Brain Injury Essay

Discussion:
Acquired Brain Injury
Acquired brain injury is a condition which can result from infection, trauma, cardiovascular events or other factors which are not congenital, hereditary or degenerative in nature (Kamalakannan et al, 2015). These factors often lead to brain damage, presenting various neurological and physical deficits. Neurological deficits such as temporary memory loss, cognitive delays and other cognitive disturbances including problem solving ability are often seen due to disturbances in normal neural connections or neurotransmitter function (Madison, Robinson & Chadaram, 2007). Co-morbid factors such as speech and cognition deficits as well as upper limb motor impairment mean that the client’s quality of life decreases
significantly following incident of acquired brain injury. This highlights the importance of rehabilitation in order to increase the client’s meaningful occupational engagement and improve their quality of life.

Virtual Reality
Virtual reality appears to be a viable method of rehabilitation as it can encompass both neurological and physical tasks, providing multimodal engagement of the participant.
It appears to be these multimodal dimensions that are so effective in aiding the relearning of memory, cognition and motor processes by increasing neurotransmitter activity and reforming neuromuscular junctions (Levin, Weiss & Keshner, 2014 & Madison, Robinson & Chadaram, 2007). Constant referral of feedback during the intervention allows the client to reassess their movements without interruption to the activity. This allows the client to utilise their own judgement and be an integral part of their own therapy which is often important to the individual. Construction of virtual programs or environments may be effective in providing a meaningful experience to the client and therefore improving the clients rehabilitation outcomes. Virtual reality is also a therapy that may provide more interest to the client than the more traditional therapies currently used in inpatient and community settings, leading to increased client engagement with the rehabilitation program. With further development of virtual reality therapy and virtual environments it may be possible to optimise rehabilitation of motor processes. This may enhance motivation, cognition, movement and sensory feedback by altering the environment relative to the client’s needs and
interests.

Limitations of the review
The exclusion of literature focusing on children and youth acquired brain injury rehabilitation is a limitation of this review as virtual reality may well be even more effective for these clients due to generational differences. Searches only included the terms “virtual reality”, “rehabilitation” and “acquired brain injury” and therefore may have missed related articles which could add more substance to the review. This review only included studies from 2009 onwards. There is little evidence in this review to support simple virtual reality interventions given the nature of the reviewed literature and the advances seen in virtual reality in recent times. This suggests that the interventions seen in this review are more advanced than possible interventions used during the emergence of virtual reality.

Strengths and limitations of the research
Strengths include the recent review of virtual reality in acquired brain injury rehab given the technology is new (predominantly within the last 10 years), may imply though that there is little scientific backing due to lack of research. Strengths of the research include the use of virtual reality as rehabilitation for various causes of ABI such as stroke and trauma. Strengths include the use of virtual reality to rehabilitate multiple effects of ABI such as memory, cognition and upper limb deficits, supporting the method as a viable option for multiple complications of ABI. Limitations of a few studies include using a small sample size which may reduce the validity of the study as findings may not be seen as significant when compared to larger scale studies. Poor methodology in some studies is a limiting factor due to the non-randomised experimental design and non-blinding of the assessors who evaluate client performance. The participants in the reviewed studies were largely stroke patients and predominantly older (50+ years old) which does not provide much scope for virtual reality rehabilitation regarding trauma specifically. Virtual reality equipment may not be available in developing countries, therefore limiting the evidence of best practice given the varying conditions in which one client may receive rehabilitation services compared to another client.

Implications for future research
Studies should be replicated with a high level for reliability according to Cochrane review by utilising blind assessment to provide a true report of rehabilitation method validity. Virtual reality may develop in the future and allow the inclusion of tactile simulation which will help to address limb weakness and touch sensitivity which are deficits often seen in acquired brain injury. This development may also prove to be useful for developmental disorders such as autism spectrum disorder (Kadar, McDonald & Lentin, 2012). Other avenues of virtual reality may also be utilised in the future in order to provide a range of options, allowing programs that are more specific and meaningful to the client.

Conclusion:
The current literature has shown that virtual reality delivered through the Nintendo Wii or virtual environment software is effective in significantly improving cognitive and upper limb deficits during acquired brain injury rehabilitation. These results show that the study participants’ functional capacity is often rehabilitated faster and to a better standard than other methods of rehabilitation such as those seen in trial control groups. As a result, the clients are able to re-engage with their meaningful occupations following virtual reality rehabilitation earlier than those receiving traditional rehabilitation. Further research in this field will provide scope to the benefits of virtual reality in rehabilitation settings, therefore improving the functional outcomes of clients with various conditions. Awareness of this literature can lead to other research questions and assist provisional rehabilitation services in identifying factors that influence intervention.