An initial validation of the Virtual Environment Grocery Store

Immersive Virtual Reality-Based Methods for Assessing Executive Functioning: Systematic Review

BACKGROUND

Neuropsychological assessments traditionally include tests of executive functioning (EF) because of its critical role in daily activities and link to mental disorders. Established traditional EF assessments, although robust, lack ecological validity and are limited to single cognitive processes. These methods, which are suitable for clinical populations, are less informative regarding EF in healthy individuals. With these limitations in mind, immersive virtual reality (VR)-based assessments of EF have garnered interest because of their potential to increase test sensitivity, ecological validity, and neuropsychological assessment accessibility.

OBJECTIVE

This systematic review aims to explore the literature on immersive VR assessments of EF focusing on (1) EF components being assessed, (2) how these assessments are validated, and (3) strategies for monitoring potential adverse (cybersickness) and beneficial (immersion) effects.

METHODS

EBSCOhost, Scopus, and Web of Science were searched in July 2022 using keywords that reflected the main themes of VR, neuropsychological tests, and EF. Articles had to be peer-reviewed manuscripts written in English and published after 2013 that detailed empirical, clinical, or proof-of-concept studies in which a virtual environment using a head-mounted display was used to assess EF in an adult population. A tabular synthesis method was used in which validation details from each study, including comparative assessments and scores, were systematically organized in a table. The results were summed and qualitatively analyzed to provide a comprehensive overview of the findings.

RESULTS

The search retrieved 555 unique articles, of which 19 (3.4%) met the inclusion criteria. The reviewed studies encompassed EF and associated higher-order cognitive functions such as inhibitory control, cognitive flexibility, working memory, planning, and attention. VR assessments commonly underwent validation against gold-standard traditional tasks. However, discrepancies were observed, with some studies lacking reported a priori planned correlations, omitting detailed descriptions of the EF constructs evaluated using the VR paradigms, and frequently reporting incomplete results. Notably, only 4 of the 19 (21%) studies evaluated cybersickness, and 5 of the 19 (26%) studies included user experience assessments.

CONCLUSIONS

Although it acknowledges the potential of VR paradigms for assessing EF, the evidence has limitations. The methodological and psychometric properties of the included studies were inconsistently addressed, raising concerns about their validity and reliability. Infrequent monitoring of adverse effects such as cybersickness and considerable variability in sample sizes may limit interpretation and hinder psychometric evaluation. Several recommendations are proposed to improve the theory and practice of immersive VR assessments of EF. Future studies should explore the integration of biosensors with VR systems and the capabilities of VR in the context of spatial navigation assessments. Despite considerable promise, the systematic and validated implementation of VR assessments is essential for ensuring their practical utility in real-world applications.

Virtual Reality for the Rehabilitation of Acquired Cognitive Disorders: A Narrative Review

This review article explores the use of Virtual Reality (VR) technology in cognitive rehabilitation for individuals with neurological conditions, such as stroke, traumatic brain injury, and neurodegenerative diseases. The introduction highlights the challenges posed by cognitive impairments and the limitations of traditional rehabilitation methods. VR is presented as a transformative tool that immerses individuals in interactive environments, offering promising opportunities for enhancing cognitive functions and improving quality of life. This article covers the foundational principles of VR, its applications across different clinical conditions and cognitive domains, and evaluates empirical evidence supporting its efficacy. It also discusses the advantages, limitations, challenges, and ethical considerations in the use of VR for cognitive rehabilitation. This review concludes by exploring future developments, including advancements in VR technology, the integration of Augmented Reality (AR) and artificial intelligence (AI), and the importance of standardized assessment tools for the objective evaluation of rehabilitation outcomes.

Performance on a virtual environment shopping task and adaptive functioning among older adults

Neuropsychologists are often asked to evaluate patients' functional capacities, yet traditional neuropsychological tests have limited correspondence with real-world outcomes. The Virtual Environment Grocery Store (VEGS) is a virtual environment that simulates shopping tasks. The purpose of this study was to investigate the relationship between older adults' performance on the VEGS in relation to their self-reported adaptive functioning as well as performance on a performance-based adaptive functioning measure. Older adults (n = 98; age 65-90, M = 75.82, SD = 6.27) were administered the VEGS, the Instrumental Activities of Daily Living Scale (IADLS), and the Texas Functional Living Scale (TFLS). Neither premorbid functioning nor the VEGS variables were associated with self-rated adaptive functioning. However, all three VEGS variables were associated with performance-based adaptive functioning (i.e., the TFLS). Performance on the VEGS measure of correct items in the shopping cart explained 13.9% of the variance in performance on the performance-based adaptive functioning task. Whether the participant picked up the VEGS prescription explained 12.6% of the variance in performance on the performance-based adaptive functioning task. Performance on VEGS long delay free recall explained 35.1% of the variance in performance on the performance-based adaptive functioning task. These results suggest that the VEGS demonstrates value in predicting older adults' functional capacities.

