Virtual enriched environments in paediatric neuropsychological rehabilitation following traumatic brain injury: Feasibility, benefits and challenges.

A frequent consequence of traumatic brain injury (TBI) is a significant reduction in patients' cerebral activation/arousal, which clinicians agree is not conducive to optimal rehabilitation outcomes. In the context of paediatric rehabilitation, sustained periods of inactivity are particularly undesirable, as contemporary research has increasingly called into question the Kennard principle that youth inherently promotes greater neural plasticity and functional recovery following TBI. Therefore, the onus to create rehabilitation conditions most conducive to harnessing plasticity falls squarely on the shoulders of clinicians. Having noted the efficacy of environmental enrichment in promoting neural plasticity and positive functional outcomes in the animal literature, some researchers have suggested that the emerging technology of Virtual Reality (VR) could provide the means to increase patients' cerebral activation levels via the use of enriched Virtual Environments (VEs). However, 10 years on, this intuitively appealing concept has received almost no attention from researchers and clinicians alike. This paper overviews recent research on the benefits of enriched environments in the injured brain and identifies the potential and challenges associated with implementing VR-based enrichment in paediatric neuropsychological rehabilitation.