Cognitive inhibition difficulties in individuals with hemiparesis: Evidence from an immersive virtual reality target-distractor salience contrast visual search serious game

Abstract

Introduction: Stroke can result in various impairments that require multidisciplinary rehabilitation. For example, preserved cognitive executive functions predict motor recovery success. Despite knowing these links, the evaluation of executive function in hemiparesis patients remains underexplored. Here, we examined whether post-stroke individuals with upper limb hemiparesis (SI:HP) had cognitive inhibition deficits using a new immersive virtual reality (IVR) serious game . Methods: Twenty SI:HP with no known history of cognitive impairment and who were not undergoing any neuropsychological rehabilitation and twenty age-matched healthy control individuals (CI) were recruited. They performed the 6-level serious game requiring responses to spatial target presented amongst 11, 17 and 23 distractors with high versus low target-distractors saliency contrasts. Responses were made with less-effected hand for SI:HP group and dominant hand for CI. Response time (RT), and kinematic variables were measured. Results: The SI:HP group was slower and more variable than the CI group. All participants were slower and more variable when responding to the low compared to high target-distractors saliency conditions, and when responding to targets with increased numbers of distractors. A significant interaction between task saliency and distractor number showed slower and more variable responses with increased numbers of distractors in the low saliency condition, but not in the high saliency condition. Interactions involving group and saliency for RT and CV showed that SI:HP compared to CI group showed a greater differences in responses to low versus high saliency conditions. Conclusion: These results suggested that relative to the CI group, the SI:HP group showed cognitive inhibition impairments in the IVR serious game. As cognition plays a fundamental role in motor recovery, these results suggest a need for systematic cognitive screening of post-stroke patients. Trial registration http://www.clinicaltrials.gov ; Unique identifier: NCT04694833, Date of registration: 11/24/2020