Abstract:

Traumatic brain injury (TBI) can result in significant impairments in executive function, memory, and attention, adversely affecting daily functioning and rehabilitation outcomes. Cognitive rehabilitation after TBI is a challenging process often requiring training in daily living skills. While traditional rehabilitation methods benefit TBI patients, modern innovations like virtual reality (VR) offer promising potential for cognitive recovery. This study aimed to investigate the potential benefits of virtual reality-based therapy for improving cognitive function in individuals with traumatic brain injury. A single-case study was conducted involving a 23-year-old male with TBI, recruited from the neurosurgery rehabilitation ward of Saveetha Medical College and Hospitals. Pre- and post-test measurements were taken using the Digit Span Test and the Montreal Cognitive Assessment (MoCA). The patient underwent a 10-week rehabilitation protocol, including VR-based therapy, delivered six times a week for one hour per session. The MoCA score improved from 18 (pre-test) to 27 (post-test). The Digit Span forward test score increased from 4 to 7, and the Digit Span backward test score improved from 2 to 4. These findings indicate significant improvements in cognitive function following the VR-based intervention. This study highlights the potential of virtual reality as a valuable tool for enhancing cognitive recovery in individuals with traumatic brain injury.

References:

[1]. Gamito, P., Oliveira, J., Pacheco, J., Morais, D., Saraiva, T., Lacerda, R., Baptista, A., Santos, N., Soares, F., Gamito, L., and Rosa, P., 2011, Traumatic brain injury memory training: a virtual reality online solution.

[2]. Baumer, H., Schneider, B., Frank, C. W., Wallesch, M., 2001, Physicians' estimates of rehabilitation requirements after stroke and traumatic brain injury-a questionnaire survey in East Germany. Disability and rehabilitation, 23(7), pp.306-312.

[3]. Cooper, R. A., Dicianno, B. E., Brewer, B., LoPresti, E., Ding, D., Simpson, R., Grindle, G., and Wang, H., 2008, A perspective on intelligent devices and environments in medical rehabilitation. Medical Engineering & Physics, 30(10), pp.1387-1398.

[4]. Wang, P., Kreutzer, I. A., Bjärnemo, R., and Davies, R. C., 2004, A Web-based cost-effective training tool with possible application to brain injury rehabilitation. Computer methods and programs in biomedicine, 74(3), pp.235-243.

[5]. Shekhar, C., Gupta, L. N., Premsagar, I. C., Sinha, M., and Kishore, J., 2015, An epidemiological study of traumatic brain injury cases in a trauma centre of New Delhi (India). Journal of emergencies, trauma, and shock, 8(3), pp.131-139.

[6]. Alqahtani, A. A., Alam, M. K., and Ganji, K. K., 2025, Effect of Distraction by Using Virtual Reality on Pain and Anxiety During the Dental Procedure. Bangladesh Journal of Medical Science, 24(1), pp.285-292.

[7]. Gururaj, G., 2002, Epidemiology of traumatic brain injuries: Indian scenario. Neurological research, 24(1), pp.24-28.

[8]. Pasquina, P., Kirtley, R., and Ling, G., 2014, November. Moderate-to-severe traumatic brain injury. In Seminars in Neurology (Vol. 34, No. 05, pp. 572-583). Thieme Medical Publishers.

[9]. Grealy, M. A., Johnson, D. A., and Rushton, S. K., 1999, Improving cognitive function after brain injury: the use of exercise and virtual reality. Archives of physical medicine and rehabilitation, 80(6), pp.661-667.

[10]. Ross, L. K., 1992, The use of pharmacology in the treatment of head-injured patients. In Handbook of Head Trauma: Acute Care to Recovery (pp. 137-164). Boston, MA: Springer US.

[11]. Soryal, I., Sloan, R. L., Skelton, C., and Pentland, B., 1992, Rehabilitation needs after haemorrhagic brain injury: are they similar to those after traumatic brain injury?. Clinical rehabilitation, 6(2), pp.103-110.

