VR Tools for Brain Injury Rehabilitation

LFBIT are currently involved in an exciting trial of a new Virtual Reality (VR) Brain Injury Rehabilitation Tool. We sat with Peta Murphy, Assistant Research Fellow of Otago University, to discuss the project, and what it means for the future of Brain Injury Rehabilitation. A huge thanks to Peta and the team for sharing your work with us!

Can you explain the basic idea of the project?

The Virtual Reality (VR) Brain Injury Rehabilitation Tool is an exciting project that is being trialed with people recently referred to LFBIT for a rehabilitation programme following a concussion, moderate or severe traumatic brain injury (TBI). The aim of the study is to obtain clinicians’ and clients’ perception of the VR Tool, its integration into their rehabilitation programme and whether it’s engaging, relatable and effective.

The project is a collaboration between LFBIT clinicians and clients, their whānau, researchers (Otago University, Christchurch), He Waka Tapu kaimahi and VR technical specialists (Auckland University - Empathic Computing Lab, Cerebral Fix, Callaghan Innovation). The Tool aims to increase a client’s awareness of changes following their TBI, and working with their clinician, identify and safely practice strategies to manage interactions and tasks in a noisy, busy community setting (café). The treatment is occurring in the client’s home or LFBIT Clinic. We also have a client trialing the Tool with her therapists in a correctional facility.

The Tool offers clinicians the opportunity to provide clients with a safe, immersive experience that can be graded with increasing complex conversations, distractions and tasks. These experiences can be repeated as often as is needed, which is beneficial for practicing skills and strategies as the client increases their competence and confidence. The therapist accesses a summary score sheet from the VR system to support feedback and measure their client’s progress across sessions.

Preliminary findings have overall been positive from both clients and clinicians using the Tool.

For people who don't know, what is VR?

Virtual Reality (VR) is a computer-generated environment with scenes, ‘people’ and objects that appear to be real, making the person feel that they are immersed in their surroundings. This environment is viewed through a device known as a Virtual Reality headset (like a pair of large ski goggles).

VR headsets are rapidly evolving in terms of increasingly realistic computer-generated imagery and options to measure physiological responses (e.g. eye tracking, heart rate, skin moisture), which provides valuable information to the client and their clinician as to how they are responding to everyday hazards or stressors, across different situations. The headsets are also becoming increasingly more affordable, making it more accessible to a wider group of New Zealanders living in any location. (The VR Tool can run off-line). This technology is complemented by advances in artificial intelligence that would enable the ‘people’ in the virtual setting to provide unique responses based on the questions asked by the person with a TBI.

What kinds of situations does the software simulate?

VR can simulate almost any situation. For this study, the VR Tool involves interactions with realistic characters and the completion of tasks in a busy café. The Tool simulates real world interactions and stressors (e.g. environmental noises, group conversations and visual distractions), associated with this type of setting. The client is challenged to ‘filter’ out distractions, shift and sustain their attention, process spoken and written information and recall it. They are also required to respond to questions in this challenging but realistic environment, that utilises their retrospective (past) and prospective (future) memory. The client rates their fatigue and anticipated/actual difficulty at the start and end of the game to assist with increasing awareness of cognitive fatigue and its impact on functioning in this type of situation.

How will this be applied in the future?

Clients and clinicians involved in the trial of the VR Tool will help inform how VR can be integrated into rehab programmes and future improvements for the next iteration. The next version will include physiological measures to further assist with identification of challenges experienced by the client and potentially allow for more targeted intervention. Ultimately, we would like this Tool to be available to all New Zealanders no matter where they live or their personal circumstances. We also see its potential to benefit people living with other health conditions that impacts cognition, cognitive fatigue, communication and community integration.

Client feedback on the project has been positive, and it is exciting to hear about the confidence building potential of VR.

Client Participant: “It’s [VR] been helping me (to) order my own food (I'm feeling a) bit more confident in the community with conversation. I didn’t used to order my own food and stuff like that…” “Now I say 'Hello' and yeah, it’s been a bit better now at the gym and…that’s always busy and loud, so I used to avoid that as well.”

His whānau member: “…The week before he come in [takeaway shop]. He told them, well, they asked him and he answered, whereas normally he’d either sit in the car or wait for me to answer.”

His Clinician: “...really cool platform to actually trial strategies in a really safe, supported and repetitive environment…. practice skills…carry over into more real-life tasks…developing awareness into limitations and the functional application…we struggled with that within one-to-one therapy sessions. Even getting out in the community, his ability to identify what challenges he experienced was quite limited. It’s been a really useful tool to help build that insight, and for him to practice things in the same situation like on multiple occasions”

Feedback from another client participant:

“It’s [VR Tool] been awesome actually…. feels like if I get asked a question that’s not on point for me… I need a little bit of time after it to recap to get things stuck in there [my brain] properly… if things carry on too quickly I am going to lose what I just had, but if it stops for a bit… even repeat it in my own head… [I learnt this] recently.. I never used to notice anything, I thought I was perfect… but I’m noticing as I go along, in bits and pieces, and not remembering… slowly pulls it out of you… it must be something do with [VR]… I’m noticing different things that aren’t the same…”

Awards:

The VR Brain Injury Rehabilitation Tool was a runner up in the 2022 New Zealand Rehabilitation Association Innovation awards and second runner up at the MedTech awards (June, 2023).