How immersive virtual reality methods may meet the criteria of the National Academy of Neuropsychology and American Academy of Clinical Neuropsychology: A software review of the Virtual Reality Everyday Assessment Lab (VR-EAL)

Effects of video game immersion and task interference on cognitive performance: a study on immediate and delayed recall and recognition accuracy

This study investigates the cognitive impacts of video game immersion and task interference on immediate and delayed recall as well as recognition tasks. We enrolled 160 subjects aged 18 to 29, who were regular players of "shoot-em-up" video games for at least 3 years. Participants were assigned to one of three experimental groups or a control group. The experimental conditions varied in the timing and type of tasks: the first group performed a video game session between recall tasks, the second group multitasked with video games and recall tasks simultaneously, and the third group engaged in task switching from video games to recall tasks. Using the Rey Auditory Verbal Learning Test, we measured the effects of these conditions on cognitive performance, focusing on error types and recall accuracy. Results indicated that multitasking and task switching significantly affected the subjects' performance, with notable decrements in recall and recognition accuracy in conditions of high task interference. The study highlights the cognitive costs associated with multitasking in immersive digital games and provides insights into how task similarity and interference might increase error rates and affect memory performance.

Clinical Feasibility of Applying Immersive Virtual Reality during Robot-Assisted Gait Training for Individuals with Neurological Diseases: A Pilot Study

BACKGROUND

Immersive virtual reality has the potential to motivate and challenge patients who need and want to relearn movements in the process of neurorehabilitation.

OBJECTIVE

The aim of this study was to evaluate the feasibility and user acceptance of an innovative immersive virtual reality system (head-mounted display) used in combination with robot-assisted gait training in subjects suffering from neurological diseases.

METHODS

Fifteen participants suffering from cerebrovascular accident or spinal cord injury completed a single session of immersive virtual reality using a head-mounted display during a Lokomat® gait session. Training parameters and safety indicators were collected, and acceptance was investigated among participants and therapists.

RESULTS

The results suggest that an immersive virtual reality system is feasible in terms of safety and tolerance. Furthermore, the very positive overall acceptance of the system suggests that it has the potential to be included in a robot-assisted gait training session using Lokomat®.

CONCLUSION

Overall, this study demonstrates that a fully immersive virtual reality system based on a head-mounted display is both feasible and well received by cerebrovascular accident and spinal cord injury patients and their therapists during robot-assisted gait training. This study suggests that such a virtual reality system could be a viable alternative to the screen-based training games currently used in neurorehabilitation. It may be especially suitable for enhancing patient motivation and adherence to training, particularly if the application is enjoyable and not mentally taxing.

The Neuropsychological Assessment of Unilateral Spatial Neglect Through Computerized and Virtual Reality Tools: A Scoping Review

Unilateral Spatial Neglect is a disabling neuropsychological deficit. Patients with spatial neglect fail to detect and report events, and to perform actions in the side of space contralateral to a hemispheric cerebral lesion. Neglect is assessed by evaluating the patients' abilities in daily life activities and by psychometric tests. Computer-based, portable and Virtual Reality technologies may provide more and precise data, and be more sensitive and informative, compared to current paper-and-pencil procedures. Studies since 2010, in which such technologies have been used, are reviewed. Forty-two articles meeting inclusion criteria are categorized according to their technological approaches (computer-, graphics tablet or tablet-, virtual reality-based assessment, and other). The results are promising. However, a definite golden standard, technologically based procedure cannot be still established. Developing technologically based tests is a laborious process, which requires technical and user experience improvements as well as normative data, to increase the evidence of efficacy for clinical evaluation of at least some of the tests considered in this review.

Ecologically valid virtual reality-based technologies for assessment and rehabilitation of acquired brain injury: a systematic review

Purpose

A systematic review was conducted to examine the state of the literature regarding using ecologically valid virtual environments and related technologies to assess and rehabilitate people with Acquired Brain Injury (ABI).

Materials and methods

A literature search was performed following the PRISMA guidelines using PubMed, Web of Science, ACM and IEEE databases. The focus was on assessment and intervention studies using ecologically valid virtual environments (VE). All studies were included if they involved individuals with ABI and simulated environments of the real world or Activities of Daily Living (ADL).

