Benefits of Telerehabilitation for Patients With Severe Acquired Brain Injury: Promising Results From a Multicenter Randomized Controlled Trial Using Nonimmersive Virtual Reality

Abstract

Background In neurorehabilitation, the use of innovative technologies offers many opportunities to monitor and improve the health status of patients with severe acquired brain injury (SABI). Telerehabilitation allows for continuity of service through the entire rehabilitation cycle, including assessment, intervention, consultation, and education, affording early reintegration and positively enhancing the quality of life (QoL). Objective The main purpose of this multicenter randomized controlled trial was to test the effectiveness of advanced training provided using a nonimmersive virtual reality rehabilitation system (ie, the VRRS HomeKit device) in improving functional outcomes in patients with SABI. Methods In total, 40 patients with SABI and their 40 caregivers visiting 2 Italian rehabilitation centers were enrolled in the study protocol and randomized into 2 groups. Of the 40 patients, 20 (50%) underwent the experimental training using the VRRS HomeKit (teleneuro-VRRS group), whereas the other 20 (50%) were administered usual territorial rehabilitative treatments (UTRTs; control group). To investigate motor and neuropsychological functioning, patients with SABI were evaluated before (T0) and at the end of (T1) each training session by a multispecialist team through a complete clinical and psychometric battery: the Barthel Index (BI), the Tinetti Scale (TS), the Modified Ashworth Scale (MAS), the Montreal Cognitive Assessment (MoCa), the Frontal Assessment Battery (FAB), the Beck Depression Inventory II (BDI-II), the Short Form Health Survey 36 (SF-36), and the Psychological General Well-Being Index (PGWBI). In addition, the Caregiver Burden Inventory (CBI) was administered to each caregiver to investigate the emotional burden status. Results The teleneuro-VRRS group achieved a statistically significant improvement in both general and motor outcomes, as well as psychological well-being and QoL, compared to the control group. In particular, the BI (P<.001), FAB (P<.001), and BDI-II (P<.001) were the outcome scales with the best improvement. The burden of caregivers also significantly improved in the teleneuro-VRRS group (CBI; P<.004). Between-group analysis showed statistical differences in the anxiety (effect size [ES]=0.85, P<.02) and self-control (ES=0.40, P<.03) subtests of the PGWBI and in the social role functioning (ES=0.85, P<.02) subtest of the SF-36, confirmed by quite medium and large ESs. Conclusions Our results suggest that the VRRS is a suitable alternative tool or complementary tool or both to improve motor (level of functional independence) and cognitive (frontal/executive abilities) outcomes, reducing behavioral alterations (anxiety and depression symptoms) in patients with SABI, with a beneficial impact also on the caregivers’ burden distress management, mitigating distress and promoting positive aspects of caring. Trial Registration ClinicalTrials.gov NCT03709875; https://classic.clinicaltrials.gov/ct2/show/NCT03709875

Effects of Virtual Reality Cognitive Training on Neuroplasticity: A Quasi-Randomized Clinical Trial in Patients with Stroke

“…Third, we did not assess any behavioral tools after the intervention, so we cannot determine if and to what extent VR may have influenced our patients' clinical outcomes. Nonetheless, there is a lack of literature demonstrating that patients undergoing VR have superior (or at least the same) results than conventional training [65][66][67][68][69]. Also, this issue was outside the scope of the article, which focused on demonstrating the underpinning of VR-inducing neuroplasticity.…”

Use of Virtual Reality in Patients with Acquired Brain Injury: A Systematic Review

“…Improvements were found in the following areas: attention, flexibility, symbol learning, and execution abilities [19][20][21][22][23]. The tool also improved the emotional space of these patients in terms of mood and reduced the symptoms of anxiety and depression [24]. These studies found sex differences in which cognitive improvement was better in women than in men [21].…”

“…VR rehabilitation of brain injury patients was evaluated in five articles [19][20][21][22][23]. The effectiveness and verification of VR in rehabilitation programs with TBI patients were evaluated in six other articles [24][25][26][27][28][29]. VR rehabilitation in stroke patients has been discussed in an article [30].…”

“…Another study suggests that VRRS is a suitable alternative or complementary tool, or both at the same time, to improve motor (levels of functional independence) and cognitive (frontal/executive abilities) outcomes, reduce behavioral changes (symptoms of anxiety and depression) in patients with SABI, and also has a beneficial effect on pain relief for caregivers, reducing pain and encouraging positive aspects of compassion [24]. Another program, such as Virtual Reality Shopping Tasks (VRST), demonstrates its environmental value and is a sensitive indicator of future memory dysfunction after TBI [25].…”

Smartphone-Based Cognitive Telerehabilitation: A Usability and Feasibility Study Focusing on Mild Cognitive Impairment

“…Another pearl from the study regarding the use of remote home training via mobile apps is the low-cost implementation for the NHS in guaranteeing the continuity of healthcare assistance [ 56 ]. In fact, other telerehabilitation systems, like Virtual Reality Rehabilitation System (VRRS)-HomeKit, are more expensive [ 57 ], costing around EUR 36,000. In contrast, the Rehastart app can be downloaded free, reducing expenditure on healthcare.…”