Self-rehabilitation of acquired brain injury patients including neglect and attention deficit disorder with a tablet game in a clinical setting

We designed and evaluated a whack-a-mole (WAM) style game (see Figure 1) in a clinical randomized controlled trial (RCT) with reminder-assisted but self-initiated use over the period of a month with 43 participants from a post-lesion pool. While game play did not moderate rehabilitative progress indices of standard neuropsychological control tests, it did significantly improve in-game performance when compared to the control group. Its performance indicators and interaction data were highly accurate in predicting neglect and which hand the patients used for input. Patients found playing beneficial to their rehabilitation and attributed gains in the attention training properties of the game. The game showed potential for bedside assessment, insight support, and motivation by providing knowledge about rehabilitative progress

Strategies that shape perception

In recent years there has been an increased focus on individual differences. Such differences have been observed in conditions where people display performance deficits, such as developmental prosopagnosia (McConachie, 1976), in conditions where subjects demonstrate enhanced skills, such as synesthesia (Terhune et al., 2013), as well as in neurotypical individuals, for instance, in the form of subtle individual differences in visual perception (Zelazny & Sørensen, 2020). Our interaction with the environment during brain maturation shapes how perceptual strategies are formed and prioritized. One of the principal tasks for the brain during this stage is to establish templates and context frames in long-term memory. These templates and context frames serve as the basis for various perceptual strategies used to interpret sensory information. Over time, these templates are updated in light of both sensory evidence and the perceptual strategies that have proven advantageous. Successful strategies thus have a greater likelihood of being used in the future, hence shaping our perceptual strategic preferences. In the well-known case of AB, who was afflicted with developmental prosopagnosia (McConachie, 1976), there is evidence to suggest that she prioritized peoples’ clothing as a strategy for recognition over the more common one of relying on facial features. Similarly, grapheme-color synesthesia may develop as a strategy for learning the alphabet. Here, a common strategy may be to associate the abstract letter shapes with previously established color categories in an attempt to aid letter recognition (Brogaard & Sørensen, in press). If this particular strategy is sufficiently prioritized, this may result in grapheme-color synesthesia (cf. Mannix & Sørensen, in press). Here, we argue that individual variability in visual perception reflects differences in perceptual strategies. An interesting consequence of this thesis is that perceptual experience is likely to vary considerably more across individuals than hitherto assumed

Visualization and Interaction Technologies in Serious and Exergames for Cognitive Assessment and Training: A Survey on Available Solutions and Their Validation

Exergames and serious games, based on standard personal computers, mobile devices and gaming consoles or on novel immersive Virtual and Augmented Reality techniques, have become popular in the last few years and are now applied in various research fields, among which cognitive assessment and training of heterogeneous target populations. Moreover, the adoption of Web based solutions together with the integration of Artificial Intelligence and Machine Learning algorithms could bring countless advantages, both for the patients and the clinical personnel, as allowing the early detection of some pathological conditions, improving the efficacy and adherence to rehabilitation processes, through the personalisation of training sessions, and optimizing the allocation of resources by the healthcare system. The current work proposes a systematic survey of existing solutions in the field of cognitive assessment and training. We evaluate the visualization and interaction technologies commonly adopted and the measures taken to fulfil the need of the pathological target populations. Moreover, we analyze how implemented solutions are validated, i.e. The chosen experimental designs, data collection and analysis. Finally, we consider the availability of the applications and raw data to the large community of researchers and medical professionals and the actual application of proposed solutions in the standard clinical practice. Despite the potential of these technologies, research is still at an early stage. Although the recent release of accessible immersive virtual reality headsets and the increasing interest on vision-based techniques for tracking body and hands movements, many studies still rely on non-immersive virtual reality (67.2%), mainly mobile and personal computers, and standard gaming tools for interactions (41.5%). Finally, we highlight that although the interest of research community in this field is increasingly higher, the sharing of dataset (10.6%) and implemented applications (3.8%) should be promoted and the number of healthcare structures which have successfully introduced the new technological approaches in the treatment of their host patients is limited (10.2%)

Investigating the Comprehensive Inventory of Thriving (CIT) as a rehabilitation outcome measure

Reliable and valid outcome measures are needed in community rehabilitation settings following acquired neurological injury. The Comprehensive Inventory of Thriving (CIT) (Su, Tay and Diener, 2013) was investigated for this purpose. The CIT is a 54 item self-report measure that provides 18 subscales and seven main scales of thriving: Relationships, Engagement, Mastery, Autonomy, Meaning, Optimism and Subjective Well-being. Participants (n=76) were administered the CIT on admission to a community rehabilitation service. The mean age of participants was 54.8 (SD = 17.7), with 43% being male. The main diagnostic groups were cerebrovascular disease (28%), traumatic brain injury (17%) and Parkinson's disease (12%). Internal consistency was moderate to high (α =.6 to .9) for all subscales with the exception of Support (Relationships) and Skills (Mastery); and high (α=.79-.93) for all indexes with the exception of Subjective Wellbeing. Correlational analyses supported the scale groupings. However, the subscales of Support (Relationships) and Skills (Mastery) did not correlate significantly with any subscales. Additionally the Subjective Well-being scale should not be calculated, but instead its three subscales (Negative Feelings, Life Satisfaction, Positive Feelings) used individually. In terms of demographic variables, there were no significant gender differences on CIT scales. Age had low correlations with two Relationships subscales only (Trust r=.23, p=.04; Loneliness r=-.25, p=.03). Diagnostic group minimally influenced CIT scores. Significant between-group differences were only found for Accomplishment (Mastery), with post-hoc analyses indicating higher levels for the cerebrovascular group. The CIT shows considerable promise in rehabilitation outcomes as a reliable and valid multi-component measure of wellbeing

