Conventional Mirror Therapy versus Immersive Virtual Reality Mirror Therapy: The Perceived Usability after Stroke.

Background: Stroke is a widespread and complex health issue, with many survivors requiring long-term rehabilitation due to upper-limb impairment. This study is aimed at comparing the perceived usability of two feedback-based stroke therapies: conventional mirror therapy (MT) and immersive virtual reality mirror therapy (VR). Methods: The study involved 45 participants, divided into three groups: the stroke survivors (n = 15), stroke-free older adults (n = 15), and young controls (n = 15). Participants performed two tasks using both MT and VR in a semirandom sequence. Usability instruments (SUS and NASA-TLX) were applied at the end of the activities, along with two experience-related questions. Results: The results indicated that both MT and VR had similar levels of perceived usability, with MT being more adaptable and causing less overall discomfort. Conversely, VR increased the perception of task difficulty and prevented participants from diverting their attention from the mirror-based feedback. Conclusion: While VR was found to be less comfortable than MT, both systems exhibited similar perceived usability. The comfort levels of the goggles may play a crucial role in determining the usability of VR for upper limb rehabilitation after stroke.

Verbal Learning as a predictor of risks of accidents in elderly drivers / Aprendizado verbal como preditor de risco de acidentes em idosos

ABSTRACT Background: Age-related cognitive decline impacts cognitive abilities essential for driving. Objective: We aimed to measure main cognitive functions associated with a high number of traffic violations in different driving settings. Methods: Thirty-four elderly individuals, aged between 65 and 90 years, were evaluated with a driving simulator in four different settings (Intersection, Overtaking, Rain, and Malfunction tasks) and underwent a battery of cognitive tests, including memory, attention, visuospatial, and cognitive screening tests. Individuals were divided into two groups: High-risk driving (HR, top 20% of penalty points) and normal-risk driving (NR). Non-parametric group comparison and regression analysis were performed. Results: The HR group showed higher total driving penalty score compared to the NR group (median=29, range= 9-44 vs. median=61, range= 47-97, p<0.001). The HR group showed higher penalty scores in the Intersection task (p<0.001) and the Overtaking and Rain tasks (p<0.05 both). The verbal learning score was significantly lower in the HR group (median=33, range=12-57) compared with the NR group (median=38, range=23-57, p<0.05), and it was observed that this score had the best predictive value for worse driving performance in the regression model. General cognitive screening tests (Mini-Mental State Examination and Addenbrooke's Cognitive Evaluation) were similar between the groups (p>0.05), with a small effect size (Cohen's d=0.3 both). Conclusion: The verbal learning score may be a better predictor of driving risk than cognitive screening tests. High-risk drivers also showed significantly higher traffic driving penalty scores in the Intersection, Overtaking, and Rain tests.

RESUMO Antecedentes: O declínio cognitivo relacionado à idade impacta as habilidades cognitivas essenciais para direção. Objetivos: Nosso objetivo foi medir as funções cognitivas associadas ao alto número de violações de trânsito em diferentes contextos de direção. Métodos: Trinta e quatro idosos entre 65 e 90 anos foram avaliados em simulador de direção em quatro diferentes contextos (Travessia, Ultrapassagem, Chuva e Mal-funcionamento) e realizaram uma série de testes cognitivos, incluindo memória, atenção, visuoespacial e rastreamento. Indivíduos foram então divididos em dois grupos: Alto Risco de condução (HR, top 20% de pontos de penalidades de condução), e Risco Normal (NR). Comparações não-paramétricas e análise de regressão foram realizadas. Resultados: O grupo HR mostrou aumento no escore total de penalidades de condução quando comparado com o grupo NR (mediana=29, limites=9-44 vs. mediana=61, limites=47-97, p<0.001). O grupo HR mostrou maiores escores de penalidade na tarefa de Travessia (p<0.001), Ultrapassagem e Chuva (p<0.05 ambos). O escore de aprendizado verbal foi significativamente menor no grupo HR (mediana=33, limite=12-57) comparado com o grupo NR (mediana=38, limite=23-57, p<0.05), e foi observado que este escore foi o melhor preditor de pior performance de condução no modelo de regressão. Testes de rastreio cognitivo (Mini-exame do estado mental e Avaliação Cognitiva de Addenbroke) foram similar entre os grupos (p>0.05), com pequena magnitude de efeito (Cohen's d=0.3). Conclusões: O escore de aprendizado verbal pode ser o melhor preditor de risco de condução do que os testes de rastreio cognitivos. Motoristas de alto risco também mostraram maior escores de penalidade de trânsito nos testes de Travessia, Ultrapassagem e Chuva.

Verbal Learning as a predictor of risks of accidents in elderly drivers.

