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Thomasson M, Perez-Marcos D, Crottaz-Herbette S, Brenet F, Saj A, Bernati T, Serino A, Tadi T, Blanke O, Ronchi R. An immersive virtual reality tool for assessing left and right unilateral spatial neglect. J Neuropsychol 2024. [PMID: 38225801 DOI: 10.1111/jnp.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/13/2023] [Accepted: 12/30/2023] [Indexed: 01/17/2024]
Abstract
The reported rate of the occurrence of unilateral spatial neglect (USN) is highly variable likely due to the lack of validity and low sensitivity of classical tools used to assess it. Virtual reality (VR) assessments try to overcome these limitations by proposing immersive and complex environments. Nevertheless, existing VR-based tasks are mostly focused only on near space and lack analysis of psychometric properties and/or clinical validation. The present study evaluates the clinical validity and sensitivity of a new immersive VR-based task to assess USN in the extra-personal space and examines the neuronal correlates of deficits of far space exploration. The task was administrated to two groups of patients with right (N = 28) or left (N = 11) hemispheric brain lesions, also undergoing classical paper-and-pencil assessment, as well as a group of healthy participants. Our VR-based task detected 44% of neglect cases compared to 31% by paper-and-pencil tests in the total sample. Importantly, 30% of the patients (with right or left brain lesions) with no clear sign of USN on the paper-and-pencil tests performed outside the normal range in the VR-based task. Voxel lesion-symptom mapping revealed that deficits detected in VR were associated with lesions in insular and temporal cortex, part of the neural network involved in spatial processing. These results show that our immersive VR-based task is efficient and sensitive in detecting mild to strong manifestations of USN affecting the extra-personal space, which may be undetected using standard tools.
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Affiliation(s)
- Marine Thomasson
- Laboratory for Behavioral Neurology and Imaging of Cognition, University of Geneva, Geneva, Switzerland
- Neuropsychology Unit, Neurology Department, University Hospital of Geneva, Geneva, Switzerland
- Cognitive and Experimental Neuropsychology Laboratory, University of Geneva, Geneva, Switzerland
| | | | - Sonia Crottaz-Herbette
- MindMaze SA, Lausanne, Switzerland
- Neuropsychology and Neurorehabilitation Service, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | - Arnaud Saj
- Laboratory for Behavioral Neurology and Imaging of Cognition, University of Geneva, Geneva, Switzerland
- Department of Psychology, University of Montréal, Montréal, Quebec, Canada
- CRIR/Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, Quebec, Canada
- Spectre Biotech, Paris, France
| | - Thérèse Bernati
- Laboratory for Behavioral Neurology and Imaging of Cognition, University of Geneva, Geneva, Switzerland
| | - Andrea Serino
- MindMaze SA, Lausanne, Switzerland
- MySpace Lab, Department of Clinical Neurosciences, Lausanne, University of Lausanne, Lausanne, Switzerland
- Laboratory of Cognitive Neuroscience, Neuro-X Institute and Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
| | - Tej Tadi
- MindMaze SA, Lausanne, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Neuro-X Institute and Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Neurosurgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Roberta Ronchi
- Laboratory for Behavioral Neurology and Imaging of Cognition, University of Geneva, Geneva, Switzerland
- Neuropsychology Unit, Neurology Department, University Hospital of Geneva, Geneva, Switzerland
- Laboratory of Cognitive Neuroscience, Neuro-X Institute and Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
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Stammler B, Flammer K, Schuster T, Lambert M, Neumann O, Lux M, Matuz T, Karnath HO. Spatial Neglect Therapy With the Augmented Reality App "Negami" for Active Exploration Training: A Randomized Controlled Trial on 20 Stroke Patients With Spatial Neglect. Arch Phys Med Rehabil 2023; 104:1987-1994. [PMID: 37582475 DOI: 10.1016/j.apmr.2023.07.017] [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: 03/24/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE To investigate the efficacy of the augmented reality (AR) app "Negami" as an active exploration training for the treatment of spatial neglect. Improvements of the ipsilesional attention and orientation bias (and resulting contralesional neglect) will be examined in stroke patients with spatial neglect and compared with a control group. DESIGN Randomized controlled trial with an experimental Negami group, consisting of patients with spatial neglect, and a group of neglect patients receiving standard neglect therapy. SETTING Three rehabilitation hospitals. PARTICIPANTS Twenty right hemispheric stroke patients with spatial neglect (N=20). INTERVENTION Over a period of 2 weeks, both groups received 5 training sessions per week (à 25 minutes). Neglect behavior was assessed weekly over a 5-week period, with the Negami therapy group receiving a second follow-up assessment at 1-to-2-month intervals after completion of training. MAIN OUTCOME MEASURES Letter Cancellation, Bells Test, Copying Task, Line Bisection Task, and a self-developed "Exploration Test". RESULTS Both groups improved significantly. While the Negami therapy group improved in 4 of 5 neglect tests used, the standard therapy group improved in only 1 of these tests. We observed significantly better improvement in the Negami group already after the first week of training. This difference was also significant after the end of the training as well as 1 week after the end of training and remained stable 1-2 months after the end of treatment. CONCLUSION Negami can be used as an effective alternative or addition to current standard neglect therapy, and may even be superior to it.
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Affiliation(s)
- Britta Stammler
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | | | | | | | - Michael Lux
- Neurological Rehabilitation Center Quellenhof, Sana Kliniken AG, Bad Wildbad, Germany
| | - Tamara Matuz
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; Kreiskliniken Reutlingen, Reutlingen, Germany
| | - Hans-Otto Karnath
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
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Salatino A, Zavattaro C, Gammeri R, Cirillo E, Piatti ML, Pyasik M, Serra H, Pia L, Geminiani G, Ricci R. Virtual reality rehabilitation for unilateral spatial neglect: A systematic review of immersive, semi-immersive and non-immersive techniques. Neurosci Biobehav Rev 2023; 152:105248. [PMID: 37247829 DOI: 10.1016/j.neubiorev.2023.105248] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION In recent decades, new virtual reality (VR)-based protocols have been proposed for the rehabilitation of Unilateral Spatial Neglect (USN), a debilitating disorder of spatial awareness. However, it remains unclear which type of VR protocol and level of VR immersion can maximize the clinical benefits. To answer these questions, we conducted a systematic review of the use of VR for the rehabilitation of USN. METHOD Studies between 2000 and 2022 that met the inclusion criteria were classified according to their research design and degree of immersion (non-immersive, NIVR; semi-immersive, SIVR; immersive, IVR). RESULTS A total of 375 studies were identified, of which 26 met the inclusion criteria. Improvements were found in 84.6% of the reviewed studies: 85.7% used NIVR, 100% used SIVR and 55.6% used IVR. However, only 42.3% of them included a control group and only 19.2% were randomized control trials (RCT). CONCLUSION VR protocols may offer new opportunities for USN rehabilitation, although further RCTs are needed to validate their clinical efficacy.
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Affiliation(s)
- Adriana Salatino
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; Department of Life Sciences, Royal Military Academy, Hobbema 8, 1000 Brussels, Belgium
| | - Claudio Zavattaro
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Roberto Gammeri
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Emanuele Cirillo
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Maria Luisa Piatti
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Maria Pyasik
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Via Verdi, 10, 10124 Turin, Italy
| | - Hilary Serra
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Lorenzo Pia
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Via Verdi, 10, 10124 Turin, Italy; NIT - Neuroscience Institute of Turin, Via Verdi, 8, 10124 Turin, Italy
| | - Giuliano Geminiani
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; NIT - Neuroscience Institute of Turin, Via Verdi, 8, 10124 Turin, Italy
| | - Raffaella Ricci
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; NIT - Neuroscience Institute of Turin, Via Verdi, 8, 10124 Turin, Italy.