Kaasaegsete kognitiivsete ja sotsiaalsete sekkumistehnikate loomine pediaatrilises neurorehabilitatsioonis ajukahjustusega lastel

Väitekirja elektrooniline versioon ei sisalda publikatsiooneOmandatud ajukahjustusega lapsed vajavad kaasuva kognitiivse ja sotsiaalse defitsiidi diagnostikat ja rehabilitatsiooni, mis on oluline lapse akadeemilise edukuse ja elukvaliteedi parandamisel. Neurorehabilitatsioon on plaanipärane sekkumine, mille eesmärk on kompenseerida või kergendada ajukahjustusest põhjustatud defitsiiti. Antud doktoritöö eesmärk oli uute arvutipõhiste meetodite kasutuselevõtmine omandatud ajukahjustusega laste kognitiivses ja sotsiaalses neurorehabilitatioonis. Treeningdisainid loodi tähelepanu, ruumitaju ja sotsiaalse kompetentsi häirete raviks. Uuringus osales 59 epilepsia, ajutrauma või tikkide diagnoosiga ja 47 tervet kontrollgrupi last vanuses 8–12 aastat. Patsiendid läbisid rehabilitatsiooni (10 treeningut) koos eelneva ja treeningujärgse testimisega. Tähelepanu ja ruumitaju treeningus kasutati arvutipõhist ForamenRehab lastele kohandatud programmi väljatöötatud treeningprotokollidega. Sotsiaalsete häirete raviks loodi esmalt struktureeritud neurorehabilitatsiooni mudel, mis koosnes sotsiaalse kompetentsi olulistest komponentidest, nende hindamismeetoditest ja rehabilitatsiooni vahenditest: puutetundlikud lauad Snowflake Multiteach Tabletop ja Diamond Touch Table, ning virtuaalreaalsuse keskkonnad. Tulemusena esines patsientidel treeningu eelselt väljendunud tähelepanu, ruumitaju ja sotsiaalse kompetentsi defitsiit. Arvutipõhised ja virtuaalreaalsuse programmid olid efektiivsed kognitiivsete häirete ravis. Patsientidel esines treeningute järgselt oluline paranemine kahes tähelepanu komponendis (tähelepanu jagamine ja seiramine) ja kolmes ruumitaju komponendis (visuaal-konstruktiivsed võimed, visuaalne tähelepanu ja nägemis-ruumitaju) ning raviefekt oli säilinud järeltestimisel 1,3 aastat hiljem. Sotsiaalse rehabilitatsiooni järgselt paranesid oluliselt patsientide vaimuteooria (Theory of Mind) ja emotsioonide äratundmine, kasutati rohkem koostööoskuseid, verbaalset ja mitteverbaalset kommunikatsiooni ning pragmaatika oskuseid. Uuringute tugevuseks oli sajaprotsendiline ravisoostumus ning positiivne tagasiside. Olulised on töö käigus välja töötatud teaduspõhised sekkumisprotokollid ja uued tehnoloogiapõhised rehabilitatsioonimeetodid häirunud funktsioonide spetsiifiliseks raviks lastel.Children with acquired brain injury (ABI) need diagnosis of accompanying cognitive and socio-emotional deficits and neurorehabilitation to enhance their future academic success and quality of life. Neurorehabilitation is a systematic intervention designed to compensate for or remediate the impairments caused by brain injury. The main aim of the thesis was implementing new computer-based programs, multitouch-multiuser tabletops and virtual reality in cognitive and social neurorehabilitation for children with ABI. Rehabilitation designs were developed for the treatment of attention, visuospatial, and social competence deficits. 59 children aged 8–12 years with ABI diagnosis (epilepsy, traumatic brain injury or tic disorder) and 47 healthy controls participated. Study group patients completed 10 training sessions guided by therapists. Pre-intervention assessments, and outcome assessments immediately and 1.31 years after the rehabilitation were carried out. ForamenRehab computer-programme was adapted to children and intervention protocols were created for attention and visuospatial function remediation. For social deficit remediation, the structured neurorehabilitation model was created, composed of the main components of social competence with evaluation and intervention tools: Snowflake Multiteach Tabletop, Diamond Touch Table and virtual reality programmes. Pre-intervention assessments showed that children with ABI had significant deficits in attention, visuospatial abilities and social competence functions. Computer-based and virtual reality programs were effective in the remediation of cognitive deficits in patients. After training, the patients had improved performance in two attention (complex attention and tracking) and three visuospatial components (visual organization, visual attention and visuospatial perception). The positive training effect had preserved after 1.3 years in follow-up assessments. Additionally, after social deficit rehabilitation, the patients showed improvements in Theory of Mind and emotion recognition, and they used more cooperation, communication, and pragmatic skills. The patients’ compliance was 100% and feedback was positive for all three interventions. In sum, the developed evidence-based intervention protocols and new technology-based rehabilitation methods are important in the remediation of specific cognitive deficits in children.https://www.ester.ee/record=b528718

"You Owe It to Yourself": Discourses of Hope and Work in Brain Injured Individuals' Experiences With Brain Training Games

Brain training is a multi-million dollar market, with products that boast claims to enhance cognitive functions through the power of neuroplasticity. In this MA research I explore the experiences of individuals with an Acquired Brain Injury (ABI) who use brain training in an attempt to regain past identities or to create new and improved ones. The concept of neuroplasticity embedded in brain training programs represented hope to brain injured individuals: hope that they could regain skills that they have lost because of their injury. Brain training programs are also part of a larger theme of self-rehabilitation, in which individuals who were either neglected by the healthcare system or who wanted additional care turned to at-home treatments and programs. Finally, I argue that brain training fits with the dominant cultural imperative of health in North American society in which individuals must work to exercise self control and better themselves and their health in order to contribute to society