Predictors of improved attentional control after Virtual Reality-based cognitive rehabilitation in chronic traumatic brain injury

T Johansen; M Matre; M Løvstad; A Olsen; A Lund; A C T Martinsen; F Becker; C Brunborg; J Ponsford; S Tornås

doi:10.1080/09638288.2026.2663968

Predictors of improved attentional control after Virtual Reality-based cognitive rehabilitation in chronic traumatic brain injury

Disabil Rehabil. 2026 Apr 29:1-13. doi: 10.1080/09638288.2026.2663968. Online ahead of print.

Authors

T Johansen^{1

2}, M Matre^{1

3}, M Løvstad^{1

3}, A Olsen^{4

5

6}, A Lund², A C T Martinsen^{1

7}, F Becker^{1

8}, C Brunborg⁹, J Ponsford^{10

11}, S Tornås¹²

Affiliations

¹ Center for Research and Education, Sunnaas Rehabilitation Hospital, Nesodden, Norway.
² Department of Occupational Therapy, Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
³ Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
⁴ Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
⁵ Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁶ Norwegian Centre for Headache Research, Trondheim, Norway.
⁷ Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
⁸ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁹ Oslo Centre for Biostatistics & Epidemiology, Oslo University Hospital, Oslo, Norway.
¹⁰ Monash Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Australia.
¹¹ Epworth Healthcare, Richmond, Australia.
¹² The Norwegian Directorate of Health, Department of Innovation, Oslo, Norway.

PMID: 42053561
DOI: 10.1080/09638288.2026.2663968

Abstract

Purpose: The purpose of this paper was to explore predictors of change in attentional control observed in a randomized controlled trial (RCT) investigating VR-based cognitive training, using the game BeatSaber.

Materials and methods: Data were collected at baseline of the RCT, including 100 participants in the chronic phase of TBI, defined as at least one year post-injury. The 51 participants randomized to the VR group were included in this analysis. Primary outcome measure was based on the main significant finding from the RCT, a ratio score between speed and accuracy, Inverse Efficiency Score (IES). To explore potential predictors of post-treatment change in IES, a multivariable regression analysis was performed. Based on previous research, age, years since injury, executive functioning, level of abstract thinking, and immersive tendencies were selected as predictors.

Results: The model explained 40% of the variance of the post treatment change in IES. More years since injury, lower baseline executive functioning and higher immersive tendencies towards games explained greater change in VR-training. However, after bootstrapping, only years since injury remained a significant predictor.

Conclusion: In light of the bootstrapped analyses, the findings should be interpreted as exploratory and considered hypothesis-generating, warranting further investigation in larger samples.

Keywords: TBI; VR; Virtual Reality; attentional control; traumatic brain injury.

Plain language summary

Virtual reality (VR) is an emerging tool for cognitive rehabilitation and may be considered as a supplement to conventional cognitive training, particularly for attentional and executive functions.Clinicians may consider the timing of cognitive interventions in rehabilitation, as patients further along in their recovery process may benefit more from VR-based cognitive training.VR-based cognitive training may be especially relevant for individuals with reduced executive functioning, where structured and engaging training environments may support cognitive improvement.Overall, VR-based cognitive rehabilitation may be integrated as part of a patient-centered rehabilitation approach, taking individual cognitive profiles and stage of recovery into account.