Skip to Content
MDPIMDPI
JCMJournal of Clinical Medicine
PDF
  • Systematic Review
  • Open Access

14 December 2023

Use of Virtual Reality in Patients with Acquired Brain Injury: A Systematic Review

,
,
,
,
,
and
IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med.2023, 12(24), 7680;https://doi.org/10.3390/jcm12247680
This article belongs to the Section Brain Injury
Version Notes
Order Reprints

Abstract

Background and Objectives: ABI is found in all societies as the most severe, disabling neurological disorder. A cognitive rehabilitation program is essential for the clinical recovery of these patients, improving functional outcomes and quality of life. Modern technologies such as virtual reality (VR) offer several advantages over traditional therapies, including the ability to engage people in simulated performance of functional tasks. This review will examine the studies in which virtual reality has been used as an aid, technique, or intervention in patients with acquired brain injury. Materials and Methods: Studies were identified from an online search of PubMed, Cochrane Library, and Web of Science databases. Results: We found that TBI patients responded positively to VR treatment depending on the damaged or impaired cognitive and motor functions they acquired. It is now a tool that is available in the rehabilitation of these patients and supports the recovery of various motor and cognitive functions. Conclusions: This review has shown that VR is an intervention technique that increasingly exists in clinical rehabilitation practice for ABI patients. The device uses advanced technologies that can cause general changes in cognitive, motor, and psychological aspects and create a simulated environment that can partially restore these functions and behaviors, as well as the behaviors of everyday life.

1. Introduction

Acquired brain injury (ABI) represents the main cause of death and impairment among young adults. It is an injury to the brain that is not hereditary, congenital, degenerative, or caused by birth trauma, as it occurs after birth. The injury alters the neuronal activity of the brain, affecting the physical integrity of the brain, the metabolic activity, or the functioning of the nerve cells in the brain. Traumatic brain injury (TBI) is the most common type of ABI (excluding stroke), with motor vehicle accidents and falls being the most common causes [1,2]. TBI is characterized as “an alteration in brain function, or other evidence of brain pathology, caused by an external force” [3] and is present in all societies as the most serious and disabling neurological disorder for more than 57 million patients worldwide [4]. Brain injuries can be divided into two main categories according to their cause: traumatic brain injury and non-traumatic brain injury. In TBI, brain damage is usually caused by direct or transmitted external influences such as falls, vehicle collisions, sports injuries, abuse/assault, and pressure explosions. In non-traumatic brain injury, brain damage is mainly caused by infection, brain tumors, ischemia, and stroke. In surgical cases, brain tissue may be inadvertently damaged by invasive procedures [5,6]. The incidence of TBI peaks in both young and late adulthood and is one of the most common causes of morbidity and mortality in young adults under 45 years of age [7]. The increased mortality risk associated with this serious condition has been shown to persist for at least seven years after the initial injury; survivors of TBI tend to develop long-term disability, negatively affecting not only the individual but also caregivers and society as a whole [8].
This clinical picture is not an isolated injury but a long-term disease process that creates a moving target for any specific treatment. Longitudinal processes after ABI include cell death, network destruction, network reorganization, immunological responses, formation of abnormal neuronal networks, glial reactions, and amyloid deposition, as well as many other mechanisms. These neurobiological mechanisms can persist for many years and occur unpredictably [9]. Individual personality traits and psychological characteristics can influence injury healing. TBI is traditionally classified using injury severity scores. The most widely used scoring system in the acute phase is the Glasgow Coma Scale (GCS), which consists of three categories (open-eye response, verbal response, and motor response) and is administered within 24 h of injury. It is performed within 24 h of injury to assess impairment of consciousness and coma. Scores range from 3 to 15, with higher scores indicating better function [10]. The clinical picture is characterized by different dysfunctions in different brain regions depending on the affected area, leading to many cognitive, motor, emotional, and neurobiological symptoms. However, cognitive function can be partially restored even in damaged brain regions thanks to neuroplastic mechanisms in the brain and can be stimulated by rehabilitation using modern technologies such as VR.

