Advances in the Rehabilitation of Hemispatial Inattention

PURPOSE OF REVIEW: There continue to be a plethora of approaches to the rehabilitation of hemispatial inattention, from different forms of sensory stimulation (visual, auditory and somatosensory feedback), through all major modes of non-invasive brain stimulation to drug therapies. Here we summarise trials published in the years 2017-2022 and tabulate their effect sizes, with the aim of drawing on common themes that may serve to inform future rehabilitative studies. RECENT FINDINGS: Immersive virtual reality approaches to visual stimulation seem well tolerated, although they have yet to yield any clinically relevant improvements. Dynamic auditory stimulation looks very promising and has high potential for implementation. Robotic interventions are limited by their cost and are perhaps best suited to patients with a co-occurring hemiparesis. Regarding brain stimulation, rTMS continues to demonstrate moderate effects but tDCS studies have yielded disappointing results so far. Drugs, primarily aimed at the dopaminergic system, often demonstrate beneficial effects of a medium size, but as with many of the approaches, it seems difficult to predict responders and non-responders. Our main recommendation is that researchers consider incorporating single-case experimental designs into their studies as rehabilitation trials are likely to remain small in terms of patient numbers, and this is the best way to deal with all the factors that cause large between-subject heterogeneity

Virtual Reality as a Vehicle to Empower Motor-Cognitive Neurorehabilitation

In this paper, we advocate the combination of four key ingredients that we believe are necessary to design long-lasting effective treatments for neurorehabilitation: (i) motor-cognitive training, (ii) evidence-based neuroscience principles, in particular those related to body perception, (iii) motivational games, and (iv) empowerment techniques. Then, we propose virtual reality (VR) as the appropriate medium to encompass all the requirements mentioned above. VR is arguably one of the most suitable technologies for neurorehabilitation able to integrate evidence-based neurorehabilitation techniques and neuroscience principles into motivating training approaches that promote self-management by empowering patients to own their recovery process. We discuss the advantages and challenges of such an approach on several exemplary applications and outline directions for future developments. We strongly believe that the combination of positive psychology and positive technology mediated by VR-based interventions can heavily impact the rehabilitation outcomes of motor-cognitive functions along all the stages of the rehabilitation path

Virtual reality as a potential tool to face frailty challenges

The aging population and the corresponding increase in age-related diseases present scientific community and public health authorities with imminent challenges. One of these challenges deals with a deeper understanding of functional status of elderly in order to prevent and/or delay the onset of late-life disability (Rodr\uedguez-Artalejo and Rodr\uedguez-Ma\uf1as, 2014). The syndrome of \u201cfrailty\u201d has been recently introduced in literature to specifically characterize the health of older individuals who deserve special attention because of their increased vulnerability to adverse health outcomes (Afilalo et al., 2010). Although there is not a unique definition of frailty (Morley et al., 2013), the majority of studies refers to the five operational criteria (Fried et al., 2001): decreased gait speed, reduced grip strength, prolonged and unmotivated exhaustion, low physical activity, unintended weight loss. The problem of different definitions leads also to a large variation in reported prevalence rates, which range approximately from 5 to 60% (Collard et al., 2012). However, this multifaceted decline in different physiological systems make frail older individuals progressively more exposed to stressors (Clegg et al., 2013), making urgent the need for better care intervention

Adaptive, Multisensorial, Physiological and Social: The Next Generation of Telerehabilitation Systems

Some people require special treatments for rehabilitating physical, cognitive or even social capabilities after an accident or degenerative illness. However, the ever-increasing costs of looking after an aging population, many of whom suffer chronic diseases, is straining the finances of healthcare systems around Europe. This situation has given rise to a great deal of attention being paid to the development of telerehabilitation (TR) systems, which have been designed to take rehabilitation beyond hospitals and care centers. In this article, we propose which features should be addressed in the development of TR systems, that is, they should consider adaptive, multisensorial, physiological and social aspects. For this aim, the research project Vi-SMARt is being conducted for evaluating whether and how different technologies, such as virtual reality (VR), multi-sensorial feedback, or telemonitoring, may be exploited for the development of the next generation of TR systems. Beyond traditional aural and visual feedback, the exploitation of haptic sense by using devices such as haptic gloves or wristbands, can provide patients with additional guidance in the rehabilitation process. For telemonitoring, Electroencephalography (EEG) devices show signs of being a promising approach, not only to monitor patients’ emotions, but also to obtain neuro-feedback useful for controlling his/her interaction with the system and thus to provide a better rehabilitation experience

Effects of sensory cueing in virtual motor rehabilitation. A review.

Objectives To critically identify studies that evaluate the effects of cueing in virtual motor rehabilitation in patients having different neurological disorders and to make recommendations for future studies. Methods Data from MEDLINE®, IEEExplore, Science Direct, Cochrane library and Web of Science was searched until February 2015. We included studies that investigate the effects of cueing in virtual motor rehabilitation related to interventions for upper or lower extremities using auditory, visual, and tactile cues on motor performance in non-immersive, semi-immersive, or fully immersive virtual environments. These studies compared virtual cueing with an alternative or no intervention. Results Ten studies with a total number of 153 patients were included in the review. All of them refer to the impact of cueing in virtual motor rehabilitation, regardless of the pathological condition. After selecting the articles, the following variables were extracted: year of publication, sample size, study design, type of cueing, intervention procedures, outcome measures, and main findings. The outcome evaluation was done at baseline and end of the treatment in most of the studies. All of studies except one showed improvements in some or all outcomes after intervention, or, in some cases, in favor of the virtual rehabilitation group compared to the control group. Conclusions Virtual cueing seems to be a promising approach to improve motor learning, providing a channel for non-pharmacological therapeutic intervention in different neurological disorders. However, further studies using larger and more homogeneous groups of patients are required to confirm these findings

Collaborative Computer-Assisted Cognitive Rehabilitation System

Recently have been proposed different physical and cognitive rehabilitation system that allow people with some disabilities to improve and recover some lost capabilities. All these systems allow to carry out these therapies at home proving patients the possibility to accomplish a better rehabilitation, due to the fact that they can practice at home and in a more controlled environment. But, it is not so common that these systems include some social features that reduce the feeling of social isolation of the patients. Thus, in this paper we present an adaptation of a previous proposal including some multiuser therapies that try include some social features and other aspect related to videogames that increases the motivation and makes the treatment funny