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Virtual reality (VR) is increasingly being used for the assessment and treatment of impairments arising from acquired brain injuries (ABIs) due to perceived benefits over traditional methods. However, no tailored options exist for the design and implementation of VR for ABI rehabilitation and, more specifically, traumatic brain injury (TBI) rehabilitation. In addition, the evidence base lacks systematic reviews of immersive VR use for TBI rehabilitation. Recommendations for this population are important because of the many complex and diverse impairments that individuals can experience.
This study aims to conduct a two-part systematic review to identify and synthesize existing recommendations for designing and implementing therapeutic VR for ABI rehabilitation, including TBI, and to identify current evidence for using immersive VR for TBI assessment and treatment and to map the degree to which this literature includes recommendations for VR design and implementation.
This review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive search of 11 databases and gray literature was conducted in August 2019 and repeated in June 2020. Studies were included if they met relevant search terms, were peer-reviewed, were written in English, and were published between 2009 and 2020. Studies were reviewed to determine the level of evidence and methodological quality. For the first part, qualitative data were synthesized and categorized via meta-synthesis. For the second part, findings were analyzed and synthesized descriptively owing to the heterogeneity of data extracted from the included studies.
In the first part, a total of 14 papers met the inclusion criteria. Recommendations for VR design and implementation were not specific to TBI but rather to stroke or ABI rehabilitation more broadly. The synthesis and analysis of data resulted in three key phases and nine categories of recommendations for designing and implementing VR for ABI rehabilitation. In the second part, 5 studies met the inclusion criteria. A total of 2 studies reported on VR for assessment and three for treatment. Studies were varied in terms of therapeutic targets, VR tasks, and outcome measures. VR was used to assess or treat impairments in cognition, balance, and anxiety, with positive outcomes. However, the levels of evidence, methodological quality, and inclusion of recommendations for VR design and implementation were poor.
There is limited research on the use of immersive VR for TBI rehabilitation. Few studies have been conducted, and there is limited inclusion of recommendations for therapeutic VR design and implementation. Future research in ABI rehabilitation should consider a stepwise approach to VR development, from early co-design studies with end users to larger controlled trials. A list of recommendations is offered to provide guidance and a more consistent model to advance clinical research in this area.
The use of virtual reality (VR) in health care has expanded in recent years and continues to be investigated due to the increasing availability and advancement of technology [
VR refers to “a computer-generated digital environment that can be experienced and interacted with as if that environment were real” [
The existing literature provides guidance for safety and ethical considerations in clinical VR research [
Part 1 of this review had originally planned to include recommendations for using VR in TBI rehabilitation exclusively; however, no studies were identified. Examining the use of VR with other ABIs may provide guidance for this population. Recommendations specific to ABI are necessary, as individuals may experience motor, visual, or vestibular impairments that could impact their ability to use VR [
ABI rehabilitation aims to improve function or provide compensatory strategies to reduce impairments and increase participation in activities and quality of life [
The benefits of VR for ABI rehabilitation include enhanced ecological validity, the ability to maintain experimental control over assessment and treatment standardization [
The development of VR for ABI rehabilitation should incorporate co-design design principles [
With regard to using VR in TBI rehabilitation specifically, there are no known systematic reviews that examine the evidence base for using immersive VR to assess and treat any impairment sustained from TBIs. Experimental and review studies have mainly investigated VR for assessing or treating cognitive or motor impairments [
This systematic review contains two parts and aims to:
Identify and synthesize existing recommendations and frameworks for designing and implementing therapeutic VR for ABI rehabilitation. By doing so, we aim to identify key technological and co-design factors to propose recommendations for the systematic development of VR apps in this field.
Determine the current published evidence base for using immersive VR for TBI assessment and treatment. The identified studies will be compared against the synthesized recommendations from part 1 to determine strengths and potential gaps in the literature with reference to recommendations for VR design and implementation to propose ways to improve future research and practice.
