E. Sorita

Do patients with traumatic brain injury learn a route in the same way in real and virtual environments

An increasing number of studies address the use of virtual environments (VE) in the cognitive assessment of spatial abilities. However, the differences between learning in a VE and a real environment (RE) remain controversial. Purpose: To compare the topographical behavior and spatial representations of patients with traumatic brain injury navigating in a real environment and in a virtual reproduction of this environment. Methods: Twenty-seven subjects with moderate to severe traumatic brain injury were consecutively included and allocated to one of two groups. The subjects were taught the same route in either the virtual environment or the real environment and had to recall it twice immediately after learning the route and once after a delay. At the end of these sessions, the subjects were asked to complete three representational tests: a map test, a map recognition test recognition and a scene arrangement test. Results: No significant difference was found between the two groups with regards to demographics, severity of brain injury or episodic memory. As a main result, the number of error rates did not significantly differ between the real and virtual environment [F (1, 25) = 0.679; p = 0.4176)]. Scores on the scene arrangement test were higher in the real environment [U = 32.5; p = 0.01]. Conclusions: Although spatial representations probably differ between the real and virtual environment, virtual reality remains a trusty assessment tool for spatial abilities. Implications for Rehabilitation The transfer of cognitive skills and strategy acquired during rehabilitation programs into daily life situations remains a matter of debate. Virtual reality might provide ecological and rehabilitation scenarios that can be used to look at the daily functioning of patients. The route learning performance after traumatic brain injury shows no significant difference between the real environment and its virtual reproduction in this study.

Virtual reality for cognitive rehabilitation: from new use of computers to better knowledge of brain black box?

Abstract Virtual reality (VR)-based technologies are one of the emerging tools that appear to have great potential for use in cognitive rehabilitation. However, it still is unclear how brain capacities are involved and what is the best approach to such training. Quantitative aspects are encouraging because some improvements have been shown after few training sessions. By contrast, qualitative design of VR tools is more questionable. Choice of errorless or error-full designs may depend on the severity of disturbances. Most VR tools emphasize the explicit component of tasks; even procedural aspects comprise the main strength of VR retraining programs. VR and augmented reality tools give various stimuli and indicators, but their best modalities stay unclear, given that most data are coming from learning studies in normal subjects more than rehabilitation studies in brain-injured patients. Specific studies to explore the impact of sensorial transmodal effects and emotional involvement in VR tasks are required. Rehabilitation protocols utilizing virtual environments are moving from single applications to cognitive impairment (i.e., alertness, memory, neglect, language, executive functions) to comprehensive rehabilitation programs, with the aim of achieving efficient improvement in autonomy and transfer of benefits in real life conditions. A core issue that presents challenges to rehabilitation is decreased ability of persons with brain injury to transfer learning from one situation or context to another. The multi-context approach to cognitive rehabilitation proposes treatment methods for teaching the use of strategies across a wide range of meaningful activities, which can promote generalization and enhance functional performance.

AGATHE: A tool for personalized rehabilitation of cognitive functions

Virtual Reality has recognized assets to address some cognitive rehabilitation issues. The purpose of this poster is to present an overview of the design of AGATHE, a tool for personalized rehabilitation of cognitive functions based on simulated Basic and Instrumental Activities of Daily Living (sBADL and sIADL).

Rééducation personnalisée des fonctions cognitives via des activités de vie quotidienne simulées (sAVQ)

Objectif.– Étudier les troubles cognitifs présentés suite à un arrêt cardiaque extra-hospitalier. Matériel et patients.– Étude rétrospective et prospective d’une cohorte de 49 patients adultes (35 hommes, 14 femmes), d’un âge moyen de 43 ans (SD : 13,3), suivie dans un service de MPR à orientation neurologique. Méthode.–Évaluation neuropsychologique précise de l’ensemble des fonctions cognitives à un délai moyen de 13,8 mois de l’arrêt cardiaque. Étude longitudinale de 14 patients réévalués en moyenne 25 mois après le premier bilan. Résultats.– Le premier bilan neuropsychologique met en évidence des tableaux hétérogènes. Des troubles attentionnels et dysexécutifs sont constatés chez plus de 90 % des patients. 80 % des patients présentent une altération, modérée à sévère, de la mémoire antérograde. Même si une atteinte du stockage est observée chez 40 % des patients, les troubles mnésiques sont le plus souvent majorés par les troubles attentionnels et dysexécutifs ou imputables à ces derniers. La mémoire rétrograde et les fonctions instrumentales (langage, praxies, gnosies) sont perturbées chez environ 50 % des patients. Une nouvelle évaluation montre des progrès significatifs chez la plupart des patients (13 sur 14), même si des troubles persistent. Discussion.– Le tableau classique du syndrome amnésique isolé n’est pas retrouvé. Tous les troubles objectivés lors du premier bilan neuropsychologique sont rapportés dans la littérature mais notre population présente des troubles plus sévères et plus fréquents. Dans la littérature, la fréquence des troubles semble variable, dépendante des critères d’inclusion, de la sensibilité des tests utilisés et du délai entre l’arrêt cardiaque et l’évaluation neuropsychologique. Les progrès importants mis en évidence lors des réévaluations sont sans doute en partie liés à une récupération spontanée mais également en rapport avec la rééducation, nous amenant à préconiser une prise en charge adaptée aux difficultés cognitives présentées par cette population particulière. Pour en savoir plus Moulaert V, Verbunt J, Van Heugten C, Wade D. Cognitive impairments in survivors of out-of-hospital cardiac arrest: a systematic review. Resuscitation 2009;80:297–305. Peskine A, Rosso C, Picq C, Caron E, Pradat-Diehl P. Neurological sequelae after cerebral anoxia. Brain Injury 2010;24:755–61.

Rééducation des troubles des fonctions exécutives et de l’attention après AVC

Les atteintes cognitives sont a cote des sequelles motrices un facteur majeur de la dependance des survivants a un AVC. Si la negligence visuo-spatiale, l’aphasie ou l’apraxie sont des consequences bien identifi ees des accidents vasculaires cerebraux, d’autres troubles cognitifs traduisant les repercussions sur les fonctions distribuees sont moins souvent evoques alors qu’ils sont frequents et invalidants: troubles attentionnels, difficultes executives et mnesiques.