executive functions computerized rehabilitation using virtual reality to improve activities of daily living post-stroke

Conditions: Stroke

Summary: this research aims to evaluate the effects of a cognitive reeducation carried out with the covirtua cognition software using a virtual environment, on real-life execution of activities of daily living (adl) for patients with post-stroke dysexecutive disorders. we will assess patients' performances in achieving adls by the goal attainment scaling (gas) throughout the follow-up (3 months), based on the goals set at the beginning of management with each patient.

many post-stroke patients, especially those with frontal lobe lesions, have chronic impairments in mental flexibility, leading to difficulties in decision-making, action planning, or behavioural perseverance. techniques for remediation of these dysexecutive disorders are often performed in a hospital or in a liberal office. the possible progress resulting from this rehabilitation is rarely transposed into the patient daily life performances, executed in a richer and less controlled environment than the usual place of re-educational. here, we wish to assess the effective benefits (i.e. in carrying out the activities of daily living) of a computerized rehabilitation program addressing executive functions and based on virtual reality, simulating adls. we use in this study a multiple baseline single case experimental design (ab design with a follow-up beyond), including for each patient: pretreatment (phase a), treatment (phase b), and follow-up phase. pretreatment includes a routine sensitivomotor neurological rehabilitation program that doesn't specifically target executive functions in daily living activities (3 to 5 weeks depending on randomization). treatment consists in a 4 weeks virtual reality cognitive training program, including four 45-minute sessions per week with an occupational therapist for cognitive rehabilitation in a virtual environment with the covirtua cognition software. the follow-up phase (5 to 3 weeks depending on randomization) includes no support for executive functions, either in a rehabilitation centre or in a liberal office.

Eligibility criteria:
inclusion criteria: * vascular brain injury (stroke), in chronic phase (6 months or more after stroke), responsible for dysexecutive syndrome authenticated by the grefex/greco battery (executive function evaluation reflection group) * men and women over the age of 18 * presence of a caregiver * social security affiliation * signing free and informed consent following clear and detailed information * sufficient understanding of the french language to participate in the study exclusion criteria: * pregnant women (clinical examination) * alcohol and/or narcotics addiction * major hearing deficit * major visual deficit * neurological pathology other than stroke or psychiatric disorder * unstable epilepsy * patient undergoing rehabilitation at a liberal therapist targeting executive functions during study time * patient under safeguard of justice. * patient simultaneously participating in another research study

Keywords: n-of-1 trials cognitive rehabilitation computerized rehabilitation virtual reality executive functions occupational therapy post-stroke rehabilitation