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Faria AL, Latorre J, Silva Cameirão M, Bermúdez i Badia S, Llorens R. Ecologically valid virtual reality-based technologies for assessment and rehabilitation of acquired brain injury: a systematic review. Front Psychol 2023; 14:1233346. [PMID: 37711328 PMCID: PMC10497882 DOI: 10.3389/fpsyg.2023.1233346] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023] Open
Abstract
Purpose A systematic review was conducted to examine the state of the literature regarding using ecologically valid virtual environments and related technologies to assess and rehabilitate people with Acquired Brain Injury (ABI). Materials and methods A literature search was performed following the PRISMA guidelines using PubMed, Web of Science, ACM and IEEE databases. The focus was on assessment and intervention studies using ecologically valid virtual environments (VE). All studies were included if they involved individuals with ABI and simulated environments of the real world or Activities of Daily Living (ADL). Results Seventy out of 363 studies were included in this review and grouped and analyzed according to the nature of its simulation, prefacing a total of 12 kitchens, 11 supermarkets, 10 shopping malls, 16 streets, 11 cities, and 10 other everyday life scenarios. These VE were mostly presented on computer screens, HMD's and laptops and patients interacted with them primarily via mouse, keyboard, and joystick. Twenty-five out of 70 studies had a non-experimental design. Conclusion Evidence about the clinical impact of ecologically valid VE is still modest, and further research with more extensive samples is needed. It is important to standardize neuropsychological and motor outcome measures to strengthen conclusions between studies. Systematic review registration identifier CRD42022301560, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=301560.
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Affiliation(s)
- Ana Lúcia Faria
- Faculdade de Artes e Humanidades, Universidade da Madeira, Funchal, Portugal
- NOVA Laboratory for Computer Science and Informatics, Lisbon, Portugal
- Agência Regional para o Desenvolvimento da Investigação, Tecnologia e Inovação, Funchal, Portugal
| | - Jorge Latorre
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
- NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Valencia, Spain
| | - Mónica Silva Cameirão
- NOVA Laboratory for Computer Science and Informatics, Lisbon, Portugal
- Agência Regional para o Desenvolvimento da Investigação, Tecnologia e Inovação, Funchal, Portugal
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
| | - Sergi Bermúdez i Badia
- NOVA Laboratory for Computer Science and Informatics, Lisbon, Portugal
- Agência Regional para o Desenvolvimento da Investigação, Tecnologia e Inovação, Funchal, Portugal
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
| | - Roberto Llorens
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
- NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Valencia, Spain
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Stammler B, Flammer K, Schuster T, Lambert M, Karnath HO. Negami: An Augmented Reality App for the Treatment of Spatial Neglect After Stroke. JMIR Serious Games 2023; 11:e40651. [PMID: 36848215 PMCID: PMC10012013 DOI: 10.2196/40651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/06/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND A widely applied and effective rehabilitation method for patients experiencing spatial neglect after a stroke is "visual exploration training." Patients improve their ipsilesional bias of attention and orientation by training exploration movements and search strategies toward the contralesional side of space. In this context, gamification can have a positive influence on motivation for treatment and thus on the success of treatment. In contrast to virtual reality applications, treatment enhancements through augmented reality (AR) have not yet been investigated, although they offer some advantages over virtual reality. OBJECTIVE This study aimed to develop an AR-based app (Negami) for the treatment of spatial neglect that combines visual exploration training with active, contralesionally oriented rotation of the eyes, head, and trunk. METHODS The app inserts a virtual element (origami bird) into the real space surrounding the patient, which the patient explores with the camera of a tablet. Subjective reports from healthy elderly participants (n=10) and patients with spatial neglect after stroke (n=10) who trained with the new Negami app were analyzed. Usability, side effects, and game experience were assessed by various questionnaires. RESULTS Training at the highest defined difficulty level was perceived as differently challenging but not as frustrating by the group of healthy elderly participants. The app was rated with high usability, hardly any side effects, high motivation, and entertainment. The group of patients with spatial neglect after stroke consistently evaluated the app positively on the dimensions of motivation, satisfaction, and fun. CONCLUSIONS The Negami app represents a promising extension by adding AR to traditional exploration training for spatial neglect. Through participants' natural interaction with the physical surrounding environment during playful tasks, side effects as symptoms of cybersickness are minimized and patients' motivation appeared to markedly increase. The use of AR in cognitive rehabilitation programs and the treatment of spatial neglect seems promising and should receive further investigation.
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Affiliation(s)
- Britta Stammler
- Center of Neurology, Division of Neuropsychology, University of Tübingen, Tübingen, Germany
| | | | | | | | - Hans-Otto Karnath
- Center of Neurology, Division of Neuropsychology, University of Tübingen, Tübingen, Germany
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Zhou Y, Zhao Y, Xiang Z, Yan Z, Shu L, Xu X, Zhang L, Tian X. A dual-task-embedded virtual reality system for intelligent quantitative assessment of cognitive processing speed. Front Hum Neurosci 2023; 17:1158650. [PMID: 37063104 PMCID: PMC10097903 DOI: 10.3389/fnhum.2023.1158650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023] Open
Abstract
Introduction Processing speed is defined as the ability to quickly process information, which is generally considered as one of the affected cognitive functions of multiple sclerosis and schizophrenia. Paper-pencil type tests are traditionally used in the assessment of processing speed. However, these tests generally need to be conducted under the guidance of clinicians in a specific environment, which limits their application in cognitive assessment or training in daily life. Therefore, this paper proposed an intelligent evaluation method of processing speed to assist clinicians in diagnosis. Methods We created an immersive virtual street embedded with Stroop task (VR-Street). The behavior and performance information was obtained by performing the dual-task of street-crossing and Stroop, and a 50-participant dataset was established with the label of standard scale. Utilizing Pearson correlation coefficient to find the relationship between the dual-task features and the cognitive test results, and an intelligent evaluation model was developed using machine learning. Results Statistical analysis showed that all Stroop task features were correlated with cognitive test results, and some behavior features also showed correlation. The estimated results showed that the proposed method can estimate the processing speed score with an adequate accuracy (mean absolute error of 0.800, relative accuracy of 0.916 and correlation coefficient of 0.804). The combination of Stroop features and behavior features showed better performance than single task features. Discussion The results of this work indicates that the dual-task design in this study better mobilizes participants' attention and cognitive resources, and more fully reflects participants' cognitive processing speed. The proposed method provides a new opportunity for accurate quantitative evaluation of cognitive function through virtual reality.
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Affiliation(s)
- Yuzhao Zhou
- School of Electronic and Information Engineering, South China University of Technology, Guangzhou, China
| | - Yixuan Zhao
- School of Electronic and Information Engineering, South China University of Technology, Guangzhou, China
| | - Zirui Xiang
- School of Electronic and Information Engineering, South China University of Technology, Guangzhou, China
| | - Zhixin Yan
- School of Future Technology, South China University of Technology, Guangzhou, China
| | - Lin Shu
- School of Electronic and Information Engineering, South China University of Technology, Guangzhou, China
- School of Future Technology, South China University of Technology, Guangzhou, China
- Pazhou Lab, Guangzhou, China
- *Correspondence: Lin Shu,
| | - Xiangmin Xu
- School of Electronic and Information Engineering, South China University of Technology, Guangzhou, China
- School of Future Technology, South China University of Technology, Guangzhou, China
- Zhongshan Institute of Modern Industrial Technology of South China, University of Technology, Zhongshan, China
| | - Lulu Zhang
- Department of Psychiatry, Guangzhou First People’s Hospital, The Second Affiliated Hospital, South China University of Technology, Guangzhou, China
| | - Xiang Tian
- School of Electronic and Information Engineering, South China University of Technology, Guangzhou, China
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Mondellini M, Arlati S, Gapeyeva H, Lees K, Märitz I, Pizzagalli SL, Otto T, Sacco M, Teder-Braschinsky A. User Experience during an Immersive Virtual Reality-Based Cognitive Task: A Comparison between Estonian and Italian Older Adults with MCI. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22218249. [PMID: 36365947 PMCID: PMC9657959 DOI: 10.3390/s22218249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 06/10/2023]
Abstract
Mild cognitive impairment (MCI) is an early stage of cognitive abilities loss and puts older adults at higher risk of developing dementia. Virtual reality (VR) could represent a tool for the early assessment of this pathological condition and for administering cognitive training. This work presents a study evaluating the acceptance and the user experience of an immersive VR application representing a supermarket. As the same application had already been assessed in Italy, we aimed to perform the same study in Estonia in order to compare the outcomes in the two populations. Fifteen older adults with MCI were enrolled in one Rehabilitation Center of Estonia and tried the supermarket once. Afterwards, they were administered questionnaires aimed at evaluating their technology acceptance, sense of presence, and cybersickness. Estonian participants reported low side effects and discrete enjoyment, and a sense of presence. Nonetheless, their intention to use the technology decreased after the experience. The comparison between Italian and Estonian older adults showed that cybersickness was comparable, but technology acceptance and sense of presence were significantly lower in the Estonian group. Thus, we argue that: (i) cultural and social backgrounds influence technology acceptance; (ii) technology acceptance was rather mediated by the absence of positive feelings rather than cybersickness.
