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

Author(s)

Thiago Mazzoli Pedroso de Moraes

• Document type: Master's Dissertation
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2020-03-03

Examining board members

Wellingson Silva Paiva; Rubens Gisbert Cury; Juliana Teixeira Fiquer

• Advisor: Wellingson Silva Paiva

Abstract

Introduction: Traumatic Brain injury (TBI) is one of the most socioeconomically disabling diseases in young adults. TBI can cause cognitive impairment that might burden society and especially family members. Frontal injuries can affect executive functions (EF) which are fundamental skills and cognitive processes for the individual\'s daily life. So far, there are no satisfactory results with conventional treament methods for cognitive disorders following TVI, especially executive dysfunctions. Immersive Virtual Reality (VR) can provide an alternative for cognitive training that would be too costly or dangerous to perform in real life. Objetive: To evaluate possible effects with cognitive training on EF with moderate and severe TBI. Methods: This was a prospective, unicentric study that evaluated data from 13 male vicims of moderate and severe TBI. Patients were submitted to 12 cognitive training sessions focused on executive functions and lasting approximately 20 minutes each. At the end of each cognitive training session participants answered a cybersickness symptoms questionnaire. All patients underwent neuropsychological (ANP) and mood assessment at three states: before the intervention (A1), within one week after the end of the last cognitive training session (A2) and after three months of last evaluation (A3). The ANP instruments were focused on evaluating EF, memory and processing speed. The primary outcome of this study was the composite score of EF instruments. Results: The EF composite scores were -1,33 (DP ± 0,46), -1,13 (DP ± 0,52) and -0,99 (DP ± 0,64) at times A1,A2 and A3, respectively. A one-way repeated measures ANOVA was conducted and the intervention elicited statistically significant changes in EF over time F (2,24) = 7,32, p < 0,01. Post hoc analysis with a Bonferroni adjustment revealed that composite scores of EF was only statistically significantly increased from A1 to A3 (p = 0,02). Individual analyzes of each instrument that were part of EF composite scores (n = 5) revealed that only the mental flexibility assessment instrument showed statistical difference and only between A1 and A3 (p < 0,01). We also observed that patiets with worse EF performance in A1 made more mistakes (r(11) = -0,85, p < 0,01) and took longer time to complete the sessions (rs = -0,71, p < 0,01). However, analysis of the effect of the intervention on processing speed (p = 0,74) and memory (p = 0,26) showed no statistically significant differences between evaluations. Patients had a lower depression and anxiety score between evaluations, but there was no statistically significant differente. Patients had few symptoms of cybersickness with an average of 4,33 points (SD ± 4,06, maximum score of the instrument = 48) after the sessions. Conclusion: Patients in this study were able to perform all proposed activities with little to no symptoms of cybersickness. The proposed method may be an alternative to conventional techniques and has demonstrated a preliminary effect on EF in patients with moderate to severe TBI. (AU)

• FAPESP's process: 16/11706-0 - Assessment of cognitive training method with virtual reality in patients with moderate and severe traumatic brain injury
• Grantee: Thiago Mazzoli Pedroso de Moraes
• Support Opportunities: Scholarships in Brazil - Master