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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.
- Augmented Human Assistance (AHA)Publication . Bermúdez i Badia, Sergi; Odekerken-Schröder, Gaby; Mahr, Dominik; Čaić, Martina; Lee, Min Hun; Siewiorek, Dan; Smailagic, Assim; Gamboa, Hugo; Belo, David; Carnide, Maria Filomena Araújo da Costa Cruz; Baptista, Maria de Fátima Marcelina; Simão, Hugo; Avelino, João; Sousa, Honorato; Paulino, Teresa; Gonçalves, Afonso; Cardona, John Muñoz; Cameirão, Mónica S.; Bernardino, Alexandre; Gouveia, Élvio RúbioAging and sedentarism are two main challenges for social and health systems in modern societies. To face these challenges a new generation of ICT based solutions is being developed to promote active aging, prevent sedentarism and find new tools to support the large populations of patients that suffer chronic conditions as result of aging. Such solutions have the potential to transform healthcare by optimizing resource allocation, reducing costs, improving diagno ses and enabling novel therapies, thus increasing quality of life. The primary goal of the “AHA: Augmented Human Assistance” project is to de velop novel assistive technologies to promote exercise among the elderly and patients of motor disabilities. For exercise programs to be effective, it is essential that users and patients comply with the prescribed schedule and perform the ex ercises following established protocols. Until now this has been achieved by hu man monitoring in rehabilitation and therapy session, where the clinicians or therapists permanently accompany users or patient. In many cases, exercises are prescribed for home performance, in which case it is not possible to validate their execution. In this context, the AHA project is an integrative and cross-discipli nary approach of 4 Portuguese universities, the CMU, and 2 Portuguese industry partners, that combines innovation and fundamental research in the areas of hu man-computer interaction, robotics, serious games and physiological computing (see partner list in Appendix A). In the project, we capitalize on recent innova tions and aim at enriching the capabilities and range of application of assistive devices via the combination of (1) assistive robotics; (2) technologies that use well-understood motivational techniques to induce people to do their exercises in the first place, and to do them correctly and completely; (3) tailored and relevant guidance in regard to health care and social support and activities; and (4) tech nologies to self-monitoring and sharing of progress with health-care provider enabling clinicians to fine-tune the exercise regimen to suit the participant’s ac tual progress. We highlight the development of a set of exergames (serious games controlled by the movement of the user’s body limbs) specifically designed for the needs of the target population according to best practices in sports and human kinetics sciences. The games can be adapted to the limitations of the users (e.g. to play in a sitting position) so a large fraction of the population can benefit from them. The games can be executed with biofeedback provided from wearable sensors, to pro duce more controlled exercise benefits. The games can be played in multi-user settings, either in cooperative or competitive mode, to promote the social rela tions among players. The games contain regional motives to trigger memories from the past and other gamification techniques that keep the users involved in the exercise program. The games are projected in the environment through aug mented reality techniques that create a more immersive and engaging experience than conventional displays. Virtual coach techniques are able to monitor the cor rectness of the exercise and provide immediate guidance to the user, as well as providing reports for therapists. A socially assistive robot can play the role of the coach and provide an additional socio-cognitive dimension to the experience to complement the role of the therapist. A web service that records the users’ per formances and allows the authorized therapists to access and configure the exer cise program provides a valuable management tool for caregivers and clinical staff. It can also provide a social network for players, increasing adherence to the therapies. We have performed several end-user studies that validate the proposed ap proaches. Together, or in isolation, these solutions provide users, caregivers, health professionals and institutions, valuable tools for health promotion, disease monitoring and prevention.
- The impact of positive, negative and neutral stimuli in a virtual reality cognitive-motor rehabilitation task: a pilot study with stroke patientsPublication . Cameirão, Mónica S.; Faria, Ana Lúcia; Paulino, Teresa; Alves, Júlio; Bermúdez 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 patient’s mood and cognitive status.
- 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.
- The benefits of emotional stimuli in a virtual reality cognitive and motor rehabilitation task: assessing the impact of positive, negative and neutral stimuli with stroke patientsPublication . Faria, Ana Lúcia; Cameirão, Mónica S.; Paulino, Teresa; Bermúdez i Badia, SergiVR-based methods for stroke rehabilitation have mainly focused on motor rehabilitation, but there is increasing interest towards the integration of cognitive training for providing more ecologically valid solutions. However, more studies are needed, especially in 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 Socio-emotional Selectivity Theory, as people age, this emotional salience arises for positive and neutral, but not for negative stimuli. Conversely, negative stimuli can be better remembered. In this study, we investigated the impact of using emotional stimuli with positive, negative and neutral valence in a VR cognitive and motor attention task. Ten stroke patients participated in a within subjects experiment with four conditions based on the type of stimuli: abstract (control condition), positive, negative and neutral. The main task consisted of finding a target stimulus, shown for only two seconds, among fourteen neutral distractors. Eye movements were recorded with an eye-tracking system to investigate differences between conditions and in search patterns. Subsequently, a recall task took place and the patients had to identify all the target images among a valence-matched number of distractors. Our results corroborate the attention salience effect of positive and neutral stimuli in the VR task performance. Although we found no statistically significant differences between conditions in the recall task, there was a trend for recalling more negative images. This negative advantage comes at the expense of significantly more wrongly identified images/false memories for negative stimuli. Finally, we performed an analysis in which we relate performance scores with well-established cognitive assessment instruments, which supportsG the use of this approach both for assessment and rehabilitation purposes.
- Characterizing the use of interactive technologies for cognitive rehabilitation in portuguese healthcare institutionsPublication . Paulino, Teresa; Cameirão, Mónica S.The increasing predominance of cognitive deficits following neurological conditions such as dementia and stroke is a major concern in Portugal. Cognitive rehabilitation has been shown to be fundamental to alleviate some of the deficits, but it is not always customized to the specific profile of each patient. More critically, patients typically do not have rehabilitation while they are in the waiting list or after discharge. One way to address these limitations is using interactive technologies specifically designed for cognitive rehabilitation. Their digital nature allows the customization of parameters enabling personalization and adaptation to each patient’s profile, as well as the possibility of quantification of performance. In addition, these tools have the potential to be used at home, allowing patients to continue their rehabilitation and being monitored remotely, alleviating the burden of institutionalization for both patients and healthcare systems. However, before proposing novel technologies, it is imperative to understand current practices, needs, preferences and expectations of health professionals in this domain. For this purpose, we developed an online questionnaire that was distributed among health professionals in Portugal. 116 participants have responded, with 35% reporting having experience in the use of interactive technologies for cognitive rehabilitation. Our results show that health professionals that use these technologies mainly value ease of interaction, diversity of activities, task personalization to the patient’s cognitive profile, and adaptation based on performance. These and other insights will be used to inform the development of novel tools for cognitive rehabilitation in clinical and home settings.