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Simoncini G, Borghesi F, Mancuso V, Pedroli E, Cipresso P. Assessing alexithymia: the proposal of a psychometric tool based on spheric videos. Front Hum Neurosci 2024; 18:1375342. [PMID: 38562229 PMCID: PMC10982385 DOI: 10.3389/fnhum.2024.1375342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
The present perspective introduces a novel psychometric tool designed to enhance the evaluation of alexithymia. Alexithymia, a condition marked by difficulties in recognizing and expressing emotions, along with a propensity to direct attention outside rather than toward one's own interior experiences, is commonly investigated through self-report questionnaires. These instruments assume that individuals have sufficient self-awareness and abstraction capabilities, which restricts the understanding of the underlying mechanisms of emotional recognition in individuals who do not possess these capacities. To address this lack, emerging technologies like virtual reality (VR) and 360° videos facilitate the recreation of immersive contexts, enabling subjects to engage with scenarios even remotely. Our innovative tool employs spherical video technology to recreate social and non-social scenarios that elicit emotions. Psychophysiological measures are collected during video observation; then, questions are asked to investigate how the subject consciously processes the emotions they experienced. This multimodal approach aims to capture both implicit and explicit emotion processing, providing a comprehensive assessment. Overall, the proposed psychometric tool offers the potential for a more nuanced understanding of alexithymic traits and their real-life impact, empowering clinicians to tailor treatment processes to individual needs based on a richer set of information.
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Affiliation(s)
| | | | | | - Elisa Pedroli
- Faculty of Psychology, eCampus University, Novedrate, Italy
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Mirmosayyeb O, Yazdan Panah M, Mokary Y, Ghaffary EM, Ghoshouni H, Zivadinov R, Weinstock-Guttman B, Jakimovski D. Optical coherence tomography (OCT) measurements and disability in multiple sclerosis (MS): A systematic review and meta-analysis. J Neurol Sci 2023; 454:120847. [PMID: 37924591 DOI: 10.1016/j.jns.2023.120847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Studies have demonstrated that people with multiple sclerosis (pwMS) experience visual impairments and neurodegenerative retinal processes. The disability progression in pwMS may be associated with retinal changes assessed with optical coherence tomography (OCT). This meta-analysis aims at synthesizing the correlations between OCT measurements of disability in pwMS. METHODS We systematically searched four databases (PubMed/MEDLINE, Embase, Scopus, and Web of Science) from inception to November 2022, then conducted a meta-analysis using a random effects model to determine the pooled correlation coefficient(r) between OCT measurements and disability scales by R version 4.2.3 with the meta version 6.2-1 package. RESULTS From 3129 studies, 100 studies were included. Among 9051 pwMS, the female-to-male ratio was 3.15:1, with a mean age of 39.57 ± 6.07 years. The mean disease duration and Expanded Disability Status Scale (EDSS) were 8.5 ± 3.7 and 2.7 ± 1.1, respectively. Among the pooled subgroup analyses, macular ganglion cell inner plexiform layer (mGCIPL) in patients with relapsing-remitting (pwRRMS) and peripapillary retinal nerve fiber layer (pRNFL) in patients with progressive MS (pwPMS) had strong correlations with EDSS, r = -0.33 (95% CI: -0.45 to -0.20, I2 = 45%, z-score = -4.86, p < 0.001) and r = -0.20 (95% CI:-0.58 to 0.26, I2 = 76%, z-score = -0.85, p = 0.395), respectively. According to subgroup analysis on pwMS without optic neuritis (ON) history, the largest correlation was seen between EDSS and macular ganglion cell complex (mGCC): r = -0.39 (95% CI: -0.70 to 0.04, I2 = 79%, z-score = -1.79, p = 0.073). CONCLUSION OCT measurements are correlated with disability in pwMS, and they can complement the comprehensive neurological visit as an additional paraclinical test.
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Affiliation(s)
- Omid Mirmosayyeb
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Mohammad Yazdan Panah
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yousef Mokary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Moases Ghaffary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Ghoshouni
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA; Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Dejan Jakimovski
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA.
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Hsu WY, Anguera JA, Rizzo A, Campusano R, Chiaravalloti ND, DeLuca J, Gazzaley A, Bove RM. A virtual reality program to assess cognitive function in multiple sclerosis: A pilot study. Front Hum Neurosci 2023; 17:1139316. [PMID: 37007676 PMCID: PMC10060881 DOI: 10.3389/fnhum.2023.1139316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/17/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction: Cognitive impairment is a debilitating symptom in people with multiple sclerosis (MS). Most of the neuropsychological tasks have little resemblance to everyday life. There is a need for ecologically valid tools for assessing cognition in real-life functional contexts in MS. One potential solution would involve the use of virtual reality (VR) to exert finer control over the task presentation environment; however, VR studies in the MS population are scarce.Objectives: To explore the utility and feasibility of a VR program for cognitive assessment in MS.Methods: A VR classroom embedded with a continuous performance task (CPT) was assessed in 10 non-MS adults and 10 people with MS with low cognitive functioning. Participants performed the CPT with distractors (i.e., WD) and without distractors (i.e., ND). The Symbol Digit Modalities Test (SDMT), California Verbal Learning Test—II (CVLT-II), and a feedback survey on the VR program was administered.Results: People with MS exhibited greater reaction time variability (RTV) compared to non-MS participants, and greater RTV in both WD and ND conditions was associated with lower SDMT.Conclusions: VR tools warrant further research to determine their value as an ecologically valid platform for assessing cognition and everyday functioning in people with MS.
