Using Virtual Reality to investigate multitasking ability in individuals with frontal lobe lesions

Validation of a Persian version of an English language ecologically-valid assessment of executive functions through childhood and adolescence

Childhood and adolescence are pivotal periods for cognitive development. Executive functions are crucial for efficient cognitive functioning, so accurate assessment is important. One ecologically-valid virtual reality test is the Jansari assessment of Executive Functions for Children (JEF-C©). In a cross-sectional study, we aimed at translating, adapting and validating JEF-C into Persian, and at investigating whether this Persian version (JEF-C (P)) can identify stages of development of executive functions in children aged from 8 to 16. Children and adolescents (N = 146) falling into three age groups participated: 8-10, 11-13 and 14-16 years old. They completed JEF-C (P) and the Wisconsin Card Sorting Test (WCST). There were acceptable Cronbach's alpha coefficients for JEF-C(P) total score (α = .72) and all constructs, except action-based prospective memory, had a positive impact on total internal consistency. There was an effect of age group on overall JEF-C (P) performance and of age on four constructs. There was also a correlation between the number of categories on WCST and the prioritization construct of JEF-C (P). It seems that JEF-C (P) is an ecologically valid executive function assessment sensitive to age and could be useful for both researchers and clinicians working with children.

Conceptualization of the term "ecological validity" in neuropsychological research on executive function assessment: a systematic review and call to action

OBJECTIVE

"Ecological validity" (EV) is classically defined as test's ability to predict real-world functioning, either alone or together with test's similarity to real-world tasks. In neuropsychological literature on assessment of executive functions (EF), EV is conceptualized inconsistently, leading to misconceptions about the utility of tests. The goal of this systematic review was to examine how EV is conceptualized in studies of EF tests described as ecologically valid.

METHOD

MEDLINE and PsychINFO Databases were searched. PRISMA guidelines were observed. After applying inclusion and exclusion criteria, this search yielded 90 articles. Deductive content analysis was employed to determine how the term EV was used.

RESULTS

About 1/3 of the studies conceptualized EV as the test's ability to predict functional outcomes, 1/3 as both the ability to predict functional outcome and similarity to real-world tasks, and 1/3 were either unclear about the meaning of the term or relied on notions unrelated to classical definitions (e.g., similarity to real-world tasks alone, association with other tests, or the ability to discriminate between populations).

CONCLUSIONS

Conceptualizations of the term EV in literature on EF assessment vary grossly, subsuming the notions of criterion, construct, and face validity, as well as sensitivity/specificity. Such inconsistency makes it difficult to interpret clinical utility of tests that are described as ecologically valid. We call on the field to require that, at minimum, the term EV be clearly defined in all publications, or replaced with more concrete terminology (e.g., criterion validity).

Exploring Executive Functioning of Adults With Probable Developmental Coordination Disorder Using the Jansari Assessment of Executive Functions

Many individuals with Developmental Coordination Disorder (DCD) demonstrate executive functioning difficulties on standardized assessments, yet these difficulties have not been investigated using ecologically-valid measures. 26 adults with probable DCD (pDCD), and 26 typically developing (TD) adults completed selected background measures and the Jansari assessment of Executive Functions (JEF©). JEF© is an ecologically-valid measure that provides measures of Planning, Prioritization, Selective-Thinking, Creative-Thinking, Adaptive-Thinking, and Action-, Event- and Time-Based Prospective Memory. pDCD participants were impaired relative to TD participants, with difficulties in Planning, Action-, and Event-Based Prospective Memory. These findings are consistent with self-reported difficulty and provide avenues for research investigating intervention.

A virtual reality program to assess cognitive function in multiple sclerosis: A pilot study

Introduction: Cognitive impairment is a debilitating symptom in people with multiple sclerosis (MS). Most of the neuropsychological tasks have little resemblance to everyday life. There is a need for ecologically valid tools for assessing cognition in real-life functional contexts in MS. One potential solution would involve the use of virtual reality (VR) to exert finer control over the task presentation environment; however, VR studies in the MS population are scarce.

