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The Effectiveness of Virtual Reality Interventions for Improvement of Neurocognitive Performance After Traumatic Brain Injury

A Systematic Review

Manivannan, Susruta, BSc (Hons); Al-Amri, Mohammad, PhD; Postans, Mark, PhD; Westacott, Laura Jayne, BSc (Hons); Gray, William, PhD; Zaben, Malik, PhD

The Journal of Head Trauma Rehabilitation: March/April 2019 - Volume 34 - Issue 2 - p E52–E65
doi: 10.1097/HTR.0000000000000412
Focus on Clinical Research and Practice

Objective: To evaluate current evidence for the effectiveness of virtual reality (VR) interventions in improving neurocognitive performance in individuals who have sustained a traumatic brain injury (TBI).

Methods: A systematic literature search across multiple databases (PubMed, EMBASE, Web of Science) for articles of relevance. Studies were evaluated according to study design, patient cohort, VR intervention, neurocognitive parameters assessed, and outcome. VR interventions were evaluated qualitatively with respect to methodology and extent of immersion and quantitatively with respect to intervention duration.

Outcomes: Our search yielded 324 articles, of which only 13 studies including 132 patients with TBI met inclusion criteria. A wide range of VR interventions and cognitive outcome measures is reported. Cognitive measures included learning and memory, attention, executive function, community skills, problem solving, route learning, and attitudes about driving. Several studies (n = 10) reported statistically significant improvements in outcome, and 2 studies demonstrated successful translation to real-life performance.

Conclusions: VR interventions hold significant potential for improving neurocognitive performance in patients with TBI. While there is some evidence for translation of gains to activities of daily living, further studies are required to confirm the validity of cognitive measures and reliable translation to real-life performance.

Neuroscience and Mental Health Research Institute (NMHRI) (Mr Manivannan, Drs Postans, Gray, and Zaben, and Ms Westacott) and Brain Repair & Intracranial Neurotherapeutics (BRAIN) (Drs Postans and Gray), School of Medicine, and School of Healthcare Sciences, College of Biomedical and Life Sciences (Mr Al-Amri), Cardiff University, Cardiff, United Kingdom.

Corresponding Author: Malik Zaben, PhD, Neuroscience and Mental Health Research Institute (NMHRI), School of Medicine, Cardiff University, Room 4FT 80E, 4th Floor, University Hospital Wales, Heath Park, Cardiff, CF14 4XN, United Kingdom (

The authors report no conflicts of interest.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.