Reh@City v2.0: a comprehensive virtual reality cognitive training system based on personalized and adaptive simulations of activities of daily living

Abstract

Cognitive impairments are among the most common age-related disabilities worldwide. Literature has shown that cognitive training using Virtual Reality (VR) systems can be a valid and effective solution for cognitive rehabilitation. Virtual environments can be easily customized to deliver very specific training by controlling the presentation of stimuli and keeping track of the user responses. Reh@City (RC) is a virtual reality simulation of a city where patients can train a variety of cognitive skills while performing simulated activities of daily living. An initial prototype of this city with four environments was clinically validated with a stroke sample, and the encouraging results motivated further iterations and improvements in the RC, in terms of its tasks, interaction with the content, and task adaptation. This paper presents the efforts of creating RC v2.0, a VR-based software system for cognitive rehabilitation that presents different cognitive training tasks that take place in 8 realistically modeled 3D environments, that are personalized to the patient clinical profile and also implements automatic difficulty adaptation.

A comparison of two personalization and adaptive cognitive rehabilitation approaches: a randomized controlled trial with chronic stroke patients

“…Our VR-based intervention consisted of the same TG paper-and-pencil tasks contextualized in different locations of a virtual city with streets, sidewalks, buildings, shops, and parksthe Reh@City v2.0 [67] (Table 1).…”

“…Reh@City v1.0 was an initial prototype with four commonly frequented places of daily life (Pharmacy, Bank, Supermarket, and Post-office) [28]. The upgrade to Reh@City v2.0 included: an increase of the ecological validity through the improvement in the overall visual realism of the city and existing tasks, and the interaction through the paretic arm using an adapted handle; the implementation of dynamic difficulty adaptation based on the framework we developed for TG tasks [23]; and the increase of the number of cognitive training tasks and locations (Magazine Kiosk, Home, Park, and Fashion Store) [67].…”

Comparing adaptive cognitive training in virtual reality and paper-pencil in a sample of stroke patients

“…Tools Two tools were developed to create personalized cognitive rehabilitation: a web tool that generates paper-andpencil tasks named the Task Generator (TG) [27] and the Reh@City v2.0 (RC) [28], a virtual reality system that integrates the simulation of tasks based on ADL's on a virtual environment. The two tools are described as follows:…”

“…Reh@City v2.0: The RC [28] system is a virtual environment that consists of a city with different locations where the user can perform cognitive tasks equivalent to the ones generated by the TG. Like in the TG, tasks are personalized for each user profile based on the MoCA's results of the same cognitive domains: attention, memory, executive function, and language.…”

“…Based on the NeuroRehabLab's cognitive rehabilitation adaptation framework, which established quantitative and task-specific guidelines to personalize training difficulty to the patient profile [26], we developed two content equivalent tools and clinically validated them with stroke patients: a web-based paper-and-pencil Task Generator [27] and a VRbased simulation of different ADL's, the Reh@City v2.0 [28]. To compare these two rehabilitation methods, we performed an intervention study with stroke survivors in order to explore three main questions:…”