Effectiveness of executive functions training within a virtual supermarket for adults with Traumatic Brain Injury

Impairments of executive functions (EF) significantly affect the ability to lead an independent lifestyle. Virtual environments (VEs) offer a way to rehabilitate EF due to their ecological validity. The purpose of this study was to examine the effectiveness of a virtual supermarket (VMall) for treatment of EF in patients with TBI, compared to conventional occupational therapy (OT). Twelve men and women, aged 19-55 years, who had TBI resulting in EF impairments participated in this randomized control trial. Outcome measures were the Multiple Errands Test - Simplified Version (MET-SV) and the Executive Function Performance Test (EFPT). Experimental group participants received 10 treatment 45-min sessions in the VMall, and control group participants received 10 cognitive therapy sessions without VR. Treatment in both groups was based on the cognitive retraining model. Baseline performance prior to intervention showed no statistically significant between group differences. Most of the participants improved their performance on the outcome measures after therapy. The VR group demonstrated more improvement than the control group; for some measures the improvement was statistically significant - % relative change of the MET-SV total score (z=1.76; p=.046) and EFPT total score (z=1.76; p=.047). The results suggest an advantage to VR therapy compared to cognitive retraining OT without VR, as it leads to greater improvement in the performance of complex everyday activities.