Background: Defective pantomime of tool use is a hall mark of limb apraxia. Contextual information has been demonstrated to improve tool use performance. Further, knowledge about the potential impact of technological aids such as augmented reality for patients with limb apraxia is still scarce. Objective: Since augmented reality offers a new way to provide contextual information, we applied it to pantomime of tool use. We hypothesize that the disturbed movement execution can be mitigated by holographic stimulation. If visual stimuli facilitate the access to the appropriate motor program in patients with apraxia, their performance should improve with increased saliency, i.e., should be better when supported by dynamic and holographic cues vs. static and screen-based cues. Methods: Twenty one stroke patients and 23 healthy control subjects were randomized to mime the use of five objects, presented in two Environments (Screen vs. Head Mounted Display, HMD) and two Modes (Static vs. Dynamic) resulting in four conditions (ScreenStat, ScreenDyn, HMDStat, HMDDyn), followed by a real tool demonstration. Pantomiming was analyzed by a scoring system using video recordings. Additionally, the sense of presence was assessed using a questionnaire. Results: Healthy control participants performed close to ceiling and significantly better than patients. Patients achieved significantly higher scores with holographic or dynamic cues. Remarkably, when their performance was supported by animated holographic cues (e.g., striking hammer), it did not differ significantly from real tool demonstration. As the sense of presence increases with animated holograms, so does the pantomiming. Conclusion: Patients' performance improved with visual stimuli of increasing saliency. Future assistive technology could be implemented upon this knowledge and thus, positively impact the rehabilitation process and a patient's autonomy.

中文翻译：

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通过增强现实改善失用症：通过全息提示影响工具使用的哑剧。

背景：工具使用的缺陷哑剧是肢体失用症的标志。上下文信息已被证明可以提高工具使用性能。此外，关于增强现实等技术辅助对肢体失用症患者的潜在影响的了解仍然很少。目标：由于增强现实提供了一种提供上下文信息的新方法，因此我们将其应用于工具使用的哑剧中。我们假设全息刺激可以减轻运动执行受到干扰。如果视觉刺激有助于失用症患者进入适当的运动程序，那么他们的表现应该随着显着性的增加而提高，即，在动态和全息提示的支持下，他们的表现应该比静态和基于屏幕的提示更好。方法：21 名中风患者和 23 名健康对照受试者被随机模仿使用五个物体，在两种环境（屏幕与头戴式显示器，HMD）和两种模式（静态与动态）中呈现，导致四种情况（ScreenStat） 、ScreenDyn、HMDStat、HMDDyn），接下来是真实的工具演示。通过使用视频记录的评分系统对哑剧进行分析。此外，还使用问卷来评估存在感。结果：健康对照参与者的表现接近上限，并且明显优于患者。患者通过全息或动态提示获得了显着更高的分数。值得注意的是，当他们的表演得到动画全息提示（例如敲击锤子）的支持时，它与真实的工具演示没有显着差异。随着动画全息图的临场感增强，哑剧也随之增强。结论：随着视觉刺激的显着性增加，患者的表现有所改善。未来的辅助技术可以根据这些知识来实施，从而对康复过程和患者的自主权产生积极影响。