Background A widely applied and effective rehabilitation method for patients experiencing spatial neglect after a stroke is “visual exploration training.” Patients improve their ipsilesional bias of attention and orientation by training exploration movements and search strategies toward the contralesional side of space. In this context, gamification can have a positive influence on motivation for treatment and thus on the success of treatment. In contrast to virtual reality applications, treatment enhancements through augmented reality (AR) have not yet been investigated, although they offer some advantages over virtual reality. Objective This study aimed to develop an AR-based app (Negami) for the treatment of spatial neglect that combines visual exploration training with active, contralesionally oriented rotation of the eyes, head, and trunk. Methods The app inserts a virtual element (origami bird) into the real space surrounding the patient, which the patient explores with the camera of a tablet. Subjective reports from healthy elderly participants (n=10) and patients with spatial neglect after stroke (n=10) who trained with the new Negami app were analyzed. Usability, side effects, and game experience were assessed by various questionnaires. Results Training at the highest defined difficulty level was perceived as differently challenging but not as frustrating by the group of healthy elderly participants. The app was rated with high usability, hardly any side effects, high motivation, and entertainment. The group of patients with spatial neglect after stroke consistently evaluated the app positively on the dimensions of motivation, satisfaction, and fun. Conclusions The Negami app represents a promising extension by adding AR to traditional exploration training for spatial neglect. Through participants’ natural interaction with the physical surrounding environment during playful tasks, side effects as symptoms of cybersickness are minimized and patients’ motivation appeared to markedly increase. The use of AR in cognitive rehabilitation programs and the treatment of spatial neglect seems promising and should receive further investigation.

BACKGROUND A widely applied and effective rehabilitation method in stroke patients suffering from spatial neglect is the ‘visual exploration training’. Patients improve their ipsilesional bias of attention and orientation by training of exploration movements and search strategies towards the contralesional side of space. In this context, gamification can have a positive influence on motivation for treatment and thus on the success of treatment. In contrast to Virtual Reality (VR) applications, treatment enhancements through Augmented Reality (AR) have not yet been investigated although they offer some advantages over VR. OBJECTIVE The aim of this study was to develop an AR-based application for the treatment of spatial neglect that combines a visual exploration training with active, contralesionally oriented rotation of gaze, head, and trunk. METHODS The app inserts a virtual element (origami bird) into the real space surrounding the patient which the patient explores with the camera of a tablet. Subjective reports from healthy, elderly participants (n=10) as well as patients with spatial neglect after stroke (n=10) who trained with the new application “Negami” were analyzed. Usability, side effects, and game experience were assessed by various questionnaires. RESULTS Training at the highest defined difficulty level was perceived as differently challenging but not as frustrating by the group of healthy, elderly participants. The application was rated with high usability, hardly any side effects, high motivation, and entertainment. The group of stroke patients with spatial neglect, consistently evaluated the app positively on the dimensions of motivation, satisfaction, and fun. CONCLUSIONS The app “Negami" represents a promising extension by using AR to the traditional exploration training for spatial neglect. Through the natural interaction with the physical surrounding environment during playful tasks, side effects as symptoms of cybersickness are minimized and patients’ motivation appear to markedly increase. The use of AR in cognitive rehabilitation programs, and in the treatment of spatial neglect in particular, seems very promising and should receive further investigation.

Background: A widely applied and effective rehabilitation method in stroke patients suffering from spatial neglect is the 'visual exploration training'. Patients improve their ipsilesional bias of attention and orientation by training of exploration movements and search strategies towards the contralesional side of space. Here we investigate the effectiveness of the augmented reality (AR)-based app 'Negami' for the treatment of spatial neglect in a randomized control trial. Negami combines a visual exploration training with active, contralesionally oriented rotation of eyes, head, and trunk. Methods: Twenty patients with spatial neglect were randomly assigned to the experimental Negami group or to a group receiving standard neglect therapy. Over a period of two weeks, both groups received five training sessions per week. Each session lasted about 25 minutes. Neglect behavior was assessed weekly over a five-week period, with the Negami therapy group receiving a second follow-up assessment at one-to-two-month intervals after completion of training. Results: Both groups improved significantly. While the Negami therapy group improved in four of five neglect tests used, the standard therapy group improved in only one of these tests. We observed significantly better improvement in the Negami group already after the first week of training. This difference was also significant after the end of the training as well as one week after the end of training and remained stable one to two months after the end of treatment. Conclusion: Negami can be used as an effective alternative or addition to current standard neglect therapy, and may even be superior to it.

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