76 research outputs found

    Novel supports to the assessment of cognitive functions through the combined use of technologies and subjective and objective measurements

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    Tesis por compendio[ES] Las funciones cognitivas incluyen todos los procesos a través de los cuales un individuo percibe, registra, mantiene, manipula, usa y expresa información que está involucrada en cualquier actividad cotidiana. Las principales herramientas estandarizadas se pueden dividir en tres grupos principales: escalas cortas de pruebas de seguimiento cognitivo: cuestionarios, baterías neuropsicológicas generales y pruebas específicas. Estas herramientas están bien validadas y son confiables, pero, en la última década, varias investigaciones han demostrado que algunos pacientes pueden realizar bien estas pruebas neuropsicológicas, incluso cuando tienen dificultades significativas para adaptar sus comportamientos a las actividades de la vida diaria. De acuerdo con esto, más recientemente, un nuevo enfoque ha aumentado sustancialmente, lo que podría proporcionar una mayor validez ecológica en la evaluación de las capacidades cognitivas funcionales que el enfoque estandarizado: el uso de sistemas tecnológicos avanzados para la evaluación neuropsicológica (STAEN). STAEN se refiere a un conjunto de dispositivos y aplicaciones de software tales como pruebas computarizadas, juegos divertidos e interactivos de fantasía (JS) y / o sistemas de realidad virtual simulada (RV) y / o aumentada (RA) que van más allá de las pruebas de evaluación tradicionales y que Brindar la posibilidad de entregar estímulos controlados y dinámicos, en entornos ecológicamente válidos y seguros. Partiendo de estas premisas, el objetivo principal de la tesis era diseñar, desarrollar y validar un SG 2D no inmersivo versus un JS 3D inmersivo y una actividad de la vida diaria en un entorno 3D RV inmersivo versus un RA para la evaluación de funciones cognitivas, comparando la eficacia y efectividad de ellos. El primer estudio 2D incluyó 354 sujetos sanos y se encontraron correlaciones entre el juego y los métodos tradicionales, lo que sugiere que el juego podría ser una herramienta válida para evaluar las funciones cognitivas en adultos. El segundo estudio, comparó la versión 2D versus una versión 3D STAEN, involucró a 94 sujetos sanos y mostró que la versión 3D fue capaz de generar tiempos más bajos y respuestas correctas más altas que la 2D, lo que sugiere evidencia inicial de la eficacia de un sistema más inmersivo en comparación con un sistema no-inmersivo. Aunque este resultado destaca una posible limitación en el uso de diferentes sistemas tecnológicos debido a las diferencias en los dos métodos de interacción (el sistema 2D aplicó el mouse y el teclado; los controladores de dos manos virtuales 3D) y el registro de datos de latencia de hardware y software. Con respecto a la variabilidad individual en edad, género y educación, los hallazgos mostraron consistencia con la literatura de referencia. Específicamente, los más jóvenes mostraron un mayor rendimiento que los mayores; niveles educativos más altos reflejados en una mejor puntuación y sobre género, los resultados mostraron un panorama más compuesto. Además, para mejorar la validez ecológica de la evaluación, el último estudio de esta tesis comparó el rendimiento conductual y las respuestas fisiológicas, durante una tarea de cocina ecológica, entre un sistema virtual y un sistema aumentado en 50 sujetos sanos. La tarea de cocinar consistió en 4 niveles que aumentaron en dificultad. A medida que el nivel aumentó, aparecieron actividades adicionales. Los resultados de comportamiento mostraron que los tiempos son siempre más bajos en realidad virtual que en RA, aumentando constantemente de acuerdo con la dificultad de las tareas. Con respecto a las respuestas fisiológicas, los hallazgos mostraron que la condición RA produjo más excitación y activación individual que la realidad virtual. Para concluir, STAEN está demostrando ser herramientas confiables y efectivas para la evaluación de las funciones cognitivas en adultos, proporcionando más validez ec[CA] Les funcions cognitives inclouen tots els processos a través dels quals un individu percep, registra, manté, manipula, usa i expressa informació que està involucrada en qualsevol activitat quotidiana. Les principals ferramentes estandarditzades es poden dividir en tres grups principals: escales curtes de proves de seguiment cognitiu: qüestionaris, bateries neuropsicológiques generals i proves específiques. Estes ferramentes estan ben validades i són confiables, però, en l'última dècada, diverses investigacions han demostrat que alguns pacients poden realitzar bé estes proves neuropsicológiques, inclús quan tenen dificultats significatives per a adaptar els seus comportaments a les activitats de la vida diària. D'acord amb açò, més recentment, un nou enfocament ha augmentat substancialment, la qual cosa podria proporcionar una major validesa ecològica en l'avaluació de les capacitats cognitives funcionals que l'enfocament estandarditzat: l'ús de sistemes tecnològics avançats per a l'avaluació neuropsicológica (STAEN). STAEN es referix a un conjunt de dispositius i aplicacions de software com ara proves computaritzades, jocs divertits i interactius de fantasia (JS) i / o sistemes de realitat virtual simulada (RV) i / o augmentada (RA) que van més enllà de les proves d'avaluació tradicionals i que brinden la possibilitat de presentar estímuls controlats i dinàmics, en entorns ecològicament vàlids i segurs. Partint d'estes premisses, l'objectiu principal de la tesi era dissenyar, desenrotllar i validar un SG 2D no inmersiu versus un JS 3D inmersiu i una activitat de la vida diària en un entorn 3D RV inmersiu versus un RA per a l'avaluació de funcions cognitives, comparant l'eficàcia i efectivitat d'ells. El primer estudi 2D va incloure 354 subjectes