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Affiliation(s)
- Marta Mondellini
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council (CNR), Via Previati 1/E, 23900 Lecco, Italy
| | - Sara Arlati
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council (CNR), Via Previati 1/E, 23900 Lecco, Italy
| | - Helena Gapeyeva
- Clinic of Medical Rehabilitation, East Tallinn Central Hospital, Ravi Street 18, 10138 Tallinn, Estonia
| | - Kairi Lees
- Clinic of Medical Rehabilitation, East Tallinn Central Hospital, Ravi Street 18, 10138 Tallinn, Estonia
| | - Ingrid Märitz
- Clinic of Medical Rehabilitation, East Tallinn Central Hospital, Ravi Street 18, 10138 Tallinn, Estonia
| | - Simone Luca Pizzagalli
- Department of Mechanical and Industrial Engineering, Tallinn University of Technology (TalTech), Ehitajate tee 5, 19086 Tallinn, Estonia
| | - Tauno Otto
- Department of Mechanical and Industrial Engineering, Tallinn University of Technology (TalTech), Ehitajate tee 5, 19086 Tallinn, Estonia
| | - Marco Sacco
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council (CNR), Via Previati 1/E, 23900 Lecco, Italy
| | - Anneli Teder-Braschinsky
- Clinic of Medical Rehabilitation, East Tallinn Central Hospital, Ravi Street 18, 10138 Tallinn, Estonia
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Corti C, Oprandi MC, Chevignard M, Jansari A, Oldrati V, Ferrari E, Martignoni M, Romaniello R, Strazzer S, Bardoni A. Virtual-Reality Performance-Based Assessment of Cognitive Functions in Adult Patients With Acquired Brain Injury: A Scoping Review. Neuropsychol Rev 2022; 32:352-399. [PMID: 33929656 DOI: 10.1007/s11065-021-09498-0] [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: 06/10/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
Individuals with acquired brain injury (ABI) commonly present with impairments in cognitive abilities. As these competencies seem to be predictive of patients' abilities to reintegrate into the everyday settings, it is crucial to assess them properly. However, previous research has indicated that patients may perform relatively well on standard tests of cognitive functioning, but may nonetheless encounter significant difficulties in organizing and executing everyday tasks. In order to overcome this issue, virtual reality (VR) methods have been introduced in clinical practice with the aim of creating assessments that simulate real-world activities and thus, provide a clearer picture of patients' functioning in everyday settings. This review offers an overview of VR assessment tools described in the scientific literature between 2010 and 2019. Overall, 38 relevant records describing 31 different tools were found. Among these tools, 16 assessed executive functions and prospective memory, while the other 15 assessed visuo-spatial abilities. Although promising results have been reported, our analysis indicated that about half of the tools deliver tasks that differ from everyday activities, thus limiting the generalizability of patients' performance to the real-world. Moreover, a variety of methodological shortfalls related to study Internal and External Validity have been highlighted, which hamper the possibility of drawing definite recommendations on tool choice. These limitations suggest the importance of putting considerable efforts into the improvement or development of VR tools for patients with ABI for both research and clinical purposes, considering the great potential of this form of assessment.
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Affiliation(s)
- Claudia Corti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy.
| | | | - Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Brain Injury, Saint Maurice Hospital, Saint Maurice, France
- Laboratoire D'Imagerie Biomedicale (LIB), Sorbonne Université, Paris, France
- GRC 24 Handicap Moteur Et Cognitif Et Réadaptation (HaMCRe), Sorbonne Université, Paris, France
| | | | - Viola Oldrati
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | | | | | | | - Sandra Strazzer
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
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Kaiser AP, Villadsen KW, Samani A, Knoche H, Evald L. Virtual Reality and Eye-Tracking Assessment, and Treatment of Unilateral Spatial Neglect: Systematic Review and Future Prospects. Front Psychol 2022; 13:787382. [PMID: 35391965 PMCID: PMC8982678 DOI: 10.3389/fpsyg.2022.787382] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Unilateral spatial neglect (USN) is a disorder characterized by the failure to report, respond to, or orient toward the contralateral side of space to a brain lesion. Current assessment methods often fail to discover milder forms, cannot differentiate between unilateral spatial neglect subtypes and lack ecological validity. There is also a need for treatment methods that target subtypes. Immersive virtual reality (VR) systems in combination with eye-tracking (ET) have the potential to overcome these shortcomings, by providing more naturalistic environments and tasks, with sensitive and detailed measures. This systematic review examines the state of the art of research on these technologies as applied in the assessment and treatment of USN. As we found no studies that combined immersive VR and ET, we reviewed these approaches individually. The review of VR included seven articles, the ET review twelve. The reviews revealed promising results. (1) All included studies found significant group-level differences for several USN measures. In addition, several studies found asymmetric behavior in VR and ET tasks for patients who did not show signs of USN in conventional tests. Particularly promising features were multitasking in complex VR environments and detailed eye-movement analysis. (2) No VR and only a few ET studies attempted to differentiate USN subtypes, although the technologies appeared appropriate. One ET study grouped USN participants using individual heatmaps, and another differentiated between subtypes on drawing tasks. Regarding (3) ecological validity, although no studies tested the prognostic validity of their assessment methods, VR and ET studies utilized naturalistic tasks and stimuli reflecting everyday situations. Technological characteristics, such as the field of view and refresh rate of the head-mounted displays, could be improved, though, to improve ecological validity. We found (4) no studies that utilized VR or ET technologies for USN treatment up until the search date of the 26th of February 2020. In conclusion, VR-ET-based systems show great potential for USN assessment. VR-ET holds great promise for treatment, for example, by monitoring behavior and adapting and tailoring to the individual person's needs and abilities. Future research should consider developing methods for individual subtypes and differential diagnostics to inform individual treatment programs.
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Affiliation(s)
- Alexander Pilgaard Kaiser
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Kristian Westergaard Villadsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Afshin Samani
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Hendrik Knoche
- Department of Architecture, Design and Media Technology, Aalborg University, Aalborg, Denmark
| | - Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark,*Correspondence: Lars Evald,
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Hreha K, Barrett AM, Gillen RW, Gonzalez-Snyder C, Masmela J, Chen P. The Implementation Process of Two Evidence-Based Protocols: A Spatial Neglect Network Initiative. FRONTIERS IN HEALTH SERVICES 2022; 2:839517. [PMID: 36925858 PMCID: PMC10012810 DOI: 10.3389/frhs.2022.839517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/23/2022] [Indexed: 11/13/2022]
Abstract
Introduction Spatial neglect, a neurocognitive disorder of lateralized spatial attention, is prevalent among stroke survivors especially in inpatient rehabilitation facilities (IRFs). The ultimate goal of the project was to improve spatial neglect care in inpatient rehabilitation and trained as many OTs as possible using both tools in their regular practices as the means to achieve our overall objective. Therefore, we conducted a project aimed at implementing two evidence-based protocols, one for assessment (KF-NAP®) and the other for treatment (KF-PAT®), and share the implementation process, which included barriers and facilitators identified during and after the process, and implementation outcomes. Methods Sixteen IRFs were involved. The Knowledge-To-Action Cycle was used to describe the process of knowledge inquiry (training), translating knowledge (implementation) and evaluating the use of knowledge in clinical practice (outcomes). Barriers and strategies were reported using the Consolidated Framework for Implementation Research and identified through a survey, after the study concluded. Results Thirty-two therapists at the participating sites were trained to some level of the KF-NAP and KF-PAT. Throughout the project and also once after it finished, different barriers were identified by researchers and clinicians, who then determined together actions to eliminate or minimize the barriers. For example, multiple sites reported: "not having time to train other staff at their hospital due to high patient volume and other responsibilities." Discussion The project shared our implementation process which demonstrated the importance of using implementation methods and incorporating a researcher-clinician partnership, not only for knowledge generation but also knowledge translation. Frequent communications and exchanging information with stakeholders at different levels, may be determinant to the success of each implementation phase. Further research is needed.
