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Title: A comparison of two personalization and adaptive cognitive rehabilitation approaches: a randomized controlled trial with chronic stroke patients
Authors: Faria, Ana Lúcia 
Pinho, Maria Salomé 
Bermúdez I Badia, Sergi 
Keywords: Cognitive rehabilitation; Virtual reality; Stroke; Ecological validity
Issue Date: 16-Jun-2020
Publisher: Springer Nature
Project: European Commission through the RehabNet project (Neuroscience-Based Interactive Systems for Motor Rehabilitation) under grant 303891 RehabNet FP7-PEOPLE-2011-CIG 
LARSyS UID/EEA/50009/2019, MACBIOIDI (INTERREG program MAC/1.1.b/098) 
FCT through the BRaNT project (PTDC/CCI-COM/31046/2017) 
Agência Regional para o Desenvolvimento da Investigação, Tecnologia e Inovação 
Serial title, monograph or event: Journal of NeuroEngineering and Rehabilitation
Volume: 17
Issue: 1
Abstract: Paper-and-pencil tasks are still widely used for cognitive rehabilitation despite the proliferation of new computer-based methods, like VR-based simulations of ADL's. Studies have established construct validity of VR assessment tools with their paper-and-pencil version by demonstrating significant associations with their traditional construct-driven measures. However, VR rehabilitation intervention tools are mostly developed to include mechanisms such as personalization and adaptation, elements that are disregarded in their paper-and-pencil counterparts, which is a strong limitation of comparison studies. Here we compare the clinical impact of a personalized and adapted paper-and-pencil training and a content equivalent and more ecologically valid VR-based ADL's simulation. Methods: We have performed a trial with 36 stroke patients comparing Reh@City v2.0 (adaptive cognitive training through everyday tasks VR simulations) with Task Generator (TG: content equivalent and adaptive paper-and-pencil training). The intervention comprised 12 sessions, with a neuropsychological assessment pre, post-intervention and follow-up, having as primary outcomes: general cognitive functioning (assessed by the Montreal Cognitive Assessment - MoCA), attention, memory, executive functions and language specific domains. Results: A within-group analysis revealed that the Reh@City v2.0 improved general cognitive functioning, attention, visuospatial ability and executive functions. These improvements generalized to verbal memory, processing speed and self-perceived cognitive deficits specific assessments. TG only improved in orientation domain on the MoCA, and specific processing speed and verbal memory outcomes. However, at follow-up, processing speed and verbal memory improvements were maintained, and a new one was revealed in language. A between-groups analysis revealed Reh@City v2.0 superiority in general cognitive functioning, visuospatial ability, and executive functions on the MoCA. Conclusions: The Reh@City v2.0 intervention with higher ecological validity revealed higher effectiveness with improvements in different cognitive domains and self-perceived cognitive deficits in everyday life, and the TG intervention retained fewer cognitive gains for longer. Trial registration: The trial is registered at, number NCT02857803. Registered 5 August 2016,
ISSN: 1743-0003
DOI: 10.1186/s12984-020-00691-5
Rights: openAccess
Appears in Collections:FPCEUC - Artigos em Revistas Internacionais

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