reMIND

Lars Evald
PhD, Head of Neuropsychological Development and Research, Head of reMIND Research Group

Lisbeth Frølund
PhD fellow, speech and language therapist

More than 31,000 people in Denmark live with aphasia following acquired brain injuries. Aphasia, characterized by a profound language impairment, carries extensive and devastating repercussions, severely impeding affected individuals' communication abilities.

The impact extends beyond the individual, affecting their caregivers as well. Consequences include social isolation, depression, loss of friendships, decreased autonomy, altered family dynamics, and heightened reliance on rehabilitation services.

Living well with aphasia

Finalised research project (2022-2023) carried out in collaboration with Jytte Kjærgaard Isaksen, associate professor, Department of Language and Communication, University of Southern Denmark, and Leena Eklund Karlsson, associate professor, Department of Public Health, University of Southern Denmark.

To prevent some of the many negative consequences, rehabilitation after aphasia and stroke should include both the person with aphasia and significant others throughout the care pathway. However, it is unclear how current care pathways through the cross-sectorial Danish systems work and if and how much the consequences for the whole family living with aphasia are considered.

Hence, the overall aim of this project was to produce a comprehensive needs assessment for developing a cross-sectoral system-oriented care pathway for people with aphasia and their significant others.

The needs assessment included:

1. An exploration and mapping of families living with aphasia's route through and experiences of the existing care pathway
2. A catalogue of ideas and solutions created by stakeholders for further development and implementation across the care pathway from acute care to civil society. The catalogue of ideas was launched at an event in February 2024.

Aphasia is more than a language impairment: Cross-sectorial and cross-disciplinary psychosocial care for people with aphasia and their families

This new study (2024-2027) will based on the ideas from "Living well with aphasia" develop feasibility test and implement intervention for families with aphasia that goes across the care pathway and into third sector for families living with aphasia. The main body of research will be delivered by two PhD students, one of these affiliated with Hammel Neurorehabilitation and Research Centre, Lisbeth Frølund Kristensen.

The research will be carried out in collaboration with:

• Jytte Kjærgaard Isaksen, associate professor, Department of Language and Communication, University of Southern Denmark
• Charlotte Overgaard, professor, Research Unit for Health Promotion at Department of Public Health at University of Southern Denmark
• Jens Bak Sommer, neuropsychologist and head of research and innovation at Vejlefjord Rehabiliteringscenter A/S
• Madeline Cruice, professor, City University of London

This study have three interconnected aims:

1. To undertake a comprehensive overview of current cross-disciplinary services in Denmark along the care pathway and into third sector for families living with aphasia. The overview will focus on provision of information and communications partner training tailored for families.
2. To co-design a family based intervention focusing on improving life with aphasia, provision of information and partner communication training for families living with aphasia
3. Feasibility testing and realist evaluation of the family based intervention and assess potential for its future implementation across the care pathway and into the third sector

This project will contribute to bridge the clear gap between the needs of persons and families affected by aphasia and the care they receive. Building on the emerging evidence from international research literature as well as the newly ended Danish project exploring the needs of families living with aphasia across sectors and the key personnel (leaders of change) that families with aphasia meet during the care pathway.

The project will focus on the parts of the family intervention that are related to provision of information (probably broadly delivered by the multidisciplinary teams and at later stages SLTs and patient organisations) and communication partner training (probably delivered by SLTs and later patient organisations).

Spatial neglect is a neurocognitive disorder characterised by deficits in spatial attention and intention, impacting spatial perception, representation, and motor action planning. Those affected show a failure or slowness to report, respond, orient, or initiate action towards stimuli in the side of space opposite to the brain injury.

Spatial neglect is a prevalent impairment following stroke, affecting 30-50 percent of stroke survivors during hospitalisation. Spatial neglect predicts prolonged hospitalisation, poorer rehabilitation outcomes, slowed recovery and increased caregiver burden. Notably, spatial neglect is a heterogeneous disorder with diverse sub-symptoms that respond differentially to various treatment approaches.

Virtual reality whack-a-mole

Ongoing research project in collaboration with associate professor Hendrik Knoche and PhD student Bastian Ilsø Hougaard, Department of Architecture, Design and Media Technology, Aalborg University, Denmark.

Virtual reality (VR) offers unparalleled control over both input and output parameters, and the capability to capture data in high temporal and spatial resolution, making it an optimal tool for exploring spatial cognition. Consequently, spatial neglect can be examined within a four-dimensional multi-modal space to accurately diagnose its various sub-symptoms.

Leveraging this assessment, personalised VR-based treatments can be tailored to address each patient’s specific sub-symptoms. Moreover, training difficulty can be automatically and dynamically be adjusted based on the patient’s performance, thereby optimising the treatment effect.

Our objective is to develop and evaluate a VR system designed for both assessment and treatment of spatial neglect, with the goal of enhancing training specificity and intensity via precision medicine and gamification techniques. Additionally, we aim to bolster treatment intensity and efficiency by promoting self-training and tele-rehabilitation, facilitated by readily available, cost-effective, off-the-shelf technology.

We have developed a VR whack-a-mole (WAM) game integrated with eye-tracking capabilities, serving as a dual-purpose tool for assessment and treatment of spatial neglect and related disorders. Our procedures encompass diagnostic protocols for neglect subtypes diagnostic and for assessment of motor range.

Within the VR system, we have integrated three conventional neglect training methods: prism adaptation training, mirror therapy and half-field eye-patching. We are planning pilot studies on diagnostic accuracy and treatment efficacy.

International multidisciplinary network on VR neurorehabilitation

In collaboration with international partners in more than 20 countries, we have fostered a multidisciplinary network of clinicians and researchers working with VR and spatial neglect.

The network has submitted a proposal to the European Cooperation in Science and Technology (COST) for a so-called COST Action network. These networks offer an open collaboration between researchers across Europe (and beyond) and thereby give impetus to innovation and research progress.

There are several research groups in Europe working on the development of assessment and treatment of spatial neglect in VR, but only a few projects achieve commercialisation or implementation in practice. There is great potential for increasing the intensity and effectiveness of neurorehabilitation of spatial neglect through the use of VR, but this requires international cooperation in terms of development and research.

The aim is to improve diagnostic precision of spatial neglect subtypes in order to increase the intensity and effectiveness of the training through personalisation (precision medicine), motivation (gamification), self- and home training (tele-rehabilitation). The ultimate goal is to increase patients' independence in everyday activities and reduce the caregiver burden.

The methods are to establish network meetings, workshops, conferences, short scientific missions and training schools to form a theoretical and empirical basis (white papers) for the implementation of assessment and treatment of spatial neglect in VR. Thus creating the foundation for future funding proposals in order to initiate multicentre studies of diagnostic accuracy and treatment efficacy.

The reMIND research group also has research activities within other cognitive and affective disorders as well as other neurological disorders and diagnosis groups.

For example, ongoing research collaborations on cognitive and affective disorders following cardiac arrest, partly with the Research Center for Emergency Research, Aarhus University Hospital, partly with the Department of Psychology, University of Southern Denmark and finally with the Division of Neurology, Department of Clinical Sciences Lund, Lund University, Sweden.

In addition, the group has ongoing research collaboration with the Center for Functionally Integrative Neuroscience (CFIN) regarding cognitive and affective consequences of congenital heart defects and hypoparathyroidism amongst others.