VR Rehabilitation

The term virtual rehabilitation is used to describe a form of training in which the patient interacts with a virtual or augmented environment delivered with the help of technology [11]. Virtual rehabilitation can engage individuals in simulated practice of high-dose, functional tasks compared to traditional treatments [12], with automatic assessment of performance over time, flexibility in scaling task constraints, various reward structures to maintain compliance, and many other advantages [13]. One of the most important tools used in virtual rehabilitation is VR. It is a computer technology that refers to a computer-generated artificial environment with special sensory characteristics that can be interacted with in real time [14]. The benefits of this tool include the expectation of active learning during motivational activities, the ability to control the difficulty of the task, and the ability to measure individual behavior and performance. It can also be adapted to an individual’s specific treatment goals to provide repetitive exercises with less guidance from a clinical therapist or to gradually increase the difficulty of a task [15]. Cognitive and motor rehabilitation programs are an integral part of the clinical recovery of TBI patients and improve functional outcomes and quality of life. They are based on restorative and compensatory strategies and adapt to the patient’s resources and disability [16]. They should provide goals and opportunities to practice real and meaningful tasks to maximize function and enable engagement outside the clinical setting [17].
For example, cognitive, physiotherapy, and communication therapy goals should be implemented in everyday life [18] and relevant community settings (home, café, workplace).
The aim of this review is to examine studies using VR as a tool, technique, or intervention in patients with ABI.

2. Materials and Methods

2.1. Search Strategy

A review of currently published studies was carried out for articles in which VR was used as a tool, technique, or intervention in patients with ABI. The literature search was conducted via PubMed, Cochrane Library, and Web of Science, and it was carried out for articles using the following search keyword terms: ((((ALL = (acquired brain injuries)) OR ALL = (traumatic brain injuries)) AND ALL = (cognitive rehabilitation)) OR ALL = (neurorehabilitation)) AND ALL = (virtual reality). We adopted the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram to describe the sequence of steps (identification, screening, eligibility, and inclusion) for the collection and identification of eligible studies, as shown in Figure 1. To avoid bias, several expert teams worked together, selected the articles, analyzed the data independently, and discussed any discrepancies with each other.
Figure 1. PRISMA flow chart for the current review.

2.2. Inclusion Criteria

A study was included if it described or investigated the use of VR in ABI patients during cognitive or neurorehabilitation. Only articles written in English were included in the review.

2.3. Exclusion Criteria

A study was excluded if there was a lack of data or information about the use of VR in ABI patients. Systematic, integrative, or narrative reviews were also excluded, although their reference lists were reviewed and included if appropriate. All articles written in languages other than English were excluded.

3. Results

In total, 3380 articles were searched. 568 articles were removed due to duplication after screening, and 44 articles were excluded because they were not present in English. 2462 articles were removed based on title and abstract screening. Finally, 293 articles were removed based on screening for inadequate study designs and untraceable articles. Thirteen research articles met the inclusion criteria. A summary of these studies is shown in Table 1.
Table 1. Summary of studies included in the research.
The articles in this review have investigated the use of VR as a tool, technique, or intervention in ABI patients. Aspects of neurological rehabilitation were also considered an integral part of the patient’s cognitive experience.
VR rehabilitation of brain injury patients was evaluated in five articles [19,20,21,22,23]. The effectiveness and verification of VR in rehabilitation programs with TBI patients were evaluated in six other articles [24,25,26,27,28,29]. VR rehabilitation in stroke patients has been discussed in an article [30]. The evaluation of IADL using VR has been evaluated in the last article [31].

