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A "virtually minimal" visuo-haptic training of attention in severe traumatic brain injury.

Dvorkin AY, Ramaiya M, Larson EB, Zollman FS, Hsu N, Pacini S, Shah A, Patton JL - J Neuroeng Rehabil (2013)

Bottom Line: However, patients exhibited attention loss both before (prolonged initiation) and during (pauses during motion) a movement.Compared to no haptic feedback, patients benefited from haptic nudge cues but not break-through forces.As training progressed, patients increased the number of targets acquired and spontaneously improved from one day to the next.

View Article: PubMed Central - HTML - PubMed

Affiliation: Rehabilitation Institute of Chicago, 345 E, Superior Street, Chicago, IL 60611, USA. sasaf@vms.huji.ac.il

ABSTRACT

Background: Although common during the early stages of recovery from severe traumatic brain injury (TBI), attention deficits have been scarcely investigated. Encouraging evidence suggests beneficial effects of attention training in more chronic and higher functioning patients. Interactive technology may provide new opportunities for rehabilitation in inpatients who are earlier in their recovery.

Methods: We designed a "virtually minimal" approach using robot-rendered haptics in a virtual environment to train severely injured inpatients in the early stages of recovery to sustain attention to a visuo-motor task. 21 inpatients with severe TBI completed repetitive reaching toward targets that were both seen and felt. Patients were tested over two consecutive days, experiencing 3 conditions (no haptic feedback, a break-through force, and haptic nudge) in 12 successive, 4-minute blocks.

Results: The interactive visuo-haptic environments were well-tolerated and engaging. Patients typically remained attentive to the task. However, patients exhibited attention loss both before (prolonged initiation) and during (pauses during motion) a movement. Compared to no haptic feedback, patients benefited from haptic nudge cues but not break-through forces. As training progressed, patients increased the number of targets acquired and spontaneously improved from one day to the next.

Conclusions: Interactive visuo-haptic environments could be beneficial for attention training for severe TBI patients in the early stages of recovery and warrants further and more prolonged clinical testing.

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Related in: MedlinePlus

Apparatus and design of break-through force. (A) Screen shot of an individual performing within the VRROOM system. (B) The change in force as a function of distance from the target center for the break-through condition.
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Figure 1: Apparatus and design of break-through force. (A) Screen shot of an individual performing within the VRROOM system. (B) The change in force as a function of distance from the target center for the break-through condition.

Mentions: The VRROOM (Virtual Reality and Robotics Optical Operations Machine), a three-dimensional haptics/graphics system was used for this study. A cinema-quality digital projector (Christie Mirage 3000 DLP) displayed the images over five-foot-wide 1280x1024 pixel image resulting in a 110° wide viewing angle [19]. A 6-degree of freedom PHANToM Premium 3.0 robot (SensAble Technologies) was used to measure arm movement and apply forces during movement. The correct perspective and stereo projections for the view of the scene were computed using values for the current position and orientation of the head (6 DOF) supplied at 100 Hz by a tracking sensor (‘Flock of birds’, Ascension Technology) attached to the stereo shutter glasses worn by the subject (Crystal Eyes, StereoGraphics Inc.). The immersive virtual environment had no background textures and included only a cursor and a target (generated as 3D virtual ball-shaped targets with a 4.5 cm radius) in the field of view. Targets appeared one at a time at various locations and could be both seen (using VR technology) and felt (using robotics to render haptic sensation) (Figure 1A). Patients sat in a dark room on a chair placed in front of the VRROOM system, grasping the handle of the robot with their hand. The VRROOM is capable of recording events occurring in the scene (e.g., appearance of a target), as well as the subject’s arm and head position in space at any given time.


A "virtually minimal" visuo-haptic training of attention in severe traumatic brain injury.

Dvorkin AY, Ramaiya M, Larson EB, Zollman FS, Hsu N, Pacini S, Shah A, Patton JL - J Neuroeng Rehabil (2013)

Apparatus and design of break-through force. (A) Screen shot of an individual performing within the VRROOM system. (B) The change in force as a function of distance from the target center for the break-through condition.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750632&req=5

Figure 1: Apparatus and design of break-through force. (A) Screen shot of an individual performing within the VRROOM system. (B) The change in force as a function of distance from the target center for the break-through condition.
Mentions: The VRROOM (Virtual Reality and Robotics Optical Operations Machine), a three-dimensional haptics/graphics system was used for this study. A cinema-quality digital projector (Christie Mirage 3000 DLP) displayed the images over five-foot-wide 1280x1024 pixel image resulting in a 110° wide viewing angle [19]. A 6-degree of freedom PHANToM Premium 3.0 robot (SensAble Technologies) was used to measure arm movement and apply forces during movement. The correct perspective and stereo projections for the view of the scene were computed using values for the current position and orientation of the head (6 DOF) supplied at 100 Hz by a tracking sensor (‘Flock of birds’, Ascension Technology) attached to the stereo shutter glasses worn by the subject (Crystal Eyes, StereoGraphics Inc.). The immersive virtual environment had no background textures and included only a cursor and a target (generated as 3D virtual ball-shaped targets with a 4.5 cm radius) in the field of view. Targets appeared one at a time at various locations and could be both seen (using VR technology) and felt (using robotics to render haptic sensation) (Figure 1A). Patients sat in a dark room on a chair placed in front of the VRROOM system, grasping the handle of the robot with their hand. The VRROOM is capable of recording events occurring in the scene (e.g., appearance of a target), as well as the subject’s arm and head position in space at any given time.

Bottom Line: However, patients exhibited attention loss both before (prolonged initiation) and during (pauses during motion) a movement.Compared to no haptic feedback, patients benefited from haptic nudge cues but not break-through forces.As training progressed, patients increased the number of targets acquired and spontaneously improved from one day to the next.

View Article: PubMed Central - HTML - PubMed

Affiliation: Rehabilitation Institute of Chicago, 345 E, Superior Street, Chicago, IL 60611, USA. sasaf@vms.huji.ac.il

ABSTRACT

Background: Although common during the early stages of recovery from severe traumatic brain injury (TBI), attention deficits have been scarcely investigated. Encouraging evidence suggests beneficial effects of attention training in more chronic and higher functioning patients. Interactive technology may provide new opportunities for rehabilitation in inpatients who are earlier in their recovery.

Methods: We designed a "virtually minimal" approach using robot-rendered haptics in a virtual environment to train severely injured inpatients in the early stages of recovery to sustain attention to a visuo-motor task. 21 inpatients with severe TBI completed repetitive reaching toward targets that were both seen and felt. Patients were tested over two consecutive days, experiencing 3 conditions (no haptic feedback, a break-through force, and haptic nudge) in 12 successive, 4-minute blocks.

Results: The interactive visuo-haptic environments were well-tolerated and engaging. Patients typically remained attentive to the task. However, patients exhibited attention loss both before (prolonged initiation) and during (pauses during motion) a movement. Compared to no haptic feedback, patients benefited from haptic nudge cues but not break-through forces. As training progressed, patients increased the number of targets acquired and spontaneously improved from one day to the next.

Conclusions: Interactive visuo-haptic environments could be beneficial for attention training for severe TBI patients in the early stages of recovery and warrants further and more prolonged clinical testing.

Show MeSH
Related in: MedlinePlus