This review has been registered with the International Prospective Register of Systematic Reviews (CRD42020152884) and was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement [
A systematic search was conducted in August 2019. A total of 11 databases were accessed: CINAHL, Cochrane Central, Embase, Institute of Electrical and Electronics Engineers Xplore, MEDLINE, ProQuest Central, PsycBITE, PsychINFO, Scopus, speechBITE, and Web of Science. Search strategies were adapted for individual database requirements. Gray literature was also searched to ensure that all relevant studies were identified (ie, peer-reviewed conference proceedings and clinical guidelines). Additional studies were sourced by hand searching the reference lists of the included papers and repeating database searches in June 2020.
Two systematic searches were conducted to address the research aims in this review. For part 1, the general search strategy was
Provided clear guidelines, consensus statements, recommendations, considerations, or pathways for using virtual reality with adults aged ≥18 years with an acquired brain injury, or the study referred to acquired brain injury populations.
All study designs were considered.
Included data or review of existing scientific evidence as a basis for recommendations.
All virtual reality types were considered (recommendations for development and implementation are likely to be applicable for all therapeutic virtual reality designs despite potential variability in virtual reality systems and levels of immersion [
Papers that provided recommendations for a specific virtual reality system were excluded (ie, recommendations could not be applied to using virtual reality for acquired brain injury rehabilitation more broadly).
Included adults aged ≥18 years with a diagnosis of traumatic brain injury (studies were required to have ≥50% participants with a traumatic brain injury).
Evaluated use of immersive virtual reality for assessing or treating any impairment sustained from a traumatic brain injury (immersive virtual reality was considered due to rapid advancements in technology [
Intervention studies included pre-post outcomes.
Original research design (eg, randomized controlled trial, case series, and case study).
Review papers and studies with semi-immersive or nonimmersive virtual reality systems were excluded.
The following process was conducted separately for each systematic search. Search results were exported to a reference manager (EndNote X9, Clarivate), where any duplicate references were excluded. Nonduplicate references were exported to a systematic review management program (Covidence) [
The following data were extracted and entered into a Microsoft Excel [
For part 1, data were synthesized via a qualitative meta-synthesis: (1) extracting recommendations from the included studies, (2) coding individual recommendations, (3) grouping recommendations based on similarities, and (4) synthesis of grouped recommendations to produce a single comprehensive list [
Where possible, studies were classified according to the Oxford Centre of Evidence-Based Medicine Levels of Evidence [
Part 1 of this review aimed to develop recommendations for the design and implementation of therapeutic VR for ABI rehabilitation based on a synthesis of the existing literature.
Database, gray literature, and hand searches returned 1320 potential studies. Following the removal of duplicates, 995 studies were reviewed for keywords and eligibility criteria. After reading the full texts, 14 studies met the criteria for this review (
PRISMA flow diagram for studies included in part 1.
A variety of study designs were included: 1 systematic review [
Study characteristics of the papers included in part 1.