VR Rehabilitation in ABI Patients: The Use of Virtual Environments

The inclusion of VR in rehabilitation can provide a more economical method of training that reduces contact with one-on-one therapists, as well as an objective and accurate measurement of the patient’s response to a series of repetitive tasks. Since virtual reality provides a safe and changeable environment for learning, it can bring an approach to cognitive rehabilitation for those who experience ABI. The simulated environment has been proven to have good reliability and parallel validity for assessing cognitive function in patients with brain injury [19]. The VR exercise on social problem solving emphasized that as the degree and source of relevant and unrelated information increases, group differences in social problem solving become more pronounced in children with TBI [20]. In addition, sex differences have been found in the use of VR recovery of cognitive function in these patients. Women who received VR training showed better cognitive improvement. This type of training not only improved mood but also produced cognitive flexibility and selective attention. All this was influenced by sex [21]. Exercising in a virtual environment offers the potential for significant improvements in cognitive function. Combining physical activity with VR has been proven to be an effective treatment for improving cognitive function. In one study, patients with brain injuries performed significantly better in the control of numerical symbols and verbal and visual learning tasks. Significant improvements in reaction time and exercise duration were achieved after a single VR exercise [22]. A specific virtual kitchen environment was used to evaluate selective cognitive function in patients after brain injury. The computer-generated VR environment has proven to be a reproducible tool for assessing selected cognitive functions and can be used in addition to traditional rehabilitation assessments of people with ABI [23].
Another study suggests that VRRS is a suitable alternative or complementary tool, or both at the same time, to improve motor (levels of functional independence) and cognitive (frontal/executive abilities) outcomes, reduce behavioral changes (symptoms of anxiety and depression) in patients with SABI, and also has a beneficial effect on pain relief for caregivers, reducing pain and encouraging positive aspects of compassion [24]. Another program, such as Virtual Reality Shopping Tasks (VRST), demonstrates its environmental value and is a sensitive indicator of future memory dysfunction after TBI [25]. It was found that the use of this technique is useful in the neural rehabilitation of these patients with the improvement of various cognitive functions and mood, such as cognitive flexibility, attention switching, visual search, as well as executive and visual–spatial functions necessary for planning and managing daily life [26]. The inclusion of artificial intelligence software in the program of the professional training system for psychological education was also applied. They used this new system to show the viability of improving problem-solving skills and improving professional outcomes for people with TBI [27]. VR has also been used in the rehabilitation of children with brain injuries, proving its effectiveness and validity. In particular, the effect of VR training on the body function of the upper extremities using three-dimensional upper extremity kinematic assessment is a reliable and accurate tool for objectively measuring changes in joint kinematics after treatment [28]. VR programs can also be used to allow patients to experience real-life situations in which certain skills are required to perform tasks that require cognitive skills, such as memory and executive functions. In fact, future memory has been shown to improve both real-life post-rehabilitation and virtual reality, as well as various cognitive traits such as frontal lobe function and semantic fluency. VR-based training may be well accepted by ABI patients as it shows promising developments [29]. The real-world environment of virtual games also suggests the use of new therapeutic techniques that respond better and support neurological rehabilitation in patients with stroke or right brain injury [30]. The latest study has shown that the use of kitchen and coffee tasks via VR is an effective tool for the IADL assessment of patients who have sustained TBI [31].

4. Discussion

Our review aims to analyze studies in which VR has been used as a tool, technique, or intervention in patients with ABI. All the studies included in this review have shown that VR is more effective in ABI patients who promote improvements in cognition (positive memory, executive function, attention), exercise, and society (activities of daily living). It is widely used and functional in the rehabilitation of cognitive function in patients with ABI. Improvements were found in the following areas: attention, flexibility, symbol learning, and execution abilities [19,20,21,22,23]. The tool also improved the emotional space of these patients in terms of mood and reduced the symptoms of anxiety and depression [24]. These studies found sex differences in which cognitive improvement was better in women than in men [21]. Finally, these VR programs have the property of being useful in assessing cognitive impairment and different simulated environments. They reproduce the daily environment and promote greater commitment and recovery during rehabilitation [25,26,27,28,29,30,31]. We found virtual kitchens, cafes, virtual shopping malls, and virtual games among the main life simulation environments used in virtual rehabilitation [21,22,23,31]. Each of them has certain characteristics and objects that remind of cognitive, motor, and social functions that can be rehabilitated in certain continuous sessions. We know that VR technology offers the opportunity to develop human performance testing and educational environments [32]. These virtual surroundings can present the illusion of three-dimensional space. Participants with limited motor control can safely “move” and engage in a range of activities in a simulated environment, relatively far from the restrictions imposed by obstacles. It provides a high degree of control and, at the same time, integrates various sensory functions simultaneously. Since the computer system calculates and records changes over time, the evaluation in the virtual world can be carried out objectively with minimal human error and bias [33]. Exercises performed in a virtual environment allow the patient to understand the consequences of movements (knowledge of results) and the quality of movements (knowledge of performance), which positively affect the functional recovery of the patient, including cognitive ones. Some studies based on VR for cognitive assessment of individuals with brain injury have shown that the technology is able to detect disturbances in daily living activity and that the simulated environment is a good predictor of daily living function [34,35].
However, we also need to take into account that TBI damage can interfere with physical ability, cognition, and emotional state, depending on the injured area [36]. These disorders may leave a residual deficiency that may prevent the injured person from participating in activities of daily living (ADL). This involves multiple cognitive and motor processes (e.g., to achieve functional goals requires organization, ordering steps, object identification, and vehicle use), and healthy people can easily perform these tasks, even if they experience a hitch when moving under a large number of conditions, such as temporal pressure, or divided attention [37]. This premise was made to be able to adapt the virtual world to the abilities and needs of each individual, unlike the real world. It offers great flexibility in virtual work and experience, which includes the necessary sequence of functional movements to achieve autonomy in real-life activities. The analysis and control of the virtual component of all activities by occupational therapists allows for virtual achievements that cannot be achieved in real life due to disability or environmental restrictions. These results increase motivation and commitment to the rehabilitation process [38].

