Rehabilitation Treatment of Time Deficits in Brain-damaged Patients
Condition: Brain Damage
MeSH terms: Brain Injuries
Study type: Interventional

Summary: 
      The efficacy of an innovative rehabilitation treatment for deficit in time processing is
      tested in right brain damaged patients.

      Patients with a focal lesion following a stroke and without general cognitive impairment will
      be submitted to computerized tests assessing the ability to estimate time duration (intervals
      around 7500 ms) and to mental travel in time. Moreover, the impact of the deficit in time
      processing in everyday life will be evaluated by using ad hoc questionnaires.

      Patients will perform tasks before and after two weeks of a new rehabilitation treatment,
      combining a training for one week with prismatic googles inducing prismatic adaptation (PA)
      plus Virtual Reality (VR) and a training for one week with neutral googles inducing
      no-adaptation (NA) plus Virtual Reality. Participants will be randomized into two groups.
      Each group will be submitted to both treatments in a different order, accordingly with a
      crossover design.

      A greater amelioration in time processing after PA+VR than NA+VR training should be found.
      Moreover, an improvement in everyday life activities is expected accordingly with the
      amelioration in time processing.
    

Detailed description: 
      Time processing involves different abilities - i.e. estimating the duration of an event and
      moving in past and future time - and it is a fundamental ability in everyday life. However,
      in neuropsychology, time processing is routinely neglected in the assessment of cognitive
      deficits in brain-damaged patients. This is surprising since time is an important function
      that permeates our activities: we perceive mismatches in lip reading (milliseconds), we
      estimate how long it takes to be ready for work (minutes), and we plan how long it will take
      a manuscript to be accepted (usually months). Thus, impairment in processing time has
      important consequences in daily life.

      For instance, it is known that right brain damaged (RBD) patients with spatial attentional
      deficit (neglect) are impaired in estimate the duration of a time interval as well as in the
      ability of mentally moving in time (Mental Time Travelling).

      Previous studies have demonstrated an improvement of time estimation and mental time travel
      after a leftward shift of spatial attention induced by a single session of prismatic
      adaptation (PA). Moreover, a recent study investigated the long-term duration of the benefits
      induced by 10 daily sessions of PA treatment on mental time travel and functional abilities
      in neglect patients. Results suggest that the PA treatment induces a long-lasting and stable
      ameliorations of mental time travel and functional competences.

      To generalize the effects of PA treatment to everyday life, here we propose to combine PA
      with a virtual reality training (VR). VR has recently been used as an effective tool both for
      the assessment and rehabilitation of cognitive deficits, because it allows post-stroke
      patients to interact with ecological environments similar to the real ones, but in a safe and
      controlled condition.

      Aim of this study is to set up a rehabilitation procedure for temporal deficits, combining a
      well-established PA procedure with an innovative, more engaging and ecological VR approach.

      Patients will perform tasks before and after two weeks of a new rehabilitation treatment,
      combining a training for one week with prismatic googles inducing prismatic adaptation (PA)
      plus Virtual Reality (VR) and a training for one week with neutral googles inducing
      no-adaptation (NA) plus Virtual Reality. Participants will be randomized into two groups.
      Each group will be submitted to both treatments in a different order, accordingly with a
      crossover design.

      A greater amelioration in time processing after PA+VR than NA+VR training should be found.
      Moreover, an improvement in everyday life activities is expected accordingly with the
      amelioration in time processing.
    

Intervention name(s): Prismatic googles inducing prismatic adaptation (PA) associated to Virtual Reality (VR); Neutral googles inducing no-adaptation (NA) associated to Virtual Reality (VR)
Intervention type(s): Behavioral; Other
Intervention description(s): The experimental condition consists of PA procedure associated to VR task: the pointing task will be followed by 5 sessions of VR task.
Pointing task. Patients will perform a session of 90 pointing movements toward a visual target presented in a variety of positions on the right, the left or at the center of the visual field. This pointing task will be performed with prismatic googles inducing a rightward shift of the visual field (experimental condition). After lenses removal, a leftward shift of spatial attention will be produced.
Virtual Reality task consists of a 3D computer-generated virtual environment that will be displayed on a desktop VR computer monitor. A joystick will provide the graphical interface for patients by allowing user-friendly exploration of virtual scenarios. Patients will be presented 16 actions, with dynamic simulations of real life situations. They will verbally estimate and reproduce the duration of each previously presented action.; The sham condition of this study consists of NA procedure associated to VR task: the pointing task will be followed by 5 sessions of VR task.
Pointing task. Patients will perform a session of 90 pointing movements toward a visual target presented in a variety of positions on the right, the left or at the center of the visual field. This pointing task will be performed with neutral goggles (control condition), which should not induce a shift of the visual field and of spatial attention.
Virtual Reality task consists of a 3D computer-generated virtual environment that will be displayed on a desktop VR computer monitor. A joystick will provide the graphical interface for patients by allowing user-friendly exploration of virtual scenarios. Patients will be presented 16 actions, with dynamic simulations of real life situations. They will verbally estimate and reproduce the duration of each previously presented action.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Right Brain Damaged Patients; Time perception; Mental Time Travel; Prismatic adaptation; Virtual Reality