EXECUTIVE-FUNCTIONS INNOVATIVE TOOL - EXIT 360: DEVELOPMENT AND VALIDATION OF A NEW 360-VIDEO INSTRUMENT FOR EXECUTIVE FUNCTIONS

Questa tesi offre un'ampia panoramica dello sviluppo di EXecutive-functions Innovative Tool 360° (EXIT 360°), dalla sua progettazione alla validazione come strumento sensibile per la valutazione della funzionalità esecutiva (FE). Identificare strategie precoci per rilevare i deficit esecutivi appare una priorità, dal momento che la disfunzione esecutiva rappresenta un problema significativo a causa del suo impatto sulle attività quotidiane. Pertanto, abbiamo ideato e sviluppato EXIT 360°, un nuovo strumento che sfrutta la tecnologia 360° per una valutazione ecologicamente valida del FE. Si tratta di un nuovo compito fruibile tramite smartphone e visore per la realtà virtuale, in cui i partecipanti devono eseguire sette compiti giornalieri in ambienti domestici. Le tre principali proprietà psicometriche di EXIT 360° —usabilità, validità convergente e di costrutto— sono state il focus degli studi discussi in questa tesi. Gli studi sull'usabilità hanno dimostrato che EXIT 360º debba essere considerato uno strumento tecnologico semplice, usabile e facile da apprendere. Lo studio di validità convergente ha mostrato una correlazione tra i punteggi di EXIT 360° e i test standardizzati carta-e-matita per il FE. Infine, lo studio di validità di costrutto ha mostrato l'efficacia di EXIT 360° nel discriminare il gruppo patologico da quello di controllo, evidenziando una maggiore accuratezza diagnostica rispetto ai test tradizionali. Nel complesso, i risultati offrono una chiara evidenza che EXIT 360° debba essere visto come uno strumento valido e innovativo per una valutazione ecologicamente valida del FE, altamente utilizzabile per una diagnosi tempestiva e l’arruolamento precoce del paziente in una riabilitazione mirata.This thesis offers a broad overview of EXecutive-functions Innovative Tool 360° (EXIT 360°) development from its concept to validation as a sensitive instrument for evaluating executive functionality (EF). Identifying early strategies to detect executive impairments appears a priority since executive dysfunction represents a significant health problem due to its high negative impact on daily activities. Therefore, we conceptualized and developed EXIT 360°, a new 360°-based instrument for an ecologically valid assessment of EF. It consists of a new task delivered via smartphone and a comfortable head-mounted display, where participants must perform seven everyday subtasks in 360° domestic environments. The three main psychometric properties of EXIT 360°—usability, convergent and construct validity—have been the focus of the studies discussed in this thesis. Usability studies involving patients and healthy subjects showed EXIT 360° is a straightforward, usable, and easy-to-learn technological instrument. Convergent validity study displayed a correlation between EXIT 36o° scores and standardized paper-and-pencil tests for EF. Finally, the construct validity study showed the effectiveness of EXIT 360° in discriminating between pathological and control groups with high precision, displaying its higher diagnostic accuracy compared to traditional tests. Overall, findings offer clear evidence that EXIT 360° must be seen as a valuable and innovative instrument for an ecologically valid evaluation of EF, highly usable for prompt diagnosis and early patient enrolment in focused rehabilitation

Whole-Head Functional Near-Infrared Spectroscopy as an Ecological Monitoring Tool for Assessing Cortical Activity in Parkinson’s Disease Patients at Different Stages

