiving the experimental VR treatment (n=21). VR training consisted of daily life scenarios, for example, in a kitchen, focusing on treating executive functions such as planning and problem-solving. The control group (n=21) received conventional computerized cognitive training. Each participant received a minimum of 18 treatment sessions in their respective group. Patients were tested for cognitive status, subjective health, and quality of life before and after the intervention (Alters-Konzentrations-Test, Wechsler Memory Scale—Revised, Trail Making Test A and B, Tower of London—German version, Short Form 36, European Quality of Life 5 Dimensions visual analog scale, and Fragebogen zur Erfassung der Performance in VR). Results Repeated-measures ANOVA revealed several significant main effects in the cognitive tests: Tower of London—German version (P=.046), Trail Making Test A (P=.01), and Wechsler Memory Scale—Revised (P=.006). However, post hoc tests revealed that the VR group showed significant improvement in the planning, executive control, and problem-solving domains (P=.046, Bonferroni P=.02). In contrast, no significant improvement in the control group between t0 and t1 was detected (all P>.05). Furthermore, a nonsignificant trend was observed in visual speed in the VR group (P=.09, Bonferroni P=.02). Conclusions The results of this pilot randomized controlled trial showed that immersive VR training in cognitive rehabilitation had greater effectiveness than the standard of care in treating patients experiencing stroke in some cognitive domains . These findings support the further use and study of VR training incorporating activities of daily living in other neurological disorders involving cognitive dysfunction. Trial Registration Federal Registry of Clinical Trials of Germany (DRKS) DRKS00023605; https://drks.de/search/de/trial/DRKS00023605

BACKGROUND Neurological rehabilitation is rapidly evolving in the technological domain, resulting in new treatment options for patients suffering the consequences of a neurological disease. Stroke, which is one of the most prevalent conditions in neurological rehabilitation, has been a particular focus in recent years. Patients often suffer from physical and cognitive constraints, whereby the cognitive domain in neurorehabilitation does not technologically exploit the potential that already exists. Often, cognitive rehabilitation is done with pen and paper or on a computer, which leads to limitations in terms of preparation for activities of daily living. Technologies such as virtual reality can bridge this gap. OBJECTIVE This pilot study was designed to study the use of immersive VR in cognitive rehabilitation for patients in inpatient neurorehabilitation. The goal was to determine the difference between rehabilitation effectiveness with VR training that combines everyday activities with cognitive paradigms and a conventional computerized cognitive training used in standard care. METHODS We recruited patients with acute brain affection from a XXXXX neurorehabilitation clinic in inpatient care with MMST>20 to participate in this randomized controlled clinical trial, consisting of two parallel groups, one receiving the experimental VR treatment. Each participant received a minimum of 18 treatment sessions in the group assigned before intervention start. The VR-training consists of scenarios relevant to daily life, e.g. a kitchen, focusing on treating executive functions like planning and problem solving. The control group received conventional computerized cognitive training. Patients were tested prior to and after the intervention. RESULTS Repeated measures ANOVA revealed several significant main effects in cognitive tests. The VR-group showed significant improvement in post-hoc tests in the domains of planning, executive control and problem solving. No significant improvement in the control group between t0 and t1 was detected. Further, some non-significant trends were observed in the VR-group in visual speed and subjective health state. CONCLUSIONS The results of this trial indicate greater effectiveness for use of immersive VR training in cognitive rehabilitation compared to standard of care in the treatment of patients suffering from stroke in some cognitive domains in a randomized controlled pilot trial. The findings support the further use and study of VR training incorporating activities of daily living in other neurological disorders involving cognitive dysfunction CLINICALTRIAL The trial has been registered at the Federal Registry of Clinical Trials of XXXXXXX (DRKS) and according to European law in the registry for medical devices EUDAMED.