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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.
- Evaluating body tracking interaction in floor projection displays with an elderly populationPublication . Cameirão, Mónica; Gonçalves, AfonsoThe recent development of affordable full body tracking sensors has made this technology accessible to millions of users and gives the opportunity to develop new natural user interfaces. In this paper we focused on developing 2 natural user interfaces that could easily be used by an elderly population for interaction with a floor projection display. One interface uses feet positions to control a cursor and feet distance to activate interaction. In the second interface, the cursor is controlled by ray casting the forearm into the projection and interaction is activated by hand pose. The interfaces were tested by 19 elderly participants in a point-and-click and a drag-and-drop task using a between-subjects experimental design. The usability and perceived workload for each interface was assessed as well as performance indicators. Results show a clear preference by the participants for the feet controlled interface and also marginal better performance for this method.
- From body tracking interaction in floor projection displays to elderly cardiorespiratory training through exergamingPublication . Gonçalves, Afonso; Nóbrega, Filipa; Cameirão, Mónica; Muñoz, John E.; Gouveia, Élvio; Bermúdez i Badia, SergiThe opportunity to develop new natural user interfaces has come forward due to the recent development of inexpensive full body tracking sensors, which has made this technology accessible to millions of users. In this paper, we present a comparative study between two natural user interfaces, and a cardiorespiratory training exergame developed based on the study results. The focus was on studying interfaces that could easily be used by an elderly population for interaction with floor projection displays. One interface uses both feet position to control a cursor and feet distance to trigger activation. In the alternative interface, the cursor is controlled by forearm ray casting into the projection floor and interaction is activated by hand pose. These modes of interaction were tested with 19 elderly participants in a point-and-click and a drag-and-drop task using a between-subjects experimental design. The usability, perceived workload and performance indicators were measured for each interface. Results show a clear preference towards the feet-controlled interface and a marginally better performance for this method. The results from the study served as a guide to the design of a cardiorespiratory fitness exergame for the elderly. The game “Grape Stomping” uses ground projection and mapping to display real-size winery elements. These virtual elements are used to simulate, in a playful way, the process of grape maceration through repeated stomping. A playtest session with nine elderly users was completed and its insights are presented in addition to the description of the game.
- A critical time window for recovery extends beyond one-year post-strokePublication . Ballester, Belén Rubio; Maier, Martina; Duff, Armin; Cameirão, Mónica; Bermúdez i Badia, Sergi; Duarte, Esther; Cuxart, Ampar; Rodríguez, Susana; San Segundo Mozo, Rosa María; Verschure, Paul F. M. J.The impact of rehabilitation on post-stroke motor recovery and its dependency on the patient's chronicity remain unclear. The field has widely accepted the notion of a proportional recovery rule with a "critical window for recovery" within the first 3-6 mo poststroke. This hypothesis justifies the general cessation of physical therapy at chronic stages. However, the limits of this critical window have, so far, been poorly defined. In this analysis, we address this question, and we further explore the temporal structure of motor recovery using individual patient data from a homogeneous sample of 219 individuals with mild to moderate upper-limb hemiparesis. We observed that improvement in body function and structure was possible even at late chronic stages. A bootstrapping analysis revealed a gradient of enhanced sensitivity to treatment that extended beyond 12 mo poststroke. Clinical guidelines for rehabilitation should be revised in the context of this temporal structure. NEW & NOTEWORTHY Previous studies in humans suggest that there is a 3- to 6-mo "critical window" of heightened neuroplasticity poststroke. We analyze the temporal structure of recovery in patients with hemiparesis and uncover a precise gradient of enhanced sensitivity to treatment that expands far beyond the limits of the so-called critical window. These findings highlight the need for providing therapy to patients at the chronic and late chronic stages.
- User experience of interactive technologies for people with dementia: comparative observational studyPublication . Ferreira, Luis Duarte Andrade; Ferreira, Henrique; Cavaco, Sofia; Cameirão, Mónica; Bermúdez i Badia, SergiBackground: Serious games (SGs) are used as complementary approaches to stimulate patients with dementia. However, many of the SGs use out-of-the-shelf technologies that may not always be suitable for such populations, as they can lead to negative behaviors, such as anxiety, fatigue, and even cybersickness. Objective: This study aims to evaluate how patients with dementia interact and accept 5 out-of-the-shelf technologies while completing 10 virtual reality tasks. Methods: A total of 12 participants diagnosed with dementia (mean age 75.08 [SD 8.07] years, mean Mini-Mental State Examination score 17.33 [SD 5.79], and mean schooling 5.55 [SD 3.30]) at a health care center in Portugal were invited to participate in this study. A within-subject experimental design was used to allow all participants to interact with all technologies, such as HTC VIVE, head-mounted display (HMD), tablet, mouse, augmented reality (AR), leap motion (LM), and a combination of HMD with LM. Participants’ performance was quantified through behavioral and verbal responses, which were captured through video recordings and written notes. Results: The findings of this study revealed that the user experience using technology was dependent on the patient profile; the patients had a better user experience when they use technologies with direct interaction configuration as opposed to indirect interaction configuration in terms of assistance required (P=.01) and comprehension (P=.01); the participants did not trigger any emotional responses when using any of the technologies; the participants’performance was task-dependent; the most cost-effective technology was the mouse, whereas the least cost-effective was AR; and all the technologies, except for one (HMD with LM), were not exposed to external hazards. Conclusions: Most participants were able to perform tasks using out-of-the-shelf technologies. However, there is no perfect technology, as they are not explicitly designed to address the needs and skills of people with dementia. Here, we propose a set of guidelines that aim to help health professionals and engineers maximize user experience when using such technologies for the population with dementia.