Functional near-infrared spectroscopy (fNIRS) is increasingly employed as an ecological neuroimaging technique in assessing age-related chronic neurological disorders, such as Parkinson’s disease (PD), mainly providing a cross-sectional characterization of clinical phenotypes in ecological settings. Current fNIRS studies in PD have investigated the effects of motor and non-motor impairment on cortical activity during gait and postural stability tasks, but no study has employed fNIRS as an ecological neuroimaging tool to assess PD at different stages. Therefore, in this work, we sought to investigate the cortical activity of PD patients during a motor grasping task and its relationship with both the staging of the pathology and its clinical variables. This study considered 39 PD patients (age 69.0 ± 7.64, 38 right-handed), subdivided into two groups at different stages by the Hoehn and Yahr (HY) scale: early PD (ePD; N = 13, HY = [1; 1.5]) and moderate PD (mPD; N = 26, HY = [2; 2.5; 3]). We employed a whole-head fNIRS system with 102 measurement channels to monitor brain activity. Group-level activation maps and region of interest (ROI) analysis were computed for ePD, mPD, and ePD vs. mPD contrasts. A ROI-based correlation analysis was also performed with respect to contrasted subject-level fNIRS data, focusing on age, a Cognitive Reserve Index questionnaire (CRIQ), disease duration, the Unified Parkinson’s Disease Rating Scale (UPDRS), and performances in the Stroop Color and Word (SCW) test. We observed group differences in age, disease duration, and the UPDRS, while no significant differences were found for CRIQ or SCW scores. Group-level activation maps revealed that the ePD group presented higher activation in motor and occipital areas than the mPD group, while the inverse trend was found in frontal areas. Significant correlations with CRIQ, disease duration, the UPDRS, and the SCW were mostly found in non-motor areas. The results are in line with current fNIRS and functional and anatomical MRI scientific literature suggesting that non-motor areas—primarily the prefrontal cortex area—provide a compensation mechanism for PD motor impairment. fNIRS may serve as a viable support for the longitudinal assessment of therapeutic and rehabilitation procedures, and define new prodromal, low-cost, and ecological biomarkers of disease progression

Translation, Adaptation and Validation of the Five-Word Test (Test Delle 5 Parole, T5P) in an Italian Sample: A Rapid Screening for the Assessment of Memory Impairment

Discriminating between Alzheimer’s disease (AD), mild cognitive impairment (MCI) and functional memory disorders (FMD) can sometimes be difficult because amnesic syndrome can be confused with memory dysfunction due to aging and/or depression. This work aims to translate, adapt and validate the five-word test (FWT) in an Italian sample (Test delle 5 Parole, T5P). FWT is a screening memory task specifically built to discriminate the hippocampal memory deficit—typical of AD and amnesic MCI—from those related to functional disorders. We involved a large number of subjects (n = 264): 60 with AD, 80 with MCI, 46 with FMD, and 78 healthy controls (CTRL). Two traditional screening tests and the T5P were administered to all participants. Results showed an excellent convergent validity of the T5P (p < 0.05). Moreover, the T5P appeared as an effective test able to discriminate between the four conditions, except for FMD and CTRL. In particular, a total score of ≤9 allowed for accurately discriminating subjects with AD + MCI compared to participants with FMD + CTRL with high sensitivity (83.87%) and specificity (76.43%). Overall, the T5P is a simple, rapid and sensible test of the hippocampal memory that is recommended in clinical practice to screen persons with subjective/probable amnesic difficulties and to discriminate between patients with AD or MCI and CTRL

Translation, Adaptation and Validation of the Five-Word Test (Test Delle 5 Parole, T5P) in an Italian Sample: A Rapid Screening for the Assessment of Memory Impairment

Discriminating between Alzheimer’s disease (AD), mild cognitive impairment (MCI) and functional memory disorders (FMD) can sometimes be difficult because amnesic syndrome can be confused with memory dysfunction due to aging and/or depression. This work aims to translate, adapt and validate the five-word test (FWT) in an Italian sample (Test delle 5 Parole, T5P). FWT is a screening memory task specifically built to discriminate the hippocampal memory deficit—typical of AD and amnesic MCI—from those related to functional disorders. We involved a large number of subjects (n = 264): 60 with AD, 80 with MCI, 46 with FMD, and 78 healthy controls (CTRL). Two traditional screening tests and the T5P were administered to all participants. Results showed an excellent convergent validity of the T5P (p < 0.05). Moreover, the T5P appeared as an effective test able to discriminate between the four conditions, except for FMD and CTRL. In particular, a total score of ≤9 allowed for accurately discriminating subjects with AD + MCI compared to participants with FMD + CTRL with high sensitivity (83.87%) and specificity (76.43%). Overall, the T5P is a simple, rapid and sensible test of the hippocampal memory that is recommended in clinical practice to screen persons with subjective/probable amnesic difficulties and to discriminate between patients with AD or MCI and CTRL

Psychometric Calibration of a Tool Based on 360 Degree Videos for the Assessment of Executive Functions