Author | Country | Study design | Population or participant details | VRa definition (VR equipment and environment) | Aims of the study |
Birckhead et al [ |
United States | Expert opinion consensus | Clinical health care and rehabilitation (makes references to stroke) | Immersive VR, defined VR as using an “HMDb with a close proximity screen” | To develop a methodological, best practice framework to guide development and implementation of high-quality therapeutic VR in health care |
Bryant et al [ |
Australia | Qualitativec | Rehabilitation, including ABId (communication disability) | Immersive VR | To explore views of health care and VR professionals on VR-based rehabilitation |
Deutsch and Westcott McCoy [ |
United States | Literature reviewc | Neurological rehabilitation | Mentions nonimmersive, semi-immersive, and immersive VR systems | To review literature on VR in neurorehabilitation and offer suggestions for bridging gaps between research and practice when adopting VR |
Glegg and Levac [ |
Canada | Perspective or discussionc | Rehabilitation (based on neurorehabilitation) | Mentions nonimmersive, semi-immersive, and immersive VR systems | To provide recommendations for the development, research, and clinical implementation of VR based on known barriers and facilitators |
Glegg and Levac [ |
Canada | Scoping review | Rehabilitation (including ABI) | Included studies used a range of nonimmersive, semi-immersive, and immersive VR systems | To determine factors that contribute to facilitators and barriers to implementing VR in rehabilitation and to develop recommendations to address barriers |
Kellmeyer [ |
Germany | Perspective or discussion | Neurology and psychiatry | Immersive VR | To discuss implications of using highly immersive VR systems within neurology and psychiatry, including ethical issues and adverse effects |
Laver et al [ |
Australia | Systematic review (1e) | Stroke | Included studies used a range of nonimmersive, semi-immersive, and immersive VR systems | To determine efficacy of VR for stroke rehabilitation |
Lee et al [ |
Korea | Mixed methods | Acute stroke; 8 participants (4 male and 4 female; mean age 63 years) | Semi-immersive VR system (Microsoft Kinect; whack-a-mole game for upper limb movement) | To explore patients’ perceived difficulty and enjoyment during VR rehabilitation and the factors affecting experiences and to suggest implementation strategies for VR-based rehabilitation for acute stroke |
Levin et al [ |
Canada | Literature review | ABI (upper limb impairments) | Defines VR with examples of nonimmersive, semi-immersive, and immersive systems | To review motor control and learning principles and to discuss how they can be included in the design of VR training environments |
Lewis and Rosie [ |
New Zealand | Literature review | Chronic neurological conditions (associated movement disorders) | Included studies used a range of nonimmersive, semi-immersive, and immersive VR systems | To review studies that examine users’ responses to VR interventions and develop suggestions for how future VR systems can address user needs and expectations |
Proffitt and Lange [ |
United States | Perspective or discussion | Stroke | VR systems that allow for immersion without assistance (ie, robotic devices) | To outline steps for developing VR interventions for stroke rehabilitation |
Proffitt et al [ |
United States | Review of case studies | Rehabilitation (including stroke and TBIf) | Included studies used a range of nonimmersive and semi-immersive VR systems | To review examples of end user involvement in VR research to provide recommendations for user-engaged design and implementation for VR in clinical practice |
Ramírez-Fernández et al [ |
Mexico | Literature reviewc | Stroke (upper limb impairments) | Not specified; all VR environments | To develop a taxonomy of VR design factors for upper limb rehabilitation of stroke patients |
Vaezipour et al [ |
Australia | Mixed methodsc | Speech pathologists trialed a VR system designed for neurological conditions including ABI (communication impairments) | Immersive VR system (HTC VIVE Pro; simulated kitchen activity) | To explore speech pathologists’ perspectives about immersive VR for rehabilitation of neurogenic communication disorders and to determine advantages and barriers to VR use |
aVR: virtual reality.
bHMD: head-mounted display.
cConference proceeding.
dABI: acquired brain injury.
eOxford levels of evidence (not applied to mixed methods or qualitative papers).
fTBI: traumatic brain injury.
Studies included a range of participants or populations: ABIs (8/14, 57%) [
Various VR systems and levels of immersion were considered or described in the included studies: a combination of nonimmersive, semi-immersive, and immersive systems (7/14, 50%) [
Three key phases of therapeutic VR development in health care were recommended according to the methodological framework developed by Birckhead et al [
Further synthesis and analysis of recommendations from the 14 included studies identified nine categories of recommendations related to participant, design, and technology factors for VR development and implementation in ABI rehabilitation: (1) end user involvement; (2) participant factors; (3) adverse effects and safety; (4) researcher involvement; (5) barriers and facilitators; (6) rehabilitation principles; (7) technological design and development; (8) supporting implementation; and (9) research study design, reporting, and analysis. Many of these categories are interlinked and can be considered across the suggested phases of design and implementation for therapeutic VR (
Phases and categories of recommendations for virtual reality design and implementation.
