1. Virtual exercises to promote cognitive recovery in stroke patients: The comparison between HMD vs. screen exposure displays Pedro Gamito, PhD Laboratory of Computational Psychology University Lusófona of Humanities and Technologies Lisbon, Portugal pedro.gamito@ulusofona.pt

2. Introduction I TBI/stroke Attention Executive functions Daily live activities

3. Introduction II VR Repetition Feedback Motivation WWW Free access Online VR Repetition FeedbackMotivation Rehabilitation

4. Introduction III Fishtank VR Projection VR Occlusive HBDs Non- occlusive HBDs Palm VR Stationary Displays Head-based Displays Hand-based Displays

5. Introduction IV Fishtank VR Projection VR Occlusive HBDs Nonocclusiv e HBDs Stationary Displays Head-based Displays -more immersive; -head tracker; -more expensive; -hard/software proficiency; -additional cost. -less immersive; -no head tracker; -less expensive; -no hard/software proficiency; -available on almost every household.

6. Introduction V

7. Introduction VI

8. Introduction VII

9. Introduction VIII Fishtank VR Projection VR Occlusive HBDs Nonocclusiv e HBDs Stationary Displays Head-based Displays dissemination

10. Participants – n = 17 – M = 51 years old (SD = 14); – Male/Female = 58%/42%; – Stroke; – Memory and attention impairments (Mini Mental - Folstein et al, 1975); – No previous psychiatric disorders, drug abuse, severe depression or neurological disease. Method I

11. Measures Method II Memory: Wechsler Memory Scale – WMS-III (Wechsler, 1954) & copy of Rey Complex Figure – RCF (Osterrieth, 1994) Attention: Toulouse Piéron – TP (Piéron, 1955)

12. Procedures Psychology Department of the Centro de Medicina de Reabilitação de Alcoitão, Lisbon, Portugal; VR + WWW: Unity 2.5; HP Intel® Core™2 Quad Processor Q6600 PC equipped with a GeForce GT 220; Tasks: daily activities + working memory + visuo- spatial orientation + recognition memory Method III

13. Procedures HMD: eMagin Z8 (n=9); 21’’ Asus VE228D screen display (1680 X 1050 pixels of screen resolution) (n=8) Method IV

14. Procedures 13 sessions (one session per week); first session, memory and attention tests (WMS-III, RCF and TP); on second and third session patients acquired computer interaction skills on a training platform; next nine sessions were used for cognitive training by VR. last session, memory and attention tests (WMS-III, RCF and TP). Method V

15. Method VI

16. Procedures: session 0 - training Method IV

17. Procedures: session 1 - daily life activities Method V

18. Procedures: session 2 – finding way to minimarket + buying several items Method VI

19. Procedures: session 3 - finding the way back home Method VII

20. Procedures: session 4 - finding a different way to the minimarket Method VIII

21. Procedures: session 5 - finding a yellow dressed BOT Method IX

22. Procedures: session 6 - finding the door number 29 Method X

23. Procedures: session 7 - retention of outdoor advertisements Method XI

24. Procedures: session 8 - Mini-Mental State Examination (Folstein et al, 1975) and Short test of Mental Status (Kokmen et al, 1991) Method XII

25. Procedures: session 9 - spawned on a different local of the VR world, the patient had to find his way back home with an item bought at the minimarket Method XIII

26. Results I WMS mean scores (left figure) and RCF mean scores (right figure) to each experimental condition. main effect of evaluation in WMS (F(1, 16) = 12.491; MSE = 117.813; p < 0.01) and RCF (F(1, 16) = 8.676; MSE = 19.709; p < 0.05) significant increase in WMS (M = 85.71; SD = 3.89 vs. M = 98.94; SD = 3.99) and RCF scores no significant interaction effects were reported between factors (p > 0.05) in the WMS and RCF assessments

27. Results II TP mean scores to each experimental condition main effect of evaluation in the TP test (F(1, 16) = 15.935; MSE = 542.598; p < 0.01), attention increased from initial (M = 75.69; SD = 10.83) to final assessment (M = 108.56; SD = 16.23) no significant interaction effects (p > 0.05)

28. VR exercises aimed at training memory and attention functions in stroke patients; No interaction effects between factors (p > 0.05), Final remarks using VR exercises aimed at training memory and attention functions in stroke patients.

29. Thanks ! pedro.gamito@ulusofona.pt labpsicom.ulusofona.pt