sans i es van trobar correlacions entre el joc i els mètodes tradicionals, la qual cosa suggerix que el joc podria ser una ferramenta vàlida per a avaluar les funcions cognitives en adults. El segon estudi, va comparar la versió 2D versus una versió 3D STAEN, va involucrar a 94 subjectes sans i va mostrar que la versió 3D va ser capaç de generar temps més baixos i respostes correctes més altes que la 2D, la qual cosa suggerix evidència inicial de l'eficàcia d'un sistema més inmersiu en comparació amb un sistema no-inmersiu. Encara que este resultat destaca una possible limitació en l'ús de diferents sistemes tecnològics a causa de les diferències en els dos mètodes d'interacció (el sistema 2D va aplicar el ratolí i el teclat; els controladors de dos mans virtuals 3D) i el registre de dades de latència de hardware i software. Respecte a la variabilitat individual en edat, gènere i educació, les troballes van mostrar consistència amb la literatura de referència. Específicament, els més jóvens van mostrar un major rendiment que els majors; nivells educatius més alts reflectits en una millor puntuació i sobre gènere, els resultats van mostrar un panorama més compost. A més, per a millorar la validesa ecològica de l'avaluació, l'últim estudi d'esta tesi va comparar el rendiment conductual i les respostes fisiològiques, durant una tasca de cuina ecològica, entre un sistema virtual i un sistema augmentat en 50 subjectes sans. La tasca de cuinar va consistir en 4 nivells que van augmentar en dificultat. A mesura que el nivell va augmentar, van aparéixer activitats addicionals. Els resultats de comportament van mostrar que els temps són sempre més baixos en realitat virtual que en RA, augmentant constantment d'acord amb la dificultat de les tasques. Respecte a les respostes fisiològiques, les troballes van mostrar que la condició RA va produir més excitació i activació individual que la realitat virtual. Per a concloure, STAEN està demostrant ser ferramentes confiables i efectives per a l'avaluació de les funcions cognitives en adults, proporcionant més validesa ecològica i objectivitat que els mètodes tradicio[EN] Cognitive functions include all the processes through which an individual perceives, records, maintains, manipulates, uses and expresses information that are involved in any everyday activity. The main standardized tools can be divided in three main groups: short scales of cognitive tracking tests - questionnaires, general neuropsychological batteries, and specific tests. These tools are well-validated and reliable but, in the last decade, several research have shown that some patients can perform these neuropsychological tests well, even when they have significant difficulties in adapting their behaviours to daily life activities. According to this, more recently, a new approach has substantially increased, potentially providing a higher ecological validity in functional cognitive abilities assessment than standardized approach: the use of advanced technological systems for neuropsychological assessment (ATSNA). ATSNA refer to a set of devices and software applications such as computerized tests, fun and interactive fantasy serious games (SG), and/or simulated virtual (VR) and/or augmented (AR) reality systems that go beyond traditional assessment tests and that supply the possibility to deliver controlled and dynamic stimuli, in ecologically valid, and secure environments. Starting from these premises, the main objective of the thesis was to design, develop, and validate a non-immersive 2D SG versus an immersive 3D SG and a daily life activity in an immersive 3D VR environment versus an AR for the assessment of cognitive functions, comparing the efficacy and effectiveness of them. The first 2D study involved 354 healthy subjects and correlations were found between the game and traditional methods, suggesting that the game could be a valid tool for assessing cognitive functions in adults. The second study, compared 2D versus a 3D ATSNA version, it involved 94 healthy subjects and showed that 3D version was able to generate lower times and higher correct answers that the 2D, suggesting initial evidence of efficacy of a more immersive system compared to a non-immersive system. Although this result highlights a potential limitation on using different technological systems due to the differences on the two interaction methods (the 2D system applied mouse and keyboard; the 3D two virtual hands' controllers) and hardware and software latency data recording. Regarding individual variability on age, gender, and education, the findings showed consistency with the reference literature. Specifically, younger showed higher performance that older; higher educational levels reflected on a better score and about gender, results showed a more composite panorama. Furthermore, to enhance the ecological validity of assessment, the last study of this thesis compared the behavioural performance and physiological responses, during an ecological cooking task, between a virtual and an augmented system on 50 healthy subjects. The cooking task consisted of 4 levels that increased in difficulty. As the level increased, additional activities appeared. The behavioural results showed that times are always lower in VR than in AR, increasing constantly in accordance with the difficulty of the tasks. Regarding physiological responses, the findings showed that AR condition produced more individual excitement and activation than VR. To conclude, ATSNA are proving to be reliable and effective tools for the assessment of cognitive functions in adults, providing more ecological validity and objectivity than traditional methods of assessment.Chicchi Giglioli, IAM. (2020). Novel supports to the assessment of cognitive functions through the combined use of technologies and subjective and objective measurements [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/139075TESISCompendi