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Affiliation(s)
- Wan-Yu Hsu
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Joaquin A. Anguera
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Albert Rizzo
- Institute for Creative Studies, University of Southern California, Los Angeles, CA, United States
| | - Richard Campusano
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, San Francisco, CA, United States
| | - Nancy D. Chiaravalloti
- Kessler Foundation, East Hanover, NJ, United States
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, United States
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Adam Gazzaley
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
- Department of Physiology, University of California, San Francisco, San Francisco, CA, United States
| | - Riley M. Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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Borgnis F, Borghesi F, Rossetto F, Pedroli E, Lavorgna L, Riva G, Baglio F, Cipresso P. Psychometric Calibration of a Tool Based on 360 Degree Videos for the Assessment of Executive Functions. J Clin Med 2023; 12:jcm12041645. [PMID: 36836179 PMCID: PMC9958906 DOI: 10.3390/jcm12041645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Over the last decades, interactive technologies appeared a promising solution in the ecological evaluation of executive functioning. We have developed the EXecutive-functions Innovative Tool 360° (EXIT 360°), a new instrument that exploits 360° technologies to provide an ecologically valid assessment of executive functioning. AIM This work wanted to evaluate the convergent validity of the EXIT 360°, comparing it with traditional neuropsychological tests (NPS) for executive functioning. METHODS Seventy-seven healthy subjects underwent an evaluation that involved: (1) a paper-and-pencil neuropsychological assessment, (2) an EXIT 360° session, involving seven subtasks delivered by VR headset, and (3) a usability assessment. To evaluate convergent validity, statistical correlation analyses were performed between NPS and EXIT 360° scores. RESULTS The data showed that participants had completed the whole task in about 8 min, with 88.3% obtaining a high total score (≥12). Regarding convergent validity, the data revealed a significant correlation between the EXIT 360° total score and all NPS. Furthermore, data showed a correlation between the EXIT 360° total reaction time and timed neuropsychological tests. Finally, the usability assessment showed a good score. CONCLUSION This work appears as a first validation step towards considering the EXIT 360° as a standardized instrument that uses 360° technologies to conduct an ecologically valid assessment of executive functioning. Further studies will be necessary to evaluate the effectiveness of the EXIT 360° in discriminating between healthy control subjects and patients with executive dysfunctions.
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Affiliation(s)
| | | | | | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
- Faculty of Psychology, eCampus University, 22060 Novedrate, Italy
| | - Luigi Lavorgna
- Division of Neurology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
- Humane Technology Lab, Catholic University of the Sacred Heart, 20123 Milan, Italy
| | - Francesca Baglio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
- Correspondence: ; Tel.: +39-0240308848
| | - Pietro Cipresso
- Department of Psychology, University of Turin, 10124 Turin, Italy
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
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Kabiri S, Jameie M, Balali P, Adib Moradi S, Sanjari Moghaddam H, Aghamollaii V, Harirchian MH. Trail Making Test Could Predict Impairment in Cognitive Domains in Patients with Multiple Sclerosis: A Study of Diagnostic Accuracy. ARCHIVES OF CLINICAL NEUROPSYCHOLOGY : THE OFFICIAL JOURNAL OF THE NATIONAL ACADEMY OF NEUROPSYCHOLOGISTS 2023; 38:37-48. [PMID: 35901460 DOI: 10.1093/arclin/acac059] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Cognitive impairment (CI) and executive dysfunction (ED) are prevalent in patients with multiple sclerosis (PwMS). The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) is the gold standard neuropsychological battery (NPB) for detecting CI. Delis-Kaplan Executive Function System (DKEFS) NPB evaluates ED. We aimed to find practical test(s) from DKEFS with acceptable diagnostic utility for early detection of impairment in cognitive and executive domains. METHODS Cognitive and executive tasks, physical disability, and depression scores of 30 PwMS were assessed (17 women, age: 38.1). Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and Controlled Oral Word Association Test (COWAT) from MACFIMS and Trail Making Test (TMT), Design Fluency Test (DFT), and Verbal Fluency Test (VFT) from DKEFS were selected. The association between patients' characteristics and performance in tests, and diagnostic accuracy of DKEFS tests in detecting impairment in cognitive tasks were evaluated, using Pearson correlation and receiver operator characteristic curve analyses, respectively. RESULTS A significant correlation was found between disease duration and SDMT and TMT subtests. Expanded Disability Status Scale was significantly related to SDMT, VFT-switching, and TMT subtests. Beck Depression Inventory was significantly related to DFT. TMT-switching detected abnormalities in SDMT and PASAT with 100% sensitivity, 93.3% (for SDMT), and 85.7% specificity (for PASAT). TMT-letter showed 100% sensitivity and 90% specificity in identifying abnormalities in COWAT. CONCLUSIONS TMT, particularly the switching condition, is a practical paper-based test that could predict impairment in cognitive tasks. Clinicians may use TMT as a screening tool among PwMS.
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Affiliation(s)
- Samaneh Kabiri
- Neurology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Melika Jameie
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Pargol Balali
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahand Adib Moradi
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Sanjari Moghaddam
- Department of Neurology, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vajiheh Aghamollaii
- Department of Neurology, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Capturing cognitive changes in multiple sclerosis by performance-based functional and virtual reality assessments. Ann Phys Rehabil Med 2022; 66:101677. [PMID: 35667625 DOI: 10.1016/j.rehab.2022.101677] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 04/25/2022] [Accepted: 05/07/2022] [Indexed: 12/03/2022]
Abstract
Cognitive impairment (CI) has been recognized as one of the core multiple sclerosis (MS) symptoms that profoundly impact lives of people with MS (PwMS). Clinical trials have begun to focus on cognition as a primary or secondary outcome, but translating improvements in cognitive testing scores to functioning in the real world is difficult. Performance-based functional assessments and virtual reality (VR) assessments, which incorporate real-world challenges, have been proposed as a way to better assess functional cognition (i.e., cognitive performance and its impact on real-life cognitive functioning of PwMS) and could address the difficulty in evaluating the impact of a treatment on real-world functioning. In this narrative review, we identify and summarize some of the promising recent research applications of performance-based functional assessments and VR tools to assess functional cognition in MS. Overall, most of the studies suggest that functional and VR assessments can detect cognitive differences between people with and without MS and between PwMS with and without CI. Furthermore, performance on some of the functional and VR assessments was associated with performance on standard cognitive assessments. However, developing any guidelines on how to implement these assessments in clinical practice is difficult because of the relatively small sample size across these studies. Performance-based functional and VR assessments represent an innovative approach to increasing sensitivity of how cognitive impairments/abilities present in the daily life of PwMS. More studies, with a larger sample size, robust research methods, and pre- and post-treatment assessments, are warranted to validate relevant, accessible functional and VR assessments before implementing these assessment approaches in clinical practice.
