Diogo Morais

PTSD Elderly War Veterans: A Clinical Controlled Pilot Study

Around 25,000 war veterans in Portugal suffer posttraumatic stress disorder (PTSD). This clinically controlled study evaluates virtual reality exposure therapy (VRET) as an alternative procedure to reduce PTSD symptoms. Ten patients were assigned to three groups: VRET, exposure in imagination (EI), and waiting list (WL). The patients were Portuguese veterans from a series of wars fought in former African colonies more than 30 years ago. While the EI group participated in traditional imagination therapy, the VRET group was exposed to a virtual reality (VR) war scenario. Cues such as ambush, mortar blasting, and waiting for rescue were used in the VR. Patients enrolled in the VRET group showed statistical reduction of PTSD-associated disorders like depression and anxiety. Far from being conclusive, this pilot study nonetheless presents some promising data on the use of VRET on old war veteran populations.

Executive Functioning in Alcoholics Following an mHealth Cognitive Stimulation Program: Randomized Controlled Trial

Background The consequences of alcohol dependence are severe and may range from physical disease to neuropsychological deficits in several cognitive domains. Alcohol abuse has also been related to brain dysfunction specifically in the prefrontal cortex. Conventional neuropsychological interventions (paper-and-pencil cognitive stimulation training) have a positive effect but are time-consuming, costly, and not motivating for patients. Objective Our goal was to test the cognitive effects of a novel approach to neuropsychological intervention, using mobile technology and serious games, on patients with alcohol dependence. Methods The trial design consisted of a two-arm study assessing the cognitive outcomes of neuropsychological intervention with mobile serious games (mHealth) versus control (treatment-as-usual with no neuropsychological intervention) in patients undergoing treatment for alcohol dependence syndrome. Sixty-eight patients were recruited from an alcohol-rehab clinic and randomly assigned to the mHealth (n=33) or control condition (n=35). The intervention on the experimental group consisted of a therapist-assisted cognitive stimulation therapy for 4 weeks on a 2-3 days/week basis. Results Fourteen patients dropped out of the study. The results of the neuropsychological assessments with the remaining 54 patients showed an overall increase (P<.05) of general cognitive abilities, mental flexibility, psychomotor processing speed, and attentional ability in both experimental (n=26) and control groups (n=28). However, there was a more pronounced improvement (P=.01) specifically in frontal lobe functions from baseline (mean 13.89, SE 0.58) to follow-up (mean 15.50, SE 0.46) in the experimental group but not in the control group. Conclusions The overall increase in general cognitive function for both experimental and control groups supports the beneficial role of existing alcohol treatment protocols aimed at minimizing withdrawal symptoms, but the differential improvements observed in frontal lobe functioning supports the use of mobile serious games for neuropsychological stimulation to overcome executive dysfunction in patients with alcohol dependence. This trial was negative on two neuropsychological/cognitive tests, and positive on one. Trial Registration ClinicalTrials.gov NCT01942954; http://www.clinicaltrials.gov/ct2/show/NCT01942954 (Archived by WebCite at http://www.webcitation.org/6OYDqHLwB).

Cognitive training on stroke patients via virtual reality-based serious games

Abstract Purpose: Use of virtual reality environments in cognitive rehabilitation offers cost benefits and other advantages. In order to test the effectiveness of a virtual reality application for neuropsychological rehabilitation, a cognitive training program using virtual reality was applied to stroke patients. Methods: A virtual reality-based serious games application for cognitive training was developed, with attention and memory tasks consisting of daily life activities. Twenty stroke patients were randomly assigned to two conditions: exposure to the intervention, and waiting list control. Results: The results showed significant improvements in attention and memory functions in the intervention group, but not in the controls. Conclusions: Overall findings provide further support for the use of VR cognitive training applications in neuropsychological rehabilitation. Implications for Rehabilitation Improvements in memory and attention functions following a virtual reality-based serious games intervention. Training of daily-life activities using a virtual reality application. Accessibility to training contents.

Traumatic brain injury memory training: a virtual reality online solution

Abstract This study aims at assessing an online portal where patients with traumatic brain injury (TBI) can carry on memory and attention exercises outside clinic premises. The training took place in a virtual reality (VR) setup where one TBI patient had to complete a set of 10 online VR sessions. The neuropsychological evaluation was carried out with the PASAT (Paced Auditory Serial Addition Task) at pre-, during and post-treatment assessments. The results showed an increase in working memory and attention levels from the first to the final assessment, which can suggest that VR applications may promote the autonomy and increase in overall quality of life of these patients. The average time for task conclusion was 5 min.

Serious Games for Serious problems: from Ludicus to Therapeuticus

Within the primate family, the members of our species are the ones that present the longest period of immaturity. Originally thought as an adaptive evolutionary strategy, since natural selection would only opt for the characteristics that are more “cost-efficient”, the longer period of dependency from progenitors is now perceived as a spin-off of another traitintelligence. As a result of the relative narrow birth canal, humans’ offspring need longer time, when compared to other primates, to puff up the cranial volume compatible to the volume and complexity of the brain from where our intelligence levels arise. This means that the cost of brightness leans on the necessity of further time to allow the brain to develop. More specifically, social intelligence seems to be the driving agent. According to Alexander (1987), as humans accomplished dominance over the other species, competition was shifted to their fellow members, which boosted the need to cope with the complex systems of relationships within the group. The long period of brain development accounts for an increased ability towards the behavioral flexibility needed to deal with such multidimensional network which, according to Bjorklund (2007) is responsible for our species success. This flexibility, and the resulting social, competence are particularly acquired during the time young humans are playing. Since they are born, babies s senses are stimulated, learn how to use their muscles, learn how to control their body, and, develop the strategies to interact and cope with other individuals by playing games (Papalia et al., 2005). In fact (Rakoczy, 2007) states that games because of the make-believe, in one hand, and of the associate inherent rules, in the other, are the doorway to the entrance on the structured institutional adulthood reality. Children’s interaction with the surrounding elements enables them to understand that the others are potential cooperators which allows them to accept their role as persons and, specially, the opportunity of sharing the same cultural background with others from which they acquire new ways of behavior and new ways of thinking (Rakoczy, 2007). Games enable children to engage more easily in this process. Playing games is therefore a medium for learning the complexities of human systems. Huizinga (1971) states on his book Homo ludens, that playing is the basis of all human

