Workshops

Workshop 1a: Virtual environments to evaluate and treat cognitive deficits in everyday function

Organizer/Presenters:

Name: Evelyne KLINGER, Eng, PhD, Director of Research
Affiliation: Federative Institute for Research on Handicap, EA 4136 University of Bordeaux Email: evelyne.klinger@orange.fr

Name: Naomi JOSMAN, PhD, OTI, Associate faculty Dean for research
Affiliation: Department of Occupational therapy, Faculty of Social welfare & Health Sciences, University of Haifa
Email: njosman@univ.haifa.ac.il

Organizer contact Information:

Name: Evelyne KLINGER
Email: Evelyne.klinger@orange.fr

Learning Objectives

After completing this workshop, participants should be able to:

  1. Demonstrate an understanding of the Virtual Reality‐based technologies available in the field of cognitive rehabilitation

  2. Describe in which ways such technologies can be applied to provide cognitive rehabilitation

  3. Identify the different performance and Executive Functions profiles of clients with various Central Nervous System deficits.

Summary

Numerous disorders such as brain injury, neurodegenerative pathologies, and mental diseases, are manifested as concomitant, significant cognitive functioning disability. There is a need to assess such cognitive functional capacity, based upon efficient methods and tools prior to planning therapeutic intervention and rehabilitation. Among the Instrumental Activities of Daily Living (IADL), shopping behavior constitutes a vital activity which contains both complexity and integration of various cognitive functions. The assessment of, as well as the treatment of real‐life people’s shopping behavior poses practical difficulties, whereas a Virtual Reality‐based supermarket substantially facilitates this task.

The proposed workshop aims, at first, to provide a critical overview of the current state of, the rationale for, and the design and use of virtual supermarkets (or simulated IADL) for cognitive assessment and rehabilitation, with a focus on the Virtual Action Planning Supermarket (VAP‐S) and its first use in Parkinson Disease. The perspectives brought by its new version, the VAPS Market, will be presented. Thereafter, a description and analysis of the use of the VAP‐S, for investigating executive functions and IADL in several neurological populations, will be presented. Finally, the workshop will include a discussion of the key issues for developing and implementing VR‐based cognitive rehabilitation. Barriers to implementation in clinical practice and strategies to overcome these will also be discussed.

Detailed Workshop Outline (3 hours)

Part 1 (45 mins): Virtual supermarkets for cognitive rehabilitation: A critical overview (Evelyne Klinger)

A critical overview of the current state of the rationale, design and use of virtual supermarkets for cognitive evaluation and treatment, with a focus on the Virtual Action Planning Supermarket (VAP‐S) and its first use in Parkinson Disease. Key issues in the simulation of IADL will be discussed. The perspectives brought by its new version, the VAPS Market, will be presented.

Part 2 (45 mins): Lessons learned in use of virtual reality as a performance‐based tool (Naomi Josman)

Research results and analysis of the use of the VAP‐S for investigating executive functions and IADL will be presented. The studies include 250 participants with central nervous system deficits: acute stroke, schizophrenia, mild cognitive impairment, home‐dwelling stroke, and healthy controls in different age groups. The results revealed significant differences between the respective groups of participants, as well as distinctive profiles. The VAP‐S was able to identify a participant’s EF profile according to the respective diagnosis. Using the VAP‐S as a tool for advancing shopping skills in a group of adolescents diagnosed with high function Autism.

Health break (10 mins)

Part 3 (45 mins): Key issues for developing and implementing VR‐based cognitive rehabilitation in a cross‐disciplinary approach (Evelyne Klinger and Naomi Josman)

A presentation of the development cycle which makes it possible to move from the idea / concept to the realization of the application and its use in rehabilitation centers or at home. We will highlight the importance of the user‐centered design approach and cross‐disciplinary interactions (between clinicians, researchers and engineers), and provide an overview of the clinical studies that can be used at the various stages of the technology development (from needs to efficacy) in order to make the applications available to clinicians

Part 4 (30 mins): Demo of the VAPS Market, Questions and Answers Part 5 (5 mins): Summary

Intended audience:

All ICVR attendees and particularly people interested in using VR in Cognitive Rehabilitation are welcome, including: Researchers, Therapists, Engineers, Students

Presenter biographies:

Evelyne KLINGER, Federative Institute for Research on Handicap, EA 4136 University of Bordeaux, is an internationally recognized expert in the clinical applications of Virtual Reality and associated technologies. Active in many national and international projects, her responsibilities include the chairmanship of the Interactive Systems for Participation and Autonomy of the French Research Institute on Disability (IFRH) program. She is an active member of the board of the International Society for Virtual Rehabilitation (ISVR). The majority of her research activity is dedicated to the design of VR‐based methods, concepts and systems for cognitive rehabilitation (e.g., the Virtual Action Planning Supermarket: VAP‐S). Her fields of interest include virtual reality, human activity, rehabilitation, cognitive functions, emotions, behavior and disability, with a strong commitment to the engineering of digital technologies for the purpose of better understanding, treating and accompanying patients and people with disabilities.

