Virtual environments for stroke rehabilitation: examining a novel technology against end-user, clinical and management demands with reference to UK care provision

In the field of post-stroke rehabilitation, there appears to be growing interest in the use of virtual reality (VR)-based systems as adjunct technologies to standard therapeutic practices. The limitations and the potentials of this technology are not, however, generally well understood. The present study thus seeks to determine the value of the technology with reference to end-user requirements by surveying and evaluating its application against a variety of parameters: user focus, clinical effectiveness, marketability and contextual meaningfulness, etc. A key theme in the research considers how a technology developed internationally might interface with care provision demands and cultures specific to the United Kingdom. The barriers to innovation entry in this context are thus examined. Further practical study has been conducted in the field with a small sample of post-stroke rehabilitation patients. The data garnered from these enquiries have informed a detailed system analysis, a strategy for innovation and a broad theoretical discussion as to the effectiveness of the technology in delivering VR environments by which the patient can undertake ‘meaningful’ therapeutic activities. The data reveal that there does appear to be clinical value in using this technology, yet establishing its maximal value necessitates greater integrity among clinicians and engineers, and the furthering of progressive channels for innovation by public health administrators

Valutazione delle funzioni esecutive in ambienti di Realtà Virtuale (RV): uno studio sui pazienti con Disturbo Ossessivo Compulsivo

Lo studio è volto a valutare l'affidabilità e la validità della Realtà Virtuale come strumento per la valutazione neuropsicologica dei pazienti con Disturbo Ossessivo Compulsivo. Tale obiettivo è stato perseguito attraverso la somministrazione della batteria neuropsicologica e la versione virtuale del Multiple Errand Test (V-MET), sviluppato tramite il software NeuroVR, al fine di valutare le funzioni esecutive e la capacità di pianificazione su compiti complessi in pazienti con Disturbo Ossessivo Compulsivo (DOC) e in soggetti sani. Le performance esaminate, in particolar modo il tempo, l’accuratezza e gli errori nell’esecuzione dei compiti ed il numero delle inefficienze sembrano essere validi criteri per evidenziare le differenze delle capacità cognitive tra i pazienti e i soggetti sani. I risultati evidenziano nei pazienti un basso livello di attenzione divisa, elevati livelli di errori, un alto range medio di inefficienze, molti errori di interpretazione, violazioni delle regole e molto tempo nell'esecuzione dei compiti. I soggetti sani, invece, mostrano un elevato livello di efficienza e migliori prestazioni. Inoltre, le significative correlazioni trovate tra il V-MET e la batteria neuropsicologica supportano la validità ecologica e la flessibilità dell’ambiente virtuale come strumento valutativo delle funzioni esecutive.This study is aimed at evaluation the reliability and validity of the Virtual Reality as tool for the neuropsychological assessment in OCD patients. Was used neuropsychological battery and the virtual version of the Multiple Errand Test (V-MET)- developed using the NeuroVR software, in order to evaluate the executive functions, the ability to plan ahead on complex problem solving tasks in daily life in obsessive compulsive disorder (OCD) patients and healthy controls. The results showed the presence of difficulties of OCD patients: lower level of divided attention and higher levels of errors; higher mean rank of inefficiencies, interpretation failures and rule breaks and longer time of execution of the whole task. By contrast, controls have higher level of efficiency and better performance. In addition, significant correlation found between the V-MET and the neuropsychological battery confirm and support the ecological validity of neurocognitive assessment through NeuroVirtual Realit

