Motor priming in virtual reality can augment motor-imagery training efficacy in restorative brain-computer interaction: a within-subject analysis

The use of Brain-Computer Interface (BCI) technology in neurorehabilitation provides new strategies to overcome stroke-related motor limitations. Recent studies demonstrated the brain's capacity for functional and structural plasticity through BCI. However, it is not fully clear how we can take full advantage of the neurobiological mechanisms underlying recovery and how to maximize restoration through BCI. In this study we investigate the role of multimodal virtual reality (VR) simulations and motor priming (MP) in an upper limb motor-imagery BCI task in order to maximize the engagement of sensory-motor networks in a broad range of patients who can benefit from virtual rehabilitation training.info:eu-repo/semantics/publishedVersio

An integrative framework for tailoring virtual reality based motor rehabilitation after stroke

Stroke is a leading cause of life-lasting motor impairments, undermining the quality of life of stroke survivors and their families, and representing a major chal lenge for a world population that is ageing at a dramatic rate. Important technologi cal developments and neuroscientific discoveries have contributed to a better under standing of stroke recovery. Virtual Reality (VR) arises as a powerful tool because it allows merging contributions from engineering, human computer interaction, reha bilitation medicine and neuroscience to propose novel and more effective paradigms for motor rehabilitation. However, despite evidence of the benefits of these novel training paradigms, most of them still rely on the choice of particular technologi cal solutions tailored to specific subsets of patients. Here we present an integrative framework that utilizes concepts of human computer confluence to 1) enable VR neu rorehabilitation through interface technologies, making VR rehabilitation paradigms accessible to wide populations of patients, and 2) create VR training environments that allow the personalization of training to address the individual needs of stroke patients. The use of these features is demonstrated in pilot studies using VR training environments in different configurations: as an online low-cost version, with a myo electric robotic orthosis, and in a neurofeedback paradigm. Finally, we argue about the need of coupling VR approaches and neurocomputational modelling to further study stroke and its recovery process, aiding on the design of optimal rehabilitation programs tailored to the requirements of each user.info:eu-repo/semantics/publishedVersio

Personalizing paper-and-pencil training for cognitive rehabilitation: a feasibility study with a web-based Task Generator

Cognitive impairments impose important limitations in the performance of activities of daily living. Although there is important evidence on cognitive rehabilitation benefits, its implementation is limited due to the demands in terms of time and human resources. Moreover, many cognitive rehabilitation interventions lack a solid theoretical framework in the selection of paper-and-pencil tasks by the clinicians. In this endeavor, it would be useful to have a tool that could generate standardized paper-and pencil tasks, customized according to patients’ needs. Combining the advantages of information and communication technologies (ICT’s) with a participatory design approach involving 20 health professionals, a novel web-tool for the generation of cognitive rehabilitation training was developed: the Task Generator (TG). The TG is a web-based tool that systematically addresses multiple cognitive domains, and easily generates highly personalized paper and-pencil training tasks. A clinical evaluation of the TG with twenty stroke patients showed that, by enabling the adaptation of task parameters and difficulty levels according to patient cognitive assessment, this tool provides a comprehensive cognitive training.info:eu-repo/semantics/publishedVersio

The Neurorehabilitation Training Toolkit (NTT): A Novel Worldwide Accessible Motor Training Approach for At-Home Rehabilitation after Stroke

After stroke, enduring rehabilitation is required for maximum recovery, and ideally throughout life to prevent functional deterioration. Hence we developed a new concept for at-home low-cost motor rehabilitation, the NTT, an Internet-based interactive system for upper-limb rehabilitation. In this paper we present the NTT design concepts, its implementation and a proof of concept study with 10 healthy participants. The NTT brings together concepts of optimal learning, engagement, and storytelling to deliver a personalized training to its users. In this study we evaluate the feasibility of NTT as a tool capable of automatically assessing and adapting to its user. This is achieved by means of a psychometric study where we show that the NTT is able to assess movement kinematics—movement smoothness, range of motion, arm displacement and arm coordination—in healthy users. Subsequently, a modeling approach is presented to understand how the measured movement kinematics relate to training parameters, and how these can be modified to adapt the training to meet the needs of patients. Finally, an adaptive algorithm for the personalization of training considering motivational and performance aspects is proposed. In the next phase we will deploy and evaluate the NTT with stroke patients at their homes