    Telemedicine and Virtual Reality for Cognitive Rehabilitation: A Roadmap for the COVID-19 Pandemic

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    The current COVID-19 pandemic presents unprecedented new challenges to public health and medical care delivery. To control viral transmission, social distancing measures have been implemented all over the world, interrupting the access to routine medical care for many individuals with neurological diseases. Cognitive disorders are common in many neurological conditions, e.g., stroke, traumatic brain injury, Alzheimer's disease, and other types of dementia, Parkinson's disease and parkinsonian syndromes, and multiple sclerosis, and should be addressed by cognitive rehabilitation interventions. To be effective, cognitive rehabilitation programs must be intensive and prolonged over time; however, the current virus containment measures are hampering their implementation. Moreover, the reduced access to cognitive rehabilitation might worsen the relationship between the patient and the healthcare professional. Urgent measures to address issues connected to COVID-19 pandemic are, therefore, needed. Remote communication technologies are increasingly regarded as potential effective options to support health care interventions, including neurorehabilitation and cognitive rehabilitation. Among them, telemedicine, virtual reality, augmented reality, and serious games could be in the forefront of these efforts. We will briefly review current evidence-based recommendations on the efficacy of cognitive rehabilitation and offer a perspective on the role of tele- and virtual rehabilitation to achieve adequate cognitive stimulation in the era of social distancing related to COVID-19 pandemic. In particular, we will discuss issues related to their diffusion and propose a roadmap to address them. Methodological and technological improvements might lead to a paradigm shift to promote the delivery of cognitive rehabilitation to people with reduced mobility and in remote regions

    An assistive tabletop keyboard for stroke rehabilitation

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    We propose a tabletop keyboard that assists stroke patients in using computers. Using computers for purposes such as paying bills, managing bank accounts, sending emails, etc., which all include typing, is part of Activities of Daily Living (ADL) that stroke patients wish to recover. To date, stroke rehabilitation research has greatly focused on using computer-assisted technology for rehabilitation. However, working with computers as a skill that patients need to recover has been neglected. The conventional human computer interfaces are mouse and keyboard. Using keyboard stays the main challenge for hemiplegic stroke patients because typing is usually a bimanual task. Therefore, we propose an assistive tabletop keyboard which is not only a novel computer interface that is specially designed to facilitate patient-computer interaction but also a rehab medium through which patients practice the desired arm/hand functions. © 2013 Authors

    All Hands on Deck: Choosing Virtual End Effector Representations to Improve Near Field Object Manipulation Interactions in Extended Reality