Individualized Virtual Reality Rehabilitation after Brain Injuries

Context-sensitive cognitive rehabilitation aims to address the specific deficits of patients by taking into account the unique strengths and weaknesses of each brain-injured individual. However, this approach requires customized assessments and trainings that are difficult to validate, time-consuming or simply unavailable for daily clinical use. Given the currently struggling economy and an increasing number of patients with brain injuries, a feasible and efficient solution for this individualized rehabilitation concept is needed. This dissertation addresses the development and evaluation of a VE-based training and assessment for context-sensitive cognitive rehabilitation. The proposed application is designed to closely resemble real-world places that are relevant to each individual neurological patient. Despite such an ecologically valid approach to rehabilitation, the application also integrates traditional process-specific tasks that offer potential for standardization and collection of normative data across patient populations. Three cognitive tasks (navigation, orientation, spatial memory) have been identified for use in individualized VEs. In three experimental trials the feasibility and validity of the technological implementation and theoretical foundation of these tasks has been assessed. In a fourth trial one of the tasks has been used for the rehabilitation of a brain-injured patient. Based on the results of these studies a workflow for the rapid development of VEs has been established which allows a VR developer to provide clinicians with individualized cognitive tasks. In addition, promising results for the clinical use and validation of the proposed system form the basis for future randomized controlled clinical trials. In conclusion, this dissertation elaborates how context-sensitive and process-specific rehabilitation approaches each offer a unique perspective on cognitive rehabilitation and how combining both through the means of VR technology may offer new opportunities to further this clinical discipline

Remediace kognitivního deficitu u neuropsychiatrických poruch pomocí úloh ve virtuální realitě

Teoretická východiska: Tato práce zkoumá obecnou uplatnitelnost virtuální reality (VR) pro kognitivní remediaci u neuropsychiatrických pacientů. Hlavním cílem práce bylo vytvořit VR úlohy vhodné pro tento účel, posoudit vlastnosti různých VR platforem a stanovit validitu a efektivitu vyvinutého programu u cílové populace. Metoda: Ve studii 1 se zdraví senioři (n = 36) a mladí dospělí (n = 25) zúčastnili nově vyvinuté úlohy Virtual Supermarket Shopping Task (VSST) v imerzivní VR (IVR) nebo neimerzivní VR (non-IVR) za účelem zkoumání jejich charakteristik. Studie 2 hodnotila validitu (n = 21) a spolehlivost (n = 8) Much, nové VR úlohy zaměřené na psychomotorickou rychlost. Ve studii 3 byl VSST administrován 20 pacientům se schizofrenií (SZ) a 20 zdravým kontrolám (HC), aby se vyhodnotila jeho validita. Ve studii 4 se 28 pacientů se schizofrenií nebo depresí zúčastnilo VE programu a standardního programu tužka-papír, aby byla ověřena uplatnitelnost a efektivita obou metod. Výsledky: Ve studii 1 si senioři vedli výrazně hůře v IVR než v non-IVR, kognitivní výkon u mladých dospělých byla stabilní napříč platformami, mladí dospělí preferovali IVR před non-IVR. Studie 2 zjistila významnou korelaci mezi Mouchami a standardními kognitivními testy a test- retest reliabilita přesahovala hodnotu 0,7. Ve studii...Theoretical background: This dissertation investigates the feasibility of virtual reality (VR) for cognitive remediation in neuropsychiatric patients. The main goal was to create VR tasks appropriate for this purpose, assess the characteristics of the applied VR media, and investigate the validity and efficacy of the developed program in the target population. Method: In Study 1, healthy seniors (n = 36) and young adults (n = 25) participated in a newly developed Virtual Supermarket Shopping Task (VSST) in immersive VR (IVR) or non-immersive VR (non-IVR) to investigate their characteristics. Study 2 assessed validity (n = 21) and reliability (n = 8) of a novel VR task focused on psychomotor speed called Flies. In Study 3, VSST was administered to 20 patients with schizophrenia (SZ) and 20 healthy controls (HC) to investigate its validity. Finally, in Study 4, 28 patients with schizophrenia or depression participated in the proposed VE program and standard paper-pencil remediation approach to investigate feasibility and efficacy. Results: In Study 1, the seniors performed significantly worse in IVR than in non-IVR, cognitive performance in young adults was stable across different VR media, the young adults preferred IVR over non-IVR. Study 2 found a significant correlation between the Flies and...Department of Physiology 3FM CUÚstav fyziologie 3. LF UK3. lékařská fakultaThird Faculty of Medicin