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- Efficacy of adaptive cognitive training through desktop virtual reality and paper-and-pencil in the treatment of mental and behavioral disordersPublication . CĂąmara, Joana; Ferreira, Rute; Teixeira, Liliana; NĂłbrega, Joana; Romeira, Carina; BermĂșdez i Badia, Sergi; Faria, Ana LĂșciaCognitive defcits are a core feature of mental and behavioral disorders, leading to poor treatment adherence and functional ity. Virtual reality (VR) methodologies are promising solutions for cognitive interventions in psychiatry once they provide greater ecological validity. This study assessed and compared two content-equivalent cognitive training (CT) interventions, delivered in desktop VR (Reh@City v2.0) and paper-and-pencil (Task Generator (TG)) formats, in patients with mental and behavioral disorders. 30 patients were randomly assigned to the Reh@City v2.0 group and the TG group. Both groups of patients underwent a time-matched 24-sessions intervention. Neuropsychological assessments were performed at baseline, post-intervention, and follow-up. A within-groups analysis revealed signifcant improvements in visual memory and depres sive symptomatology after the Reh@City intervention. The TG group improved in processing speed, verbal memory, and quality of life (social relationships and environmental domains). Between groups, Reh@City led to a greater reduction in depressive symptomatology, whereas the TG group showed higher improvements in social relationships aspects of quality of life. At follow-up, previous gains were maintained and new improvements found in the Reh@City (global cognitive func tion, language, visuospatial and executive functions) and the TG groups (attention). The Reh@City signifcantly reduced depressive symptomatology, and the TG led to greater improvements in processing speed, abstraction, and social relationships domain of quality of life at follow-up. Both interventions were associated with important cognitive, emotional, and quality of life benefts, which were maintained after two months. Reh@City and TG should be considered as complementary CT methods for patients with mental and behavioral disorders. Trial registration The trial is registered at ClinicalTrials.gov, number NCT04291586.
- An integrative virtual reality cognitive-motor intervention approach in stroke rehabilitation: a pilot studyPublication . Faria, A. L.; Vourvopoulos, A.; CameirĂŁo, M. S.; Fernandes, J. C.; BermĂșdez i Badia, SergiStroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patientâs capability to live independently. In post-stroke it is imperative to initiate a process of intensive rehabilitation and personalized objectives to maximize functional cognitive and motor recovery. Virtual Reality (VR) technology is being widely applied to rehabilitation of stroke, however, not in an integrative manner. Like traditional rehabilitation, these new tools mostly focus either in the cognitive or in the motor domain, which can take to a reduced impact in the performance of activities of daily living, most of them dual-task. Assuming the existence of cognitive and motor recovery interdependence, RehabNet proposes a holistic approach. Here we present a one-month long pilot study with three stroke patients whose training was a game-like VR version of the Toulouse-PiĂ©ron cancellation test, adapted to be performed by repetitive arm reaching movements. A standardized motor and cognitive assessment was performed pre and post intervention. The first results on this intervention support a holistic model for rehabilitation of stroke patients, sustaining interdependence on cognitive and motor recovery. Furthermore, we observed that the impact of the integrative VR approach generalizes to the performance of the activities of daily living.
- Combined cognitive-motor rehabilitation in virtual reality improves motor outcomes in chronic strokeâa pilot studyPublication . Faria, Ana L.; CameirĂŁo, MĂłnica S.; Couras, Joana F.; Aguiar, Joana R. O.; Costa, Gabriel M.; BermĂșdez i Badia, SergiStroke 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. Virtual Reality (VR) based methods for stroke rehabilitation have mainly focused on motor rehabilitation but there is increasing interest toward the integration of cognitive training for providing more effective solutions. Here we investigate the feasibility for stroke recovery of a virtual cognitive-motor task, the Reh@Task, which combines adapted arm reaching, and attention and memory training. 24 participants in the chronic stage of stroke, with cognitive and motor deficits, were allocated to one of two groups (VR, Control). Both groups were enrolled in conventional occupational therapy, which mostly involves motor training. Additionally, the VR group underwent training with the Reh@Task and the control group performed time-matched conventional occupational therapy. Motor and cognitive competences were assessed at baseline, end of treatment (1 month) and at a 1-month follow-up through the Montreal Cognitive Assessment, Single Letter Cancelation, Digit Cancelation, Bells Test, Fugl-Meyer Assessment Test, Chedoke Arm and Hand Activity Inventory, Modified Ashworth Scale, and Barthel Index. Our results show that both groups improved in motor function over time, but the Reh@Task group displayed significantly higher between-group outcomes in the arm subpart of the Fugl-Meyer Assessment Test. Improvements in cognitive function were significant and similar in both groups. Overall, these results are supportive of the viability of VR tools that combine motor and cognitive training, such as the Reh@Task. Trial Registration: This trial was not registered because it is a small clinical study that addresses the feasibility of a prototype device.
