Virtual Reality Assessment Research Articles

Virtual reality for assessing emergency medical competencies in junior doctors – a pilot study

BackgroundThe teaching and assessment of clinical-practical skills in medical education face challenges in adequately preparing students for professional practice, especially in handling emergency situations. This study aimed to evaluate the emergency medical competencies of junior doctors using Virtual Reality (VR)-based scenarios to determine their preparedness for real-world clinical situations.MethodsJunior doctors with 0–6 months of professional experience participated in one of three VR-based emergency scenarios. These scenarios were designed to test competencies in emergency medical care. Performance was automatically assessed through a scenario-specific checklist, and participants also completed self-assessments and a clinical reasoning ability test using the Post-Encounter Form.ResultsTwenty-one junior doctors participated in the study. Results showed that while general stabilization tasks were performed well, there were notable deficiencies in disease-specific diagnostic and therapeutic actions. On average, 65.6% of the required actions were performed correctly, with no significant variance between different scenarios. Participants achieved an average score of 80.5% in the Post-Encounter-Form, indicating a robust ability to handle diagnostic decisions. Self-assessments did not correlate significantly with objective measures of competency, highlighting the subjective nature of self-evaluation.ConclusionVR-based simulations can provide a detailed picture of EMC, covering both diagnostic and therapeutic aspects. The findings of this pilot study suggest that while participants are generally well-prepared for routine tasks, more focus is needed on complex case management. VR assessments could be a promising tool for evaluating the readiness of new medical professionals for clinical practice.

B - 90 Establishing Cutoffs for Impaired Cognition in Virtual Reality Assessment: the Virtual Kitchen Protocol for Learning and Memory

Abstract Objective The Virtual Kitchen Protocol for Learning and Memory (VKP-LM) is a virtual-reality-based measure of everyday functioning through procedural memory tasks. Previous literature has introduced the VKP-LM and begun validation processes. This study explores cutoff scores to determine cognitive impairment across the Immediate (VKP-IR) and Delayed-Recall (VKP-DR) portions of the VKP-LM. Method Adults (N = 126; Mage = 70.29; 56.3% Female) completed the VKP-LM as a part of a neuropsychological evaluation in a community-based assessment center. Participants were categorized binarily as to whether they received a neurocognitive disorder (NCD) diagnosis. Discriminatory abilities and cutoffs were determined by the Receiver Operator Curve’s (ROC) Area Under the Curve (AUC) and sensitivity-specificity charts. Classification tables determined the Positive Predictive Power (PPP) and Negative Predictive Power (NPP) given the established cutoffs. Results ROC analysis showed the VKP-IR (Max = 70; Cutoff = 28) to have good discriminatory abilities (AUC = 0.788) and the VKP-DR (Max = 70; Cutoff = 26;) to have excellent discriminatory abilities (AUC = 0.855). The classification tables showed that the VKP-IR had a PPP = 63.0% and NPP = 87.9%, while the VKP-DR had a PPP = 86.4% and NPP = 90.4%. Conclusion Due to the multifaceted nature of diagnosing NCDs, single-domain measures (i.e., procedural memory) will always struggle to obtain excellent PPP, as not all NCDs have amnestic cognitive profiles (e.g., cerebral vascular, Lewy body disease, etc.). Further research should explore comparing discriminatory abilities against other measures, increasing the sample size (both groups), and comparing discriminatory abilities among only NCDs with amnestic cognitive profiles, such as Alzheimer’s disease.

Investigation of Working Memory Responses in Recreational Athletes Using Virtual Reality Assessment System

Investigation of Working Memory Responses in Recreational Athletes Using Virtual Reality Assessment System

Exploring perceived oppressiveness of high-rise window views: A virtual reality assessment of planning measures and visual elements' influence

Under compact city policies, the dense configuration of buildings surrounding high-rise structures can obstruct window views, increasing perceptions of oppressiveness among occupants. While prior research has primarily focused on the impact of building forms and surrounding environments on perceived oppressiveness, there is limited investigation into how planning measures (such as building layout, building spacing, and surrounding trees) and visual element ratios (such as sky, grass, trees, foreground buildings, and background buildings) affect this perception. To address this gap, we used virtual reality (VR) technology to have 50 participants rate the oppressiveness of 24 visual scenes. Our findings indicated that staggered building layout, increased building spacing, and the presence of surrounding trees significantly reduced perceived oppressiveness. An ordinal logistic regression model was used to predict the impact of specific planning measures and viewing floor levels on perceived oppressiveness. Quantitative analysis revealed that increasing the ratio of sky and trees in window views mitigated perceived oppressiveness. Additionally, the ratio of built elements had a dual effect: enhancing foreground buildings exacerbated the perception of oppressiveness while increasing background buildings helped alleviate it. These results suggest that thoughtful planning and the strategic integration of natural visual elements can effectively reduce the perceived oppressiveness of window views in high-rise residential buildings.

