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- Is it necessary to show virtual limbs in action observation neurorehabilitation systems?Publication . Modroño, Cristián; Bermúdez, Sergi; Cameirão, Mónica; Pereira, Fábio; Paulino, Teresa; Marcano, Francisco; Hernández-Martín, Estefanía; Plata-Bello, Julio; Palenzuela, Nereida; Núñez-Pádron, Daniel; Pérez-González, José M; González-Mora, José LAction observation neurorehabilitation systems are usually based on the observation of a virtual limb performing different kinds of actions. In this way, the activity in the frontoparietal Mirror Neuron System is enhanced, which can be helpful to rehabilitate stroke patients. However, the presence of limbs in such systems might not be necessary to produce mirror activity, for example, frontoparietal mirror activity can be produced just by the observation of virtual tool movements. The objective of this work was to explore to what point the presence of a virtual limb impacts the Mirror Neuron System activity in neurorehabilitation systems.
- The use of game modes to promote engagement and social involvement in multi-user serious games: a within-person randomized trial with stroke survivorsPublication . Pereira, Fábio; Bermúdez i Badia, Sergi; Jorge, Carolina; Cameirão, Mónica S.Serious games are promising for stroke rehabilitation, with studies showing a positive impact on reducing motor and cognitive defcits. However, most of the evidence is in the context of single-user rehabilitation, and little is known concerning the impact in multi-user settings. This study evaluates the impact that diferent game modes can have on engagement and social involvement during a two-user game. Specifcally, we want to under stand the benefts of game modalities based on competition, co-activation, and collaboration and analyze the infu ence of diferent motor and cognitive defcits and personality traits. Methods: We developed a two-player setup—using tangible objects and a large screen interactive table—for upper limb rehabilitation purposes. We implemented a game that, while keeping the same basic mechanics, can be played in the three diferent modes (Competitive, Co-active, and Collaborative). We ran a within-person randomized study with 21 stroke survivors that were paired and played the game in its three versions. We used the Game Experi ence Questionnaire—Core Module to assess engagement and the Social Presence Module to assess Social Involve ment. For personality, motor, and cognitive function, users answered the International Personality Item Pool (short version), Fugl-Meyer Assessment—Upper Extremity, Modifed Ashworth Scale, and Montreal Cognitive Assessment, respectively. Results: The Collaborative mode promoted signifcantly more Behavioral Involvement. The Competitive mode pro moted more Flow and Challenge than the Co-active mode with participants with better cognitive performance, with low extraversion, or with higher motor skills. Participants with higher cognitive defcits reported more Competence with the Co-active mode. Conclusions: Our results indicate that, for multi-user motor rehabilitation settings, the collaborative mode is the more appropriate gaming approach to promote social involvement, showing a high potential for increasing adher ence and efectiveness of therapy. Additionally, we show that a player’s motor and cognitive ability and personality should be considered when designing personalized tasks for multiplayer settings.
- Impact of game mode in multi-user serious games for upper limb rehabilitation: a within-person randomized trial on engagement and social involvementPublication . Pereira, Fábio; Bermúdez i Badia, Sergi; Ornelas, Rúben; Cameirão, Mónica S.Background: Serious games have been increasingly used for motor rehabilitation. However, it is not well known how different game features can be used to impact specific skills properly. Here, we study how the mode (competitive, co-active, collaborative) in which a multi-user game is presented impacts engagement and social involvement. Methods: We collected data from 20 pairs of community-dwelling older adults (71.5 ± 8.7 years) in a study following a within-persons design. The participants performed a two-player upper limb rehabilitation game with three conditions (Competitive, Co-active, and Collaborative modes). Engagement and social involvement were assessed through the Core Module and Social Presence Module, respectively, from the Game Experience Questionnaire. To infer the impact of personality and cognitive function, users answered the International Personality Item Pool (short version) and the Montreal Cognitive Assessment, respectively. Results: Results show that the Collaborative game mode promotes more social involvement when compared to Competitive and Co-active modes. This result is mostly explained by those participants with higher cognitive skills, and those that are more extrovert. Extrovert participants feel more empathy and are behaviorally more involved when playing the Collaborative mode. Also, the Collaborative mode is shown to be appropriate to promote interaction with participants that previously had a distant relationship, while the Competitive mode seems to be more beneficial to promote empathy between players with a closer relationship. Conclusions: The Collaborative game mode elicited significantly higher social involvement in terms of Empathy, Positive Affect, and Behavioral Involvement. Hence, this game mode seems to be the most adequate choice to be used in multiplayer rehabilitation settings, where social interaction is intended.