Involve end users when designing virtual reality apps [
Consider participant factors when designing prototypes (eg, age, gender, ethnicity, health conditions, social position, cognition, and physical limitations) [
Determine the impact of virtual reality on motivation and how to sustain engagement [
Observe users to learn about their behavior [
Measure and report physical and emotional adverse effects [
Examine safety of virtual reality devices and tasks to determine suitability and contraindications [
Develop ideas and evaluate virtual reality prototypes as a team [
Identify potential barriers and facilitators to designing and implementing virtual reality with key stakeholders [
Maintain therapeutic principles in virtual reality tasks (eg, principles of motor learning) [
Tasks should be progressively challenging and customizable [
When providing feedback, consider real-time knowledge of performance [
Use hardware and software that is unrestrictive and allows for movement and possible postural constraints [
Work in collaboration with virtual reality experts, game developers, and engineers [
Support therapists with virtual reality [
Provide information, training, and support for patients using virtual reality [
Conduct larger, adequately powered trials [
For randomized controlled trials, use appropriate randomization, conceal allocation, use CONSORT (Consolidated Standards of Reporting Trials) guidelines [
When reporting virtual reality research, consider using reporting guidelines (eg, Template for Intervention Description and Replication) [
When selecting outcome measures, consider clinical relevance and validity [
Involving end users in co-design for therapeutic VR was recommended in 6 studies [
A range of participant factors should be considered when developing therapeutic VR for ABI rehabilitation [
Participants may experience a range of potential adverse physical and emotional effects when using VR. Some of the potential adverse effects of using VR include headaches, vertigo, nausea, dizziness, fear, and anxiety [
Potential barriers and facilitators of VR use and implementation should be identified via site-specific assessments or interviews during VR development [
Birckhead et al [
A total of 5 studies [
A total of 4 of the included studies [
Recommendations for supporting the implementation of VR in practice for therapists and patients were provided in 8 of the included studies [
Among the included studies, 4 [
The methodological quality of the included studies varied (
Published guidelines for the management of TBI were included as gray literature in the search for this review. None of the reviewed guidelines [
Part 2 of this review aimed to identify current evidence for using immersive VR for assessment and treatment in TBI rehabilitation. These studies were also examined to determine the extent to which they incorporate recommendations for developing and implementing therapeutic VR based on the findings from part 1 of this review.
Database, gray literature, and hand searches returned 1536 potential studies. A total of 830 duplicate studies were removed. Following the screening of titles and abstracts, 77 nonduplicates were identified for full-text screening. Of these studies, 5 met the inclusion criteria. This process is illustrated in
PRISMA flow diagram for studies included in part 2. VR: virtual reality.
Included studies investigated the use of VR for assessment (2/5, 40%) [
Study characteristics and participant details of the studies included in part 2.
Author | Country | Study design | Participant numbers (TBIa severity) | Age (years) | Gender | Time post TBI | Setting |
Banville and Nolin [ |
Canada | Quasi-experimental assessment (4b) | TBI=31 (7 moderate and 24 severe) and matched healthy controls=31 | TBI: mean 27 (SD 11) and controls: mean 27 (SD 11) | TBI: 23 males and 8 females; controls: 23 males and 8 females | Mean 3.78 (SD 2.5) years | Outpatient |
Cikajlo et al [ |
Slovenia | Case series (4b) | TBI=3, brain tumor=1, and nonbrain injury=4 | TBI or brain tumor: range 24-48 and nonbrain injury: range 27-40 | Not reported | Not reported | Outpatient |
Gamito et al [ |
Portugal | Case study | TBI=1 (severe) | 20 | Male | 3 months | Inpatient rehabilitation ward |
Ma et al [ |
United States | Case studyc | TBI=1 (moderate-severe) | 26 | Male | 9 months | Physical therapy clinic |
Robitaille et al [ |
Canada | Proof of concept (4b) | TBI=6 (mild) and healthy controls=6 | TBI: mean 30.3 (SD 8.6; range 18-61) and controls: mean 30.3 (SD 5.3) | Not reported | Median 0.46 years; range 2 weeks to 7 years | Not reported |
aTBI: traumatic brain injury.
bOxford levels of evidence.
cConference proceeding.
