Negami: An Augmented Reality App for the Treatment of Spatial Neglect After Stroke (Preprint)

Abstract

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.