“Exploring VESPA 2.0 Implementation for Cognitive Rehabilitation in Severe Acquired Brain Injury: A Preliminary Study”

Authors

  • Davide Cardile Centro Neurolesi “Bonino-Pulejo”, Messina; Department of Clinical and Experimental Medicine, University of Messina
  • Francesco Corallo Centro Neurolesi “Bonino-Pulejo”, Messina
  • Helena Danesvalle Department of Clinical and Experimental Medicine, University of Messina
  • Daniele Mollaioli Department of Clinical and Experimental Medicine, University of Messina
  • Salvatore Marco Pappalardo Software Engineering Italia S.r.l, Catania
  • Noemi Giovinco Department of Clinical and Experimental Medicine, University of Messina
  • Rosalia Calapai Centro Neurolesi “Bonino-Pulejo”, Messina
  • Miriana Mirabile Centro Neurolesi “Bonino-Pulejo”, Messina
  • Rosaria De Luca Centro Neurolesi “Bonino-Pulejo”, Messina
  • Maria Grazia Maggio Centro Neurolesi “Bonino-Pulejo”, Messina
  • Desiree Latella Centro Neurolesi “Bonino-Pulejo”, Messina
  • Carmela Rifici Centro Neurolesi “Bonino-Pulejo”, Messina
  • Angelo Quartarone Centro Neurolesi “Bonino-Pulejo”, Messina
  • Rocco Salvatore Calabrò Centro Neurolesi “Bonino-Pulejo”, Messina
  • Laura Culicetto Centro Neurolesi “Bonino-Pulejo”, Messina
  • Francesco Tomaiuolo Department of Clinical and Experimental Medicine, University of Messina

DOI:

https://doi.org/10.13129/3035-062X/prnr-5542

Keywords:

acquired brain injury, virtual reality, neurorehabilitation, cognitive recovery, neuroplasticity

Abstract

Background: Severe acquired brain injury (ABI) frequently results in profound cognitive impairment. Non-immersive virtual reality (VR) delivered at the bedside represents a promising rehabilitation tool for patients who have emerged from a minimally conscious state.

Objective: To evaluate the feasibility, safety, and preliminary efficacy of VESPA 2.0, a tablet-based non-immersive VR system, for cognitive rehabilitation in severe ABI.

Methods: Six patients (4 males, 2 females; mean age 40.8 ± 14.5 years) with traumatic brain injury (n = 1), ischemic stroke (n = 4), or cerebral hemorrhage (n = 1) completed a 12-week individualized bedside VR training program (30–45 min, three times/week), targeting orientation, attention, reaction time, semantic memory, and executive functions. Clinical outcomes (MMSE, FIM, Barthel Index, RCS-E) were assessed at baseline, mid-treatment, and post-treatment. Group-level changes were examined via Friedman tests; individual task trajectories were analyzed using Kendall's Tau-U.

Results: All patients completed the protocol with full adherence and no adverse events. Significant group-level improvements were observed in MMSE (χ²(2) = 11.273, p = .004, W = 0.939), FIM (χ²(2) = 10.333, p = .006, W = 0.861), and Barthel Index (χ²(2) = 10.000, p = .007, W = 0.833), all with large effect sizes. At the single-case level, two patients achieved statistically significant Tau-U effects: the patient with TBI showed faster semantic matching performance (Tau-U = −0.97, p < .05), and one patient with ischemic stroke reached maximal accuracy in semantic categorization (Tau-U = +1.00, p < .05). Remaining patients showed positive but non-significant trends. All patients preferred VR over traditional paper-and-pencil exercises.

Conclusions: Tablet-based, bedside non-immersive VR with VESPA 2.0 was feasible, safe, and associated with significant cognitive and functional gains in severe ABI. Larger controlled trials are warranted to confirm these preliminary findings

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Published

2026-07-17

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Vol. 3 No. 1 (2026): Virtual Reality: New Frontiers and Critical Perspectives in Life Sciences and the Humanities (Vol 2)

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Original Articles

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