Virtual reality with customized positive stimuli in a cognitive-motor rehabilitation task: a feasibility study with subacute stroke patients with mild cognitive impairment

Virtual Reality applications for integrated cognitive and motor stroke rehabilitation show promise for providing more comprehensive rehabilitation programs. However, we are still missing evidence on its impact in comparison with standard rehabilitation, particularly in patients with cognitive impairment. Additionally, little is known on how specific stimuli in the virtual environment affect task performance and its consequence on recovery. Here we investigate the impact in stroke recovery of a virtual cognitive-motor task customized with positive stimuli, in comparison to standard rehabilitation. The positive stimuli were images based on individual preferences, and self-selected music (half of the sessions). 13 participants in the subacute stage of stroke, with cognitive and motor deficits, were allocated to one of two groups (VR, Control). Motor and cognitive outcomes were assessed at end of treatment (4-6 weeks) and at a 4-week followup. Both groups showed significant improvements over time in functional ability during task performance, but without changes in motor impairment. Cognitive outcomes were modest in both groups. For participants in the VR group, the score in the task was significantly higher in sessions with music. There were no statistical differences between groups at end of treatment and follow-up. The impact of VR therapy was lower than in similar studies with stroke patients without cognitive deficits. This study is a first step towards understanding how VR could be shaped to address the particular needs of this population.info:eu-repo/semantics/publishedVersio

Comparing adaptive cognitive training in virtual reality and paper-pencil in a sample of stroke patients

The growing number of people with cognitive deficits creates an urgent need for new cognitive training solutions. Paper-and-pencil tasks are still widely used for cognitive rehabilitation despite the proliferation of new computer-based methods, like VR-based simulations of ADL’s. The health professionals’ resistance in adopting new tools might be explained by the small number of validation trials. Studies have established construct validity of VR assessment tools with their paper-and-pencil versions by demonstrating significant associations with their traditional construct-driven measures. However, adaptive rehabilitation tools for intervention are mostly not equivalent to their counterpart paper-and-pencil versions, which makes it difficult to carry out comparative studies. Here we present a 12-session intervention study with 31 stroke survivors who underwent different rehabilitation protocols based on the same content and difficulty adaptation progression framework: 17 performed paper-and-pencil training with the Task Generator and 14 performed VR-based training with the Reh@City. Results have shown that both groups performed at the same level and there was not an effect of the training methodology in overall performance. However, the Reh@City enabled more intensive training, which may translate in more cognitive improvements.info:eu-repo/semantics/publishedVersio

Reh@City v2.0: a comprehensive virtual reality cognitive training system based on personalized and adaptive simulations of activities of daily living

Cognitive impairments are among the most common age-related disabilities worldwide. Literature has shown that cognitive training using Virtual Reality (VR) systems can be a valid and effective solution for cognitive rehabilitation. Virtual environments can be easily customized to deliver very specific training by controlling the presentation of stimuli and keeping track of the user responses. Reh@City (RC) is a virtual reality simulation of a city where patients can train a variety of cognitive skills while performing simulated activities of daily living. An initial prototype of this city with four environments was clinically validated with a stroke sample, and the encouraging results motivated further iterations and improvements in the RC, in terms of its tasks, interaction with the content, and task adaptation. This paper presents the efforts of creating RC v2.0, a VR-based software system for cognitive rehabilitation that presents different cognitive training tasks that take place in 8 realistically modeled 3D environments, that are personalized to the patient clinical profile and also implements automatic difficulty adaptation.info:eu-repo/semantics/publishedVersio

AI-Rehab: a framework for AI driven neurorehabilitation training - the profiling challenge

