Novel integrative virtual rehabilitation reduces symptomatology of primary progressive aphasia - a case report

Abstract

Purpose: BrightBrainer™ integrative cognitive rehabilitation system evaluation in an Adult Day Program by a subject with Primary Progressive Aphasia (PPA) assumed to be of the mixed nonfluent/logopenic variant, and for determination of potential benefits. Methods: The subject was a 51-year-old Caucasian male diagnosed with PPA who had attended an Adult Day Program for 18 months prior to BrightBrainer training. The subject interacted with therapeutic games using a controller that measured 3D hand movements and flexion of both index fingers. The computer simulations adapted difficulty level based on task performance; results were stored on a remote server. The clinical trial consisted of 16 sessions, twice/week for 8 weeks. The subject was evaluated through neuropsychological measures, therapy notes and caregiver feedback forms. Results: Neuropsychological testing indicated no depression (BDI 0) and severe dementia (BIMS 1 and MMSE 3). The 6.5 h of therapy consisted of games targeting Language comprehension; Executive functions; Focusing; Short-term memory; and Immediate/working memory. The subject attained the highest difficulty level in all-but-one game, while averaging 1300-arm task-oriented active movement repetitions and 320 index finger flexion movements per session. While neuropsychological testing showed no benefits, the caregiver reported strong improvements in verbal responses, vocabulary use, speaking in complete sentences, following one-step directions and participating in daily activities. This corroborated well with therapy notes. Conclusions: Preliminary findings demonstrate a meaningful reduction of PPA symptoms for the subject, suggesting follow-up imaging studies to detail neuronal changes induced by BrightBrainer system and controlled studies with a sufficiently large number of PPA subjects.

KEYWORDS:

• primary progressive aphasia
• virtual rehabilitation
• bimanual game controller
• BrightBrainer
• caregiver feedback

Acknowledgements

We thank Jasdeep Hundal, PsyD for performing the cognitive and depression evaluations of the subject. We also thank the staff of the Medical Adult Day Program for facilitating this study, and the subject's caregivers for providing detailed and timely feedback on his progress they witnessed outside the Medical Adult Day Program.

Declaration of Interest

Grigore Burdea, PhD, is inventor on a patent related to the technology described in this article. He is Founder, President and majority shareholder of Bright Cloud International Corp (BCI). Kevin Polistico and Gregory House, PhD are full-time employees and Richard Liu, Assistant, was an intern of BCI. Roberto Muñiz is President and CEO of the multisite aging organization, Natalie Macaro is Director of Adult Day Programs and Lisa Slater is Director of Professional Education at the same multisite aging organization. The authors alone are responsible for the content and writing of the article.

Research reported here was supported in part by grant 9R44AG044639-02A1 from the National Institutes of Health/NIA.