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Affiliation(s)
- Kimberly Hreha
- Division of Occupational Therapy Doctorate, Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, NC, United States
| | - A M Barrett
- Atlanta VA Health Care System, U.S. Department of Veterans Affairs, Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, United States.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Robert W Gillen
- Neuropsychology Department, Sunnyview Rehabilitation Hospital, Schenectady, NY, United States
| | - Chris Gonzalez-Snyder
- Division of In-Patient Rehabilitation, Select Medical, Mechanicsburg, PA, United States
| | - Jenny Masmela
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, United States
| | - Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
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11
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Chen P, Zanca J, Esposito E, Barrett AM. Barriers and Facilitators to Rehabilitation Care of Individuals With Spatial Neglect: A Qualitative Study of Professional Views. Arch Rehabil Res Clin Transl 2021; 3:100122. [PMID: 34179758 PMCID: PMC8212009 DOI: 10.1016/j.arrct.2021.100122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To identify barriers and facilitators to achieving optimal inpatient rehabilitation outcome among individuals with spatial neglect (SN). Design Cross-sectional, semistructured focus group discussions. Setting Rehabilitation hospitals. Participants A total of 15 occupational therapists and 14 physical therapists treating patients with SN on 3 campuses of a rehabilitation hospital system (N=29). Six focus group sessions were conducted and audio-recorded for transcription. Interventions Not applicable. Main Outcome Measures Not applicable. Results Participants identified several patient-related characteristics that posed barriers to treatment, including the symptoms of SN itself, cognitive issues, physical weakness, comorbidities, and reduced therapy engagement. Supportive family members were considered a key facilitator, but lack of preparedness to assume caregiving roles, poor understanding of SN and rehabilitation goals, and inadequate levels of involvement were family-related barriers to successful treatment. Participants expressed that having resources and technologies available at their center to support SN treatment facilitated positive outcomes and perceived limited staff knowledge and skills and poor interclinician communication as barriers to treatment. At the health care system level, barriers included a lack of responsive measures of SN progress and insurer-related issues. Strong continuity of care between transitions was considered an important factor for enabling effective treatment. Conclusions Barriers and facilitators to the current practice of SN care were identified from occupational and physical therapists’ point of view. Opportunities exist to promote identified facilitators and minimize barriers to improve SN rehabilitation. The present study makes a unique contribution in identifying specific needs for innovative interventions that involve family support and training, promotion of interdisciplinary collaboration, development of interprofessional vocabulary, and continuous treatment and follow-up assessment for SN through care transitions.
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Affiliation(s)
- Peii Chen
- Kessler Foundation, West Orange, New Jersey, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States
| | - Jeanne Zanca
- Kessler Foundation, West Orange, New Jersey, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States
| | - Emily Esposito
- Department of Psychology, University of California, Riverside, California, United States
| | - A M Barrett
- Department of Neurology, Emory University, Atlanta, Georgia, United States.,Atlanta VA Health Care System, U.S. Department of Veterans Affairs, Decatur, Georgia, United States
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12
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Jeon B, Oh J, Son S. Effects of Tooth Brushing Training, Based on Augmented Reality Using a Smart Toothbrush, on Oral Hygiene Care among People with Intellectual Disability in Korea. Healthcare (Basel) 2021; 9:348. [PMID: 33803836 PMCID: PMC8003269 DOI: 10.3390/healthcare9030348] [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: 01/12/2021] [Revised: 02/27/2021] [Accepted: 03/05/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Purpose: In modern society, augmented reality (AR)-based training using a smart device has emerged as a means of resolving problems with training. Thus, this feasibility study aimed to identify the effects of tooth-brushing training, based on AR using a smart toothbrush, on oral hygiene care among people with an intellectual disability in Korea. (2) Methods: Thirty people with an intellectual disability, residing in a residential care facility, were selected. Tooth-brushing training based on AR, using a smart toothbrush, was applied in the experimental group (n = 15), and training using visual material was applied in the control group (n = 15). As an assessment of oral hygiene care, the changes in tooth-brushing performance and oral hygiene were measured. (3) Results: There were significant differences in all results after training between the two groups. (4) Conclusions: Tooth-brushing training based on AR using a smart toothbrush is more effective than training using visual material on oral hygiene care among the subjects of this feasibility study. Thus, training based on AR using a smart toothbrush could be applied to people with intellectual disabilities residing in residential care facilities as an individual tool for tooth-brushing training.
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Affiliation(s)
- Byoungjin Jeon
- Department of Occupational Therapy, Kangwon National University, Samcheok 25949, Korea;
| | - Jinseok Oh
- Department of Emergency Medical Rehabilitation Service, Graduate School of Kangwon National University, Samcheok 25949, Korea;
| | - Sungmin Son
- Department of Occupational Therapy, Jeonju Kijeon College, Jeonju 54989, Korea
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13
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Vaezipour A, Aldridge D, Koenig S, Theodoros D, Russell T. "It's really exciting to think where it could go": a mixed-method investigation of clinician acceptance, barriers and enablers of virtual reality technology in communication rehabilitation. Disabil Rehabil 2021; 44:3946-3958. [PMID: 33715566 DOI: 10.1080/09638288.2021.1895333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Acquired communication disorders can result in significant barriers to everyday life activities, and commonly require long-term rehabilitation. This research aimed to investigate usability, acceptance, barriers and enablers to the use of immersive virtual reality (VR) technology for communication rehabilitation from the perspective of speech-language pathologists (SLPs). METHODS Semi-structured interviews and surveys (system usability and motion sickness) were carried out with 15 SLPs following their participation in communication activities typical of daily life, experienced within an immersive VR kitchen environment. RESULTS The system usability scores were average. In addition, motion sickness symptoms were low after interaction with the VR system. The main findings from semi-structured interviews are discussed across five main themes: (i) attitude towards the use of VR in communication rehabilitation (ii) perceived usefulness of VR (iii) perceived ease of use of VR (iv) intention to use VR, and (v) clinical adoption barriers and enablers. CONCLUSIONS Overall, participants were positive about VR and its potential applications to communication rehabilitation. This study provides a foundation to inform the design, development, and implementation of a VR system to be used in the rehabilitation of individuals with acquired communication disorders.IMPLICATIONS FOR REHABILITATIONVirtual Reality applications could simulate social communication situations within the clinic.VR could be used as a rehabilitation tool for communication assessment and/or outcome measure.VR requires customisation to the specific communication rehabilitation needs of the client.Participants identified barriers and enablers to adoption of VR by speech-language pathologists.
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Affiliation(s)
- Atiyeh Vaezipour
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Danielle Aldridge
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | | | - Deborah Theodoros
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Trevor Russell
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
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14
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Harvey M, Learmonth G, Rossit S, Chen P. Editorial for special issue on neglect rehabilitation. Neuropsychol Rehabil 2021; 32:629-639. [PMID: 33467990 DOI: 10.1080/09602011.2021.1873150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
It is clear already that in current and future years more people will suffer from stroke, whether related to COVID-19 or not, and given its prevalence, many more people's lives will be affected by neglect. Here we hope to have contributed to its possible amelioration with highlights of the latest thinking on neglect diagnosis, prevalence and treatment.
