An Innovative Rehabilitation Treatment of Time Deficits in Brain-damaged Patients Combining Prism Adaptation and Virtual Reality
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Brain Damage
- Sponsor
- Istituti Clinici Scientifici Maugeri SpA
- Enrollment
- 20
- Locations
- 1
- Primary Endpoint
- Change in Time Reproduction Ability on the Time Reproduction Task
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
The efficacy of an innovative rehabilitation treatment for deficit in time processing is tested in right brain damaged patients.
Patients with a focal lesion following a stroke and without general cognitive impairment will be submitted to computerized tests assessing the ability to estimate time duration (intervals around 7500 ms) and to mental travel in time. Moreover, the impact of the deficit in time processing in everyday life will be evaluated by using ad hoc questionnaires.
Patients will perform tasks before and after two weeks of a new rehabilitation treatment, combining a training for one week with prismatic googles inducing prismatic adaptation (PA) plus Virtual Reality (VR) and a training for one week with neutral googles inducing no-adaptation (NA) plus Virtual Reality. Participants will be randomized into two groups. Each group will be submitted to both treatments in a different order, accordingly with a crossover design.
A greater amelioration in time processing after PA+VR than NA+VR training should be found. Moreover, an improvement in everyday life activities is expected accordingly with the amelioration in time processing.
Detailed Description
Time processing involves different abilities - i.e. estimating the duration of an event and moving in past and future time - and it is a fundamental ability in everyday life. However, in neuropsychology, time processing is routinely neglected in the assessment of cognitive deficits in brain-damaged patients. This is surprising since time is an important function that permeates our activities: we perceive mismatches in lip reading (milliseconds), we estimate how long it takes to be ready for work (minutes), and we plan how long it will take a manuscript to be accepted (usually months). Thus, impairment in processing time has important consequences in daily life. For instance, it is known that right brain damaged (RBD) patients with spatial attentional deficit (neglect) are impaired in estimate the duration of a time interval as well as in the ability of mentally moving in time (Mental Time Travelling). Previous studies have demonstrated an improvement of time estimation and mental time travel after a leftward shift of spatial attention induced by a single session of prismatic adaptation (PA). Moreover, a recent study investigated the long-term duration of the benefits induced by 10 daily sessions of PA treatment on mental time travel and functional abilities in neglect patients. Results suggest that the PA treatment induces a long-lasting and stable ameliorations of mental time travel and functional competences. To generalize the effects of PA treatment to everyday life, here we propose to combine PA with a virtual reality training (VR). VR has recently been used as an effective tool both for the assessment and rehabilitation of cognitive deficits, because it allows post-stroke patients to interact with ecological environments similar to the real ones, but in a safe and controlled condition. Aim of this study is to set up a rehabilitation procedure for temporal deficits, combining a well-established PA procedure with an innovative, more engaging and ecological VR approach. Patients will perform tasks before and after two weeks of a new rehabilitation treatment, combining a training for one week with prismatic googles inducing prismatic adaptation (PA) plus Virtual Reality (VR) and a training for one week with neutral googles inducing no-adaptation (NA) plus Virtual Reality. Participants will be randomized into two groups. Each group will be submitted to both treatments in a different order, accordingly with a crossover design. A greater amelioration in time processing after PA+VR than NA+VR training should be found. Moreover, an improvement in everyday life activities is expected accordingly with the amelioration in time processing.
Investigators
Eligibility Criteria
Inclusion Criteria
- •patients with focal right brain-damage
Exclusion Criteria
- •generalized cognitive impairment (score lower than 24 at the Mini Mental State Examination)
- •psychiatric disorders
- •additional neurological disorders
- •abusive use of alcohol or illicit drugs
Outcomes
Primary Outcomes
Change in Time Reproduction Ability on the Time Reproduction Task
Time Frame: baseline, after one week treatment (T1), after two weeks treatment (T2), one week after the end of treatment (follow-up)
In the Time Reproduction task a blue square is presented for a variable time interval (3500, 5500, 7500, 9500, 11500 ms) on the computer screen. Next, a red square appears on the screen and participants are instructed to reproduce the entire duration of the preceding blue square by pressing the space bar on the keyboard. For each subject, the reproduced time intervals before PA will be subtracted from the reproduced time intervals after PA. Thus, this difference will be positive when reproduced time will be longer after than before treatment (underestimation of time duration) and negative when reproduced time will be shorter after than before treatment (overestimation of time duration).