Naomi JOSMAN is Professor of Occupational Therapy in the Department of Occupational Therapy, and the associate faculty dean for research the Faculty of Social Welfare & Health Sciences at the University of Haifa, Israel. Prof. Josman is an internationally recognized leader, scholar and educator in the area of cognitive rehabilitation. Her research investigates cognition, metacognition, executive functions and their influence on everyday life. Her work is based on an ecologically‐valid assessment of cognitive impairments to performance‐based assessments, utilizing innovative methods and tools, inter alia Virtual Reality, for evaluation and intervention. Her research activities extend to the study of a wide range of populations, including people with central nervous system deficits, clients with schizophrenia, and the elderly.

Workshop 1b: The Role of Mental Imagery in Virtual Rehabilitation

Organizer/Presenters:

Mr. Eric Franklin, B.Sc., BFA
The International Institute for Franklin Method, Hitnauerstrasse 40 CH‐8623 Wetzikon, Zurich, Switzerland.
Email: franklinmethod@me.com

Dr. Amit Abraham, Ph.D., MAPhty (Musculoskeletal), B.P.T
Emory University School of Medicine, Department of Medicine, Division of General Medicine and Geriatrics, Atlanta, GA, USA; Department of Kinesiology, College of Education, University of Georgia, Athens, GA, USA
Email: amit.abraham@emory.edu

Organizer Contact Information:

Dr. Amit Abraham
202 Gran Ellen Drive, Athens, GA, 30606, USA. amit.abraham@emory.edu

Learning Objectives

After completing this workshop, participants will be able to

  1. Identify key elements of motor imagery (MI) and dynamic neuro‐cognitive imagery (DNI) relevant for virtual rehabilitation settings and goals.

  2. Describe ways in which scientific research supports the use of MI and DNI for the motor, sensory, and cognitive goals of virtual rehabilitation.

  3. Outline advantages of implementing MI and DNI training approaches within virtual rehabilitation.

Workshop Overview

Virtual rehabilitation (VR) involves the operator moving his or her own body in interaction with the virtual‒as well as realistic‒environment. As such, the operator’s self‐awareness and body schema play an important role in the VR’s efficacy. Mental imagery‒the cognitive process of mentally creating and using images and metaphors to ameliorate motor‐ and non‐motor functions‒can be used to facilitate motor, sensory, and cognitive gains of VR through addressing body schema and self‐awareness. This workshop introduces participants to innovative ways in which mental imagery can be used to improve postural control and motor performance while using VR, with an emphasis on the pelvic girdle. In this workshop, an overview of scientific evidence and clinical experiences supporting the integration of two mental imagery approaches‒motor imagery (MI) and dynamic neuro‐cognitive imagery (DNI)‒ within VR will be provided. Participants will then actively participate in a live, interactive class and get acquainted with ways in which MI and DNI can be used to enhance body schema and improve self‐awareness while engaging in VR. Specific applications for VR practices will be outlined, with particular attention to how these tools can facilitate comprehensive, efficient, and effective client outcomes. Lastly, future research and clinical paths, and challenges for scientific and clinical research collaborations, will be discussed.

Detailed Workshop Outline (3 hours)

Part 1 (45 mins): Scientific background for mental imagery (MI and DNI) as a rehabilitative approach. (Amit Abraham; Lecture)

Part 2 (45 mins): Introduction to MI and DNI. (Eric Franklin; Interactive) Rest break (20 mins)

Part 3 (60 mins): Enhancing body schema and self‐awareness through MI and DNI, and specific application to virtual rehabilitation. (Eric Franklin & Amit Abraham; Lecture & Interactive)

Part 4 (10 mins): Summary and Q&A. (Eric Franklin & Amit Abraham)

Intended audience:

This workshop is intended for ALL ICVR attendees, including, but not limited to computer engineers, biomedical engineers, researchers, physical therapists, occupational therapists, speech and language therapists, recreation therapists, virtual reality program designers, managers, and students.

Presenter biographies:

Mr. Eric Franklin is a movement teacher and an expert in imagery training and its applications to dance, movement, and body therapies. Mr. Franklin holds a BSc Degree from the University of Zürich (Switzerland) and a BFA Degree from New York University (USA). He is the founder of "The Franklin Method" and "Dynamic Neuro‐ cognitive Imagery" methods, and he has written 23 books about body‐mind, imagery, and movement. Mr. Franklin teaches at universities and schools throughout the world, including the Juilliard School in New York, Rutgers University, the University of Vienna, the Royal Ballet School, and the Laban Center in London.