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Affiliation(s)
- Monika Harvey
- School of Psychology, University of Glasgow, Glasgow, UK
| | - Gemma Learmonth
- Centre for Cognitive Neuroimaging, Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | | | - Peii Chen
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, New Brunswick, NJ, USA
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15
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Esposito E, Shekhtman G, Chen P. Prevalence of spatial neglect post-stroke: A systematic review. Ann Phys Rehabil Med 2020; 64:101459. [PMID: 33246185 DOI: 10.1016/j.rehab.2020.10.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/18/2020] [Accepted: 10/26/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Spatial neglect (SN) impedes stroke rehabilitation progress, slows functional recovery, and increases caregiver stress and burden. The estimation of SN prevalence varies widely across studies. BACKGROUND We aimed to establish the prevalence of SN based on the injured cerebral hemisphere, recovery stage post-stroke, and diagnostic methodology. MATERIALS AND METHODS All journal articles published up to February 27, 2019 from CINAHL, PsycINFO, PubMed and Web of Science were searched. We selected original research articles that described observational studies, included both individuals with left brain damage (LBD) and those with right brain damage (RBD) post-stroke, and reported specific diagnostic methods for SN. All authors reached consensus for the final selection of 41 articles. Time post-stroke, patient selection criteria, study setting, SN diagnostic methods were extracted. RESULTS A total of 6324 participants were included: 3411 (54%) with RBD and 2913 (46%) with LBD. Without considering time post-stroke or diagnostic methods, the occurrence rate of SN was 29% (38% after RBD and 18% after LBD). Using ecological assessments resulted in higher prevalence than using tests not directly related to daily life activities (53% vs. 24%). Using methods based on a single-cutoff criterion led to lower occurrence of SN than using multi-test methods (27% vs. 33%). The prevalence decreased from the acute to chronic stage post-stroke. CONCLUSIONS The estimated prevalence of SN after unilateral stroke is 30%. SN is more common after RBD than after LBD, but SN after LBD is still quite common. Using ecological assessments and multi-test methods to detect SN is preferred to using a single-cutoff criterion of a test that is not directly related to daily function. The decrease in SN prevalence over time is evident, but the exact prevalence in later stages cannot be estimated. More research is needed to better understand chronic SN.
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Affiliation(s)
- Emily Esposito
- Department of Psychology, University of California, Riverside, 900, University avenue, Riverside, CA, USA
| | - Grigoriy Shekhtman
- Centre for Stroke Rehabilitation Research, Kessler Foundation, 1199, Pleasant Valley Way, West Orange, NJ, USA; Department of Psychology, Seton Hall University, 400, South Orange avenue, South Orange, NJ, USA
| | - Peii Chen
- Centre for Stroke Rehabilitation Research, Kessler Foundation, 1199, Pleasant Valley Way, West Orange, NJ, USA; Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, 183, South Orange avenue, Newark, NJ, USA.
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16
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Faria AL, Pinho MS, Bermúdez I Badia S. A comparison of two personalization and adaptive cognitive rehabilitation approaches: a randomized controlled trial with chronic stroke patients. J Neuroeng Rehabil 2020; 17:78. [PMID: 32546251 PMCID: PMC7298954 DOI: 10.1186/s12984-020-00691-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 05/05/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Paper-and-pencil tasks are still widely used for cognitive rehabilitation despite the proliferation of new computer-based methods, like VR-based simulations of ADL's. Studies have established construct validity of VR assessment tools with their paper-and-pencil version by demonstrating significant associations with their traditional construct-driven measures. However, VR rehabilitation intervention tools are mostly developed to include mechanisms such as personalization and adaptation, elements that are disregarded in their paper-and-pencil counterparts, which is a strong limitation of comparison studies. Here we compare the clinical impact of a personalized and adapted paper-and-pencil training and a content equivalent and more ecologically valid VR-based ADL's simulation. METHODS We have performed a trial with 36 stroke patients comparing Reh@City v2.0 (adaptive cognitive training through everyday tasks VR simulations) with Task Generator (TG: content equivalent and adaptive paper-and-pencil training). The intervention comprised 12 sessions, with a neuropsychological assessment pre, post-intervention and follow-up, having as primary outcomes: general cognitive functioning (assessed by the Montreal Cognitive Assessment - MoCA), attention, memory, executive functions and language specific domains. RESULTS A within-group analysis revealed that the Reh@City v2.0 improved general cognitive functioning, attention, visuospatial ability and executive functions. These improvements generalized to verbal memory, processing speed and self-perceived cognitive deficits specific assessments. TG only improved in orientation domain on the MoCA, and specific processing speed and verbal memory outcomes. However, at follow-up, processing speed and verbal memory improvements were maintained, and a new one was revealed in language. A between-groups analysis revealed Reh@City v2.0 superiority in general cognitive functioning, visuospatial ability, and executive functions on the MoCA. CONCLUSIONS The Reh@City v2.0 intervention with higher ecological validity revealed higher effectiveness with improvements in different cognitive domains and self-perceived cognitive deficits in everyday life, and the TG intervention retained fewer cognitive gains for longer. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov, number NCT02857803. Registered 5 August 2016, .
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Affiliation(s)
- Ana Lúcia Faria
- Madeira Interactive Technologies Institute, Universidade da Madeira, Funchal, Portugal.
- Faculdade de Psicologia e de Ciências da Educação, Universidade de Coimbra, Coimbra, Portugal.
- NOVA-LINCS, Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Maria Salomé Pinho
- Faculdade de Psicologia e de Ciências da Educação, Universidade de Coimbra, Coimbra, Portugal
- Laboratório de Memória, Linguagem e Funções Executivas, Coimbra, Portugal
| | - Sergi Bermúdez I Badia
- Madeira Interactive Technologies Institute, Universidade da Madeira, Funchal, Portugal
- NOVA-LINCS, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
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17
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Krohn S, Tromp J, Quinque EM, Belger J, Klotzsche F, Rekers S, Chojecki P, de Mooij J, Akbal M, McCall C, Villringer A, Gaebler M, Finke C, Thöne-Otto A. Multidimensional Evaluation of Virtual Reality Paradigms in Clinical Neuropsychology: Application of the VR-Check Framework. J Med Internet Res 2020; 22:e16724. [PMID: 32338614 PMCID: PMC7215516 DOI: 10.2196/16724] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/07/2020] [Accepted: 02/07/2020] [Indexed: 01/16/2023] Open
Abstract
Virtual reality (VR) represents a key technology of the 21st century, attracting substantial interest from a wide range of scientific disciplines. With regard to clinical neuropsychology, a multitude of new VR applications are being developed to overcome the limitations of classical paradigms. Consequently, researchers increasingly face the challenge of systematically evaluating the characteristics and quality of VR applications to design the optimal paradigm for their specific research question and study population. However, the multifaceted character of contemporary VR is not adequately captured by the traditional quality criteria (ie, objectivity, reliability, validity), highlighting the need for an extended paradigm evaluation framework. To address this gap, we propose a multidimensional evaluation framework for VR applications in clinical neuropsychology, summarized as an easy-to-use checklist (VR-Check). This framework rests on 10 main evaluation dimensions encompassing cognitive domain specificity, ecological relevance, technical feasibility, user feasibility, user motivation, task adaptability, performance quantification, immersive capacities, training feasibility, and predictable pitfalls. We show how VR-Check enables systematic and comparative paradigm optimization by illustrating its application in an exemplary research project on the assessment of spatial cognition and executive functions with immersive VR. This application furthermore demonstrates how the framework allows researchers to identify across-domain trade-offs, makes deliberate design decisions explicit, and optimizes the allocation of study resources. Complementing recent approaches to standardize clinical VR studies, the VR-Check framework enables systematic and project-specific paradigm optimization for behavioral and cognitive research in neuropsychology.