Neurorehabilitation with VR

Cognitive and physical rehabilitation programs optimize activity, function, performance, productivity, participation, and quality of life, improving clinical outcomes in ABI patients. Rehabilitation programs are based on recovery, compensation, and adaptation strategies that vary depending on the patient’s potential and degree of disability [39]. VR provides a higher level of engagement and cognitive participation than memory and imagination provide, but also directly through “real” experiences. Its multisensory stimulation can be applied to functional and ecological real-world demands (for example, finding objects, deconstructing objects, etc.) and has the potential to improve brain plasticity and regeneration processes [40,41]. Based on the identified studies, VR technologies used for the rehabilitation of ABI patients include the immersive type (high-accuracy resolution of panoramic view and head-mounted screens, data gloves, or bodysuits are used); the non-immersive type is desktop-based (computer and large monitor, smartphone, etc.). We can assess that there are three main types of video capture VR (virtual environment created and displayed by the speaker) that are not immersive. It is different from desktop-based, video capture VR in the necessary equipment and control mode. Instead of using a desktop computer, a color key background, a large video screen, and a video camera are used in the video capture VR. These three types can be used to create a sophisticated simulated environment that can replicate the situations and events of everyday life, making the neural rehabilitation process functional and realistic. We know that TBI causes deficits in attention, memory, information processing speed, and executive function. A high level of cognitive function depends on well-functioning distributed brain networks and finely regulated neurotransmitter systems that can be destroyed by damage [42,43]. In this clinical context, VR can help to partially restore this brain network through virtual simulations, such as daily life activities. They are multitasking activities and require not only motor participation, but also cognitive participation. From this point of view, it seems even more likely that VR will play a new fundamental role in neural rehabilitation. Of all the possible applications, one of the most common is the VMall. It consists of exercises performed in a virtual environment that recreates the supermarket [44]. Simulated exercise can improve the patient’s active participation in rehabilitation performed using robots, which carries the risk of becoming practically passive [45]. At the neurobiological level, visual feedback can activate a network of cortical regions, including the upper and lower parietal cortex, ventral premotor cortex, primary motor cortex, dorsal premotor cortex, lower frontal gyrus, and auxiliary motor regions [46]. Despite these advantages, the use of VR technology in the rehabilitation of ABI patients remains limited. In a study conducted on a small number of registered patients with mild traumatic brain injury, it was found that its use led to moderate improvements in terms of gait and balance [47,48]. VR can contribute to increasing awareness of patient performance and promoting mental concentration and participation, which are all necessary elements for motor learning [49]. In this sense, the type and intensity of exercise and the context of the environment are important factors [50,51]. VR allows for a real learning process that can reconstruct the brains of ABI patients through a simulated environment and the necessary tasks, causing changes in neuronal formation. When a brain region loses some of its connections, it undergoes a cascade of changes related to the clearance of degenerating debris, the remodeling of neuronal processes, and the production of new neural connections (synapses) by remaining inputs, a process termed reactive synaptogenesis [52]. Further research could analyze and deepen the role of virtual reality in both cognitive and emotional rehabilitation by analyzing further correlations between the cognitive and perceptual learning experience and their impact on the mood or emotionality of the patient with ABI within a rehabilitation process.

5. Conclusions

The review shows that VR is an intervention technique that increasingly exists in the clinical rehabilitation practices of ABI patients. The device can partially restore functions and behaviors, as well as daily life behaviors, using advanced technologies that can create a simulated environment that can often cause changes in cognitive, motor, and psychological aspects. We can say that rehabilitation has become possible not only in real life but also through VR. We have observed a limited number of studies on the use of this tool in ABI patients during cognitive or neurological dysfunction (only 13 out of a total of more than 300 articles). This data could be possibly indicative of a lack of research related to the specific use of these instruments during rehabilitation, despite the number of patients with ABI constantly increasing. Other updates to this device could create new simulated environments and help open up new rehabilitation perspectives for patients diagnosed with ABI. Furthermore, subsequent studies on the effects of virtual reality rehabilitation and the plastic changes of the brain resulting from learning mechanisms could provide further developments on the cognitive reserve of patients after TBI.

