https://doi.org/10.4081/ejtm.2025.13275
Virtual reality and cognitive function rehabilitation after traumatic brain injury: a systematic review
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 10 April 2025
Traumatic Brain Injury (TBI) is the leading cause of injury-related death worldwide. In recent years, Virtual Reality (VR) has emerged as a promising diagnostic and treatment tool capable of improving Cognitive Function (CF) after TBI. We sought to review the literature on this issue systematically. Web of Science, PubMed and PsycINFO were screened for relevant literature. Only randomized control trials whereby TBI-affected individuals underwent VR training and control groups received standard rehabilitative care were included. Screening, quality appraisal and data extraction were conducted by independent reviewers using a standardized protocol. Six studies of ~300 participants met the inclusion criteria and showed that both groups improved their overall CF post-intervention. However, non-immersive and semi-immersive VR groups had markedly better scores in all of the cognitive domains measured when compared to non-VR groups. VR is a potent post-TBI rehabilitative tool that can improve CF in this population and facilitate the return-to-work process. Future studies should adopt a similar design yet use fully immersive VR to enhance CF potentially to a greater degree.
Downloads
McDonald BC, Flashman LA, Saykin AJ. Executive dysfunction following traumatic brain injury: neural substrates and treatment strategies. Neuro Rehabilitation 2002;17:333–44. DOI: https://doi.org/10.3233/NRE-2002-17407
Chieregato A, Martino C, Pransani V, et al. Classification of a traumatic brain injury: the Glasgow Coma scale is not enough. Acta Anaesthesiol Scand 2010;54:696–702. DOI: https://doi.org/10.1111/j.1399-6576.2010.02234.x
Maas AIR, Menon DK, Manley GT, et al. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol 2022;21:1004–60. DOI: https://doi.org/10.1016/S1474-4422(22)00307-6
Lui SK, Fook-Chong SMC, Teo QQ. Demographics of traumatic brain injury and outcomes of continuous chain of early rehabilitation in Singapore. Proc Singapore Healthc 2020;29:33–41. DOI: https://doi.org/10.1177/2010105819901137
Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Centre for Disease Control and Prevention; 2006. Available from: https://stacks.cdc.gov/view/cdc/12294 DOI: https://doi.org/10.1037/e721222007-001
Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 2006;21:375–8. DOI: https://doi.org/10.1097/00001199-200609000-00001
Frost RB, Farrer TJ, Primosch M, Hedges DW. Prevalence of traumatic brain injury in the general adult population: a meta-analysis. Neuroepidemiology 2013;40:154–9. DOI: https://doi.org/10.1159/000343275
Dang B, Chen W, He W, Chen G. Rehabilitation treatment and progress of traumatic brain injury dysfunction. Neural Plast 2017;2017:1582182. DOI: https://doi.org/10.1155/2017/1582182
Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019;18:56–87.
Blair C. Educating executive function. Wiley Interdiscip Rev Cogn Sci 2017;8:10.1002/wcs.1403. DOI: https://doi.org/10.1002/wcs.1403
Carlozzi NE, Kratz AL, Sander AM, et al. Health-related quality of life in caregivers of individuals with traumatic brain injury: development of a conceptual model. Arch Phys Med Rehabil 2015;96:105–13. DOI: https://doi.org/10.1016/j.apmr.2014.08.021
Corrigan JD, Cuthbert JP, Harrison-Felix C, et al. US population estimates of health and social outcomes 5 years after rehabilitation for traumatic brain injury. J Head Trauma Rehabil 2014;29:E1-9. DOI: https://doi.org/10.1097/HTR.0000000000000020
Julien A, Danet L, Loisel M, et al. Update on the efficacy of cognitive rehabilitation after moderate to severe traumatic brain injury: a scoping review. Arch Phys Med Rehabil 2023;104:315–30. DOI: https://doi.org/10.1016/j.apmr.2022.07.007
Alashram AR, Padua E, Annino G. Virtual reality for balance and mobility rehabilitation following traumatic brain injury: A systematic review of randomized controlled trials. J Clin Neurosci 2022;105:115–21. DOI: https://doi.org/10.1016/j.jocn.2022.09.012
Rizzo A “Skip”, Kim GJ. A SWOT Analysis of the field of virtual reality rehabilitation and therapy. Presence Teleoperators Virtual Environ 2005;14:119–46. DOI: https://doi.org/10.1162/1054746053967094
Kyaw BM, Saxena N, Posadzki P, et al. Virtual reality for health professions education: systematic review and meta-analysis by the digital health education collaboration. J Med Internet Res 2019;21:e12959. DOI: https://doi.org/10.2196/12959
Gunawan H, Gunawan I, Hambarsari Y, et al. Virtual reality intervention for improving cognitive function in post-stroke patient: A systematic review and meta-analysis. Brain Disord 2024;15:100152. DOI: https://doi.org/10.1016/j.dscb.2024.100152
Man DWK, Poon WS, Lam C. The effectiveness of artificial intelligent 3-D virtual reality vocational problem-solving training in enhancing employment opportunities for people with traumatic brain injury. Brain Inj 2013;27:1016–25. DOI: https://doi.org/10.3109/02699052.2013.794969
Kozhevnikov M, Dhond RP. Understanding immersivity: image generation and transformation processes in 3D immersive environments. Front Psychol 2012;3:284. DOI: https://doi.org/10.3389/fpsyg.2012.00284
LaValle SM. Virtual reality. Cambridge university press; 2023. DOI: https://doi.org/10.1017/9781108182874