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Affiliation(s)
- Stephan Krohn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johanne Tromp
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Max-Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Eva M Quinque
- Max-Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Julia Belger
- Max-Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Felix Klotzsche
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Max-Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Sophia Rekers
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Paul Chojecki
- Fraunhofer Institute for Telecommunications, Heinrich Hertz Institute, Berlin, Germany
| | - Jeroen de Mooij
- Max-Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Mert Akbal
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Max-Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Hochschule der Bildenden Künste Saar, Saarbrücken, Germany
| | - Cade McCall
- Department of Psychology, University of York, York, United Kingdom
| | - Arno Villringer
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Max-Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Michael Gaebler
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Max-Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Carsten Finke
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Angelika Thöne-Otto
- Max-Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
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18
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Gammeri R, Iacono C, Ricci R, Salatino A. Unilateral Spatial Neglect After Stroke: Current Insights. Neuropsychiatr Dis Treat 2020; 16:131-152. [PMID: 32021206 PMCID: PMC6959493 DOI: 10.2147/ndt.s171461] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 12/24/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Unilateral spatial neglect (USN) is a disorder of contralesional space awareness which often follows unilateral brain lesion. Since USN impairs awareness of contralesional space/body and often of concomitant motor disorders, its presence represents a negative prognostic factor of functional recovery. Thus, the disorder needs to be carefully diagnosed and treated. Here, we attempted to present a clear and concise picture of current insights in the comprehension and rehabilitation of USN. METHODS We first provided an updated overview of USN clinical and neuroanatomical features and then highlighted recent progresses in the diagnosis and rehabilitation of the disease. In relation to USN rehabilitation, we conducted a MEDLINE literature research on three of the most promising interventions for USN rehabilitation: prismatic adaptation (PA), non-invasive brain stimulation (NIBS), and virtual reality (VR). The identified studies were classified according to the strength of their methods. RESULTS The last years have witnessed a relative decrement of interest in the study of neuropsychological disorders of spatial awareness in USN, but a relative increase in the study of potential interventions for its rehabilitation. Although optimal protocols still need to be defined, high-quality studies have demonstrated the efficacy of PA, TMS and tDCS interventions for the treatment of USN. In addition, preliminary investigations are suggesting the potentials of GVS and VR approaches for USN rehabilitation. CONCLUSION Advancing neuropsychological and neuroscience tools to investigate USN pathophysiology is a necessary step to identify effective rehabilitation treatments and to foster our understanding of neurofunctional bases of spatial cognition in the healthy brain.
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Affiliation(s)
- Roberto Gammeri
- Department of Psychology, SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, University of Turin, Turin, Italy
| | - Claudio Iacono
- Department of Psychology, SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, University of Turin, Turin, Italy
| | - Raffaella Ricci
- Department of Psychology, SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, University of Turin, Turin, Italy
- Neuroscience Institute of Turin (NIT), University of Turin, Turin, Italy
| | - Adriana Salatino
- Department of Psychology, SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, University of Turin, Turin, Italy
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19
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Tamura M, Shirakawa M, Luo ZW, Noda K, Tanemura R. Qualitative assessment for extrapersonal neglect in patients with stroke using a virtual reality system task. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1687272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Masaki Tamura
- Graduate School of Health Sciences, Kobe University, Kobe, Hyogo 654-0142, Japan
- Department of Physical Therapy, Asahi College of Medical and Health Professionals, Okayama, Okayama 700-0026, Japan
| | - Makoto Shirakawa
- Graduate School of System Informatics, Kobe University, Kobe, Hyogo 657-8501, Japan
| | - Zhi-wei Luo
- Graduate School of System Informatics, Kobe University, Kobe, Hyogo 657-8501, Japan
| | - Kazue Noda
- Graduate School of Health Sciences, Kobe University, Kobe, Hyogo 654-0142, Japan
| | - Rumi Tanemura
- Graduate School of Health Sciences, Kobe University, Kobe, Hyogo 654-0142, Japan
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20
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Borrego A, Latorre J, Alcañiz M, Llorens R. Comparison of Oculus Rift and HTC Vive: Feasibility for Virtual Reality-Based Exploration, Navigation, Exergaming, and Rehabilitation. Games Health J 2018; 7:151-156. [DOI: 10.1089/g4h.2017.0114] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Adrián Borrego
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Jorge Latorre
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Mariano Alcañiz
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Roberto Llorens
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Valencia, Spain
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21
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De Luca R, Russo M, Naro A, Tomasello P, Leonardi S, Santamaria F, Desireè L, Bramanti A, Silvestri G, Bramanti P, Calabrò RS. Effects of virtual reality-based training with BTs-Nirvana on functional recovery in stroke patients: preliminary considerations. Int J Neurosci 2018; 128:791-796. [PMID: 29148855 DOI: 10.1080/00207454.2017.1403915] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM OF THE STUDY Cognitive impairment occurs frequently in post-stroke patients. This study aimed to determine the effects of a virtual reality training (VRT) with BTs-Nirvana (BTsN) on the recovery of cognitive functions in stroke patients, using the Interactive-Semi-Immersive Program (I-SIP). MATERIALS AND METHODS We enrolled 12 subjects (randomly divided into two groups: experimental group (EG); and control group (CG)), who attended the Laboratory of Robotic and Cognitive Rehabilitation of IRCCS Neurolesi of Messina from January to June 2016. The EG underwent a VRT with BTsN, whereas CG received a standard cognitive treatment. Both the groups underwent the same conventional physiotherapy program. Each treatment session lasted 45 minutes and was repeated three times a week for 8 weeks. All the patients were evaluated by a specific clinical-psychometric battery before (T0), immediately (T1), and one month (T2) after the end of the training. RESULTS At T1, the EG presented a greater improvement in the trunk control test (p = 0.03), the Montreal Cognitive Assessment (p = 0.01), the selective attention assessment scores (p = 0.01), the verbal memory (p = 0.03), and the visuospatial and constructive abilities (p = 0.01), as compared to CG. Moreover, such amelioration persisted at T2 only in the EG. CONCLUSIONS According to these preliminary data, VRT with I-SIP can be considered a useful complementary treatment to potentiate functional recovery, with regard to attention, visual-spatial deficits, and motor function in patients affected by stroke.
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Affiliation(s)
| | | | - Antonino Naro
- a IRCCS Centro Neurolesi 'Bonino Pulejo' , Messina , Italy
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Russo M, De Luca R, Naro A, Sciarrone F, Aragona B, Silvestri G, Manuli A, Bramanti A, Casella C, Bramanti P, Calabrò RS. Does body shadow improve the efficacy of virtual reality-based training with BTS NIRVANA?: A pilot study. Medicine (Baltimore) 2017; 96:e8096. [PMID: 28930852 PMCID: PMC5617719 DOI: 10.1097/md.0000000000008096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Aim of the present study was to evaluate whether the presence of body shadows during virtual reality (VR) training with BTS NIRVANA (BTs-N) may lead to a better functional recovery. METHODS We enrolled 20 poststroke rehabilitation inpatients, who underwent a neurocognitive-rehabilitative training consisting of 24 sessions (3 times a week for 8 weeks) of BTs-N. All the patients were randomized into 2 groups: semi-immersive virtual training with (S-IVTS group) or without (S-IVT group) body shadows. Each participant was evaluated before (T0) and immediately (T1) after the end of the training (Trial Registration Number: NCT03095560). RESULTS The S-IVTS group showed a greater improvement in visuo-constructive skills and sustained attention, as compared with the S-IVT group. The other measures showed nonsignificant within-group and between-group differences. CONCLUSION Our results showed that body shadow may represent a high-priority class of stimuli that act by "pushing" attention toward the body itself. Further studies are needed to clarify the role of body shadow in promoting the internal representation construction and thus self-recognition.