- InclusĂŁo digital e envelhecimento ativo no sĂ©culo XXIPublication . Agrela, Diana; Santos, EstefĂąnia; Guzman, Khristina; Aveiro, Laura; Pestana, Paulo; Faria, Ana LĂșciaAo longo dos Ășltimos anos, a sociedade estĂĄ cada vez mais envelhecida. A par disso, o uso das novas tecnologias cresce gradualmente, tendo impacto na vida quotidiana dos mais velhos. PorĂ©m, apesar desta influĂȘncia, a maioria desta população possui vontade para integrar esta nova era tecnolĂłgica. A presente revisĂŁo aborda o idoso e o envelhecimento, mas tambĂ©m a sua adaptação Ă s novas tecnologias, evidenciando os seus aspetos positivos e menos positivos. Adicionalmente, foi feita uma pesquisa a alguns recursos que existem na RegiĂŁo AutĂłnoma da Madeira (RAM) e que tentam cobrir as necessidades dos idosos e que pretendem proporcionar um envelhecimento mais ativo, criando redes sociais alternativas.
- Capturing expert knowledge for the personalization of cognitive rehabilitation: study combining computational modeling and a participatory design strategyPublication . Faria, Ana LĂșcia; Pinho, Maria SalomĂ©; BermĂșdez i Badia, SergiBackground: Cognitive impairments after stroke are not always given sufficient attention despite the critical limitations they impose on activities of daily living (ADLs). Although there is substantial evidence on cognitive rehabilitation benefits, its implementation is limited because of time and human resourceâs demands. Moreover, many cognitive rehabilitation interventions lack a robust theoretical framework in the selection of paper-and-pencil tasks by the clinicians. In this endeavor, it would be useful to have a tool that could generate standardized paper-and-pencil tasks, parameterized according to patients' needs. Objective: In this study, we aimed to present a framework for the creation of personalized cognitive rehabilitation tasks based on a participatory design strategy. Methods: We selected 11 paper-and-pencil tasks from standard clinical practice and parameterized them with multiple configurations. A total of 67 tasks were assessed according to their cognitive demands (attention, memory, language, and executive functions) and overall difficulty by 20 rehabilitation professionals. Results: After assessing the internal consistency of the dataâthat is, alpha values from .918 to .997âwe identified the parameters that significantly affected cognitive functions and proposed specific models for each task. Through computational modeling, we operationalized the tasks into their intrinsic parameters and developed a Web tool that generates personalized paper-and-pencil tasksâthe Task Generator (TG). Conclusions: Our framework proposes an objective and quantitative personalization strategy tailored to each patient in multiple cognitive domains (attention, memory, language, and executive functions) derived from expert knowledge and materialized in the TG app, a cognitive rehabilitation Web tool.