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Bruni F, Mancuso V, Stramba-Badiale C, Greci L, Cavallo M, Borghesi F, Riva G, Cipresso P, Stramba-Badiale M, Pedroli E. ObReco-2: Two-step validation of a tool to assess memory deficits using 360° videos. Front Aging Neurosci 2022; 14:875748. [PMID: 35966782 PMCID: PMC9366856 DOI: 10.3389/fnagi.2022.875748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022] Open
Abstract
Traditional neuropsychological evaluations are usually carried out using psychometric paper and pencil tests. Nevertheless, there is a continuous discussion concerning their efficacy to capture life-like abilities. The introduction of new technologies, such as Virtual Reality (VR) and 360° spherical photos and videos, has improved the ecological validity of the neuropsychological assessment. The possibility of simulating realistic environments and situations allows clinicians to evaluate patients in realistic activities. Moreover, 360° photos and videos seem to provide higher levels of graphical realism and technical user-friendliness compared to standard VR, regardless of their limitations in terms of interactivity. We developed a novel 360° tool, ObReco-2 (Object Recognition version 2), for the assessment of visual memory which simulates a daily situation in a virtual house. More precisely, patients are asked to memorize some objects that need to be moved for a relocation. After this phase, they are asked to recall them after 15 min and later to recognize them in the same environment. Here we present a first study about the usability of ObReco-2, and a second one exploring its clinical efficacy and updated usability data. We focused on Free Recall and Recognition scores, comparing the performances obtained by the participants in the standard and the 360° test. The preliminary results support the use of 360° technology for enhancing the ecological value of standard memory assessment tests.
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Affiliation(s)
- Francesca Bruni
- Faculty of Psychology, eCampus University, Novedrate, Italy
- *Correspondence: Francesca Bruni,
| | | | - Chiara Stramba-Badiale
- Applied Technology for Neuropsychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Luca Greci
- Institute of Intelligent Industrial Technologies and System for Advanced Manufacturing, Milan, Italy
| | - Marco Cavallo
- Faculty of Psychology, eCampus University, Novedrate, Italy
| | - Francesca Borghesi
- Applied Technology for Neuropsychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuropsychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Human Technology Lab, Catholic University of the Sacred Heart, Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuropsychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | - Marco Stramba-Badiale
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Elisa Pedroli
- Faculty of Psychology, eCampus University, Novedrate, Italy
- Applied Technology for Neuropsychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Borgnis F, Baglio F, Pedroli E, Rossetto F, Uccellatore L, Oliveira JAG, Riva G, Cipresso P. Available Virtual Reality-Based Tools for Executive Functions: A Systematic Review. Front Psychol 2022; 13:833136. [PMID: 35478738 PMCID: PMC9036486 DOI: 10.3389/fpsyg.2022.833136] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/17/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Executive dysfunctions constitute a significant public health problem: their high impact on everyday life makes it a priority to identify early strategies for evaluating and rehabilitating these disorders in a real-life context. The ecological limitation of traditional neuropsychological tests and several difficulties in administering tests or training in real-life scenarios have paved the way to use Virtual Reality-based tools to evaluate and rehabilitate Executive Functions (EFs) in real-life. Objective This work aims to conduct a systematic review to provide a detailed description of the VR-based tools currently developed for the evaluation and rehabilitation of EFs. Methods We systematically searched for original manuscripts regarding VR tools and EFs by looking for titles and abstracts in the PubMed, Scopus, PsycInfo, and Web of Science databases up to November 2021 that contained the following keywords “Virtual Reality” AND “Executive function*.” Results and Conclusion We analyzed 301 articles, of which 100 were included. Our work shows that available VR-based tools appear promising solutions for an ecological assessment and treatment of EFs in healthy subjects and several clinical populations.
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Affiliation(s)
- Francesca Borgnis
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Faculty of Psychology, eCampus University, Milan, Italy
| | | | - Lidia Uccellatore
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Giuseppe Riva
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
- *Correspondence: Pietro Cipresso
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Borgnis F, Baglio F, Pedroli E, Rossetto F, Meloni M, Riva G, Cipresso P. A Psychometric Tool for Evaluating Executive Functions in Parkinson's Disease. J Clin Med 2022; 11:jcm11051153. [PMID: 35268244 PMCID: PMC8911216 DOI: 10.3390/jcm11051153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022] Open
Abstract
Recently, there has been an increasing interest in using 360° virtual-reality video for an ecologically valid assessment of executive functioning in the neurologic population. In this framework, we have developed the EXecutive-functions Innovative Tool (EXIT 360°), an original 360°-based instrument for a multicomponent, ecologically valid evaluation of executive functioning in Parkinson’s Disease (PD). This work aimed to test the usability and user experience of EXIT 360° in patients with PD (PwPD). Twenty-seven PwPD and twenty-seven healthy controls underwent an evaluation that involved: (1) usability assessment by the System Usability Scale and (2) evaluation of user experience using the ICT—Sense of Presence and User Experience Questionnaire. Results showed a satisfactory level of usability for patients (mean = 76.94 ± 9.18) and controls (mean = 80 ± 11.22), with good scores for usability and learnability. Regarding user experience, patients provided a positive overall impression of the tool, evaluating it as attractive, enjoyable, activating, and funny. Moreover, EXIT 360° showed good pragmatic (e.g., efficient, fast, clear) and hedonic quality (e.g., exciting, interesting, and creative). Finally, PwPD considered EXIT 360° as an original tool with high ecological validity (mean = 4.29 ± 0.61), spatial presence (mean = 3.11 ± 0.83) and engagement (mean = 3.43 ± 0.54) without relevant adverse effects. Technological expertise had no impact on performance. Overall, EXIT 360° appeared to be a usable, easy-to-learn, engaging, and innovative instrument for PD. Further studies will be conducted to deepen its efficacy in distinguishing between healthy subjects and patients with executive dysfunctions.
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Affiliation(s)
- Francesca Borgnis
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (F.B.); (F.B.); (F.R.); (M.M.)
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy;
| | - Francesca Baglio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (F.B.); (F.B.); (F.R.); (M.M.)