Author Contributions

Conceptualization, D.C. (Davide Cardile) and F.C.; methodology, D.C. (Davide Cardile); software, D.C. (Diamante Carta); validation, R.S.C., F.C. and A.Q.; formal analysis, D.C. (Diamante Carta); investigation, A.C.; resources, C.R.; data curation, D.C. (Davide Cardile); writing—original draft preparation, A.C.; writing—review and editing, R.S.C. and D.C. (Davide Cardile); visualization, C.R.; supervision, A.Q.; project administration, F.C.; funding acquisition, A.Q. All authors have read and agreed to the published version of the manuscript.

Funding

This study was supported by Current Research Funds 2023, Ministry of Health, Italy.

Institutional Review Board Statement

Not applicable.

Data Availability Statement

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. World Health Organization. Neurological Disorders: Public Health Challenges; World Health Organization: Geneva, Switzerland, 2006.
  2. Tagliaferri, F.; Compagnone, C.; Korsic, M.; Servadei, F.; Kraus, J. A systematic review of brain injury epidemiology in Europe. Acta Neurochir. 2006, 148, 255–268. [Google Scholar] [CrossRef] [PubMed]
  3. Hayes, R.L.; Jenkins, L.W.; Lyeth, B.G. Neurotransmitter-mediated mechanisms of traumatic brain injury: Acetylcholine and excitatory amino acids. J. Neurotrauma 1992, 9 (Suppl. 1), S173–S187. [Google Scholar] [PubMed]
  4. Faden, A.I. Pharmacologic treatment of acute traumatic brain injury. JAMA 1996, 276, 569–570. [Google Scholar] [CrossRef] [PubMed]
  5. Najem, D.; Rennie, K.; Ribecco-Lutkiewicz, M.; Ly, D.; Haukenfrers, J.; Liu, Q.; Nzau, M.; Fraser, D.D.; Bani-Yaghoub, M. Traumatic brain injury: Classification, models, and markers. Biochem. Cell Biol. 2018, 96, 391–406. [Google Scholar] [CrossRef] [PubMed]
  6. Reis, C.; Wang, Y.; Akyol, O.; Ho, W.M.; Ii, R.A.; Stier, G.; Martin, R.; Zhang, J.H. What’s New in Traumatic Brain Injury: Update on Tracking, Monitoring and Treatment. Int. J. Mol. Sci. 2015, 16, 11903–11965. [Google Scholar] [CrossRef] [PubMed]
  7. McIntosh, T.K.; Saatman, K.E.; Raghupathi, R.; Graham, D.I.; Smith, D.H.; Lee, V.M.; Trojanowski, J.Q. The Dorothy Russell Memorial Lecture. The molecular and cellular sequelae of experimental traumatic brain injury: Pathogenetic mechanisms. Neuropathol. Appl. Neurobiol. 1998, 24, 251–267. [Google Scholar] [CrossRef] [PubMed]
  8. Selassie, A.W.; Zaloshnja, E.; Langlois, J.A.; Miller, T.; Jones, P.; Steiner, C. Incidence of long-term disability following traumatic brain injury hospitalization, United States, 2003. J. Head Trauma Rehabil. 2008, 23, 123–131. [Google Scholar] [CrossRef] [PubMed]
  9. Vespa, P. Traumatic brain injury is a longitudinal disease process. Curr. Opin. Neurol. 2017, 30, 563–564. [Google Scholar] [CrossRef]
  10. Teasdale, G.; Jennett, B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974, 2, 81–84. [Google Scholar] [CrossRef]
  11. Weiss, P.L.; Kizony, R.; Feintuch, U.; Katz, N. Virtual reality in neurorehabilitation. In Textbook of Neural Repair and Rehabilitation; Cambridge University Press: Cambridge, UK, 2006; Volume 51, pp. 182–197. [Google Scholar]
  12. Kwakkel, G.; van Peppen, R.; Wagenaar, R.C.; Wood Dauphinee, S.; Richards, C.; Ashburn, A.; Miller, K.; Lincoln, N.; Partridge, C.; Wellwood, I.; et al. Effects of augmented exercise therapy time after stroke: A meta-analysis. Stroke 2004, 35, 2529–2539. [Google Scholar] [CrossRef]
  13. Rizzo, A.A.; Schultheis, M.; Kerns, K.A.; Mateer, C. Analysis of assets for virtual reality applications in neuropsychology. Neuropsychol. Rehabil. 2004, 14, 207–239. [Google Scholar] [CrossRef]