Enhancing Ecological Validity: Virtual Reality Assessment of Executive Functioning in Children and Adolescents with ADHD.

SmartAction-VR uses virtual reality to simulate daily life tasks and assess cognitive performance based on the multi-errand paradigm. This study explored whether this new task could provide insights into the executive functioning of children and adolescents with ADHD in their everyday activities. A cross-sectional study was conducted between November 2021 and December 2022. It consisted of one session and was divided into two parts (cognitive tests; and SmartAction-VR). The sample comprised 76 children and adolescents with a median age (IQR) of 13 (11-14) years and an age range of 9-17 years. Of these participants, 60.50% (n = 46) were males. Out of this sample, 40 participants were in the ADHD group and 36 were in the neurotypical group. The following instruments were used: Waisman Activities of Daily Living Scale, Assessment of Sensory Processing and Executive Functioning, Pediatric Simulator Disease Questionnaire, Digit span subtest, Stroop test, NEPSY-II Subtest of Auditory Attention and Cognitive Flexibility, Trail Making Test, Zoo Map Test, and SmartAction-VR. The ADHD group demonstrated lower accuracy (U = 406, p = 0.010), higher values for total errors (U = 292, p = 0.001), more commissions (U = 417, p = 0.003), new actions (U = 470, p = 0.014), and forgetting actions (U = 406, p = 0.010), as well as fewer perseverations compared to the neurotypical group (U = 540.5, p = 0.029). Additionally, participants who forgot more actions were found to have lower independence in daily life (r = -0.281, p = 0.024). The correlations between the results of SmartAction-VR and activities of daily living, as well as cognitive tests, suggest that this new task could be useful for evaluating executive functioning in daily life.

Virtual reality assessment of reaching accuracy in patients with recent cerebellar stroke

BackgroundDysmetria, the inability to accurately estimate distance in motor tasks, is a characteristic clinical feature of cerebellar injury. Even though subjective dysmetria can be quickly detected during the neurological examination with the finger-to-nose test, objective quantification of reaching accuracy for clinical assessment is still lacking. Emerging VR technology allows for the delivery of rich multisensory environmental stimuli with a high degree of control. Furthermore, recent improvements in the hand-tracking feature offer an opportunity to closely examine the speed, accuracy, and consistency of fine hand movements and proprioceptive function. This study aims to investigate the application of virtual reality (VR) with hand tracking in the rapid quantification of reaching accuracy at the bedside for patients with cerebellar stroke (CS).Methods and resultsThirty individuals (10 CS patients and 20 age-matched neurologically healthy controls) performed a simple task that allowed us to measure reaching accuracy using a VR headset (Oculus Quest 2). During this task, the participant was asked to reach for a target placed along a horizontal sixty-degree arc. Once the fingertip passed through the arc, the target immediately extinguished. 50% of the trials displayed a visible, real-time rendering of the hand as the participant reached for the target (visible hand condition), while the remaining 50% only showed the target being extinguished (invisible hand condition). The invisible hand condition isolates proprioception-guided movements by removing the visibility of the participant’s hand. Reaching error was calculated as the difference in degrees between the location of the target, and where the fingertip contacted the arc. Both CS patients and age-matched controls displayed higher average reaching error and took longer to perform a reaching motion in the invisible hand condition than in the visible hand condition. Reaching error was higher in CS than in controls in the invisible hand condition but not in the visible hand condition. Average time taken to perform each trial was higher in CS than in controls in the invisible hand conditions but not in the visible hand condition.ConclusionsReaching accuracy assessed by VR offers a non-invasive and rapid approach to quantifying fine motor functions in clinical settings. Furthermore, this technology enhances our understanding of proprioceptive function in patients with visuomotor disabilities by allowing the isolation of proprioception from vision. Future studies with larger cohorts and longitudinal designs will examine the quantitative changes in reaching accuracy after stroke and explore the long-term benefits of VR in functional recovery.