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, 20149 Milan, Italy;
- Faculty of Psychology, eCampus University, 22060 Novedrate, Italy
| | - Federica Rossetto
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (F.B.); (F.B.); (F.R.); (M.M.)
| | - Mario Meloni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (F.B.); (F.B.); (F.R.); (M.M.)
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy;
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, 20149 Milan, Italy;
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, 20149 Milan, Italy;
- Department of Psychology, Università degli Studi di Torino, 10124 Turin, Italy
- Correspondence:
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Riva G. Virtual Reality in Clinical Psychology. COMPREHENSIVE CLINICAL PSYCHOLOGY 2022. [PMCID: PMC7500920 DOI: 10.1016/b978-0-12-818697-8.00006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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EXecutive-Functions Innovative Tool (EXIT 360°): A Usability and User Experience Study of an Original 360°-Based Assessment Instrument. SENSORS 2021; 21:s21175867. [PMID: 34502758 PMCID: PMC8433836 DOI: 10.3390/s21175867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022]
Abstract
Over the last few decades, several studies have shown the feasibility, acceptability, and efficacy of VR-based instruments in the early evaluation of executive dysfunction (ED) in psychiatric and neurologic conditions. Due to the negative impact of ED in everyday functioning, identifying innovative strategies for evaluating ED allows clinicians to detect executive impairment early and minimize its effects. This work aimed to test the usability and user experience (UX) of EXecutive-functions Innovative Tool 360° (EXIT 360°), a 360°-based tool for assessing ED. Seventy-six healthy subjects underwent an evaluation that involved (1) usability assessment using System Usability Scale and (2) evaluation of UX using the ICT-Sense of Presence and UX Questionnaire. Results showed a satisfactory level of usability (mean = 75.9 ± 12.8), with good scores for usability and learnability. As regards UX, EXIT 360° showed an absence of negative effects (mean = 1.79 ± 0.95) and high scores in ecological validity (mean = 4.32 ± 0.54) and engagement (mean = 3.76 ± 0.56). Moreover, it obtained good scores in efficiency (mean = 1.84 ± 0.84), originality (mean = 2.49 ± 0.71), and attractiveness (mean = 1.93 ± 0.98). Interestingly, demographic characteristics and technological expertise had no impact on the performance (p > 0.05). Overall, EXIT 360° appeared to be a usable, learn-to-use, engaging, and creative tool with irrelevant negative effects. Further studies will be conducted to evaluate these aspects in the clinical population.
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Isernia S, Cabinio M, Di Tella S, Pazzi S, Vannetti F, Gerli F, Mosca IE, Lombardi G, Macchi C, Sorbi S, Baglio F. Diagnostic Validity of the Smart Aging Serious Game: An Innovative Tool for Digital Phenotyping of Mild Neurocognitive Disorder. J Alzheimers Dis 2021; 83:1789-1801. [PMID: 34459394 DOI: 10.3233/jad-210347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Smart Aging Serious Game (SASG) is an ecologically-based digital platform used in mild neurocognitive disorders. Considering the higher risk of developing dementia for mild cognitive impairment (MCI) and vascular cognitive impairment (VCI), their digital phenotyping is crucial. A new understanding of MCI and VCI aided by digital phenotyping with SASG will challenge current differential diagnosis and open the perspective of tailoring more personalized interventions. OBJECTIVE To confirm the validity of SASG in detecting MCI from healthy controls (HC) and to evaluate its diagnostic validity in differentiating between VCI and HC. METHODS 161 subjects (74 HC: 37 males, 75.47±2.66 mean age; 60 MCI: 26 males, 74.20±5.02; 27 VCI: 13 males, 74.22±3.43) underwent a SASG session and a neuropsychological assessment (Montreal Cognitive Assessment (MoCA), Free and Cued Selective Reminding Test, Trail Making Test). A multi-modal statistical approach was used: receiver operating characteristic (ROC) curves comparison, random forest (RF), and logistic regression (LR) analysis. RESULTS SASG well captured the specific cognitive profiles of MCI and VCI, in line with the standard neuropsychological measures. ROC analyses revealed high diagnostic sensitivity and specificity of SASG and MoCA (AUCs > 0.800) in detecting VCI versus HC and MCI versus HC conditions. An acceptable to excellent classification accuracy was found for MCI and VCI (HC versus VCI; RF: 90%, LR: 91%. HC versus MCI; RF: 75%; LR: 87%). CONCLUSION SASG allows the early assessment of cognitive impairment through ecological tasks and potentially in a self-administered way. These features make this platform suitable for being considered a useful digital phenotyping tool, allowing a non-invasive and valid neuropsychological evaluation, with evident implications for future digital-health trails and rehabilitation.
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Affiliation(s)
- Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan-Florence, Italy
| | - Monia Cabinio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan-Florence, Italy
| | - Sonia Di Tella
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan-Florence, Italy.,Department of Psychology, Universitá Cattolica del Sacro Cuore, Milan, Italy
| | - Stefania Pazzi
- Consorzio di Bioingegneria e Informatica Medica (CBIM), Pavia, Italy
| | | | - Filippo Gerli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan-Florence, Italy
| | | | - Gemma Lombardi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan-Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan-Florence, Italy
| | - Sandro Sorbi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan-Florence, Italy.,Universitá degli Studi di Firenze, NEUROFARBA, Firenze, Italy
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13
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Borgnis F, Baglio F, Pedroli E, Rossetto F, Riva G, Cipresso P. A Simple and Effective Way to Study Executive Functions by Using 360° Videos. Front Neurosci 2021; 15:622095. [PMID: 33912001 PMCID: PMC8072005 DOI: 10.3389/fnins.2021.622095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/01/2021] [Indexed: 11/17/2022] Open
Abstract
Executive dysfunctions constitute a significant public health problem due to their high impact on everyday life and personal independence. Therefore, the identification of early strategies to assess and rehabilitate these impairments appears to be a priority. The ecological limitations of traditional neuropsychological tests and the numerous difficulties in administering tests in real-life scenarios have led to the increasing use of virtual reality (VR) and 360° environment-based tools for assessing executive functions (EFs) in real life. This perspective aims at proposing the development and implementation of Executive-functions Innovative Tool 360° (EXIT 360°), an innovative, enjoyable, and ecologically valid tool for a multidimensional and multicomponent evaluation of executive dysfunctions. EXIT 360° allows a complete and integrated executive functioning assessment through an original task for EFs delivered via a mobile-powered VR headset combined with eye tracker (ET) and electroencephalograms (EEG). Our tool is born as a 360°-based instrument, easily accessible and clinically usable, that will radically transform clinicians’ and patient’s assessment experience. In EXIT 360°, patients are engaged in a “game for health,” where they must perform everyday subtasks in 360° daily life environments. In this way, the clinicians can obtain quickly more ecologically valid information about several aspects of EFs (e.g., planning, problem-solving). Moreover, the multimodal approach allows completing the assessment of EFs by integrating verbal responses, reaction times, and physiological data (eye movements and brain activation). Overall, EXIT 360° will allow obtaining simultaneously and in real time more information about executive dysfunction and its impact in real life, allowing clinicians to tailor the rehabilitation to the subject’s needs.
