Improving brain injury cognitive rehabilitation by personalized telerehabilitation services: Guttmann neuropersonal trainer

Cognitive rehabilitation aims to remediate or alleviate the cognitive deficits appearing after an episode of acquired brain injury (ABI). The purpose of this work is to describe the telerehabilitation platform called Guttmann Neuropersonal Trainer (GNPT) which provides new strategies for cognitive rehabilitation, improving efficiency and access to treatments, and to increase knowledge generation from the process. A cognitive rehabilitation process has been modeled to design and develop the system, which allows neuropsychologists to configure and schedule rehabilitation sessions, consisting of set of personalized computerized cognitive exercises grounded on neuroscience and plasticity principles. It provides remote continuous monitoring of patient's performance, by an asynchronous communication strategy. An automatic knowledge extraction method has been used to implement a decision support system, improving treatment customization. GNPT has been implemented in 27 rehabilitation centers and in 83 patients' homes, facilitating the access to the treatment. In total, 1660 patients have been treated. Usability and cost analysis methodologies have been applied to measure the efficiency in real clinical environments. The usability evaluation reveals a system usability score higher than 70 for all target users. The cost efficiency study results show a relation of 1-20 compared to face-to-face rehabilitation. GNPT enables brain-damaged patients to continue and further extend rehabilitation beyond the hospital, improving the efficiency of the rehabilitation process. It allows customized therapeutic plans, providing information to further development of clinical practice guidelines

Intelligent Therapy Assistant (ITA) for cognitive rehabilitation in patients with Acquired Brain Injury

This paper presents the design, development and first evaluation of an algorithm, named Intelligent Therapy Assistant (ITA), which automatically selects, configures and schedules rehabilitation tasks for patients with cognitive impairments after an episode of Acquired Brain Injury. The ITA is integrated in "Guttmann, Neuro Personal Trainer" (GNPT), a cognitive tele-rehabilitation platform that provides neuropsychological services

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Content-based image retrieval system for brain magnetic resonance imaging based on pseudo-zernike coefficients combined with wavelet features

Content-based image retrieval system for brain magnetic resonance imaging based on pseudo-zernike coefficients combined with wavelet feature

Automated landmark registration in neuroimaging

Automated Landmark Registration in Neuroimagin

CogniVis: 3d visualization and navigation module of brain structures

The 3D visualization of brain anatomy plays an important role in the field of medical research, allowing to spatial locate anatomical structures in order to analyze them from different points of view and find the relationships between them. Several research groups have developed tools that allow three-dimensional visualization and navigation on brain models [1]. Amongst the most significant tools, 3Dslicer [2], Brain Voyager [3], and FreeSurfer [4] can be mentioned. However, to the authors’ knowledge there is no a 3D visualization tool capable of working with multiple brain atlas and specifically designed both for researchers and clinicians. In this paper we present Cognivis, a module for 3D neuroimage visualization and navigation designed and implemented as part of a national Spanish project named COGNITIO

Estudio de validación preclínica de un entorno de rehabilitación cognitiva basado en vídeo interactivo y eye-tracking

Los entornos virtuales interactivos pueden ser utilizados para reproducir situaciones de la vida real. Su incorporación al proceso de rehabilitación cognitiva permite implementar estrategias de intervención terapéutica sobre actividades de vida diaria. Se busca incrementar la validez ecológica del tratamiento de forma sostenible y segura, a través de intervenciones no presencial, asíncrona y dentro de un contexto controlado. En trabajos previos se presentó un entorno de rehabilitación que, basado en las tecnologías de vídeo interactivo y eye-tracking, sirviera de soporte al desarrollo de este tipo de tratamientos. El presente trabajo de investigación tiene por objetivo evaluar dicho entorno de rehabilitación como paso previo a su uso clínico. Para ello se realiza un estudio experimental con la participación de dos grupos de sujetos: sanos y pacientes con daño cerebral. El análisis de los resultados extraídos de dicho estudio demuestra la viabilidad del uso del entorno por pacientes con déficit cognitivo y el potencial del mismo para intervenir y monitorizar el comportamiento de sujetos en actividades de vida diaria reproducidas sobre un entorno virtual interactivo

Módulo de clasificación de estructuras anatómicas del cerebro basado en el análisis multiparamétrico de imágenes de resonancia magnética en la herramienta CogniVis

En este trabajo de investigación se describe la metodología utilizada para la segmentación y clasificación de estructuras anatómicas cerebrales en la herramienta de visualización y navegación CogniVis. Dicha metodología utiliza algoritmos de registros 3D entre nubes de puntos generadas en estudios de resonancia magnética de pacientes y modelos generados con el atlas cerebral LPBA40 para obtener un modelo tridimensional del cerebro del paciente con las estructuras anatómicas segmentadas lo que sirve de ayuda y soporte a la decisión clínica

Diseño y desarrollo de un sistema de evaluación de déficits atencionales en pacientes con DCA mediante técnicas de eye-tracking

El objetivo principal de este trabajo es el diseño e implementación de una herramienta que permita la evaluación de déficits atencionales en pacientes con Daño Cerebral Adquirido (DCA), integrando un dispositivo de eye-tracking en una tarea de rehabilitación por ordenador. La tarea utilizada para la evaluación de déficits atencionales ha sido definida por expertos neuropsicólogos del Institut Guttmann, y consiste en una secuencia de pantallas donde se muestran parejas de imágenes, que pueden ser idénticas o bien presentar alguna mínima diferencia. El usuario deberá responder en cada pantalla si las imágenes son iguales o no hasta completar el total de 30 pantallas. Además, el dispositivo de eye-tracking integrado nos aportará información sobre la atención visual, sabiendo en todo momento dónde mira el usuario y cuál es su estrategia para buscar y encontrar las diferencias. En este trabajo se presentan los resultados preliminares tras analizar la ejecución de 18 sujetos control utilizados para validar el entorno de monitorización. Aparte de analizar dónde fijan los usuarios su atención visual, se ha analizado el tiempo de respuesta y, por último, si se produce algún tipo de aprendizaje a lo largo de la tarea