More than 30 percent of patients who survive an episode of critical illness presents brain alterations that go beyond those of the disease that has led to the admission to intensive care (ICU). As a result of this cerebral dysfunction, patients present cognitive alterations to long term that hinder the return to their daily life, pose an increase of human and economic costs associated to their treatment, and have a great impact in the quality of life of patients and their families.
From the need of reducing the morbidity neurocognitive in ICU survivors, Hospital Parc Taulí of Sabadell (Barcelona) has driven a project of virtual reality for apply an intervention of neurocognitive stimulation in patients admitted in the ICU at risk of develop cognitive alterations cognitive during the income. The project, led by Dr. Dr. Lluís Blanch (director of research and innovation of the Parc Taulí Foundation), has been developed by two neuropsychologists experts in cognitive rehabilitation (Marc Turon and Sol Fernández), in addition to having the support of a multidisciplinary team of ICU nurses, intensivists and engineers specializing in biomedical signal monitoring.
The platform of stimulation neurocognitive, that has received the support of the Massachusetts Institute of Technology (MIT) and of the Fundación para la Innovación y la Prospectiva en Salud en España (FIPSE), uses a very similar cognitive stimulation to which traditionally is applied to the patients that have suffered trauma cranial, stroke and neurodegenerative diseases. However, the platform ENRIC (acronym in English Early Neurocognitive Rehabilitation in Intensive Care) adapts to the characteristics of the critical patient, especially in those cases with reduced mobility and impossibility of verbal communication due to mechanical ventilation.
The platform uses virtual reality to transport the patient to relaxing scenarios – a beach or a forest, for example–accompanied at all times by a virtual avatar that helps the patient perform a serie of cognitive exercises with varying degrees of difficulty, adapted to the situation of the critical patient, since awake sedation until receive the discharge from ICU. The system also has a Kinect® Microsoft ©(Redmond, Washington, USA) device, that captures the user’s movement and recognize his/her gestures, so the patient can interact with the system directly from the bed, without using any physical device and thus reducing the likelihood of cross-infection.
In spite of the consequences of cognitive alterations can be devastating for patients, the rehabilitation and subsequent treatment rarely occurs after admission to the ICU. For this reason, preventive interventions during hospitalization are especially needed.
Virtual reality and others new technological solutions seem to be suitable for providing to the health profesional tools that allow interventions of cognitive stimulation in a safe way, viable and of easy application, helping to reduce the barriers to this type of interventions could be implemented in the usual clinical practice.
Potential benefits of this type of interventions during the early stages of critical illness could include decreasing the incidence and duration of episodes of agitation/delirium syndrome, the reduction ICU stay, and consequently a reduction in hospital costs, in addition to the improvement of cognitive function and quality of life of patients after discharge.
The project, which has been described as a “responsable research that obeys to the real problems of the patients”, has received a 400,000 euros funding by FIPSE, La Marató de TV3, Instituto Carlos III de Madrid and Fundació Parc Taulí de Sabadell.
From Proyecto HU-CI, our congratulations to all of the research team that makes possible this wonderful initiative!.