Eficacia y seguridad de la aplicación de la realidad virtual mediante el dispositivo kinect como tratamiento de la heminegligencia en pacientes que hayan sufrido un ictus

[Resumen] Introducción. Cada año, en el mundo 15 millones de personas sufren un ictus. Más del 40 % experimenta inatención visual unilateral (heminegligencia), por lo que ésta es un aspecto fundamental a tener en cuenta en el proceso de neurorrehabilitación del ictus. Los estudios relacionados con la utilización de nuevas tecnologías como la realidad virtual, han ido proliferando en el campo de la neuorrehabilitación. Esta tecnología ofrece nuevas perspectivas de trabajo y tratamiento. En España, se ha desarrollado virtualrehab, un programa específico para la neurorehabilitación. Hipótesis. La implantación de la terapia para la heminegligencia mediante terapia con realidad virtual mejora este déficit en comparación con la terapia convencional. Objetivos. El objetivo de este proyecto de investigación es evaluar la eficacia y seguridad de la aplicación de la realidad virtual utilizando el programa virtualrehab mediante el dispositivo kinect en pacientes que hayan sufrido un ictus como tratamiento de la heminegligencia. Material y métodos. Se realizará un ensayo clínico aleatorizado con pacientes con daño cerebral adquirido que se encuentren en proceso de neurorrehabilitación en el Centro Neurológico de Navarra (CNAI). Todos los pacientes serán valorados inicialmente por el médico neurólogo y posteriormente por la terapeuta ocupacional, decidiendo la idoneidad de la aplicación de la realidad virtual como estrategia terapéutica para la heminegligencia o tratamiento convencional. En caso de que se considere oportuno se realizará un protocolo de actuación de 8 semanas con 16 sesiones; realizándose una valoración pre-post tratamiento. Todos los pacientes firmarán el consentimiento informado y se les explicará el procedimiento.[Abstract] Introduction Every year, 15 million people in the world suffer a stroke. More than 40% of them experience unilateral visual inattention (usn), which is a fundamental aspect to be taken into account in the stroke rehabilitation process. Studies related to the use of new technologies such as virtual reality have proliferated in the neurological rehabilitation field. This technology offers new work and treatment perspectives. In Spain, virtualrehab, a specific program for neurorehabilitation, has been developed. Hypothesis The implementation of therapy for neglect through virtual reality therapy improves this deficit compared to conventional therapy. Aims The main aim of this investigation project is to evaluate the efficacy and safety of the virtual reality application using the virtualrehab program by means of the kinect device in patients who have suffered a stroke as a treatment of unilateral neglect. Material and methods A randomized control trial study is performed in patients with stroke who are undergoing neurorehabilitation at the Navarra Neurological Center (CNAI). All patients will be evaluated initially by the neurologist and later by the occupational therapist, deciding the appropriateness of the virtual reality application as a therapeutic strategy for unilateral neglect or conventional treatment. If it is considered opportune, an action protocol of 8 weeks with 16 sessions will be carried out; with a pre-post treatment evaluation. All patients will sign informed consent and the procedure will be explained to them.Traballo fin de mestrado (UDC.FCS). Asistencia e investigación sanitaria. Especialidade en investigación clínica. Curso 2016/201

Inducing Visuomotor Adaptation Using Virtual Reality Gaming with a Virtual Shift as a Treatment for Unilateral Spatial Neglect

