Publications

Autism is a neurodevelopmental disorder characterized by deficits in social communication and repetitive patterns of behavior. Individuals affected by Autism Spectrum Disorder (ASD) may face overwhelming sensory hypersensitivities that hamper their everyday life. In order to promote awareness about neurodiversity among the neurotypical population, we have developed an interactive virtual reality simulation to experience the oversensory stimulation that an individual with autism spectrum disorder may experience in a natural environment. In this experience, we project the user in a first-person perspective in a classroom where a teacher is presenting a lecture. As the user explores the classroom and attends the lecture, he/she is confronted with sensory distortions which are commonly experienced by persons with ASD. We provide the users with a virtual reality headset with motion tracking, two wireless controllers for interaction, and a wristband for physiological data acquisition to create a closed feedback loop. This wearable device measures blood volume pulse (BVP) and electrodermal activity (EDA), which we use to perform online estimations of the arousal levels of users as they respond to the virtual stimuli. We use this information to modulate the intensity of auditory and visual stimuli simulating a vicious cycle in which increased arousal translates into increased oversensory stimulation. Here, we present the architecture and technical implementation of this system.

JTD Keywords: autism spectrum disorder, neurodiversity, physiology, Autism, Autism spectrum disorder, Neurodiversity, Physiology, Virtual reality

Background: There is a pressing need for scalable healthcare solutions and a shift in the rehabilitation paradigm from hospitals to homes to tackle the increase in stroke incidence while reducing the practical and economic burden for patients, hospitals, and society. Digital health technologies can contribute to addressing this challenge; however, little is known about their effectiveness in at-home settings. In response, we have designed the RGS@home study to investigate the effectiveness, acceptance, and cost of a deep tech solution called the Rehabilitation Gaming System (RGS). RGS is a cloud-based system for delivering Al-enhanced rehabilitation using virtual reality, motion capture, and wearables that can be used in the hospital and at home. The core principles of the brain theory-based RGS intervention are to deliver rehabilitation exercises in the form of embodied, goal-oriented, and task-specific action.; Methods: The RGS@home study is a randomized longitudinal clinical trial designed to assess whether the combination of the RGS intervention with standard care is superior to standard care alone for the functional recovery of stroke patients at the hospital and at home. The study is conducted in collaboration with hospitals in Spain, Sweden, and France and includes inpatients and outpatients at subacute and chronic stages post-stroke. The intervention duration is 3 months with assessment at baseline and after 3, 6, and 12 months. The impact of RGS is evaluated in terms of quality of life measurements, usability, and acceptance using standardized clinical scales, together with health economic analysis. So far, one-third of the patients expected to participate in the study have been recruited (N = 90, mean age 60, days after stroke >= 30 days). The trial will end in July 2023.; Discussion: We predict an improvement in the patients' recovery, high acceptance, and reduced costs due to a soft landing from the clinic to home rehabilitation. In addition, the data provided will allow us to assess whether the prescription of therapy at home can counteract deterioration and improve quality of life while also identifying new standards for online and remote assessment, diagnostics, and intervention across European hospitals.

JTD Keywords: deep tech, e-health, home treatment, motor recovery, randomized clinical trial, stroke, upper extremities, virtual reality, Deep tech, E-health, Functional recovery, Home treatment, Motor recovery, Randomized clinical trial, Stroke, Upper extremities, Virtual reality, Wearables

We describe the concepts, methodology, technology, and practice of a user-centric and historical space-oriented approach towards Historical and Cultural Learning (HCL). The Future Memory project pursues the unifying hypothesis that physical space can play a critical role in the authentication and education of this singular historical event, or space as a frame for memory formation and a source of authentication. We illustrate these aspects in the context of concrete Future Memory projects realized over the last ten years in collaboration with several memorial sites, museums, and archives. Based on these experiences, we subsequently analyze the lessons learned and future challenges. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

JTD Keywords: Augmented reality, Commemoration, Digital heritage, Future memory, Post-wtiness era, Virtual reality

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.

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

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.

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

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.

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

Cerebral palsy (CP) is a disabling life-long condition progressively impeding a patient’s independence. Although incident rates are high, a clear understanding of the disease is missing. CP is characterized by several motor disorders and sensory or perceptive comorbidities. This multifaceted nature complicates proper diagnosis and hampers the search for possible treatments. During adolescence and adulthood, individuals with CP experience a drastic deterioration in gross motor control, independence, and quality of life. There is poor evidence that physical therapy promotes the retention of function through aging, and no clinical studies exist that explore the potential of VRbased training to prevent deterioration. In this pilot randomized controlled trial, we expose 14 adults with CP to the Rehabilitation Gaming System (RGS) and examine its usability, effectiveness, and acceptability. Our results show that the RGS difficulty adaptation algorithm automatically matches the patients' impairment level as captured by clinical scales (Barthel and Box & Blocks). The clinical effectiveness and acceptability of the RGS and conventional therapy were comparable. We conclude that VR-based physical therapy as an adjunct to usual treatment may be a promising approach for the prevention of deterioration in adolescents and adults with CP.

JTD Keywords: Cerebral palsy, Virtual realitY, Motor function, Physical therapy, Rehabilitation

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.

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

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.

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

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.

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

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.

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