The efficacy and feasibility of an immersive virtual reality game to train spatial attention orientation after stroke: A stage 2 report

Spatial neglect is a post-stroke attention deficit for which there is no evidence-based intervention. Immersive virtual reality (IVR) may increase treatment efficacy, as it allows to train spatial attention in a rich environment. This study evaluated the efficacy and feasibility of an IVR patient-tailored training (HEMIRehApp). Using a cross-over design, an active (spatially biased) and placebo (spatially unbiased) IVR intervention were compared. We aimed to recruit 8 per-protocol left-sided neglect patients. The primary outcome was response times on the Posner cueing task. To evaluate feasibility, we documented the number of recruited patients, cybersickness and patients' experience with HEMIRehApp. After 2 years of recruitment, we were able to enrol 6 patients, of whom 2 completed the full protocol. The target sample size was not feasible due to a lower than expected prevalence of left-sided neglect and a higher than expected drop-out rate. The planned group-level analysis was therefore replaced by a single-case analysis. The results in the 2 per-protocol cases suggest a superior effect of spatially biased IVR training than unbiased IVR training inside IVR. IVR training was feasible as all 6 enrolled patients were able to complete 10 IVR training sessions, but the cross-over protocol itself was unfeasible. While the low sample size prevented us from conclusively evaluating the efficacy of HEMIRehApp, our preliminary single-case results suggest that neglect patients were able to improve attentional orientation towards eccentric target locations in IVR. Follow-up studies are needed to further validate these findings.