A total of 42 participants with TBI were included in this study (
Impairments targeted in VR assessment included executive functions [
Keeping with the definition of immersive VR systems, all studies used HMDs to create immersive VEs [
Assessment studies did not report the time spent in VR. Where reported, therapy session duration ranged from 5 to 25 minutes; total dosage ranged from 50 minutes to 3 hours; and participants received 5, 8, or 10 therapy sessions. One study provided breaks during VR sessions [
Virtual reality details of the studies included in part 2.
Study | Target | Dosage or time in VRa and VR hardware | Task details | Outcome measures | Results | Adverse effects and potential issues | Eligibility criteria |
Banville and Nolin [ |
Prospective memory and executive functions | Time in VR not reported; HMDb (eMagin Z800) with head tracker | Non-VR task: prospective memory assessment based on Rivermead Behavioral Memory Test; VR task: virtual prospective memory tasks completed in a virtual city (included visiting apartments and selecting an apartment to live in) | Non-VR: correct actions, time to complete, and whether prompting was required; VR: prospective memory score, precision score, time to complete, success in task, and IPQc | Participants could be classified as having a TBId by performance on each task. TBI participants were significantly less precise with prospective memory VR tasks ( |
SSQe completed; no reported cybersickness; SSQ scores did not differ between groups | Inclusion criteria: confirmed TBI |
Cikajlo et al [ |
Stress and anxiety | 8 sessions (25 minutes per session, once weekly); Samsung Galaxy X7 mobile phone mounted to HMD (Samsung Gear VR) | Mindfulness stress reduction program conducted by an instructor (eg, self-meditation and group discussions in various VEsf such as a mountain view or a room with a fireplace) | MAAS,g SWLS,h MMSEi (TBI only), session and task ratings, and head motion | Slight improvement in MAAS and SWLS scores (TBI group>non-TBI group); one participant increased MMSE (not reported for others); task ratings: simple to use and interesting; varying head motions | Potential for overheating of mobile phones (sessions were, therefore, limited to 30 minutes) | Inclusion criteria: mild or no cognitive impairment and able to understand instructions; exclusion criteria: high diopters, astigmatism, and wore glasses |
Gamito et al [ |
Working memory and attention | 10 sessions (5 minutes each session); HMD (eMagin Z800) | Activities included performing ADLsj in the VE (eg, breakfast, navigating to and from a supermarket, and buying items) | PASATk and completion time of each task | Significant increase in correct responses between initial and final PASAT scores ( |
Not reported | Inclusion criteria: diagnosed with a TBI 3-12 months prior, clinical deficit in memory and attention, and aged 18-60 years; exclusion criteria: a previous psychiatric disorder that may impact memory and attention and neurological diseases |
Ma et al [ |
Balance and functional mobility | 5 sessions (12 trials, with a 1- to 2-minute break in between); breaks were decided by the participant. Samsung Galaxy X7 mobile phone mounted to HMD (Samsung Gear VR) | Standing balance exercises in a VE with traffic lights, street crossing and traffic island, night and day versions, moving cars, and static buildings | DGI,l mini-BEST,m DHI,n ABC,o GROC,p and patient-specific functional scale (self-scoring street crossing and multitasking abilities) | Improvements in DGI, mini-BEST, DHI, GROC, and patient-specific functional scale | Not reported | Not reported |
Robitaille et al [ |
Executive functions | Time in VR not reported; HMD (piSight 166-43) with head tracking and body tracking (MoCap) | Exploration of a simulated military patrol scene in a village with different conditions and obstacles to navigate (eg, fences, wires, beams, and avatars) | PQ,q SUS,r errors, walking speed and fluidity, and obstacle clearance | TBI group walked faster and had slightly greater obstacle clearances. Significant difference in walking fluidity between groups for two hostile blocks ( |
SSQ completed: 1 participant with TBI and 1 control participant reported slight headaches | Inclusion criteria (TBI): mild TBI; inclusion criteria (controls): no known TBI or other neurological or musculoskeletal issues |
aVR: virtual reality.
