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RehAtt – scanning training for neglect enhanced by multi-sensory stimulation in Virtual Reality
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.ORCID iD: 0000-0003-1650-8856
Umeå University, Faculty of Science and Technology, Department of Computing Science. Umeå University, Faculty of Science and Technology, High Performance Computing Center North (HPC2N).ORCID iD: 0000-0002-4748-0086
Umeå University, Faculty of Medicine, Department of Radiation Sciences.ORCID iD: 0000-0002-2031-722X
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.ORCID iD: 0000-0001-6451-1940
2016 (English)In: Topics in Stroke Rehabilitation, ISSN 1074-9357, E-ISSN 1945-5119, Vol. 23, no 3, p. 191-199Article in journal (Refereed) Published
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Text
Abstract [en]

Background: There is a lack of effective treatment for neglect. We have developed a new training method, RehAtt (TM). The objective of this study was to determine whether RehAtt (TM) improves spatial attention in chronic neglect after stroke. Methods: RehAtt (TM) consists of a computer with monitor, 3D glasses, and a force feedback interface (Robotic pen) giving sensory motor activation to the contra-lesional arm. The software combines visual scanning training with multi-sensory stimulation in 3D virtual reality (VR) game environment. Fifteen stroke patients with chronic neglect (duration > 6 month) had repeated baseline evaluations to confirm stability of symptoms. There were no test-retest effects for any of the tests. Thereafter, all patients trained 15 h in RehAtt (TM) (3 x 1 h for 5 weeks). A neglect test battery and Catherine Bergego Scale, CBS, were used to assess behavioral outcome after intervention. CBS was also used at a 6-month follow-up. Results: Using repeated measurement analysis improvements due to the training were found for Star cancellation test (p = 0.006), Baking tray task (p < 0.001), and Extinction test (p = 0.05). In the Posner task improvements were seen fewer missed targets (p = 0.024). CBS showed improvements in activities of daily life immediately after training (p < 0.01). After 6 months the patients still reported improvement in CBS. Conclusion: RehAtt (TM) is a new concept for rehabilitation of neglect. Training with the VR-method improved spatial attention and showed transfer to improved spatial attention in activities of daily living in chronic neglect. Our results are promising and merit further studies.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2016. Vol. 23, no 3, p. 191-199
Keywords [en]
Spatial neglect, Cognitive rehabilitation, Attention, treatment, virtual reality, stroke
National Category
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-121621DOI: 10.1080/10749357.2016.1138670ISI: 000375149700007PubMedID: 27077985OAI: oai:DiVA.org:umu-121621DiVA, id: diva2:940154
Available from: 2016-06-20 Created: 2016-06-03 Last updated: 2018-06-07Bibliographically approved
In thesis
1. Virtual Reality for Enriched Rehabilitation of Stroke Patients with Spatial Neglect: Diagnostics and the Rehabilitation Effect on Spatial Attention and Neuronal Activity
Open this publication in new window or tab >>Virtual Reality for Enriched Rehabilitation of Stroke Patients with Spatial Neglect: Diagnostics and the Rehabilitation Effect on Spatial Attention and Neuronal Activity
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Virtual reality-förstärkt rehabilitering för strokepatienter med spatialt neglekt : diagnostik och utvärdering av rehabiliteringseffekt på spatial uppmärksamhet och neuronal aktivitet
Abstract [en]

Background: Approximately a third of all stroke patients develop spatial neglect, a debilitating symptom associated with poor outcome. Spatial neglect is clinically defined as a deficit in processing and responding to stimuli presented on the contralesional side of the body, or the space surrounding that side of the body. The heterogenetic, multi-sensory nature of the symptoms renders it difficult to diagnose and treat; therefor effective methods for screening and intervention for neglect are needed. Virtual reality (VR) is a method of brain–computer interaction that involves realtime simulation of an environment, scenario or activity that allows for user interaction and targets multiple senses. We hypothesize that VR can facilitate identification of spatial neglect in stroke patients and that training with this interface will improve patient’s functional outcome, through stimulation to neuronal networks including those controlling attention.

Objective: The objective was to construct and validate a computerized test battery for spatial neglect and to investigate its usability in stroke patients. Also to design and develop a VR rehabilitation method for spatial neglect and to evaluate its effects on spatial attention and on neuronal activity in the brain.

Method: We designed, developed and evaluated a new concept for assessment (VR-DiSTRO®) and training (RehAtt®) of spatial attention, using VR technology. The hardware consisted of a PC, monitor, 3D-glasses and a force feedback device to control the tasks (i.e., a robotic pen). The software enabled targets to be moved, rotated and manipulated in the 3D environment using the robotic pen. RehAtt® made it possible to combine intense visual scanning training, multi-sensory stimulation (i.e., audio, visual, tactile) and sensory-motor activation of the contralesional arm. In a first study on 31 stroke patients we performed a construct validation of VR-DiSTRO® against Rivermead Behavioural Test Battery (BIT) and investigated the usability. In a second study, 15 subjects with chronic spatial neglect (symptoms >6 month) had self-training, 3 x 1 hour for 5 weeks using RehAtt®. Outcome were measured by changes in neglect tests and in Cathrine Bergego Scale (CBS). Training-related changes in neuronal activity of the brain was studied using fMRI during task and in resting state.

Results: VR-DiSTRO® correctly identified all patients with neglect. The sensitivity was 100% and the specificity 82% for VR-DiSTRO® compared to BIT. Usability was high and no side-effects were noted. Using repeated measurement analysis, improvements due to the RehAtt® intervention were found for Baking tray task (p < 0.001), Star cancellation test (p = 0.006) and Extinction test (p = 0.05). Improvements were also seen in the Posner task as fewer missed targets (p = 0.024). Improvement in activities of daily living (CBS) was shown immediately after training (p < 0.01) and patients still reported improvement at 6 months follow-up. Trainingrelated changes in neuronal activity were seen as an increased task-evoked brain activity in prefrontal and temporal cortex, mainly outside the attention network but in related cortical areas. During resting state, changes in network connectivity were seen after intervention with RehAtt® in the Dorsal Attention Network (DAN) and interhemispheric connectivity.

Conclusion: VR-DiSTRO® identified visuospatial neglect in stroke patients quickly and with a high accuracy. RehAtt® training improved in spatial attention in chronic neglect with transfer to functions in daily living. Increased neuronal brain activity was found in and between attention networks and related brain structures. This could represent a compensatory effect in addition to sign of a restorative effect from the RehAtt training. The results obtained in this study are promising, encourage further development of the methods and merit for further studies.

Place, publisher, year, edition, pages
Umeå universitet, 2017. p. 77
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1929
Keywords
Stroke, spatial neglect, rehabilitation, virtual reality, enriched environment, fMRI
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-141920 (URN)978-91-7601-792-0 (ISBN)
Public defence
2017-12-08, Sal E04, R1, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Funder
Västerbotten County CouncilEU, FP7, Seventh Framework Programme
Available from: 2017-11-16 Created: 2017-11-15 Last updated: 2018-06-09Bibliographically approved

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Fordell, HelenaBodin, KennethEklund, AndersMalm, Jan

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