Virtual reality as a method of cognitive training of processing speed, working memory and sustained attention in persons with acquired brain injury: a protocol for a randomized controlled trial

Background : Acquired brain injury (ABI) often leads to persisting somatic, cognitive and social impairments. Cognitive impairments of processing speed, sustained attention and working memory are frequently reported, and may negatively affect activities of daily living and quality of life. Rehabilitation efforts aiming to retrain these cognitive functions have often consisted of computerized training programs. However, few studies have demonstrated effects that transfer beyond the trained tasks. There is a growing optimism regarding the potential usefulness of Virtual Reality (VR) in cognitive rehabilitation. The research literature is sparse, and existing studies are characterized by considerable methodological weaknesses. There is also a lack of knowledge about the acceptance and tolerability of VR as an intervention method for people with ABI. The present study aims to investigate whether playing a commercially available VR-game is effective in training cognitive functions after ABI, and to explore if the possible effects transfer into everyday functioning. Methods: One hundred participants (18-65 years), with a verified ABI, impairments of processing speed/attention, and/or working memory, and minimum 12 months post injury will be recruited. Participants with severe aphasia, apraxia, visual neglect, epilepsy and severe mental illness will be excluded. Participants will be randomized into two parallel groups; 1) an intervention group playing a commercial VR game taxing processing speed, working memory and sustained attention, 2) an active control group receiving psychoeducation regarding compensatory strategies, and general cognitive training tasks such as crossword puzzles or sudoku. The intervention period is five weeks. The VR-group will be asked to train at home for 30 minutes five days per week. Each participant will be assessed at baseline with neuropsychological tests and questionnaires, after the end of the intervention (5 weeks), and 16 weeks after baseline. After the end of the intervention period, focus group interviews will be conducted with 10 of the participants in the intervention group, in order to investigate acceptance and tolerability of VR as a training method. Discussion : This study will contribute to improved understanding of how VR is tolerated and experienced by the ABI population. If proven effective, the study can contribute with new rehabilitation methods that persons with ABI can utilize in a home setting, after the post-acute rehabilitation has ended.