Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients

Background: stroke is one of the most common causes of acquired disability,leaving numerous adults with cognitive and motor impairments,and affecting patients' capability to live independently. there is substancial evidence on post-stroke cognitive rehabilitation benefits,but its implementation is generally limited by the use of paper-and-pencil methods,insufficient personalization,and suboptimal intensity. virtual reality tools have shown potential for improving cognitive rehabilitation by supporting carefully personalized,ecologically valid tasks through accessible technologies. notwithstanding important progress in vr-based cognitive rehabilitation systems,specially with activities of daily living (adl's) simulations,there is still a need of more clinical trials for its validation. in this work we present a one-month randomized controlled trial with 18 stroke in and outpatients from two rehabilitation units: 9 performing a vr-based intervention and 9 performing conventional rehabilitation. methods: the vr-based intervention involved a virtual simulation of a city - reh@city - where memory,attention,visuo-spatial abilities and executive functions tasks are integrated in the performance of several daily routines. the intervention had levels of difficulty progression through a method of fading cues. there was a pre and post-intervention assessment in both groups with the addenbrooke cognitive examination (primary outcome) and the trail making test a and b,picture arrangement from wais iii and stroke impact scale 3.0 (secondary outcomes). results: a within groups analysis revealed significant improvements in global cognitive functioning,attention,memory,visuo-spatial abilities,executive functions,emotion and overall recovery in the vr group. the control group only improved in self-reported memory and social participation. a between groups analysis,showed significantly greater improvements in global cognitive functioning,attention and executive functions when comparing vr to conventional therapy. conclusions: our results suggest that cognitive rehabilitation through the reh@city,an ecologically valid vr system for the training of adl's,has more impact than conventional methods. trial registration: this trial was not registered because it is a small sample study that evaluates the clinical validity of a prototype virtual reality system. © 2016 the author(s).