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Research Project
MULTIMODAL NEURO-ROBOTIC VR SYSTEM FOR STROKE REHABILITATION
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Publications
Efficacy and brain imaging correlates of an immersive motor imagery BCI-driven VR system for upper limb motor rehabilitation: a clinical case report
Publication . Vourvopoulos, Athanasios; Jorge, Carolina; Abreu, Rodolfo; Figueiredo, Patrícia; Fernandes, Jean-Claude; Bermúdez i Badia, Sergi
To maximize brain plasticity after stroke, a plethora of rehabilitation strategies have been
explored. These include the use of intensive motor training, motor-imagery (MI), and
action-observation (AO). Growing evidence of the positive impact of virtual reality (VR)
techniques on recovery following stroke has been shown. However, most VR tools
are designed to exploit active movement, and hence patients with low level of motor
control cannot fully benefit from them. Consequently, the idea of directly training the
central nervous system has been promoted by utilizing MI with electroencephalography
(EEG)-based brain-computer interfaces (BCIs). To date, detailed information on which
VR strategies lead to successful functional recovery is still largely missing and very
little is known on how to optimally integrate EEG-based BCIs and VR paradigms for
stroke rehabilitation. The purpose of this study was to examine the efficacy of an EEG based BCI-VR system using a MI paradigm for post-stroke upper limb rehabilitation
on functional assessments, and related changes in MI ability and brain imaging. To
achieve this, a 60 years old male chronic stroke patient was recruited. The patient
underwent a 3-week intervention in a clinical environment, resulting in 10 BCI-VR training
sessions. The patient was assessed before and after intervention, as well as on a
one-month follow-up, in terms of clinical scales and brain imaging using functional
MRI (fMRI). Consistent with prior research, we found important improvements in upper
extremity scores (Fugl-Meyer) and identified increases in brain activation measured by
fMRI that suggest neuroplastic changes in brain motor networks. This study expands
on the current body of evidence, as more data are needed on the effect of this type of
interventions not only on functional improvement but also on the effect of the intervention
on plasticity through brain imaging.
An integrative virtual reality cognitive-motor intervention approach in stroke rehabilitation: a pilot study
Publication . Faria, A. L.; Vourvopoulos, A.; Cameirão, M. S.; Fernandes, J. C.; Bermúdez i Badia, Sergi
Stroke is one of the most common causes of acquired disability, leaving numerous adults with
cognitive and motor impairments, and affecting patient’s capability to live independently. In
post-stroke it is imperative to initiate a process of intensive rehabilitation and personalized
objectives to maximize functional cognitive and motor recovery. Virtual Reality (VR)
technology is being widely applied to rehabilitation of stroke, however, not in an integrative
manner. Like traditional rehabilitation, these new tools mostly focus either in the cognitive or
in the motor domain, which can take to a reduced impact in the performance of activities of
daily living, most of them dual-task. Assuming the existence of cognitive and motor recovery
interdependence, RehabNet proposes a holistic approach. Here we present a one-month long
pilot study with three stroke patients whose training was a game-like VR version of the
Toulouse-Piéron cancellation test, adapted to be performed by repetitive arm reaching
movements. A standardized motor and cognitive assessment was performed pre and post
intervention. The first results on this intervention support a holistic model for rehabilitation of
stroke patients, sustaining interdependence on cognitive and motor recovery. Furthermore, we
observed that the impact of the integrative VR approach generalizes to the performance of the
activities of daily living.
Quantifying cognitive-motor interference in virtual reality training after stroke: the role of interfaces
Publication . Vourvopoulos, A.; Faria, A. L.; Cameirão, M. S.; Bermúdez i Badia, Sergi
Globally, stroke is the second leading cause of death above the age of 60 years, with the actual
number of strokes to increase because of the ageing population. Stroke results into chronic
conditions, loss of independence, affecting both the families of stroke survivors but also public
health systems. Virtual Reality (VR) for rehabilitation is considered a novel and effective low-cost
approach to re-train motor and cognitive function through strictly defined training tasks in a safe
simulated environment. However, little is known about how the choice of VR interfacing
technology affects motor and cognitive performance, or what the most cost-effective rehabilitation
approach for patients with different prognostics is. In this paper we assessed the effect of four
different interfaces in the training of the motor and cognitive domains within a VR
neurorehabilitation task. In this study we have evaluated the effect of training using 2-dimensional
and 3-dimensional as well as traditional and natural user interfaces with both stroke survivors and
healthy participants. Results indicate that 3-dimensional interfaces contribute towards better
results in the motor domain at the cost of lower performance in the cognitive domain, suggesting
the use 2-dimensional natural user interfaces as a trade-off. Our results provide useful pointers for
future directions towards a cost-effective and meaningful interaction in virtual rehabilitation tasks
in both motor and cognitive domains.
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 patients
Publication . Faria, Ana Lúcia; Cameirão, Mónica S.; Paulino, Teresa; Bermúdez i Badia, Sergi
VR-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.
RehabCity: design and validation of a cognitive assessment and rehabilitation tool through gamified simulations of activities of daily living
Publication . Vourvopoulos, Athanasios; Faria, Ana Lúcia; Ponnam, Kushal; Bermúdez i Badia, Sergi
Worldwide, more than one in three adults suffers from a cardiovascular disease. According to the World Health Organization, 15 million people experience a stroke each year and, of these, 5 million stay permanently disabled. The current limitations of traditional rehabilitation methods push towards the design of personalized tools that can be used intensively by patients and therapists in clinical or athome environments. In this paper we present the design, implementation and validation of RehabCity, an online game designed for the rehabilitation of cognitive deficits through a gamified approach on activities of daily living (ADLs). Among other findings, our results show a strong correlation between the RehabCity scoring system and the Mini Mental State Examination test for clinical assessment of cognitive function in several domains. These findings suggest that RehabCity is a valid tool for the quantitative assessment of patients with cognitive deficits derived from a brain lesion.
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Funding agency
Fundação para a Ciência e a Tecnologia
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Funding Award Number
SFRH/BD/97117/2013