Publications

by Keyword: Virtual reality


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Grechuta, K., Rubio Ballester, B., Espín Munne, R., Usabiaga Bernal, T., Molina Hervás, B., Mohr, B., Pulvermüller, F., San Segundo, R., Verschure, P., (2019). Augmented dyadic therapy boosts recovery of language function in patients with nonfluent aphasia Stroke 50, (5), 1270-1274

Background and Purpose- Evidence suggests that therapy can be effective in recovering from aphasia, provided that it consists of socially embedded, intensive training of behaviorally relevant tasks. However, the resources of healthcare systems are often too limited to provide such treatment at sufficient dosage. Hence, there is a need for evidence-based, cost-effective rehabilitation methods. Here, we asked whether virtual reality-based treatment grounded in the principles of use-dependent learning, behavioral relevance, and intensity positively impacts recovery from nonfluent aphasia. Methods- Seventeen patients with chronic nonfluent aphasia underwent intensive therapy in a randomized, controlled, parallel-group trial. Participants were assigned to the control group (N=8) receiving standard treatment or to the experimental group (N=9) receiving augmented embodied therapy with the Rehabilitation Gaming System for aphasia. All Rehabilitation Gaming System for aphasia sessions were supervised by an assistant who monitored the patients but did not offer any elements of standard therapy. Both interventions were matched for intensity and materials. Results- Our results revealed that at the end of the treatment both groups significantly improved on the primary outcome measure (Boston Diagnostic Aphasia Examination: control group, P=0.04; experimental group, P=0.01), and the secondary outcome measure (lexical access-vocabulary test: control group, P=0.01; experimental group, P=0.007). However, only the Rehabilitation Gaming System for aphasia group improved on the Communicative Aphasia Log ( P=0.01). The follow-up assessment (week 16) demonstrated that while both groups retained vocabulary-related changes (control group, P=0.01; experimental group, P=0.007), only the Rehabilitation Gaming System for aphasia group showed therapy-induced improvements in language ( P=0.01) and communication ( P=0.05). Conclusions- Our results demonstrate the effectiveness of Rehabilitation Gaming System for aphasia for improving language and communication in patients with chronic aphasia suggesting that current challenges faced by the healthcare system in the treatment of stroke might be effectively addressed by augmenting traditional therapy with computer-based methods. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02928822.

Keywords: Aphasia, Embodied training, Neurological rehabilitation, Virtual reality


Ballester, B. R., Maier, M., Duff, A., Cameirão, M., Bermúdez, S., Duarte, E., Cuxart, A., Rodríguez, S., San Segundo Mozo, R. M., Verschure, P., (2019). A critical time window for recovery extends beyond one-year post-stroke Journal of neurophysiology 122, (1), 350-357

The impact of rehabilitation on post-stroke motor recovery and its dependency on the patient's chronicity remain unclear. The field has widely accepted the notion of a proportional recovery rule with a "critical window for recovery" within the first 3-6 mo poststroke. This hypothesis justifies the general cessation of physical therapy at chronic stages. However, the limits of this critical window have, so far, been poorly defined. In this analysis, we address this question, and we further explore the temporal structure of motor recovery using individual patient data from a homogeneous sample of 219 individuals with mild to moderate upper-limb hemiparesis. We observed that improvement in body function and structure was possible even at late chronic stages. A bootstrapping analysis revealed a gradient of enhanced sensitivity to treatment that extended beyond 12 mo poststroke. Clinical guidelines for rehabilitation should be revised in the context of this temporal structure. NEW & NOTEWORTHY Previous studies in humans suggest that there is a 3- to 6-mo "critical window" of heightened neuroplasticity poststroke. We analyze the temporal structure of recovery in patients with hemiparesis and uncover a precise gradient of enhanced sensitivity to treatment that expands far beyond the limits of the so-called critical window. These findings highlight the need for providing therapy to patients at the chronic and late chronic stages.

Keywords: Motor recovery, Neuroplasticity, Neurorehabilitation, Stroke recovery, Virtual reality


Maier, Martina, Rubio Ballester, Belén, Duff, Armin, Duarte Oller, Esther, Verschure, P., (2019). Effect of specific over nonspecific VR-based rehabilitation on poststroke motor recovery: A systematic meta-analysis Neurorehabilitation and Neural Repair 33, (2), 112-129