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    Extended reality, or XR , is the adopted umbrella term that is heavily gaining traction to collectively describe Virtual reality (VR), Augmented reality (AR), and Mixed reality (MR) technologies. Together, these technologies extend the reality that we experience either by creating a fully immersive experience like in VR or by blending in the virtual and real worlds like in AR and MR. The sustained success of XR in the workplace largely hinges on its ability to facilitate efficient user interactions. Similar to interacting with objects in the real world, users in XR typically interact with virtual integrants like objects, menus, windows, and information that convolve together to form the overall experience. Most of these interactions involve near-field object manipulation for which users are generally provisioned with visual representations of themselves also called self-avatars. Representations that involve only the distal entity are called end-effector representations and they shape how users perceive XR experiences. Through a series of investigations, this dissertation evaluates the effects of virtual end effector representations on near-field object retrieval interactions in XR settings. Through studies conducted in virtual, augmented, and mixed reality, implications about the virtual representation of end-effectors are discussed, and inferences are made for the future of near-field interaction in XR to draw upon from. This body of research aids technologists and designers by providing them with details that help in appropriately tailoring the right end effector representation to improve near-field interactions, thereby collectively establishing knowledge that epitomizes the future of interactions in XR

    A virtual versus an augmented reality cooking task based-tools: a behavioral and physiological study on the assessment of executive functions.

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    [EN] Virtual reality (VR) and augmented reality (AR) are two novel graphics immersive techniques (GIT) that, in the last decade, have been attracting the attention of many researchers, especially in psychological research. VR can provide 3D real-life synthetic environments in which controllers allow human interaction. AR overlays synthetic elements to the real world and the human gaze to target allow hand gesture to act with synthetic elements. Both techniques are providing more ecologically environments than traditional methods, and most of the previous researches, on one side, have more focused on the use of VR for treatment and assessment showing positive effectiveness results. On the other, AR has been proving for the treatment of specific disorders but there are no studies that investigated the feasibility and effectiveness of augmented reality in the neuropsychological assessment. Starting from these premises, the present study aimed to compare the performance and sense of presence using both techniques during an ecological task, such as cooking. The study included 50 cognitively healthy subjects. The cooking task consisted of 4 levels that increased in difficulty. As the level increased, additional activities appeared. The order of presentation of each exposure condition (AR and VR) was counterbalanced for each participant. The virtual reality-cooking task has been performed through ¿HTC/VIVE¿ and augmented reality through ¿Microsoft HoloLens¿.¿Furthermore, the study recorded and compared the psychophysiological changes (heart rate and skin conductance response) during the cooking task in both conditions. To measure the sense of presence occurring during the two exposure conditions, subjects completed the SUSQ and the ITC-SOPI immediately after each condition. The behavioral results showed that times are always lower in VR than in AR, increasing constantly in accordance with the difficulty of the tasks. Regarding physiological responses, the findings showed that AR condition produced more individual excitement and activation than VR. Finally, VR was able to produce higher levels of sense of presence than AR condition. The overall results support that VR currently represents the GIT with greater usability and feasibility compared to AR, probably due to the differences in the human-computer interaction between the two techniques.Chicchi-Giglioli, IA.; Bermejo Vidal, C.; Alcañiz Raya, ML. (2019). A virtual versus an augmented reality cooking task based-tools: a behavioral and physiological study on the assessment of executive functions. Frontiers in Psychology. 1-12. https://doi.org/10.3389/fpsyg.2019.02529S112Barratt, E. S. (1959). Anxiety and Impulsiveness Related to Psychomotor Efficiency. 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    StableHand VR: a virtual reality serious game for hand rehabilitation