bHMD: head-mounted display.
cIPQ: Igroup Presence Questionnaire.
dTBI: traumatic brain injury.
eSSQ: Simulator Sickness Questionnaire.
fVE: virtual environment.
gMAAS: Mindfulness Attention Awareness Scale.
hSWLS: Satisfaction With Life Scale.
iMMSE: Mini-Mental State Examination.
jADL: activities of daily living.
kPASAT: Paced Auditory Serial Addition Task.
lDGI: Dynamic Gait Index.
mmini-BEST: Mini-Balance Evaluation System Test.
nDHI: Dizziness Handicap Index.
oABC: Activities Balance Confidence Scale.
pGROC: Global Rating of Change.
qPQ: Presence Questionnaire.
rSUS: Slater-Usoh-Steed Questionnaire.
One assessment study investigated participant performance on a VR and non-VR assessment of prospective memory [
One intervention study [
Various outcome measures were used, and all studies included more than one measure. VR task-specific outcome measures were used in 4 studies [
The results from the assessment studies suggested that VR assessment tasks have the potential for use as novel diagnostic tools [
Statistically significant outcomes were reported in one case study [
The quality assessments of the included treatment studies are presented in
VR assessment and treatment studies for TBI rehabilitation were examined regarding the three suggested phases of VR development [
Recommendations that were not included in the assessment and treatment studies were as follows: involving researchers when developing VR tasks, considering barriers and facilitators to VR use, technological design and development, and supporting VR in practice. However, many of these recommendations are applicable to specific phases of VR development and implementation, so they may not have been relevant for all studies. Furthermore, recommendations may have been addressed but not specifically reported on.
Inclusion of recommendations for virtual reality design and implementation in traumatic brain injury studies.
Recommendations for VRa development | Banville and Nolin [ |
Cikajlo et al [ |
Gamito et al [ |
Ma et al [ |
Robitaille et al [ |
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Phase 1: co-design |
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Phase 2: feasibility |
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Phase 3: controlled trials |
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End user involvement |
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Participant factors |
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Adverse effects and safety | ✓ | ✓ |
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Researcher involvement |
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Determining barriers and facilitators to VR |
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Rehabilitation principles |
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✓ | ✓ |
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Technological design and development |
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Supporting implementation |
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Research study design, reporting, and analysis | ✓ | ✓ | ✓ | ✓ | ✓ |
aVR: virtual reality.
bRecommendation present.
The findings of this systematic review highlight that research in the field of VR and ABI rehabilitation, particularly for TBI, is still emerging. To our knowledge, this is the first study to synthesize existing recommendations for developing VR for ABI rehabilitation and to systematically review the current evidence base for using immersive VR for TBI rehabilitation. Recommendations for future research have been provided based on the results of this review.
Part 1 of this review aimed to identify and synthesize the recommendations for designing and implementing therapeutic VR for ABI rehabilitation, with a focus on using existing frameworks to determine key technological and co-design factors. The findings appear to be consistent across VR technologies and health care settings and contain important considerations for using VR with people who have an ABI.
