11th Congresso Nacional de Psicologia da Saúde

In the 28th of January I presented the following paper at the 11th Congresso Nacional de Psicologia da Saúde in Lisbon: Faria, A. L., Pinho, M., & Bermudez i Badia, S. (2016). Do papel-e-lápis à realidade virtual: uma nova abordagem para reabilitação cognitiva personalizada.

The congress proceedings can be found following this link: http://11cnps.iscte-iul.pt/sites/default/files/docs/livro_atas.pdf


I International Congress of Neuropsychological Rehabilitation in Acquired Brain Injury (Oporto, Portugal)

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.


Rehab 2015: 3rd workshop on ICT’s for improving patients rehabilitation research techniques (Lisbon, Portugal)

Development and evaluation of a web-based cognitive task generator for personalized cognitive training: a proof of concept study with stroke patients

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 time and human resources demands. 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, parameterized according to patients’ needs. In this paper, we combine the advantages of information and communication technologies with a participatory design approach with 20 health professionals to develop a novel cognitive rehabilitation web-tool: the NeuroRehabLab Task Generator (NTG). The NTG is a free and online available tool that systematically addresses multiple cognitive domains, and easily generates highly personalized paper-and-pencil training tasks. A field evaluation of the NTG with ten stroke patients showed moderate and strong correlations of patients’ task performance with their cognitive assessment in multiple cognitive domains. That is, corroborating its usefulness both as an assessment and as rehabilitation tool.


International Conference on Virtual Rehabilitation 2015 (Valencia, Spain)

The benefits of emotional stimuli in a virtual reality cognitive and motor rehabilitation task – Assessing the impact of positive, negative and neutral stimuli with stroke patients

VR-based methods for stroke rehabilitation have mainly focused on motor rehabilitation, but there is increasing interest towards the integration of cognitive training for providing more ecologically valid solutions. However, more studies are needed, especially in the definition of which type of content should be used in the design of these tools. One possibility is the use of emotional stimuli, which are known to enhance attentional processes. According to the Socio-emotional Selectivity Theory, as people age, this emotional salience arises for positive and neutral, but not for negative stimuli. Conversely, negative stimuli can be better remembered. In this study, we investigated the impact of using emotional stimuli with positive, negative and neutral valence in a VR cognitive and motor attention task. Ten stroke patients participated in a within-subjects experiment with four conditions based on the type of stimuli: abstract (control condition), positive, negative and neutral. The main task consisted of finding a target stimulus, shown for only two seconds, among fourteen neutral distractors. Eye movements were recorded with an eye-tracking system to investigate differences between conditions and in search patterns. Subsequently, a recall task took place and the patients had to identify all the target images among a valence-matched number of distractors. Our results corroborate the attention salience effect of positive and neutral stimuli in the VR task performance. Although we found no statistically significant differences between conditions in the recall task, there was a trend for recalling more negative images. This negative advantage comes at the expense of significantly more wrongly identified images/false memories for negative stimuli. Finally, we perform an analysis in which we relate performance scores with well-established cognitive assessment instruments, which supports the use of this approach both for assessment and rehabilitation purposes.

2015-06-10 11.01.54

2015-06-10 11.17.18

10th International Conference on Disability, Virtual Reality and Associated Technologies (Gothenburg, Sweden)

An integrative virtual reality cognitive-motor intervention approach in stroke rehabilitation: a pilot study (Best Student Paper Commendation)

ABSTRACT: Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patient’s capability to live independently. In post- stroke it is imperative to initiate a process of intensive rehabilitation and personalized objectives to maximize functional cognitive and motor recovery. Virtual Reality (VR) technology is being widely applied to rehabilitation of stroke, however, not in an integrative manner. Like traditional rehabilitation, these new tools mostly focus either in the cognitive or in the motor domain, which can take to a reduced impact in the performance of activities of daily living, most of them dual- task. Assuming the existence of cognitive and motor recovery interdependence, RehabNet proposes a holistic approach. Here we present a one-month long pilot study with three stroke patients whose training was a game-like VR version of the Toulouse-Piéron cancellation test, adapted to be performed by repetitive arm reaching movements. A standardized motor and cognitive assessment was performed pre and post intervention. The first results on this intervention support a holistic model for rehabilitation of stroke patients, sustaining interdependence on cognitive and motor recovery. Furthermore, we observed that the impact of the integrative VR approach generalizes to the performance of the activities of daily living.