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Affiliation(s)
- Francesca Borgnis
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.,Faculty of Psychology, eCampus University, Novedrate, Italy
| | | | - Giuseppe Riva
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy.,Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Pietro Cipresso
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy.,Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
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14
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Bottiroli S, Bernini S, Cavallini E, Sinforiani E, Zucchella C, Pazzi S, Cristiani P, Vecchi T, Tost D, Sandrini G, Tassorelli C. The Smart Aging Platform for Assessing Early Phases of Cognitive Impairment in Patients With Neurodegenerative Diseases. Front Psychol 2021; 12:635410. [PMID: 33790839 PMCID: PMC8005545 DOI: 10.3389/fpsyg.2021.635410] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Smart Aging is a serious game (SG) platform that generates a 3D virtual reality environment in which users perform a set of screening tasks designed to allow evaluation of global cognition. Each task replicates activities of daily living performed in a familiar environment. The main goal of the present study was to ascertain whether Smart Aging could differentiate between different types and levels of cognitive impairment in patients with neurodegenerative disease. Methods: Ninety-one subjects (mean age = 70.29 ± 7.70 years)—healthy older adults (HCs, n = 23), patients with single-domain amnesic mild cognitive impairment (aMCI, n = 23), patients with single-domain executive Parkinson's disease MCI (PD-MCI, n = 20), and patients with mild Alzheimer's disease (mild AD, n = 25)—were enrolled in the study. All participants underwent cognitive evaluations performed using both traditional neuropsychological assessment tools, including the Mini-Mental State Examination (MMSE), Montreal Overall Cognitive Assessment (MoCA), and the Smart Aging platform. We analyzed global scores on Smart Aging indices (i.e., accuracy, time, distance) as well as the Smart Aging total score, looking for differences between the four groups. Results: The findings revealed significant between-group differences in all the Smart Aging indices: accuracy (p < 0.001), time (p < 0.001), distance (p < 0.001), and total Smart Aging score (p < 0.001). The HCs outperformed the mild AD, aMCI, and PD-MCI patients in terms of accuracy, time, distance, and Smart Aging total score. In addition, the mild AD group was outperformed both by the HCs and by the aMCI and PD-MCI patients on accuracy and distance. No significant differences were found between aMCI and PD-MCI patients. Finally, the Smart Aging scores significantly correlated with the results of the neuropsychological assessments used. Conclusion: These findings, although preliminary due to the small sample size, suggest the validity of Smart Aging as a screening tool for the detection of cognitive impairment in patients with neurodegenerative diseases.
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Affiliation(s)
- Sara Bottiroli
- Faculty of Law, Giustino Fortunato University, Benevento, Italy.,National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Sara Bernini
- National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Elena Cavallini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elena Sinforiani
- National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Chiara Zucchella
- Neurology Unit, Department of Neurosciences, Verona University Hospital, Verona, Italy
| | - Stefania Pazzi
- Consorzio di Bioingegneria Medica e Informatica CBIM, Pavia, Italy
| | - Paolo Cristiani
- Consorzio di Bioingegneria Medica e Informatica CBIM, Pavia, Italy
| | - Tomaso Vecchi
- National Neurological Institute C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Daniela Tost
- Computer Graphics Division Research Centre for Biomedical Engineering (CREB), Universitat Politecnica de Catalunya, Barcelona, Spain
| | - Giorgio Sandrini
- National Neurological Institute C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- National Neurological Institute C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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15
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Di Tella S, Isernia S, Pagliari C, Jonsdottir J, Castiglioni C, Gindri P, Gramigna C, Canobbio S, Salza M, Molteni F, Baglio F. A Multidimensional Virtual Reality Neurorehabilitation Approach to Improve Functional Memory: Who Is the Ideal Candidate? Front Neurol 2021; 11:618330. [PMID: 33519699 PMCID: PMC7840659 DOI: 10.3389/fneur.2020.618330] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/07/2020] [Indexed: 01/09/2023] Open
Abstract
Aims: We aimed to identify the significant predictors of ecological memory amelioration after the Human Empowerment Aging and Disability (HEAD) rehabilitation program, a multidimensional treatment for chronic neurological diseases. Materials and Methods: Ninety-three patients with Parkinson disease (n = 29), multiple sclerosis (n = 26), and stroke (n = 38) underwent a multidimensional rehabilitation. We focused on changes after treatment on ecological memory (outcome measure) evaluated by Rivermead Behavioral Memory Test, Third Edition (RBMT-3). Minimal clinically important difference (MCID) after treatment were calculated for RBMT-3. The change score on RBMT-3 was categorized in positive effect, stabilization, or no effect of the treatment. Random forest classification identified who significantly benefited from treatment against who did not in terms of ecological memory functioning. Accordingly, logistic regression models were created to identify the best predictors of the treatment effect. A predicted probability value was derived, and the profile of the ideal candidate of HEAD protocol was shown by combining different ranks of significant predictors in a 3 × 3 matrix for each pair of predictors. Results: A significant number of cases reported positive effect of the treatment on ecological memory, with an amelioration over the MCID or a stabilization. The random forest analysis highlighted a discrete accuracy of prediction (>0.60) for all the variables considered at baseline for identifying participants who significantly benefited and who did not from the treatment. Significant logistic regression model (Wald method) showed a predictive role of Montreal Cognitive Assessment (MoCA; p = 0.007), 2-Minute Walk Test (2MWT; p = 0.038), and RBMT-3 (p < 0.001) at baseline on HEAD treatment effect. Finally, we observed a high probability of success in people with higher residual cognitive functioning (MoCA; odds ratio = 1.306) or functional mobility (2MWT; odds ratio = 1.013). Discussion: The HEAD program is a rehabilitation with effects on multiple domains, including ecological memory. Residual level of cognitive and/or motor functioning is a significant predictor of the treatment success. These findings confirm the intrinsic relationship subsisting between motor and cognitive functions and suggest the beneficial effects of physical activity on cognitive functions and vice versa.
