Rodrigo Brito

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.

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.

The contexts and structures of relating to others: How memberships in different types of groups shape the construction of interpersonal relationships

A study tested hypotheses derived from relational models theory on how four models — communal sharing, authority ranking, equality matching, and market pricing — are used to structure relationships in different types of social groupings. Portuguese participants rated 10 relationships on the Modes of Relationships Questionnaire and reported their shared group memberships. The four-factor structure of the models was confirmed, and a bottom-up approach identified families, friendships, and organizations as the main distinct types of social groupings. The main results showed that relations within families combine mostly communal relations with authority between age groups, whereas relations in organizations combine mostly market relations with authority between age groups as well as professions. Friendships feature a mix of all models, except authority.

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.

Insights into the neural mechanisms underlying hand praxis: implications for the neurocognitive rehabilitation of apraxia

The understanding of the neural basis of limb apraxia (deficits in performing previously learned skilled movements) has benefited greatly from cognitive research on gesture processing and recognition, but the influence of this research on the treatment of apraxia is limited (Cantagallo et al., 2012). In our view, it would be desirable that this field of research have an impact also on treatment of apraxia, and Helon and Kroliczaks (2014) studies offer useful insights for the design of apraxia treatments. Apraxia typically results from left-brain lesions but impairs movements in both upper limbs equally. This is because disturbances affect the conceptual formulation of the movement rather than their executive ability (Frey, 2008). Research has also shown that access to internal representations underlying tool-use pantomimes (transitive) is more likely to be impaired than access to internal representations of communicative (intransitive) gestures (Foundas et al., 1999). The most common explanation is that tool-use actions are more left-lateralized than communicative gestures (Stamenova et al., 2010), but recent neuroimaging studies (Kroliczak and Frey, 2009; Kroiliczak, 2013) suggest a common representational system, on which transitive gestures are however more dependent. Helon and Kroliczaks (2014) finding that categorization of transitive and intransitive gestures were affected by both pictorial and linguistic priming in the right-visual field (RVF) suggests that communicative and tool-use actions share a left-lateralized mechanism intersecting language functions. This converges with results from the recent literature on the cognitive rehabilitation of limb apraxia (for reviews, see Buxbaum et al., 2008; Cantagallo et al., 2012), which includes treatments focusing on alleviating apraxic deficits by relearning motor sequences, and treatments designed to compensate for apraxic deficits by improving the functioning of processes spared by apraxia. In both approaches, the use of contextual and object-related cues can improve procedural memory, which may explain why patients are more proficient in reproducing gestures in their natural context than in a laboratory or clinical setting. This relies on priming and, because priming is somewhat resistant to brain damage, priming-based rehabilitation is one of the techniques of choice to restore hand praxis skills (Sohlberg and Mateer, 2001). Priming refers to a change in the nervous system triggered by prior exposure to a stimulus, which guides the order of activation in a given neural network according to previous experience (Pachalska et al., 2002). Given the dichotomy of privileged verbal left-hemisphere processing vs. visual right-hemisphere processing, Helon and Kroliczak (2014) had participants carry out a behavioral task to test whether the effects of pictorial (study 1) and linguistic (study 2) primes biased either to the left (RVF) or right hemisphere (left visual field) would affect categorization of clips of either meaningful transitive, meaningful intransitive, or meaningless hand movements. They found that intransitive gestures were categorized faster in both studies (pictorial and linguistic priming), which indicates lower complexity. They also found that categorization of both types of gestures was facilitated by RVF presentation of pictorial primes, but this was stronger for transitive gestures, whereas linguistic priming effects following RVF presentation were significant only for intransitive gestures. At a basic level, the common effects of RVF priming for both gestures, consistent with recent findings with fMRI (Kroliczak and Frey, 2009; Kroiliczak, 2013) and with known deficits in both language and praxis skills following left-brain damage, suggest a common neural substrate underlying language and praxis. This supports the idea that complex tool-use skills were evolutionary precursors of both non-verbal communication and language functions (Frey, 2008). In fact, there is evidence that praxis skills are more associated with the laterality of language functions than with hand preference (Meador et al., 1999). Recent neuroimaging data (Kroliczak et al., 2011) provide further evidence for an association between praxis and language by showing that this relationship remains even in left-handers with atypical lateralization of language. What do these results suggest for rehabilitation? First, more attention should be paid to the interdependence between motor and language functions when dealing with apraxic patients. “Intersystemic gestural reorganization” (Luria, 1970), a method that uses gestures to improve verbal production in aphasic patients, could provide a model to integrate those functions: an intriguing but untested possibility is that the reverse treatment (train verbal descriptions of gestures) could improve gestural performance in apraxia patients. Additionally, the deficits that apraxic patients often exhibit in gestural communication (Borod et al., 1989) point to its importance in the development of rehabilitative treatments. Smania et al. (2000, 2006) have shown that training both transitive and intransitive gestures, using contextual information (pictures depicting objects) produces significant improvements in specific apraxia tests and functionality. Considering the links between language and action, it seems probable that the use of pictorial cues depicting an object or context, combined with linguistic cues of words describing the same situations, will prompt the involvement of different neural pathways in accessing stored action representations, thus maximizing the probability of success of rehabilitative treatment. Involving both cues in pilot treatment programmes need not wait for further research to better clarify their roles (note that effects of verbal commands could be different from visual cues and need to be studied). Second, the differential effects found by Helon and Kroliczak (2014) for transitive and intransitive gestures support a greater complexity account of tool-use pantomimes over communicative gestures (Carmo and Rumiati, 2009), which from a practical viewpoint should be considered when developing training-based rehabilitative treatments for apraxia. One possible approach to these treatments could rely on mixed-reality systems that are under development for motor rehabilitation, such as augmented-reality environments that allow users to view a representation of their own body interacting with the real world (Regenbrecht et al., 2012). It is possible and desirable that these features will provide a standard for rehabilitation in the near future, and that this may not be limited to motor training, but may also be used to train either planning or execution components of the motor system involved in transitive and intransitive actions.

