Ana Lúcia Faria

Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients

BackgroundStroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients’ capability to live independently. There is substancial evidence on post-stroke cognitive rehabilitation benefits, but its implementation is generally limited by the use of paper-and-pencil methods, insufficient personalization, and suboptimal intensity. Virtual reality tools have shown potential for improving cognitive rehabilitation by supporting carefully personalized, ecologically valid tasks through accessible technologies. Notwithstanding important progress in VR-based cognitive rehabilitation systems, specially with Activities of Daily Living (ADL’s) simulations, there is still a need of more clinical trials for its validation. In this work we present a one-month randomized controlled trial with 18 stroke in and outpatients from two rehabilitation units: 9 performing a VR-based intervention and 9 performing conventional rehabilitation.MethodsThe VR-based intervention involved a virtual simulation of a city – Reh@City - where memory, attention, visuo-spatial abilities and executive functions tasks are integrated in the performance of several daily routines. The intervention had levels of difficulty progression through a method of fading cues. There was a pre and post-intervention assessment in both groups with the Addenbrooke Cognitive Examination (primary outcome) and the Trail Making Test A and B, Picture Arrangement from WAIS III and Stroke Impact Scale 3.0 (secondary outcomes).ResultsA within groups analysis revealed significant improvements in global cognitive functioning, attention, memory, visuo-spatial abilities, executive functions, emotion and overall recovery in the VR group. The control group only improved in self-reported memory and social participation. A between groups analysis, showed significantly greater improvements in global cognitive functioning, attention and executive functions when comparing VR to conventional therapy.ConclusionsOur results suggest that cognitive rehabilitation through the Reh@City, an ecologically valid VR system for the training of ADL’s, has more impact than conventional methods.Trial registrationThis trial was not registered because it is a small sample study that evaluates the clinical validity of a prototype virtual reality system.

RehabCity: design and validation of a cognitive assessment and rehabilitation tool through gamified simulations of activities of daily living

Worldwide, more than one in three adults suffers from a cardiovascular disease. According to the World Health Organization, 15 million people experience a stroke each year and, of these, 5 million stay permanently disabled. The current limitations of traditional rehabilitation methods push towards the design of personalized tools that can be used intensively by patients and therapists in clinical or at-home environments. In this paper we present the design, implementation and validation of RehabCity, an online game designed for the rehabilitation of cognitive deficits through a gamified approach on activities of daily living (ADLs). Among other findings, our results show a strong correlation between the RehabCity scoring system and the Mini Mental State Examination test for clinical assessment of cognitive function in several domains. These findings suggest that RehabCity is a valid tool for the quantitative assessment of patients with cognitive deficits derived from a brain lesion.

The impact of positive, negative and neutral stimuli in a virtual reality cognitive-motor rehabilitation task: a pilot study with stroke patients.

BackgroundVirtual Reality (VR) based methods for stroke rehabilitation have mainly focused on motor rehabilitation, but there is increasing interest in integrating motor and cognitive training to increase similarity to real-world settings. Unfortunately, more research is needed for the definition of which type of content should be used in the design of these tools. One possibility is the use of emotional stimuli, which are known to enhance attentional processes. According to the Socioemotional Selectivity Theory, as people age, the emotional salience arises for positive and neutral, but not for negative stimuli.MethodsFor this study we developed a cognitive-motor VR task involving attention and short-term memory, and we investigated the impact of using emotional images of varying valence. The task consisted of finding a target image, shown for only two seconds, among fourteen neutral distractors, and selecting it through arm movements. After performing the VR task, a recall task took place and the patients had to identify the target images among a valence-matched number of distractors. Ten stroke patients participated in a within-subjects experiment with three conditions based on the valence of the images: positive, negative and neutral. Eye movements were recorded during VR task performance with an eye tracking system.ResultsOur results show decreased attention for negative stimuli in the VR task performance when compared to neutral stimuli. The recall task shows significantly more wrongly identified images (false memories) for negative stimuli than for neutral. Regression and correlation analyses with the Montreal Cognitive Assessment and the Geriatric Depression Scale revealed differential effects of cognitive function and depressive symptomatology in the encoding and recall of positive, negative and neutral images. Further, eye movement data shows reduced search patterns for wrongly selected stimuli containing emotional content.ConclusionsThe results of this study suggest that it is feasible to use emotional content in a VR based cognitive-motor task for attention and memory training after stroke. Stroke survivors showed less attention towards negative information, exhibiting reduced visual search patterns and more false memories. We have also shown that the use of emotional stimuli in a VR task can provide additional information regarding patient’s mood and cognitive status.