One of the health clinic challenges is rehabilitation therapy cognitive impairment that can happen after brain injury, dementia and in normal cognitive decline due to aging. Current cognitive rehabilitation therapy has been shown to be the most effective way to address this problem. However, a) it is not adaptive for every patient, b) it has a high cost, and c) it is usually implemented in clinical environments. The Task Generator (TG) is a free tool for the generation of cognitive training tasks. However, TG is not designed to adapt and monitor the cognitive progress of the patient. Hence, we propose in the BRaNT project an enhancement of TG with belief revision and machine learning techniques, gamification and remote monitoring capabilities to enable health professionals to provide a long-term personalized cognitive rehabilitation therapy at home. The BRaNT is an interdisciplinary effort that addresses scientific limitations of current practices as well as provides solutions towards the sustainability of health systems and contributes towards the improvement of quality of life of patients. This paper proposes the AI-Rehab framework for the BRaNT, explains profiling challenge in the situation of insufficient data and presents an alternate AI solutions which might be applicable once enough data is available.info:eu-repo/semantics/publishedVersio

Capturing expert knowledge for the personalization of cognitive rehabilitation: study combining computational modeling and a participatory design strategy

Background: Cognitive impairments after stroke are not always given sufficient attention despite the critical limitations they impose on activities of daily living (ADLs). Although there is substantial evidence on cognitive rehabilitation benefits, its implementation is limited because of time and human resource’s demands. Moreover, many cognitive rehabilitation interventions lack a robust theoretical framework in the selection of paper-and-pencil tasks by the clinicians. In this endeavor, it would be useful to have a tool that could generate standardized paper-and-pencil tasks, parameterized according to patients' needs. Objective: In this study, we aimed to present a framework for the creation of personalized cognitive rehabilitation tasks based on a participatory design strategy. Methods: We selected 11 paper-and-pencil tasks from standard clinical practice and parameterized them with multiple configurations. A total of 67 tasks were assessed according to their cognitive demands (attention, memory, language, and executive functions) and overall difficulty by 20 rehabilitation professionals. Results: After assessing the internal consistency of the data—that is, alpha values from .918 to .997—we identified the parameters that significantly affected cognitive functions and proposed specific models for each task. Through computational modeling, we operationalized the tasks into their intrinsic parameters and developed a Web tool that generates personalized paper-and-pencil tasks—the Task Generator (TG). Conclusions: Our framework proposes an objective and quantitative personalization strategy tailored to each patient in multiple cognitive domains (attention, memory, language, and executive functions) derived from expert knowledge and materialized in the TG app, a cognitive rehabilitation Web tool.info:eu-repo/semantics/publishedVersio

A comparison of two personalization and adaptive cognitive rehabilitation approaches: a randomized controlled trial with chronic stroke patients

Background: Paper-and-pencil tasks are still widely used for cognitive rehabilitation despite the proliferation of new computer-based methods, like VR-based simulations of ADL’s. Studies have established construct validity of VR assessment tools with their paper-and-pencil version by demonstrating significant associations with their traditional construct-driven measures. However, VR rehabilitation intervention tools are mostly developed to include mechanisms such as personalization and adaptation, elements that are disregarded in their paper-and-pencil counterparts, which is a strong limitation of comparison studies. Here we compare the clinical impact of a personalized and adapted paper-and-pencil training and a content equivalent and more ecologically valid VR-based ADL’s simulation. Methods: We have performed a trial with 36 stroke patients comparing Reh@City v2.0 (adaptive cognitive training through everyday tasks VR simulations) with Task Generator (TG: content equivalent and adaptive paper-and-pencil training). The intervention comprised 12 sessions, with a neuropsychological assessment pre, post-intervention and follow-up, having as primary outcomes: general cognitive functioning (assessed by the Montreal Cognitive Assessment - MoCA), attention, memory, executive functions and language specific domains. Results: A within-group analysis revealed that the Reh@City v2.0 improved general cognitive functioning, attention, visuospatial ability and executive functions. These improvements generalized to verbal memory, processing speed and self-perceived cognitive deficits specific assessments. TG only improved in orientation domain on the MoCA, and specific processing speed and verbal memory outcomes. However, at follow-up, processing speed and verbal memory improvements were maintained, and a new one was revealed in language. A between-groups analysis revealed Reh@City v2.0 superiority in general cognitive functioning, visuospatial ability, and executive functions on the MoCA. Conclusions: The Reh@City v2.0 intervention with higher ecological validity revealed higher effectiveness with improvements in different cognitive domains and self-perceived cognitive deficits in everyday life, and the TG intervention retained fewer cognitive gains for longer.info:eu-repo/semantics/publishedVersio