Unilateral spatial neglect after stroke is characterized by reduced responses to stimuli on the contralesional side, causing significant impairments in self-care and safety. Conventional visuomotor adaptation (VMA) with prisms that cause a lateral shift of the visual scene can decrease neglect symptoms but is not engaging according to patients. Performing VMA within a virtual reality (VR) environment may be more engaging but has never been tested. To determine if VMA can be elicited in a VR environment, healthy subjects (n=7) underwent VMA that was elicited by either wearing prisms that caused an optical shift, or by application of a virtual shift of the hand cursor within the VR environment. A low cost VR system was developed by coupling the Kinect v2 gaming sensor to online games via the Flexible Action and Articulated Skeleton Toolkit (FAAST) software. The adaptation phase of training consisted of a reaching task in online games or in a custom target pointing program. Following the adaptation phase the optical or virtual shift was removed and participants were assessed during the initial portion of the de-adaptation phase for the presence of an after-effect on their reaching movements, with lateral reaching errors indicating the successful induction of VMA. Results show that practicing reaching in a VR environment with a virtual shift lead to a horizontal after-effect similar to conventional prism adaptation. The results demonstrate that VMA can be elicited in a VR environment and suggest that VR gaming therapy could be used to improve recovery from unilateral spatial neglect

Construção e validação da prova shoe closet (sct) com idosos em realidade virtual

Orientação: Paulo Lopes ; co-orientação: Jorge OliveiraAo longo do tempo, a avaliação neuropsicológica foi baseada em papel e lápis. No entanto encontram-se desatualizadas, uma vez que não são representativos do funcionamento do mundo real. Uma variedade de cenários de realidade virtual (RV) já foram elaboradas com o objetivo de obter melhores resultados na avaliação funcional, obtendo deste modo, uma maior validade ecológica dos testes de avaliação neuropsicológica. O objetivo deste estudo é estudar uma tarefa de avaliação cognitiva que replique uma atividade da vida diária de modo a verificar a sua validade e sensibilidade. A amostra é constituída por 31 (29 mulheres e 2 homens), com uma média de idade de 79,9 anos (DP = 8,2) e com uma média de 8,1 anos de escolaridade (DP = 5,3). Os resultados da SCT estão correlacionados com o MoCA, sendo significativo apenas para o tempo de execução (p = -.04). O mesmo padrão foi obtido para a FAB. Não foram encontradas correlações significativas entre a pontuação total BDI e o índice de interferência do CTT com o SCT (p> 0,05). Os resultados indicaram que estas correlações foram observadas apenas para testes globais de funcionamento cognitivo (MoCA e FAB). Esses resultados mostraram que um desempenho mais fraco na SCT está associado a um mau funcionamento cognitivo e do lobo frontal, avaliado, respetivamente, pelo MoCA e pela FABOver time, the neuropsychological assessment was based on paper and pencil. However, they are outdated as they are not representative of current real-world functioning. Several virtual reality (VR) scenarios have already been developed with the purpose of obtaining better results in the functional evaluation, obtaining in this way a greater ecological validity of the tests of neuropsychological evaluation. The goal of this study is to study a cognitive evaluation task that replicates an activity of daily living to verify its validity and sensitivity. The sample consisted of 31 (29 women and 2 men), with an average age of 79,9 years (DP = 8,2) and an average of 8,1 years of schooling (DP = 5,3). The results of the SCT are correlated with the MoCA, being significant only for the execution time (p = -.04). The same pattern was obtained for the FAB. No significant correlations were found between total BDI score and CTT interference index with SCT (p> 0,05). The results indicated that these correlations were only observed for global tests of cognitive functioning (MoCA and FAB). These results showed that a weaker performance in SCT is associated with a malfunction of the cognitive and frontal lobe, evaluated respectively by MoCA and FAB

