Limits...
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.

Show MeSH

Related in: MedlinePlus

Mean (±SE) number of targets acquired across the 12 blocks of trials (6 blocks per visit).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3750632&req=5

Figure 4: Mean (±SE) number of targets acquired across the 12 blocks of trials (6 blocks per visit).

Mentions: Patients completed 6 blocks of trials each visit (total of 12 blocks). Analysis of the number of targets acquired as the study progressed (across the 12 blocks of trials) showed a clear improvement over the two visits (Figure 4). A two-way repeated measures ANOVA (visit x block number) revealed a significant increase in the number of targets acquired, suggesting that patients benefited from practice across blocks. Analysis revealed a main effect of visit (F(1,17) = 20.2, p = 0.0003), and a main effect of block number (F(5,85) = 8.95, p < 0.0001), but this was especially true for the first visit (F(5,85) = 10.28, p < 0.0001). Analysis also revealed an interaction (F(5,85) = 4.64, p = 0.0009). Bonferroni post-hoc test indicated that number of targets acquired was significantly lower for the first two blocks than for the other blocks (p < 0.005).


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)

Mean (±SE) number of targets acquired across the 12 blocks of trials (6 blocks per visit).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Mean (±SE) number of targets acquired across the 12 blocks of trials (6 blocks per visit).
Mentions: Patients completed 6 blocks of trials each visit (total of 12 blocks). Analysis of the number of targets acquired as the study progressed (across the 12 blocks of trials) showed a clear improvement over the two visits (Figure 4). A two-way repeated measures ANOVA (visit x block number) revealed a significant increase in the number of targets acquired, suggesting that patients benefited from practice across blocks. Analysis revealed a main effect of visit (F(1,17) = 20.2, p = 0.0003), and a main effect of block number (F(5,85) = 8.95, p < 0.0001), but this was especially true for the first visit (F(5,85) = 10.28, p < 0.0001). Analysis also revealed an interaction (F(5,85) = 4.64, p = 0.0009). Bonferroni post-hoc test indicated that number of targets acquired was significantly lower for the first two blocks than for the other blocks (p < 0.005).

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