  14. Knight, R.; Titov, N. Use of Virtual Reality Tasks to Assess Prospective Memory: Applicability and Evidence. Brain Impair. 2009, 10, 3–13. [Google Scholar] [CrossRef]
  15. Riva, G.; Davide, F.; IJsselsteijn, W.A. Being There: Concepts, Effects and Measurements of User Presence in Synthetic Environments; IOS Press: Amsterdam, The Netherlands, 2003. [Google Scholar]
  16. Maggio, M.G.; De Luca, R.; Molonia, F.; Porcari, B.; Destro, M.; Casella, C.; Salvati, R.; Bramanti, P.; Calabro, R.S. Cognitive rehabilitation in patients with traumatic brain injury: A narrative review on the emerging use of virtual reality. J. Clin. Neurosci. 2019, 61, 1–4. [Google Scholar] [CrossRef] [PubMed]
  17. Zanier, E.R.; Zoerle, T.; Di Lernia, D.; Riva, G. Virtual Reality for Traumatic Brain Injury. Front. Neurol. 2018, 9, 345. [Google Scholar] [CrossRef] [PubMed]
  18. Tate, R.; Kennedy, M.; Ponsford, J.; Douglas, J.; Velikonja, D.; Bayley, M.; Stergiou-Kita, M. INCOG recommendations for management of cognition following traumatic brain injury, part III: Executive function and self-awareness. J. Head Trauma Rehabil. 2014, 29, 338–352. [Google Scholar] [CrossRef] [PubMed]
  19. Zhang, L.; Abreu, B.C.; Seale, G.S.; Masel, B.; Christiansen, C.H.; Ottenbacher, K.J. A virtual reality environment for evaluation of a daily living skill in brain injury rehabilitation: Reliability and validity. Arch. Phys. Med. Rehabil. 2003, 84, 1118–1124. [Google Scholar] [CrossRef]
  20. Hanten, G.; Cook, L.; Orsten, K.; Chapman, S.B.; Li, X.; Wilde, E.A.; Schnelle, K.P.; Levin, H.S. Effects of traumatic brain injury on a virtual reality social problem solving task and relations to cortical thickness in adolescence. Neuropsychologia 2011, 49, 486–497. [Google Scholar] [CrossRef][Green Version]
  21. Bruschetta, R.; Maggio, M.G.; Naro, A.; Ciancarelli, I.; Morone, G.; Arcuri, F.; Tonin, P.; Tartarisco, G.; Pioggia, G.; Cerasa, A.; et al. Gender Influences Virtual Reality-Based Recovery of Cognitive Functions in Patients with Traumatic Brain Injury: A Secondary Analysis of a Randomized Clinical Trial. Brain Sci. 2022, 12, 491. [Google Scholar] [CrossRef]
  22. Grealy, M.A.; Johnson, D.A.; Rushton, S.K. Improving cognitive function after brain injury: The use of exercise and virtual reality. Arch. Phys. Med. Rehabil. 1999, 80, 661–667. [Google Scholar] [CrossRef]
  23. Zhang, L.; Abreu, B.C.; Masel, B.; Scheibel, R.S.; Christiansen, C.H.; Huddleston, N.; Ottenbacher, K.J. Virtual reality in the assessment of selected cognitive function after brain injury. Am. J. Phys. Med. Rehabil. 2001, 80, 597–604. [Google Scholar] [CrossRef]
  24. Calabrò, R.S.; Bonanno, M.; Torregrossa, W.; Cacciante, L.; Celesti, A.; Rifici, C.; Tonin, P.; De Luca, R.; Quartarone, A. Benefits of Telerehabilitation for Patients with Severe Acquired Brain Injury: Promising Results from a Multicenter Randomized Controlled Trial Using Nonimmersive Virtual Reality. J. Med. Internet Res. 2023, 25, e45458. [Google Scholar] [CrossRef] [PubMed]
  25. Canty, A.L.; Fleming, J.; Patterson, F.; Green, H.J.; Man, D.; Shum, D.H. Evaluation of a virtual reality prospective memory task for use with individuals with severe traumatic brain injury. Neuropsychol. Rehabil. 2014, 24, 238–265. [Google Scholar] [CrossRef] [PubMed]
  26. De Luca, R.; Maggio, M.G.; Maresca, G.; Latella, D.; Cannavò, A.; Sciarrone, F.; Lo Voi, E.; Accorinti, M.; Bramanti, P.; Calabrò, R.S. Improving Cognitive Function after Traumatic Brain Injury: A Clinical Trial on the Potential Use of the Semi-Immersive Virtual Reality. Behav. Neurol. 2019, 2019, 9268179. [Google Scholar] [CrossRef] [PubMed]
