Abstract
Chronic disorders of consciousness cause a total or partial and fluctuating unawareness of the surrounding environment. Virtual reality (VR) can be useful as a diagnostic and/or a neurorehabilitation tool, and its effects can be monitored by means of both clinical and electroencephalography (EEG) data recording of brain activity. We reported on the case of a 17-year-old patient with a disorder of consciousness (DoC) who was provided with VR training to improve her cognitive-behavioral outcomes, which were assessed using clinical scales (the Coma Recovery Scale-Revised, the Disability Rating Scale, and the Rancho Los Amigos Levels of Cognitive Functioning), as well as EEG recording, during VR training sessions. At the end of the training, significant improvements in both clinical and neurophysiological outcomes were achieved. Then, we carried out a systematic review of the literature to investigate the role of EEG and VR in the management of patients with DoC. A search on PubMed, Web of Science, Scopus, and Google Scholar databases was performed, using the keywords: “disorders of consciousness” and “virtual reality”, or “EEG”. The results of the literature review suggest that neurophysiological data in combination with VR could be useful in evaluating the reactions induced by different paradigms in DoC patients, helping in the differential diagnosis. In conclusion, the EEG plus VR approach used with our patient could be promising to define the most appropriate stimulation protocol, so as to promote a better personalization of the rehabilitation program. However, further clinical trials, as well as meta-analysis of the literature, are needed to be affirmative on the role of VR in patients with DoC.
Highlights
Unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) are chronic disorders of consciousness (DoC) that can occur after a severe brain injury
We reported on the case of a young female patient with DoC who was provided with Virtual reality (VR) training to improve her cognitive-behavioral outcomes, which were monitored by means of both clinical and EEG data
To evaluate residual brain activity of DoC patients potentially suggesting cognition [44,45,46,47,48,49,55,56]; (iii) two studies used the enrichment environment or VR to stimulate cognitive function and awareness recovery in DoC patients, without EEG monitoring [13,14]; (iv) seven studies used other neurophysiological tools in DoCs, without EEG or VR, to evaluate residual brain activity of DoC patients [50,51,52,53,54,57]. These studies suggest that VR and several types of neurophysiological assessment, both individually and in combination, are potentially effective in corroborating DoC differential diagnosis and prognosis
Summary
Unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) are chronic disorders of consciousness (DoC) that can occur after a severe brain injury. In such conditions, the patient is totally or partially and variably unaware of and unresponsive to the surrounding environment, respectively. Brain Sci. 2020, 10, 414 information of healthcare professionals and family members [6,7]. These procedures can lead to diagnostic biases that could negatively affect the therapeutic and rehabilitative decisions [6,8]
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