BACKGROUND: Age-related cognitive decline impacts cognitive abilities essential for driving. OBJECTIVE: We aimed to measure main cognitive functions associated with a high number of traffic violations in different driving settings. METHODS: Thirty-four elderly individuals, aged between 65 and 90 years, were evaluated with a driving simulator in four different settings (Intersection, Overtaking, Rain, and Malfunction tasks) and underwent a battery of cognitive tests, including memory, attention, visuospatial, and cognitive screening tests. Individuals were divided into two groups: High-risk driving (HR, top 20% of penalty points) and normal-risk driving (NR). Non-parametric group comparison and regression analysis were performed. RESULTS: The HR group showed higher total driving penalty score compared to the NR group (median=29, range= 9-44 vs. median=61, range= 47-97, p<0.001). The HR group showed higher penalty scores in the Intersection task (p<0.001) and the Overtaking and Rain tasks (p<0.05 both). The verbal learning score was significantly lower in the HR group (median=33, range=12-57) compared with the NR group (median=38, range=23-57, p<0.05), and it was observed that this score had the best predictive value for worse driving performance in the regression model. General cognitive screening tests (Mini-Mental State Examination and Addenbrooke's Cognitive Evaluation) were similar between the groups (p>0.05), with a small effect size (Cohen's d=0.3 both). CONCLUSION: The verbal learning score may be a better predictor of driving risk than cognitive screening tests. High-risk drivers also showed significantly higher traffic driving penalty scores in the Intersection, Overtaking, and Rain tests.

Desempenho de longevos caidores e não caidores na avaliação do timed up and go utilizando um aplicativo de Smartphone / Performance of very elderly fallers and non-fallers evaluated by timed-up-and-go with Smartphone APP

Este estudo tem por objetivo observar o desempenho de longevos caidores e não caidores por meio do teste Timed Up and Go (TUG) utilizando um aplicativo de smartphone (Mobility Suite®). Participaram longevos (≥90 anos), de Porto Alegre (RS), acompanhados em domicílio. Cada longevo realizou o TUG utilizando um smartphone com sistema operacional Android que foi colocado em uma cinta elástica com velcro e preso no peito, na altura do esterno. Assim, parâmetros das fases individuais do teste foram fornecidos pelo aplicativo, sendo eles: a) duração total do TUG em segundos; b) duração da transição de sentado para em pé em segundos; c) duração da transição de pé para sentado em segundos; d) variação máxima do ângulo do tronco na fase de inclinação para frente em graus e; e) velocidade angular máxima durante a fase de inclinação para frente em graus/segundos. Análise de variáveis sociodemográficas e clínicas, presença de multimorbidades e polifarmácia e variáveis relacionadas às quedas foram utilizadas para comparações. Dos 98 avaliados, 26,5% referiram quedas nos últimos seis meses. Longevos caidores apresentaram mais sintomas depressivos (p<0,001). Caidores apresentaram pior desempenho em cada uma das fases do TUG de acordo com o aplicativo. O aplicativo de smartphone Mobility Suite® foi capaz de avaliar o desempenho de longevos caidores e não caidores por meio do tempo do TUG e seus parâmetros. A depressão mostrou-se a única variável estatisticamente significativa, indicando que longevos com sintomas depressivos apresentam mais chances de cair. Este foi o primeiro relato da utilização do MobilitySuite® em longevos. O aplicativo mostrou-se útil para utilização no ambiente domiciliar, podendo ser utilizado em investigações futuras.

The performance of very elderly people, fallers and non-fallers, is evaluated by the Timed Up and Go (TUG) test with smartphone app (Mobility Suite®). Elderly people (≥90 years) from Porto Alegre, Brazil, were monitored at home. Each one performed TUG using smartphone with Android operational system placed within an elastic belt and tied on the breast near the sternum. The parameters of the test´s individual phases were provided by the app, namely, a) total duration of TUG, in seconds; b) duration of sitting-standing transition, in seconds; c) duration of standing-sitting, in seconds; d) maximum variation of the trunk angle within the inclination phase forward, in degrees; e) maximum angle speed during the inclination phase forward in degrees/seconds. Analysis of socio-demographic and clinical variables, multi-morbidities and poly-pharmacy and variables related to falls were compared. Further, 26.5% of 98 very elderly people evaluated mentioned falls during the previous six months. Elderly people with falls had more depression symptoms (p<0.001). According to app, fallers had the worst performance in each TUG phase. Smartphone Mobility Suite® app evaluated the performance of very elderly fallers and non-fallers during TUG and its parameters. Depression was the only variable statistically significant and indicated that very elderly people with depression had better chances for falling. This paper presents the first report in the use of MobilitySuite® for very elderly people. In fact, app was highly useful for use in the home and may be further used successfully.

An algorithm to track laboratory zebrafish shoals.