Cognitive Decline Detection for Alzheimer's Disease Patients Through an Activity of Daily Living (ADL)

There are conventional screening instruments for the detection of cognitive impairment, but they have a reduced ecological validity and the information they present could be biased. This study aimed at evaluating the effectiveness and usefulness of a task based on an activity of daily living (ADL) for the detection of cognitive impairment for an Alzheimer's disease (AD) population. Twenty-four participants were included in the study. The AD group (ADG) included twelve older adults (12 female) with AD (81.75±7.8 years). The Healthy group (HG) included twelve older adults (5 males, 77.7 ± 6.4 years). Both groups received a ADL-based intervention at two time frames separated 3 weeks. Cognitive functions were assessed before the interventions by using the MEC-35. The test-retest method was used to evaluate the reliability of the task, as well as the Intraclass Correlation Coefficient (ICC). The analysis of the test-retest reliability of the scores in the task indicated an excellent clinical relevance for both groups. The hypothesis of equality of the means of the scores in the two applications of the task was accepted for both the ADG and HG, respectively. The task also showed a significant high degree of association with the MEC-35 test (rho = 0.710, p = 0.010) for the ADG. Our results showed that it is possible to use an ADL-based task to assess everyday memory intended for cognitive impairments detection. In the same way, the task could be used to promote cognitive function and prevent dementia.

Comparison of Traditional and Virtual Reality-Based Episodic Memory Performance in Clinical and Non-Clinical Cohorts

The California Verbal Learning Test, Second Edition (CVLT-II) and the Virtual Environment Grocery Store (VEGS) use list learning and recognition tasks to assess episodic memory. This study aims to: (1) Replicate prior construct validity results among a new sample of young adults and healthy older adults; (2) Extend this work to a clinical sample of older adults with a neurocognitive diagnosis; (3) Compare CVLT-II and VEGS performance among these groups; and (4) Validate the independence of CVLT and VEGS episodic memory performance measures from executive functioning performance measures. Typically developing young adults (n = 53) and older adults (n = 85), as well as older adults with a neurocognitive diagnosis (n = 18), were administered the CVLT-II, VEGS, and D-KEFS CWIT. Results found that (1) the relationship of the VEGS and CVLT-II measures was highly correlated on all variables, (2) compared to the CVLT-II, participants (particularly older adults) recalled fewer items on the VEGS, and (3) the CVLT-II and VEGS were generally independent of D-KEFS CWIT. It appeared that the VEGS may be more difficult than the CVLT-II, possibly reflecting the word length effect. Performance may have also been impacted by the presence of everyday distractors in the virtual environment.

The Use of Immersive Virtual Reality for Cancer-Related Cognitive Impairment Assessment and Rehabilitation: A Clinical Feasibility Study

Objective

This brief study aimed to examine the potential effects of virtual reality (VR)-assisted cognitive rehabilitation intervention on the health outcomes of patients with cancer.

Methods

A single group of pre-test and post-test study designs were used. An innovative VR system was developed to assess cancer-related cognitive impairment and provide cognitive rehabilitation. The potential effects of the system were determined by measuring changes in cognitive function (learning and memory, information processing speed, executive function, and verbal fluency) and the severity of depression, anxiety, and insomnia.

Results

Nine subjects completed the entire VR intervention and were included in the analysis. The participants’ mean age was 43.3 years (standard deviation, 8.9 years). The VR-based cognitive intervention significantly improved the subjective cognitive measures of perceived cognitive impairment and perceived cognitive ability (P ​= ​0.01 and P ​< ​0.01, respectively). The intervention also improved the objective cognitive measures of verbal learning memory as measured using the Auditory Verbal Learning Test (eg., P ​< ​0.01 for 5-min delay recall), information processing speed as measured using the trail-making test-A (P ​= ​0.02) and executive function as measured using the trail-making test-B (P ​= ​0.03). Only the subtest of delayed recall showed no statistically significant difference after the intervention (P ​= ​0.69). The VR-based psychological intervention significantly reduced the severity of sleep disorders (P ​< ​0.01).

