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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

Effects of haptic feedback type on performance. (A) Normalized number of targets acquired per haptic feedback type. Mean (±SE) and individual subject data, collapsed across visits. (B) Hand velocity and distance from target from a representative patient during the haptic nudge condition. Patient completed the movement after receiving a haptic nudge. (C) Hand path from a representative patient during the break-through condition, showing how the cursor moved on the surface of the force boundary before penetrating the target.
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Figure 3: Effects of haptic feedback type on performance. (A) Normalized number of targets acquired per haptic feedback type. Mean (±SE) and individual subject data, collapsed across visits. (B) Hand velocity and distance from target from a representative patient during the haptic nudge condition. Patient completed the movement after receiving a haptic nudge. (C) Hand path from a representative patient during the break-through condition, showing how the cursor moved on the surface of the force boundary before penetrating the target.

Mentions: Figure 3A shows the mean and individual subject data for each condition, collapsed across visits, calculated by subtracting the number of targets acquired from the no force condition. To investigate the effect of force type for each visit, a two-way repeated measures ANOVA (visit x force type) was conducted. A significant main effect of visit (F(1,17) = 437, p < 0.0001) was found, indicating that patients acquired more targets on the second visit. This held true for all three force conditions. In addition, a significant main effect of force type (F(2,34) = 16.4, p < 0.0001) was found, with no interaction. Bonferroni post-hoc test indicated that for the first visit, the break-through and no force were different than the nudge (p < 0.02), and resulted in less targets acquired compared to the nudge. Break-through and no force however were not different from each other. For the second visit, the nudge and no force were different than the break-through (p < 0.002), and resulted in more targets acquired compared to the break-through. Nudge and no force were not different from each other.


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)

Effects of haptic feedback type on performance. (A) Normalized number of targets acquired per haptic feedback type. Mean (±SE) and individual subject data, collapsed across visits. (B) Hand velocity and distance from target from a representative patient during the haptic nudge condition. Patient completed the movement after receiving a haptic nudge. (C) Hand path from a representative patient during the break-through condition, showing how the cursor moved on the surface of the force boundary before penetrating the target.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Effects of haptic feedback type on performance. (A) Normalized number of targets acquired per haptic feedback type. Mean (±SE) and individual subject data, collapsed across visits. (B) Hand velocity and distance from target from a representative patient during the haptic nudge condition. Patient completed the movement after receiving a haptic nudge. (C) Hand path from a representative patient during the break-through condition, showing how the cursor moved on the surface of the force boundary before penetrating the target.
Mentions: Figure 3A shows the mean and individual subject data for each condition, collapsed across visits, calculated by subtracting the number of targets acquired from the no force condition. To investigate the effect of force type for each visit, a two-way repeated measures ANOVA (visit x force type) was conducted. A significant main effect of visit (F(1,17) = 437, p < 0.0001) was found, indicating that patients acquired more targets on the second visit. This held true for all three force conditions. In addition, a significant main effect of force type (F(2,34) = 16.4, p < 0.0001) was found, with no interaction. Bonferroni post-hoc test indicated that for the first visit, the break-through and no force were different than the nudge (p < 0.02), and resulted in less targets acquired compared to the nudge. Break-through and no force however were not different from each other. For the second visit, the nudge and no force were different than the break-through (p < 0.002), and resulted in more targets acquired compared to the break-through. Nudge and no force were not different from each other.

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