Introduction: Over the last decades, interactive technologies appeared a promising solution in the ecological evaluation of executive functioning. We have developed the EXecutive-functions Innovative Tool 360° (EXIT 360°), a new instrument that exploits 360° technologies to provide an ecologically valid assessment of executive functioning. Aim: This work wanted to evaluate the convergent validity of the EXIT 360°, comparing it with traditional neuropsychological tests (NPS) for executive functioning. Methods: Seventy-seven healthy subjects underwent an evaluation that involved: (1) a paper-and-pencil neuropsychological assessment, (2) an EXIT 360° session, involving seven subtasks delivered by VR headset, and (3) a usability assessment. To evaluate convergent validity, statistical correlation analyses were performed between NPS and EXIT 360° scores. Results: The data showed that participants had completed the whole task in about 8 min, with 88.3% obtaining a high total score (≥12). Regarding convergent validity, the data revealed a significant correlation between the EXIT 360° total score and all NPS. Furthermore, data showed a correlation between the EXIT 360° total reaction time and timed neuropsychological tests. Finally, the usability assessment showed a good score. Conclusion: This work appears as a first validation step towards considering the EXIT 360° as a standardized instrument that uses 360° technologies to conduct an ecologically valid assessment of executive functioning. Further studies will be necessary to evaluate the effectiveness of the EXIT 360° in discriminating between healthy control subjects and patients with executive dysfunctions

System Integrated Digital Empowering and teleRehabilitation to promote patient Activation and well-Being in chronic disabilities: A usability and acceptability study

IntroductionTelerehabilitation systems represent a promising way for the management of chronic disability, delivering technology-enabled rehabilitation outside the hospital setting. However, usability and acceptability assessment with users represents a critical starting point when using digital healthcare solutions. This study aims at evaluating the user experience with a Telerehabilitation system (SIDERA∧B) from the end-user side.MethodsSIDERA∧B consists of an asynchronous delivery of rehabilitation activities through multimedia digital contents and tele-monitoring of vital parameters with technological devices for individualized, home-based management of chronic conditions. Usability (with the System Usability Scale, SUS) and acceptability (using the Technology Acceptance Model, TAM - and The Service User Technology Acceptance Questionnaire, SUTAQ) data were analyzed from the dataset of the SIDERA∧B project (N = 112 patients with Chronic Heart Failure, Parkinson's Disease and Chronic Obstructive Pulmonary Disease). The possible influence of five external factors (i.e., technological expertise, education, sex, age, and level of disability) on TAM domains was tested using Spearman's Correlation analysis.ResultsResults showed a satisfactory level of technological usability (SUS Median = 77.5) and good scores in usability and learnability SUS subdomains (mean scores &gt; 2.5). Regarding technological acceptability, participants showed high scores (Median &gt; 4) in “Behavioral Intention”, “Perceived Usefulness”, and “Perceived Ease of Use” TAM domains. Finally, results from the SUTAQ scale highlighted that the SIDERA∧B system obtained optimal scores in all domains, especially in “Increased accessibility,” “Care personnel concerns,” and “Satisfaction.” Age (rho = −0.291, p = 0.002) and disability level (WHODAS Total score: rho = −0.218, p = 0.021) were the two external factors inversely associated with the Perceived Ease of Use.DiscussionThe age of digital transformation requires everyone to understand, accept and master the changes affecting modern-day healthcare. The usability and acceptability of the SIDERA∧B system were high across all end-users, despite the medium-low level of the technological expertise of the sample. These findings support the efficiency and the suitability of these digital solutions in the modern digital age transition of rehabilitation from inside to outside the clinic

Psychometric validation for a brand-new tool for the assessment of executive functions using 360° technology

Abstract EXecutive-functions Innovative Tool 360° (EXIT 360°) is an original 360° instrument for an ecologically valid and multicomponent evaluation of executive functioning. This work aimed to test the diagnostic efficacy of EXIT 360° in distinguishing executive functioning between healthy controls (HC) and patients with Parkinson’s Disease (PwPD), a neurodegenerative disease in which executive dysfunction is the best-defined cognitive impairment in the early stage. 36 PwPD and 44 HC underwent a one-session evaluation that involved (1) neuropsychological evaluation of executive functionality using traditional paper-and-pencil tests, (2) EXIT 360° session and (3) usability assessment. Our findings revealed that PwPD made significantly more errors in completing EXIT 360° and took longer to conclude the test. A significant correlation appeared between neuropsychological tests and EXIT 360° scores, supporting a good convergent validity. Classification analysis indicated the potential of the EXIT 360° for distinguishing between PwPD and HC in terms of executive functioning. Moreover, indices from EXIT 360° showed higher diagnostic accuracy in predicting PD group membership compared to traditional neuropsychological tests. Interestingly, EXIT 360° performance was not affected by technological usability issues. Overall, this study offers evidence that EXIT 360° can be considered an ecological tool highly sensitive to detect subtle executive deficits in PwPD since the initial phases of the disease

