Cognitive rehabilitation through interactive technologies: a randomized controlled trial with stroke patients (Best Communication Prize)
Stroke is one of the main causes of acquired adult disability worldwide, leaving more than 40% of survivors with cognitive impairments associated with higher mortality and greater rates of institutionalization. Rehabilitation of post-stroke cognitive impairment is generally limited by the use of paper-and-pencil methodologies, insufficient training personalization, and suboptimal intensity because of human resources. Virtual Reality (VR) tools have shown potential for improving cognitive rehabilitation by supporting carefully personalized, ecologically valid tasks through accessible technologies. Despite important progress in VR-based cognitive rehabilitation, there is still a need for the validation of key principles in clinical trials. In this work we present a one-month randomized controlled trial with 18 stroke patients: 9 performing a VR-based intervention and 9 performing a traditional intervention.
The VR-based intervention involved a virtual simulation of a city (RehabCity) where memory, attention, executive functions and language tasks are integrated in the performance of several activities of daily living. All participants were assessed pre and post-interventions with Addenbrooke Cognitive Examination, Trail Making Test A and B, Picture Completion from WAIS-III and Stroke Impact Scale. Additionally, the VR group answered the System Usability to evaluate the usability of the RehabCity.
A within groups analysis revealed significant improvements (Wilcoxon, p<.05) in global cognitive functioning, attention, memory (assessed and self-reported), visuo-spatial abilities, executive functions, emotion and overall recovery in the VR group. The control group improved in self-reported memory and social participation. A between groups analysis, showed significantly greater improvements (Mann-Whitney, p<.05) in global cognitive functioning, attention and executive functions when comparing VR to traditional therapy, which improvements were only in global cognitive functioning and attention. Finally, RehabCity obtained good levels of usability (Mdn=80/100). The results of this study suggest that cognitive rehabilitation, through an ecologically valid VR system, has more impact than standard methods.