Conclusions

The use of immersive VR was shown to have potential effects on improving cognitive function for patients with cancer. Future studies will require a larger sample size to examine the effects of immersive VR-assisted cognitive rehabilitation on the health outcomes of patients with cancer.

Available Virtual Reality-Based Tools for Executive Functions: A Systematic Review

Introduction

Executive dysfunctions constitute a significant public health problem: their high impact on everyday life makes it a priority to identify early strategies for evaluating and rehabilitating these disorders in a real-life context. The ecological limitation of traditional neuropsychological tests and several difficulties in administering tests or training in real-life scenarios have paved the way to use Virtual Reality-based tools to evaluate and rehabilitate Executive Functions (EFs) in real-life.

Objective

This work aims to conduct a systematic review to provide a detailed description of the VR-based tools currently developed for the evaluation and rehabilitation of EFs.

Methods

We systematically searched for original manuscripts regarding VR tools and EFs by looking for titles and abstracts in the PubMed, Scopus, PsycInfo, and Web of Science databases up to November 2021 that contained the following keywords “Virtual Reality” AND “Executive function^*.”

Results and Conclusion

We analyzed 301 articles, of which 100 were included. Our work shows that available VR-based tools appear promising solutions for an ecological assessment and treatment of EFs in healthy subjects and several clinical populations.

Examining the Academic Trends in Neuropsychological Tests for Executive Functions Using Virtual Reality: Systematic Literature Review

Background

In neuropsychology, fully immersive virtual reality (VR) has been spotlighted as a promising tool. It is considered that VR not only overcomes the existing limitation of neuropsychological tests but is also appropriate for treating executive functions (EFs) within activities of daily living (ADL) due to its high ecological validity. While fully immersive VR offers new possibilities of neuropsychological tests, there are few studies that overview the intellectual landscape and academic trends in the research related to mainly targeted EFs with fully immersive VR.

Objective

The objective of this study is to get an overview of the research trends that use VR in neuropsychological tests and to analyze the research trends using fully immersive VR neuropsychological tests with experimental articles.

Methods

This review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were searched in three web databases using keywords related to VR, EFs, and cognitive abilities. The study was conducted in two steps, keyword analysis and in-depth systematic review. In the web database search from 2000 to 2019, 1167 articles were initially collected, of which 234 articles in the eligibility phase were used to conduct keyword analysis and a total of 47 articles were included for systematic review.

Results

In keyword analysis, the number of articles focused on dementia including the keywords “MCI,” “SCD,” and “dementia” were highlighted over the period, rather than other symptoms. In addition, we identified that the use of behavioral and physiological data in virtual environments (VEs) has dramatically increased in recent studies. In the systematic review, we focused on the purpose of study, assessment, treatment, and validation of usability and structure. We found that treatment studies and uncategorized studies including presence and cybersickness issues have emerged in the recent period. In addition, the target symptoms and range of participants were diversified.

Conclusions

There has been a continuously increasing interest in dealing with neuropsychology by using fully immersive VR. Target cognitive abilities have been diversified, as well as target symptoms. Moreover, the concept of embodied cognition was transplanted in this research area.

Test-retest reliability and practice effects of the virtual environment grocery store (VEGS)

INTRODUCTION

The use of virtual reality (VR) technology has been suggested as a method to increase ecological validity in neuropsychological assessments. Although validity has been a focus in VR research, little attention has been paid to other psychometric properties such as test-retest reliability and practice effects. Practice effects are common on traditional neuropsychological tests and can be impacted by novelty. Because VR is not widely used it was expected that participants would demonstrate higher practice effects on VR as compared to paper-and-pencil testing.

METHOD

To compare test-retest reliability and practice effects in VR and traditional paper-and-pencil testing, the Virtual Environment Grocery Store (VEGS) and California Verbal Learning Test - Second Edition (CVLT-II) were used in healthy adults (n = 44). Participants received follow-up testing approximately 2 weeks after the initial visit.

RESULTS

Significant practice effects of similar magnitude were seen on memory scores (i.e., total learning, long-delay free recall, and long-delay cued recall) on the VEGS and the CVLT-II. The VEGS and CVLT-II memory scores also demonstrated strong test-retest reliability (r's > .71). Lastly, total learning scores (d = .32) and long-delay cued recall (d = .70) scores were significantly higher on the CVLT-II compared to the VEGS (p's < .01).

