Motion-based virtual reality cognitive training targeting executive functions in acquired brain injury community-dwelling individuals: A feasibility and initial efficacy pilot

Acquired brain injury (ABI) is a leading cause of long-term cognitive disability, often involving deficits in executive functions (EF). ABI patients usually stop receiving cognitive treatment when leaving the rehabilitation facility or shortly thereafter, due to the high cost of therapy sessions and the mobility requirement to access therapy. Software solutions offer a promising tool for accessible and affordable cognitive rehabilitation in the home environment. However, research provides limited evidence for effective transfer of benefits from computerized cognitive training to real-life functions. Virtual reality (VR) exergames using motion-interaction offer a more realistic and natural training environment, and are therefore expected to facilitate a more effective transfer. Although commercial exergames may bring about some cognitive gains, they usually do not target cognitive functions directly. Here we describe a novel exergames platform, the Active Brain Trainer (ABT), designed to directly target EF, using games in multiple realistic contexts. The software adapts in real-time to the patient's behavior, providing feedback and rewards, and hence may enhance usability and compliance. The primary goal of the current study is to assess the feasibly and acceptability of this platform for community-dwelling ABI patients during the chronic phase. A secondary goal is to assess the initial efficacy on EF and functional benefits from program training. Participants were instructed to use the games for 15-20 sessions. Neuropsychological assessments of EF and daily life functions were performed before and after training. Participants also filled a satisfaction questionnaire following training. All training and assessments were conducted in the participants' homes. Game performance was recorded throughout training sessions. Preliminary results from the six ABI patients who successfully completed the program so far show no adverse effects. Participants reported enjoyment and satisfaction from training. Participants performed increasingly more challenging EF tasks within game environments. Initial results show improvements in functional tasks and most executive neuropsychological assessments following training. Additional participants are currently being trained to increase the power of the results. These preliminary findings support the feasibility and potential efficacy of the motion-based cognitive training of EF for community-dwelling individuals with ABI.