New insights into the diagnosis, rehabilitation and understanding of hemineglect using new technologies

Hemineglect is one of the most frequent cognitive impairments after stroke, causing a major limitation for functional remission, with symptoms persisting years post-onset. Despite the extent of the impairment, a large part of the fundamental research and applied clinical practice has focused on the perceptive aspects of hemineglect, and overlooked links with action and action abilities. The aim of the present thesis was to bring new insights in the assessment, rehabilitation and understanding of the condition, combining perception and action measures. Throughout the thesis, an innovative sensitive and reliable robot test measuring visuo-spatial hemineglect and associated action kinematics was validated on stroke patients. Additionally, the thesis provided a novel hemineglect robot rehabilitation using a serious game, where game difficulty was auto-adapted in accordance to the patient’s impairment severity. Finally, by using these technological tools, factors moderating the link between perception and action in hemineglect were identified.(PSYE - Sciences psychologiques et de l'éducation) -- UCL, 201

Robot diagnosis test for egocentric and allocentric hemineglect

Objective: Patients with hemineglect fail to respond to egocentric stimuli or allocentric parts of stimuli contralateral to the brain lesion. The clinical diagnosis of hemineglect mainly involves evaluation of the egocentric form, while less sensitive standardized tests exist for other forms. Our global aim is to develop an innovative integrative robot measure, the MonAmour test, combining the assessment of egocentric, allocentric and motor hemineglect. Here, we present the egocentric and allocentric evaluations. Methods: Thirty-five first stroke patients (25 hemineglect) and 56 age-matched healthy controls were assessed on the index test (MonAmour) and on three reference standard tests (Bells test, Apples test and Neglect subtest of the Test for Attentional Performance). Based on controls' performance, normative data were created. Validity was evaluated between the MonAmour and the reference standard tests through correlations and test sensitivity/specificity. Reliability of the MonAmour was measured with test-retest and minimal detectable change. Results: Results demonstrated moderate to strong correlations between the MonAmour and the reference standard tests (r = .40-.88, p < .001 - p = .016). The sensitivity was high (50%-96%), with accurate diagnosis of patients with hemineglect, and reliability was excellent (Intraclass Correlation Coefficient = .79-.95, p < .001). Conclusions: The MonAmour robot test is a valid, sensitive and reliable tool that can diagnose egocentric and allocentric hemineglect. Future studies will deepen the assessment and understanding of the different forms of hemineglect by testing the motor component of the test in order to use this accurate and integrative measure in daily clinical routine

INNOVATIONS EN MÉDECINE PHYSIQUE ET RÉADAPTATION QUE RETENIR DE 2016 ?

Suite à une lésion cérébrale, les troubles moteurs et cognitifs sont fréquents et leur rééducation constitue un défi de longue haleine pour les patients et les thérapeutes. Ces dernières années, la robotique et les jeux sérieux se sont fortement développés dans ce domaine afin d’augmenter la récupération fonctionnelle des patients. La robotique permet d’intensifier la thérapie, d’assister le mouvement du patient et de lui fournir un feedback. Quant aux jeux sérieux, ils rendent la rééducation ludique et motivante et le niveau de difficulté du jeu s’adapte continuellement aux performances du patient. Ces deux technologies complémentaires sont donc prometteuses dans la rééducation des patients cérébro-lésés

Motor and cognitive combined control system for upper limb robot assisted rehabilitation after stroke

Question: Despite intensive rehabilitation, stroke patients keep neurological impairments limiting their activities of daily living. To improve upper limb (UL) rehabilitation, current guidelines recommend robotic assisted therapy (RAT). To date, RAT relies on assisted-as-needed (AAN) principles. New treatment modalities, combining simultaneous motor and cognitive rehabilitation, aim for better recovery outcomes. Our team developed ROBiGAME, a serious game that simultaneously rehabilitates motor and cognitive functions and continuously regulates game difficulty. Exercise characteristics are continuously adapted according to the patients’ performances during the game. This study investigated whether this dynamic difficulty adjustment is optimal according to neurorehabilitation principles of variable practice and increasing difficulty (using as optimal success rate of 75%). Method: 9 stroke patients were enrolled in a 5-day protocol. Clinical and robot-based assessment (including Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT)) was done during the first two sessions. Then, every participant completed three 30 minutes sessions of RAT playing with ROBiGAME. Initial low level of game difficulty was set to be the same for every participant at the beginning of the first session. Patients’ performance and the serious game’s exercise characteristics were recorded throughout the sessions. Results: Motor difficulty parameters oscillate towards a steady state half-way through the first session (after 10 to 15 exercises) underlying a rapid adaptation of the system to every individual. In addition, mean success rates average 74,55% ±3% indicating an optimal success rate to maintain patients’ motivation. Finally, FMA and ARAT scores strongly correlated to haptic assistance indices (FMA:r=0,95 p<0,001; ARAT: r=0,87 p=0,005) showing that motor difficulty adapts well to the severity of patients’ motor impairment. Conclusions: This study demonstrates that continuous motor difficulty adjustment when using ROBiGAME is adapted to the patients’ degree of impairment and remains optimal throughout treatment. Further investigations on how cognitive parameters influence game difficulty adjustment and arm kinematics indices should be done

