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Ajana K, Everard G, Lejeune T, Edwards MG. A feature and conjunction visual search immersive virtual reality serious game for measuring spatial and distractor inhibition attention using response time and action kinematics. J Clin Exp Neuropsychol 2023:1-12. [PMID: 37260369 DOI: 10.1080/13803395.2023.2218571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Treisman (1980) proposed that visual-spatial attention to targets presented with distractors involves parallel and serial cognition. When the target is different from distractors by a single feature, the number of distractors does not influence search speed (parallel). However, when the target is different from the distractor by a conjunction of features, increased numbers of distractors increase task difficulty (serial). Here, we developed a serious game in immersive virtual reality (IVR) for evaluating spatial and distractor inhibition attention. METHODS We tested 60 healthy participants. They performed the serious game in which they had to find a target mole wearing a red miner's helmet. In the single feature parallel conditions, the distractor moles wore blue (miner's or horned) helmets, and in the conjunction feature serial conditions, the distractor moles wore blue miner's helmets or red horned helmets. There were 11-17-23 distractors. Responses were made with the dominant hand by hitting the target with a virtual hammer. We measured mean response time (RT), mean velocity (MV) and coefficient of variance of speed (CV). RESULTS Participants were significantly slower (RT and MV) and showed greater CV when responding to targets in conjunction compared to single feature search tasks. Further, participants were slower (RT and MV) and showed greater CV when the number of distractors increased. A significant interaction between search tasks and distractors showed that RT and CV only increased with distractor number for the conjunction search tasks. MV decreased with distractor number for both single and conjunction tasks, with a stronger decrease for conjunction relative to single feature search. CONCLUSION The results replicated previous findings, providing support for the use of immersive virtual reality technology for the simultaneous evaluation of spatial and distractor inhibition attention using complex 3D objects.
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Affiliation(s)
- Khawla Ajana
- Secteur Des Sciences Humaines, Institut de recherche en sciences psychologiques (IPSY), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- Louvain Bionics, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Gauthier Everard
- Louvain Bionics, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Laboratory (NMSK), Université catholique de Louvain, Brussels, Belgium
| | - Thierry Lejeune
- Louvain Bionics, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Laboratory (NMSK), Université catholique de Louvain, Brussels, Belgium
- Cliniques universitaires Saint-Luc, Service de médecine physique et réadaptation, Brussels, Belgium
| | - Martin Gareth Edwards
- Secteur Des Sciences Humaines, Institut de recherche en sciences psychologiques (IPSY), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- Louvain Bionics, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
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Burton Q, Lejeune T, Dehem S, Lebrun N, Ajana K, Edwards MG, Everard G. Performing a shortened version of the Action Research Arm Test in immersive virtual reality to assess post-stroke upper limb activity. J Neuroeng Rehabil 2022; 19:133. [PMID: 36463219 PMCID: PMC9719653 DOI: 10.1186/s12984-022-01114-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/23/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To plan treatment and measure post-stroke recovery, frequent and time-bounded functional assessments are recommended. With increasing needs for neurorehabilitation advances, new technology based methods, such as virtual reality (VR) have emerged. Here, we developed an immersive VR version of the Action Research Arm Test (ARAT-VR) to complement neurorehabilitation. OBJECTIVE This study aimed to assess the validity, usability and test-retest reliability of the ARAT-VR among individuals with stroke, healthcare professionals and healthy control subjects (HCS). METHODS Among the 19 items of the ARAT, 13 items were selected and developed in immersive VR. 11 healthcare professionals, 30 individuals with stroke, and 25 HCS were recruited. Content validity was assessed by asking healthcare professionals to rate the difficulty of performing each item of the ARAT-VR