Improving Cognitive Function after Traumatic Brain Injury: A Clinical Trial on the Potential Use of the Semi-Immersive Virtual Reality

Table 2

TBI cognitive rehabilitative program.

Cognitive domain	Conventional cognitive rehabilitation	Cognitive training by BTs-Nirvana
Executive functions	The patient uses tools, such as a pencil, sheets, and a pen, to perform exercises in a specific physical space (rehabilitation table); the exercises can also provide tasks of simple associations (i.e., letter-color), inhibitory control, and arithmetic operations; estimating the numerical quantity and the categorization; and the deductive logical reasoning.	The patient performs exercises in a virtual environment through the movement performed in the interactive screen. The movements allow to move or manipulate specific objects, in different directions (i.e., balls, flowers, and butterfly), or to create specific associations (i.e., color-number) with a dynamic interaction in the virtual environment. When the patient touches the virtual objects, he/she determines an audio and video feedback (using the sprite activity). In particular, the subject can perform ideomotor sequences with the guidance of the therapist, calculation and numerical processing, inhibitory control, and arithmetic operations; can estimate the numerical quantity and the categorization; and can perform the deductive logical reasoning, using a specific virtual task.
	Rehabilitative resources: face-to-face rehabilitative session between the patient and the therapist, using paper and pencil materials.	Virtual scenarios: The Bricklaying Tools; Hopscotch; The Colour of Fruit; Walk Through; and Eggs Circle.
	Each training is divided into three different levels of difficulty in relation to the complexity of the tasks, the number of errors, or the speed of execution of the exercise.	The difficulty level increases (from the first to the third level) with the increment of the complexity of the virtual task, elements on the screen, and greater difficulty of the requests by the therapist.
Attention processes and visual-spatial cognition	The patient must indicate and touch specific target stimuli in relation to specific characteristics (color, image, animal, function, etc.), neglecting the distractors. The therapist gives verbal deliveries to the patient, combining the image corresponding to the selection (which reflects the characteristics of the objects to choose).	The patient selects/explores some elements (colors, musical arcs, geometric shapes or not, animals, etc.) observed in the virtual environment. These elements remain visible to the observer for a variable time, established by the interaction between the virtual system, the therapist, and the patient. The patient touches the virtual target element, at a specific time; this action causes a visual change with a typical audio/video feedback (positive reinforcement); otherwise, the element disappears (negative reinforcement) (Hunt task).
	Rehabilitative resources: face-to-face rehabilitative session between patient and therapist, use of paper and pencil materials.	Virtual scenarios: Billiards, Piano, Storm, Flowerized, and Goal.
	Cognitive therapist structures tasks with increased difficulty, according to specific parameters such as number and type target, number and type of distractor, and complexity of consign.	The level of difficulty increases with the increase of the numbers of distractors and reducing the usable time of execution.