Objectives: To explore the utility and feasibility of a VR program for cognitive assessment in MS.

Methods: A VR classroom embedded with a continuous performance task (CPT) was assessed in 10 non-MS adults and 10 people with MS with low cognitive functioning. Participants performed the CPT with distractors (i.e., WD) and without distractors (i.e., ND). The Symbol Digit Modalities Test (SDMT), California Verbal Learning Test—II (CVLT-II), and a feedback survey on the VR program was administered.

Results: People with MS exhibited greater reaction time variability (RTV) compared to non-MS participants, and greater RTV in both WD and ND conditions was associated with lower SDMT.

Conclusions: VR tools warrant further research to determine their value as an ecologically valid platform for assessing cognition and everyday functioning in people with MS.

The self and self-knowledge after frontal lobe neurosurgical lesions

BACKGROUND

Evidence suggests that damage to the frontal lobes can be associated with changes in cognitive and behavioral functioning and reduced awareness that such changes have occurred. In the current study, the Cognitive Awareness Model was used as a theoretical framework to explore knowledge of the self in people with acquired frontal lesions.

METHODS

Fifteen individuals with focal frontal lobe lesions (FFL) and their nominated informants were compared with fifteen healthy matched control-informant dyads on questionnaire measures designed to assess awareness of difficulties. Questionnaires were adapted to ensure all enabled pre- and post-injury perspectives to be gained from both patient and informant, and to allow novel exploration of awareness of deficits from a third person perspective.

RESULTS

Individuals with frontal lobe lesions showed adequate awareness of their post-surgery changes, which was substantiated by their informant report. Compared to the control group, the patient group was found to acknowledge more difficulties in current functioning. Perspective-taking ability was limited with both patients and controls being comparatively unreliable in assessing how they were perceived by others.

CONCLUSION

These results demonstrate that FLL patients are engaging in more atypical behaviors compared to healthy controls, but suggest that they are aware of and acknowledge these difficulties. The importance of obtaining multiple viewpoints when examining an individual's level of awareness and the clinical implications of this are discussed.

Augmented and virtual reality usage in awake craniotomy: a systematic review

Augmented and virtual reality (AR, VR) are becoming promising tools in neurosurgery. AR and VR can reduce challenges associated with conventional approaches via the simulation and mimicry of specific environments of choice for surgeons. Awake craniotomy (AC) enables the resection of lesions from eloquent brain areas while monitoring higher cortical and subcortical functions. Evidence suggests that both surgeons and patients benefit from the various applications of AR and VR in AC. This paper investigates the application of AR and VR in AC and assesses its prospective utility in neurosurgery. A systematic review of the literature was performed using PubMed, Scopus, and Web of Science databases in accordance with the PRISMA guidelines. Our search results yielded 220 articles. A total of six articles consisting of 118 patients have been included in this review. VR was used in four papers, and the other two used AR. Tumour was the most common pathology in 108 patients, followed by vascular lesions in eight patients. VR was used for intraoperative mapping of language, vision, and social cognition, while AR was incorporated in preoperative training of white matter dissection and intraoperative visualisation and navigation. Overall, patients and surgeons were satisfied with the applications of AR and VR in their cases. AR and VR can be safely incorporated during AC to supplement, augment, or even replace conventional approaches in neurosurgery. Future investigations are required to assess the feasibility of AR and VR in various phases of AC.

Capturing cognitive changes in multiple sclerosis by performance-based functional and virtual reality assessments

