Effects of an Eye-Tracking Linkage Attention Training System on Cognitive Function Compared to Conventional Computerized Cognitive Training System in Patients with Stroke

Eye-tracking training improves visuospatial working memory of children with attention-deficit/hyperactivity disorder and autism spectrum disorder

Given the close connection between eye movement and frontal lobe functions and some evidence supporting the effect of eye-tracking training on enhancing cognitive performance mediated by the frontal lobe, this study aimed to explore if after-school eye-tracking training can improve the visuospatial working memory (VSWM) and cognitive flexibility performance in children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). This study is a non-randomized cluster trial. Forty children from eight primary schools were selected, half receiving eye-tracking training for 20 sessions over 9 months, while the other half served as a waitlist control. They were matched on demographic characteristics and baseline cognitive performance. Their VSWM and cognitive flexibility were assessed at the beginning and end of the study. Results showed that children who received eye-tracking training, but not those on a waitlist, exhibited significant improvements in the total score and working memory span of the VSWM tests, and the correct responses in cognitive flexibility tests. Specifically, VSWM performance at higher span levels (5 or above) yielded a greater improvement. The findings suggest that eye-tracking training can be a feasible and effective after-school program for improving working memory and cognitive flexibility performance in children with ADHD and ASD. This study was prospectively registered at ClinicalTrials.gov (https://clinicaltrials.gov/, trial number: NCT05428657).

Feasibility of Computerized Visuomotor Integration System for Visual Field Defects and Spatial Neglect in Poststroke Patients

OBJECTIVE

To develop a computerized visuomotor integration system for assessment and training of visual perception impairments and evaluate its safety and feasibility in patients with a stroke. Visual field defects and spatial neglect lead to substantial poststroke impairment. Most diagnostic assessments are anchored in traditional methods, and clinical effects of rehabilitation treatments are limited.

METHODS

The CoTras Vision system included two evaluations and four training modules. The evaluation modules were based on the Albert's test and Star cancellation test, and training modules were based on visual tracking, central-peripheral integration, and visuomotor perception techniques. Bland-Altman plots for agreement with the traditional paper-and-pencil test were performed, and the modified Intrinsic Motivation Inventory, Patient Satisfaction Questionnaire, and Simulator Sickness Questionnaire were conducted.

RESULTS

Ten patients with acute stroke completed the study. Bland-Altman plots revealed good agreements for Albert's test (mean difference, -0.3±4.5) and Star cancellation test (mean difference, 0.3±0.7). The mean±standard deviation scores of the modified Intrinsic Motivation Inventory, Patient Satisfaction Survey, and Simulator Sickness Questionnaire were 84.7±30.6, 40.5±7.9, and 34.0±34.5 respectively.

CONCLUSION

The CoTras Vision system is feasible and safe in patients with stroke. Most patients had a high degree of motivation to use the system and did not experience severe adverse events. Further studies are needed to confirm its usefulness in stroke patients with visual field defects and hemineglect symptoms. Furthermore, a large, well-designed, randomized controlled trial will be needed to confirm the treatment effect of the CoTras Vision system.

The effects of visual skills training on cognitive and executive functions in stroke patients: a systematic review with meta-analysis

The visual system and associated skills are of particular importance in stroke rehabilitation. The process of neuroplasticity involved in restoring cognitive function during this period is mainly based on anatomical and physiological mechanisms. However, there is little evidence-based knowledge about the effects of visual skills training that could be used to improve therapeutic outcomes in cognitive rehabilitation. A computerized systematic literature search was conducted in the PubMed, Medline, and Web of Science databases from 1 January 1960 to 11 Febuary 2024. 1,787 articles were identified, of which 24 articles were used for the calculation of weighted standardized mean differences (SMD) after screening and eligibility verification. The findings revealed moderate effects for global cognitive function (SMD = 0.62) and activities of daily living (SMD = 0.55) as well as small effects for executive function (SMD = 0.20) - all in favor of the intervention group. The analyses indicate that the results may not be entirely robust, and should therefore be treated with caution when applied in practice. Visual skills training shows positive effects in improving cognitive and executive functions, especially in combination with high cognitive load and in an early phase of rehabilitation. An improvement in activities of daily living can also be observed with this type of intervention. The high heterogeneity of the studies and different treatment conditions require the identification of a relationship between certain visual skills and executive functions in future research.

