Improving Cognitive Function after Traumatic Brain Injury: A Clinical Trial on the Potential Use of the Semi-Immersive Virtual Reality

Abstract

Traumatic brain injury (TBI) is the most common cause of long-term disability and death among young adults, and it represents an enormous socioeconomic and healthcare burden. Our purpose is to evaluate the effects of a virtual reality training with BTs-Nirvana (BTs-N) on the recovery of cognitive functions in TBI subjects, using the interactive semi-immersive program. One hundred patients with TBI were enrolled in this study and randomized into either the Traditional Cognitive Rehabilitation Group (TCRG: n=50) or the Virtual Reality Training Group (VRTG: n=50). The VRTG underwent a VRT with BTs-N, whereas the TCRG received a standard cognitive treatment. Each treatment session lasted 60 minutes and was repeated three times a week for 8 weeks. All of the patients were evaluated by a specific psychometric battery before (T0) and immediately (T1) after the end of the training. VRTG and TCRG had a significant improvement in cognitive functioning and in mood, but only VRTG presented with a significant increase in cognitive flexibility and shifting skills and in selective attention. In conclusion, our results suggest that VR may be a useful and effective approach for the rehabilitation of patients with TBI, leading to better cognitive and behavioral outcomes.

Virtual Reality for Neurorehabilitation and Cognitive Enhancement

“…Significant improvements in learning following a VR exercise program are thought to be associated with changes in neuronal plasticity that enhance the working memory [ 139 ]. VR also significantly increases cognitive flexibility, shifting skills, and selective attention, leading to better behavioral outcomes in brain-injured patients [ 140 ]. Improvement in selective memory processes and problem-solving skills facilitate social reintegration and leads to better vocational outcomes [ 141 ].…”

Virtual Reality Based Cognitive Rehabilitation in Minimally Conscious State: A Case Report with EEG Findings and Systematic Literature Review

“…To stimulate our patient, we used the Nirvana system, which creates a VR semi-immersive environment, allowing to observe a three-dimensional scene projected on a screen: the playful environment could increase patient’s compliance, amplifying the effects of the rehabilitation treatment tailored to the actual needs of the patients [ 31 , 66 , 67 ]. Various studies have shown that VR activates different perceptual and experiential aspects, with the stimulation of multiple perceptual channels, thanks to the use of auditory and visual feedback [ 13 , 14 , 32 , 33 ]. This complex sensory stimulation may increase the patient’s awareness of his/her performance, inducing changes in neural plasticity processes [ 13 , 14 , 56 , 68 , 69 , 70 ].…”

“…Second, the identification of spatially and temporally distributed brain responses, which are unlikely when awareness is not present or not entrained [ 74 ]. Therefore, these indices may be useful to evaluate adequately motor-cognitive outcomes (with particular regard to anchoring and visual), and to monitor EEG responsiveness to a task (sensorimotor rhythms reshape) even in a VR environment, where it is suggested that the patient could be more stimulated [ 13 , 14 , 32 , 33 ]. In the current literature, two studies integrated VR with ERPs on patients with DoC by using the Neurowave (Khymeia SRL; Padua, Italy) a technologically advanced device that allows the automated programming and administration of sensory stimuli and the simultaneous monitoring of multiple biophysiological signals [ 42 , 43 ].…”

Is the Weigl Colour-Form Sorting Test Specific to Frontal Lobe Damage?

“…The Weigl has been used with patients with a range of aetiologies, including stroke (Chan et al, 2017;Gregoire et al, 2013;Leeds et al, 2001), traumatic brain injury (Baird et al, 2005;De Luca et al, 2019), dementia (Byrne-Davis et al, 1998;Chiu et al, 2012;Tian et al, 2003), Parkinson's disease (Hobson et al, 2007), psychiatric illness (Tamkin, 1980;Tamkin & Kunce, 1982;Tamkin et al, 1984), and alcoholism (Tamkin & Dolenz, 1991). However, few studies have investigated the performance of patients with focal lesions.…”