Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology

Highlights

• Virtual reality technology improves cognitive function post-traumatic brain injury.

• Optimal treatment protocol is; 10–12 sessions, 20–40 min in duration with 2–4 sessions per week.

• There was weak evidence for positive effect of virtual reality on attention.

Abstract

Background

Traumatic brain injury (TBI) can causes numerous cognitive impairments usually in the aspects of problem-solving, executive function, memory, and attention. Several studies has suggested that rehabilitation treatment interventions can be effective in treating cognitive symptoms of brain injury. Virtual reality (VR) technology potential as a useful tool for the assessment and rehabilitation of cognitive processes.

Objectives

The aims of present systematic review are to examine effects of VR training intervention on cognitive function, and to identify effective VR treatment protocol in patients with TBI.

Methods

PubMed, Scopus, PEDro, REHABDATA, EMBASE, web of science, and MEDLINE were searched for studies investigated effect of VR on cognitive functions post TBI. The methodological quality were evaluated using PEDro scale. The results of selected studies were summarized.

Results

Nine studies were included in present study. Four were randomized clinical trials, case studies (n = 3), prospective study (n = 1), and pilot study (n = 1). The scores on the PEDro ranged from 0 to 7 with a mean score of 3. The results showed improvement in various cognitive function aspects such as; memory, executive function, and attention in patients with TBI after VR training.

Conclusion

Using different VR tools with following treatment protocol; 10–12 sessions, 20–40 min in duration with 2–4 sessions per week may improves cognitive function in patients with TBI. There was weak evidence for effects of VR training on attention post TBI.

Introduction

Traumatic brain injury (TBI) is a leading cause of physical and cognitive disability worldwide [1], [2]. Modulations of neurotransmitter and neuroendocrine activity post TBI have been related to behavioral changes and abnormalities in cognition [3]. The cognitive impairment is defined as a limitation in capacity for mental tasks and is frequently associated with deficit in executive function [4]. TBI can cause numerous cognitive impairments usually in the aspects of problem-solving, executive function, memory, and attention [5], [6], [7], [8]. The cognitive recovery after TBI is slow and difficult in most cases [9].

Activities of daily living (ADL) require multiple cognitive and motor processes (e.g., organizing, ordering steps, identifying objects, tool use) to achieve functional goals. Healthy people perform these tasks easily, even if they may experience lapses when acting under numerous conditions such as time pressure, or divided attention [10]. Neuropsychological researches have clearly established that patients with TBI record higher error rates on daily activities. In fact, one of the long-term consequences of TBI is that individuals are prone to lapses and slips in the performance of ADL [11], [12].

Several studies has suggested that rehabilitation treatment interventions can be effective in treating cognitive symptoms of brain injury [13], [14], [15]. Virtual reality (VR) is a computer technology, which designate computer-generated artificial environments with special sensory properties that can be interacted with in real time [16]. Concerning rehabilitation field, repetition, feedback and motivation may gain from the use of VR [17]. In rehabilitation, one of the most common procedures is the repeated and systematic training of the impaired functions [18]. The utilization of 3D interactive VR environments in rehabilitation enables valid and dynamic training to be provided [19]. VR technology potential as a useful tool for the assessment and rehabilitation of cognitive processes [19], [20].

The advantages of VR tool include; prospect for active learning during an activity that is motivating, ability to control the degree of task difficulty, and the ability to measure an individual’s behavior and performance. In addition, it may be adapted to an individuals specific treatment objective goals, to provide repetitive exercise and to increase the difficulty of the task gradually, while reducing the guidance given by a clinical therapist [21], [22], [23], [24]. Applications of VR in specific medicine and psychology fields have demonstrated promise. Yet, little is known about how to effectively integrate VR technology into the rehabilitation field as a means of improving functional performance [25].

A recent reviews showed that VR tool has the possible for effective assessment and rehabilitation instrument for the treatment of cognitive disorder post TBI [26], [27], [28]. However, to our knowledge, no systematic review has yet been published examined cognitive function after VR environment exposure post TBI. Besides, no review has yet been established provide clear assent about virtual reality protocol dosage in treatment of individuals after traumatic brain injury conditions. Therefore, this systematic review aimed at; (i) investigate effects of VR on cognitive function post TBI, (ii) identify effective virtual reality treatment protocol in patients with traumatic brain injury.