Characterization and assessment of executive functions through a virtual cooking task in euthymic patients with bipolar disorder

Bipolar disorder (BD)1 implies impairments in executive functions during euthymia that interfere in psychosocial functioning. Virtual reality assessments may confer advantages respect to traditional assessments in terms of efficiency and ecological validity. The aim of this study was to validate a novel Virtual Cooking Task (VCT) for executive functions assessment in euthymic patients with BD. This is a cross-sectional study in which a group of BD patients (n = 42) and healthy controls (n = 42) were assessed with the VCT and a battery of computerized standard tasks (CST). Additionally, the influence on psychosocial functioning of both forms of assessment, measured with the FAST, was investigated to check ecological validity. In BD group significant impairments in interference, working memory and sustained attention were found in CST and VCT respect to controls. However, deficits in planning and problem-solving were also revealed with the VCT. With respect to psychosocial functioning, only VCT variables were able to predict FAST scores at the assessment time. The VCT showed a greater sensitivity than CST to assess executive functions and real-life functioning in BD. This provides evidence about the opportunity to design novel cognitive assessments for diagnostic and therapeutic purposes in BD.

Virtual reality assessment of a high-calorie food bias: Replication and food-specificity in healthy participants

BackgroundTheoretical models and behavioural studies indicate faster approach behaviour for high-calorie food (approach bias) among healthy participants. A previous study with Virtual Reality (VR) and online motion-capture quantified this approach bias towards food and non-food cues in a controlled VR environment with hand movements. The aim of this study was to test the specificity of a manual approach bias for high-calorie food in grasp movements compared to low-calorie food and neutral objects of different complexity, namely, simple balls and geometrically more complex office tools. MethodsIn a VR setting, healthy participants (N = 27) repeatedly grasped or pushed high-calorie food, low-calorie food, balls and office tools in randomized order with 30 item repetitions. All objects were rated for valence and arousal. ResultsHigh-calorie food was less attractive and more arousing in subjective ratings than low-calorie food and neutral objects. Movement onset was faster for high-calorie food in push-trials, but overall push responses were comparable. In contrast, responses to high-calorie food relative to low-calorie food and to control objects were faster in grasp trials for later stages of interaction (grasp and collect). Non-parametric tests confirmed an approach bias for high-calorie food. ConclusionA behavioural bias for food was specific to high-calorie food objects. The results confirm the presence of bottom-up advantages in motor-cognitive behaviour for high-calorie food in a non-clinical population. More systematic variations of object fidelity and in clinical populations are outstanding. The utility of VR in assessing approach behaviour is confirmed in this study by exploring manual interactions in a controlled environment.

Systematic review of memory assessment in virtual reality: evaluating convergent and divergent validity with traditional neuropsychological measures.

The evaluation of memory is a crucial aspect of both cognitive research and clinical applications, as it offers valuable insights into an individual's cognitive wellbeing and performance. Conventional neuropsychological assessments represent the established method for assessing different aspects of memory. Recent technological advancements, specifically in the field of virtual reality (VR), have introduced novel methods for evaluating memory. This systematic review aims to examine the current state of memory assessment using VR technologies, assessing the degree of convergence and divergence between VR-based memory assessments and conventional neuropsychological tests. A systematic review of the literature was conducted searching PubMed, PsycINFO, Web of Science databases, leading to the incorporation of 24 studies. Studies were grouped according to the examined memory domain (episodic, prospective, spatial domain). Convergence and divergence validity were examined for each, and information on software and hardware features was collected. This review demonstrates a notable alignment between VR-based memory assessments and conventional neuropsychological tests. Moreover, VR tasks have shown to exhibit associations with executive functions and overall cognitive performance. The inclusion of various ecological contexts, such as residential environments, commercial establishments, and simulated scenarios, serves to augment the ecological validity of memory evaluations conducted in VR. The findings indicate that VR assessments demonstrate a functional perspective by effectively capturing the dynamic relationship between memory, executive functions, and overall cognitive performance. Nevertheless, it is imperative to acknowledge and tackle certain constraints that may hinder the widespread adoption and utilization of VR tasks. These limitations encompass factors such as restricted accessibility to VR tasks and the presence of heterogeneity in VR hardware and software. The dynamic and ever-changing nature of VR technology presents a range of potential avenues for future investigation and utilization in the domain of memory evaluation.

