Each year, many people are affected by stroke, which may – depending on the extent of neuroanatomical lesions and functional loss - have tremendous consequences for their future lifes. At the functional level, such people are then confronted with two important sources of impairment. Firstly, post-stroke patients may experience severe cognitive deficits; secondly, they may have to deal with severe motor impairment. Both aspects may increase dependence on others, promoting feelings of lost autonomy and helplessness, which often accelerate the development of depression. Early intervention to maintain or restore patients’ independence, which is linked to better well-being and overall management of daily life, is therefore of paramount importance. Unfortunately, a huge gap exists between institutionalized rehabilitation and management of patients in their home environments. Rehabilitation efforts terminate abruptly on discharge and so do efforts to monitor any changes in motor and cognitive function, daily life activities and social integration, health parameters and quality of life. CONTRAST will bridge this gap.
Figure 1. The Chronic Care Model requires that Community and Health Systems contribute to well prepared practise teams and informed active patients who are in a productive interaction allowing for shared decision making. Improved outcome is demostrated, for example, by increased patients' self-efficacy, which is associated with low levels of depression and feelings of helplessness.
The main goals of CONTRAST are to:
- Bridge the gap between institutional rehabilitation, and continuous training and monitoring of impaired function and health parameters at home and
- Provide an adaptive human-computer interface (HCI) architecture for improving impaired cognitive function by changing brain activity using neurofeedback.
Figure 2. Implementation of feedback of physiological signals such as EEG, ECG and HRV for improvement of general attention, specific cognitive function and affective state.
These main goals are achieved by developing a new HCI architecture that processes and integrates data acquired from multiple sources at the patients’ home, on the basis of which shared decision making between experts and patients can be implemented. CONTRAST’s core interventions for improvement of recovery after stroke are training modules, which address general and specific cognitive functions. Affective states are also important targets of these intervention modules, since depression is frequent in post-stroke patients and hampers executive functions, and functioning in daily life. Therefore, CONTRAST will provide accurate, adaptive, individually tailored interventions to improve both cognitive function and affective state.
The individually tailored interventions will be based on sound medical and neuropsychological assessments, for which CONTRAST will provide an algorithm that will help the expert and patient work together to further develop the best training schedule. CONTRAST will result in a product that comprises three core elements:
- The HCI with cognitive training modules,
- The medical and neuropsychological decision algorithm for shared decision making, and
- A test battery for measuring outcome at the behavioural (neuropsychological tests, activity measures, quality of life) and physiological level (heart rate variability, EEG parameters).
CONTRAST will develop:
- Selection procedures for individuals with stroke and a standard procedure for medical and neuropsychological assessment – the decision algorithm;
- Training modules for the improvement of general attention and executive functions, affective state and specific cognitive function;
- Individually tailored training schedules - CONTRAST will provide a clearly defined training procedure for clearly defined cognitive (dys)functions, adapted to the individual patient;
- Remote controlled data processing and performance monitoring and monitoring of health parameters. Results will continuously provide the basis for shared decision-making between expert and patient; and will provide outcome measures.
- An engaging, straightforward HCI architecture that incorporates virtual reality research and neurofeedback principles to increase motivation and keep users engaged;
6. An integrated package that incorporates all of the above components.