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    Dissertação de mestrado integrado em Biomedical Engineering Medical InformaticsA third of all injuries at work are sustained to the hand, and hand and wrist injuries are estimated to account between 10% to 30% of all Emergency Department (ED) attendances. In 2017, there were approximately 18 million hand and wrist fractures, 2 million thumb amputations and 4 million non-thumb digit amputations worldwide. Several injuries, disabilities and diseases can affect manual motor control. Hand physiotherapy is indispensable to restore hand functionality. However, this process is often a strenuous and cognitively demanding experience. This work proposes a Virtual Reality (VR) serious game to improve conventional physiotherapy in hand rehabilitation. It focuses on resolving recurring limitations reported in most technological solutions to the problem, namely the limited diversity support of movements and exercises, complicated calibrations, and exclusion of patients with open wounds or other disfigurements of the hand. Concepts such as mixed reality, serious games for health, and hand rehabilitation are addressed in this dissertation to provide the reader with a background for the project. The latest developments of digital games and technologies in the hand rehabilitation field, specifications, requirements, general game characteristics and the most relevant details of the game implementation process are also presented in this dissertation. The system was assessed in two mid-term validations to test its viability and adjust the development. The first validation was performed with eight able-bodied participants and the second with four health professionals working in the rehabilitation field. The validations were performed following ten minutes of guided functional task practices followed by a Semi-Structured Interview for the first validation and an online questionnaire for the second validation. The questions made in the interview and online questionnaire focused on the participants’ familiarity with videogames, opinion about the Oculus Quest and its hand tracking system, and the StableHand VR game. The System Usability Scale (SUS) scores obtained and the participants’ positive feedback showed the potential of both conceptual and technological approaches adopted for this game as a viable complement to conventional hand rehabilitation. The project’s main objectives were achieved, and several relevant topics for further research were identified.Um terço de todos os ferimentos no trabalho afetam a mão e estima-se que 10% a 30% de todos os atendimentos nas Urgências se devem a ferimentos na mão e no pulso. Em 2017, houve aproximadamente 18 milhões de fraturas da mão e do pulso, 2 milhões de amputações do polegar e 4 milhões de amputações de dígitos não polegares em todo o mundo. Vários ferimentos, deficiências e doenças podem afetar o controlo motor manual. A fisioterapia é indispensável para recuperar a funcionalidade da mão. No entanto, este processo é frequentemente uma experiência extenuante e cognitivamente exigente. Este trabalho propõe um jogo sério em Realidade Virtual para melhorar a fisioterapia convencional na reabilitação da mão. O trabalho desenvolvido concentra-se na resolução de recorrentes limitações relatadas na maioria das soluções tecnológicas para o problema, nomeadamente o apoio limitado de diversidade de movimentos e exercícios, calibrações complicadas e exclusão de pacientes com feridas abertas ou outras desfigurações da mão. Esta dissertação aborda conceitos como a realidade mista, jogos sérios para a saúde e reabilitação para fornecer ao leitor contextualização para o projeto. Os últimos desenvolvimentos de jogos digitais e tecnologias no campo da reabilitação da mão são também apresentados nesta dissertação, assim como especificações, requisitos, características gerais do jogo e o processo de implementação do mesmo. O sistema foi avaliado através de dois ensaios realizados durante o processo de desenvolvimento, para testar a viabilidade e proceder a ajustes da solução especificada. A primeira validação foi conduzida com oito participantes saudáveis e a segunda validação com quatro profissionais de saúde que trabalham em reabilitação. As validações foram realizadas após dez minutos de práticas funcionais orientadas, seguidas de uma Entrevista Semiestruturada, no caso da primeira validação, ou de um questionário online, no caso da segunda validação. As perguntas feitas na entrevista e no questionário online centraram-se na familiaridade dos participantes com os videojogos, opinião sobre o Oculus Quest e o seu sistema de localização de mãos e o jogo StableHand VR. As pontuações obtidas no System Usability Scale e o feedback positivo dos participantes demostrou o potencial das abordagens conceptuais e tecnológicas adotadas para que este jogo fosse visto como um complemento viável para a reabilitação convencional das mãos. Os principais objetivos do projeto foram alcançados, tendo também sido identificado um conjunto de tópicos relevantes de investigação futura

    Virtual reality based upper extremity stroke rehabilitation system.

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    Some studies suggest that the use of Virtual Reality technologies as an assistive technology in combination with conventional therapies can achieve improved results in post stroke rehabilitation. Despite the wealth of ongoing research applied to trying to build a virtual reality based system for upper extremity rehabilitation, there still exists a strong need for a training platform that would provide whole arm rehabilitation. In order to be practical such a system should ideally be low cost (affordable or inexpensive for a common individual or household) and involve minimal therapist involvement. This research outlines some of the applications of virtual reality that have undergone clinical trials with patients suffering from upper extremity functional motor deficits. Furthermore, this thesis presents the design, development, implementation and feasibility testing of a Virtual Reality-based Upper Extremity Stroke Rehabilitation System. Motion sensing technology has been used to capture the real time movement data of the upper extremity and a virtual reality glove has been used to track the flexion/extension of the fingers. A virtual room has been designed with an avatar of the human arm to allow a variety of training tasks to be accomplished. An interface has been established to incorporate the real time data from the hardware to a virtual scene running on a PC. Three different training scenes depicting a real world scenario have been designed. These have been used to analyze the motion patterns of the users while executing the tasks in the virtual environment simulation. A usability study with the healthy volunteers performing the training tasks have been undertaken to study the ease of use, ease of learning and improved motivation in the virtual environment. Moreover this system costing approximately 2725 pounds would provide home based rehabilitation of the whole arm augmenting conventional therapy on a positive level. Statistical analysis of the data and the evaluation studies with the self report methodologies suggests the feasibility of the system for post stroke rehabilitation in home environment
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