Background. Despite the rise of virtual reality (VR)-based interventions in stroke rehabilitation over the past decade, no consensus has been reached on its efficacy. This ostensibly puzzling outcome might not be that surprising given that VR is intrinsically neutral to its use—that is, an intervention is effective because of its ability to mobilize recovery mechanisms, not its technology. As VR systems specifically built for rehabilitation might capitalize better on the advantages of technology to implement neuroscientifically grounded protocols, they might be more effective than those designed for recreational gaming. Objective. We evaluate the efficacy of specific VR (SVR) and nonspecific VR (NSVR) systems for rehabilitating upper-limb function and activity after stroke. Methods. We conducted a systematic search for randomized controlled trials with adult stroke patients to analyze the effect of SVR or NSVR systems versus conventional therapy (CT). Results. We identified 30 studies including 1473 patients. SVR showed a significant impact on body function (standardized mean difference [SMD] = 0.23; 95% CI = 0.10 to 0.36; P = .0007) versus CT, whereas NSVR did not (SMD = 0.16; 95% CI = −0.14 to 0.47; P = .30). This result was replicated in activity measures. Conclusions. Our results suggest that SVR systems are more beneficial than CT for upper-limb recovery, whereas NSVR systems are not. Additionally, we identified 6 principles of neurorehabilitation that are shared across SVR systems and are possibly responsible for their positive effect. These findings may disambiguate the contradictory results found in the current literature.

Keywords: Stroke, Paresis, Virtual reality, Rehabilitation, Occupational therapy, Review


Truschzinski, M., Betella, A., Brunnett, G., Verschure, P., (2018). Emotional and cognitive influences in air traffic controller tasks: An investigation using a virtual environment? Applied Ergonomics 69, 1-9

Air traffic controllers are required to perform complex tasks which require attention and high precision. This study investigates how the difficulty of such tasks influences emotional states, cognitive workload and task performance. We use quantitative and qualitative measurements, including the recording of pupil dilation and changes in affect using questionnaires. Participants were required to perform a number of air traffic control tasks using the immersive human accessible Virtual Reality space in the "eXperience Induction Machine". Based on the data collected, we developed and validated a model which integrates personality, workload and affective theories. Our results indicate that the difficulty of an air traffic control task has a direct influence on cognitive workload as well as on the self-reported mood; whereas both mood and workload seem to change independently. In addition, we show that personality, in particular neuroticism, affects both mood and performance of the participants.

Keywords: Air traffic control, Mood, Personality, Virtual reality, Workload


Pacheco, D., Verschure, P. F. M. J., (2018). Long-term spatial clustering in free recall Memory 26, (6), 798–806

We explored the influence of space on the organisation of items in long-term memory. In two experiments, we asked our participants to explore a virtual environment and memorise discrete items presented at specific locations. Memory for those items was later on tested in immediate (T1) and 24 hours delayed (T2) free recall tests, in which subjects were asked to recall as many items as possible in any order. In experiment 2, we further examined the contribution of active and passive navigation in recollection dynamics. Results across experiments revealed a significant tendency for participants to consecutively recall items that were encountered in proximate locations during learning. Moreover, the degree of spatial organisation and the total number of items recalled were positively correlated in the immediate and the delayed tests. Results from experiment 2 indicated that the spatial clustering of items was independent of navigation types. Our results highlight the long-term stability of spatial clustering effects and their correlation with recall performance, complementing previous results collected in immediate or briefly delayed tests.

Keywords: Free recall, Spatial clustering, Spatial memory, Spatial navigation, Virtual reality


Pacheco, D., Sánchez-Fibla, M., Duff, A., Verschure, P. F. M. J., (2017). A spatial-context effect in recognition memory Frontiers in Behavioral Neuroscience 11, Article 143

We designed a novel experiment to investigate the modulation of human recognition memory by environmental context. Human participants were asked to navigate through a four-arm Virtual Reality (VR) maze in order to find and memorize discrete items presented at specific locations in the environment. They were later on tested on their ability to recognize items as previously presented or new. By manipulating the spatial position of half of the studied items during the testing phase of our experiment, we could assess differences in performance related to the congruency of environmental information at encoding and retrieval. Our results revealed that spatial context had a significant effect on the quality of memory. In particular, we found that recognition performance was significantly better in trials in which contextual information was congruent as opposed to those in which it was different. Our results are in line with previous studies that have reported spatial-context effects in recognition memory, further characterizing their magnitude under ecologically valid experimental conditions.

Keywords: Context effects, Recognition memory, Spatial behavior, Spatial memory and navigation, Virtual reality


Hernansanz, A., Amat, J., Casals, A., (2009). Optimization criterion for safety task transfer in cooperative robotics 14th International Conference on Advanced Robotics (ICAR) , IEEE (Munich, Germany) , 254-259

This paper presents a strategy for a cooperative multirobot system, constituting a virtual robot. The virtual robot is composed of a set of robotic arms acting as only one, transferring the execution of a teleoperated task from one to another when necessary. To decide which of the robots is the most suitable to execute the task at every instant, a multiparametric decision function has been defined. This function is based on a set of intrinsic and extrinsic evaluation indexes of the robot. Since the internal operation of the virtual robot must be transparent to the user, a control architecture has been developed.

Keywords: Control engineering computing, Manipulators, Multi-robot systems, Optimsation, Telerobotics, Virtual reality