A "virtually minimal" visuo-haptic training of attention in severe traumatic brain injury.
BACKGROUND
Although common during the early stages of recovery from severe traumatic brain injury (TBI), attention deficits have been scarcely investigated. Encouraging evidence suggests beneficial effects of attention training in more chronic and higher functioning patients. Interactive technology may provide new opportunities for rehabilitation in inpatients who are earlier in their recovery.


METHODS
We designed a "virtually minimal" approach using robot-rendered haptics in a virtual environment to train severely injured inpatients in the early stages of recovery to sustain attention to a visuo-motor task. 21 inpatients with severe TBI completed repetitive reaching toward targets that were both seen and felt. Patients were tested over two consecutive days, experiencing 3 conditions (no haptic feedback, a break-through force, and haptic nudge) in 12 successive, 4-minute blocks.


RESULTS
The interactive visuo-haptic environments were well-tolerated and engaging. Patients typically remained attentive to the task. However, patients exhibited attention loss both before (prolonged initiation) and during (pauses during motion) a movement. Compared to no haptic feedback, patients benefited from haptic nudge cues but not break-through forces. As training progressed, patients increased the number of targets acquired and spontaneously improved from one day to the next.


CONCLUSIONS
Interactive visuo-haptic environments could be beneficial for attention training for severe TBI patients in the early stages of recovery and warrants further and more prolonged clinical testing.
Rehabilitation Institute of Chicago, 345 E, Superior Street, Chicago, IL 60611, USA. sasaf@vms.huji.ac.il
Assaf Y
AY
Dvorkin
Milan
M
Ramaiya
Eric B
EB
Larson
Felise S
FS
Zollman
Nancy
N
Hsu
Sonia
S
Pacini
Amit
A
Shah
James L
JL
Patton
D000328:Adult; D001288:Attention / Q000502:physiology*; D001930:Brain Injuries / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D012371:Robotics / Q000379:methods*; D063367:Virtual Reality Exposure Therapy / Q000379:methods*