Francesca Morganti

Training with Computer-Supported Motor Imagery in Post-Stroke Rehabilitation

Converging lines of evidence suggest that motor imagery (the mental simulation of a motor act within working memory) is associated with subliminal activation of the motor system. This observation has led to the hypothesis that cortical activation during motor imagery may affect the acquisition of specific motor skills and help the recovery of motor function. In this paper, we describe a clinical protocol in which we use interactive tools to stimulate motor imagery in hemiplegic stroke patients, thereby helping them to recover lost motor function. The protocol consists of an inpatient and an outpatient phase, combining physical and mental practice. In the inpatient phase, patients are trained in a laboratory setting, using a custom-made interactive workbench (VR Mirror). After discharge, patients use a portable device to guide mental and physical practice in a home setting. The proposed strategy is based on the hypotheses that: (a) combined physical and mental practice can make a cost-effective contribution to the rehabilitation of stroke patients, (b) effective mental practice is not possible without some form of support, from a therapist (as in our inpatient phase) or from technology (as in the outpatient phase), (c) the inclusion of an outpatient phase will allow the patient to practice more often than would otherwise be possible, therefore increasing the speed and/or effectiveness of learning, and (d) the use of interactive technology will reduce the patients need for skilled support, therefore improving the cost-effectiveness of training.

Immersive Virtual Telepresence: virtual reality meets eHealth.

Immersive Virtual Telepresence (IVT) tools are virtual reality environments combined with wireless multimedia facilities--real-time video and audio--and advanced input devices--tracking sensors, biosensors, brain-computer interfaces. For its features IVT can be considered an innovative communication interface based on interactive 3D visualization, able to collect and integrate different inputs and data sets in a single real-like experience. In this paper we try to outline the current state of research and technology that is relevant to the development of IVT in medicine. Moreover, we discuss the clinical principles and possible advantages associated with the use of IVT in this field.

Computer-enhanced mental practice in upper-limb rehabilitation after cerebrovascular accident: a case series study

We examined the potential of using computer-enhanced mental practice in the rehabilitation of upper-extremity function after cerebrovascular accident (CVA). Design: Single case series, before-after design (ABA). Participants: 9 adults with stable motor deficit of the upper extremity following CVA. Methods: Patients received three computer-enhanced motor imagery practice sessions per week at the rehabilitation center. In addition, they practiced at home with specific exercises recorded on a DVD. The intervention lasted 8 weeks. Baseline, mid-term, post-intervention and follow-up evaluations included the upper-extremity scale of the Fugl-Meyer Assessment of Sensorimotor Impairment and the Action Research Arm Test. Results. At 8 weeks from the beginning of treatment, five patients showed reduction in impairment, with no decrease of motor function to follow up, as indicated by functional assessment scores and physiatrist observations. Conclusion: current findings encourage further investigation of the role that computer-guided motor imagery practice might play in upper limb rehabilitation.

A Free, Open-Source Virtual Reality Platform for the Rehabilitation of Cognitive and Psychological Disorders

The adoption of Virtual Reality in rehabilitation of cognitive and psychological disorders is limited by high costs of software development, lack of technical expertise among end-users, and the difficulty of adapting the contents of the virtual environments (VEs). In this paper, we describe NeuroVR, (http://www.neurovr.org), a cost-free virtual reality platform based on open-source software components that allows non-expert users to easily customize a VE by using a set of pre-designed virtual scenes, and to run them in an immersive or non-immersive modality. In this paper, we provide a description of the key functional features of the platform.

A virtual reality paradigm for the assessment and rehabilitation of executive function deficits post stroke: Feasibility study

The ability to perform successive or simultaneous tasks is a common and necessary aspect of everyday life. This ability is often impaired in people suffering from brain lesions affecting, in particular, the frontal regions. The assessment and recovery of executive functions and dual task abilities conducted in laboratory settings do not always succeed, in part, due to the ecological and contextual nature of the abilities impaired. The present study was designed to develop and test a virtual reality based tool for the rehabilitation of shifting of attention and action planning functions using tasks reminiscent of daily life tasks. The virtual environment employed in the study is a supermarket developed using NeuroVR software. While actively exploring this environment, participants were requested to collect some items from a list while attending to different audio announcements that would modify the sequence or number of items collected. This executive function evaluation and rehabilitation procedure has been conceived as a hierarchical series of tasks, starting from a single-task condition and ending with successive multiple tasks. In this paper, we present the results of a small-scale pilot trial where we investigated the feasibility of the procedure in a healthy elderly population. These results provided important usability data for a subsequent randomized clinical trial.

Implementation of the multiple errand test in a NeuroVR-supermarket

Our goal is to develop a tool for the assessment and rehabilitation of executive functions by customizing a virtual reality VR system. The specific objective of this study was to conduct a pilot study using a virtual version of the Multiple Errand Test (VMET) in a healthy population. Results are presented which provide support for the feasibility of using the VMET for a subsequent randomized clinical trial.

A context-based interactive evaluation of neglect syndrome in virtual reality

A classical approach to neglect syndrome evaluation is generally based on visual scanning tasks. Due to its laboratory-based approach, neglect assessment generally failed to individuate patient¿s behavior impairments in everyday contexts. Simultaneously, the introduction of computer-based interactive simulations provides the possibility to have a context-based assessment linked with rigorous methodological procedure validity. According to this vision, the present work aims in introducing the use of virtual reality scenarios for the assessment of attentional-spatial deficits in unilateral neglect patients both in indoor and outdoor daily situations. For this purpose, two virtual reality environments were developed and four brain-damaged patients were requested to immersively explore them in order to memorize, replace and recognize familiar objects. Patient included in the study were previously evaluated with ¿paper and pencil¿ neuropsychological assessment and they presented, respectively, a neglect syndrome, an overcome neglect, a unilateral right brain damage without neglect and a bilateral frontal brain injury with slight spatial neglect. Quantitative and qualitative analysis revealed as patients in virtual reality assessment provide perceptive and explorative behaviors congruent with neurological and neuropsychological evaluation. Virtual reality-based evaluation will also provide evidences of neglect induced biases in coping with everyday contexts that could be unclear detectable in paper and pencil assessment. Those results will support the use of virtual reality for situated neglect assessment and provide guidelines for rehabilitation trials in more ecologically-like contexts.