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Affiliation(s)
| | - Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | | | - Patrizia Gindri
- Fondazione Opera San Camillo Presidio Sanitario San Camillo, Turin, Italy
| | | | - Samuela Canobbio
- Villa Beretta Rehabilitation Center, Ospedale Valduce, Como, Italy
| | - Marco Salza
- Fondazione Opera San Camillo Presidio Sanitario San Camillo, Turin, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Ospedale Valduce, Como, Italy
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16
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Riva G, Serino S. Virtual Reality in the Assessment, Understanding and Treatment of Mental Health Disorders. J Clin Med 2020; 9:E3434. [PMID: 33114623 PMCID: PMC7693021 DOI: 10.3390/jcm9113434] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 12/21/2022] Open
Abstract
Computer scientists usually describe virtual reality (VR) as a set of fancy hardware and software technologies. However, psychology and neuroscience are starting to consider VR as the most advanced form of human-computer interaction allowing individuals to act, communicate and become present in a computer-generated environment. In this view, the feeling of "being there" experienced during a VR experience can become a powerful tool for personal change: it offers a dynamic and social world where individuals can live and share a specific experience. For this reason, the use of VR in mental health shows promise: different researches support its clinical efficacy for conditions including anxiety disorders, stress-related disorders, obesity and eating disorders, pain management, addiction and schizophrenia. However, more research is needed to transform the promises of VR in a real clinical tool for mental health. This Special Issue aims to present the most recent advances in the mental health applications of VR, as well as their implications for future patient care.
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Affiliation(s)
- Giuseppe Riva
- Humane Technology Lab, Università Cattolica del Sacro Cuore, 20123 Milan, Italy;
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, 28824 Piancavallo, Italy
| | - Silvia Serino
- Humane Technology Lab, Università Cattolica del Sacro Cuore, 20123 Milan, Italy;
- MySpace Lab, Department of Clinical Neuroscience, University Hospital Lausanne (CHUV), 1011 Lausanne, Switzerland
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17
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Riva G, Mancuso V, Cavedoni S, Stramba-Badiale C. Virtual reality in neurorehabilitation: a review of its effects on multiple cognitive domains. Expert Rev Med Devices 2020; 17:1035-1061. [PMID: 32962433 DOI: 10.1080/17434440.2020.1825939] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Neurological diseases frequently cause adult-onset disability and have increased the demand for rehabilitative interventions. Neurorehabilitation has been progressively relying on computer-assisted programs and, more recently, on virtual reality (VR). Current reviews explore VR-based neurorehabilitation for assessing and treating the most common neurological pathologies. However, none of them explored specifically the impact of VR on multiple cognitive domains. AREAS COVERED The present work is a review of 6 years of literature (2015-2020) on VR in neurorehabilitation with the purpose of analyzing its effects on memory, attention, executive functions, language, and visuospatial ability. EXPERT OPINION Our review suggests that VR-based neurorehabilitation showed encouraging results for executive functions and visuospatial abilities particularly for both acute and neurodegenerative conditions. Conversely, memory, and attention outcomes are conflicting, and language did not show significant improvements following VR-based rehabilitation. Within five years, it is plausible that VR-based intervention would be provided in standalone and mobile-based platforms that won't need a PC to work, with reduced latency and improved user interaction.
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Affiliation(s)
- Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart , Milan, Italy
| | - Valentina Mancuso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy
| | - Silvia Cavedoni
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy
| | - Chiara Stramba-Badiale
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy
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18
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Mancuso V, Stramba-Badiale C, Cavedoni S, Pedroli E, Cipresso P, Riva G. Virtual Reality Meets Non-invasive Brain Stimulation: Integrating Two Methods for Cognitive Rehabilitation of Mild Cognitive Impairment. Front Neurol 2020; 11:566731. [PMID: 33117261 PMCID: PMC7561425 DOI: 10.3389/fneur.2020.566731] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
Mild cognitive impairment (MCI) refers to a subtle, general cognitive decline with a detrimental impact on elderlies' independent living and quality of life. Without a timely diagnosis, this condition can evolve into dementia over time, hence the crucial need for early detection, prevention, and rehabilitation. For this purpose, current neuropsychological interventions have been integrated with (i) virtual reality, which immerses the user in a controlled, ecological, and safe environment (so far, both virtual reality-based cognitive and motor rehabilitation have revealed promising positive outcomes); and (ii) non-invasive brain stimulation, i.e., transcranial magnetic or electric brain stimulation, which has emerged as a promising cognitive treatment for MCI and Alzheimer's dementia. To date, these two methods have been employed separately; only a few studies (limited to motor rehabilitation) have suggested their integration. The present paper suggests to extend this integration to cognitive rehabilitation as well as to provide a multimodal stimulation that could enhance cognitive training, resulting in a more efficient rehabilitation.
