Do Individuals with Spinal Cord Injury Benefit from Semi-Immersive Virtual Reality Cognitive Training? Preliminary Results from an Exploratory Study on an Underestimated Problem

Abstract

A spinal cord injury (SCI) is damage to any part of the spinal cord, caused by traumatic or non-traumatic events. Clinically, SCI is associated with partial or complete loss of motor, sensory, and autonomic functions below the site of injury. However, cognitive alterations in specific domains can also occur. The aim of this study was to evaluate the effects of semi-immersive virtual reality (VR) cognitive training (using the BTS Nirvana, Italy) in promoting global functional recovery in patients with SCI. Forty-two SCI patients were included in this retrospective case-control study, and the analysis was carried out using an electronic data retrieval system. The enrolled patients were divided into two groups with the same demographic and medical characteristics: the control group (CG: 21 patients) participated in traditional therapy, whereas the experimental group (EG: 21 patients) received training using semi-immersive VR. In both groups, there were patients with A- or B-grade impairments according to the American Spinal Injury Association (ASIA) scale. Both study groups underwent the same amount of cognitive training (but using a different type of training: conventional vs. innovative), consisting of three weekly sessions for eight weeks (24 sessions in total), each session lasting approximately sixty minutes, as well as the same amount of physiotherapy. The effect of the two treatments (EG/CG) was significantly different in global cognitive functioning (MOCA: p = 0.001), mood (BDI: p = 0.006), and overall quality of life (SF12 Total: p < 0.001), especially in physical perception (SF12-Physics: p = 0.004). Our results suggest that SCI patients could benefit from cognitive training using semi-immersive VR. Indeed, the integration of cognitive exercises that require movement and provide increased feedback could allow for better motor and cognitive recovery in people with SCI.

Improving Outcomes in People with Spinal Cord Injury: Encouraging Results from a Multidisciplinary Advanced Rehabilitation Pathway

“…This study provided evidence of benefits for both motor and cognitive outcomes [22,23]. Consequently, VR emerges as a valuable tool in promoting multi-sensory stimulation, engaging the cortical sensory-motor network and subcortical brain regions, thereby potentially enhancing motor and cognitive functions [16,17,22]. Thus, there arises the necessity to adopt an integrated approach that combines conventional rehabilitation methodologies with technological innovations, such as VR and robotics.…”

“…Indeed, in a case report and recent study [21,22], our group demonstrated the efficacy of training using a non-immersive VR system in individuals with SCI. This study provided evidence of benefits for both motor and cognitive outcomes [22,23]. Consequently, VR emerges as a valuable tool in promoting multi-sensory stimulation, engaging the cortical sensory-motor network and subcortical brain regions, thereby potentially enhancing motor and cognitive functions [16,17,22].…”

“…Although SCI directly impacts movement and sensation but does not have a direct effect on cognition, a systematic review reveals that up to 64% of individuals with SCI exhibit some degree of cognitive impairment [20]. Indeed, in a case report and recent study [21,22], our group demonstrated the efficacy of training using a non-immersive VR system in individuals with SCI. This study provided evidence of benefits for both motor and cognitive outcomes [22,23].…”

A Systematic Review: Exercise Based Approaches to Activate Central Pattern Generator in Spinal Cord Injury Survivors

“…Exercise also acts as neuroprotective therapy. Findings of the studies have been justified with the fact that exercise-based approach cannot induce neural firing however it is believed to modulate the increased rate of spontaneous neuronal firing specific to activate the CPG for Locomotion thus justifying the synergistic effects with the better functional outcome at the end [24][25][26][27]. However, extensive variability was observed in terms of intervention dosage, frequency and variety of exercises such as intensity of activity, duration of activity, repetition of activity, number and frequency of sessions [28,29].…”

The Role of Immersive Virtual Reality Interventions in Pediatric Cerebral Palsy: A Systematic Review across Motor and Cognitive Domains

“…By simulating real-world scenarios and activities, VR allows people to improve cognitive and motor abilities in a safe and controlled environment. Furthermore, VR holds promise in spinal cord injury rehabilitation, providing opportunities for motor and sensory retraining, as well as psychological support through immersive experiences [19]. These diverse applications highlight the potential of VR to transform neuromotor rehabilitation, offering innovative and personalized interventions tailored to individuals' unique neurological needs.…”