Virtual Reality-Based Early Neurocognitive Stimulation in Critically Ill Patients: A Pilot Randomized Clinical Trial

Abstract

This study focuses on the application of a non-immersive virtual reality (VR)-based neurocognitive intervention in critically ill patients. Our aim was to assess the feasibility of direct outcome measures to detect the impact of this digital therapy on patients’ cognitive and emotional outcomes. Seventy-two mechanically ventilated adult patients were randomly assigned to the “treatment as usual” (TAU, n = 38) or the “early neurocognitive stimulation” (ENRIC, n = 34) groups. All patients received standard intensive care unit (ICU) care. Patients in the ENRIC group also received adjuvant neurocognitive stimulation during the ICU stay. Outcome measures were a full neuropsychological battery and two mental health questionnaires. A total of 42 patients (21 ENRIC) completed assessment one month after ICU discharge, and 24 (10 ENRIC) one year later. At one-month follow-up, ENRIC patients had better working memory scores (p = 0.009, d = 0.363) and showed up to 50% less non-specific anxiety (11.8% vs. 21.1%) and depression (5.9% vs. 10.5%) than TAU patients. A general linear model of repeated measures reported a main effect of group, but not of time or group–time interaction, on working memory, with ENRIC patients outperforming TAU patients (p = 0.008, ηp2 = 0.282). Our results suggest that non-immersive VR-based neurocognitive stimulation may help improve short-term working memory outcomes in survivors of critical illness. Moreover, this advantage could be maintained in the long term. An efficacy trial in a larger sample of participants is feasible and must be conducted.

Virtual Reality Rehabilitation Systems for Cancer Survivors: A Narrative Review of the Literature

“…Therefore, in the last years, many studies have been investigating the role of telerehabilitation in the rehabilitative care of cancer survivors to improve adherence and as a safe and more accessible alternative to traditional rehabilitation [27][28][29]. One of the latest technologies proposed to remotely connect patients and rehabilitation professionals is Virtual Reality (VR) [26,[30][31][32][33][34]. Virtual Reality Rehabilitation (VRR) has been tested in various clinical conditions, such as stroke-related deficits [35], spinal cord injuries [36], multiple sclerosis [37], Parkinson's disease [32], cerebral palsy [38][39][40], and cancer rehabilitation.…”

Delirium‐related psychiatric and neurocognitive impairment and the association with post‐intensive care syndrome—A narrative review

“…This option can allow tailoring the assessment to the neuropsychological profile described in post‐ICU survivors and the individual patient needs as well as refining the interpretation of the results. Considering the above information, we suggest a neuropsychological test battery that integrates the most relevant literature on neurocognitive assessment in critically ill patients going beyond the RBANS 100,112 and supported with the authors' clinical and research experience 98,113 (Table 1). This is only intended to be an indicative proposal that reflects the authors' recommendation based on clinical and research practice and the most frequently used tests and procedures in the scientific literature.…”

“…Although their use in critical illness survivors is still in its infancy, digital assessment tools should be considered due to their potential cost–benefit advantage compared to the use of paper‐and‐pencil tests 130,131 . Some recent initiatives have also emerged that focus on the prevention and rehabilitation of the cognitive and psychological sequelae using both paper‐and‐pencil and computerized strategies 113,132,133 . Given the high personal, social, and economic impact of these deficits, efforts to develop and improve such initiatives may be worthwhile.…”

“…130,131 Some recent initiatives have also emerged that focus on the prevention and rehabilitation of the cognitive and psychological sequelae using both paper-and-pencil and computerized strategies. 113,132,133 Given the high personal, social, and economic impact of these deficits, efforts to develop and improve such initiatives may be worthwhile.…”

Virtual reality in intensive care

“…Navarra-Ventura et al randomised 72 critically ill patients. One month after ICU discharge, patients who underwent early neurocognitive VR evidenced higher working memory scores and less anxiety and depression than the control group [ 12 ].…”