There are trials under way studying virtual reality cognitive and physical rehabilitation in people with mild cognitive impairment: the intermediate state between normal ageing and dementia. And what those trials are measuring, at this stage, is not what most people expect.
They measure feasibility, usability and acceptability. That is: can the person use it? Do they want to come back? Can the team fit it into what they already do?
Why that is not a lesser result
At first glance it looks like the study you run when you lack the nerve to measure efficacy. It is not.
In a device you place on the head of a 78-year-old, feasibility is the question. If half the participants give up in the second minute, if the weight bothers them, if the interface demands coordination that is not there, or if the team needs fifteen minutes to get it working during a shift that has no fifteen minutes, no efficacy question is even answerable.
That is the right order: first usable, then useful. A field that skips the first question produces handsome results under conditions that exist nowhere.
Almost every device sitting in an institution's storeroom failed the first question, not the second.
What we have learned, in practice
We do not have a trial of our own, and we are not going to pretend otherwise. What we have is use in the real world (more than 50,000 sessions in Portuguese institutions) and a few lessons that look a lot like what these trials set out to measure:
- Fitting the headset is the critical moment. Whoever runs the session has to know how to place it on someone with limited neck mobility, without crushed glasses and without a fright.
- The first session decides the second. If the person was startled, no scene makes up for it.
- Refusal is a legitimate outcome. We wrote about it in when the patient refuses virtual reality: insisting is the most expensive mistake in this field.
- Duration is not what people imagine. That deserves its own article: session duration and frequency.
And cybersickness
It is the objection that always comes up, and rightly: motion sickness in virtual reality is real and is common in computer-generated content with free camera movement.
We made a different choice: real filmed video, with a mostly static camera, rather than 3D environments with locomotion. We have no reported cases of cybersickness to date. That is not a clinical trial and is not presented as one: it is what we have observed in use, and the reason the instruction to stop at any dizziness, nausea or discomfort is in every implementation guide.
What this means for an institution today
That the right question, before asking "does it work?", is: can our people use this inside the week they already have?
If the answer is no, the rest is conversation. If it is yes, then it is worth discussing what to measure, with whom, and for how long.
Source: trial registered at ClinicalTrials.gov on feasibility, usability and acceptability of virtual reality-based cognitive and physical rehabilitation in people with mild cognitive impairment.
Frequently asked questions
Why do the trials measure feasibility rather than efficacy?
Because in a device placed on an older person's head, feasibility is the first question. If the person gives up, if the headset bothers them or if the team cannot fit it into a shift, no efficacy question is even answerable.
Does RVer cause motion sickness?
We have no reported cases of cybersickness to date, which is an observation from use and not a clinical trial. Choosing real filmed video with a mostly static camera reduces exposure to the movement that causes sickness. The instruction is to stop immediately at any dizziness, nausea or discomfort.
Does RVer treat cognitive impairment?
No. It is used by clinical teams in cognitive stimulation settings. It does not assess, classify or diagnose, and it does not replace any clinical assessment.