- Envelhecimento na terceira idadePublication . Encarnação, Carla; Santos, Guadalupe; Gonzalez, Luzbeni; Barradas, Natacha; Sousa, Paulo; Faria, Ana LĂșciaA população portuguesa Ă© caracterizada pela sua maioria idosa, sendo esta uma realidade com tendĂȘncia crescente nos prĂłximos anos. Envelhecer Ă© um processo natural e gradual do ser humano, caracterizado pela alteração no funcionamento do organismo, pela debilidade do sistema imunolĂłgico e maiores necessidades nutricionais. Estas transformaçÔes fisiolĂłgicas sĂŁo frequentemente associadas ao aparecimento de doença. Na perspetiva de promover o envelhecimento ativo, este trabalho terĂĄ como alvo de estudo a alimentação e a sua influĂȘncia no aparecimento e desenvolvimento de doença. Para tal, propomo-nos a contextualizar a saĂșde do idoso, as suas necessidades nutricionais com as doenças mais frequentas apresentadas pelo idoso, nomeadamente: as cardiovasculares, oncolĂłgicas, diabetes, neurodegenerativas, osteoporose e a desidratação. A incidĂȘncia do estudo na alimentação tem como finalidade a consciencialização da sua prĂĄtica como medida preventiva Ă doença, promovendo um envelhecimento ativo, qualidade de vida e o aumento da esperança mĂ©dia de vida.
- RehabNet: a distributed architecture for motor and cognitive neuro-rehabilitationPublication . Vourvopoulos, Athanasios; Faria, Ana LĂșcia; CameirĂŁo, MĂłnica S.; BermĂșdez i Badia, SergiEvery year millions of people worldwide suffer from stroke, resulting in motor and/or cognitive disability. As a result, patients experience an increased loss of independence, autonomy and low self-esteem. Evolving to a chronic condition, stroke requires of continuous rehabilitation and therapy. Current ICT approaches, with the use of robotics and Virtual Reality, show some benefits over conventional therapy. However, most of the novel approaches are suitable only for a reduced subset of patients. RehabNet proposes an inclusive approach towards an open and distributed architecture for âin-homeâ neurorehabilitation and monitoring by means of non-invasive ICT. In this paper we present the RehabNet architecture, its design and the implementation of a combined motor-and-cognitive system for post-stroke rehabilitation.
- The impact of positive, negative and neutral stimuli in a virtual reality cognitive-motor rehabilitation task: a pilot study with stroke patientsPublication . CameirĂŁo, MĂłnica S.; Faria, Ana LĂșcia; Paulino, Teresa; Alves, JĂșlio; BermĂșdez i Badia, SergiBackground: Virtual Reality (VR) based methods for stroke rehabilitation have mainly focused on motor rehabilitation, but there is increasing interest in integrating motor and cognitive training to increase similarity to real-world settings. Unfortunately, more research is needed for the definition of which type of content should be used in the design of these tools. One possibility is the use of emotional stimuli, which are known to enhance attentional processes. According to the Socioemotional Selectivity Theory, as people age, the emotional salience arises for positive and neutral, but not for negative stimuli. Methods: For this study we developed a cognitive-motor VR task involving attention and short-term memory, and we investigated the impact of using emotional images of varying valence. The task consisted of finding a target image, shown for only two seconds, among fourteen neutral distractors, and selecting it through arm movements. After performing the VR task, a recall task took place and the patients had to identify the target images among a valence-matched number of distractors. Ten stroke patients participated in a within-subjects experiment with three conditions based on the valence of the images: positive, negative and neutral. Eye movements were recorded during VR task performance with an eye tracking system. Results: Our results show decreased attention for negative stimuli in the VR task performance when compared to neutral stimuli. The recall task shows significantly more wrongly identified images (false memories) for negative stimuli than for neutral. Regression and correlation analyses with the Montreal Cognitive Assessment and the Geriatric Depression Scale revealed differential effects of cognitive function and depressive symptomatology in the encoding and recall of positive, negative and neutral images. Further, eye movement data shows reduced search patterns for wrongly selected stimuli containing emotional content. Conclusions: The results of this study suggest that it is feasible to use emotional content in a VR based cognitivemotor task for attention and memory training after stroke. Stroke survivors showed less attention towards negative information, exhibiting reduced visual search patterns and more false memories. We have also shown that the use of emotional stimuli in a VR task can provide additional information regarding patientâs mood and cognitive status.