L’apport de nouvelles technologies dans la rééducation motrice et cognitive des patients cérébro-lésés

Suite à une lésion cérébrale, les troubles moteurs et cognitifs sont fréquents et leur rééducation constitue un réel défi pour les patients et les thérapeutes. Ces dernières années, la robotique et les jeux sérieux se sont fortement développés dans ce domaine afin d’augmenter la récupération fonctionnelle des patients. La robotique permet d’intensifier la thérapie, d’assister le mouvement du patient et de lui fournir un feedback. Quant aux jeux sérieux, ils rendent la rééducation ludique et motivante et le niveau de difficulté du jeu s’adapte continuellement aux performances du patient. Ces deux technologies complémentaires sont donc prometteuses dans la rééducation de patients cérébro-lésés

Action observation and imagery reduce hemineglect

Hemineglect significantly hinders the functional daily activities of patients. In the present study, we evaluated the efficacy of a new method for the rehabilitation of this condition using the Mirror Neuron System (MNS). The MNS shows co-activation by the execution, observation and imagination of actions. We aimed to investigate if action observation and imagination can prime attention in hemineglect. We tested five post-stroke patients with hemineglect. The study used a counterbalanced design. The experimental condition involved forty video clips of daily life actions starting in the center of the screen and then moving to the contralesional hemifield of the screen, and filmed from a first-person perspective. A white screen during which the patients had to imagine the actions they had just observed followed each clip. The control condition featured the same video clips as the experimental condition but flipped in a way that the actions were oriented to the ipsilesional hemifield. Each condition consisted of the viewing of the appropriate forty clips for four days in a row. The study lasted for four weeks, with five repeated measures of hemineglect severity across the period. All of the results were analyzed using single case 95% confidence interval analyses. Every patient showed a reduced hemineglect after the experimental condition on at least one measure, and this effect was absent or statistically lower in the control condition. In conclusion, the results from the study were encouraging for future research and for the development of potential clinical treatments for hemineglect rehabilitation

Action observation and imagination to reduce hemineglect : a pilot study

Hemineglect significantly hinders functional daily activities, and although treatments exist, none are completely effective. In the present study, we evaluated the efficacy of a new rehabilitation method using Mirror Neuron System (MNS) theory. We investigated if action observation and imagination could prime attention in hemineglect. We tested five patients with left hemineglect using a counterbalanced design. The experimental condition involved forty video clips of daily life first-person perspective actions (25 minutes) starting in the center of the screen and moving to the contralesional hemifield of the screen, followed by a white screen during which the patients had to imagine the actions that they had just observed. The control condition featured the same observation and imagination of video clips as the experimental condition, but flipped so that the actions were made to the ipsilesional hemifield. The study lasted for three weeks, with four repeated measures of hemineglect severity across the period. Results were analyzed using single case 95% confidence interval analyses. Every patient showed some reduced hemineglect on at least one measure following the experimental compared to the control condition. The results are discussed in terms of the development of new potential clinical treatments for hemineglect

Action observation and imagination to reduce hemineglect

Hemineglect is a condition where brain-damaged patients are impaired at perceiving contralesional objects and space. The condition significantly hinders functional daily activities, and although treatments exist, none are completely effective. In the present study, we evaluated the efficacy of a new rehabilitation method. Using Mirror Neuron System (MNS) theory of co-activation between action execution, observation and imagination, we investigated if action observation and imagination could prime attention in hemineglect. We tested five patients with hemineglect using a counterbalanced design. The experimental condition involved forty video clips of daily life first-person perspective actions (25 minutes) starting in the center of the screen and moving to the contralesional hemifield of the screen, followed by a white screen during which the patients had to imagine the actions that they had just observed. The control condition featured the same observation and imagination of video clips as the experimental condition, but flipped so that the actions were made to the ipsilesional hemifield. The study lasted for three weeks, with four repeated measures of hemineglect severity across the period. Results were analyzed using single case 95% confidence interval analyses. Every patient showed some reduced hemineglect on at least one measure following the experimental compared to the control condition. Moreover, patients having the most neglect-related difficulties in their daily life (Catherine Bergego scale) benefited the most from the rehabilitation method. The results are discussed in terms of the development of new potential clinical treatments for hemineglect