CONCLUSIONS

Results suggested similar test-retest reliability and practice effects of the VEGS and CVLT-II, although the VEGS has the benefit of being an immersive technology that simulates an everyday activity. The study replicated past findings that the VEGS is more difficult than the CVLT-II which may be a useful property for clinical assessment.

Usability and Effectiveness of Immersive Virtual Grocery Shopping for Assessing Cognitive Fatigue in Healthy Controls: Protocol for a Randomized Controlled Trial

BACKGROUND

Cognitive fatigue (CF) is a human response to stimulation and stress and is a common comorbidity in many medical conditions that can result in serious consequences; however, studying CF under controlled conditions is difficult. Immersive virtual reality provides an experimental environment that enables the precise measurement of the response of an individual to complex stimuli in a controlled environment.

OBJECTIVE

We aim to examine the development of an immersive virtual shopping experience to measure subjective and objective indicators of CF induced by instrumental activities of daily living.

METHODS

We will recruit 84 healthy participants (aged 18-75 years) for a 2-phase study. Phase 1 is a user experience study for testing the software functionality, user interface, and realism of the virtual shopping environment. Phase 2 uses a 3-arm randomized controlled trial to determine the effect that the immersive environment has on fatigue. Participants will be randomized into 1 of 3 conditions exploring fatigue response during a typical human activity (grocery shopping). The level of cognitive and emotional challenges will change during each activity. The primary outcome of phase 1 is the experience of user interface difficulties. The primary outcome of phase 2 is self-reported CF. The core secondary phase 2 outcomes include subjective cognitive load, change in task performance behavior, and eye tracking. Phase 2 uses within-subject repeated measures analysis of variance to compare pre- and postfatigue measures under 3 conditions (control, cognitive challenge, and emotional challenge).

RESULTS

This study was approved by the scientific review committee of the National Institute of Nursing Research and was identified as an exempt study by the institutional review board of the National Institutes of Health. Data collection will begin in spring 2021.

CONCLUSIONS

Immersive virtual reality may be a useful research platform for simulating the induction of CF associated with the cognitive and emotional challenges of instrumental activities of daily living.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04883359; http://clinicaltrials.gov/ct2/show/NCT04883359.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/28073.

Considerations and practical protocols for using virtual reality in psychological research and practice, as evidenced through exposure-based therapy

Everyday client stressors are often challenging to replicate in clinical and research environments, which hinders the ability to reliably reproduce clinical outcomes. To overcome this obstacle, tools that can bridge the inherent disconnect between these settings and the real-world experiences of clients are urgently needed. Virtual reality (VR) promises to provide immersive experiences within controlled laboratory or clinical settings. While the potential opportunities and challenges of VR applications have been scientifically reviewed, clinical adoptions into psychology are hampered by a paucity of practical and methodological publications. This paper intends to address that gap, by providing a four-step process for decision-making considerations, including practical recommendations and an applied case study of developing an exposure-based system for obsessive-compulsive disorder. We provide a framework to make VR accessible for clinician-researchers to create similar systems that realise the promise while encouraging ongoing scientific rigour.

Ethical Challenges of Using Virtual Environments in the Assessment and Treatment of Psychopathological Disorders

Clinicians are increasingly interested in the potential of virtual environments for research and praxes. Virtual environments include both immersive and non-immersive simulations of everyday activities. Moreover, algorithmic devices and adaptive virtual environments allow clinicians a medium for personalizing technologies to their patients. There is also increasing recognition of social virtual environments that connect virtual environments to social networks. Although there has been a great deal of deliberation on these novel technologies for assessment and treatment, less discourse has occurred around the ethical challenges that may ensue when these technologies are applied clinically. In this paper, some of the ethical issues involved in the clinical use of novel technologies are discussed.

Socioeconomic position and the impact of increasing availability of lower energy meals vs. menu energy labelling on food choice: two randomized controlled trials in a virtual fast-food restaurant

BACKGROUND

Food consumed outside of the home is often high in energy and population level interventions that reduce energy intake of people from both lower and higher socioeconomic position (SEP) are needed. There is a lack of evidence on the effectiveness and SEP equity of structural-based (e.g. increasing availability of lower energy options) and information provision (e.g. menu energy labelling) interventions on food choice.

