RESUMEN
Objective：It is often difficult to provide effective functional training in patients with severe attention deficit caused by organic damage to the brain. Herein, we report a case of attention deficit in a patient with subarachnoid hemorrhage, which was successfully treated by virtual reality (VR)-guided rehabilitation.Methods：A 71-year-old woman was transferred to our hospital for rehabilitation after a subarachnoid hemorrhage. The patient suffered from severe attention deficit. She was unable to follow instructions from therapists and was unable to concentrate on rehabilitation tasks. We attempted VR-guided rehabilitation using mediVR KAGURA (mediVR, Toyonaka, Japan) in order to improve her attention deficit. The training was performed approximately 20 min every weekday, for 4 months in a 360-degree VR environment, with no background image initially. The difficulties in physical and cognitive tasks were adjusted by focusing on the size, range of appearance, and falling speed of each task object, so that even patients with severe attention deficit could respond to these tasks appropriately.Results：After the above-mentioned VR-guided training, the trail making test A, behavioral inattention test, and moss attention rating scale were improved from 300 s (could not complete the test）to 100 s, 119 to 133, and 55 to 98, respectively. In addition, in the clinical assessment for attention, the time required for visual obliteration tests was significantly shortened, and clinical symptoms associated with attention deficit were also improved clinically.Conclusion：VR-guided rehabilitation has the potential to be used as a new therapeutic approach to improve attention deficit.
RESUMEN
Objective：It is often difficult to provide effective functional training in patients with severe attention deficit caused by organic damage to the brain. Herein, we report a case of attention deficit in a patient with subarachnoid hemorrhage, which was successfully treated by virtual reality (VR)-guided rehabilitation.Methods：A 71-year-old woman was transferred to our hospital for rehabilitation after a subarachnoid hemorrhage. The patient suffered from severe attention deficit. She was unable to follow instructions from therapists and was unable to concentrate on rehabilitation tasks. We attempted VR-guided rehabilitation using mediVR KAGURA (mediVR, Toyonaka, Japan) in order to improve her attention deficit. The training was performed approximately 20 min every weekday, for 4 months in a 360-degree VR environment, with no background image initially. The difficulties in physical and cognitive tasks were adjusted by focusing on the size, range of appearance, and falling speed of each task object, so that even patients with severe attention deficit could respond to these tasks appropriately.Results：After the above-mentioned VR-guided training, the trail making test A, behavioral inattention test, and moss attention rating scale were improved from 300 s (could not complete the test) to 100 s, 119 to 133, and 55 to 98, respectively. In addition, in the clinical assessment for attention, the time required for visual obliteration tests was significantly shortened, and clinical symptoms associated with attention deficit were also improved clinically.Conclusion：VR-guided rehabilitation has the potential to be used as a new therapeutic approach to improve attention deficit.
RESUMEN
Recently, the importance of terminal care has been emphasized in studies of patients with malignant brain tumors. Healthcare professionals should have knowledge of symptoms caused by brain tumors when treating patients in the terminal phase. This study aimed to investigate the data collection method, evaluation time, and symptoms of patients with brain tumor in the terminal phase through literature search. Seven papers were extracted by a literature search. Data collection methods included collecting information from medical records (4 papers), questionnaire (2 papers), and telephone survey (1 paper). Evaluation times ranged from 46 days to 1 week before death. Symptoms presented by patients with malignant brain tumors in the terminal phase could be classified according to disease-specific symptoms and general symptoms presented by patients with other types of terminal cancer. The most commonly reported disease-specific symptoms were disturbance of consciousness (4 papers), seizures (7 papers), dysphagia (6 papers), and headache (6 papers). The proportion of patients with dysphagia increased as they approached the end of life. These results suggest that the data collection method and evaluation time differ depending on the previous studies and that patients with brain tumors in the terminal phase are likely to present disease-specific symptoms.