Structured Abstract
Brain Injury Structured Abstract - BI #13
Virtual exercise may improve cognitive function in clients with brain injury
CITATION: Grealy, M. A., Johnson, D. A., & Rushton, S. K. (1999). Improving cognitive function after brain injury: The use of exercise and virtual reality. Archives of Physical Medicine & Rehabilitation, 80(6), 661-667.
LEVEL OF EVIDENCE: IIB2b
This random allocation crossover design study, sample size ranged below 20 per each condition with moderate internal validity and moderate external validity provided a IIB level of evidence.
RESEARCH OBJECTIVE/QUESTION
To assess the impact of exercise and virtual reality on cognitive rehabilitation of persons with traumatic brain injury.
DESIGN
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RCT |
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Single Case |
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Case Control |
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X |
Cohort |
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Before-After |
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Cross-Sectional |
This study is occasionally referred to as a prospective design. A cohort design involves a group of people who have been exposed to a certain situation (not an identical situation necessarily) and the results that follow. This group of people is compared to a control that has not been exposed to the situation. This is different from an RCT study because a group of exposed people is formed primarily, and a group of non-exposed people is found to match the experimental group as best as possible. Random allocation cross over design.
SAMPLING PROCEDURE
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Random |
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Consecutive |
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X |
Controlled |
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Convenience |
Individuals for the study were selected according to criteria that had been pre-selected for the study. This sampling procedure is not necessarily composed of volunteers but people who fit the criteria. Patients were of similar age, severity, and time post injury.
SAMPLE
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N = 13 |
M age = 32.08 |
Male = 7 |
Ethnicity = NR |
Female = 6 |
NR = Not reported
The study used a control population of at least 25 clients on whom data were collected from a database of 320 clients admitted to the same hospital over the previous 2 years in which there was no rehabilitation program. Twelve controlled populations were used.
PARTICIPANT CHARACTERISTICS
13 Traumatic brain injured; Controls: 12 Controlled populations (minimum of 25 patients/population) from database of 320 patients.
MEDICAL DIAGNOSIS/CLINICAL DISORDER
Traumatic Brain Injury
OT TREATMENT DIAGNOSIS
Physical substrate: Cognitive substrates: Arousal level, low/not maintained, lethargy, memory loss, deficit or impaired, permanent; Sensory motor substrates: Neuromuscular systems: Reflex/reaction response abnormal.
OUTCOMES
1. Attention Learning and Memory Information Processing Tests
2. Reaction and movement times
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Measures |
Reliability |
Validity |
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1. Reaction Time (4 choice response time program) |
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2. Movement Time |
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3. Digit Symbol (WAIS-R) |
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4. Verbal Learning (Rey) |
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5. Visual Learning (AMIPS) |
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6. Logical Memory (AIMPS) |
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7. Complex Figure (Rey) |
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8. Auditory/Verbal Learning (Rey) |
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NR = Not Reported
Outcome - OT terminology
I. Performance Components
A. Sensorimotor Component
1. Sensory
b. Sensory processing
4. Visual
B. Cognitive Integration & Cognitive Components
Outcome - ICIDH-2 terminology
Body Structure: Neuropsychological function
INTERVENTION
1. Exercise and virtual reality bicycle
2. Control - no VR - exercise
Description
Intervention consisted of combined exercise with VR to increase stimulation reaction by combining cognitive and physical tasks.
Who delivered
Not stated, assumed to be neuro-psychology PhD trained
Setting
Rehabilitation Center in Edinburgh, Scotland
Pre- & Post-intervention
RT and MT measures taken before and after exercise
Frequency
40 Stimuli presentations frequency not stated
Duration
4 Weeks
RESULTS
- Paired t tests & two-way ANOVA with repeated measures, compared the pre-intervention and post-intervention scores on all sub-scales
- Digit symbol task: t = 5.21, p < 0.1
- Verbal learning: t = 3.03, p < .05, trial 6 t = 4.13, p < .01
- Visual learning task: t = 2.96, p < .01
- Reaction times: t = 1.79, p < .01
- Movement times: t = 2.22, p < .05
- Immediate retention visual memory: t = 2.9, p < .05
- Work on finder: 402, p < .01
- A two-way ANOVA (2 X 6) with repeated measures showed the VR exercise program scores improved significantly F = 7.48; p < .05
CONCLUSIONS
Biases
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Attention |
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Masking/blinding |
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Drop outs |
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Contamination |
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Co-intervention |
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Significant improvement in cognitive tasks, reaction times and movement times following VR exercises.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice - Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Beatriz C. Abreu, PhD, OTR, FAOTA, and colleagues. For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
