Comparing adaptive cognitive training in virtual reality and paper-pencil in a sample of stroke patients

The growing number of people with cognitive deficits creates an urgent need for new cognitive training solutions. Paper-and-pencil tasks are still widely used for cognitive rehabilitation despite the proliferation of new computer-based methods, like VR-based simulations of ADL's. The health professionals' resistance in adopting new tools might be explained by the small number of validation trials. Studies have established construct validity of VR assessment tools with their paper-and-pencil versions by demonstrating significant associations with their traditional construct-driven measures. However, adaptive rehabilitation tools for intervention are mostly not equivalent to their counterpart paper-and-pencil versions, which makes it difficult to carry out comparative studies. Here we present a 12-session intervention study with 31 stroke survivors who underwent different rehabilitation protocols based on the same content and difficulty adaptation progression framework: 17 performed paper-and-pencil training with the Task Generator and 14 performed VR-based training with the Reh@City. Results have shown that both groups performed at the same level and there was not an effect of the training methodology in overall performance. However, the Reh@City enabled more intensive training, which may translate in more cognitive improvements.