Virtual reality-based assessment of cognitive-locomotor interference in healthy young adults.

BACKGROUND: A recent literature review emphasized the importance of assessing dual-task (DT) abilities with tasks that are representative of community ambulation. Assessing DT ability in real-life activities using standardized protocols remains difficult. Virtual reality (VR) may represent an interesting alternative enabling the exposure to different scenarios simulating community walking. To better understand dual-task abilities in everyday life activities, the aims of this study were (1) to assess locomotor and cognitive dual-task cost (DTC) during representative daily living activities, using VR, in healthy adults; and 2) to explore the influence of the nature and complexity of locomotor and cognitive tasks on DTC. METHODS: Fifteen healthy young adults (24.9 ± 2.7 years old, 8 women) were recruited to walk in a virtual 100 m shopping mall corridor, while remembering a 5-item list (DT condition), using an omnidirectional platform and a VR headset. Two levels of difficulty were proposed for the locomotor task (with vs. without virtual agent avoidance) and for the cognitive task (with vs. without items modification). These tasks were also performed in single task (ST) condition. Locomotor and cognitive DTC were measured by comparing performances in ST and DT conditions. Locomotor performance was characterized using walking speed, walking fluidity, and minimal distance between the participant and the virtual agent during avoidance. Cognitive performance was assessed with the number of items correctly recalled. Presence of DTC were determined with one-sample Wilcoxon signed-rank tests. To explore the influence of the tasks' complexity and nature on DTC, a nonparametric two-way repeated measure ANOVA was performed. RESULTS: No locomotor interference was measured for any of the outcomes. A cognitive DTC of 6.67% was measured (p = .017) while participants performed simultaneously both complex locomotor and cognitive tasks. A significant interaction between locomotor task complexity and cognitive task nature (p = .002) was identified on cognitive DTC. CONCLUSIONS: In challenging locomotor and cognitive conditions, healthy young adults present DTC in cognitive accuracy, which was influenced by the locomotor task complexity task and the cognitive task nature. A similar VR-based protocol might be used to investigate DT abilities in older adults and individuals with a stroke.

Quantification of upper limb position sense using an exoskeleton and a virtual reality display.

BACKGROUND: Proprioceptive sense plays a significant role in the generation and correction of skilled movements and, consequently, in most activities of daily living. We developed a new proprioception assessment protocol that enables the quantification of elbow position sense without using the opposite arm, involving active movement of the evaluated limb or relying on working memory. The aims of this descriptive study were to validate this assessment protocol by quantifying the elbow position sense of healthy adults, before using it in individuals who sustained a stroke, and to investigate its test-retest reliability. METHODS: Elbow joint position sense was quantified using a robotic device and a virtual reality system. Two assessments were performed, by the same evaluator, with a one-week interval. While the participant's arms and hands were occluded from vision, the exoskeleton passively moved the dominant arm from an initial to a target position. Then, a virtual arm representation was projected on a screen placed over the participant's arm. This virtual representation and the real arm were not perfectly superimposed, however. Participants had to indicate verbally the relative position of their arm (more flexed or more extended; two-alternative forced choice paradigm) compared to the virtual representation. Each participant completed a total of 136 trials, distributed in three phases. The angular differences between the participant's arm and the virtual representation ranged from 1° to 27° and changed pseudo-randomly across trials. No feedback about results was provided to the participants during the task. A discrimination threshold was statistically extracted from a sigmoid curve fit representing the relationship between the angular difference and the percentage of successful trials. Test-retest reliability was evaluated with 3 different complementary approaches, i.e. a Bland-Altman analysis, an intraclass correlation coefficient (ICC) and a standard error of measurement (SEm). RESULTS: Thirty participants (24.6 years old; 17 males, 25 right-handed) completed both assessments. The mean discrimination thresholds were 7.0 ± 2.4 (mean ± standard deviation) and 5.9 ± 2.1 degrees for the first and the second assessment session, respectively. This small difference between assessments was significant (- 1.1 ± 2.2 degrees), however. The assessment protocol was characterized by a fair to good test-retest reliability (ICC = 0.47). CONCLUSION: This study demonstrated the potential of this assessment protocol to objectively quantify elbow position sense in healthy individuals. Futures studies will validate this protocol in older adults and in individuals who sustained a stroke.

Worldwide Survey on Digital Assistive Technology (DAT) Provision.