Results

Seventy out of 363 studies were included in this review and grouped and analyzed according to the nature of its simulation, prefacing a total of 12 kitchens, 11 supermarkets, 10 shopping malls, 16 streets, 11 cities, and 10 other everyday life scenarios. These VE were mostly presented on computer screens, HMD's and laptops and patients interacted with them primarily via mouse, keyboard, and joystick. Twenty-five out of 70 studies had a non-experimental design.

Conclusion

Evidence about the clinical impact of ecologically valid VE is still modest, and further research with more extensive samples is needed. It is important to standardize neuropsychological and motor outcome measures to strengthen conclusions between studies.

Systematic review registration

identifier CRD42022301560, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=301560.

Development of the Virtual Kitchen Protocol for Prospective Memory: a virtual reality-based measure of everyday prospective memory abilities

INTRODUCTION

Prospective memory is the ability to remember to accomplish a task at a specified point in the future. While this cognitive ability has a large impact on daily functioning, it is rarely assessed during neuropsychological evaluations. Furthermore, existing clinical prospective memory measures are few in number and have significant limitations, including applicability to everyday functioning and appropriate norming for older adulthood. There are also many gaps in the literature on prospective memory, such as how environmental factors affect performance across the lifespan.

METHOD

In the current study, we develop and establish a new virtual reality-based measure of prospective memory, the Virtual Kitchen Protocol for Prospective Memory. Young adults (ages 18-29; n = 56), healthy older adults (ages 60-90; n = 94), and clinical older adults (ages 62-90; n = 30) were compared on their performances on both the developed virtual reality prospective memory test and a parallel paper-and-pencil prospective memory test to investigate the impact of test environment across participant group.

RESULTS

The Virtual Kitchen Protocol for Prospective Memory was found to adequately differentiate between young adult, healthy older adult, and clinical older adult populations - suggesting baseline ability for prospective memory assessment in clinical settings with older adults and potential for future improvement of neuropsychological evaluations. Additionally, the developed virtual prospective memory task appeared to mimic environmental factors in everyday life but did not replicate the benefit previously measured in healthy older adults' prospective memory ability in naturalistic settings.

CONCLUSIONS

Overall, the current study built upon extant knowledge of prospective memory in both normal and abnormal aging, suggesting future directions in replicating familiar home environments. Findings provided additional evidence toward future validation of virtual reality assessment tools in clinical neuropsychological evaluations of cognitive abilities, such as prospective memory, with both healthy and clinical older adult populations.

Cybersickness, Cognition, & Motor Skills: The Effects of Music, Gender, and Gaming Experience

Recent research has attempted to identify methods to mitigate cybersickness and examine its aftereffects. In this direction, this paper examines the effects of cybersickness on cognitive, motor, and reading performance in VR. Also, this paper evaluates the mitigating effects of music on cybersickness, as well as the role of gender, and the computing, VR, and gaming experience of the user. This paper reports two studies. In the 1st study, 92 participants selected the music tracks considered most calming (low valence) or joyful (high valence) to be used in the 2nd study. In the 2nd study, 39 participants performed an assessment four times, once before the rides (baseline), and then once after each ride (3 rides). In each ride either Calming, or Joyful, or No Music was played. During each ride, linear and angular accelerations took place to induce cybersickness in the participants. In each assessment, while immersed in VR, the participants evaluated their cybersickness symptomatology and performed a verbal working memory task, a visuospatial working memory task, and a psychomotor task. While responding to the cybersickness questionnaire (3D UI), eye-tracking was conducted to measure reading time and pupillometry. The results showed that Joyful and Calming music substantially decreased the intensity of nausea-related symptoms. However, only Joyful music significantly decreased the overall cybersickness intensity. Importantly, cybersickness was found to decrease verbal working memory performance and pupil size. Also, it significantly decelerated psychomotor (reaction time) and reading abilities. Higher gaming experience was associated with lower cybersickness. When controlling for gaming experience, there were no significant differences between female and male participants in terms of cybersickness. The outcomes indicated the efficiency of music in mitigating cybersickness, the important role of gaming experience in cybersickness, and the significant effects of cybersickness on pupil size, cognition, psychomotor skills, and reading ability.