In this paper, a semi-automatic multi-object tracking method to track a group of unmarked zebrafish is proposed. This method can handle partial occlusion cases, maintaining the correct identity of each individual. For every object, we extracted a set of geometric features to be used in the two main stages of the algorithm. The first stage selected the best candidate, based both on the blobs identified in the image and the estimate generated by a Kalman Filter instance. In the second stage, if the same candidate-blob is selected by two or more instances, a blob-partitioning algorithm takes place in order to split this blob and reestablish the instances' identities. If the algorithm cannot determine the identity of a blob, a manual intervention is required. This procedure was compared against a manual labeled ground truth on four video sequences with different numbers of fish and spatial resolution. The performance of the proposed method is then compared against two well-known zebrafish tracking methods found in the literature: one that treats occlusion scenarios and one that only track fish that are not in occlusion. Based on the data set used, the proposed method outperforms the first method in correctly separating fish in occlusion, increasing its efficiency by at least 8.15% of the cases. As for the second, the proposed method's overall performance outperformed the second in some of the tested videos, especially those with lower image quality, because the second method requires high-spatial resolution images, which is not a requirement for the proposed method. Yet, the proposed method was able to separate fish involved in occlusion and correctly assign its identity in up to 87.85% of the cases, without accounting for user intervention.

Atlas selection for hippocampus segmentation: Relevance evaluation of three meta-information parameters.

Current state-of-the-art methods for whole and subfield hippocampus segmentation use pre-segmented templates, also known as atlases, in the pre-processing stages. Typically, the input image is registered to the template, which provides prior information for the segmentation process. Using a single standard atlas increases the difficulty in dealing with individuals who have a brain anatomy that is morphologically different from the atlas, especially in older brains. To increase the segmentation precision in these cases, without any manual intervention, multiple atlases can be used. However, registration to many templates leads to a high computational cost. Researchers have proposed to use an atlas pre-selection technique based on meta-information followed by the selection of an atlas based on image similarity. Unfortunately, this method also presents a high computational cost due to the image-similarity process. Thus, it is desirable to pre-select a smaller number of atlases as long as this does not impact on the segmentation quality. To pick out an atlas that provides the best registration, we evaluate the use of three meta-information parameters (medical condition, age range, and gender) to choose the atlas. In this work, 24 atlases were defined and each is based on the combination of the three meta-information parameters. These atlases were used to segment 352 vol from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Hippocampus segmentation with each of these atlases was evaluated and compared to reference segmentations of the hippocampus, which are available from ADNI. The use of atlas selection by meta-information led to a significant gain in the Dice similarity coefficient, which reached 0.68 ±â€¯0.11, compared to 0.62 ±â€¯0.12 when using only the standard MNI152 atlas. Statistical analysis showed that the three meta-information parameters provided a significant improvement in the segmentation accuracy.

Desempenho de idosos em simulador de direção e cognição / Elderly performance in a driving simulator and cognition

Introdução: Dirigir automóvel é importante para manter a independência, autonomia e qualidade de vida e requer a integridade das funções cognitivas, as quais tendem a diminuir com o envelhecimento, podendo interferir nas habilidades necessárias para a direção segura. Testes neuropsicológicos permitem detectar deficiências cognitivas e junto com o uso de simuladores de direção podem auxiliar a identificar o risco de acidentes e infrações. Objetivo: Investigar a relação entre o desempenho de idosos em um simulador de direção e em testes cognitivos. Métodos: Trinta e quatro condutores com mais de 65 anos foram submetidos a exercícios em um simulador de direção e avaliados cognitivamente. Resultados: Contatou-se associação entre o desempenho nas tarefas no simulador e o funcionamento cognitivo. Conclusão: O uso de testes cognitivos, em especial os que avaliam atenção e memória revelam-se promissores na identificação de idosos que possam apresentar problemas no trânsito.

Introduction: Driving cars is an important to maintain the independence, autonomy and quality of life and that requires the integrity of the cognitive functions, which tend to decline with aging, and may interfere in the skills needed for safe driving. Neuropsychological tests can detect cognitive impairment and together with the use of driving simulators can help to identify the risk of accidents and violations. Objective: To investigate the relation between the performance of the elderly in a driving simulator and in cognitive tests. Methods: Thirty-four drivers over 65 years were evaluated through exercises on the driving simulator and cognitively. Results: It was found an association between performance on tasks in the simulator and cognitive functioning. Conclusion: The use of cognitive tests, especially that evaluate attention and memory functions, are promising in the identification of elderly people who may present traffic problems.

