JMIR Publications

ABSTRACT

Background:

Virtual reality (VR) is increasingly being used for the assessment and treatment of impairments arising from acquired brain injuries (ABIs) due to perceived benefits over traditional methods. However, no tailored options exist for the design and implementation of VR for ABI rehabilitation and more specifically, traumatic brain injury (TBI) rehabilitation. Additionally, the evidence base lacks systematic reviews of immersive VR use for TBI rehabilitation. Recommendations for this population are important because of the many complex and diverse impairments that individuals can experience.

Objective:

To conduct a 2-part systematic review to: (1) identify and synthesize existing recommendations for designing and implementing therapeutic VR for ABI rehabilitation, including TBI, and, (2) identify current evidence for using immersive VR for TBI assessment and treatment, and to map the degree to which this literature includes recommendations for VR design and implementation.

Methods:

This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. A comprehensive search of 11 databases and grey literature was conducted in August 2019. Studies were included if they met relevant search terms, were peer-reviewed, were written in English, and published within the last 10 years. Studies were reviewed for level of evidence and methodological quality. Part 1: Qualitative data were synthesized and categorized via meta-synthesis. Part 2: Findings were analyzed and synthesized descriptively due to the heterogeneity of data extracted from the included studies.

Results:

Part 1: A total of 14 papers met inclusion criteria. Recommendations for VR design and implementation were not specific to TBI, but rather to stroke or ABI rehabilitation more broadly. Synthesis and analysis of data resulted in 3 key phases and 9 categories of recommendations for designing and implementing VR for ABI rehabilitation. Part 2: Five studies met inclusion criteria. Two studies reported on VR for assessment, and 3 for treatment. Studies were varied in terms of therapeutic targets, VR tasks, and outcome measures. VR was used to assess or treat impairments in cognition, balance, and anxiety with positive outcomes. However, levels of evidence, methodological quality, and inclusion of recommendations for VR design and implementation were poor.

Conclusions:

There is limited research into the use of immersive VR for TBI rehabilitation. Few studies have been conducted and there is limited inclusion of recommendations for therapeutic VR design and implementation. Future research in ABI rehabilitation should consider a stepwise approach to VR development, from early co-design studies with end-users through to larger controlled trials. A list of recommendations is offered to provide guidance and a more consistent model to advance clinical research in this area.