Change in Mental Time Travel Ability on the Mental Time Travel (MTT) Task
Time Frame: baseline, after one week treatment (T1), after two weeks treatment (T2), one week after the end of treatment (follow-up)
In the MTT task participants are listened to auditory stimuli consisting of brief descriptions of personal and non-personal events. They are required to project themselves in the past (10 years ago), present or future (10 years from now) and to verbally determine whether each event has already happened (relative past event) or is yet to happen (relative future event) with respect to the specific self-location in time (past, present and future). Error rates and reaction times will be recorded and analyzed. The improvement will be defined as changes in the Inverse Efficiency (IE) ability: reaction times/accuracy.
Change in Time Estimation Ability on the Time Estimation Task
Time Frame: baseline, after one week treatment (T1), after two weeks treatment (T2), one week after the end of treatment (follow-up)
The Time Estimation task consists of a red square that is displayed for different durations (3500, 5500, 7500, 9500, 11500 ms) on the computer screen. Participants are instructed to verbally judge whether the duration of each stimulus is "short" or "long" with respect to previously acquired pair of reference durations (3500 and 11500 ms). A psychophysical response function will be created for each participant by calculating the proportion of "long" responses: the Point of Subjective Equality (PSE) is the duration at which a participant is equally likely to classify the stimuli as short or long. An increase of "long" response after treatment, as compared to baseline performance, induces a decreased PSE, reflecting a relative shift towards overestimation of temporal midpoint. Conversely, an increase of "short" responses after treatment, as compared to baseline performance, induces an increased PSE, reflecting a relative shift towards underestimation of temporal midpoint.
Secondary Outcomes
- Assessment of General Cognitive Functioning on the Mini Mental State Examination (MMSE)(baseline)
- Assessment of Unilateral Spatial Neglect on the Behavioral Inattention Test (BIT)(baseline)
- Assessment of Frontal Functions on the Wisconsin Card Sorting Test (WCST)(baseline)
- Change in Unilateral Spatial Neglect on the Bells Cancellation Test(baseline, after two weeks treatment (T2), one week after the end of treatment (follow-up))
- Change in Unilateral Spatial Neglect on the Apples Cancellation Test(baseline, after two weeks treatment (T2), one week after the end of treatment (follow-up))
- Change in Frontal Functions on the Frontal Assessment Battery (FAB)(baseline, after two weeks treatment (T2))
- Change in Functional Abilities on the Motricity Index(baseline, after two weeks treatment (T2))
- Assessment of Memory on the Rey's 15 Words Auditory Learning Test(baseline)
- Assessment of Verbal Comprehension on the Token Test(baseline)
- Change in Verbal Estimation Ability on the Time and Weight Estimation Test (STEP)(baseline, after two weeks treatment (T2))
- Change in Functional Abilities on the Functional Independent Measure (FIM)(baseline, after two weeks treatment (T2))
- Change in Functional Abilities on the Questionnaire of Temporal Ability(baseline, after two weeks treatment (T2), one week after the end of treatment (follow-up))
- Change in Verbal Estimation Ability on the Cognitive Estimation Task (CET)(baseline, after two weeks treatment (T2))
- Change in Functional Abilities on the Activities of Daily Living (ADL)(baseline, after two weeks treatment (T2), one week after the end of treatment (follow-up))
- Change in Spatial Working Memory on the Spatial Working Memory Test(baseline, after two weeks treatment (T2))