Eliciting nicotine craving with virtual smoking cues

Craving is a strong desire to consume that emerges in every case of substance addiction. Previous studies have shown that eliciting craving with an exposure cues protocol can be a useful option for the treatment of nicotine dependence. Thus, the main goal of this study was to develop a virtual platform in order to induce craving in smokers. Fifty-five undergraduate students were randomly assigned to two different virtual environments: high arousal contextual cues and low arousal contextual cues scenarios (17 smokers with low nicotine dependency were excluded). An eye-tracker system was used to evaluate attention toward these cues. Eye fixation on smoking-related cues differed between smokers and nonsmokers, indicating that smokers focused more often on smoking-related cues than nonsmokers. Self-reports of craving are in agreement with these results and suggest a significant increase in craving after exposure to smoking cues. In sum, these data support the use of virtual environments for eliciting craving.

Frequency is not enough

This paper reports an exploratory analysis of the relation between Internet addiction and patterns of use among Portuguese adolescents (n?=?2617) from the WHO 2010 Health Behavior in School-aged children study, with a short version of Youngs Internet Addiction Test (the brief Internet Addiction Questionnaire - bIAQ) and self-reports on online behaviors and access. Two-Step Cluster analysis identified two clusters of users based on their usage pattern: a minority of high-frequency users, with higher bIAQ scores, and a majority of low-frequency users, with lower bIAQ scores. Low and high-frequency users are particularly distinct in specific activities, which converges with previous research showing addiction to specific Internet activities rather than to the Internet as a whole. Study measured Internet addiction and behavior patterns in Portuguese teenagers.Cluster analysis shows many low-frequency and few high-frequency users.High-frequency is distinguished by particular, active forms of usage.High-frequency users at greater risk of Internet addiction.

NeuAR – A Review of the VR/AR Applications in the Neuroscience Domain

Since the 1980’s, computational applications based on virtual reality (VR) aimed at treating mental disorders and rehabilitating individuals with cognitive or motor disabilities have been around. They started off by focusing on simple phobias like acrophobia (Emmelkamp et al., 2002) and agoraphobia (Botella et al., 2004), fear of flying (Rothbaum, Hodges, Smith, Lee & Price, 2000), and evolved to fear of driving (Saraiva et al., 2007) or posttraumatic stress disorder (PTSD) (Gamito et al., 2010), schizophrenia (Costa & Carvalho, 2004) or traumatic brain injuries (Gamito et al., 2011a), among many others (Gamito et al., 2011b).

Cognitive Training through mHealth for Individuals with Substance Use Disorder

BACKGROUND Heroin addiction has a negative impact on cognitive functions, and even recovering addicts suffer from cognitive impairment. Recent approaches to cognitive intervention have been taking advantage of what new technologies have to offer. OBJECTIVES We report a study testing the efficacy of a serious games approach using tablets to stimulate and rehabilitate cognitive functions in recovering addicts. METHODS A small-scale cognitive training program with serious games was run with a sample of 14 male heroin addicts undergoing a rehabilitation program. RESULTS We found consistent improvements in cognitive functioning between baseline and follow-up assessments for frontal lobe functions, verbal memory and sustained attention, as well as in some aspects of cognitive flexibility, decision-making and in depression levels. More than two thirds of patients in cognitive training had positive outcomes related to indicators of verbal memory cognitive flexibility, which contrasts to patients not in training, in which only one patient improved between baseline and follow-up. CONCLUSIONS The results are promising but still require randomized control trials to determine the efficiency of this approach to cognitive rehabilitation programs for the cognitive recovery of heroin addicts.

Eye Movement Analysis and Cognitive Assessment. The Use of Comparative Visual Search Tasks in a Non-immersive VR Application.

BACKGROUND An adequate behavioral response depends on attentional and mnesic processes. When these basic cognitive functions are impaired, the use of non-immersive Virtual Reality Applications (VRAs) can be a reliable technique for assessing the level of impairment. However, most non-immersive VRAs use indirect measures to make inferences about visual attention and mnesic processes (e.g., time to task completion, error rate). OBJECTIVES To examine whether the eye movement analysis through eye tracking (ET) can be a reliable method to probe more effectively where and how attention is deployed and how it is linked with visual working memory during comparative visual search tasks (CVSTs) in non-immersive VRAs. METHODS The eye movements of 50 healthy participants were continuously recorded while CVSTs, selected from a set of cognitive tasks in the Systemic Lisbon Battery (SLB). Then a VRA designed to assess of cognitive impairments were randomly presented. RESULTS The total fixation duration, the number of visits in the areas of interest and in the interstimulus space, along with the total execution time was significantly different as a function of the Mini Mental State Examination (MMSE) scores. CONCLUSIONS The present study demonstrates that CVSTs in SLB, when combined with ET, can be a reliable and unobtrusive method for assessing cognitive abilities in healthy individuals, opening it to potential use in clinical samples.