Dr. Amit Abraham is a musculoskeletal physical therapist with a specialization in dance injuries and imagery training for dancers and other populations (e.g., individuals with Parkinson's Disease, Low Back Pain, etc.). Dr. Abraham holds a Bachelor in Physical Therapy from Tel‐Aviv University (Israel), a Master's Degree in Musculoskeletal Physical Therapy from The University of Queensland (Australia), and a Ph.D. in Physical Therapy from the University of Haifa (Israel). Currently, Dr. Abraham is a post‐doctoral research fellow at Emory University School of Medicine (USA) and an adjunct assistant professor at the Department of Kinesiology, The University of Georgia (USA).

Workshop 2: Use of virtual reality technologies in basic & clinical science research

Organizers/Presenters:

Name, credentials: Meir Plotnik, PhD (Organizer)
Affiliation: Center of Advanced Technologies in Rehabilitation (CATR), Sheba Medical Center, Ramat Gan, Israel Email: meir.plotnik@sheba.health.gov.il

Name, credentials: Glen M. Doniger, PhD (Organizer)
Affiliation: The Joseph Sagol Neuroscience Center & Center of Advanced Technologies in Rehabilitation (CATR), Sheba Medical Center, Ramat Gan, Israel
Email: glen.doniger@sheba.health.gov.il

Name, credentials: Zoya Katzir, MSc
Affiliation: Center of Advanced Technologies in Rehabilitation (CATR), Sheba Medical Center, Ramat Gan, Israel Email: zoya.katzir@sheba.health.gov.il

Name, credentials: Oran Ben-Gal, BSc
Affiliation: Center of Advanced Technologies in Rehabilitation (CATR), Sheba Medical Center, Ramat Gan, Israel Email: oran.bengal@sheba.health.gov.il

Name, credentials: Amit Benady, MSc
Affiliation: Center of Advanced Technologies in Rehabilitation (CATR), Sheba Medical Center, Ramat Gan, Israel Email: amit.benady@gmail.com

Name, credentials: Sean Zadik, BSc
Affiliation: Multiple Sclerosis Center, Sheba Medical Center, Ramat Gan, Israel Email: sean.zadik@sheba.health.gov.il

Organizer contact Information:

Name: Meir Plotnik & Glen M. Doniger
Address: Center of Advanced Technologies in Rehabilitation (CATR), Sheba Medical Center, 31 Emek Ha'ela, Ramat Gan Israel
Email: meir.plotnik@sheba.health.gov.il, glen.doniger@sheba.health.gov.il

Learning Objectives

After completing this workshop, participants should be able to:

  1. Identify challenges involved in the use of virtual reality (VR) to study human behavior.

  2. Describe how online physiological measurements can be combined with immersion in VR.

  3. Outline guidelines for tailoring a VR environment to address specific scientific hypotheses.

Summary

The proposed workshop aims to introduce attendees to conceptual and methodological aspects of implementation of virtual reality (VR) technologies in basic and clinical research. VR is an advanced digital technology that generates a lifelike environment able to dynamically interact with human behavior as elements of the VR environment are systematically modified based on online behavioral feedback. Further, VR possesses the capacity for simultaneous multimodal stimulation and measurement of sensory and functional processing. Thus VR is an unprecedented tool that allows for comprehensive, ecological and controlled study of the human experience. Specifically, as the ultimate agent of virtualization, VR is ideally suited for exploring the impact of rapidly changing, increasingly virtualized digital technologies upon human function. Within this framework, workshop attendees will be introduced to novel research paradigms designed to elucidate various aspects of human function in a VR

environment. One paradigm will demonstrate how VR facilitates the study of physiological network interactions underlying the pathogeneses of freezing of gait in Parkinson’s disease. A VR-based paradigm for understanding sensorimotor integration will be presented. Other assessment and training paradigms will illustrate the potential of VR-based cognitive-motor measures to identify, track and possibly mitigate debilitating illness by leveraging neuroplasticity. The workshop will comprise conceptual discussions, presentation of results, and hands-on demonstrations, in which attendees will be able to experience immersion in a VR environment.

Detailed Workshop Outline (3 hours)

Session 1 (15 mins)

The use of VR for basic and clinical science

Theoretical models and concepts for the study of human-VR interactions from basic and clinical science perspectives.

Presenter: Meir Plotnik

Session 2 (60 mins) includes hands-on*

Part A (30 mins)

”Mobile cognition” – ecological cognitive-motor interaction in VR for building cognitive resilience

VR-based cognitive-motor training for delaying cognitive deterioration among middle-aged adults at high risk for Alzheimer's disease.

