Virtual reality for cognitive rehabilitation: from new use of computers to better knowledge of brain black box?

Abstract

Virtual reality (VR)-based technologies are one of the emerging tools that appear to have great potential for use in cognitive rehabilitation. However, it still is unclear how brain capacities are involved and what is the best approach to such training. Quantitative aspects are encouraging because some improvements have been shown after few training sessions. By contrast, qualitative design of VR tools is more questionable. Choice of errorless or error-full designs may depend on the severity of disturbances. Most VR tools emphasize the explicit component of tasks; even procedural aspects comprise the main strength of VR retraining programs. VR and augmented reality tools give various stimuli and indicators, but their best modalities stay unclear, given that most data are coming from learning studies in normal subjects more than rehabilitation studies in brain-injured patients. Specific studies to explore the impact of sensorial transmodal effects and emotional involvement in VR tasks are required. Rehabilitation protocols utilizing virtual environments are moving from single applications to cognitive impairment (i.e., alertness, memory, neglect, language, executive functions) to comprehensive rehabilitation programs, with the aim of achieving efficient improvement in autonomy and transfer of benefits in real life conditions. A core issue that presents challenges to rehabilitation is decreased ability of persons with brain injury to transfer learning from one situation or context to another. The multi-context approach to cognitive rehabilitation proposes treatment methods for teaching the use of strategies across a wide range of meaningful activities, which can promote generalization and enhance functional performance.