Playing for cognition: investigating the feasibility and user experience of a virtual reality serious game for cognitive assessment in children with congenital heart disease

BackgroundIn order to facilitate the development and implementation of innovative technology in clinical practice, it is important to understand the user experience of end-users. Virtual Reality (VR) offers the possibility to assess cognitive functioning in a dynamic environment that simulates real-world situations. The purpose of this cross-sectional study was to investigate the feasibility of a VR Serious Game for cognitive assessment in school-aged children with congenital heart disease (CHD). The sub-aims were two-fold: (1) to objectively evaluate the feasibility of the VR Serious Game in children with CHD in comparison to typically developing (TD) children and (2) to explore the user experience of both groups following their interaction with the VR Serious Game.ResultsA total of 101 children participated in this study; 98 children were included in the final analysis (CHD: n = 54; TD: n = 47). The VR Serious Game appeared feasible for both children with CHD and TD children, with 88% children completing the innovative VR assessment without encountering any issues. There were no discernible differences in completion rates between groups. Children with CHD reported significantly lower scores than TD children on three user experience scales: Engagement, Flow and Presence. Nonetheless, the scores for Engagement and Flow were still considered "moderate to good". Both groups reported minimal adverse physiological reactions.ConclusionsThe findings suggested that the VR Serious Game was feasible for children with CHD and that the user experience was positive. Future research should investigate the effectiveness of the VR Serious Game compared with a conventional or digital neuropsychological assessment, prioritising the development of novel outcome measures that can better estimate and explain the impact of cognitive impairment on daily functioning.

Normative performance data on visual attention in neurotypical children: virtual reality assessment of cognitive and psychomotor development

Introduction: Virtual Reality (VR) is revolutionizing healthcare research and practice by offering innovative methodologies across various clinical conditions. Advances in VR technology enable the creation of controllable, multisensory 3D environments, making it an appealing tool for capturing and quantifying behavior in realistic scenarios. This paper details the application of VR as a tool for neurocognitive evaluation, specifically in attention process assessment, an area of relevance for informing the diagnosis of childhood health conditions such as Attention Deficit Hyperactivity Disorder (ADHD).Methods: The data presented focuses on attention performance results from a large sample (n = 837) of neurotypical male and female children (ages 6–13) tested on a visual continuous performance task, administered within an immersive VR classroom environment. This data was collected to create a normative baseline database for use to inform comparisons with the performances of children with ADHD to support diagnostic decision-making in this area.Results: Results indicate systematic improvements on most metrics across the age span, and sex differences are noted on key variables thought to reflect differential measures of hyperactivity and inattention in children with ADHD. Results support VR technology as a safe and viable option for testing attention processes in children, under stimulus conditions that closely mimic ecologically relevant challenges found in everyday life.Discussion: In response to these stimulus conditions, VR can support advanced methods for capturing and quantifying users’ behavioral responses. VR offers a more systematic and objective approach for clinical assessment and intervention and provides conceptual support for its use in a wide variety of healthcare contexts.

The Body Image Virtual Reality Assessment (BIVRA): Measuring the body representation through virtual reality.

Our physical and psychological well-being is significantly influenced by how we perceive our body, in addition to our thoughts and emotions associated with it. Dysfunctional body perceptions and attitudes play a key role in the development and maintenance of severe conditions such as eating disorders in both males and females. Given its relevance, some attempts have been made to improve body image assessment methods in terms of perceptual accuracy and body satisfaction taking advantage of technological advances such as virtual reality. However, existing applications have mainly focused on women and clinical conditions. In this study, we presented the Body Image Virtual Reality Assessment (BIVRA), a virtual reality figure rating scale to assess body image in both male and female subjects. We tested BIVRA's ability to measure perceptual accuracy and compared its results with a standardized body satisfaction questionnaire. Additionally, we investigated gender differences. BIVRA was found to be effective in assessing body image. We observed that a perceptually based task successfully captured both low and high levels of body representations, shedding light on the significant gender differences. The association between BIVRA and the body satisfaction questionnaires was moderated by gender, with a stronger association for women. While further validation of BIVRA is needed to fully exploit its potential, our results suggest that the integration of virtual reality into the assessment of body image and related disorders may significantly enhance our understanding of individuals struggling with body image issues and has the potential to advance current methods and techniques.

