➣ By Madeleine Grealy
Earlier this year 11,430 healthy adults took part in an experiment to test whether “brain training” using computerized games could improve reasoning, memory, planning, spatial skills and attention. After six weeks of training the results showed no evidence that this type of “brain training” resulted in cognitive enhancement. This suggests that using Virtual Reality (VR) to improve the cognitive abilities of fit young adults is not likely to be successful, however, there are many people in society for whom this may not be the case. People with brain injuries or people who are experiencing age-related cognitive decline are two likely groups of individuals who might benefit greatly from using VR to enhance, or prevent the decline of, their cognitive powers.
My own interest in this area is in helping people with brain injuries to reach their optimum level of recovery. Following a brain injury there is a critical time during which the brain undergoes some regenerative growth and reorganization. Whilst this critical period will differ for each individual, it is generally accepted that the greatest rates of recovery will occur during the first year or so after the injury has occurred. However, during these early weeks and months following the injury, the patient is most likely to experience high levels of fatigue, low levels of concentration and low levels of activation. The last thing they feel like doing is engaging in cognitive rehabilitation tasks such as trying to remember lists of words, plan a journey using a map or solve complex puzzles. Attention grabbing and engaging virtual environments on the other hand can be both motivational, enjoyable and provide the required therapy in a manner that is accessible to the patient. The environments virtual nature means that it can be tailored to meet the individual’s needs, and changed as their rehabilitation progresses.
So is there compelling evidence that VR can assist in brain injury rehabilitation processes? Whilst the existing research studies suggest that it might, it is still too early to tell which executive functions can be improved and the best way to do this. Professor David Rose’s group at the University of East London have been very influential in this field, and in a review paper in 2005 they described 101 studies that have been concerned with using VR to assist in the assessment and rehabilitation of brain injured patients abilities to plan, form strategies, memorize and perform spatial orientation tests. They concluded that there are many promising signs that VR can enhance cognition during brain injury rehabilitation, but there are still many challenges that have to be overcome before “VR rehab” becomes widely available. By far the most common brain injury is caused by stroke and in 2007 Dr. Jacqui Crosbie and colleagues from the University of Ulster also published a review which looked at the VR intervention studies that have been conducted for stroke rehabilitation. They found 11 studies which had been published in peer-reviewed journals and all of these reported positive results for the use of VR interventions. However, like Rose et al,. the authors noted a series of issues with many of these studies which led them to be somewhat cautious in drawing definitive conclusions. Many studies suffer from small sample sizes and not all have been able to adopt rigorous enough experimental designs to be able to make comparisons between those who have received a VR intervention and a control group who have not. These are fair criticisms but in defense of many of the researchers working in this area, it is worth noting that this is still a new field of research and conducting large robust studies is not at all easy. There are many things to consider. First, there is the type of VR experience that the patient should receive. The use of immersive displays seems favorable but this has to be counteracted by the potential adverse effects of using immersive VR, particularly head-mounted displays. The second issue concerns the content of the VR task, that is what the person is asked to do. For the purposes of designing a research study it is better that every participant receives the same type of intervention, but in reality it is unlikely that one VR memory task or one VR planning task will be suitable for all patients and specifically tailoring the virtual environments to meet the individual needs of each patient seems the best way to produce the most gains. The other big issue is in trying to have matched control groups for the purposes of comparison. Matching for type of injury, time since injury, other aspects of treatment, hospital/ clinic experience, age, gender etc. is by no means an easy task, and those researchers who have tried to do this should be commended for their efforts.
At present, we can only really speculate on how VR rehabilitation programs influence the structure and function of the human brain, but as brain scanning technologies improve we are moving towards more sophisticated ways of determining this. Undoubtedly though, VR holds great potential to enhance the cognitive capabilities of people with brain injuries and hopefully as it becomes easier for non-specialists to create and use VR technology, the evidence base for its effectiveness will increase as will its availability to all who could benefit from it.
Madeleine Grealy, Ph.D.
University of Strathclyde
President of Virtual Reality Medical Institute (VRMI) in Brussels, Belgium. Executive VP Virtual Reality Medical Center (VRMC), based in San Diego and Los Angeles, California. CEO of Interactive Media Institute a 501c3 non-profit Clinical Instructor in Department of Psychiatry at UCSD Founder of CyberPsychology, CyberTherapy, & Social Networking Conference Visiting Professor at Catholic University Milan.