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A New Software for Rehabilitation Using Touch-Screen Technology

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A New Software for Rehabilitation Using Touch-Screen Technology Sede Amministrativa: Università degli Studi di Padova Dipartimento di Psicologia Generale CORSO DI DOTTORATO DI RICERCA IN SCIENZE PSICOLOGICHE CICLO XXIX New frontiers in neuropsychology. The Padua Rehabilitation Tool: a new software for rehabilitation using touch-screen technology Coordinatore: Ch.mo Prof. Francesca Peressotti Supervisore: Ch.mo Prof. Daniela Mapelli Co-Supervisore: Ch.mo Prof. Luciano Gamberini Dottorando: Stefano Cardullo Summary Recently, the advancement and the development of new technologies is shaping and establishing new frontiers in neuropsychological rehabilitation. In particular, the use of touchscreen technology, together with the use of mobile devices, is giving new opportunities for the development of innovative programs of rehabilitation tailored to the specific needs of patients. The touchscreen technology allows to go beyond some limits of classic paper and pencil exercise including the possibility for patients of practice rehabilitation outside clinic in a personalized manner and controlled by remote by the clinician. The overview of software for rehabilitation today is wide, but the poor availability of such software for Italian population and specifically designed for people with cognitive impairments, some years ago, led me to the development of the first mobile devices’ software for cognitive rehabilitation. The aim of this dissertation is to describe the development process and the efficacy evaluation of this software, the Padua Rehabilitation Tool (PRT). Initially will be described and analyzed the base for every cognitive intervention: the plasticity of brain. Today, we know that the brain has the ability to undergo functional and structural alterations in response to internal and external environmental changes, including cognitive interventions. Moreover, I will discuss the use of technology and computerized training for rehabilitation. In Section1 I will report a study for understanding the relationship between performance in computerized exercises and the performance in standardized tests. None before investigated the relationship between this two different measures of outcome. The perceived relationship is not necessarily automatically provided, thus, it is important to examine how exercises and standardized tests are related: if improvement in therapy exercises mirrors improvement in standardized test. The results of this study will confirm that changes in performance on therapy exercises and in standardized test are not just in co-occurrence but are directly related each other and this relation allows the clinician to make predictions. In Section 2, I will describe the development of the PRT and the use of this software in population with different etiologies. Originally, the PRT was designed for people with dementia and thus the most important study of efficacy was conducted on this population. I will report the results of a comparison between a cognitive training using PRT, a classic paper and pencil training, and a no treatment condition. It is demonstrated that both cognitive interventions led to significantly improvement compared to no treatment conditions. Moreover, the cognitive training using the Padua Rehabilitation Tool is effective such as a more classic paper and pencil approach to rehabilitation. Thus, the advantages of using touch screen technology rely on usability, portability, precision and motivation aspects rather than in efficacy. Lastly, given the flexibility and the variety of exercises and cognitive domains engaged by the PRT it was possible to deliver a cognitive rehabilitation to people with acquired brain injury. I will describe the effects of a cognitive rehabilitation with PRT in several single cases including patients after stroke, with a history of traumatic brain injury and an early post-coma rehabilitation. The results obtained with these patients were certainly positive, and in most of the cases, the cognitive improvement was observed also in the neuropsychological assessment. Table of Contents GENERAL INTRODUCTION Chapter_1 Basis of Neuropsychological Rehabilitation: The Plastic Brain ............................................ 1 1.1. Mechanisms underlying brain plasticity ............................................................................................... 1 1.2. Cortical reorganization: peripheral lesion ............................................................................................ 3 1.3. Cortical reorganization: cortical lesion ................................................................................................. 4 1.4. Cortical reorganization: exposure to environment and learning ........................................................ 5 1.5. Cortical reorganization: effects of cognitive training ........................................................................... 8 1.6. Cortical reorganization: elderly brain ................................................................................................. 10 1.7. Conclusions ........................................................................................................................................ 12 Chapter_2 Use of technology for cognition ......................................................................................... 13 2.1. What about the Italian context? ........................................................................................................ 27 2.2. Conclusions ........................................................................................................................................ 28 SECTION 1 Chapter_3 Investigating the relationship between standardized tests and therapy exercises: The outcomes of a computer-based treatment for aphasia ...................................................................... 33 Introduction .................................................................................................................................................... 33 Methods .......................................................................................................................................................... 36 Participants ................................................................................................................................................. 36 Therapy Program ........................................................................................................................................ 37 How to align therapy exercises to Standardized Test ................................................................................. 38 Calculating the dependent measures .......................................................................................................... 39 Data Analysis .............................................................................................................................................. 41 Results ............................................................................................................................................................. 41 Discussion ........................................................................................................................................................ 44 Conclusions ..................................................................................................................................................... 46 SECTION 2 Chapter_4 The Padua Rehabilitation Tool ........................................................................................... 49 4.1. Software architecture ........................................................................................................................ 50 4.2. Tablet and Touch-screen technology ................................................................................................. 52 4.3. Theoretical Background ..................................................................................................................... 53 4.4. Flexibility ............................................................................................................................................ 56 4.5. Usability, Feedbacks and other characteristics .................................................................................. 58 4.6. The exercises ...................................................................................................................................... 60 4.6.1. Attention .................................................................................................................................... 60 4.6.2. Memory ..................................................................................................................................... 61 4.6.3. Language ................................................................................................................................... 62 4.6.4. Logic Reasoning ......................................................................................................................... 63 4.6.5. Identification .............................................................................................................................. 64 4.6.6. Orientation ................................................................................................................................ 64 4.6.7. Motor Control ............................................................................................................................ 65 Chapter_5 Efficacy evaluation of PRT in patients with dementia
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