A look into the use of VR for ABI/TBI Neuro-Cognitive Rehabilitation in Canada

The American Brain Injury Association defines an acquired brain injury (ABI) as “an injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma. Essentially, this type of brain injury is one that has occurred after birth.” (Brain Injury Association of America, 2019) A Traumatic Brain Injury (TBI) is a subtype of brain injury that the Brain Injury Association of America defines as “an alteration in brain function, or other evidence of brain pathology, caused by an external force. (2019) Looking ahead to the future of Canada, it is projected that by 2031, ABI, specifically traumatic brain injury (TBI), will be one of the most common neurological disorders in Canada. Currently, an estimated 1.5 million Canadians are living with TBI (Appireddy et al., 2019)

Traditionally, cognitive rehab treatment is carried out by Occupational Therapists (OT) and relies heavily on repetition, intensity, time and specificity. These principals rely heavily on patient engagement, excessive repetition and monotony during mass practice. This may result in decreased motivation and decreased commitment to the rehabilitation regimen. Advancements in technology play a crucial role in augmenting the effectiveness of ABI rehabilitation by promoting patient engagement and adherence to therapy. (Mathieu Figeys et al., 2023) Looking at survivors' perspectives, carers and clinicians Morse et al. found they were accepting, interested and confident about using self-administered VR telerehabilitation regardless of their level of technology experience. (2020) There was also the potential for psychological benefits, such as increased independence and confidence, that can be associated with motivating and engaging feedback provided by VR. (Morse et al., 2020)

As the future of health care becomes more digital and information technologies advance, the development of cognitive rehab therapies is changing. Computer-assisted cognitive rehabilitation (CACR) and virtual reality (VR) technologies are more and more widely used in clinical rehabilitation environments. (Xiao et al., 2022)a comparative meta-analysis study conducted by Xiao et al. examined the efficacy comparison of Virtual Reality and Computer-assisted Cognitive Rehab vs traditional cognitive rehab. The results indicated VR and CACR have superior efficacy than traditional rehab, and CACR was superior to VR.

In the clinical context, our neuro-rehab regimen incorporates the utilization of Constant Therapy App, specifically designed for speech therapy interventions addressing disorders consequent to traumatic brain injury, stroke, aphasia, and analogous conditions. A challenge to our therapeutic approach is our clientele's limited access to personal tablet devices. Our existing resource comprises a singular iPad to be used during sessions with a clinician; however, the absence of personal smartphones or tablets among clients significantly hinders autonomous app use outside direct therapy appointments. Neurorehabilitation hinges on the principle of repetitive exercises to develop new neural connections. Restricted app access poses a challenge to the progression of rehabilitation efforts. I anticipate this would be the same with VR and CACR therapies. Intensive rehabilitative resources are at our disposal in acute settings, but a lack of accessibility persists within community settings.

The landscape of cognitive rehabilitation is evolving in Canada with technological advancements. Computer-assisted cognitive rehabilitation (CACR) and virtual reality (VR) technologies are increasingly integrated into clinical rehabilitation settings, with comparative studies suggesting their superior efficacy over traditional methods. In the shift towards digitalization in healthcare, we must proactively confront these challenges to guarantee fair access to neuro-rehabilitative interventions.

References:

Appireddy, R., Khan, S., Leaver, C., Martin, C., Jin, A., Durafourt, B. A., & Archer, S. L. (2019). Home Virtual Visits for Outpatient Follow-Up Stroke Care: Cross-Sectional Study. Journal of Medical Internet Research, 21(10), e13734. https://doi.org/10.2196/13734

Brain Injury Association of America. (2019). What is the difference between an acquired brain injury and a traumatic brain injury? Brain Injury Association of America. https://www.biausa.org/brain-injury/about-brain-injury/nbiic/what-is-the-difference-between-an-acquired-brain-injury-and-a-traumatic-brain-injury

Mathieu Figeys, Farnaz Koubasi, Hwang, D., Hunder, A., Miguel-Cruz, A., & Adriana Ríos Rincón. (2023). Challenges and promises of mixed-reality interventions in acquired brain injury rehabilitation: A scoping review. International Journal of Medical Informatics, 179(129), 105235–105235. https://doi.org/10.1016/j.ijmedinf.2023.105235

‌Xiao, Z., Wang, Z., Ge, S., Zhong, Y., & Zhang, W. (2022). Rehabilitation efficacy comparison of virtual reality technology and computer-assisted cognitive rehabilitation in patients with post-stroke cognitive impairment: A network meta-analysis. Journal of Clinical Neuroscience, 103, 85–91. https://doi.org/10.1016/j.jocn.2022.07.005

‌