Cognitive impairment (CI) has been recognized as one of the core multiple sclerosis (MS) symptoms that profoundly impact lives of people with MS (PwMS). Clinical trials have begun to focus on cognition as a primary or secondary outcome, but translating improvements in cognitive testing scores to functioning in the real world is difficult. Performance-based functional assessments and virtual reality (VR) assessments, which incorporate real-world challenges, have been proposed as a way to better assess functional cognition (i.e., cognitive performance and its impact on real-life cognitive functioning of PwMS) and could address the difficulty in evaluating the impact of a treatment on real-world functioning. In this narrative review, we identify and summarize some of the promising recent research applications of performance-based functional assessments and VR tools to assess functional cognition in MS. Overall, most of the studies suggest that functional and VR assessments can detect cognitive differences between people with and without MS and between PwMS with and without CI. Furthermore, performance on some of the functional and VR assessments was associated with performance on standard cognitive assessments. However, developing any guidelines on how to implement these assessments in clinical practice is difficult because of the relatively small sample size across these studies. Performance-based functional and VR assessments represent an innovative approach to increasing sensitivity of how cognitive impairments/abilities present in the daily life of PwMS. More studies, with a larger sample size, robust research methods, and pre- and post-treatment assessments, are warranted to validate relevant, accessible functional and VR assessments before implementing these assessment approaches in clinical practice.

Understanding the relationship between apathy, cognition and functional outcome in schizophrenia: The significance of an ecological assessment

In recent years there has been an increasing interest in understanding the role apathy plays in mediating the relationship between cognitive impairment and functional outcome. In general, most studies measure cognition with traditional cognitive tests that give explicit instructions and guide the participants toward generating a response. However, given that apathy is defined by a decrease in self-initiated behavior, it is crucial to evaluate cognition with ecological tasks that do not explicitly direct the patient´s motivation to generate behaviors to assess the actual effect. This study investigated whether an ecological cognitive assessment (the Jansari Executive Function Assessment, JEF^©) would uniquely contribute to the relationship between cognition, apathy, and functional outcome in schizophrenia. The Apathy Evaluation Scale (AES), neuropsychological tests and the JEF^© were administered to 20 patients with schizophrenia. Hierarchical multiple regression and mediation analysis were performed to test the associations between the variables of interest. Results showed that JEF^© explained a significant portion of the variance in AES (25%). In addition, apathy explained 36% of the variance in functional outcome. However, AES did not mediate between cognition and functional outcome. Our results highlight the importance of assessing cognition with tasks that require integration of cognitive functions needed for real life demands.

Virtual-Reality Performance-Based Assessment of Cognitive Functions in Adult Patients With Acquired Brain Injury: A Scoping Review

Individuals with acquired brain injury (ABI) commonly present with impairments in cognitive abilities. As these competencies seem to be predictive of patients' abilities to reintegrate into the everyday settings, it is crucial to assess them properly. However, previous research has indicated that patients may perform relatively well on standard tests of cognitive functioning, but may nonetheless encounter significant difficulties in organizing and executing everyday tasks. In order to overcome this issue, virtual reality (VR) methods have been introduced in clinical practice with the aim of creating assessments that simulate real-world activities and thus, provide a clearer picture of patients' functioning in everyday settings. This review offers an overview of VR assessment tools described in the scientific literature between 2010 and 2019. Overall, 38 relevant records describing 31 different tools were found. Among these tools, 16 assessed executive functions and prospective memory, while the other 15 assessed visuo-spatial abilities. Although promising results have been reported, our analysis indicated that about half of the tools deliver tasks that differ from everyday activities, thus limiting the generalizability of patients' performance to the real-world. Moreover, a variety of methodological shortfalls related to study Internal and External Validity have been highlighted, which hamper the possibility of drawing definite recommendations on tool choice. These limitations suggest the importance of putting considerable efforts into the improvement or development of VR tools for patients with ABI for both research and clinical purposes, considering the great potential of this form of assessment.

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.

Application of virtual reality in neurosurgery: Patient missing. A systematic review

