Virtual rehabilitation of upper-limb function in traumatic brain injury: A mixed-approach evaluation of the Elements system

The aim of this study was to assess the efficacy of the Elements virtual reality (VR) system for rehabilitation of upper-limb function in patients with traumatic brain injury (TBI). A mixed-approach design was used. Performance was evaluated at three time points using a within-group design: Preintervention 1 and 2, conducted 4 weeks apart, and Postintervention. Subjective ratings were provided after patients completed exploratory tasks. The intervention consisted of 12 1-hour training sessions over 4 weeks in addition to conventional physical therapy. Nine patients aged 18–48 years with severe TBI were recruited. The Elements system is comprised of a 40-inch tabletop LCD, camera tracking system, tangible user interfaces (i.e., graspable objects), and software. The system provided two modes of interaction with augmented feedback: goal-directed and exploratory. Upper-limb performance was assessed using system-rated measures (movement speed, accuracy, & efficiency), and standardised tests. Planned comparisons revealed little change in performance over the pretest period apart from an increase in movement speed. Significant training effects, with large effect sizes were shown on most measures. Subjective data revealed high levels of presence (inc. user involvement/control) and user satisfaction for the exploratory tasks. These findings support an earlier case study evaluation of the Elements system, further demonstrating that VR training is a viable adjunct in movement rehabilitation of TBI.