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Tobler-Ammann BC, Surer E, de Bruin ED, Rabuffetti M, Borghese NA, Mainetti R, Pirovano M, Wittwer L, Knols RH. Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect: A Feasibility Study. JMIR Serious Games 2017; 5:e17. [PMID: 28842388 PMCID: PMC5591404 DOI: 10.2196/games.7923] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/13/2017] [Accepted: 07/31/2017] [Indexed: 01/08/2023] Open
Abstract
Background Use of exergames can complement conventional therapy and increase the amount and intensity of visuospatial neglect (VSN) training. A series of 9 exergames—games based on therapeutic principles—aimed at improving exploration of the neglected space for patients with VSN symptoms poststroke was developed and tested for its feasibility. Objectives The goal was to determine the feasibility of the exergames with minimal supervision in terms of (1) implementation of the intervention, including adherence, attrition and safety, and (2) limited efficacy testing, aiming to document possible effects on VSN symptoms in a case series of patients early poststroke. Methods A total of 7 patients attended the 3-week exergames training program on a daily basis. Adherence of the patients was documented in a training diary. For attrition, the number of participants lost during the intervention was registered. Any adverse events related to the exergames intervention were noted to document safety. Changes in cognitive and spatial exploration skills were measured with the Zürich Maxi Mental Status Inventory and the Neglect Test. Additionally, we developed an Eye Tracker Neglect Test (ETNT) using an infrared camera to detect and measure neglect symptoms pre- and postintervention. Results The median was 14 out of 15 (93%) attended sessions, indicating that the adherence to the exergames training sessions was high. There were no adverse events and no drop-outs during the exergame intervention. The individual cognitive and spatial exploration skills slightly improved postintervention (P=.06 to P=.98) and continued improving at follow-up (P=.04 to P=.92) in 5 out of 7 (71%) patients. Calibration of the ETNT was rather error prone. The ETNT showed a trend for a slight median group improvement from 15 to 16 total located targets (+6%). Conclusions The high adherence rate and absence of adverse events showed that these exergames were feasible and safe for the participants. The results of the amount of exergames use is promising for future applications and warrants further investigations—for example, in the home setting of patients to augment training frequency and intensity. The preliminary results indicate the potential of these exergames to cause improvements in cognitive and spatial exploration skills over the course of training for stroke patients with VSN symptoms. Thus, these exergames are proposed as a motivating training tool to complement usual care. The ETNT showed to be a promising assessment for quantifying spatial exploration skills. However, further adaptations are needed, especially regarding calibration issues, before its use can be justified in a larger study sample.
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Affiliation(s)
- Bernadette C Tobler-Ammann
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.,Care and Public Health Research Institute (CAPHRI], Maastricht University, Maastricht, Netherlands
| | - Elif Surer
- Graduate School of Informatics, Department of Modeling and Simulation, Middle East Technical University, Ankara, Turkey.,Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zürich, Zurich, Switzerland
| | - Marco Rabuffetti
- Polo Tecnologico, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - N Alberto Borghese
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Renato Mainetti
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Michele Pirovano
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Lia Wittwer
- Parkinson Center, Epileptology, Neurorehabilitation, Clinic Bethesda, Tschugg, Switzerland
| | - Ruud H Knols
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
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Tobler-Ammann BC, Surer E, Knols RH, Borghese NA, de Bruin ED. User Perspectives on Exergames Designed to Explore the Hemineglected Space for Stroke Patients With Visuospatial Neglect: Usability Study. JMIR Serious Games 2017; 5:e18. [PMID: 28842390 PMCID: PMC5591406 DOI: 10.2196/games.8013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/12/2017] [Accepted: 07/27/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Visuospatial neglect due to stroke is characterized by the inability to perceive stimuli emerging in the area opposite to the side of brain damage. Besides adopting conventional rehabilitation methods to treat neglect symptoms, the use of virtual reality (VR) is becoming increasingly popular. We designed a series of 9 exergames aimed to improve exploration of the neglected side of space. When new VR interventions are designed, it is important to assess the usability aspects of such management strategies within the target population. To date, most studies used questionnaires to assess user satisfaction with the intervention or product being tested. However, only a combination of both quantitative and qualitative data allows a full picture of user perspective. OBJECTIVE The purpose of this study was to quantitatively and qualitatively assess patient and therapist perspectives of a VR intervention based on the series of 9 exergames designed to explore hemineglected space. Specifically, we wanted to evaluate (1) perceived-user friendliness of the exergames, (2) attitude towards using the exergames, and (3) intention to use the exergames in the future. METHODS A total of 19 participants (7 patients, 12 therapists) evaluated the exergames they had used 5 times a week during 3 weeks. The Technology Acceptance Model (TAM) questionnaire was filled out after the intervention. Based on those responses, we conducted focus group interviews (with therapists) and individual interviews (with patients). To analyze the TAM questionnaires, we used descriptive statistics. We adopted content and comparative analysis to analyze the interviews and drew illustration maps to analyze the focus group interviews. RESULTS The therapists took a more critical stance with a mean TAM questionnaire total score of 48.6 (SD 4.5) compared to the patients who had a mean total score of 56.1 (SD 12.3). The perceived user-friendliness score was 5.6 (SD 1.4) for patients and 4.9 (SD 1.4) for therapists. The attitude towards using the exergames was rated 4.8 (SD 1.9) by patients and 3.6 (SD 1.4) by therapists, respectively. The intention to use the exergames in the future was rated 3.9 (SD 2.1) by patients and 3.7 (SD 1.8) by therapists. We gained information on how to improve the exergames in the interviews. CONCLUSIONS Patients and therapists perceived the exergames as user-friendly; however, using the games further with the actual test version was not perceived as conceivable. The therapists were generally more critical towards future use than the patients. Therefore, involving both users to achieve acceptable and user-friendly versions of game-based rehabilitation for the future is deemed crucial and warranted. TRIAL REGISTRATION Clinicaltrials.gov NCT02353962; https://clinicaltrials.gov/ct2/show/NCT02353962 (Archived by WebCite at http://www.webcitation.org/6soxIJlAZ).
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Affiliation(s)
- Bernadette C Tobler-Ammann
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.,Care and Public Health Research Institute [CAPHRI], Maastricht University, Maastricht, Netherlands
| | - Elif Surer
- Graduate School of Informatics, Department of Modeling and Simulation, Middle East Technical University, Ankara, Turkey.,Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Ruud H Knols
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - N Alberto Borghese
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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Faria AL, Andrade A, Soares L, i Badia SB. Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients. J Neuroeng Rehabil 2016; 13:96. [PMID: 27806718 PMCID: PMC5094135 DOI: 10.1186/s12984-016-0204-z] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 10/25/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients' capability to live independently. There is substancial evidence on post-stroke cognitive rehabilitation benefits, but its implementation is generally limited by the use of paper-and-pencil methods, insufficient personalization, and suboptimal intensity. Virtual reality tools have shown potential for improving cognitive rehabilitation by supporting carefully personalized, ecologically valid tasks through accessible technologies. Notwithstanding important progress in VR-based cognitive rehabilitation systems, specially with Activities of Daily Living (ADL's) simulations, there is still a need of more clinical trials for its validation. In this work we present a one-month randomized controlled trial with 18 stroke in and outpatients from two rehabilitation units: 9 performing a VR-based intervention and 9 performing conventional rehabilitation. METHODS The VR-based intervention involved a virtual simulation of a city - Reh@City - where memory, attention, visuo-spatial abilities and executive functions tasks are integrated in the performance of several daily routines. The intervention had levels of difficulty progression through a method of fading cues. There was a pre and post-intervention assessment in both groups with the Addenbrooke Cognitive Examination (primary outcome) and the Trail Making Test A and B, Picture Arrangement from WAIS III and Stroke Impact Scale 3.0 (secondary outcomes). RESULTS A within groups analysis revealed significant improvements in global cognitive functioning, attention, memory, visuo-spatial abilities, executive functions, emotion and overall recovery in the VR group. The control group only improved in self-reported memory and social participation. A between groups analysis, showed significantly greater improvements in global cognitive functioning, attention and executive functions when comparing VR to conventional therapy. CONCLUSIONS Our results suggest that cognitive rehabilitation through the Reh@City, an ecologically valid VR system for the training of ADL's, has more impact than conventional methods. TRIAL REGISTRATION This trial was not registered because it is a small sample study that evaluates the clinical validity of a prototype virtual reality system.
