Dual-task training software for neurorehabilitation

Katarzyna is 60 years old. She has undergone several brain surgeries. Despite long-term rehabilitation, she still has cognitive problems, i.e. poorer memory and concentration, trouble planning activities and solving problems. She also suffers from partial Neuroforma - software for rehabilitation paralysis and uses crutches. Also, her hand-eye coordination is impaired.

When searching for new rehabilitation methods, Katarzyna found Neuroforma - a virtual reality software for rehabilitation featuring motor and cognitive exercises.

At one of the meetings, Katarzyna took a series of exercises, during which she simultaneously performed highly engaging motor and cognitive tasks. When finished, the woman stood straight on her feet – a feat that none of the previous physiotherapy sessions let her achieve. So what made it possible all of a sudden?

Mind and body training

The common statement “a sound mind in a sound body” has long since lost its status of sheer folk wisdom, and today it may well be assumed to be a scientific truth. In 2013, scientists from the US and Canada, Louis Bherer, Krik Erickson and Teresa Liu-Ambrose compiled dozens of available studies on the relationship between physical activity and mental efficiency1. It turned out that the vast majority confirmed the beneficial impact of various types of physical activity on the mind. An analysis of studies on seniors2 brought similar results.

Dual-task training software It has been known for ages now that mental activity has a positive impact on physical fitness. To speed up the healing process, athletes with injuries are recommended to watch recordings of their performances and to imagine from time to time that they train and perform specific exercises3.

Now, the 2013 study of the American researcher Renae Smith-Ray suggests that motor skills in seniors may only be improved by regularly performing computer cognitive exercises. After a ten-week training that developed e.g. information processing speed and spatial memory, her subjects scored better than before the training in the test that involved getting up from a chair as fast as possible, walking three meters and getting back to the chair (Timed Up and Go Test)4.

Thus, while physical activity affects the condition of the mind, cognitive exercises have an impact on the efficiency of the body. Now, over the years, patients had one session to train with a physiotherapist, a body expert, and another with a neuropsychologist, who “worked on” their mind. There were no tools or ideas available on how to combine cognitive and motor training, nor was it known what benefits it could bring.

Games for neurorehabilitation

The last decade have unlocked new opportunities for the development of an integrated cognitive-motor training for patients. This process got an invaluable support from the ever more advanced and common computers. Software for neurorehabilitation emerged that often offered appealing interactive games for rehabilitation, where the user controls the character on the screen, moving under the supervision of a special camera.5,6

Computer programs for rehabilitation are increasingly used by patients who want to supplement their rehabilitation or keep training regularly after leaving the hospital or a rehabilitation centre. If the software for neurorehabilitation enables the therapist to use remote supervision (on-line rehabilitation), patients can remain under the care of a specialist without leaving their home.

It is still hard, though, to find a tool that deliberately combines elements of cognitive and motor exercises. Such a tool has been provided by the designers of the Neuroforma system - dual-task training software.

Games for neurorehabilitation Previously during her rehabilitation, Katarzyna stood facing a wall or a mirror and performed sequences of motion exercises as described in the instructions, while doing cognitive tasks on the computer. When using the Neuroforma virtual reality software for rehabilitation, patients stand or sit in front of a computer screen and see their mirror reflection on the screen, while various objects appear around it. The patient catches them, moves or removes them, hits or avoids them.

Games for rehabilitation Such training assumes the form of attractive games for rehabilitation with scenarios featuring motor exercises, combined with elements of cognitive training, such as training the processes of perception, planning, attention and memory. For example one exercise consists in trying to catch a scampering butterfly, which changes every now and then the direction of flight and blends in with other hosts of insects, forcing a continuous intense concentration. Here, the results achieved by patients depend both on their mobility and mental ability - which is the very essence of dual-task training software.

But why should we combine cognitive and motor exercises? Whether and why it can be expected to offer better results, and what do we actually mean by “better results”?

Transfer of skills

Daily life abounds in situations where we use both our motor and cognitive skills. For example:

  • when driving, we are talking with a passenger;
  • when crossing the street, we are mentally reviewing the shopping list,
  • while trekking with a friend in the mountains, we're going over a tough work problem...

Such situations are nothing but natural for us, and we cope with them automatically, without much effort.

Scientists have long been aware that the closer study conditions are to the natural ones which we face in real life, the less biased the study results. It is no different with training skills: it is all the more effective, the more it reflects what can actually happen in life, the closer it is to reality. Since this is so, it is easier to get the effect of the transfer of skills: what you learn in the context of training (e.g. by memorizing a list of words), you use in real life (e.g. by remembering a shopping list).7

Neuroforma is an attempt at approximation of the training situation to real life conditions. Simultaneous cognitive and motor training is meant to increase the chances to transfer the skills acquired in the course of rehabilitation to everyday life, which is, after all, full of situations where we both move and “think.” This makes games for neurorehabilitation offered by dual-task training software Neuroforma more effective than physical and cognitive exercises performed separately.

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1 Bherer, L., Erickson, K. I., Liu-Ambrose, T. (2013). A review of the effects of physical activity and exercise on cognitive and brain functions in older adults.Journal of aging research, 2013 (full text).

2 Angevaren, M., Aufdemkampe, G., Verhaar, H. J., Aleman, A., Vanhees, L. (2008). Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. Cochrane Database Syst Rev, 3(3) (full text).

3 Faubert, J., Sidebottom, L. (2012). Perceptual-cognitive training of athletes.Journal of Clinical Sport Psychology, 6(1), 85 (full text).

4 Smith-Ray, R. L., Hughes, S. L., Prohaska, T. R., Little, D. M., Jurivich, D. A., Hedeker, D. (2013). Impact of cognitive training on balance and gait in older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, gbt097 (full text).

5 Correa, A. G. D., de Assis, G. A., Nascimento, M. D., Ficheman, I., Lopes, R. D. D. (2007, September). Genvirtual: An augmented reality musical game for cognitive and motor rehabilitation. In Virtual Rehabilitation, 2007 (pp. 1-6). IEEE (full text).

6 Burdea, G., Rabin, B., Chaperon, A., Hundal, J. (2011, June). Emotive, cognitive and motor rehabilitation post severe traumatic brain injury-A new convergent approach. In Virtual Rehabilitation (ICVR), 2011 International Conference on (pp. 1-8). IEEE (full text).

7 Cormier, S. M., Hagman, J. D. (red.). (2014). Transfer of learning: Contemporary research and applications. Academic Press (abstract).