Locally sourced: Bringing local natural environments to a neurorehabilitation ward with virtual reality. A feasibility randomised controlled trial on the impact on psychological distress

Acquired Brain Injury (ABI) can result in significant psychological distress; depression, stress, and anxiety, are greatly increased following even a mild ABI. The current approach to healthcare design can contribute to these poor outcomes, and there is a need for alternative rehabilitation environments. The natural environment is well-established as having a positive impact on psychological distress. However, the evidence for beneficial effects of nature on psychological distress following ABI specifically is limited, and access to nature is challenging during hospital-based rehabilitation. One solution to accessing nature is virtual reality. This study aims to establish the feasibility, and explore the effects, of immersive virtual nature exposure on the psychological distress of people in hospital-based rehabilitation following an ABI. Video content in nature videos is rarely purpose-built with local environments, despite the potential benefits. Our videos include a selection of scenes from 3 local geographic locations. A single centre, non-blinded, crossover (4-week total) quasi-randomised controlled trial (RCT) feasibility study was undertaken. We found virtual access to local natural spaces during inpatient rehabilitation is feasible, with very low levels of motion sickness and simulator sickness, and high levels of enjoyment. Further, virtual nature may be efficacious in reducing symptoms of psychological distress for people who have experienced a brain injury. The local, familiar places in the study appeared to contribute to the experience; theoretical implications that arose from our use of local, familiar natural places are discussed, as are improvements in the feasibility of the design which could inform a full randomised controlled trial. The findings support the inclusion of nature in rehabilitation from brain injury, delivered virtually, as a method of reducing psychological distress. • Virtual reality-based nature exposure is feasible in inpatient rehabilitation • Motion sickness was low and enjoyment high in people with acquired brain injury • Virtual reality-based nature exposure reduced symptoms of psychological distress • The local, familiar locations of the content contributed to the experience • Local nature experiences may provide different mechanisms to observed benefits