Use of Virtual Reality Cognitive Training to Improve Executive and Complex Attentional Functions: Can Virtual Reality Performance PredictNeurorehabilitation Outcomes?

Background: VR has proven successful in simulating activities and settings that prove inaccessible or unsafe to rehabilitate patients in. Current VR rehabilitation studies largely focus on assessing cognitive skills, not on training cognitive deficits. The current study focused on repeated exposure with a VR-based cognitive intervention to improve deficits known to impact the ability to resume complex activities. Associations between the VR Stroop and neuropsychological, speech therapy, and global rehabilitation measures were examined. We included a brain injured control group to address this frequently cited methodological concern. Design: This was a mixed design study with quasi-experimental Intervention group (N = 12) and retrospective Control group (N = 12). Both groups comprised individuals with brain injury admitted to an outpatient day neurorehabilitation program. Results: Patients with higher level of education and shorter acute medical course deliberated longer before responding on specific Virtual Stroop indices. The brain injury group receiving Virtual Stroop intervention demonstrated a significant increase in level of independence in the home and in community participation by discharge from day neurorehabilitation, compared with the Control group. Increased independence of the virtual reality group was associated with improved attention and self-monitoring, and less disinhibition on the Virtual Stroop. Conclusion: Patients with brain injury demonstrated improvements in various executive functioning and attention indices on the Virtual Stroop, compared with patients who received standard neurorehabilitation. Neurocognitive training within an immersive real-world setting was associated with improved global and specific neurorehabilitation outcomes. Performance on the Virtual Stroop also demonstrated a relationship with cognitive flexibility on traditional neuropsychological testing.