Rehabilitation Institute of Chicago, 345 E, Superior Street, Chicago, IL 60611, USA.
J Neuroeng Rehabil. 2013 Aug 9;10:92. doi: 10.1186/1743-0003-10-92.
Although common during the early stages of recovery from severe traumatic brain injury (TBI), attention deficits have been scarcely investigated. Encouraging evidence suggests beneficial effects of attention training in more chronic and higher functioning patients. Interactive technology may provide new opportunities for rehabilitation in inpatients who are earlier in their recovery.
We designed a "virtually minimal" approach using robot-rendered haptics in a virtual environment to train severely injured inpatients in the early stages of recovery to sustain attention to a visuo-motor task. 21 inpatients with severe TBI completed repetitive reaching toward targets that were both seen and felt. Patients were tested over two consecutive days, experiencing 3 conditions (no haptic feedback, a break-through force, and haptic nudge) in 12 successive, 4-minute blocks.
The interactive visuo-haptic environments were well-tolerated and engaging. Patients typically remained attentive to the task. However, patients exhibited attention loss both before (prolonged initiation) and during (pauses during motion) a movement. Compared to no haptic feedback, patients benefited from haptic nudge cues but not break-through forces. As training progressed, patients increased the number of targets acquired and spontaneously improved from one day to the next.
Interactive visuo-haptic environments could be beneficial for attention training for severe TBI patients in the early stages of recovery and warrants further and more prolonged clinical testing.
尽管在严重创伤性脑损伤 (TBI) 康复的早期阶段很常见，但注意力缺陷很少被研究。有令人鼓舞的证据表明，注意力训练对慢性和功能更高的患者有益。交互式技术可能为处于康复早期的住院患者提供新的康复机会。
我们设计了一种“几乎最小”的方法，使用机器人呈现的触觉在虚拟环境中训练严重受伤的住院患者，以维持对视觉运动任务的注意力。21 名患有严重 TBI 的住院患者完成了重复的伸手取目标的动作，这些目标既可见又可感。患者在连续两天内接受测试，在 12 个连续的 4 分钟块中体验 3 种条件（无触觉反馈、突破力和触觉轻推）。
交互式视触觉环境耐受性好且引人入胜。患者通常保持对任务的注意力。然而，患者在运动前（运动启动延长）和运动中（运动过程中停顿）表现出注意力丧失。与无触觉反馈相比，患者受益于触觉轻推线索，但不受突破力的影响。随着训练的进展，患者增加了获得的目标数量，并自发地从一天到另一天有所改善。
交互式视触觉环境可能有益于严重 TBI 患者在康复早期的注意力训练，值得进一步和更长期的临床测试。
