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- 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.
- Reh@City v2.0: a comprehensive virtual reality cognitive training system based on personalized and adaptive simulations of activities of daily livingPublication . Paulino, Teresa; Faria, Ana Lúcia; Bermúdez i Badia, SergiCognitive impairments are among the most common age-related disabilities worldwide. Literature has shown that cognitive training using Virtual Reality (VR) systems can be a valid and effective solution for cognitive rehabilitation. Virtual environments can be easily customized to deliver very specific training by controlling the presentation of stimuli and keeping track of the user responses. Reh@City (RC) is a virtual reality simulation of a city where patients can train a variety of cognitive skills while performing simulated activities of daily living. An initial prototype of this city with four environments was clinically validated with a stroke sample, and the encouraging results motivated further iterations and improvements in the RC, in terms of its tasks, interaction with the content, and task adaptation. This paper presents the efforts of creating RC v2.0, a VR-based software system for cognitive rehabilitation that presents different cognitive training tasks that take place in 8 realistically modeled 3D environments, that are personalized to the patient clinical profile and also implements automatic difficulty adaptation.
- Comparing adaptive cognitive training in virtual reality and paper-pencil in a sample of stroke patientsPublication . Faria, Ana Lúcia; Paulino, Teresa; Bermúdez i Badia, SergiThe growing number of people with cognitive deficits creates an urgent need for new cognitive training solutions. Paper-and-pencil tasks are still widely used for cognitive rehabilitation despite the proliferation of new computer-based methods, like VR-based simulations of ADL’s. The health professionals’ resistance in adopting new tools might be explained by the small number of validation trials. Studies have established construct validity of VR assessment tools with their paper-and-pencil versions by demonstrating significant associations with their traditional construct-driven measures. However, adaptive rehabilitation tools for intervention are mostly not equivalent to their counterpart paper-and-pencil versions, which makes it difficult to carry out comparative studies. Here we present a 12-session intervention study with 31 stroke survivors who underwent different rehabilitation protocols based on the same content and difficulty adaptation progression framework: 17 performed paper-and-pencil training with the Task Generator and 14 performed VR-based training with the Reh@City. Results have shown that both groups performed at the same level and there was not an effect of the training methodology in overall performance. However, the Reh@City enabled more intensive training, which may translate in more cognitive improvements.
- 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.