Avaliação da Atenção com recurso ao Teste da Galeria Virtual

Orientação: Jorge Oliveira ; co-orientação: Paulo LopesO presente estudo tem como objetivo específico avaliar o desempenho de participantes com idade superior a 60 anos, na realização da prova da Galeria Virtual de forma a poder ser feita uma comparação relativamente à prova Color Trail Test, d2, FAB (Frontal Assessment Battery) e MoCA (Montreal Cognitive Assessment) a fim de se comprovar se esta prova é um bom preditor da avaliação do constructo da Atenção e permitir aferir a sua validade convergente. A Galeria Virtual é uma prova em ambiente virtual que avalia o contructo da Atenção, originalmente integrada na bateria sistémica de Lisboa 2.0. Esta prova consiste na apresentação de três sequências de quadros distintos em que o participante inicialmente tem de encontrar as diferenças entre dois quadros apresentados lado a lado. Existem sete diferenças entre os dois quadros apresentados. O segundo conjunto de quadros consiste em um quadro central que é dividido em várias partes, em que o sujeito tem de clicar na figura de fora e na figura de dentro, de modo a esta desaparecer. No terceiro conjunto de quadros, os participantes têm de encontrar cinco figuras destacadas nos quadros que estão demonstrados em cima. A amostra é constituída por 27 participantes com idades compreendidas entre os 65 e os 92 anos, com uma média de 76. Através da análise dos resultados é possivel concluir que existe uma correlação entre as provas do Color Trail Test e as provas da Galeria Virtual, significando que esta tem uma avaliação mais executiva.The present study has the specific objective of evaluating the performance of participants over 60 years old, in the accomplishment of the Art Gallery Test in order to compare the Color Trail Test, d2, FAB (Frontal Assessment Battery) and MoCA (Montreal Cognitive Assessment) in order to verify if this test is a good predictor of the evaluation of the Attention construct and allow to verify its convergent validity. The Art Gallery is a proven virtual environment that evaluates the contruct of attention, originally built in the assessment battery of Lisbon 2.0. This test consists of the presentation of three sequences of distinct frames in which the participant initially has to find the differences between two frames presented side by side. There are seven differences between the two frames presented. The second set of frames consists of a central frame that is divided into several parts, in which the participant has to click on the outside figure and the figure inside so that it disappears. In the third set of paintings, participants have to find five figures highlighted on the set of paintings that are shown above. The sample consisted of 27 participants aged between 65 and 92 years, with a mean of 76. Through the analysis of the results it is possible to conclude that there is a correlation between the tests of the Color Tail Test and the tests of the Art Gallery meaning that it has a more executive evaluation

La riabilitazione neuropsicologica dell’eminegligenza spaziale unilaterale: le tecniche evidence-based tradizionali e le possibili innovazioni per il trattamento a domicilio.

L’eminegligenza spaziale unilaterale, nota anche come negligenza spaziale unilaterale (NSU) o neglect, è una sindrome neuropsicologica acquisita che insorge in seguito a lesioni cerebrali unilaterali, e che si caratterizza per un insieme di deficit relativi alla compromissione dell’elaborazione conscia delle informazioni presenti nella parte controlesionale dello spazio (Bisiacchi & Tressoldi, 2005). Può verificarsi in seguito a numerosi eventi patologici come malattie neurodegenerative, neoplasie e traumi, ma è più comunemente esito di ictus ischemico (Li & Malhotra, 2015). La sua frequenza si attesta attorno al 25-30% degli individui colpiti da ictus (Appelros, Karlsson, Seiger & Nydevik, 2002; Buxbaum, Ferraro, Veramonti, Farne, Whyte & Làdavas, 2004), e più del 90% degli individui con neglect spaziale presenta lesioni emisferiche destre e neglect dell’emispazio sinistro, probabilmente a causa del ruolo chiave rivestito dall’emisfero destro nell’esecuzione dei processi attentivi (Corbetta, Kincade, Lewis, Snyder & Sapir, 2005; Mesulam, 1981). I sintomi dell’eminegligenza spaziale sono molto eterogenei. Essi possono dissociarsi a seconda della modalità sensoriale coinvolta, come neglect visivo, uditivo o somatosensoriale; e dei settori dello spazio colpiti, come neglect personale, peri-personale o extra-personale. Rispetto al sistema di coordinate di riferimento, è possibile anche distinguere tra forme di neglect egocentrico ed allocentrico. Nel primo, emispazio destro e sinistro sono definiti dalla linea mediana dell’osservatore, codificata sulla base dello sguardo, della testa o della posizione del corpo; mentre nel secondo la linea mediana che definisce gli emispazi è relativa all’asse centrale di uno stimolo (Corbetta & Shulman, 2011; Medina et al., 2009). Il neglect può inoltre colpire le immagini mentali (neglect rappresentazionale) o la possibilità di usare spontaneamente l’arto controlesionale (neglect motorio) (Rode, Pagliari, Huchon, Rossetti & Pisella, 2017; Spaccavento, Cellamare, Falcone, Loverre & Nardulli, 2017; Gammeri, Iacono, Ricci & Salatino, 2020). Pertanto, il neglect si configura come una sindrome complessa. (Vallar, 1998). Per la complessità delle sue caratteristiche, il neglect costituisce argomento di enorme interesse scientifico, in quanto modello utile a incrementare la comprensione delle basi neurali della consapevolezza, della lateralizzazione cerebrale, della cognizione spaziale e del recupero funzionale (Corbetta et al., 2011; Karnath & Dieterich, 2006). Al contempo, si tratta di “un’importante condizione neuropsicologica, che necessita di essere diagnosticata e trattata” (Gammeri et al., 2020, p. 132). Al fine di mettere in luce i possibili risultati raggiungibili attraverso la riabilitazione neuropsicologica, la presente trattazione, dopo una descrizione delle caratteristiche principali della sindrome, presenterà una sintesi delle principali tecniche in uso, per poi illustrare alcune delle declinazioni che sono state recentemente ideate per il trattamento in contesto domiciliare