Occupational therapists have long been involved in assistive technology (AT) provision worldwide. AT is recognized by the World Health Organization (WHO) to enhance functioning, independence, and autonomy and ultimately promote well-being for people living with disabilities. With the digitalisation of societies, the everyday lives and occupations of individuals are changing, becoming more reliant on digital solutions. The development of digital assistive technology (DAT) also offers opportunities for people with disabilities to access, interact, and pilot the digital world. However, we do not know how occupational therapists are involved in DAT provision worldwide. A survey was conducted in the global occupational therapist's community in June 2022 to describe DAT provision and the factors influencing it. Occupational therapy practitioners were included (n = 660) in the analysis. In DAT provision, occupational therapists mostly provide advice to people, assess their needs, provide instruction or training, prescribe DAT, and fit DAT to people and their environment. The clients served through DAT provision are most frequently people with neurological impairments, chronic illnesses, sensory impairments, and older people. The reasons for providing DAT focus on education, work, school, and leisure. It is expected that DAT provision will enhance independence, self-esteem, occupational participation, and social relationships. Issues faced by occupational therapists when providing DAT are costs of product and funding schemes, sufficient knowledge, and access to knowledge sources. Survey respondents are mostly from Western countries with access to the Internet and the digital world, including having digital literacy, highlighting the digital divide that exists between world regions and countries, but also within countries worldwide. There is a need to continue research to better understand the issues related to digitalisation and the digital participation of people living with disabilities.

Development of a virtual reality-based intervention for community walking post stroke: an integrated knowledge translation approach.

PURPOSE: To develop a virtual reality (VR) based intervention targeting community walking requirements. METHODS: Two focus groups each involving 7 clinicians allowed exploring optimal features, needed support and perceived favorable/unfavorable factors associated with the use of the VR-based intervention from the clinicians' perspective. Three stroke survivors and 2 clinicians further interacted with the intervention and filled questionnaires related to acceptability and favorable/unfavorable perceptions on the VR intervention. Stroke participants additionally rated their perceived effort (NASA Tax Load Index), presence (Slater-Usoh-Steed) and cybersickness (Simulator Sickness Questionnaire). RESULTS: Results identified optimal features (patient eligibility criteria, task complexity), needed support (training, human assistance), as well as favorable (cognitive stimulation, engagement, representativeness of therapeutic goals) and unfavorable factors (misalignment with a natural walking pattern, client suitability, generalization to real-life) associated with the intervention. Acceptability scores following the interaction with the tool were 28 and 42 (max 56) for clinicians and ranged from 43 to 52 for stroke participants. Stroke participants reported moderate perceptions of effort (range:20-33/max:60), high levels of presence (29-42/42) and minimal cybersickness (0-3/64). CONCLUSION: Findings collected in the early development phase of the VR intervention will allow addressing favorable/unfavorable factors and incorporating desired optimal features, prior to conducting effectiveness and implementation studies.

This study presents the development process of a new virtual reality (VR) intervention for community walking and participation in stroke survivors.Results from the focus group and hands-on pilot trial suggest that the VR intervention is feasible and accepted by clinicians and stroke survivors.Addressing favorable/unfavorable factors and incorporating features desired by clinicians in the development of the VR tool should promote its eventual implementation in clinical setting.

Dual-Task Abilities During Activities Representative of Daily Life in Community-Dwelling Stroke Survivors: A Pilot Study.

Background: In addition to several physical skills, being able to walk in the community, walking independently and safely in the community requires the ability to divide attention between walking and other tasks performed simultaneously. The aims of the present pilot study were to measure cognitive-locomotor dual-task (DT) abilities during activities representative of daily living in stroke survivors and to compare them with age- and gender-matched healthy individuals. Methods: To assess DT abilities, all participants walked along a virtual shopping mall corridor and memorized a 5-item shopping list. Two levels of task complexity were used for the walking task (with or without virtual agents to avoid) and the cognitive task to recall a list of items (with or without a modification at mid-course). The assessment was conducted using an omnidirectional platform and a virtual reality (VR) headset. Locomotor and cognitive DT costs (DTC) were calculated as the percent change from single-task (ST) performance. Walking speed and minimal distance between the participant and the virtual agents were used to characterize locomotor performance. Cognitive performance was assessed by the number of correctly recalled items. One-sample Wilcoxon tests were used to determine the presence of DTCs and Mann-Whitney tests were performed to compare DTCs between the 2 groups. Results: Twelve community-dwelling stroke survivors [60.50 years old (25-75th percentiles: 53.50-65.75); 5 women; 13.41 months post-stroke (5.34-48.90)] and 12 age- and gender- matched healthy individuals were recruited. Significant cognitive or mutual (cognitive and locomotor) interferences were observed in participants with stroke in all DT conditions, except the simplest (no virtual agents, no modifications to the list). For the control group, significant mutual interferences were only observed during the most complex DT condition. A group difference was detected in cognitive DTCs during the most complex DT condition (virtual agents and list modifications; p = 0.02). Stroke survivors had greater cognitive DTCs than the control group. Conclusions: Using an ecological perspective contributes to understanding behavior of stroke survivors in daily activities. Virtual scenarios appear to be an interesting avenue for a more comprehensive understanding of DT abilities during activities representative of daily living in stroke survivors. The usability and feasibility of such an approach will have to be studied before considering implementation in rehabilitation settings.