Virtual reality (VR) technology had its earliest developments in the 1970s in the U.S. Air Force and has since evolved into a budding area of scientific research with many practical medical purposes. VR shows a high potential to benefit to learners and trainees and improve surgery through enhanced preoperative planning and efficiency in the operating room. Neurosurgery is a field of medicine in which VR has been accepted early on as a useful and promising tool for neuro-navigation planning. Through recent technological developments, VR further increased its level of immersion, accessibility and intuitive use for surgeons and students and now reveals a therapeutic potential for patients. In this paper, we systematically reviewed the neurosurgery literature regarding the use of VR as an assistance for surgery or a tool centered on patients' care. A literature search conducted according to PRISMA guidelines resulted in the screening of 125 abstracts and final inclusion of 100 original publications reviewed. The review shows that neurosurgeons are now relatively familiar with VR technologies (N = 95 articles) for their training and practice. VR technologies are useful for education, pain management and rehabilitation in neurosurgical patients. Nevertheless, the current patient-oriented use of VR remains limited (N = 5 articles). Successful surgery does not only depend on the surgeon's skills and preparation, but also on patients' education, comfort, empowerment and care. Therefore further clinical research is needed to promote the direct use of VR technologies by patients in neurosurgery.

Addressing virtual reality misclassification: A hardware-based qualification matrix for virtual reality technology

Through its unique sensory synchronized design, virtual reality (VR) provides a convincing, user-centred experience of highly controllable scenarios. Importantly, VR is a promising modality for healthcare, where treatment efficacy has been recognized for a range of conditions. It is equally valuable across wider research disciplines. However, there is a lack of suitable criteria and consistent terminology with which to define VR technology. A considerable number of studies have misclassified VR hardware (e.g. defining laptops as VR), hindering validity and research comparisons. This review addresses these limitations and establishes a standardized VR qualification framework. As a result of a comprehensive theoretical and literature review, the hardware-based VR qualification matrix is proposed. The matrix criteria consist of (1) three-dimensional (3D) synchronized sensory stimulation; (2) degrees of freedom tracking; and (3) visual suppression of physical stimuli. To validate the model and quantify the current scale/diversity of VR misclassification, a 2019 sectional review of health-related studies was conducted. Of the 115 studies examined against standardized criteria, 35.7% utilized VR, 31.3% misclassified VR, 18.3% were considered quasi-VR, and 14.8% omitted critical specifications. The proposed model demonstrates good validity and reliability for qualifying and classifying VR. Key Practitioner Messages Virtual reality (VR) therapy has gained rapid empirical support, although many practitioners do not understand the difference between genuine and less-realistic VR variations. That has resulted from an evident lack of suitable criteria to define VR across a range of studies and protocols. Our proposed hardware-based virtual reality qualification matrix addresses issues to do with misclassification, via the introduction of standardised criteria. Applying the matrix to existing literature has revealed that more than 30% of VR studies use hardware that does not fit the high standards of rigour required for immersion in a simulated space. The model is a practical tool researchers and practitioners can use to quality and verify VR standards across research studies.

[Use of new technologies in the diagnosis of neurodegenerative pathologies]

These last ten years, new technologies are more and more used in therapeutic and rehabilitation programms for patients with dementia, and used for the diagnosis of theses diseases, from the signal treatment. A review of litterature shows this growing interest among the scientific communauty for these new technologies.

Acrophobia Quantified by EEG Based on CNN Incorporating Granger Causality

The aim of this study is to quantify acrophobia and provide safety advices for high-altitude workers. Considering that acrophobia is a fuzzy quantity that cannot be accurately evaluated by conventional detection methods, we propose a comprehensive solution to quantify acrophobia. Specifically, this study simulates a virtual reality environment called High-altitude Plank Walking Challenge, which provides a safe and controlled experimental environment for subjects. Besides, a method named Granger Causality Convolutional Neural Network (GCCNN) combining convolutional neural network and Granger causality functional brain network is proposed to analyze the subjects' noninvasive scalp EEG signals. Here, the GCCNN method is used to distinguish the subjects with severe acrophobia, moderate acrophobia, and no acrophobia in a three-class classification task or no acrophobia and acrophobia in a two-class classification task. Compared with the mainstream methods, the GCCNN method achieves better classification performance, with an accuracy of 98.74% for the two-class classification task (no acrophobia versus acrophobia) and of 98.47% for the three-class classification task (no acrophobia versus moderate acrophobia versus severe acrophobia). Consequently, our proposed GCCNN method can provide more accurate quantitative results than the comparative methods, making it to be more competitive in further practical applications.