Combined Cognitive-Motor Rehabilitation in Virtual Reality Improves Motor Outcomes in Chronic Stroke – A Pilot Study

Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients’ capability to live independently. Virtual Reality (VR) based methods for stroke rehabilitation have mainly focused on motor rehabilitation but there is increasing interest toward the integration of cognitive training for providing more effective solutions. Here we investigate the feasibility for stroke recovery of a virtual cognitive-motor task, the Reh@Task, which combines adapted arm reaching, and attention and memory training. 24 participants in the chronic stage of stroke, with cognitive and motor deficits, were allocated to one of two groups (VR, Control). Both groups were enrolled in conventional occupational therapy, which mostly involves motor training. Additionally, the VR group underwent training with the Reh@Task and the control group performed time-matched conventional occupational therapy. Motor and cognitive competences were assessed at baseline, end of treatment (1 month) and at a 1-month follow-up through the Montreal Cognitive Assessment, Single Letter Cancelation, Digit Cancelation, Bells Test, Fugl-Meyer Assessment Test, Chedoke Arm and Hand Activity Inventory, Modified Ashworth Scale, and Barthel Index. Our results show that both groups improved in motor function over time, but the Reh@Task group displayed significantly higher between-group outcomes in the arm subpart of the Fugl-Meyer Assessment Test. Improvements in cognitive function were significant and similar in both groups. Overall, these results are supportive of the viability of VR tools that combine motor and cognitive training, such as the Reh@Task. Trial Registration: This trial was not registered because it is a small clinical study that addresses the feasibility of a prototype device.

Hugvie as a Therapeutic Agent in the Improvement of Interaction Skills in Children with Developmental Disabilities: An Exploratory Study

In this exploratory study we examined the use of a Hugvie, a “huggable” pillow with an expressionless vague human form as a means of engaging and maintaining the attention of 8 children between the ages of 2 to 8 years old with a history of communication and language developmental delay and difficulties with social interaction as part of ongoing communication and speech therapy treatment in a speech pathology clinic. Results from 40 individual sessions indicate Hugvie to be an effective means of drawing and engaging the attention of the children and in facilitating the goals and objectives of the treatment plan when compared with conventional therapy aids such as toys and digital applications. The study validates previous observations related to robotic interfaces with minimalistic facial expression and sets a path for further inquiry into tangible speech therapy aids.

The benefits of emotional stimuli in a virtual reality cognitive and motor rehabilitation task: Assessing the impact of positive, negative and neutral stimuli with stroke patients

VR-based methods for stroke rehabilitation have mainly focused on motor rehabilitation, but there is increasing interest towards the integration of cognitive training for providing more ecologically valid solutions. However, more studies are needed, especially in the definition of which type of content should be used in the design of these tools. One possibility is the use of emotional stimuli, which are known to enhance attentional processes. According to the Socio-emotional Selectivity Theory, as people age, this emotional salience arises for positive and neutral, but not for negative stimuli. Conversely, negative stimuli can be better remembered. In this study, we investigated the impact of using emotional stimuli with positive, negative and neutral valence in a VR cognitive and motor attention task. Ten stroke patients participated in a within-subjects experiment with four conditions based on the type of stimuli: abstract (control condition), positive, negative and neutral. The main task consisted of finding a target stimulus, shown for only two seconds, among fourteen neutral distractors. Eye movements were recorded with an eye-tracking system to investigate differences between conditions and in search patterns. Subsequently, a recall task took place and the patients had to identify all the target images among a valence-matched number of distractors. Our results corroborate the attention salience effect of positive and neutral stimuli in the VR task performance. Although we found no statistically significant differences between conditions in the recall task, there was a trend for recalling more negative images. This negative advantage comes at the expense of significantly more wrongly identified images/false memories for negative stimuli. Finally, we performed an analysis in which we relate performance scores with well-established cognitive assessment instruments, which supportsG the use of this approach both for assessment and rehabilitation purposes.