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Affiliation(s)
- Valentina Mancuso
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Chiara Stramba-Badiale
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Silvia Cavedoni
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.,Department of Psychology, E-Campus University, Novedrate, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
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19
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Matamala-Gomez M, Malighetti C, Cipresso P, Pedroli E, Realdon O, Mantovani F, Riva G. Changing Body Representation Through Full Body Ownership Illusions Might Foster Motor Rehabilitation Outcome in Patients With Stroke. Front Psychol 2020; 11:1962. [PMID: 32973612 PMCID: PMC7471722 DOI: 10.3389/fpsyg.2020.01962] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/15/2020] [Indexed: 12/17/2022] Open
Abstract
How our brain represents our body through the integration of internal and external sensory information so that we can interact with our surrounding environment has become a matter of interest especially in the field of neurorehabilitation. In this regard, there is an increasing interest in the use of multisensory integration techniques—such as the use of body ownership illusions—to modulate distorted body representations after brain damage. In particular, cross-modal illusions such as mirror visual feedback therapy (MVFT) have been widely used for motor rehabilitation. Despite the effectiveness of the MVFT for motor rehabilitation, there are some limitations to fully modify the distorted internal representation of the paretic limb in patients with stroke. A possible explanation for this relies on the physical limitations of the mirror in reproducing upper-limb distortions, which can result in a reduced sense of ownership of the mirrored limb. New digital technologies such as virtual reality (VR) and 360° videos allow researchers to create body ownership illusions by adapting virtual bodies so that they represent specific morphological characteristics including upper-limb distortions. In this manuscript, we present a new rehabilitation approach that employs full virtual body ownership illusions, using a 360° video system, for the assessment and modulation of the internal representation of the affected upper limb in stroke patients. We suggest modifying the internal representation of the upper limb to a normal position before starting motor rehabilitation training.
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Affiliation(s)
- Marta Matamala-Gomez
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Clelia Malighetti
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Pietro Cipresso
- Department of Psychology, Catholic University of Milan, Milan, Italy.,Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Faculty of Psychology, eCampus University, Novedrate, Italy
| | - Olivia Realdon
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Fabrizia Mantovani
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Riva
- Department of Psychology, Catholic University of Milan, Milan, Italy.,Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
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20
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The Use of a Virtual Reality Platform for the Assessment of the Memory Decline and the Hippocampal Neural Injury in Subjects with Mild Cognitive Impairment: The Validity of Smart Aging Serious Game (SASG). J Clin Med 2020; 9:jcm9051355. [PMID: 32384591 PMCID: PMC7290592 DOI: 10.3390/jcm9051355] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/11/2022] Open
Abstract
Due to the lack of pharmacological treatment for dementia, timely detection of subjects at risk can be of seminal importance for preemptive rehabilitation interventions. The aim of the study was to determine the usability of the smart aging serious game (SASG), a virtual reality platform, in assessing the cognitive profile of an amnestic mild cognitive impairment (aMCI) population, its validity in discriminating aMCI from healthy controls (HC), and in detecting hippocampal degeneration, a biomarker of clinical progression towards dementia. Thirty-six aMCI and 107 HC subjects were recruited and administered the SASG together with a neuropsychological evaluation. All aMCI and 30 HC subjects performed also an MRI for hippocampal volume measurement. Results showed good usability of the SASG despite the low familiarity with technology in both groups. ROC curve analyses showed similar discriminating abilities for SASG and gold standard tests, and a greater discrimination ability compared to non-specific neuropsychological tests. Finally, linear regression analysis revealed that the SASG outperformed the Montreal cognitive assessment test (MoCA) in the ability to detect neuronal degeneration in the hippocampus on the right side. These data show that SASG is an ecological task, that can be considered a digital biomarker providing objective and clinically meaningful data about the cognitive profile of aMCI subjects.
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21
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Matamala-Gomez M, Maisto M, Montana JI, Mavrodiev PA, Baglio F, Rossetto F, Mantovani F, Riva G, Realdon O. The Role of Engagement in Teleneurorehabilitation: A Systematic Review. Front Neurol 2020; 11:354. [PMID: 32435227 PMCID: PMC7218051 DOI: 10.3389/fneur.2020.00354] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/09/2020] [Indexed: 01/04/2023] Open
Abstract
The growing understanding of the importance of involving patients with neurological diseases in their healthcare routine either for at-home management of their chronic conditions or after the hospitalization period has opened the research for new rehabilitation strategies to enhance patient engagement in neurorehabilitation. In addition, the use of new digital technologies in the neurorehabilitation field enables the implementation of telerehabilitation systems such as virtual reality interventions, video games, web-based interventions, mobile applications, web-based or telephonic telecoach programs, in order to facilitate the relationship between clinicians and patients, and to motivate and activate patients to continue with the rehabilitation process at home. Here we present a systematic review that aims at reviewing the effectiveness of different engagement strategies and the different engagement assessments while using telerehabilitation systems in patients with neurological disorders. We used PICO's format to define the question of the review, and the systematic review protocol was designed following the Preferred Reported Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Bibliographical data was collected by using the following bibliographic databases: PubMed, EMBASE, Scopus, and Web of Science. Eighteen studies were included in this systematic review for full-text analyses. Overall, the reviewed studies using engagement strategies through telerehabilitation systems in patients with neurological disorders were mainly focused on patient self-management and self-awareness, patient motivation, and patient adherence subcomponents of engagement, that are involved in by the behavioral, cognitive, and emotional dimensions of engagement. Conclusion: The studies commented throughout this systematic review pave the way for the design of new telerehabilitation protocols, not only focusing on measuring quantitative or qualitative measures but measuring both of them through a mixed model intervention design (1). The future clinical studies with a mixed model design will provide more abundant data regarding the role of engagement in telerehabilitation, leading to a possibly greater understanding of its underlying components.
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Affiliation(s)
- Marta Matamala-Gomez
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Marta Maisto
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Jessica Isbely Montana
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | | | | | | | - Fabrizia Mantovani
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Olivia Realdon
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
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22
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Montana JI, Matamala-Gomez M, Maisto M, Mavrodiev PA, Cavalera CM, Diana B, Mantovani F, Realdon O. The Benefits of emotion Regulation Interventions in Virtual Reality for the Improvement of Wellbeing in Adults and Older Adults: A Systematic Review. J Clin Med 2020; 9:jcm9020500. [PMID: 32059514 PMCID: PMC7073752 DOI: 10.3390/jcm9020500] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 01/23/2023] Open
Abstract
The impact of emotion regulation interventions on wellbeing has been extensively documented in literature, although only in recent years virtual reality (VR) technologies have been incorporated in the design of such interventions, in both clinical and non-clinical settings. A systematic search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, was therefore carried out to explore the state of the art in emotion regulation interventions for wellbeing using virtual reality. The literature on this topic was queried, 414 papers were screened, and 11 studies were included, covering adults and older adults. Our findings offer an overview of the current use of VR technologies for the enhancement of emotion regulation (ER) and wellbeing. The results are promising and suggest that VR-based emotion regulation training can facilitate the promotion of wellbeing. An overview of VR-based training interventions is crucial for better understanding how to use these tools in the clinical settings. This review offers a critical debate on the structure of such intervention protocols. It also analyzes and highlights the crucial role played by the selection of the objective and subjective wellbeing assessment measures of said intervention protocols.
