REHABNET: NEUROSCIENCE BASED INTERACTIVE SYSTEMS FOR MOTOR REHABILITATION

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Comparing adaptive cognitive training in virtual reality and paper-pencil in a sample of stroke patients

Publication . Faria, Ana Lúcia; Paulino, Teresa; Bermúdez i Badia, Sergi

The 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.

2019Conference object

Open access

Reh@City v2.0: a comprehensive virtual reality cognitive training system based on personalized and adaptive simulations of activities of daily living

Publication . Paulino, Teresa; Faria, Ana Lúcia; Bermúdez i Badia, Sergi

Cognitive 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.

2019Conference object

Open access

A comparison of two personalization and adaptive cognitive rehabilitation approaches: a randomized controlled trial with chronic stroke patients

Publication . Faria, Ana Lúcia; Pinho, Maria Salomé; Bermúdez i Badia, Sergi

Background: 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. Studies have established construct validity of VR assessment tools with their paper-and-pencil version by demonstrating significant associations with their traditional construct-driven measures. However, VR rehabilitation intervention tools are mostly developed to include mechanisms such as personalization and adaptation, elements that are disregarded in their paper-and-pencil counterparts, which is a strong limitation of comparison studies. Here we compare the clinical impact of a personalized and adapted paper-and-pencil training and a content equivalent and more ecologically valid VR-based ADL’s simulation. Methods: We have performed a trial with 36 stroke patients comparing Reh@City v2.0 (adaptive cognitive training through everyday tasks VR simulations) with Task Generator (TG: content equivalent and adaptive paper-and-pencil training). The intervention comprised 12 sessions, with a neuropsychological assessment pre, post-intervention and follow-up, having as primary outcomes: general cognitive functioning (assessed by the Montreal Cognitive Assessment - MoCA), attention, memory, executive functions and language specific domains. Results: A within-group analysis revealed that the Reh@City v2.0 improved general cognitive functioning, attention, visuospatial ability and executive functions. These improvements generalized to verbal memory, processing speed and self-perceived cognitive deficits specific assessments. TG only improved in orientation domain on the MoCA, and specific processing speed and verbal memory outcomes. However, at follow-up, processing speed and verbal memory improvements were maintained, and a new one was revealed in language. A between-groups analysis revealed Reh@City v2.0 superiority in general cognitive functioning, visuospatial ability, and executive functions on the MoCA. Conclusions: The Reh@City v2.0 intervention with higher ecological validity revealed higher effectiveness with improvements in different cognitive domains and self-perceived cognitive deficits in everyday life, and the TG intervention retained fewer cognitive gains for longer.

2020Journal article

Open access