Stepping into the virtual realm: Examining the utility of non-immersive VR on medical residents' self-efficacy, performance, and satisfaction

Central Venous Catheterization (CVC) is conducted in more than 5 million patients annually in the United States. Currently, CVC theoretical knowledge is typically taught with didactic lectures with minimal assessment of knowledge before simulation training and clinical environment. To assess CVC theoretical knowledge, virtual reality (VR) can develop residents’ surgical skills and can provide feedback on performance. While all types of VR can be used to assess improvements in residents’ knowledge prior to simulation training, few studies have compared the impact of non-immersive VR on improving resident knowledge. The current study was developed to identify the utility of a non-immersive CathSim VR on improvements in resident CVC theoretical knowledge, self-efficacy, and satisfaction when compared to a traditional multiple-choice assessment This was completed through an empirical investigation with 34 medical residents. The results showed that when compared to a traditional multiple-choice assessment, the non-immersive CathSim VR assessment led to improvements in self-efficacy and potentially better learning experience. Meanwhile, results also showed that there were no differences in assessment score, number of attempts, and overall satisfaction. Thus, we can conclude that non-immersive VR has the potential to be more effective than traditional multiple-choice test in improving self-efficacy and is as effective for residents’ assessment score, number of attempts, and overall satisfaction.

Development of a new computer simulated environment to screen cognition: assessing the feasibility and acceptability of Leaf Café in younger and older adults

BackgroundExisting traditional cognitive screening tools for dementia have various limitations, including overreliance on tests assessing verbal memory and, to a lesser extent, on some aspects of executive functioning. Comprehensive neuropsychological assessment is sensitive to impairment but time-intensive and expensive. Virtual reality may provide a dynamic and unique understanding of cognitive performance and increase the ecological validity of cognitive assessment. The use of virtual reality in screening for cognitive function in older persons is promising, but evidence for its use remains sparse.ObjectiveOur primary aim was to examine the feasibility and acceptability of a newly developed, virtual reality assessment module, ‘Leaf Café’, a computer-based program that assesses cognition in an engaging, efficient, and ecologically relevant way. The secondary aim was to assess the ability of the module to discriminate between performances of younger and older adults.MethodsA cross-sectional study was carried out in Sydney, Australia, targeting adults aged 18 years and above. Participants completed a traditional cognitive screening tool (Telephone Interview for Cognitive Status-Modified, TICS-M) and Leaf Café, a low-immersive virtual reality module designed to evaluate learning and memory, perceptual-motor function, and executive functioning. The total performance score for each participant, ranging from 0 to 180, was correlated with their cognitive performance assessed by TICS-M, using Pearson’s correlation coefficient. Following module completion, participants were presented with an open and closed-question survey to capture their perceptions, attitudes, and feedback on the module, encompassing practicality, acceptability, and enjoyment. Both descriptive and content analyses were employed to interpret the obtained data.ResultsA sample of 131 participants (mean age 54.9 years, SD = 20.8, range 20–85) took part. The majority were female (71.8%) and born in an English-speaking country (75.8%). The mean amount of time spent in the module was 32.8 min (SD = 13.3) with a mean module score of 107.6 (SD = 38.7). Most participants completed the highest level (5; 80.5%). There was a significant correlation between Leaf Café total scores with TICS-M cognitive scores overall, and for both younger (aged 18–64 years) and older adult (aged 65 + years) groups. No significant difference was found on performance between age groups on TICS-M performance, however, younger adults had significantly better performance on the Leaf Café module than older adults (M = 124.1 vs 95.9; p < .001). Participants had similar response proportions regarding user experience with most agreeing that the module was easy to use (84%) and to navigate (85%). Compared with younger adults, older adults had lower rates of agreement on the module’s design (36.8% vs 64.3%; p = .020) and support experienced (20.5% vs 53.6%; p = .007). Participants highlighted the significance of practicality and the cognitive challenges presented by the module, in terms of memory strain and user interface concerns. Feedback encompassed different opinions on the usefulness of music, with suggestions for improvements centred around clearer instructions, varied game dynamics, and considerations for diverse user needs.ConclusionsLeaf Café is a feasible and acceptable tool to be used for screening for cognitive impairment in older adults and has real-world assessment value. Further verification on the game’s utility in detecting cognitive impairment is required.

