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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

Examples of hand velocity and distance from target from a representative patient. (A) Ideal movement, (B) attention loss at movement initiation, (C) repeated attention loss during a movement (pauses during motion).
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Figure 2: Examples of hand velocity and distance from target from a representative patient. (A) Ideal movement, (B) attention loss at movement initiation, (C) repeated attention loss during a movement (pauses during motion).

Mentions: Attention loss during a task is common following TBI. We examined whether attention loss occurred between discrete movements or during a movement. Kinematic analysis of arm movements revealed attention loss both before and during a reaching movement. Investigation of the arm velocity and distance from target indicated that some movements contained prolonged movement initiation and/or a pause (or multiple pauses) occurring during the course of the movement (Figure 2). Whereas this was evident during both visits, interestingly, on the second visit patients exhibited significantly less pauses (χ2(1) = 261, p < .0001) and shorter pause duration (repeated measures ANOVA: F(1,17) = 9.4, p = 0.007).


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)

Examples of hand velocity and distance from target from a representative patient. (A) Ideal movement, (B) attention loss at movement initiation, (C) repeated attention loss during a movement (pauses during motion).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Examples of hand velocity and distance from target from a representative patient. (A) Ideal movement, (B) attention loss at movement initiation, (C) repeated attention loss during a movement (pauses during motion).
Mentions: Attention loss during a task is common following TBI. We examined whether attention loss occurred between discrete movements or during a movement. Kinematic analysis of arm movements revealed attention loss both before and during a reaching movement. Investigation of the arm velocity and distance from target indicated that some movements contained prolonged movement initiation and/or a pause (or multiple pauses) occurring during the course of the movement (Figure 2). Whereas this was evident during both visits, interestingly, on the second visit patients exhibited significantly less pauses (χ2(1) = 261, p < .0001) and shorter pause duration (repeated measures ANOVA: F(1,17) = 9.4, p = 0.007).

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