Cognitive stimulation of alcoholics through VR-based Instrumental Activities of Daily Living

Alcohol abuse impacts on cognitive functioning. We report a test of a cognitive stimulation intervention on patients recovering from alcohol dependence syndrome. 169 patients were split into 2 groups (cognitive stimulation and controls). Patients in cognitive stimulation and engaged in a 10-session protocol with cognitive exercises in the form of serious games, as well as the general treatment, whereas controls underwent general treatment only. The results show greater improvement in cognitive performance post-treatment for patients in the cognitive stimulation group.

Keeping in Touch with Context: Non-verbal Behavior as a Manifestation of Communality and Dominance

This research investigated the influence of observed touch on the perceptions of communality and dominance in dyadic interactions. We manipulated four key situational features of haptic behavior in two experiments: the initiation, reciprocity, the degree of formality of touch (Studies 1 and 2), and the context of the interaction (Study 2). The results showed that the default perception of touch, irrespective of whether it is initiated or reciprocated, is the communal intention of the toucher. Furthermore, the initiation of touch was seen as an act of dominance, particularly, when the contact between the actors was primed as being hierarchical. Reciprocation neutralized the perceived asymmetry in dominance, but such inferences seemed to hinge on the fit of the touch with the context: reciprocation of formal touch reduced the asymmetry in the hierarchical context, whereas reciprocation of informal touch reduced the asymmetry in the non-hierarchical context.

The Art Gallery Test: A Preliminary Comparison between Traditional Neuropsychological and Ecological VR-Based Tests

Ecological validity should be the cornerstone of any assessment of cognitive functioning. For this purpose, we have developed a preliminary study to test the Art Gallery Test (AGT) as an alternative to traditional neuropsychological testing. The AGT involves three visual search subtests displayed in a virtual reality (VR) art gallery, designed to assess visual attention within an ecologically valid setting. To evaluate the relation between AGT and standard neuropsychological assessment scales, data were collected on a normative sample of healthy adults (n = 30). The measures consisted of concurrent paper-and-pencil neuropsychological measures [Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), and Color Trails Test (CTT)] along with the outcomes from the three subtests of the AGT. The results showed significant correlations between the AGT subtests describing different visual search exercises strategies with global and specific cognitive measures. Comparative visual search was associated with attention and cognitive flexibility (CTT); whereas visual searches involving pictograms correlated with global cognitive function (MoCA).