in comparison to the classical Action Research Arm Test (ARAT-19). Concurrent validity was first measured using correlation (Spearman tests) between the ARAT-VR and ARAT-19 scores for the individuals with stroke, and second through correlation and comparison between the scores of the ARAT-VR and the reduced version of the ARAT (ARAT-13) for both individuals with stroke and HCS (Wilcoxon signed rank tests and Bland-Altman plots). Usability was measured using the System Usability Scale. A part of individuals with stroke and HCS were re-tested following a convenient delay to measure test-retest reliability (Intra-class correlation and Wilcoxon tests). RESULTS Regarding the content validity, median difficulty of the 13 ARAT-VR items (0[0 to - 1] to 0[0-1]) evaluated by healthcare professionals was rated as equivalent to the classical ARAT for all tasks except those involving the marbles. For these, the difficulty was rated as superior to the real tasks (1[0-1] when pinching with the thumb-index and thumb-middle fingers, and 1[0-2] when pinching with thumb-ring finger). Regarding the concurrent validity, for paretic hand scores, there were strong correlations between the ARAT-VR and ARAT-13 (r = 0.84), and between the ARAT-VR and ARAT-19 (r = 0.83). Usability (SUS = 82.5[75-90]) and test-retest reliability (ICC = 0.99; p < 0.001) were excellent. CONCLUSION The ARAT-VR is a valid, usable and reliable tool that can be used to assess upper limb activity among individuals with stroke, providing potential to increase assessment frequency, remote evaluation, and improve neurorehabilitation. Trial registration https://clinicaltrials.gov/ct2/show/NCT04694833 ; Unique identifier: NCT04694833, Date of registration: 11/24/2020.
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Affiliation(s)
- Quentin Burton
- grid.7942.80000 0001 2294 713XNeuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université catholique de Louvain, Brussels, Belgium
| | - Thierry Lejeune
- grid.7942.80000 0001 2294 713XNeuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université catholique de Louvain, Brussels, Belgium ,grid.48769.340000 0004 0461 6320Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium ,grid.7942.80000 0001 2294 713XLouvain Bionics, Université catholique de Louvain, Louvain-la-Neuve, Belgium ,grid.48769.340000 0004 0461 6320Cliniques universitaires Saint Luc, Médecine Physique et Réadaptation, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Stéphanie Dehem
- grid.7942.80000 0001 2294 713XNeuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université catholique de Louvain, Brussels, Belgium ,grid.48769.340000 0004 0461 6320Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium ,grid.7942.80000 0001 2294 713XLouvain Bionics, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Noémie Lebrun
- grid.7942.80000 0001 2294 713XNeuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université catholique de Louvain, Brussels, Belgium
| | - Khawla Ajana
- grid.7942.80000 0001 2294 713XPsychological Sciences Research Institute (IPSY), Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Martin Gareth Edwards
- grid.7942.80000 0001 2294 713XPsychological Sciences Research Institute (IPSY), Université catholique de Louvain, Louvain-la-Neuve, Belgium ,grid.7942.80000 0001 2294 713XLouvain Bionics, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Gauthier Everard
- grid.7942.80000 0001 2294 713XNeuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université catholique de Louvain, Brussels, Belgium ,grid.7942.80000 0001 2294 713XLouvain Bionics, Université catholique de Louvain, Louvain-la-Neuve, Belgium
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Everard G, Otmane-Tolba Y, Rosselli Z, Pellissier T, Ajana K, Dehem S, Auvinet E, Edwards MG, Lebleu J, Lejeune T. Concurrent validity of an immersive virtual reality version of the Box and Block Test to assess manual dexterity among patients with stroke. J Neuroeng Rehabil 2022; 19:7. [PMID: 35065678 PMCID: PMC8783988 DOI: 10.1186/s12984-022-00981-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/31/2021] [Indexed: 11/18/2022] Open
Abstract
Background After a stroke, experts recommend regular monitoring and kinematic assessments of patients to objectively measure motor recovery. With the rise of new technologies and increasing needs for neurorehabilitation, an interest in virtual reality has emerged. In this context, we have developed an immersive virtual reality version of the Box and Block Test (BBT-VR). The aim of this study was to assess the concurrent validity of the BBT-VR among patients with stroke and healthy participants.
