Feasibility and preliminary efficacy of an Occupation-based, Virtual-Reality-based intervention (VR-BrainAware) in inpatient brain injury rehabilitation

The research design is a single-centre, two parallel arm, assessor-blinded pilot and feasibility randomised controlled trial. Participants will be randomised to receive either VR-BrainAware plus usual care or usual care alone. VR-BrainAware VR-BrainAware is a manualised intervention designed to facilitate opportunities for planning, decision-making and completion of multi-step tasks in virtual scenarios (home and transport simulations). Completion and practice of multi-step tasks are required for interventions targeting executive function impairment including self-awareness, to enable opportunities for making, self-correcting and reflecting upon errors, as well as metacognitive approaches (i.e., feedback, reflection about performance). The VR-BrainAware tools include a tutorial, facilitator app and two occupation-based simulations (home and transport). The tools were codesigned over a 12-month period. The codesign team included 5 consumers (3 people with TBI, a person with stroke, and significant other), 4 clinicians and 7 clinician/researchers (with backgrounds in occupational therapy, neuropsychology, speech pathology and physiotherapy) as well as 4 technology developers. Codesign team members participated in a series of structured workshops to create the VR-Brain Aware tools. The facilitator app is accessed via a web application whereas the tutorial and the occupation-based scenarios are accessed by users wearing an Occulus 3 virtual reality headset. Users can interact with the virtual environment using minimal hand movements and are not required to use hand controls. The VR-based tutorial prepares users with the necessary skills to interact with the VR environment (e.g., moving, picking up and storing items). The facilitator app enables clinicians to customise interventions based on user needs and to monitor patient performance in the VR scenarios via a separate computer or tablet. 1. Home simulation-based tasks: planning to leave the house, finding and taking necessary items, completing tasks such as identifying and addressing hazards, locking doors or turning off appliances. 2. Public transport-based tasks: navigating the community environment including dealing with hazards, making decisions and dealing with unexpected situations and environmental distractors or events (i.e.. noise, other people). Planning a bus trip including deciding on a route, money/card handling, monitoring time, and taking the planned trip. VR-Brain Aware will be delivered by qualified, trained occupational therapists. Participants will receive VR-BrainAware twice weekly for three weeks. The intervention will be delivered in a inpatient rehabilitation treatment space. Each session will be 1 hour in duration. VR-BrainAware will be provided to the intervention group in addition to usual care, in keeping with the recommended use of VR in addition to traditional approaches in clinical guidelines.