The Potential of Short-term Visual Memory and Selective Attention Training in Immersive Virtual Reality on Near and Far Transfer Effects in Stroke Patients: Pilot Study

Janavičiūtė-Pužauskė, Jovita; Andrius, Paulauskas; Šinkariova, Liuda · 2025 · Crossref

DOI: 10.21203/rs.3.rs-6539348/v1

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Summary

This pilot study investigates the feasibility and effectiveness of short-term visual memory (VSTM) and selective attention training delivered via immersive virtual reality (iVR) for stroke survivors. The research addresses the high prevalence of cognitive impairments post-stroke, which often receive less attention than motor deficits despite significantly impacting daily functioning. Specifically, the study aims to determine if iVR-based cognitive training yields near transfer effects (improvements in related cognitive domains) and far transfer effects (improvements in emotional state and psychomotor functions) when integrated with conventional rehabilitation. Twenty-seven stroke survivors were randomly assigned to an iVR intervention group or a control group receiving standard care only. The iVR group underwent ten 30-minute sessions over two weeks using an Oculus Quest 2 headset. The training involved two tasks developed in Unreal Engine 5: an object recall task and a sequence recall task, both set in a virtual kitchen environment to enhance ecological validity. Cognitive functions were assessed using the Medical College of Georgia Complex Figures (MCGCF), Trail Making Test (TMT) Parts A and B, and the Addenbrooke’s Cognitive Examination-III (ACE-III). Far transfer outcomes were measured using the Patient Health Questionnaire-9 (PHQ-9) for depression, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety, and the Finger Tapping Test (FTT) for psychomotor speed. Statistical analysis employed nonparametric tests (Mann-Whitney and Wilcoxon) and Hedges’ g for effect sizes. Of the 27 participants, 20 completed the study (13 in the iVR group, 7 in the control group). The iVR group demonstrated statistically significant within-group improvements in attention, verbal fluency, visual search, task switching, working memory, and VSTM. Additionally, the iVR group showed significant reductions in depression and anxiety scores. In contrast, the control group exhibited no significant cognitive or emotional changes, improving only in non-dominant hand psychomotor functions. Pre-assessment data indicated baseline differences in some executive function metrics between groups, but the post-intervention gains in the iVR group were distinct from the control outcomes. The findings suggest that integrating VSTM and selective attention training into an iVR environment is feasible and effective for stroke rehabilitation. The observed improvements in unrelated cognitive domains and emotional states indicate successful near and far transfer effects. These results imply that iVR can enhance conventional rehabilitation by leveraging multisensory stimulation and engagement to promote neuroplasticity. However, due to the small sample size and pilot nature of the study, the authors conclude that larger-scale research is necessary to confirm these effects and establish iVR as a standard component of cognitive rehabilitation protocols.

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• simulator training transfer