Digital Gaming for Improving the Functioning of People With Traumatic Brain Injury: Randomized Clinical Feasibility Study
Aki Koponen; Heikki Hämäläinen; Jaana Sarajuuri; Johanna K Kaakinen; Jukka Vahlo; Jyrki Korkeila; Kaisa Mishina; Maritta Välimäki; Markus Kirjonen; Olli Tenovuo; Pekka Rantanen; Suvi K Holm; Tage Orenius; Virve Pekurinen
https://urn.fi/URN:NBN:fi-fe2021042719090
Tiivistelmä
Background
Traumatic brain injury (TBI) is a major
health problem that often requires intensive and long-term rehabilitation.
Objective
The aim of this study was to determine
whether rehabilitative digital gaming facilitates cognitive functioning and
general well-being in people with TBI.
Methods
A total of 90 Finnish-speaking adults with
TBI (18-65 years) were recruited from an outpatient neuroscience clinic. The
participants were randomly allocated to one of the three groups: a
rehabilitation gaming group (n=29, intervention), an entertainment gaming group
(n=29, active control), or a passive control group (n=32). The gaming groups
were instructed to engage in gaming for a minimum of 30 min per day for 8
weeks. Primary and secondary outcomes were measured at three time points:
before the intervention, after the intervention, and 3 months following the
intervention. The primary outcome was cognitive status measured by processing
speed and visuomotor tasks (The Trail Making Test; Wechsler Adult Intelligence
Scale-Fourth Edition, WAIS-IV, symbol search, coding, and cancellation tasks).
Secondary outcomes were attention and executive functions (Simon task), working
memory (WAIS-IV digit span and Paced Auditory Serial Addition Test, PASAT),
depression (Patient Health Questionnaire-9), self-efficacy (General
Self-efficacy Scale), and executive functions (Behavior Rating Inventory of
Executive Function-Adult Version). Feasibility information was assessed
(acceptability, measurement instruments filled, dropouts, adherence, usability,
satisfaction, and possible future use). Cognitive measurements were conducted
in face-to-face interviews by trained psychologists, and questionnaires were
self-administered.
Results
The effects of rehabilitation gaming did
not significantly differ from the effects of entertainment gaming or being in a
passive control group. For primary outcomes and PASAT tests, the participants
in all three groups showed overall improvement in test scores across the three
measurement points. However, depression scores increased significantly between
baseline and after 8 weeks and between baseline and after 3 months in the
rehabilitative gaming group. No differences were found in patients’
self-efficacy between the three measuring points in any of the groups.
Participants did use the games (rehabilitation group: 93%, 27/29; entertainment
group 100%, 29/29). Games were seen as a usable intervention (rehabilitation
group: 70%, 14/29; entertainment group: 83%, 20/29). The rehabilitation group
was less satisfied with the gaming intervention (68%, 13/29 vs 83%, 20/29), but
they were more willing to use the game after the intervention period (76%,
16/29 vs 63%, 15/29). Total time spent on gaming during the intervention period
was low (15.22 hour rehabilitation gaming group, 19.22 hour entertainment
gaming group).
Conclusions
We did not find differences between the
groups in improvement in the outcome measures. The improvements in test
performance by all three groups may reflect rehearsal effects. Entertainment
gaming had elements that could be considered when rehabilitative games are
designed for, implemented in, and assessed in larger clinical trials for
persons with TBI.
Kokoelmat
- Rinnakkaistallenteet [19207]