Cognitive Telerehabilitation Is a Viable Option for Patients With Severe Traumatic Brain Injury
Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. While most people who sustain this injury will recover from their symptoms within months after injury, some may experience long-term or permanent debilitating symptoms, including motor, cognitive, psychological, and emotional dysfunction. Cognitive impairment in particular can cause significant barriers to success in work, relationships, and everyday activities. Consequently, people who have cognitive dysfunction after TBI may suffer immensely under the burden of their injuries and may be unable to fully return to their pre-injury quality of life.
Research has aimed to address these challenges by identifying rehabilitation strategies to improve cognitive and functional status among people with severe TBI. Rapid technological advancement—and, more recently, the realities of the COVID-19 pandemic crisis—have motivated researchers to study remote telehealth options for TBI rehabilitation. Because telerehabilitation can be completed from home or in the hospital, these services are optimally accessible for patients with limited mobility, resources, or proximity to health care facilities.
However, the neurological deficits associated with TBI may interfere with patients’ ability to adapt to these new technological platforms, to comfortably watch a screen for lengths of time, or to operate a mobile device. Given these constraints, researchers must determine the feasibility of telehealth strategies before moving forward with development of remote rehabilitation services.
A recent study evaluated whether severe TBI patients and their caregivers could use and benefit from a novel telerehabilitation device during hospitalization. The Virtual Reality Rehabilitation System (VRRS) is a tablet-based telehealth device that enables patients and caregivers to participate in learning sessions, engage in cognitive rehabilitation activities, and connect with a cognitive therapist via video chat. Participants received instructions and training for using VRRS and then participated in the teletherapy regimen three times per week for two weeks.
At the end of the study, all of the participants completed the sessions without excessive difficulty and reported generally positive experiences with the platform. In particular, they showed high interest and motivation to complete the learning activities, and success with these tasks promoted a sense of self-competence and self-efficacy. About half of the patients rated the device as having “excellent” usability.
These findings indicate that telerehabilitation strategies are feasible and usable for patients with severe TBI. Although these patients participated during hospitalization, the remote device shows promise for at-home use following hospital discharge. Critically, these and similar telerehabilitation services are expected to increase accessibility of services among patients with limited time, resources, or capacity to travel to a health care facility to receive rehabilitation therapy.
De Luca R, Maggio MG, Naro A, et al. Can patients with severe traumatic brain injury be trained with cognitive rehabilitation? An inpatient feasibility and usability study. Journal of Clinical Neuroscience. (August 2020).