Hebrew version of the Jansari assessment of Executive Functions for Children (JEF-C©): Translation, adaptation and validation

The Jansari assessment of Executive Functions for Children (JEF-C^©) is a non-immersive computerized assessment of executive functions (EFs). This study aimed to create a cross-culturally adapted Hebrew version, JEF-C(H)^© and to assess reliability and validity in the Israeli context. Forty typically developing Israeli children and adolescents, aged 11-18 years, were assessed with JEF-C(H)^©. In addition, participants and their parents filled in the Behaviour Rating Inventory of Executive Function (BRIEF). JEF-C(H)^© was found to be feasible in Israeli children and adolescents. The internal consistency was acceptable (Cronbach's alpha = 0.79). Most of the JEF-C(H)^© subtests and the Average score showed significant positive moderate to high correlations with age, ranging from 0.40 to 0.78 demonstrating construct validity. Multiple significant correlations were also found between the JEF-C(H)^© Average score and the BRIEF indices as well as total score in the Parent and Self-report questionnaires. These preliminary findings support the reliability and validity of this version. Current findings demonstrate the potential clinical utility of JEF-C(H)^© as an ecologically valid tool for Israeli children and adolescents in the assessment of EFs.

Preliminary Evidence of the Role of Medial Prefrontal Cortex in Self-Enhancement: A Transcranial Magnetic Stimulation Study

Humans employ a number of strategies to improve their position in their given social hierarchy. Overclaiming involves presenting oneself as having more knowledge than one actually possesses, and it is typically invoked to increase one’s social standing. If increased expectations to possess knowledge is a perceived social pressure, such expectations should increase bouts of overclaiming. As the medial prefrontal cortex (MPFC) is sensitive to social pressure and disruption of the MPFC leads to decreases in overclaiming, we predicted that transcranial magnetic stimulation (TMS) applied to the MPFC would reduce overclaiming and the effects would be enhanced in the presence of social pressure. Twelve participants were given a test in which half of the words were real and half were fake, and they were asked how well they knew each word. They were not told that any of the words were fake. Half of the participants were exposed to social pressure while the other half were not. Following TMS delivered to the MPFC, overclaiming rates decreased, specifically under conditions of high social pressure. Medial PFC TMS did not influence real word responses and real words did not interact with the MPFC and social pressure. These preliminary findings support the significant role the MPFC plays in social cognition and the importance of the MPFC in mediating socially meaningful situations. We suggest the role of the MPFC as being highly influenced by the premium placed on social manipulation in human evolution.

Assessment of executive functions in children and adolescents with acquired brain injury (ABI) using a novel complex multi-tasking computerised task: The Jansari assessment of Executive Functions for Children (JEF-C©)

Objectives: The Jansari assessment of Executive Functions for Children (JEF-C^©) is a new non-immersive computerised assessment of executive functions. The objectives of the study were to test the feasibility and validity of JEF-C^© in children and adolescents with acquired brain injury (ABI). Methods: Twenty-nine patients with ABI aged 10-18 years and 30 age-and gender-matched controls were tested. Participants performed JEF-C^©, Wechsler Abbreviated Scale of Intelligence (WASI) and the Behavioural Assessment of the Dysexecutive Syndrome for Children (BADS-C), while parents completed the Behaviour Rating Inventory of Executive Function (BRIEF) questionnaire. Results: The JEF-C^© task proved feasible in patients with ABI. The internal consistency was medium (Cronbach's alpha = 0.62 and significant intercorrelations between individual JEF-C^© constructs). Patients performed significantly worse than controls on most of the JEF-C^© subscales and total score, with 41.4% of participants with ABI classified as having severe executive dysfunction. No significant correlations were found between JEF-C^© total score, the BRIEF indices, and the BADS-C. Significant correlations were found between JEF-C^© and demographic characteristics of the sample and intellectual ability, but not with severity/medical variables. Conclusion: JEF-C^© is a playful complex task that appears to be a sensitive and ecologically valid assessment tool, especially for relatively high-functioning individuals.