Virtual Reality Training of Social Skills in Adults with Autism Spectrum Disorder: An Examination of Acceptability, Usability, User Experience, Social Skills, and Executive Functions

Poor social skills in autism spectrum disorder (ASD) are associated with reduced independence in daily life. Current interventions for improving the social skills of individuals with ASD fail to represent the complexity of real-life social settings and situations. Virtual reality (VR) may facilitate social skills training in social environments and situations similar to those in real life; however, more research is needed to elucidate aspects such as the acceptability, usability, and user experience of VR systems in ASD. Twenty-five participants with ASD attended a neuropsychological evaluation and three sessions of VR social skills training, which incorporated five social scenarios with three difficulty levels. Participants reported high acceptability, system usability, and user experience. Significant correlations were observed between performance in social scenarios, self-reports, and executive functions. Working memory and planning ability were significant predictors of the functionality level in ASD and the VR system's perceived usability, respectively. Yet, performance in social scenarios was the best predictor of usability, acceptability, and functionality level. Planning ability substantially predicted performance in social scenarios, suggesting an implication in social skills. Immersive VR social skills training in individuals with ASD appears to be an appropriate service, but an errorless approach that is adaptive to the individual's needs should be preferred.

Impact of Virtual Reality Cognitive and Motor Exercises on Brain Health

Innovative technologies of the 21st century have an extremely significant impact on all activities of modern humans. Among them, virtual reality (VR) offers great opportunities for scientific research and public health. The results of research to date both demonstrate the beneficial effects of using virtual worlds, and indicate undesirable effects on bodily functions. This review presents interesting recent findings related to training/exercise in virtual environments and its impact on cognitive and motor functions. It also highlights the importance of VR as an effective tool for assessing and diagnosing these functions both in research and modern medical practice. The findings point to the enormous future potential of these rapidly developing innovative technologies. Of particular importance are applications of virtual reality in basic and clinical neuroscience.

EPELI: a novel virtual reality task for the assessment of goal-directed behavior in real-life contexts

A recently developed virtual reality task, EPELI (Executive Performance in Everyday LIving), quantifies goal-directed behavior in naturalistic conditions. Participants navigate a virtual apartment, performing household chores given by a virtual character. EPELI aims to tap attention, executive function, and prospective memory. To ensure its applicability to further research and clinical work and to study its relationship to relevant background factors, we examined several key properties of EPELI in 77 typically developing 9–13-year-old children. These included EPELI’s internal consistency, age and gender differences, sensitivity to gaming experience, head-mounted display (HMD) type, and verbal recall ability, as well as its relationships with parent-rated everyday executive problems. Of the eight EPELI measures, the following six showed acceptable internal consistency: task and navigation efficacy, number of correctly performed tasks and overall actions, time monitoring, and controller movement. Some measures were associated with age, gender, or verbal encoding ability. Moreover, EPELI performance was associated with parent-rated everyday executive problems. There were no significant associations of gaming background, task familiarity, or HMD type with the EPELI measures. These results attest to the reliability and ecological validity of this new virtual reality tool for the assessment of attention, executive functions, and prospective memory in children.

Action-Specific Perception & Performance on a Fitts's Law Task in Virtual Reality: The Role of Haptic Feedback

While user's perception and performance are predominantly examined independently in virtual reality, the Action-Specific Perception (ASP) theory postulates that the performance of an individual on a task modulates this individual's spatial and time perception pertinent to the task's components and procedures. This paper examines the association between performance and perception and the potential effects that tactile feedback modalities could generate. This paper reports a user study (N=24), in which participants performed a standardized Fitts's law target acquisition task by using three feedback modalities: visual, visuo-electrotactile, and visuo-vibrotactile. The users completed 3 Target Sizes × 2 Distances × 3 feedback modalities = 18 trials. The size perception, distance perception, and (movement) time perception were assessed at the end of each trial. Performance-wise, the results showed that electrotactile feedback facilitates a significantly better accuracy compared to vibrotactile and visual feedback, while vibrotactile provided the worst accuracy. Electrotactile and visual feedback enabled a comparable reaction time, while the vibrotactile offered a substantially slower reaction time than visual feedback. Although amongst feedback types the pattern of differences in perceptual aspects were comparable to performance differences, none of them was statistically significant. However, performance indeed modulated perception. Significant action-specific effects on spatial and time perception were detected. Changes in accuracy modulate both size perception and time perception, while changes in movement speed modulate distance perception. Also, the index of difficulty was found to modulate all three perceptual aspects. However, individual differences appear to affect the magnitude of action-specific effects. These outcomes highlighted the importance of haptic feedback on performance, and importantly the significance of action-specific effects on spatial and time perception in VR, which should be considered in future VR studies.