Patient Screening for Self-Expanding Percutaneous Pulmonary Valves Using Virtual Reality.

In recent years, self-expanding technology to treat pulmonary regurgitation in the native right ventricular outflow tract became Food and Drug Administration approved in the United States and is now routinely used. The current practice for selection of patients who are candidates for these devices includes screening for "anatomic fit," performed by each of the manufacturing companies. Our study aims to validate the use of virtual reality (VR) as a tool for local physician-led screening of patients. This retrospective study from Children's Hospital Colorado included patients who underwent pulmonary valve replacement and had screening for a Harmony TPV or Alterra Prestent performed between September 2020 and January 2022. The data from the commercial companies' dedicated analysis for self-expanding transcatheter pulmonary valve frames evaluation with perimeter analysis were collected. VR simulation was performed blinded by 2 congenital interventional cardiologists using Elucis VR software and an Oculus Quest 2 headset. Among the 27 evaluated cases, the use of a self-expandable valve was recommended by companies' dedicated analysis in 23 cases (85.2%), by VR assessment in 26 cases (96.3), and finally implanted in 25 cases (92.6%). Regarding the level of agreement, both modalities (manufacturer and VR) were good at screening-in patients who received a self-expanding valve (100% versus 96.1%). When it came to screening-out the patients, VR presented good capacity to accurately classify nonsuitable patients (50% versus 100%). Our institutional experience with VR transcatheter pulmonary valve implantation planning accurately predicted clinical outcomes. This paves the way for routine use of VR in patient selection for self-expanding valve technologies.

Pediatric Critical Care Fellow Perception of Learning through Virtual Reality Bronchoscopy.

Virtual reality (VR) simulators have revolutionized training in bronchoscopy, offering unrestricted availability in a low-stakes learning environment and frequent assessments represented by automatic scoring. The VR assessments can be used to monitor and support learners' progression. How trainees perceive these assessments needs to be clarified. The objective of this study was to examine what assessments learners select to document and receive feedback on and what influences their decisions. We used a sequential explanatory mixed methods strategy. All participants were pediatric critical care medicine trainees requiring competency in bronchoscopy skills. During independent simulation practice, we collected the number of learning-focused practice attempts (scores not recorded), assessment-focused practice (scores recorded and reviewed by the instructor for feedback), and the amount of time each attempt lasted. After simulation training, we conducted interviews to explore learners' perceptions of assessment. There was no significant difference in the number of attempts for each practice type. The average time per learning-focused attempt was almost three times longer than the assessment-focused attempt (mean [standard deviation] 16 ± 1 min vs. 6 ± 3 min, respectively; P < 0.05). Learners perceived documentation of their scores as high stakes and only recorded their better scores. Learners felt safer experimenting if their assessments were not recorded. During independent practice, learners took advantage of automatic assessments generated by the VR simulator to monitor their progression. However, the recording of scores from the simulation program to document learners' trajectory to a set goal was perceived as high stakes, discouraging learners from seeking supervisor feedback.

An immersive virtual reality tool for assessing left and right unilateral spatial neglect.

The reported rate of the occurrence of unilateral spatial neglect (USN) is highly variable likely due to the lack of validity and low sensitivity of classical tools used to assess it. Virtual reality (VR) assessments try to overcome these limitations by proposing immersive and complex environments. Nevertheless, existing VR-based tasks are mostly focused only on near space and lack analysis of psychometric properties and/or clinical validation. The present study evaluates the clinical validity and sensitivity of a new immersive VR-based task to assess USN in the extra-personal space and examines the neuronal correlates of deficits of far space exploration. The task was administrated to two groups of patients with right (N = 28) or left (N = 11) hemispheric brain lesions, also undergoing classical paper-and-pencil assessment, as well as a group of healthy participants. Our VR-based task detected 44% of neglect cases compared to 31% by paper-and-pencil tests in the total sample. Importantly, 30% of the patients (with right or left brain lesions) with no clear sign of USN on the paper-and-pencil tests performed outside the normal range in the VR-based task. Voxel lesion-symptom mapping revealed that deficits detected in VR were associated with lesions in insular and temporal cortex, part of the neural network involved in spatial processing. These results show that our immersive VR-based task is efficient and sensitive in detecting mild to strong manifestations of USN affecting the extra-personal space, which may be undetected using standard tools.