Faria AL, Andrade A, Soares L, I Badia SB. Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients. J Neuroeng Rehabil 2016;13:96. DOI: https://doi.org/10.1186/s12984-016-0204-z
Banville F, Nolin P, Rosinvil T, et al. Assessment and rehabilitation after traumatic brain injury using virtual reality: A systematic review and discussion concerning human-computer interactions. In: Virtual reality for psychological and neurocognitive interventions. Springer Nature Switzerland AG; 2019. p. 327–60. DOI: https://doi.org/10.1007/978-1-4939-9482-3_15
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. DOI: https://doi.org/10.1136/bmj.n71
Tacconelli E. Systematic reviews: CRD’s guidance for undertaking reviews in health care. Lancet Infect Dis 2010;10:226. DOI: https://doi.org/10.1016/S1473-3099(10)70065-7
Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:l4898. DOI: https://doi.org/10.1136/bmj.l4898
De Luca R, Maggio MG, Maresca G, et al. Improving cognitive function after traumatic brain injury: a clinical trial on the potential use of the semi-immersive virtual reality. Behav Neurol 2019;2019:9268179. DOI: https://doi.org/10.1155/2019/9268179
De Luca R, Bonanno M, Rifici C, et al. Does non-immersive virtual reality improve attention processes in severe traumatic brain injury? Encouraging data from a pilot study. Brain Sci. 2022 Sep;12(9). DOI: https://doi.org/10.3390/brainsci12091211
De Luca R, Bonanno M, Marra A, et al. Can virtual reality cognitive rehabilitation improve executive functioning and coping strategies in traumatic brain injury? A pilot study. Brain Sci 2023;13:578. DOI: https://doi.org/10.3390/brainsci13040578
Jacoby M, Averbuch S, Sacher Y, et al. Effectiveness of executive functions training within a virtual supermarket for adults with traumatic brain injury: a pilot study. IEEE Trans neural Syst Rehabil Eng a Publ IEEE Eng Med Biol Soc 2013;21:182–90. DOI: https://doi.org/10.1109/TNSRE.2012.2235184
Sharma A, Sharma A, Jain S, et al. Cognitive outcomes following virtual reality rehabilitation in patient with traumatic brain injury: a prospective randomized comparative study. Indian J Neurotrauma 2024; DOI:10.1055/s-0044-1778735 DOI: https://doi.org/10.1055/s-0044-1778735
Alashram AR, Annino G, Padua E, et al. Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology. J Clin Neurosci Off J Neurosurg Soc Australas 2019;66:209–19. DOI: https://doi.org/10.1016/j.jocn.2019.04.026
Mahncke HW, Bronstone A, Merzenich MM. Brain plasticity and functional losses in the aged: scientific bases for a novel intervention. In: Møller ARBT-P in BR, editor. Reprogramming of the Brain. Elsevier; 2006. p. 81–109. Available from: https://www.sciencedirect.com/science/article/pii/S0079612306570062 DOI: https://doi.org/10.1016/S0079-6123(06)57006-2
Riva G, Mancuso V, Cavedoni S, Stramba-Badiale C. Virtual reality in neurorehabilitation: a review of its effects on multiple cognitive domains. Expert Rev Med Devices 2020;17:1035–61. DOI: https://doi.org/10.1080/17434440.2020.1825939
Altunkaya J, Craven M, Lambe S, et al. Estimating the economic value of automated virtual reality cognitive therapy for treating agoraphobic avoidance in patients with psychosis: findings from the gamechange randomized controlled clinical trial. J Med Internet Res 2022;24:e39248. DOI: https://doi.org/10.2196/39248
Lim I, Cha B, Cho DR, et al. safety and potential usability of immersive virtual reality for brain rehabilitation: a pilot study. Games Health J 2023;12:34–41. DOI: https://doi.org/10.1089/g4h.2022.0048
Selivanov V V, Selivanova LN, Babieva NS. Cognitive processes and personality traits in virtual reality educational and training. Psychol Russ State Art 2020;13:16–28. DOI: https://doi.org/10.11621/pir.2020.0202
Menshikova GY, Kovalev AI, Barabanshchikova VV, Klimova OA. The application of virtual reality technology to testing resistance to motion sickness. Psychol Russ 2017;10:151. DOI: https://doi.org/10.11621/pir.2017.0310
Pietrzak E, Pullman S, McGuire A. Using virtual reality and videogames for traumatic brain injury rehabilitation: a structured literature review. Games Health J 2014;3:202–14. DOI: https://doi.org/10.1089/g4h.2014.0013
Rogers JM, Duckworth J, Middleton S, et al. Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study. J Neuroeng Rehabil 2019;16:56. DOI: https://doi.org/10.1186/s12984-019-0531-y
Tieri G, Morone G, Paolucci S, Iosa M. Virtual reality in cognitive and motor rehabilitation: facts, fiction and fallacies. Expert Rev Med Devices 2018;15:107–17. DOI: https://doi.org/10.1080/17434440.2018.1425613
Taylor HG, Swartwout MD, Yeates KO, et al. Traumatic brain injury in young children: postacute effects on cognitive and school readiness skills. J Int Neuropsychol Soc 2008;14:734–45. DOI: https://doi.org/10.1017/S1355617708081150
Välimäki M, Mishina K, Kaakinen JK, et al. Digital gaming for improving the functioning of people with traumatic brain injury: randomized clinical feasibility study. J Med Internet Res 2018;20:e77. DOI: https://doi.org/10.2196/jmir.7618
Bloom B, Thomas S, Ahrensberg JM, et al. A systematic review and meta-analysis of return to work after mild traumatic brain injury. Brain Inj 2018;32:1623–36. DOI: https://doi.org/10.1080/02699052.2018.1532111
Nikonova E, Rupchev G, Morozova M, Burminskiy D. Using virtual reality for relaxation in patients with schizophrenia. A pilot study. Natl Psychol J 2023;18:78–89.
How to Cite

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.