Since your doctor doesn't have 100% recovery protocols, is this the best they can do?
Avatar-Enabled Virtual Therapist Application for Cognitive Rehabilitation Intervention in Traumatic Brain Injury and Post-Stroke Patients
J Modaresi1, R Paulino2, P Gamito3, J Oliveira4, J Carmo5, T Souto6, A Fantasia7,
J Galhordas8, R Gomes9 & A Candeias10
1-6,9,10Universidade Lusófona (Lisbon, Portugal)
1,2Universitat de Barcelona (Barcelona, Spain)
1,2Université Paris Cité (Paris, France)
7,8Alcoitão Rehabilitation Medicine Centre (Lisbon, Portugal)
3-6HEI-Lab (Lusófona University)
ABSTRACT
The quality of life of post-stroke and traumatic brain injury (TBI) patients usually drops after the
end of rehabilitation due to their discharge from the hospital. This study explores the impact of
adding the avatar of a “virtual therapist” to a 3D application used in hospitals for cognitive
rehabilitation, allowing patients to continue using this application without the presence of a real
therapist after rehabilitation discharge. A sample of 5 patients from Alcoitão Rehabilitation
Medicine Centre were asked to continue their cognitive rehabilitation with the new avatar-enabled
application for minimum 6 sessions. Comparing pre and post intervention, significant improvements
in MoCA and WMS cognitive measurements were found suggesting effectiveness of using an avatar
as the virtual therapist for cognitive rehabilitation in later stages of TBI and post stroke
rehabilitation.
1. INTRODUCTION
Stroke and traumatic brain injury represent two major causes of death and disability, often leaving lasting
cognitive deficits (Wafa et al., 2020). The survivors may experience a range of cognitive impairments. Dysfunction
in memory, orientation, language, attention, and executive skills are the most frequently observed (Tatemichi et
al., 1994). Patients with cognitive impairment often need to go through cognitive rehabilitation in a clinical facility,
however, when they are sent home, the rehabilitation process abruptly stops. In addition, the improvements in
executive functions require a more intense treatment approach (Oliveira et al., 2022). Longitudinal studies found
that the quality-of-life scores reported upon rehabilitation discharge usually do not last (Schindel et al, 2021). The
capacity to use Virtual Reality (VR) to carry out rehabilitation outside of the hospital environment and into patients'
homes (Chen et al., 2019) creates opportunities for further assistance, removing constraints related to distance and
encouraging long-term rehabilitation.
This study proposes an addition of a “virtual therapist” to an existing 3D serious game digital application
named Systemic Lisbon Battery (SLB), to overcome this challenge. SLB is a validated application used for
cognitive rehabilitation on several hospitals. Various studies have found evidence that SLB is a useful tool for
improving cognitive functioning on different populations (Gamito et al., 2020; Oliveira et al., 2022). The added
“virtual therapist” will help the patient perform simple daily routine tasks in VR. This way, the patients can
continue their rehabilitation process for a longer time after being discharged from the hospital. The objective of
this study is to find out if the use of this “virtual therapist” leads to cognitive improvements in post-stoke and
traumatic brain injury patients.
2. METHOD
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