Video game play changes spatial and verbal memory: rehabilitation of a single case with traumatic brain injury

Abstract

IntroductionTraumatic brain injury (TBI) occurs when mechanicalforce causes damage to brain tissue resulting in the dis-ruption of brain functioning. Cognition is frequentlydamaged after TBI; although the effects of TBI can bevariable, the domains of memory, attention, and executivefunctioning are consistently impaired. Memory deficit isone of the most (if not the most) common and disablingimpairments caused by TBI (Vakil 2005).Theuseof3D video games inbraindamagerehabilitationis a very little explored resource at the present time. 3Dvideo games are based on virtual reality technology. Theadvantage of using VR in cognitive rehabilitation is tosimulate many real life situations, thereby providing theopportunity for more ecologically valid and dynamicassessment and training (Rose et al. 2005). The utility of thismethod has been established through some spatial memorystudies (see Rose et al. 2005). It has been shown that navi-gation ofavirtualenvironmentallowsparticipantstoencodethe spatial layout of the virtual environment and activate anetwork of areas as the Hippocampus involved in memoryprocessing(Maguireetal.1998).Someauthorsassumedthathippocampal activations are more likely to be observedwhen the knowledge acquired concerns a complex anddetailed large-scale spatial layout (Woollett et al. 2008).The aim of this exploratory study was to assess themodifications occurring in cognitive functions, in particularspatial and verbal memory, and a potential fMRI increaseof signal in hippocampal and extrahippocampal brainregions in a TBI patient after a 3D video game rehabili-tation training.MethodsThe present study describes the rehabilitation of a 24-year-old, right-handed man, with 8 years of education. Hismedical history was unremarkable till when he wasinvolved in a motor vehicle crash and sustained a TBI ofmoderate severity. His Glasgow Coma Scale score was 5.He was diagnosed with trauma cranial injury. The patientwas tested 7 months after the event and was not in the post-traumatic amnesia (PTA) stage.Neuropsychological assessment indicated the presenceof a severe anterograde (recall and recognition) and retro-grade amnesia and deficits in spatial learning (supra-spanon Corsi’s test).Thetraining consistedofaseries of1.5 hsessions thriceaweek(totallengthofintervention:5 weeks).Thevideogamewas a driving simulator. During the training the participantwas requested to explore a complex virtual town from aground-levelperspective.Ineachtrainingsessionthesubjectinterchanged 20 min of navigation with 7 min of break.The patient was evaluated before and after training bymeans of a fMRI and a standardized neuropsychologicalassessment. He was then re-tested 1 and 2 months after thelast memory training session for two follow-up testingsessions.