Virtual exercises to promote cognitive recovery in stroke patients: The comparison between HMD vs. screen exposure displays Pedro Gamito, PhD Laboratory of Computational Psychology University Lusófona of Humanities and Technologies Lisbon, Portugal

Introduction I TBI/stroke Attention Executive functions Daily live activities

Introduction II VR Repetition Feedback Motivation WWW Free access Online VR Repetition FeedbackMotivation Rehabilitation

Introduction III Fishtank VR Projection VR Occlusive HBDs Non- occlusive HBDs Palm VR Stationary Displays Head-based Displays Hand-based Displays

Introduction IV Fishtank VR Projection VR Occlusive HBDs Nonocclusiv e HBDs Stationary Displays Head-based Displays -more immersive; -head tracker; -more expensive; -hard/software proficiency; -additional cost. -less immersive; -no head tracker; -less expensive; -no hard/software proficiency; -available on almost every household.

Introduction V

Introduction VI

Introduction VII

Introduction VIII Fishtank VR Projection VR Occlusive HBDs Nonocclusiv e HBDs Stationary Displays Head-based Displays dissemination

Participants – n = 17 – M = 51 years old (SD = 14); – Male/Female = 58%/42%; – Stroke; – Memory and attention impairments (Mini Mental - Folstein et al, 1975); – No previous psychiatric disorders, drug abuse, severe depression or neurological disease. Method I

Measures Method II Memory: Wechsler Memory Scale – WMS-III (Wechsler, 1954) & copy of Rey Complex Figure – RCF (Osterrieth, 1994) Attention: Toulouse Piéron – TP (Piéron, 1955)

Procedures Psychology Department of the Centro de Medicina de Reabilitação de Alcoitão, Lisbon, Portugal; VR + WWW: Unity 2.5; HP Intel® Core™2 Quad Processor Q6600 PC equipped with a GeForce GT 220; Tasks: daily activities + working memory + visuo- spatial orientation + recognition memory Method III

Procedures HMD: eMagin Z8 (n=9); 21’’ Asus VE228D screen display (1680 X 1050 pixels of screen resolution) (n=8) Method IV

Procedures 13 sessions (one session per week); first session, memory and attention tests (WMS-III, RCF and TP); on second and third session patients acquired computer interaction skills on a training platform; next nine sessions were used for cognitive training by VR. last session, memory and attention tests (WMS-III, RCF and TP). Method V

Method VI

Procedures: session 0 - training Method IV

Procedures: session 1 - daily life activities Method V

Procedures: session 2 – finding way to minimarket + buying several items Method VI

Procedures: session 3 - finding the way back home Method VII

Procedures: session 4 - finding a different way to the minimarket Method VIII

Procedures: session 5 - finding a yellow dressed BOT Method IX

Procedures: session 6 - finding the door number 29 Method X

Procedures: session 7 - retention of outdoor advertisements Method XI

Procedures: session 8 - Mini-Mental State Examination (Folstein et al, 1975) and Short test of Mental Status (Kokmen et al, 1991) Method XII

Procedures: session 9 - spawned on a different local of the VR world, the patient had to find his way back home with an item bought at the minimarket Method XIII

Results I WMS mean scores (left figure) and RCF mean scores (right figure) to each experimental condition. main effect of evaluation in WMS (F(1, 16) = ; MSE = ; p < 0.01) and RCF (F(1, 16) = 8.676; MSE = ; p < 0.05) significant increase in WMS (M = 85.71; SD = 3.89 vs. M = 98.94; SD = 3.99) and RCF scores no significant interaction effects were reported between factors (p > 0.05) in the WMS and RCF assessments

Results II TP mean scores to each experimental condition main effect of evaluation in the TP test (F(1, 16) = ; MSE = ; p < 0.01), attention increased from initial (M = 75.69; SD = 10.83) to final assessment (M = ; SD = 16.23) no significant interaction effects (p > 0.05)

VR exercises aimed at training memory and attention functions in stroke patients; No interaction effects between factors (p > 0.05), Final remarks using VR exercises aimed at training memory and attention functions in stroke patients.

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