  27. Man, D.W.; Poon, W.S.; Lam, C. The effectiveness of artificial intelligent 3-D virtual reality vocational problem-solving training in enhancing employment opportunities for people with traumatic brain injury. Brain Inj. 2013, 27, 1016–1025. [Google Scholar] [CrossRef] [PubMed]
  28. Choi, J.Y.; Yi, S.H.; Ao, L.; Tang, X.; Xu, X.; Shim, D.; Yoo, B.; Park, E.S.; Rha, D.W. Virtual reality rehabilitation in children with brain injury: A randomized controlled trial. Dev. Med. Child. Neurol. 2021, 63, 480–487. [Google Scholar] [CrossRef] [PubMed]
  29. Yip, B.C.; Man, D.W. Virtual reality-based prospective memory training program for people with acquired brain injury. NeuroRehabilitation 2013, 32, 103–115. [Google Scholar] [CrossRef] [PubMed]
  30. Fernandes, A.B.; Passos, J.O.; Brito, D.P.; Campos, T.F. Comparison of the immediate effect of the training with a virtual reality game in stroke patients according side brain injury. NeuroRehabilitation 2014, 35, 39–45. [Google Scholar] [CrossRef]
  31. Besnard, J.; Richard, P.; Banville, F.; Nolin, P.; Aubin, G.; Le Gall, D.; Richard, I.; Allain, P. Virtual reality and neuropsychological assessment: The reliability of a virtual kitchen to assess daily-life activities in victims of traumatic brain injury. Appl. Neuropsychol. Adult. 2016, 23, 223–235. [Google Scholar] [CrossRef]
  32. Pugnetti, L.; Mendozzi, L.; Motta, A.; Cattaneo, A.; Barbieri, E.; Brancotti, A. Evaluation and retraining of adults’ cognitive impairment: Which role for virtual reality technology? Comput. Biol. Med. 1995, 25, 213–227. [Google Scholar] [CrossRef]
  33. Rose, F.D.; Attree, E.A.; Johnson, D.A. Virtual reality: An assistive technology in neurological rehabilitation. Curr. Opin. Neurol. 1996, 9, 461–467. [Google Scholar] [CrossRef]
  34. Christiansen, C.; Abreu, B.; Ottenbacher, K.; Huffman, K.; Masel, B.; Culpepper, R. Task performance in virtual environments used for cognitive rehabilitation after traumatic brain injury. Arch. Phys. Med. Rehabil. 1998, 79, 888–892. [Google Scholar] [CrossRef] [PubMed]
  35. Lee, J.H.; Ku, J.; Cho, W.; Hahn, W.Y.; Kim, I.Y.; Lee, S.M.; Kang, Y.; Kim, D.Y.; Yu, T.; Wiederhold, B.K.; et al. A virtual reality system for the assessment and rehabilitation of the activities of daily living. Cyberpsychol. Behav. 2003, 6, 383–388. [Google Scholar] [CrossRef] [PubMed]
  36. Dawson, D.R.; Chipman, M. The disablement experienced by traumatically brain-injured adults living in the community. Brain Inj. 1995, 9, 339–353. [Google Scholar] [CrossRef] [PubMed]
  37. Giovannetti, T.; Schwartz, M.F.; Buxbaum, L.J. The Coffee Challenge: A new method for the study of everyday action errors. J. Clin. Exp. Neuropsychol. 2007, 7, 690–705. [Google Scholar] [CrossRef] [PubMed]
  38. Corregidor-Sánchez, A.I.; Segura-Fragoso, A.; Criado-Álvarez, J.J.; Rodríguez-Hernández, M.; Mohedano-Moriano, A.; Polonio-López, B. Effectiveness of Virtual Reality Systems to Improve the Activities of Daily Life in Older People. Int. J. Environ. Res. Public Health 2020, 17, 6283. [Google Scholar] [CrossRef]
  39. Maas, A.I.R.; Menon, D.K.; Adelson, P.D.; Andelic, N.; Bell, M.J.; Belli, A.; Bragge, P.; Brazinova, A.; Büki, A.; Chesnut, R.M.; et al. Traumatic brain injury: Integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017, 16, 987–1048. [Google Scholar] [CrossRef] [PubMed]