EXIT 360°-EXecutive-functions innovative tool 360°-A simple and effective way to study executive functions in parkinson’s disease by using 360° videos

Executive dysfunction represents a common non-motor symptom in Parkinson’s disease (PD), with a substantial negative impact on daily functioning and quality of life. Assessing executive functions (EFs) with ecological tools is therefore essential. The ecological limitations of traditional neuropsychological tests have led to increased use of virtual reality and 360° environment-based tools for the assessment of EFs in real life. The study aims to evaluate the efficacy and usability of the EXecutive-Functions Innovative Tool 360° (EXIT 360°), a 360°-based tool for the evaluation of EFs in PD. Twenty-five individuals with PD and 25 healthy controls (HC) were assessed with a conventional neuropsychological battery and EXIT 360° delivered via a head-mounted display. EXIT 360° will show a domestic scenario and seven different subtasks of increasing complexity, and will collect verbal responses, reaction times, and physiological data. We expect that EXIT 360° will be judged usable, engaging, and challenging. Moreover, we expect to find a highly convergent (conventional test and EXIT 360°) and diagnostic validity (individuals with PD vs. HC). The validation of EXIT 360° will allow for the adoption of a fast, ecological, and useful instrument for PD screening, likely transforming the assessment for the clinic and the patient

A Psychometric Tool for Evaluating Executive Functions in Parkinson’s Disease

Recently, there has been an increasing interest in using 360◦ virtual-reality video for an ecologically valid assessment of executive functioning in the neurologic population. In this framework, we have developed the EXecutive-functions Innovative Tool (EXIT 360◦ ), an original 360◦-based instrument for a multicomponent, ecologically valid evaluation of executive functioning in Parkinson’s Disease (PD). This work aimed to test the usability and user experience of EXIT 360◦ in patients with PD (PwPD). Twenty-seven PwPD and twenty-seven healthy controls underwent an evaluation that involved: (1) usability assessment by the System Usability Scale and (2) evaluation of user experience using the ICT—Sense of Presence and User Experience Questionnaire. Results showed a satisfactory level of usability for patients (mean = 76.94 ± 9.18) and controls (mean = 80 ± 11.22), with good scores for usability and learnability. Regarding user experience, patients provided a positive overall impression of the tool, evaluating it as attractive, enjoyable, activating, and funny. Moreover, EXIT 360◦ showed good pragmatic (e.g., efficient, fast, clear) and hedonic quality (e.g., exciting, interesting, and creative). Finally, PwPD considered EXIT 360◦ as an original tool with high ecological validity (mean = 4.29 ± 0.61), spatial presence (mean = 3.11 ± 0.83) and engagement (mean = 3.43 ± 0.54) without relevant adverse effects. Technological expertise had no impact on performance. Overall, EXIT 360◦ appeared to be a usable, easy-to-learn, engaging, and innovative instrument for PD. Further studies will be conducted to deepen its efficacy in distinguishing between healthy subjects and patients with executive dysfunctions

EXecutive-Functions Innovative Tool (EXIT 360°): A Usability and User Experience Study of an Original 360°-Based Assessment Instrument

Over the last few decades, several studies have shown the feasibility, acceptability, and efficacy of VR-based instruments in the early evaluation of executive dysfunction (ED) in psychiatric and neurologic conditions. Due to the negative impact of ED in everyday functioning, identifying innovative strategies for evaluating ED allows clinicians to detect executive impairment early and minimize its effects. This work aimed to test the usability and user experience (UX) of EXecutive-functions Innovative Tool 360° (EXIT 360°), a 360°-based tool for assessing ED. Seventy-six healthy subjects underwent an evaluation that involved (1) usability assessment using System Usability Scale and (2) evaluation of UX using the ICT-Sense of Presence and UX Questionnaire. Results showed a satisfactory level of usability (mean = 75.9 ± 12.8), with good scores for usability and learnability. As regards UX, EXIT 360° showed an absence of negative effects (mean = 1.79 ± 0.95) and high scores in ecological validity (mean = 4.32 ± 0.54) and engagement (mean = 3.76 ± 0.56). Moreover, it obtained good scores in efficiency (mean = 1.84 ± 0.84), originality (mean = 2.49 ± 0.71), and attractiveness (mean = 1.93 ± 0.98). Interestingly, demographic characteristics and technological expertise had no impact on the performance (p &gt; 0.05). Overall, EXIT 360° appeared to be a usable, learn-to-use, engaging, and creative tool with irrelevant negative effects. Further studies will be conducted to evaluate these aspects in the clinical population