Tolerance of a virtual reality intervention for attention remediation in persons with severe TBI

Objective: To evaluate the feasibility of applying virtual reality and robotics technology to improve attention in patients with severe traumatic brain injury (TBI) in the early stages of recovery. Methods: A sample of TBI patients (n=18, aged 19-73) who were receiving acute inpatient rehabilitation completed three-dimensional cancellation exercises over two consecutive days in an interactive virtual environment that minimized distractions and that integrated both visual and haptic (tactile) stimuli. Observations of behaviour during the intervention and of the instructions needed to encourage compliance were recorded. Performance data were compiled to assess improvement across three different treatment conditions. Outcomes: Fifteen of the 18 patients demonstrated tolerance of the virtual environment by completing the entire treatment protocol. Within-subjects comparisons of target acquisition time during treatment showed that a treatment condition that included haptic cues produced improved performance compared to a condition in which such cues were not provided. Separating out participants who were in post-traumatic amnesia showed that this group also demonstrated improvement in performance across trials despite their memory impairment. Conclusions: It is proposed that attention exercises using virtual environments are well-tolerated and engaging and that they could be beneficial for inpatients with severe TBI.