Introduction
death, hemorrhagic stroke, traumatic brain injury, stroke, brain injury, TBI, SABI, nontraumatic, coma, anoxia, disability, cognitive and motor outcomes
HEMORRHAGIC STROKE, STROKE, DISEASE, CARDIAC ARREST, COMA, ANOXIA, COMPLICATIONS
Severe acquired brain injury (SABI) is a leading cause of death and disability worldwide. SABI refers to damage to the brain, occurring from traumatic brain injury (TBI) and nontraumatic causes (eg, ischemic or hemorrhagic stroke or anoxia following cardiac arrest), with a coma state lasting at least 24 hours [Generally, conventional techniques consist of manual/paper-and-pencil exercises with the physical presence of a therapist in a traditional setting, whereas VR exercises use a computer interface to train motor and cognitive functions in a gamelike setting [However, the families of patients with SABI can face some concerns, such as limited access to appropriate health care services and outpatient clinics because of traveling costs and geographical barriers. This reduces the amount of care provided to patients [TR has been defined as “the delivery of rehabilitation services via information and communication technologies.” Recent evidence supports the feasibility and utility of a home-based system to effectively deliver TR, improve patients’ outcomes, screen for complications of the disease, and provide the patients with a means for at-home interaction with medical personnel [In the past few years, it has been shown that VR technology could be useful to stimulate recovery following a stroke [However, there is still a lack of studies on TR and nonimmersive VR training for cognitive and motor outcomes in patients with SABI. To this end, our study could fill this gap in the neurorehabilitation field. In fact, the concomitant use of TR and VR tools may offer many opportunities to monitor and improve the health status of patients with SABI. TR may allow for continuity of service and care through the entire rehabilitation cycle, including assessment, intervention, consultation, and education, affording early reintegration and positively enhancing the QoL [Among the TR systems, the Virtual Reality Rehabilitation System (VRRS) HomeKit device (Khymeia) enables the patient to carry out the training program at home, completely supervised by the therapist through a remote workstation [The main purpose of this multicenter randomized controlled trial (RCT) was to test the effectiveness of advanced training provided using the VRRS HomeKit device in improving functional outcomes in patients with SABI. Moreover, we sought to investigate the effects of TR on the psychological well-being of caregivers of patients with SABI.