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Assessment of cognitive training method with virtual reality in patients with moderate and severe traumatic brain injury

Grant number: 16/11706-0
Support type:Scholarships in Brazil - Master
Effective date (Start): December 01, 2016
Effective date (End): November 30, 2018
Field of knowledge:Health Sciences - Medicine
Principal Investigator:Wellingson Silva Paiva
Grantee:Thiago Mazzoli Pedroso de Moraes
Home Institution: Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil

Abstract

Traumatic Brain Injury (TBI) is a global health problem and has great socioeconomic impact on the world. It is the leading cause of death from 5 to 44 years in the world, corresponding to 10% of the population. It is estimates that each year 1.7 million individuals in the United States suffer TBI and about half (43%) if patients who were hospitalized, possessed some debilitating condition after 1 year from the injury. In Brazil, epidemiological data do not differ from other countries. TBI's incidence increases every year, prevailing in young males with its main cause mean of transport. In 2012, the Unified Health System (SUS) spent in the treatment of external causes, including TBI, a value close to R$ 1 billion. The incidence of TBI varies from 26.2 to 45.6 per 100.000 inhabitants. TBI can be defined as changes in brain functioning due to external causes, commonly associated with, permanent or temporary, cognitive, physical or psychological impairments. The change of the individual's level of consciousness, allows classify TBI as mild, moderate or severe. Injuries caused by TBI can damage neural networks distributed throughout the brain, making it difficult to determine specifically which cognitive changes may occur. One of the possible changes are those that involve executive functions. Executive functions are skill sets or high-priority processes required for problem solving, planning, organization, initiative and regulation of behavior. Damages in executive functions can have an effect on social functioning and independence of TBI victims. Neuropsychological evaluation is needed to determine how the cognitive abilities may be affecting the individual's performance in their daily activities. Part of the impacts generated by TBI may be reduced through neuropsychological rehabilitation and cognitive training programs. Virtual Reality (VR) is a type of technology on the rise that has contributed significantly to the neuropsychological rehabilitation in patients with acquired brain injury. Part of this contribution is due to VR possessing the ability to generate standardized, replicable and ecological environments that would be too difficult to be practiced in the real world. VR can be defined as a computerized three dimensional processes that respond in real time to the individual interaction. One of the most popular devices is the Head Mounted Display. Recently, with the creation of the Oculus Rift, VR has become more accessible, getting more realistic simulations. This project aims to evaluate the effects of a cognitive training using the Oculus Rift Development Kit-2. We will recruit fifteen patients of TBI victims, aged between 18 and 35 years, of both sexes. Patients will be assessed through neuropsychological battery, anxiety and depression symptoms in 3 moments: 1) baseline, before the cognitive training; 2) until one week after the completion of 12 sessions; 3) after three months of the end of the sessions. Patients will be selected from a sample of TBI victims who perform follow-up in Neurotraumatismo Clinic of Neurosurgery Department of HC/FMUSP. Will he held 12 cognitive training sessions focusing on work cognitive functions such as, working memory, planning and inhibitory control. The sessions will last approximately 20 minutes each. All data will be tabulated in Excel spreadsheets and analyzed through SPSS 19.0. According to the Ministry of Health, TBI continues to be one of the most present causes of morbidity and mortality in the world, with large losses in the quality of life of victims, family and society. Virtual environments can be promising in the rehabilitation of patients who have suffered TBI. We expect that with this study we will assist with the understanding the use of VR technology in the treatment of TBI. (AU)