Virtual Environment Grocery Store

Abstract

Neuropsychologists are increasingly being asked to determine whether a patient can return to work, classroom, or play (e.g., sports). A difficulty for the neuropsychological assessment of cognitive functioning is that patients’ performance on a cognitive test may have little or no predictive value for how they may perform in a real-world situation (Burgess, Alderman, Evans, Emslie, & Wilson, 1998; Chaytor, Schmitter-Edgecombe, & Burr, 2006). To address this issue, neuropsychologists are increasingly emphasizing the need for tasks that represent real-world func­tioning and that tap into a number of executive domains (Chaytor & Schmitter-Edgecombe, 2003; Jurado & Rosselli, 2007). Burgess and colleagues (2006) argue that the majority of neuropsychological assessments currently in use today were developed to assess abstract cognitive “constructs” without regard for their ability to predict “functional” behavior. For example, although the construct-driven Wisconsin Card Sorting Test (WCST) is one of the most widely used measures of executive function, it was not originally developed as a measure of executive functioning. Instead, the WCST was preceded by a number of sorting measures that were developed from observations of the effects of brain damage (e.g., Weigl, 1927). While Milner (1963) found that patients with dorsolateral prefrontal lesions had greater difficulty on the WCST than patients with orbitofrontal or nonfrontal lesions, other studies have shown that patients with frontal lobe pathology do not always differ from control subjects on the WCST (Stuss et al., 1983). Some may argue that while there have been some inconsistencies in the literature, data from the construct-driven WCST do appear to provide information relevant to the constructs of set shifting and working memory. However, it can also be argued that the data do not necessarily offer information that would allow a neuropsychologist to predict what situations in everyday life require the abilities that the WCST measures. A number of investigators have argued that performance on traditional tests has little correspondence to everyday activities of daily living. This can leave the neuropsychologist uncertain of the efficacy of the tests for predicting the way in which patients will manage in their everyday lives (Bottari, Dassa, Rainville, & Dutil, 2009; Manchester, Priestly, & Howard, 2004; Sbordone, 2008).