Virtual Reality in Training of Sustained Attention, Processing Speed, and Working Memory After Traumatic Brain Injury: A Randomized Controlled Trial.

Objective: The study aimed to evaluate the effect of playing a commercially available virtual reality (VR)-game on sustained attention as primary outcome, and processing speed and working memory as secondary outcomes, after traumatic brain injury (TBI).

Design, setting, and participants: The study was a parallel-group randomized controlled trial with 1:1 allocation to VR training or an active control condition. One hundred participants aged 18-65 years with complicated mild-to-severe TBI and consequently impaired sustained attention, processing speed, and/or working memory were enrolled. Participants were assessed at baseline, after intervention, and 16 weeks postbaseline.

Intervention: The intervention arm played Beat Saber, a VR game requiring sustained attention and processing speed, 30 minutes per day, 5 days per week for 5 weeks. The control arm received information about everyday activities that might impact cognition.

Outcome measures: Primary outcome was sustained attention measured by Connors Continuous Performance Test-third edition (CPT-3). Secondary outcomes included processing speed (CPT-3 hit reaction time), working memory (digit span backward and sequencing from Wechsler Adult Intelligence Scale-fourth edition), and self-report measures: Behavior Rating Inventory of Executive Function-Adult Version, Patient Competency Rating Scale, Fatigue Severity Scale, and Quality of Life after BRain Injury.

Results: No statistically significant between-group effect was found for the primary outcome measure, sustained attention (P=.473). However, the VR group demonstrated a significant increase in processing speed (P=.035), which was accompanied by a reduction in the number of errors (P<.001). No differences were observed for working memory. Self-reported executive functioning (P=.017) and quality of life (P=.039) were significantly improved in the VR group.

Conclusion: VR training did not improve sustained attention. However, a combination of prolonged reaction times and a decrease in errors in the VR group may indicate improved attentional control. In addition, the findings suggest that VR training might positively affect executive functioning. VR training may be used for cognitive training after TBI.