A novel immersive virtual reality environment for the motor rehabilitation of stroke patients: A feasibility study

We designed and implemented an immersive virtual reality (VR) environment for upper limb rehabilitation, which possesses several notable features. First, by exploiting modern computer graphics its can present a variety of scenarios that make the rehabilitation routines challenging yet enjoyable for patients, thus enhancing their adherence to the therapy. Second, immersion in a virtual 3D space allows the patients to execute tasks that are closely related to everyday gestures, thus enhancing the transfer of the acquired motor skills to real-life routines. Third, in addition to the VR environment, we also developed a client app running on a PC that allows to monitor in real-time and remotely the patients’ routines thus paving the way for telerehabilitation scenarios. Here, we report the results of a feasibility study in a cohort of 16 stroke patients. All our patients showed a high degree of comfort in our immersive VR system and they reported very high scores of ownership and agency in embodiment and satisfaction questionnaires. Furthermore, and notably, we found that behavioral performances in our VR tasks correlated with the patients’ clinical scores (Fugl-Meyer scale) and they could thus be used to assess improvements during the rehabilitation program. While further studies are needed, our results clearly support the feasibility and effectiveness of VR-based motor rehabilitation processes.

Electrotactile Feedback Applications for Hand and Arm Interactions: A Systematic Review, Meta-Analysis, and Future Directions

Haptic feedback is critical in a broad range of human-machine/computer-interaction applications. However, the high cost and low portability/wearability of haptic devices remain unresolved issues, severely limiting the adoption of this otherwise promising technology. Electrotactile interfaces have the advantage of being more portable and wearable due to their reduced actuators' size, as well as their lower power consumption and manufacturing cost. The applications of electrotactile feedback have been explored in human-computer interaction and human-machine-interaction for facilitating hand-based interactions in applications, such as prosthetics, virtual reality, robotic teleoperation, surface haptics, portable devices, and rehabilitation. This article presents a technological overview of electrotactile feedback, as well a systematic review and meta-analysis of its applications for hand-based interactions. We discuss the different electrotactile systems according to the type of application. We also discuss over a quantitative congregation of the findings, to offer a high-level overview into the state-of-art and suggest future directions. Electrotactile feedback systems showed increased portability/wearability, and they were successful in rendering and/or augmenting most tactile sensations, eliciting perceptual processes, and improving performance in many scenarios. However, knowledge gaps (e.g., embodiment), technical (e.g., recurrent calibration, electrodes' durability) and methodological (e.g., sample size) drawbacks were detected, which should be addressed in future studies.

Enhance VR: A Multisensory Approach to Cognitive Training and Monitoring

Cognitive training systems aim to improve specific domains or global cognition by engaging users in cognitively demanding tasks. While screen-based applications can improve performance in the trained cognitive abilities, they are often criticized for their poor transferability to activities of daily living. These systems, however, exclude the user's body and motor skills, which invariably serves to restrict the user experience. Immersive Virtual Reality (IVR) systems, in contrast, present the user with body-related information, such as proprioceptive and visuomotor information, allowing for an immersive and embodied experience of the environment. This feature renders VR a very appealing tool for cognitive training and neurorehabilitation applications. We present Enhance VR, an IVR-based cognitive training and monitoring application that offers short daily cognitive workouts. The games are designed to train and monitor specific cognitive domains such as memory, task flexibility, information processing, orientation, attention, problem-solving, and motor control. The aim is to test whether cognitively demanding tasks, presented in an IVR setting, provide a naturalistic system to train and monitor cognitive capabilities.