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Affiliation(s)
- Jessica Isbely Montana
- Department of Human Sciences for Education, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy; (M.M.-G.); (M.M.); (P.A.M.); (B.D.); (F.M.); (O.R.)
- Correspondence:
| | - Marta Matamala-Gomez
- Department of Human Sciences for Education, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy; (M.M.-G.); (M.M.); (P.A.M.); (B.D.); (F.M.); (O.R.)
| | - Marta Maisto
- Department of Human Sciences for Education, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy; (M.M.-G.); (M.M.); (P.A.M.); (B.D.); (F.M.); (O.R.)
| | - Petar Aleksandrov Mavrodiev
- Department of Human Sciences for Education, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy; (M.M.-G.); (M.M.); (P.A.M.); (B.D.); (F.M.); (O.R.)
| | - Cesare Massimo Cavalera
- Department of Psychology, Catholic University of the Sacred Heart, Largo Gemelli 1, 20100 Milan, Italy;
| | - Barbara Diana
- Department of Human Sciences for Education, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy; (M.M.-G.); (M.M.); (P.A.M.); (B.D.); (F.M.); (O.R.)
| | - Fabrizia Mantovani
- Department of Human Sciences for Education, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy; (M.M.-G.); (M.M.); (P.A.M.); (B.D.); (F.M.); (O.R.)
| | - Olivia Realdon
- Department of Human Sciences for Education, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy; (M.M.-G.); (M.M.); (P.A.M.); (B.D.); (F.M.); (O.R.)
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23
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Riva G, Bernardelli L, Browning MHEM, Castelnuovo G, Cavedoni S, Chirico A, Cipresso P, de Paula DMB, Di Lernia D, Fernández-Álvarez J, Figueras-Puigderrajols N, Fuji K, Gaggioli A, Gutiérrez-Maldonado J, Hong U, Mancuso V, Mazzeo M, Molinari E, Moretti LF, Ortiz de Gortari AB, Pagnini F, Pedroli E, Repetto C, Sforza F, Stramba-Badiale C, Tuena C, Malighetti C, Villani D, Wiederhold BK. COVID Feel Good-An Easy Self-Help Virtual Reality Protocol to Overcome the Psychological Burden of Coronavirus. Front Psychiatry 2020; 11:563319. [PMID: 33173511 PMCID: PMC7538634 DOI: 10.3389/fpsyt.2020.563319] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/31/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Living in the time of the COVID-19 means experiencing not only a global health emergency but also extreme psychological stress with potential emotional side effects such as sadness, grief, irritability, and mood swings. Crucially, lockdown and confinement measures isolate people who become the first and the only ones in charge of their own mental health: people are left alone facing a novel and potentially lethal situation, and, at the same time, they need to develop adaptive strategies to face it, at home. In this view, easy-to-use, inexpensive, and scientifically validated self-help solutions aiming to reduce the psychological burden of coronavirus are extremely necessary. AIMS This pragmatic trial aims to provide the evidence that a weekly self-help virtual reality (VR) protocol can help overcome the psychological burden of the Coronavirus by relieving anxiety, improving well-being, and reinforcing social connectedness. The protocol will be based on the "Secret Garden" 360 VR video online (www.covidfeelgood.com) which simulates a natural environment aiming to promote relaxation and self-reflection. Three hundred sixty-degree or spherical videos allow the user to control the viewing direction. In this way, the user can explore the content from any angle like a panorama and experience presence and immersion. The "Secret Garden" video is combined with daily exercises that are designed to be experienced with another person (not necessarily physically together), to facilitate a process of critical examination and eventual revision of core assumptions and beliefs related to personal identity, relationships, and goals. METHODS This is a multicentric, pragmatic pilot randomized controlled trial involving individuals who experienced the COVID-19 pandemic and underwent a lockdown and quarantine procedures. The trial is approved by the Ethics Committee of the Istituto Auxologico Italiano. Each research group in all the countries joining the pragmatic trial, aims at enrolling at least 30 individuals in the experimental group experiencing the self-help protocol, and 30 in the control group, over a period of 3 months to verify the feasibility of the intervention. CONCLUSION The goal of this protocol is for VR to become the "surgical mask" of mental health treatment. Although surgical masks do not provide the wearer with a reliable level of protection against the coronavirus compared with FFP2 or FFP3 masks, surgical masks are very effective in protecting others from the wearer's respiratory emissions. The goal of the VR protocol is the same: not necessarily to solve complex mental health problems but rather to improve well-being and preserve social connectedness through the beneficial social effects generated by positive emotions.
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Affiliation(s)
- Giuseppe Riva
- IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | | | - Gianluca Castelnuovo
- IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Alice Chirico
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Pietro Cipresso
- IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Daniele Di Lernia
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | | | - Kei Fuji
- Division of Psychology, University of Tsukuba, Tokyo, Japan
| | - Andrea Gaggioli
- IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Upyong Hong
- Department of Media and Communication, Konkuk University, Seoul, South Korea
| | | | - Milena Mazzeo
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Enrico Molinari
- IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Luciana F Moretti
- Sociedad Española de Realidad Virtual y Psicología, Las Rozas - Madrid, Spain
| | - Angelica B Ortiz de Gortari
- The Centre for the Science of Learning & Technology (SLATE), University of Bergen, Bergen, Norway.,Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Elisa Pedroli
- IRCCS Istituto Auxologico Italiano, Milan, Italy.,Faculty of Psychology, University of eCampus, Novedrate, Italy
| | - Claudia Repetto
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | | | - Cosimo Tuena
- IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Clelia Malighetti
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Daniela Villani
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Brenda K Wiederhold
- Virtual Reality Medical Center, La Jolla, CA, United States.,Virtual Reality Medical Institute, Brussels, Belgium
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