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Efficacy of adaptive cognitive training through desktop virtual reality and paper-and-pencil in the treatment of mental and behavioral disorders
Publication . Câmara, Joana; Ferreira, Rute; Teixeira, Liliana; Nóbrega, Joana; Romeira, Carina; Bermúdez i Badia, Sergi; Faria, Ana Lúcia
Cognitive 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.
Diving into a decade of games for health research: a systematic review
Publication . Silva, Paula Alexandra; Bermúdez i Badia, Sergi; Cameirão, Mónica S.
Recent years have been characterised by a rising interest in using enter tainment computing to monitor, maintain, and improve human health. This is
observed in many systems and applications that leverage the benefits of a playful
and enjoyable experience to provide a technology-enabled health intervention.
This paper reviews one decade of papers (679) published at the intersection of
health, entertainment and technology to determine trends, studies’ characteristics,
type of solutions, domains of application and study purposes. Results show that
there is a growing body of research in the area, with the majority of studies provid ing solutions for rehabilitation and addressing motor conditions related to stroke
and/or fitness. Where half of the solutions reported are custom made, the bulk
of those studies is performed with the purpose of evaluating the solutions pro posed or validating their efficacy. In 80% of the cases, the studies are performed
with subjects from the target population with sample sizes that have been steadily
increasing over the years.
AI-Rehab: a framework for AI driven neurorehabilitation training - the profiling challenge
Publication . Fermé, Eduardo; Bermúdez i Badia, Sergi; Sirsat, Manisha; Almeida, Yuri
One of the health clinic challenges is rehabilitation therapy cognitive impairment that can happen after brain
injury, dementia and in normal cognitive decline due to aging. Current cognitive rehabilitation therapy has
been shown to be the most effective way to address this problem. However, a) it is not adaptive for every
patient, b) it has a high cost, and c) it is usually implemented in clinical environments. The Task Generator
(TG) is a free tool for the generation of cognitive training tasks. However, TG is not designed to adapt and
monitor the cognitive progress of the patient. Hence, we propose in the BRaNT project an enhancement of
TG with belief revision and machine learning techniques, gamification and remote monitoring capabilities to
enable health professionals to provide a long-term personalized cognitive rehabilitation therapy at home. The
BRaNT is an interdisciplinary effort that addresses scientific limitations of current practices as well as provides
solutions towards the sustainability of health systems and contributes towards the improvement of quality of
life of patients. This paper proposes the AI-Rehab framework for the BRaNT, explains profiling challenge in
the situation of insufficient data and presents an alternate AI solutions which might be applicable once enough
data is available.
User experience of interactive technologies for people with dementia: comparative observational study
Publication . Ferreira, Luis Duarte Andrade; Ferreira, Henrique; Cavaco, Sofia; Cameirão, Mónica; Bermúdez i Badia, Sergi
Background: 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.
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 Inpatients
Publication . Câmara, Joana; Ferreira, Luis; Faria, Ana Lúcia; Vilar, Manuela; Bermúdez i Badia, Sergi
Objective: 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).
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Funding agency
Fundação para a Ciência e a Tecnologia
Funding programme
3599-PPCDT
Funding Award Number
PTDC/CCI-COM/30990/2017