  40. Parsons, T.D. Virtual Reality for Enhanced Ecological Validity and Experimental Control in the Clinical, Affective and Social Neurosciences. Front. Hum. Neurosci. 2015, 9, 660. [Google Scholar] [CrossRef] [PubMed]
  41. Orihuela-Espina, F.; Fernández del Castillo, I.; Palafox, L.; Pasaye, E.; Sánchez-Villavicencio, I.; Leder, R.; Franco, J.H.; Sucar, L.E. Neural reorganization accompanying upper limb motor rehabilitation from stroke with virtual reality-based gesture therapy. Top. Stroke Rehabil. 2013, 20, 197–209. [Google Scholar] [CrossRef]
  42. Newcombe, V.F.; Outtrim, J.G.; Chatfield, D.A.; Manktelow, A.; Hutchinson, P.J.; Coles, J.P.; Williams, G.B.; Sahakian, B.J.; Menon, D.K. Parcellating the neuroanatomical basis of impaired decision-making in traumatic brain injury. Brain 2011, 134, 759–768. [Google Scholar] [CrossRef]
  43. Kinnunen, K.M.; Greenwood, R.; Powell, J.H.; Leech, R.; Hawkins, P.C.; Bonnelle, V.; Patel, M.C.; Counsell, S.J.; Sharp, D.J. White matter damage and cognitive impairment after traumatic brain injury. Brain 2011, 134, 449–463. [Google Scholar] [CrossRef]
  44. Knight, C.; Alderman, N.; Burgess, P.W. Development of a simplifiedversion of the multiple errands test for use in hospital settings. Neuropsychol. Rehabil. 2002, 12, 231–255. [Google Scholar] [CrossRef]
  45. Morone, G.; Paolucci, S.; Cherubini, A.; De Angelis, D.; Venturiero, V.; Coiro, P.; Iosa, M. Robot-assisted gait training for stroke patients: Current state of the art and perspectives of robotics. Neuropsychiatr. Dis. Treat. 2017, 13, 1303–1311. [Google Scholar] [CrossRef] [PubMed]
  46. Mukamel, R.; Ekstrom, A.D.; Kaplan, J.; Iacoboni, M.; Fried, I. Single-neuron responses in humans during execution and observation of actions. Curr. Biol. 2010, 20, 750–756. [Google Scholar] [CrossRef] [PubMed]
  47. Ustinova, K.I.; Perkins, J.; Leonard, W.A.; Hausbeck, C.J. Virtual reality game-based therapy for treatment of postural and co-ordination abnormalities secondary to TBI: A pilot study. Brain Inj. 2014, 28, 486–495. [Google Scholar] [CrossRef] [PubMed]
  48. Glueck, A.C.; Han, D.Y. Improvement potentials in balance and visuo-motor reaction time after mixed reality action game play: A pilot study. Virtual Real. 2019, 24, 223–229. [Google Scholar] [CrossRef]
  49. Fusco, A.; Giovannini, S.; Castelli, L.; Coraci, D.; Gatto, D.M.; Reale, G.; Pastorino, R.; Padua, L. Virtual Reality and Lower Limb Rehabilitation: Effects on Motor and Cognitive Outcome-A Crossover Pilot Study. J. Clin. Med. 2022, 11, 2300. [Google Scholar] [CrossRef]
  50. Cano Porras, D.; Siemonsma, P.; Inzelberg, R.; Zeilig, G.; Plotnik, M. Advantages of virtual reality in the rehabilitation of balance and gait: Systematic review. Neurology 2018, 90, 1017–1025. [Google Scholar] [CrossRef]
  51. Kleim, J.A.; Jones, T.A. Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. J. Speech Lang. Hear. Res. 2008, 51, S225–S239. [Google Scholar] [CrossRef]
  52. Kelley, M.S.; Steward, O. Injury-induced physiological events that may modulate gene expression in neurons and glia. Rev. Neurosci. 1997, 8, 147–177. [Google Scholar] [CrossRef]
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Article Metrics

Citations

Article Access Statistics

Journal Statistics
Multiple requests from the same IP address are counted as one view.
Impact of Breastfeeding Duration on Adenoid Hypertrophy, Snoring and Acute Otitis Media: A Case-Control Study in Preschool Children
Previous
Nighttime versus Fulltime Brace Treatment for Adolescent Idiopathic Scoliosis: Which Brace to Choose? A Retrospective Study on 358 Patients
Next