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Brain & Heart VR for TBI memory and eye fixation recovery

of times I’ve been in (brain injury support) group, and I a chair. In a first-person perspective, they strolled down a
hear someone say “I knew I shouldn’t say something, but beach near the shore, where waves crashed, and seagulls
I couldn’t stop myself.” One person reported that memory flew sporadically yet slowly in front of them. There was
was a challenge and even thought of an idea for a scenario: a ball positioned at the horizon that they were prompted
“Almost like making a map in our mind. Along the path, to focus on, under the guidance of a VR technician. The
there’s an apple tree, and under the apple tree, there’s an ball turned green when they were looking at it and turned
object that you need to remember. And then along the way, red when they were not. The HTC Vive Pro Eye headset
there are these objects associated with something along the enables pupil tracking, which is what turns the ball green
path to connect concepts.” Specifically, prospective memory or red. All relevant equipment is depicted in Figure 1.
was reported as a challenge for all members. They provided
several examples of going into a room and not remembering 2.4. VR pilot methods
why they went there in the first place. All members reported 2.4.1. Participants
balance and physical skills they would like to develop. One
reported, “Although I did go back to a dance class, the Participants provided informed consent before their
balance stuff was really challenging. I danced for 20 years participation. A randomized pilot study was conducted
when I was younger. Never had an issue with right and left, with 11 TBI survivors who were at least 1 year post-TBI
especially looking here. It was really challenging. I really to evaluate the feasibility, acceptability, and effects of the
enjoyed it, but I found it very challenging to go from left to VR scenarios on prospective memory and eye tracking.
right. Switch it and use a mirror.” Participants were recruited from a local brain injury
nonprofit by announcing the study at the beginning of a
2.2.3. Enjoyable scenario ideas support group, sending an email to those served by the
Two individuals expressed hiking as an ideal VR scenario. organization, and posting an announcement on social
One individual desired to hike in the scenario because media. Inclusion criteria comprised individuals who
she experienced challenges related to these activities after were as follows: (i) 18 years or older, (ii) diagnosed with
having a brain injury. She shared, “Something I could a TBI defined by any disruption in normal brain function
do before but can’t do now is like a day hike. I mean, I caused by an external mechanical force, such as a blow or
could go out for an hour or so, but anything requiring a jolt to the head or penetrating head injury, ranging from
backpack…my neck is too fragile for a backpack…Being mild, (often referred to as a concussion) characterized by
in that position for very long…it causes severe headaches. a temporary change in mental status or consciousness,
The balance issue, too.” Another participant described, “If to severe, which may result in an extended period of
I had to picture the perfect scenario, it would be a path unconsciousness or amnesia after the injury, (iii) at least
similar to a hike; maybe there are obstacles you have to 1-year post-TBI, and (iv) have transportation to one of
come over, so you’re forced to look around.” two study locations locally. The 1-year post-TBI criterion
was selected for this pilot to ensure participants who had
2.3. The VR scenarios
Two initial VR scenarios aimed at improving prospective
memory and eye fixation were developed by the authors
based on the focus group data. The prospective memory
VR scenario developed by the study team lasted 10 min
and involved users sitting in a chair while experiencing a
first-person scenario of walking up a hill on a mountain
hike through an HTC Vive Pro Eye headset. Along the trail,
they encountered three hikers. They could turn their head
and view their surroundings, including water moving,
hillside, and some birds. The users were prompted at the
beginning of the scenario to give each hiker specific items
as they passed other hikers on the trail. To provide the item
to the hiker, the patient must make a throwing motion and
press a trigger with a HTC hand controller that is tracked
by a HTC body tracker.
The eye-tracking VR scenario developed by the study Figure 1. Virtual reality equipment used to assess prospective memory
team lasted 6 min, during which users remained seated in and eye fixation in brain injury survivors.

Volume 2 Issue 2 (2024) 4 doi: 10.36922/bh.2685