- Feasibility, Acceptability, and Preliminary Impact of Full-Body Interaction on Computerized Cognitive Training Based on Instrumental Activities of Daily Living: A Pilot Randomized Controlled Trial with Chronic Psychiatric InpatientsPublication . CĂąmara, Joana; Ferreira, Luis; Faria, Ana LĂșcia; Vilar, Manuela; BermĂșdez i Badia, SergiObjective: To conduct a pilot randomized control trial to assess the feasibility and acceptability of full-body interaction cognitive training (FBI-CT) inspired by instrumental activities of daily living in chronic psychiatric inpatients and to explore its preliminary impact on cognitive and noncognitive outcomes. Materials and Methods: Twenty psychiatric inpatients met the inclusion criteria and were randomly allocated to the FBI-CT group (n = 10) or the tablet-based CT group (T-CT) (n = 10). Neuropsychological assessments were performed at baseline, postintervention, and 3-month follow-up. Results: Both groups presented high completion rates at postintervention and follow-up. Participants reported high satisfaction following the interventions, with the FBI-CT group exhibiting slightly higher satisfaction. A within-group analysis showed significant improvements in the FBI-CT group for processing speed and sustained attention for short periods (P = 0.012), verbal memory (P = 0.008), semantic fluency (P = 0.027), depressive symptoms (P = 0.008), and quality of life (P = 0.008) at postintervention. At 3-month follow-up, this group maintained verbal memory improvements (P = 0.047) and depressive symptoms amelioration (P = 0.026). The T-CT group revealed significant improvements in sustained attention for long periods (P = 0.020), verbal memory (P = 0.014), and executive functions (P = 0.047) postintervention. A between-group analysis demon strated that the FBI-CT group exhibited greater improvements in depressive symptoms (P = 0.042). Conclusions: Overall, we found support for the feasibility and acceptability of both training approaches. Our findings show promise regarding the preliminary impact of the FBI-CT intervention, but due to study limitations such as the small sample size, we cannot conclude that FBI-CT is a more effective approach than T-CT for enhancing cognitive and noncognitive outcomes of chronic psychiatric inpatients. Clinical trials (number: NCT05100849).
- TREINO COGNITIVO NO PĂS-AVC: UM ESTUDO-PILOTO COM A PLATAFORMA NEUROAIREH@BPublication . CĂąmara, Joana; Paulino, Teresa; SpĂnola, MĂłnica; Branco, Diogo; CameirĂŁo, MĂłnica; Faria, Ana LĂșcia; Ferreira, Luis; Moreira, AndrĂ©; Silva, Ana Rita; Vilar, Manuela; SimĂ”es, MĂĄrio; BermĂșdez i Badia, Sergi; FermĂ©, EduardoO treino cognitivo (TC) atravĂ©s das novas tecnologias representa uma estratĂ©gia de intervenção promissora na mitigação dos dĂ©fices cognitivos pĂłs-AVC. Neste estudo-piloto, avaliamos o impacto a curto prazo de um novo sistema de TC com maior validade ecolĂłgica â a plataforma NeuroAIreh@b â, numa amostra de sobreviventes de AVC na fase crĂłnica. RecrutĂĄmos dez sobreviventes de AVC que foram submetidos a uma avaliação neuropsicolĂłgica (ANP) prĂ© intervenção. Posteriormente, iniciaram uma intervenção de TC implementada via tablet, com recurso Ă versĂŁo protĂłtipo da plataforma NeuroAIreh@b, envolvendo oito sessĂ”es de 45 minutos. Nestas sessĂ”es, realizaram quatro tipos de tarefas de TC baseadas em atividades de vida diĂĄria (AVDs) (por ex., selecionar os ingredientes corretos para fazer uma receita, pagar as compras no supermercado). Foram efetuadas ANPs pĂłs-intervenção para avaliar o impacto da intervenção a curto prazo. Uma anĂĄlise intra-grupal com o teste de Wilcoxon revelou diferenças estatisticamente significativas no Montreal Cognitive Assessment (MoCA) e na pontuação total do InventĂĄrio de Avaliação Funcional de Adultos e Idosos (IAFAI). Globalmente, o TC atravĂ©s da plataforma NeuroAIreh@b parece ser benĂ©fico na fase crĂłnica do AVC, conduzindo a ganhos na cognição geral (MoCA) e na capacidade funcional (IAFAI). Estes resultados preliminares com a versĂŁo protĂłtipo da plataforma NeuroAIreh@b sĂŁo encorajadores e sugerem a generalização dos ganhos obtidos em contexto terapĂȘutico para as AVDs.