Assessment and Training of Perceptual-Motor Function: Performance of College Wrestlers Associated with History of Concussion.

Concussion may affect sport performance capabilities related to the visual perception of environmental events, rapid decision-making, and the generation of effective movement responses. Immersive virtual reality (VR) offers a means to quantify, and potentially enhance, the speed, accuracy, and consistency of responses generated by integrated neural processes. A cohort of 24 NCAA Division I male wrestlers completed VR assessments before and after a 3-week VR training program designed to improve their perceptual-motor performance. Prior to training, the intra-individual variability (IIV) among 40 successive task trials for perceptual latency (i.e., time elapsed between visual stimulus presentation and the initiation of movement response) demonstrated strong discrimination between 10 wrestlers who self-reported a history of concussion from 14 wrestlers who denied ever having sustained a concussion (Area Under Curve ≥ 0.750 for neck, arm, and step movements). Natural log transformation improved the distribution normality of the IIV values for both perceptual latency and response time (i.e., time elapsed between visual stimulus presentation and the completion of movement response). The repeated measures ANOVA results demonstrated statistically significant (p < 0.05) pre- and post-training differences between groups for the IIV in perceptual latency and the IIV in response time for neck, arm, and step movements. Five of the six IIV metrics demonstrated a statistically significant magnitude of change for both groups, with large effect sizes. We conclude that a VR assessment can detect impairments in perceptual-motor performance among college wrestlers with a history of concussion. Although significant post-training group differences were evident, VR training can yield significant performance improvements in both groups.

Virtual Reality Assessment of Attention Deficits in Traumatic Brain Injury: Effectiveness and Ecological Validity

Early detection is crucial for addressing attention deficits commonly associated with Traumatic brain injury (TBI), informing effective rehabilitation planning and intervention. While traditional neuropsychological assessments have been conventionally used to evaluate attention deficits, their limited ecological validity presents notable challenges. This study explores the efficacy and validity of a novel virtual reality test, the Computerized Battery for the Assessment of Attention Disorders (CBAAD), among a cohort of TBI survivors (n = 20), in comparison to a healthy control group (n = 20). Participants, ranging in age from 21 to 62 years, were administered a comprehensive neuropsychological assessment, including the CBAAD and the Attention Related Cognitive Errors Scale. While variations in attentional performance were observed across age cohorts, the study found no statistically significant age-related effects within either group. The CBAAD demonstrated sensitivity to attentional dysfunction in the TBI group, establishing its value as a comprehensive test battery for assessing attention in this specific population. Regression analyses demonstrated the CBAAD’s effectiveness in predicting real-life attentional errors reported by TBI patients. In summary, the CBAAD demonstrates sensitivity to attentional dysfunction in TBI patients and the ability to predict real-world attentional errors, establishing its value as a comprehensive test battery for assessing attention in this specific population. Its implementation holds promise for enhancing the early identification of attentional impairments and facilitating tailored rehabilitation strategies for TBI patients.

The Potential and Challenges of Virtual Reality as an Adjunctive Treatment of Depression Patients.

Virtual reality (VR) is a promising supplemental or alternative approach for treating depression. Focusing on the unique affordances of VR, such as immersive therapeutic settings and uniform treatment delivery, this study explores both the current applications and future potential of VR technology in treating and assessing depression. VR provides users with an "immersive" and "presence" experience through multisensory stimulation. VR is an emerging paradigm in healthcare, particularly in psychiatric treatment, and presents compelling possibilities for its role in therapeutic interventions by facilitating realistic and controlled environments for both clinicians and patients. VR technology offers promising advancements in augmenting traditional cognitive-behavioral therapy (CBT) methods for treating depression, with applications in psychoeducation, behavioral activation, and cognitive restructuring. Various VR assessment techniques including biomarkers and machine learning have been discussed in this study. Although the field remains experimental, the immersive nature of VR holds the potential for more personalized and accurate therapeutic interventions and assessments. Further research is required for definitive conclusions.