Stroke Clinical Trial
Official title:
Assessment and Training Visio Spatial Neglect in a Virtual Reality Environment
There is a lack of effective rehabilitation methods for visio-spatial neglect (VSN). By
using virtual technology, a new method (virtual reality, VR method) has been created which
focuses on stimulating attention networks: top down scanning training in a 3D game, combined
with intense visual, audio and tactile bottom-up stimulation, also including visuo-motor
training.
Objective. To evaluate clinical and functional improvement in stroke patients with VSN, as
well as before and after training with the new VR method Method:- An intense visio spatial
scanning training, enhanced by directed visual, audio and tactile stimulation cues and
feedback, also including visio-motor activation was designed in a VR game. The in-house
developed software was based on the Tetris game. The VR method consists of an interactive 3D
environment: a desktop computer, a monitor, 3D glasses and a force feedback interface. 15
patients with chronic (>6 months) visio spatial neglect was included due to right-sided
ischemia. A VR neglect test battery including a Posner task were repeated three times during
a 5 weeks baseline before the training started (to establish the chronic state) and again
after 15 hours training (3x1 h for 5 weeks). Evaluation of a new method for training
attention after stroke causing visio spatial neglect.
The method has been designed for home rehabilitation and is well suited for a tele-medicine
approach. It was built with standard components and is easy to manufacture at a low cost.
The idea is to give access to effective training, to make it available at the stroke unit
with the possibility for the patient to loan it it at discharge for home rehabilitation. The
concept of an all in one, easy-to-use device for testing, training and outcome evaluation
should be beneficial These preliminare results has been promising and indicates that the
RehAtt™ method could become an further developed into an effective and stimulating
intervention tool that would lower rehabilitation costs and reduce tiresome travelling to
hospitals for training.
A VR environment was used training (RehAtt) of post-stroke patients with neglect. Patients
played the VR games three times a week for five weeks, totally 15 hours.
A neglect test battery five neglect tests was repeated three times during a five week
baseline to estabish a chronic state and reduce the test by test learning effect, then again
after the 5 weeks training period. The main outcome results were thereafter obtained by
comparing the 5 neglect tests: Star cancellation test, Baking Tray Task, Line Bisection,,
Extinction and Posner task - unified index by SPSS Repeated Measurement ANOVA from the 3
baseline visits to the results after intervention. The Catherine Bergego neglect scale was
used to assess activities in daily life before and after intervention as well as after six
months.
Patients were included if they had a neglect that had persisted for more than six months
after a right sided ishemic stroke.
Neglect was diagnosed if one or more of the four neglect subtests of the VR test battery was
below cut off (See below and Appendix for details).
The exclusion criteria were severe visual impairment, severe medical illness, severe
depression or cognitive dysfunction (MMSE ≤ 23 points). All patients received oral and
written information with an informed and signed consent. The Umeå university ethics review
board (IRB) approved the study (2010-266-31M).
The hardware consists of a standard PC, a video graphics card, a sound card, headphones and
a separate numeric keyboard to measure behavioural responses. In the VR test part, we used a
19" CRT monitor and shutter glasses for stereoscopic vision. A 27" monitor and 3D vision
glasses (Nvidia, Santa Clara, CA, USA) replaced them in the VR game part. A robotic pen
(Phantom omni haptic device, Sensable technologies, Wilmington, USA) was used as a pointer
using the right hand for assessment activities and the paretic left hand when playing the VR
game for intervention.
;
Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
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