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.
1. Introduction
Traumatic brain injury (TBI) is a condition caused by a mechanical event that causes skull and/or brain damage due to a strong and violent head blow (i.e., falls and sport injuries), strong rotations of the head (i.e., road accidents), or penetration of objects in the cranium (i.e., bullets) thus causing focal or diffuse damage to multiple brain areas [1]. TBI is the most common cause of long-term disability and death among young adults, and it represents an enormous socioeconomic and healthcare burden [2]. It is estimated that about 5.48 million people suffer from severe TBI each year (73 cases per 100,000 people) [3]. Among the survivors of moderate to severe head injury, 31.8% of patients die or need hospitalization in a specialized health center; 44% are unable to return to work, and 88% of the patients with mild TBI have white matter damage, with negative repercussions on functional outcomes [4]. In fact, TBI may affect motor, cognitive, emotional, and psychological functions with a consequent worsening of both patient and his/her caregiver’s quality of life [5]. In particular, cognitive dysfunction may interfere with work, relationships, leisure, and daily activities, increasing the burden of the disease [6, 7]. Growing evidence demonstrates that cognitive rehabilitation (CR), through previously learned skills or new compensatory strategies, is effective in patients with TBI as it enhances cognitive and psychosocial interaction [8–12]. In recent years, technological innovations have allowed the development of new rehabilitative strategies, such as PC-based rehabilitation or Virtual Reality Training (VRT), which have proven effective in the CR of neurological patients [13–16]. Chen et al. [17], examining the efficacy of PC-based rehabilitation in TBI subjects, observed significant posttreatment improvements on cognitive domains. Moreover, it has been demonstrated that PC cognitive training can be a potential CR strategy to optimize cognitive and global functional recovery [18, 19]. Several studies using VR have shown that it increases cognitive and behavioral skills in patients with TBI [13–16]. Indeed, it has been demonstrated that VR may be effective in improving executive functions in patients with TBI in the subacute phase [20]. In a recent review, Maggio et al. [9] found that VR might positively affect memory, attention, executive function, behavior, and mood in individuals with TBI. Indeed, evidence of the use of VR in TBI cognitive neurorehabilitation is very poor and there is not enough consensus on its use in the context of TBI rehabilitation [13].
The aim of this study is to evaluate the effects of a VRT using BTs-Nirvana (BTs-N) for the recovery of cognitive and behavioral functions in patients with TBI through an interactive semi-immersive program.[…]
A patient affected by traumatic brain injury performing cognitive training in the semi-immersive virtual scenario created by BTs-Nirvana.
TBI Rehabilitation 