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

Ana Lúcia Faria, Maria Salomé Pinho, Sergi Bermúdez I Badia, Ana Lúcia Faria, Maria Salomé Pinho, Sergi Bermúdez I Badia

Abstract

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.

Trial registration: The trial is registered at ClinicalTrials.gov, number NCT02857803. Registered 5 August 2016, .

Keywords: Cognitive rehabilitation; Ecological validity; Stroke; Virtual reality.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Protocol of the intervention
Fig. 2
Fig. 2
TG training personalization parameters (on the left) and Association task generation example (on the right)
Fig. 3
Fig. 3
Reh@City v2.0 task examples: a buying food in the supermarket; b making payments at the bank ATM; c playing a cards game at the park and; d setting the table at home
Fig. 4
Fig. 4
Reh@city v2.0 three-dimensional street view. Users are given goal instructions supported with a mini-map indicating the optimal path and a street arrow. Time and point counters are used to provide feedback on performance
Fig. 5
Fig. 5
Reh@City v2.0 training personalization parameters according to MoCA total and subdomains score
Fig. 6
Fig. 6
Reh@City v2.0 experimental setup. The user faces an LCD monitor and moves a handle on the surface of the table with his/her paretic arm to interact with the virtual content

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