A virtual reality platform for assessment and rehabilitation of neglect using a kinect

Unilateral Spatial Neglect (USN) is normally assessed with paper-and-pencil tests. Virtual reality can be an effective neuropsychological tool for a more ecological and functional assessment and rehabilitation of neglect. We developed a 3D Virtual Reality platform - NeuroVirtual 3D - for the assessment and rehabilitation of cognitive deficits, in particular for USN. Within the virtual environments it is possible to interact with virtual objects and execute specific exercises using a Microsoft Kinect. Through the analysis of different grasping tasks it is possible to evaluate in an ecological way the patients' ability to find and handle objects in both sides of the virtual space

Using Technology in the Assessment and Rehabilitation of Spatial Neglect

Spatial neglect is characterised by inattention to stimuli in the contralesional side of space. The complexity of the condition (manifesting in personal, near, and far space) make it difficult to assess, with some subtypes not commonly assessed. And, due to the low quality of the current evidence, no single intervention can be formally recommended to effectively rehabilitate neglect. However, technology may offer an opportunity to improve the sensitivity of assessments and facilitate self-administration of rehabilitation at home. In Chapter 1, results from 179 healthy adults (aged 18-94 years-old) revealed that performance on the Computerised Extrapersonal Neglect Test (CENT)’s visuospatial tasks (cancellation, line bisection) were related, sensitive to age-related decline, and sex differences in extrapersonal (far) space. Age-graded normative data was produced to inform the detection of spatial neglect in extrapersonal space in stroke survivors. Chapter 2 found CENT’s cancellation test had excellent diagnostic accuracy, sensitivity and validity compared to the widely used, validated paper-and-pencil neglect tests. In a group of 57 stroke survivors, CENT identified 18 cases of extrapersonal neglect which would otherwise go undetected. The results demonstrate the capabilities of a computerised assessment in providing additional attentional measures, as well as the necessity of carrying out a comprehensive assessment of neglect subtypes to inform rehabilitation strategies. Finally, Chapter 3 found that it was feasible for NHS staff to set-up and train 7 participants to self-administer the computerised Spatial Inattention Grasping Home-based Therapy (c-SIGHT) intervention. Though the sample was small and underpowered, there was preliminary evidence of the positive effects of c-SIGHT. This trial demonstrates the value of feasibility studies in providing recommendations to inform future studies. Together these studies offer practical recommendations and novel findings demonstrating the usefulness of technology in detecting spatial neglect and delivering rehabilitation at home to better support and improve people’s lives after stroke