Three phases for VR development and implementation of therapeutic VR in health care were developed by Birckhead et al [
A phased approach to VR design should be considered [
The included studies drew on research examining various VR systems and levels of immersion. This reflects the literature from the past decade and highlights the limited use of fully immersive VR for neurological rehabilitation. However, recommendations for VR research are similar across VR platforms, particularly for design and feasibility studies [
The second part of this review aimed to determine the current evidence base for using immersive VR for TBI rehabilitation and to review the extent to which these studies addressed the recommendations developed in part 1 of this review. A total of 5 studies that investigated the use of immersive VR for TBI assessment and treatment were identified and included.
The findings demonstrate a small body of evidence for using immersive VR in TBI rehabilitation. Studies have used immersive VR to assess cognitive impairment following mild, moderate, and severe TBI [
Three different HMDs were used in the 5 studies, including the smartphone-compatible Samsung Gear, which highlights the accessibility and affordability of immersive VR technology [
There were limited adverse effects of VR use reported in 3 of the 5 included studies [
The included studies reported positive findings, but few specific conclusions can be drawn regarding assessment and treatment effectiveness due to a limited number of studies with small sample sizes, a lack of control conditions, assessment reference standards, face-to-face comparisons, and heterogeneity of data that prevented pooling of data and meta-analysis. Some studies had relatively low methodological quality and provided minimal details about participants and recruitment methods, making it challenging to generalize findings and determine the suitability of VR platforms and tasks for people with TBI.
The current evidence base for using immersive VR for TBI rehabilitation incorporates some of the recommendations proposed in part 1 of this review (
Although a systematic literature search was undertaken, some existing studies may have been excluded, as inclusion criteria limited papers to English only, and gray literature did not include conference abstracts or theses. In addition, inconsistencies with VR definitions and classifications [
There were limited high-level evidence studies that provided recommendations for developing and implementing VR in ABI rehabilitation (ie, part 1). Although this may decrease the perceived value of findings, it likely reflects the fact that VR technology and practice in this field are still emerging [
The current evidence base for using immersive VR for TBI assessment and treatment (ie, part 2) consisted mainly of lower-quality methods of case studies and case series. These study designs may be suitable for early co-design and feasibility studies for VR development, yet this was not always reflected in the included studies. On the basis of the methodological quality and levels of evidence, future studies should provide important details about participants, recruitment methods, and interventions; consider and report on adverse effects; and include reference standards and control conditions. These findings reflect the general lack of high-quality evidence, as highlighted in previous reviews of nonimmersive, semi-immersive, and immersive VR for TBI rehabilitation [
Future research should consider the proposed recommendations when designing and implementing VR tasks for ABI rehabilitation, especially for people with TBIs. As identified in this review, stepwise VR development (
Although this review offers a starting point for guiding future research in VR for TBI rehabilitation, the recommendations provided were formed from papers that included a wider range of ABIs. Work should be undertaken to develop guidelines specific to TBI to ensure more rigorous development and evaluation of therapeutic VR for this population. Expanding the evidence base for using VR with people with TBI has been encouraged and highlighted as a priority area in published guidelines for TBI management [
This systematic review highlights that the use of immersive VR in ABI rehabilitation, especially TBI, is still in its infancy. There are no existing guidelines for designing and implementing VR tasks specific to TBI, reflecting the need for more rigorous research in this area. Existing evidence demonstrates the potential to use immersive VR for TBI assessment and treatment. However, this comprises a small number of lower-quality studies with a large degree of heterogeneity, small sample sizes, and limited generalizability of the findings.
This review produced recommendations for developing and implementing VR for ABI rehabilitation (
Example database searches.
List of recommendations for the design and implementation of virtual reality for acquired brain injury rehabilitation.
Quality appraisal of the included studies.
acquired brain injury
Consolidated Standards of Reporting Trials
head-mounted display
Joanna Briggs Institute
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
randomized controlled trial
traumatic brain injury
virtual environment
virtual reality
This research was supported by a Research Training Program Scholarship and a Merit Award Scholarship awarded to the first author (SB). The authors would like to thank Petra Avramovic for assistance with the reliability screening and critical appraisal of the included papers.
None declared.