Efeitos do treino com jogos de videogame na cognição de idosos: revisão sistemática / Effects of video game training on cognition in the elderly: systematic review

OBJETIVOS: realizar uma revisão sistemática da literatura sobre o efeito do treino com jogos de videogame na cognição de idosos. MÉTODOS: Busca nas bases de dados LILACS, SciELO, PsycINFO e PubMed, idiomas Inglês e Português. Utilizaram-se os descritores treino com jogos de videogame / video game training, adicionando aos seguintes: cognição / cognition, efeito cognitivo / cognitive effects, desempenho cognitivo / cognitive performance, plasticidade cognitiva / cognitive plasticity, testes cognitivos / cognitive tests. Foram incluídos estudos de intervenção cognitiva, artigos originais e disponíveis na íntegra, população alvo idosos (60 anos ou mais), publicados entre 2005 e 2015. A revisão ocorreu entre janeiro e julho de 2015. RESULTADOS: Dos 70 artigos encontrados inicialmente, 21 estudos atenderam aos critérios de seleção. Sete estudos (33%) verificaram melhoras significativas em velocidade de processamento, atenção sustentada, alerta, memória de trabalho visoespacial, flexibilidade cognitiva, memória visual imediata e tardia e coordenação viso-motora-espacial. Em relação à metodologia de treino dos estudos, 11 (52%) foram com treino de curta duração (uma a seis semanas) e tempo total entre menor tempo 4,5 horas e maior tempo 23,5 horas; e 10 (47%) com treino de longa duração (sete a 12 semanas) e tempo total de treino entre 12 e 36 horas. Os treinos de curta duração foram mais eficazes. CONCLUSÕES: A constatação do tempo total necessário de treino foi o achado principal desta revisão sistemática. Intervenção cognitiva com uso de jogos de vídeo game de curta duração, entre uma e seis semanas, e tempo total do programa de treino cognitivo entre 4,5 horas e 23,5 horas foi eficaz para idosos, sendo esta uma dose de tempo de intervenção cognitiva necessária e suficiente para a consolidação de sistemas e aquisição de um aprendizado no envelhecimento. Os efeitos cognitivos encontrados nos estudos sugerem que o cérebro idoso é capaz de adquirir, manter e enriquecer-se com novas aprendizagens.

AIMS: To perform a systematic review of the literature on the effect of video game training on cognition in the elderly. METHODS: The search was conducted using LILACS, SciELO, PsyINFO and PubMed databases in both English and Portuguese. The search term used were video game training, combined with the following: cognition, cognitive effects, cognitive performance, cognitive plasticity, cognitive tests. The inclusion criteria consisted of intervention studies on video game training, original articles in English or Portuguese, fulltext availability, and target population older people. Studies that failed to meet these criteria were excluded. Articles from 2005 to 2015 were collected, and the review was performed between January 2015 and July 2015. RESULTS: Seventy articles were found, but only twenty-one met the selection criteria. Of the 21 articles included in the study, only 7 studies (33%) revealed statistically significant improvement in speed of processing, sustained attention and alert, working visuospatial memory, cognitive flexibility, immediate and delayed visual memory, visual-motor coordination and visuospatial ability between the research groups (p<0.05). Other results were found in relation to the methodology of the studies. Of the 21 studies, 11 studies (52%) were performed with training of short duration (1-6 weeks) and total time of training ranging between 4.5 and 23.5 hours. Ten studies (47%) were performed with training of long duration (7-12 weeks) total time of training between 12 and 36 hours. The short duration training showed better performance. CONCLUSIONS: The total time required for training was the main finding of this systematic review. Cognitive intervention using short duration training (between one and six weeks) with video games in a total time between 4.5 and 23.5 hours is effective in elderly participants. This length time between the minimum and maximum time of cognitive intervention is necessary and sufficient for the consolidation of systems and acquisition of a learning in aging. The cognitive effects observed in the studies suggest that the aging brain is able to acquire, maintain and even enrich new learnings.

Automated methods for hippocampus segmentation: the evolution and a review of the state of the art.

The segmentation of the hippocampus in Magnetic Resonance Imaging (MRI) has been an important procedure to diagnose and monitor several clinical situations. The precise delineation of the borders of this brain structure makes it possible to obtain a measure of the volume and estimate its shape, which can be used to diagnose some diseases, such as Alzheimer's disease, schizophrenia and epilepsy. As the manual segmentation procedure in three-dimensional images is highly time consuming and the reproducibility is low, automated methods introduce substantial gains. On the other hand, the implementation of those methods is a challenge because of the low contrast of this structure in relation to the neighboring areas of the brain. Within this context, this research presents a review of the evolution of automatized methods for the segmentation of the hippocampus in MRI. Many proposed methods for segmentation of the hippocampus have been published in leading journals in the medical image processing area. This paper describes these methods presenting the techniques used and quantitatively comparing the methods based on Dice Similarity Coefficient. Finally, we present an evaluation of those methods considering the degree of user intervention, computational cost, segmentation accuracy and feasibility of application in a clinical routine.