[12]. Vasanthi, R. K., Li, J., Chaw, B., Purushothaman, V. K., Kumaresan, A., Chinnusamy, S., Karuppaiyan, R. K., and Subbarayalu, A. V., 2023, Perceived usefulness and ease of using virtual reality during physiotherapy--A cross-sectional survey from physiotherapists perspective. Electronic Journal of General Medicine, 20(6).

[13]. Alashram, A. R., Annino, G., Padua, E., Romagnoli, C., and Mercuri, N. B., 2019, Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology. Journal of Clinical Neuroscience, 66, pp.209-219.

[14]. Knight, R. G., and Titov, N., 2009, Use of virtual reality tasks to assess prospective memory: applicability and evidence. Brain impairment, 10(1), pp.3-13.

[15]. Sekar, M., Suganthirababu, P., Subramanian, S. S., Vishnuram, S., Ramalingam, V., Arul, A., and Anbarason, A., 2024, The effectiveness of virtual reality (VR) therapy on balance and mobility in elderly patients: a randomized controlled trial. Fizjoterapia Polska, (5).

[16]. Allred, R. P., Maldonado, M. A., and Jones, T. A., 2005, Training the" less-affected" forelimb after unilateral cortical infarcts interferes with functional recovery of the impaired forelimb in rats. Restorative neurology and neuroscience, 23(5-6), pp.297-302.

[17]. Rose, F. D., Brooks, B. M., and Rizzo, A. A., 2005, Virtual reality in brain damage rehabilitation. Cyberpsychology & behavior, 8(3), pp.241-262.

[18]. O'Keeffe, S. T., and Gosney, M. A., 1997, Assessing attentiveness in older hospital patients: global assessment versus tests of attention. Journal of the American Geriatrics Society, 45(4), pp.470-473.

[19]. Geller, R., and Slicer, K., 2024, Montreal Cognitive Assessment (MoCA). In Clinical Integration of Neuropsychological Test Results (pp. 191-204). CRC Press.

[20]. Freitas, S., Simões, M. R., Alves, L., and Santana, I., 2013, Montreal cognitive assessment: validation study for mild cognitive impairment and Alzheimer disease. Alzheimer Disease & Associated Disorders, 27(1), pp.37-43.

[21]. Montana, J. I., Tuena, C., Serino, S., Cipresso, P., and Riva, G., 2019, Neurorehabilitation of spatial memory using virtual environments: a systematic review. Journal of clinical medicine, 8(10), p.1516.

[22]. Pietrzak, E., Pullman, S., and McGuire, A., 2014, Using virtual reality and videogames for traumatic brain injury rehabilitation: a structured literature review. GAMES FOR HEALTH: Research, Development, and Clinical Applications, 3(4), pp.202-214.

[23]. De Luca, R., Bonanno, M., Rifici, C., Pollicino, P., Caminiti, A., Morone, G., and Calabrò, R. S., 2022, Does non-immersive virtual reality improve attention processes in severe traumatic brain injury? Encouraging data from a pilot study. Brain Sciences, 12(9), p.1211.

[24]. Chellapandian H, Jeyachandran S. Retraction Note: Bridging the gap: Enhancing TBI care in Pakistan’s primary and secondary healthcare settings. Neurosurgical Review. 2025 Jan 31;48(1):124.

[25]. Larson, E. B., Ramaiya, M., Zollman, F. S., Pacini, S., Hsu, N., Patton, J. L., and Dvorkin, A. Y., 2011, Tolerance of a virtual reality intervention for attention remediation in persons with severe TBI. Brain Injury, 25(3), pp.274-281.

[26]. De Luca, R., Bonanno, M., Marra, A., Rifici, C., Pollicino, P., Caminiti, A., Castorina, M. V., Santamato, A., Quartarone, A., and Calabrò, R. S., 2023, Can virtual reality cognitive rehabilitation improve executive functioning and coping strategies in traumatic brain injury? A pilot study. Brain sciences, 13(4), p.578.