Methods Twenty-three healthy participants and 22 patients with stroke were asked to perform the classical Box and Block Test (BBT) and BBT-VR three times with both hands. Concurrent validity was assessed through correlations between these two tests and reliability of the BBT-VR through correlation on test–retest. Usability of the BBT-VR was also evaluated with the System Usability Scale. Hand kinematic data extracted from controller’s 3D position allowed to compute mean velocity (Vmean), peak velocity (Vpeak) and smoothness (SPARC). Results Results showed strong correlations between the number of blocks displaced with the BBT and the BBT-VR among patients with stroke for affected (r = 0.89; p < 0.001) and less-affected hands (r = 0.76; p < 0.001) and healthy participants for dominant (r = 0.58; p < 0.01) and non-dominant hands (r = 0.68; p < 0.001). Reliability for test–retest was excellent (ICC > 0.8; p < 0.001) and usability almost excellent (System Usability Scale = 79 ± 12.34%). On average participants moved between 30 and 40% less blocks during the BBT-VR than during the BBT. Healthy participants demonstrated significantly higher kinematic measures (Vmean = 0.22 ± 0.086 ms−1; Vpeak = 0.96 ± 0.341 ms−1; SPARC = − 3.31 ± 0.862) than patients with stroke (Vmean = 0.12 ± 0.052 ms−1; Vpeak = 0.60 ± 0.202 ms−1; SPARC = − 5.04[− 7.050 to − 3.682]).
Conclusion The BBT-VR is a usable, valid and reliable test to assess manual dexterity, providing kinematic parameters, in a population of patients with stroke and healthy participants. Trial registration http://www.clinicaltrials.gov; Unique identifier: NCT04694833, Date of registration: 11/24/2020 Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-00981-0.
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Everard G, Luc A, Doumas I, Ajana K, Stoquart G, Edwards MG, Lejeune T. Self-Rehabilitation for Post-Stroke Motor Function and Activity-A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2021; 35:1043-1058. [PMID: 34696645 DOI: 10.1177/15459683211048773] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Due to an increasing stroke incidence, a lack of resources to implement effective rehabilitation and a significant proportion of patients with remaining impairments after treatment, there is a rise in demand for effective and prolonged rehabilitation. Development of self-rehabilitation programs provides an opportunity to meet these increasing demands.Objective. The primary aim of this meta-analysis was to determine the effect of self-rehabilitation on motor outcomes, in comparison to conventional rehabilitation, among patients with stroke. The secondary aim was to assess the influence of trial location (continent), technology, time since stroke (acute/subacute vs chronic), dose (total training duration > vs ≤ 15 hours), and intervention design (self-rehabilitation in addition/substitution to conventional therapy) on effect of self-rehabilitation.Methods. Studies were selected if participants were adults with stroke; the intervention consisted of a self-rehabilitation program defined as a tailored program where for most of the time, the patient performed rehabilitation exercises independently; the control group received conventional therapy; outcomes included motor function and activity; and the study was a randomized controlled trial with a PEDro score ≥5.Results. Thirty-five trials were selected (2225 participants) and included in quantitative synthesis regarding motor outcomes. Trials had a median PEDro Score of 7 [6-8]. Self-rehabilitation programs were shown to be as effective as conventional therapy. Trial location, use of technology, stroke stage, and intervention design did not appear to have a significant influence on outcomes.Conclusion. This meta-analysis showed low to moderate evidence that self-rehabilitation and conventional therapy efficacy was equally valuable for post-stroke motor function and activity.
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Affiliation(s)
- Gauthier Everard
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Alexandre Luc
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium
| | - Ioannis Doumas
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Khawla Ajana
- Psychological Sciences Research Institute (IPSY), 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Gaëtan Stoquart
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Martin Gareth Edwards
- Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Psychological Sciences Research Institute (IPSY), 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Thierry Lejeune
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
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