Presenter: Glen M. Doniger

Part B (30 mins)

Studying interactions of physiological networks with the use of VR
for understanding freezing of gait in Parkinson’s disease and fall risk in the elderly

The introduction of physical and visual perturbations using a large-scale VR system to explore how cognitive- gait-sensory-affect interactions predispose paroxysmal gait disturbances.

Presenter: Zoya Katzir

Health Break (20 mins)

Session 3 (60 mins) includes hands-on*

Part A (30 mins)

VR for psychiatric use – studying the subconscious and alleviating phobias

Feasibility of studying subconscious with VR, distinguishing between depression and apathy in the context of dementia and alleviating phobias.

Presenters: Oran Ben Gal & Meir Plotnik

Part B (30 mins)

Exploring sensorimotor integration strategies during walking with the use of a large- scale VR system

Impact of congruent and incongruent visual flow during walking. Presenters: Amit Benady & Sean Zadik

Session 4 (25 mins)

Summary and Discussion

Open discussion among presenters and attendees, including description of additional VR environments.

*Sessions 2 and 3 include hands-on demos that allow attendees to experience immersion in a VR environment. For these sessions, attendees will be divided into two groups that will rotate between Part A and Part B.

Intended audience:

Clinicians, Engineers, Researchers

Presenter biographies:

Meir Plotnik – Dr. Plotnik is the Scientific Director in the Center of Advanced Technologies in Rehabilitation (CATR) at Sheba Medical Center. Trained as a neurophysiologist, his research has focused on motor control and vestibular function, with an emphasis on gait. He has 20 years of experience conducting studies in both animals and humans. In recent years, Dr. Plotnik initiated an inter-disciplinary research effort in collaboration with physicists, engineers, clinicians and neurocognitive scientists to understand how VR elements interact with human behavior in multiple modalities, and these interactions facilitate the delineation of complex human brain function in an entirely novel way.

 

Glen M. Doniger – Dr. Doniger is a Research Scientist in the Center of Advanced Technologies in Rehabilitation (CATR) at Sheba Medical Center. Trained as a cognitive psychologist, Dr. Doniger published a series of seminal studies on electrical mapping of the human ability to perceived complete objects from partial visual information (“perceptual closure processes”). He has considerable experience developing computerized cognitive assessment tools for early detection and monitoring of cognitive impairment. Most recently, Dr. Doniger’s research focuses on harnessing virtual reality to explore the cognitive-motor interface and devise novel therapeutic strategies.

 

Zoya Katzir – Zoya Katzir is a PhD student in the Center of Advanced Technologies in Rehabilitation (CATR) at Sheba Medical Center. She holds BSc and MSc degrees in life sciences from Ben-Gurion University. Her master's thesis dealt with protein biochemistry and structure-function interactions. At CATR, Zoya uses virtual reality to induce freezing of gait (FOG) episodes in Parkinson’s disease by manipulating sensory (i.e., visual, auditory, proprioceptive), cognitive and motor processing, with the primary goal of delineating the dynamics of neurophysiological network interactions predisposing FOG.

 

Oran Ben Gal – Oran Ben Gal is pursuing a master’s degree in neuroscience at Bar Ilan University in conjunction with Sheba Medical Center, Israel. He completed a BSc in biomedical engineering at Ben Gurion University and serves as a research and development engineer in the Center for Advanced Technologies in Rehabilitation (CATR) at Sheba Medical Center. Oran has expertise in programming and implementing virtual reality tasks and environments on multiple platforms. His research interests include physiology of gait and vestibular function, motor learning, sensory-motor-cognitive integration in gait and posture, as well as the influence of psychological and psychiatric state on motor function.

 

Amit Benady – Amit Benady is completing a medical degree at St. George’s University of London in conjunction with Sheba Medical Center, Israel. He holds BSc and MSc degrees in neuroscience, both from Tel Aviv University. His master’s thesis focused on biochemical mechanisms of traumatic brain injury. Amit is a research assistant in the Center of Advanced Technologies in Rehabilitation (CATR) at Sheba Medical Center. His research focuses on sensorimotor integration in the context of locomotion using virtual reality.

 

Sean Zadik – Sean Zadik is completing a medical degree at St. George’s University of London in conjunction with Sheba Medical Center, Israel. She received her BSc in biotechnology from Bar-Ilan University. Sean is actively involved in research in the Multiple Sclerosis (MS) center and the Center of Advanced Technologies in Rehabilitation (CATR) at Sheba Medical Center. Her research in MS focuses on patterns of biological markers associated with acute relapses of the disease. At CATR, her research involves the use of virtual reality to better understand the role of sensory input during locomotion.