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Brain & Heart VR for TBI memory and eye fixation recovery

exist among TBI patients, often based on factors such are common in about 30 – 60% of those with acute TBI
as race, ethnicity, insurance status, and transportation and 10 – 15% one year post-TBI. 19-20 A systematic review
availability. A recent study involving 106,708 TBI of oculomotor deficit interventions for individuals with
1-6
patients revealed that 77 – 88% of them did not receive any brain injury found “few studies overall,” with only six of
post-brain injury rehabilitation. Hispanic TBI patients, nine total studies having addressed fixation. In another
3
21
in particular, are less likely to receive rehabilitation than systematic review of 22 studies of visual research on mild
others, possibly due to cultural and language barriers. In TBI, fixation research was focused on the least (n = 3). 22
3-4
addition, individuals with public or no insurance coverage Immersive VR involves using a headset equipped with
exhibit the lowest rates of discharge to rehabilitation visual, audio, and body-tracking capabilities to immerse
compared to those with private insurance. Furthermore, participants in virtual scenarios. Consider an individual
3,5
transportation is another environmental barrier to putting on a headset in their living room. Before them, a
rehabilitation for TBI patients. 6
virtual scene unfolds: sand on a beach, while the ocean
Virtual reality (VR) is a recommended option waves crash on the shore. As they look downward, they
for rehabilitation, offering a solution that addresses observe their feet sinking into the virtual sand. The
geographic and financial constraints. Since transportation movements of their avatar’s feet correspond precisely to
7
to rehabilitation is a challenge for individuals with their own, mirroring their physical actions. Neurologists
brain injuries, VR can be conducted at home to prevent posit that our brains process immersive VR scenarios like
this barrier. Studies have linked payer sources, such as this in the same way that we process the real world. 23,24
6
self-pay, worker’s compensation, and insurance type, Essentially, the brain perceives the virtual environment
to the length of rehabilitation stays, highlighting the as genuine, fostering a sense of presence as if physically
importance of tailoring rehabilitation to demographics standing on the beach. This phenomenon offers distinctive
and injury characteristics. The length of rehabilitation opportunities, enabling users to explore virtual places
5
should be determined based on the specific rehabilitation beyond their physical reach and providing the opportunity
needs arising from injury characteristics, namely, injury to practice physical or cognitive skills.
severity and functional status at admission. Immersive, As the brain perceives the individual’s body as the avatar
interactive VR incorporating headsets, body trackers, within the VR scenario, they may experience heightened
and computers enables users to immerse themselves in
a virtual world, engage with audio/visual stimuli, and self-efficacy, believing they can move a body part or address
a problem that they could not have done without the VR
enable eye and body movement tracking. VR has been scenario. The skills practiced during the VR scenario
employed for rehabilitative purposes for decades, but can be applied in real-life situations. For example, if a
recent technological developments have led to a reduction participant can improve the range of motion of their hand
in both the equipment required and associated costs.
in the VR scenario, they have strengthened their brain-
Over a dozen studies have demonstrated the effectiveness to-hand communication as well as their hand muscles.
of immersive VR in improving outcomes for both adult If the participant can improve their ability to remember
and child TBI patients, including driving ability, executive concepts in VR, they are building muscle memory skills in
function, attention, memory, eye tracking, and visual- their brain to apply in real life. However, the VR scenarios
motor tasks. 8-16 While some studies found no significant and equipment utilized in studies involving United States
differences between VR and traditional rehabilitation, veterans included bulky, expensive equipment, requiring
which commonly consists of physical and occupational participants to travel to specific locations to participate in
therapy, others recommend specific parameters for VR VR activities. 11,25
7,17
interventions, such as 10 – 12 sessions lasting 20 – 40 min
each, conducted 2 – 4 times/week to improve cognitive 2. Methods
outcomes for TBI patients. 8 We received approval from the Institutional Review Board
Visual impairment hinders patients’ ability to succeed of the California State University Channel Islands before
in physical and cognitive rehabilitation. Eye tracking beginning the study (IO5625). This study is a community-
is often assessed with VR, but scant interventions are based participatory research project conducted in
provided for eye tracking. 17-18 Eye tracking includes quickly collaboration with TBI patients from a local nonprofit, a
and accurately looking (fixations), visually following trauma hospital, and interdisciplinary students and faculty
an object (pursuits), and efficiently moving eyes from from a university. Participants provided informed consent
point to point (saccades). Specifically, visual eye tracking before participation. Two focus groups, comprising TBI
(ocular motility and oculomotor function) impairments patients (N = 12), were conducted to assess their interest

Volume 2 Issue 2 (2024) 2 doi: 10.36922/bh.2685