Virtual Reality-Based Cognitive Intervention For The Prevention of Delirium & Cognitive Impairment In Geriatric Surgical Patients

基于虚拟现实的认知干预预防谵妄

• 批准号: 10516846
• 负责人: Hina Faisal
• 金额: $ 16.15万
• 依托单位: METHODIST HOSPITAL RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10516846
• 关键词: 3-Dimensional; Abdomen; Acute; Address; Adverse event; Age; Aging; Animal Model; Area; Asthenopia; Attention; Award; Awareness; Blurred vision; Brain; Clinical; Clinical Practice Guideline; Clinical Research; Clinical Trials; Cognition; Cognitive; Cognitive Therapy; Cognitive deficits; Computer software; Critical Illness; Custom; Data; Delirium; Development; Documentation; Elderly; Emerging Technologies; Environment; Exercise; Exercise Therapy; Family member; Foundations; Frequencies; Future; Guidelines; Healthcare; Hospitals; Impaired cognition; Incidence; Intensive Care Units; Intervention; Intervention Studies; Lead; Learning; Length; Memory; Methods; Modification; Morbidity - disease rate; Music; Nausea and Vomiting; Nursing Staff; Operative Surgical Procedures; Outcome; Outcome Measure; Patients; Pharmacology; Physical therapy; Physicians; Pilot Projects; Population; Prevalence; Prevention; Prevention strategy; Prevention therapy; Preventive; Primary Prevention; Randomized Controlled Trials; Research; Research Project Grants; Resources; Risk; Role; Scientist; Structure; Surgical Intensive Care; Syndrome; System; Techniques; Testing; Therapeutic; Time; Training Programs; Treatment Effectiveness; aging brain; base; cognitive function; cognitive training; cost; cost effective; cybersickness; design; digital; effectiveness outcome; executive function; functional disability; human model; improved; innovation; mortality; neurocognitive disorder; neuroregulation; novel; prevent; processing speed; prototype; relating to nervous system; usability; virtual reality; virtual reality game

PROJECT SUMMARY/ABSTRACT Delirium is an acute fluctuating syndrome of altered attention, awareness, and cognition. Delirium is highly prevalent, morbid, and costly in elderly critically ill surgical patients. It is also associated with functional and cognitive impairment. No specific pharmacological therapy or approach exists to target the specific cognitive domain involved in delirium. However, early cognitive and physical therapy has been shown to decrease the cognitive deficit, incidence, and duration of delirium. Clinical guidelines recommend multi-component, non- pharmacologic strategies focused on primary prevention (i.e., preventing delirium before it occurs) in patients at risk for delirium. These strategies include mobility/exercise, re-orientation, and cognitive stimulation exercises. Nevertheless, traditional cognitive therapy given to surgical intensive care unit (ICU) patients is non–specific, not customized, and not prioritized due to nursing staff-related issues, documentation burden, time constraints, and a lack of understanding or appreciation for the evidence supporting cognitive stimulation. Virtual Reality (VR) is an emerging technology with potential therapeutic including cognitive stimulation in critically ill patients. VR engages multiple learning systems, making it a more effective natural environment and targeting cognitive training to specific cognitive domains involved in delirium. We developed a novel, 3D simulated software platform prototype, "ReCognition" VR, to address these shortcomings to provide VR-based cognitive exercises to patients for testing in a pilot study. We propose that "ReCognition" VR -based cognitive intervention will prevent the development of delirium (before it occurs in patients at risk for delirium), short term & long-term cognitive impairment in critically ill, non-ventilated abdominal surgery patients of age > 60 years admitted to the ICU. Aim 1: To determine the feasibility, usability & acceptability of "ReCognition" VR-based cognitive stimulation exercises; Aim 2: To assess pilot outcomes measures (tolerability) for optimal implementation of "ReCognition" VR-based cognitive stimulation exercises; Aim 3: To evaluate pilot treatment effectiveness outcomes of "ReCognition" VR-based cognitive stimulation exercises in preventing delirium, short and long-term cognitive impairment.The GEMSSTAR -R03 award will support a current research project and provide a platform for me to continue focusing on geriatric-based clinical research and help me become a leader and an independent physician-scientist to perform clinical research on the delirium and post-delirium cognitive impairment in the elderly surgical population. This award will specifically provide me the support needed to develop expertise in 2 areas: (1) Modification of Recognition VR based cognitive exercise based on the result of the pilot study (2) Preliminary data on feasibility, acceptability, and tolerability for the application of VR- based cognitive exercise for the prevention of delirium and cognitive impairment in a subsequent larger clinical trial. This proposal, and the subsequent planned R01, will lay the foundation for future clinical trials addressing prevention strategies or therapy for delirium in elderly surgical patients.

项目摘要/摘要 ir妄是一种改变注意力，意识和认知的急性波动综合征。 del妄为 在基础批判性手术患者中，高度普遍，病态和昂贵。它也与功能相关 和认知障碍。没有特定的药物疗法或方法可以针对特定的认知 涉及ir妄的领域。但是，早期的认知和物理疗法已被证明可以减少 ir妄的认知缺陷，事件和持续时间。临床指南建议多组分，非 - 药理学策略的重点是原发性预防（即，在发生之前预防ir妄） ir妄的风险。这些策略包括移动性/锻炼，重新定位和认知刺激练习。 然而，对手术重症监护病房（ICU）患者进行的传统认知疗法是非特异性的，不是 根据护士相关的问题，文档烧伤，时间限制和 缺乏对支持认知刺激的证据的理解或欣赏。虚拟现实（VR）是 一种具有潜在疗法的新兴技术，包括重症患者的认知刺激。 VR 参与多个学习系统，使其成为更有效的自然环境并瞄准认知 培训涉及ir妄的特定认知领域。我们开发了一个小说3D模拟的软件平台 原型，“识别” VR，以解决这些缺点，以提供基于VR的认知练习 在一项试点研究中进行测试的患者。我们建议“识别”基于VR的认知干预将阻止 del妄的发展（在有妄想风险的患者中发生之前），短期和长期认知 入院ICU的60岁以上的危重，未通风的腹部手术患者的损害。 目标1：确定基于“识别” VR的可行性，可用性和可接受性 练习；目标2：评估试点结果措施（耐受性）以最佳实施“识别” 基于VR的认知刺激练习；目标3：评估试验治疗效率的结果 “识别”基于VR的认知刺激练习，以防止del妄，短期和长期认知 损害。GEMSSTAR-R03奖将支持当前的研究项目，并为我提供平台 继续专注于基于老年的临床研究，并帮助我成为领导者和独立 身体科学家对del妄和delirium后认知障碍进行临床研究 老年人手术人群。该奖项将特别为我提供发展2中专业知识所需的支持 区域：（1）基于试点研究的结果（2）的结果，基于识别VR的认知练习进行了修改 有关可行性，可接受性和用于应用基于VR的认知练习的可接受性和耐受性的初步数据 在随后的更大临床试验中预防ir妄和认知障碍。这个建议，然后 随后计划的R01将为未来的临床试验奠定基础，以解决预防策略或 古老的手术患者del妄的治疗。