Using virtual reality simulation to study navigation in a complex environment as a functional-cognitive task; A pilot study.

BACKGROUND: Navigation skills are required for performance of functional complex tasks and may decline due to aging. Investigation of navigation skills should include measurement of cognitive-executive and motor aspects, which are part of complex tasks. OBJECTIVE: to compare young and older healthy adults in navigation within a simulated environment with and without a functional-cognitive task. METHODS: Ten young adults (25.6±4.3 years) and seven community dwelling older men (69.9±3.8 years) were tested during a single session. After training on a self-paced treadmill to navigate in a non-functional simulation, they performed the Virtual Multiple Errands Test (VMET) in a mall simulation. Outcome measures included cognitive-executive aspects of performance and gait parameters. RESULTS: Younger adults' performance of the VMET was more efficient (1.8±1.0) than older adults (5.3±2.7; p < 0.05) and faster (younger 478.1±141.5 s, older 867.6±393.5 s; p < 0.05). There were no differences between groups in gait parameters. Both groups walked slower in the mall simulation. CONCLUSIONS: The shopping simulation provided a paradigm to assess the interplay between motor and cognitive aspects involved in the efficient performance of a complex task. The study emphasized the role of the cognitive-executive aspect of task performance in healthy older adults.

A narrative review of texting as a visually-dependent cognitive-motor secondary task during locomotion.

Typing while walking is an example of people's ability to interact with technology while engaged in real life activities. Indeed, an increasing number of studies have investigated the typing of text messages (texting) as a dual task during locomotion. The objective of this review is to (1) describe the task requirements of texting-while-walking, (2) evaluate the measurement and psychometric properties of texting as a dual task, and (3) formulate methodological recommendations for researchers who use and report on texting-while-walking. Twenty studies which used texting as a dual task during gait were identified via a literature search. The majority of these studies examined texting among young healthy adults and showed that, like other dual tasks, texting-while-walking caused decrements in both gait and texting performance. The cause of these decrements was most likely related to increased visual task requirements, task-dependent cognitive requirements and fine motor skills. Texting-while-walking gait measures were repeatable, but texting performance showed poor reliability which further depended on skill. Preliminary results show that texting-while-walking performance may discriminate between populations (e.g., young vs. older adults) but no studies have yet examined its predictive validity (e.g., for fall risk). In conclusion, texting-while-walking is an ecologically-valid dual task for locomotion which has become much more commonly used in recent years. As opposed to other secondary tasks such as subtraction by 7 or generating words, texting may challenge various cognitive, visual and sensorimotor domains depending on its content. This imposes task-specific methodological challenges on future research, which are discussed.

Living Labs: overview of ecological approaches for health promotion and rehabilitation.

PURPOSE: The term "Living Lab" was coined to reflect the use of sensors to monitor human behavior in real life environments. Until recently such measurements had been feasible only within experimental laboratory settings. The objective of this paper is to highlight research on health care sensing and monitoring devices that enable direct, objective and accurate capture of real-world functioning. METHOD: Selected articles exemplifying the key technologies that allow monitoring of the motor-cognitive activity of persons with disabilities during naturally occurring daily experiences in real-life settings are discussed in terms of (1) the ways in which the Living Lab approach has been used to date, (2) limitations related to clinical assessment in rehabilitation settings and (3) three categories of the instruments most commonly used for this purpose: personal technologies, ambient technologies and external assistive systems. RESULTS: Technology's most important influences on clinical practice and rehabilitation are in a shift from laboratory-based to field-centered research and a transition between in-clinic performance to daily life activities. Numerous applications show its potential for real-time clinical assessment. CONCLUSIONS: Current technological solutions that may provide clinicians with objective, unobtrusive measurements of health and function, as well as tools that support rehabilitation on an individual basis in natural environments provide an important asset to standard clinical measures. IMPLICATIONS FOR REHABILITATION: Until recently objective clinical assessment could not be readily performed in a client's daily functional environment. Novel technologies enable health care sensing and monitoring devices that enable direct, objective and accurate capture of real-world functioning. Such technologies are referred to as a "Living Lab" approach since they enable the capture of objective and non-obtrusive data that clinicians can use to assess performance. Research and development in this field help clinicians support maintain independence and quality of life for people who have disabilities or who are aging, and to promote more effective methods of long-term rehabilitation and maintenance of a healthy life style.