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Affiliation(s)
- Ana Lúcia Faria
- Madeira Interactive Technologies Institute, Funchal, Madeira Portugal
- Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, Coimbra, Portugal
| | | | - Luísa Soares
- Madeira Interactive Technologies Institute, Funchal, Madeira Portugal
- Universidade da Madeira, Funchal, Madeira Portugal
| | - Sergi Bermúdez i Badia
- Madeira Interactive Technologies Institute, Funchal, Madeira Portugal
- Universidade da Madeira, Funchal, Madeira Portugal
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Borrego A, Latorre J, Llorens R, Alcañiz M, Noé E. Feasibility of a walking virtual reality system for rehabilitation: objective and subjective parameters. J Neuroeng Rehabil 2016; 13:68. [PMID: 27503112 PMCID: PMC4977644 DOI: 10.1186/s12984-016-0174-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 07/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though virtual reality (VR) is increasingly used in rehabilitation, the implementation of walking navigation in VR still poses a technological challenge for current motion tracking systems. Different metaphors simulate locomotion without involving real gait kinematics, which can affect presence, orientation, spatial memory and cognition, and even performance. All these factors can dissuade their use in rehabilitation. We hypothesize that a marker-based head tracking solution would allow walking in VR with high sense of presence and without causing sickness. The objectives of this study were to determine the accuracy, the jitter, and the lag of the tracking system and its elicited sickness and presence in comparison of a CAVE system. METHODS The accuracy and the jitter around the working area at three different heights and the lag of the head tracking system were analyzed. In addition, 47 healthy subjects completed a search task that involved navigation in the walking VR system and in the CAVE system. Navigation was enabled by natural locomotion in the walking VR system and through a specific device in the CAVE system. An HMD was used as display in the walking VR system. After interacting with each system, subjects rated their sickness in a seven-point scale and their presence in the Slater-Usoh-Steed Questionnaire and a modified version of the Presence Questionnaire. RESULTS Better performance was registered at higher heights, where accuracy was less than 0.6 cm and the jitter was about 6 mm. The lag of the system was 120 ms. Participants reported that both systems caused similar low levels of sickness (about 2.4 over 7). However, ratings showed that the walking VR system elicited higher sense of presence than the CAVE system in both the Slater-Usoh-Steed Questionnaire (17.6 ± 0.3 vs 14.6 ± 0.6 over 21, respectively) and the modified Presence Questionnaire (107.4 ± 2.0 vs 93.5 ± 3.2 over 147, respectively). CONCLUSIONS The marker-based solution provided accurate, robust, and fast head tracking to allow navigation in the VR system by walking without causing relevant sickness and promoting higher sense of presence than CAVE systems, thus enabling natural walking in full-scale environments, which can enhance the ecological validity of VR-based rehabilitation applications.
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Affiliation(s)
- Adrián Borrego
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Jorge Latorre
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Roberto Llorens
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain. .,Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011, Valencia, Spain.
| | - Mariano Alcañiz
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Enrique Noé
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011, Valencia, Spain
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Ogourtsova T, Souza Silva W, Archambault PS, Lamontagne A. Virtual reality treatment and assessments for post-stroke unilateral spatial neglect: A systematic literature review. Neuropsychol Rehabil 2015; 27:409-454. [PMID: 26620135 DOI: 10.1080/09602011.2015.1113187] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Unilateral spatial neglect (USN) is a highly prevalent post-stroke deficit. Currently, there is no gold standard USN assessment which encompasses the heterogeneity of this disorder and that is sensitive to detect mild deficits. Similarly, there is a limited number of high quality studies suggesting that conventional USN treatments are effective in improving functional outcomes and reducing disability. Virtual reality (VR) provides enhanced methods for USN assessment and treatment. To establish best-practice recommendations with respect to its use, it is necessary to appraise the existing evidence. This systematic review aimed to identify and appraise existing VR-based USN assessments; and to determine whether VR is more effective than conventional therapy. Assessment tools were critically appraised using standard criteria. The methodological quality of the treatment trials was rated by two authors. The level of evidence according to stage of recovery was determined. Findings were compiled into a VR-based USN Assessment and Treatment Toolkit (VR-ATT). Twenty-three studies were identified. The proposed VR tools augmented the conventional assessment strategies. However, most studies lacked analysis of psychometric properties. There is limited evidence that VR is more effective than conventional therapy in improving USN symptoms in patients with stroke. It was concluded that VR-ATT could facilitate identification and decision-making as to the appropriateness of VR-based USN assessments and treatments across the continuum of stroke care, but more evidence is required on treatment effectiveness.
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Affiliation(s)
- Tatiana Ogourtsova
- a School of Physical and Occupational Therapy , McGill University , Montreal , Quebec H3G 1Y5 , Canada.,b Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital , Laval , Quebec H7V 1R2 , Canada
| | - Wagner Souza Silva
- a School of Physical and Occupational Therapy , McGill University , Montreal , Quebec H3G 1Y5 , Canada.,b Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital , Laval , Quebec H7V 1R2 , Canada
| | - Philippe S Archambault
- a School of Physical and Occupational Therapy , McGill University , Montreal , Quebec H3G 1Y5 , Canada.,b Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital , Laval , Quebec H7V 1R2 , Canada
| | - Anouk Lamontagne
- a School of Physical and Occupational Therapy , McGill University , Montreal , Quebec H3G 1Y5 , Canada.,b Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital , Laval , Quebec H7V 1R2 , Canada
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Pedroli E, Serino S, Cipresso P, Pallavicini F, Riva G. Assessment and rehabilitation of neglect using virtual reality: a systematic review. Front Behav Neurosci 2015; 9:226. [PMID: 26379519 PMCID: PMC4548208 DOI: 10.3389/fnbeh.2015.00226] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/10/2015] [Indexed: 12/13/2022] Open
Abstract
After experiencing a stroke in the right hemisphere, almost 50% of patients showed Unilateral Spatial Neglect (USN). In recent decades, Virtual Reality (VR) has been used as an effective tool both for the assessment and rehabilitation of USN. Indeed, this advanced technology allows post-stroke patients to interact with ecological and engaging environments similar to real ones, but in a safe and controlled way. To provide an overview of the most recent VR applications for the assessment and rehabilitation of USN, a systematic review has been carried out. Since 2010, 13 studies have proposed and tested innovative VR tools for USN. After a wide description of the selected studies, we discuss the main features of these VR tools in order to provide crucial indications for future studies, neurorehabilitation interventions, and clinical practice.
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Affiliation(s)
- Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano Milan, Italy
| | - Silvia Serino
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano Milan, Italy
| | - Federica Pallavicini
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano Milan, Italy ; Department of Psycholgy, Università Cattolica del Sacro Cuore Milan, Italy
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Lloréns R, Gil-Gómez JA, Alcañiz M, Colomer C, Noé E. Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke. Clin Rehabil 2014; 29:261-8. [PMID: 25056999 DOI: 10.1177/0269215514543333] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study the clinical effectiveness and the usability of a virtual reality-based intervention compared with conventional physical therapy in the balance recovery of individuals with chronic stroke. DESIGN Randomized controlled trial. SETTING Outpatient neurorehabilitation unit. PARTICIPANTS A total of 20 individuals with chronic stroke. INTERVENTIONS The intervention consisted of 20 one-hour sessions, five sessions per week. The experimental group combined 30 minutes with the virtual reality-based intervention with 30 minutes of conventional training. The control group underwent one hour conventional therapy. MAIN MEASURES Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale, the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment, the Brunel Balance Assessment, and the 10-m Walking Test. Subjective data of the virtual reality-based intervention were collected from the experimental group, with a feedback questionnaire at the end of the trial. RESULTS The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale (p < 0.05) and in the 10-m Walking Test (p < 0.05). Post-hoc analyses showed greater improvement in the experimental group: 3.8 ±2.6 vs. 1.8 ±1.4 in the Berg Balance Scale, -1.9 ±1.6 seconds vs. 0.0 ±2.3 seconds in the 10-m Walking Test, and also in the number of participants who increased level in the Brunel Balance Assessment (χ(2) = 2.5, p < 0.01). CONCLUSIONS Virtual reality interventions can be an effective resource to enhance the improvement of balance in individuals with chronic stroke.
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Affiliation(s)
- Roberto Lloréns
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Valencia, Spain Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Valencia, Spain
| | - José-Antonio Gil-Gómez
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Valencia, Spain
| | - Mariano Alcañiz
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Valencia, Spain
| | - Carolina Colomer
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Valencia, Spain
| | - Enrique Noé
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Valencia, Spain
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