- Virtual reality with customized positive stimuli in a cognitive-motor rehabilitation task: a feasibility study with subacute stroke patients with mild cognitive impairmentPublication . Cameirão, Mónica S.; Pereira, Fábio; Bermúdez i Badia, SergiVirtual Reality applications for integrated cognitive and motor stroke rehabilitation show promise for providing more comprehensive rehabilitation programs. However, we are still missing evidence on its impact in comparison with standard rehabilitation, particularly in patients with cognitive impairment. Additionally, little is known on how specific stimuli in the virtual environment affect task performance and its consequence on recovery. Here we investigate the impact in stroke recovery of a virtual cognitive-motor task customized with positive stimuli, in comparison to standard rehabilitation. The positive stimuli were images based on individual preferences, and self-selected music (half of the sessions). 13 participants in the subacute stage of stroke, with cognitive and motor deficits, were allocated to one of two groups (VR, Control). Motor and cognitive outcomes were assessed at end of treatment (4-6 weeks) and at a 4-week followup. Both groups showed significant improvements over time in functional ability during task performance, but without changes in motor impairment. Cognitive outcomes were modest in both groups. For participants in the VR group, the score in the task was significantly higher in sessions with music. There were no statistical differences between groups at end of treatment and follow-up. The impact of VR therapy was lower than in similar studies with stroke patients without cognitive deficits. This study is a first step towards understanding how VR could be shaped to address the particular needs of this population.
- Using decision theory for analyzing enrollment in a scientific study in the health areaPublication . Pereira, Fábio; Fermé, EduardoThis article explores the current literature about the factors that lead people to enroll in a scientific study in the area of health. Recruitment of participants has been shown to be a problem with the number of participants willing to participate decreasing widely. For this reason, it is important to understand how and why people make the decision to participate in a scientific study, in order to develop mechanisms that counteract this tendency. For that purpose, a review of current literature was conducted and the evidence was related with decision theory. The goal is to understand how the decision process to participate in a study occurs and which actions can be taken to maximize the recruitment process.
- Multi-user Touch Surfaces to Promote Social Participation and Self-efficacy in Upper-limb Stroke RehabilitationPublication . Pereira, Fábio Dinis Silva; Cameirão, Mónica da SilvaThis thesis addresses the growing incidence of stroke and its impact on long-term disability, emphasizing the importance of post-stroke rehabilitation. Predicting a 34% increase in stroke cases by 2025, this work focuses on factors affecting post-stroke motor rehabilitation, such as depressive symptoms, while recognizing the role of social participation and self-efficacy in modulating these outcomes. To tackle these challenges, we propose the use of a multi-user interactive table for upper limb rehabilitation. This innovative approach involves detecting objects of various sizes and shapes as interfaces for serious games, fostering collective therapeutic activities targeting motor rehabilitation, depressive symptoms, social participation, and self-efficacy. Four exploratory studies informed the development of the interactive table. The studies determined game mechanics, object types, and game features. Three game modes (competitive, co-active, and collaborative) were explored, with the collaborative mode showing higher social engagement and more positive outcomes. Subsequent studies involving stroke survivors confirmed the effectiveness of collaborative gameplay. Feasibility, engagement, and usability were tested using objects of different sizes and shapes, revealing insights into task performance, grasping, and task complexity adjustments. The developed interactive table accommodates up to four participants, using top down object shape tracking and a multi-touch panel. Four serious games were designed to target specific upper limb skills, played in collaborative mode with incorporated features to enhance the overall experience. A pilot study with 12 stroke survivors over four weeks demonstrated significant improvements in motor outcomes, including range of motion, dexterity, strength, and coordination. The participants reported high enjoyment and interest in the system, with good usability scores. The study suggests that a group-based holistic motor rehabilitation approach, as presented, holds potential for enhancing motor outcomes by promoting social interaction and self-efficacy. These results indicate the viability of the proposed system as a promising solution for stroke rehabilitation.