ETMT: A Tool for Eye-Tracking-Based Trail-Making Test to Detect Cognitive Impairment

The growing number of people with cognitive impairment will significantly increase healthcare demand. Screening tools are crucial for detecting cognitive impairment due to a shortage of mental health experts aiming to improve the quality of life for those living with this condition. Eye tracking is a powerful tool that can provide deeper insights into human behavior and inner cognitive processes. The proposed Eye-Tracking-Based Trail-Making Test, ETMT, is a screening tool for monitoring a person's cognitive function. The proposed system utilizes a fuzzy-inference system as an integral part of its framework to calculate comprehensive scores assessing visual search speed and focused attention. By employing an adaptive neuro-fuzzy-inference system, the tool provides an overall cognitive-impairment score, allowing psychologists to assess and quantify the extent of cognitive decline or impairment in their patients. The ETMT model offers a comprehensive understanding of cognitive abilities and identifies potential deficits in various domains. The results indicate that the ETMT model is a potential tool for evaluating cognitive impairment and can capture significant changes in eye movement behavior associated with cognitive impairment. It provides a convenient and affordable diagnosis, prioritizing healthcare resources for severe conditions while enhancing feedback to practitioners.

Eye-tracking control of an adjustable electric bed: construction and validation by immobile patients with multiple sclerosis

BACKGROUND

In severe conditions of limited motor abilities, frequent position changes for work or passive and active rest are essential bedside activities to prevent further health complications. We aimed to develop a system using eye movements for bed positioning and to verify its functionality in a control group and a group of patients with significant motor limitation caused by multiple sclerosis.

METHODS

The eye-tracking system utilized an innovative digital-to-analog converter module to control the positioning bed via a novel graphical user interface. We verified the ergonomics and usability of the system by performing a fixed sequence of positioning tasks, in which the leg and head support was repeatedly raised and then lowered. Fifteen women and eleven men aged 42.7 ± 15.9 years in the control group and nine women and eight men aged 60.3 ± 9.14 years in the patient group participated in the experiment. The degree of disability, according to the Expanded Disability Status Scale (EDSS), ranged from 7 to 9.5 points in the patients. We assessed the speed and efficiency of the bed control and the improvement during testing. In a questionnaire, we evaluated satisfaction with the system.

RESULTS

The control group mastered the task in 40.2 s (median) with an interquartile interval from 34.5 to 45.5 s, and patients mastered the task in in 56.5 (median) with an interquartile interval from 46.5 to 64.9 s. The efficiency of solving the task (100% corresponds to an optimal performance) was 86.3 (81.6; 91.0) % for the control group and 72.1 (63.0; 75.2) % for the patient group. Throughout testing, the patients learned to communicate with the system, and their efficiency and task time improved. A correlation analysis showed a negative relationship (rho = - 0.587) between efficiency improvement and the degree of impairment (EDSS). In the control group, the learning was not significant. On the questionnaire survey, sixteen patients reported gaining confidence in bed control. Seven patients preferred the offered form of bed control, and in six cases, they would choose another form of interface.

CONCLUSIONS

The proposed system and communication through eye movements are reliable for positioning the bed in people affected by advanced multiple sclerosis. Seven of 17 patients indicated that they would choose this system for bed control and wished to extend it for another application.

Eye-tracking training improves the learning and memory of children with learning difficulty

Children who experience difficulty in learning at mainstream schools usually are provided with remediation classes after school to facilitate their learning. The present study aims to evaluate an innovative eye-tracking training as possible alternative remediation. Our previous findings showed that children who received eye-tracking training demonstrated improved attention and inhibitory control, and the present randomized controlled study aims to evaluate if eye-tracking training can also enhance the learning and memory of children. Fifty-three primary school students with learning difficulty (including autism spectrum disorder, attention-deficit/hyperactivity disorder, specific learning disorder, specific language impairment and borderline intellectual functioning) were recruited and randomly assigned to either the Eye-tracking Training group or the after-school remediation class. They were assessed on their learning and memory using the Hong Kong List Learning Test before and after 8-month training. Twenty weekly parallel sessions of training, 50 min per session, were provided to each group. Children who received the eye-tracking training, not those in the control group, showed a significant improvement in memory as measured by the delayed recall. In addition, the Eye-Tracking Training group showed significantly faster learning than the control group. Also, the two groups showed a significant improvement in their reading abilities. In sum, eye-tracking training may be effective training for enhancing the learning and memory of children with learning difficulties.