METHODS

Across two online experiments, participants of lower and higher SEP made meal choices in a novel virtual fast-food restaurant. To be eligible to take part, participants were required to be UK residents, aged 18 or above, fluent in English, have access to a computer with an internet connection and have no dietary restrictions. Participants were randomized to one of four conditions in a 2 × 2 between-subjects design: menu energy labelling present vs. absent and increased availability of lower energy options (75% of menu options lower energy) vs. baseline availability (25% of menu options lower energy). Participants also completed measures of executive function and food choice motives.

RESULTS

The analysis of pooled data from both studies (n = 1743) showed that increasing the availability of lower energy options resulted in participants ordering meals with significantly less energy on average (- 71 kcal, p <  0.001, partial η² = 0.024) and this effect was observed irrespective of participant SEP. Menu labelling had no significant effect on energy ordered (- 18 kcal, p = 0.116, partial η² = 0.001) in participants from both higher and lower SEP. Furthermore, we found no evidence that executive function or food choice motives moderated the effect of increasing lower energy menu options or energy labelling on total energy ordered.

CONCLUSIONS

In a virtual fast-food environment, energy labelling was ineffective in reducing total energy ordered for both higher and lower SEP participants. Increasing the availability of lower energy options had an equitable effect, reducing total energy ordered in participants from higher and lower SEP.

TRIAL REGISTRATION

Study protocols and analysis plans were pre-registered on the Open Science Framework (https://osf.io/ajcr6/).

Technological Competence Is a Pre-condition for Effective Implementation of Virtual Reality Head Mounted Displays in Human Neuroscience: A Technological Review and Meta-Analysis

Immersive virtual reality (VR) emerges as a promising research and clinical tool. However, several studies suggest that VR induced adverse symptoms and effects (VRISE) may undermine the health and safety standards, and the reliability of the scientific results. In the current literature review, the technical reasons for the adverse symptomatology are investigated to provide suggestions and technological knowledge for the implementation of VR head-mounted display (HMD) systems in cognitive neuroscience. The technological systematic literature indicated features pertinent to display, sound, motion tracking, navigation, ergonomic interactions, user experience, and computer hardware that should be considered by the researchers. Subsequently, a meta-analysis of 44 neuroscientific or neuropsychological studies involving VR HMD systems was performed. The meta-analysis of the VR studies demonstrated that new generation HMDs induced significantly less VRISE and marginally fewer dropouts. Importantly, the commercial versions of the new generation HMDs with ergonomic interactions had zero incidents of adverse symptomatology and dropouts. HMDs equivalent to or greater than the commercial versions of contemporary HMDs accompanied with ergonomic interactions are suitable for implementation in cognitive neuroscience. In conclusion, researchers' technological competency, along with meticulous methods and reports pertinent to software, hardware, and VRISE, are paramount to ensure the health and safety standards and the reliability of neuroscientific results.

Assessment of cognitive instrumental activities of daily living: a systematic review

PURPOSE

Cognitive instrumental activities of daily living are particularly related to executive functions, such as scheduling appointments, monthly payments, managing the household economy, shopping or taking the bus. The aim of this systematic review was to determine the available tests for the assessment of executive functions with ecological validity to predict individuals' functioning.

MATERIALS AND METHODS

An electronic search was conducted in MEDLINE, Cochrane Central, PsyCInfo and IEEE Xplore until May 2019, in addition to a manual search. The PRISMA criteria and the Covidence platform were used to select articles and extract data.

RESULTS

After applying the search selection criteria, 76 studies were identified. They referred to 110 tools to assess instrumental activities of daily living. Those that have received most attention are related to menu preparation and shopping. Performance-based measures are the most widely used traditional methods. Most tests were aimed at the adult population with acquired brain damage, cognitive impairment or dementia. There was a predominance of tests based on the Multiple Errands Test paradigm.

CONCLUSIONS

In recent years, it has increased the number of tools that assess the instrumental activities of daily living based on technologies such as personal or environmental sensors and serious games.IMPLICATIONS FOR REHABILITATIONAssessment of Instrumental Activities of Daily Living through performance-based measures is especially useful for the early detection of dysfunctions or preclinical disability.Difficulties in performing instrumental activities of daily living are closely associated with deficits in executive functions and prospective memory.Activities of Daily Living can be understood as multitasks.The use of virtual reality-based tests was shown to be sensitive to the detection of cognitive deficits in Activities of Daily Living.An advantage of using virtual reality in assessments is that it can help to predict the level of personal autonomy in patients who are in an institutional environment and could be a first approximation to the real environment.