- TREINO COGNITIVO NO PÓS-AVC: UM ESTUDO-PILOTO COM A PLATAFORMA NEUROAIREH@BPublication . Câmara, Joana; Paulino, Teresa; Spínola, Mónica; Branco, Diogo; Cameirão, Mónica; Faria, Ana Lúcia; Ferreira, Luis; Moreira, André; Silva, Ana Rita; Vilar, Manuela; Simões, Mário; Bermúdez i Badia, Sergi; Fermé, EduardoO treino cognitivo (TC) através das novas tecnologias representa uma estratégia de intervenção promissora na mitigação dos défices cognitivos pós-AVC. Neste estudo-piloto, avaliamos o impacto a curto prazo de um novo sistema de TC com maior validade ecológica – a plataforma NeuroAIreh@b –, numa amostra de sobreviventes de AVC na fase crónica. Recrutámos dez sobreviventes de AVC que foram submetidos a uma avaliação neuropsicológica (ANP) pré intervenção. Posteriormente, iniciaram uma intervenção de TC implementada via tablet, com recurso à versão protótipo da plataforma NeuroAIreh@b, envolvendo oito sessões de 45 minutos. Nestas sessões, realizaram quatro tipos de tarefas de TC baseadas em atividades de vida diária (AVDs) (por ex., selecionar os ingredientes corretos para fazer uma receita, pagar as compras no supermercado). Foram efetuadas ANPs pós-intervenção para avaliar o impacto da intervenção a curto prazo. Uma análise intra-grupal com o teste de Wilcoxon revelou diferenças estatisticamente significativas no Montreal Cognitive Assessment (MoCA) e na pontuação total do Inventário de Avaliação Funcional de Adultos e Idosos (IAFAI). Globalmente, o TC através da plataforma NeuroAIreh@b parece ser benéfico na fase crónica do AVC, conduzindo a ganhos na cognição geral (MoCA) e na capacidade funcional (IAFAI). Estes resultados preliminares com a versão protótipo da plataforma NeuroAIreh@b são encorajadores e sugerem a generalização dos ganhos obtidos em contexto terapêutico para as AVDs.
- Interactive visuo-motor therapy system for stroke rehabilitationPublication . Eng, Kynan; Siekierka, Ewa; Pyk, Pawel; Chevrier, Edith; Hauser, Yves; Cameirão, Mónica; Holper, Lisa; Hägni, Karin; Zimmerli, Lukas; Duff, Armin; Schuster, Corina; Bassetti, Claudio; Verschure, Paul; Kiper, DanielWe present a virtual reality (VR)-based motor neurorehabilitation system for stroke patients with upper limb paresis. It is based on two hypotheses: (1) observed actions correlated with self-generated or intended actions engage cortical motor observation, planning and execution areas ("mirror neurons"); (2) activation in damaged parts of motor cortex can be enhanced by viewing mirrored movements of non-paretic limbs. We postulate that our approach, applied during the acute post-stroke phase, facilitates motor re-learning and improves functional recovery. The patient controls a first-person view of virtual arms in tasks varying from simple (hitting objects) to complex (grasping and moving objects). The therapist adjusts weighting factors in the non-paretic limb to move the paretic virtual limb, thereby stimulating the mirror neuron system and optimizing patient motivation through graded task success. We present the system's neuroscientific background, technical details and preliminary results.
- Personalization of assistance and knowledge of performance feedback on a hybrid mobile and myo-electric robotic system for motor rehabilitation after strokePublication . Neves, Davide; Vourvopoulos, Athanasios; Cameirão, Mónica; Bermúdez i Badia, SergiUpper limb motor deficits caused by stroke have a large impact on a person’s daily activities and independence. The personalization of the rehabilitation tasks to the needs of the patient as well as the enhancement of the feedback provided to the patient are strategies for promoting motor relearning. In this paper we describe the development and pilot evaluation of a portable system that uses a robotic orthosis to deliver assistance and meaningful feedback during rehabilitative training. Two software modules are implemented, one that investigates an optimal calibration method for the personalization of the level of assistance, and another one that combines the orthosis with a mobile application running on a tablet that provides graphical knowledge of performance feedback to stroke patients while performing therapy. Here we present two preliminary studies and discuss the potential of this technology.