Interactive virtual environment training for safe street crossing of right hemisphere stroke patients with unilateral spatial neglect.

PURPOSE: The goal of this study was to determine whether non immersive interactive virtual environments are an effective medium for training individuals who suffer from Unilateral Spatial Neglect (USN) as a result of a right hemisphere stroke, and to compare it to a standard computer visual scanning training. METHOD: Participants included 19 patients with right hemisphere stroke in two groups, 11 in an experimental group were given computer desktop-based Virtual Reality (VR) street crossing training and 8 in a control group who were given computer based visual scanning tasks, both for a total of twelve sessions, 9 hours total, over four weeks. Measures included: 1. Standard USN assessments, paper and pencil and ADL checklist; 2. Test on the VR street program; and 3. Actual street crossing videotaped. Testing was performed pre and post intervention. RESULTS: The VR group achieved on the USN measures results that equaled those achieved by the control group treated with conventional visual scanning tasks. They improved more on the VR test and they did better on some measures of the real street crossing. CONCLUSIONS: Despite several limitations in this study the present results support the effectiveness of the VR street program in the treatment of participants with USN, and further development of the program.

Validity of the Purdue Pegboard Test in assessing patients after traumatic hand injury.

OBJECTIVES: The purposes of this study were first, to determine the validity of the Purdue Pegboard Test in differentiating between groups of healthy adults and adults who suffered from traumatic hand injury. Second, to determine criterion validity of the Purdue Pegboard Test with the Functional Dexterity Test (FDT). Third, to test the correlations between the Purdue Pegboard Test and several functional hand activities. STUDY DESIGNS: Fifty-four post-traumatic hand injury participants who were treated in the Occupational Therapy Clinic at the Sheba Medical Center, Tel Hashomer, Israel. Forty-three healthy participants with no history of hand injury or disease formed the control group. All subjects were assessed with the Purdue Pegboard Test, PDT and five functional hand activities. RESULTS AND CONCLUSIONS: The Purdue Pegboard Test differentiated between the healthy population and the post-traumatic hand injury population. No significant differences were found between the dominant hand-injured group and the non-dominant hand-injured group on three scores (both hands, assembly and the summarizing of the first three sub-tests). Correlations between the Purdue Pegboard Test and the PDT were moderate to high suggesting the two tests should be used in combination when assessing patients. Correlations between the Purdue and hand activities (e.g. button, laces) were moderate. Further studies are needed to examine the relationships between types of hand injuries, ROM, pinch grip and performance on the Purdue Pegboard Test.

Upper limb functional electrical stimulation for walker ambulation in hemiplegia: a case report.

Electrical stimulation has been sporadically used in the treatment of hemiplegia. Reported benefits include decreasing spasticity, providing a supplementary means for range of motion exercises, increasing strength, and improving local blood flow in a paretic or paralyzed limb. Some studies have also shown functional gains in the hemiplegic upper limb following treatment with electrical stimulation. Nevertheless, there have been very few reports of the use of neuromuscular stimulation to achieve new hemiplegic upper limb activity not possible without the electrical stimulation. This is a case report of a head injury patient who was able to begin ambulation with a walker, without physical assistance, for the first time in the 16 yr since his injury. A new electrical stimulation device (Handmaster) initially used therapeutically, and then functionally, provided a reliable, strong grasp and release and was instrumental in achieving the new level of function. The device proved to be easy to use in the home, giving the patient microprocessor-controlled therapeutic and patterned functional electrical stimulation.