Cognitive-Locomotor Dual-Task Interference in Stroke Survivors and the Influence of the Tasks: A Systematic Review.

Background: Walking in the community can be challenging for stroke survivors. The fact that community walking often requires performing another task while walking further adds to this challenge and can lead to a deterioration of performance in one or both tasks. Objective: To review the existing literature about cognitive-locomotor dual-task interference (DTI) magnitude and pattern while walking in patients with stroke and to explore the influence of tasks' nature on DTI. Moreover, this review investigated the differences in DTI between stroke survivors and age-matched healthy adults. Methods: The literature search was conducted in 4 databases (MEDLINE, CINAHL, EMBASE and PEDro). Two authors independently identified relevant studies based on predetermined selection criteria. Among these criteria, studies had to include both locomotor and cognitive DTI. Methodological quality of the studies was independently assessed by two raters using a standardized checklist. Studies were categorized according to the nature of the locomotor and the cognitive tasks. Results: A total of twenty studies, with good to high methodological quality, were selected. Task combinations, outcome measures and participants characteristics varied widely from one study to another. Despite heterogeneous results across studies, mutual DTI (decrements in both locomotor and cognitive performance) was the most frequently observed pattern in participants with stroke. Interestingly, this DTI pattern was systematically obtained when participants had to avoid obstacles while walking. DTI seemed also to be influenced by the nature of the cognitive task. Compared to age-matched healthy participants, stroke survivors had greater DTI. Mutual interferences were also more frequently observed in stroke survivors than in age-matched healthy adults. Conclusions: DTI magnitude and pattern in persons with stroke varied considerably across studies. Multiple factors, including nature of the tasks, may influence dual-task abilities when assessing individuals with stroke. Consequently, dual-task assessments should be performed in similar contexts of individuals' daily lives to ensure ecological validity.

Use and psychometric properties of the Reintegration to Normal Living Index in rehabilitation: A systematic review.

BACKGROUND: Reintegration to Normal Living Index (RNLI) is a generic 11-item questionnaire-based instrument that measures the degree to which individuals achieve reintegration to normal social activities. OBJECTIVES: This systematic review aimed to provide an overview of the use of this questionnaire in rehabilitation (objective 1) and to analyze its psychometric properties (objective 2). METHODS: We searched the literature in 4 electronic databases (MEDLINE via PubMed, Embase, CINAHL and Web of Science) for articles published in English or French between 1988 and 2017. Studies that used RNLI or investigated at least one of its psychometric properties were included and analyzed according to the PRISMA statement. Data extraction and critical methodological appraisal of the articles were independently performed by 2 authors. RESULTS: A total of 117 studies met the inclusion criteria for objective 1. Half of these studies were conducted in North America (50.4%), mainly with stroke patients. The RNLI was used according to 7 different response formats. The 0-10 visual analog scale and 3-point Likert scale were the most commonly used response formats. For objective 2, 10 studies had evaluated the psychometric properties of the RNLI. Their results suggested good test-retest reliability (intraclass coefficient: 0.83-0.87); good internal consistency (Cronbach α: 0.73-0.97); poor to good construct validity, with Pearson's or Spearman's correlation coefficients between the RNLI and scores for many other well-known questionnaires ranging from 0.25 to 0.77. Other types of psychometric properties (e.g., responsiveness) were poorly investigated. CONCLUSION: Despite the increasing use of RNLI in clinical studies, some aspects of its psychometric properties are still poorly evaluated. In addition to the validity and reliability shown in different studies, further studies are needed to investigate other measurement properties such as responsiveness.