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Virtual environments for the assessment of attention and memory processes: The virtual classroom and office
Abstract and Figures
Virtual Reality (VR) technology offers new options for neuropsychological assessment and cognitive rehabilitation. If empirical studies demonstrate effectiveness, virtual environments (VEs) could be of considerable benefit to persons with cognitive and functional impairments due to traumatic brain injury, neurological disorders, and learning disabilities. Testing and training scenarios that would be difficult, if not impossible, to deliver using conventional neuropsychological methods are now being developed that take advantage of the assets available with VR technology. These assets include the precise presentation and control of dynamic multi-sensory 3D stimulus environments, as well as advanced methods for recording behavioral responses. When combining these assets within the context of functionally relevant, ecologically valid VEs, a fundamental advancement emerges in how human cognition and functional behavior can be assessed and rehabilitated. This paper will focus on the progress of a collaborative VR research program at the University of Southern California and the Kessler Medical Rehabilitation Research and Education Corporation. These groups are developing and evaluating VR neuropsychological applications designed to target: 1. Attention processes in children with ADHD within a HMD virtual classroom and 2. Memory processes in persons with TBI within a HMD virtual office. Results from completed research, rationales and methodology of works in progress, and our plan for future work will be discussed. Our primary vision has been to develop VR systems that target cognitive processes and functional skills that are relevant to a wide range of patient populations with CNS dysfunction. We have also sought to select cognitive/functional targets that intuitively appear well matched to the specific assets available with the current state of VR technology.
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... Virtual reality (VR) typically refers to the use of interactive simulations created with computer hardware and software to present users with opportunities to engage in environments that appear to be and feel similar to real world objects and events. [18][19][20] Users interact with displayed images, move and manipulate virtual objects, and perform other actions within the simulated environment thereby engendering a feeling of presence in the virtual world. 18 VR has the capability of creating an interactive, motivating environment where intensity of practice and feedback can be manipulated to create individualized treatment sessions. ...
... VR has been used as a medium for the assessment and rehabilitation of cognitive processes, motor coordination, hand strength, range of motion and speed of movement. [18][19][20][21][22][23][24] The studies share a common goal of using VR to construct a simulated environment that aimed at facilitating the client's motor and cognitive abilities in order to improve functional ability. Functional magnetic resonance imaging (fMRI) studies have shown that VR induces cortical reorganization in patients with stroke 25, 26 and cerebral palsy. ...
... Previous studies which used VR for the assessment and rehabilitation of visual perception, attention, memory, sequencing and executive functioning share a common goal of using VR to improve functional ability. [18][19][20][21][22][23][24] EyeToy games engage the patients cognitively in repeated movements with increasing challenge. They include many motivating and competitive environments that may be played by one user or more sequentially in a tournament fashion. ...
Aim. To evaluate the effects of "Playstation EyeToy Games" on upper extremity motor recovery and upper extremity-related motor functioning of patients with subacute stroke. Methods. The authors designed a randomized, controlled , assessor-blinded, 4-week trial, with follow-up at 3 months. A total of 20 hemiparetic inpatients (mean age 61.1 years), all within 12 months post-stroke, received 30 minutes of treatment with "Playstation EyeToy Games" per day, consisting of flexion and extension of the paretic shoulder, elbow and wrist as well as abduction of the paretic shoulder or placebo therapy (watching the games for the same duration without physical involvement into the games) in addition to conventional program, 5 days a week, 2-5 hours/day for 4 weeks. Brunnstrom's staging and self-care sub-items of the functional independence measure (FIM) were performed at 0 month (baseline), 4 weeks (post-treatment), and 3 months (follow-up) after the treatment. Results. The mean change score (95% confidence interval) of the FIM self-care score (5.5 [2.9-8.0] vs 1.8 [0.1-3.7], P=0.018) showed significantly more improvement in the EyeToy group compared to the control group. No significant differences were found between the groups for the Brunnstrom stages for hand and upper extremity. Conclusion. "Playstation EyeToy Games" combined with a conventional stroke rehabilitation program have a Suppliers.-Statistical Package for the Social Sciences (SPSS) for Windows, Version 11.5 potential to enhance upper extremity-related motor functioning in subacute stroke patients.
... The Questionnaire on the Sense of Presence for Children [47] comprises 19 items with 3-point Likert scales used to measure children's degree of presence within a VE. The items are taken from the Child Presence Measure [48] and the Presence Questionnaire [49]. The children's version in French was written and validated by the UQO Cyberpsychology Laboratory team [47]. ...
... The Simulator Sickness Questionnaire for Children [47] is an 11-item instrument with 3-point Likert scales which is used to measure the extent to which children feel simulator sickness due to their immersion in VR (e.g., nausea, eye fatigue, dizziness, etc.). The items in this questionnaire are taken from the Simulator Sickness Questionnaire [50] and the Child Simulator Sickness Questionnaire [48], both of which are frequently used during treatments in a VE. The psychometric properties of this questionnaire have been demonstrated [50]. ...
... La ENP, como mecanismo para poner de manifiesto las deficiencias en diferentes procesos cognitivos por medio de la RV, tiene sus inicios en las primeras incursiones realizadas por Rizzo et al. (2002) y Rizzo et al. (2004), quienes describieron una serie de ventajas del uso de la RV en la ENP, entre las que se encuentran: (1) capacidad de presentar de forma sistemática estímulos tridimensionales de manera dinámica e interactiva dentro una simulación virtual, tareas que no pueden conseguirse por otros medios; (2) puede crear entornos simulados que permiten la evaluación con mayor validez ecológica; (3) proporciona un feedback inmediato al rendimiento de la persona que está siendo evaluada por medio de diferentes modalidades sensoriales; (4) mejora la disponibilidad de la evaluación para personas con dificultades sensoriales y motoras, por medio de dispositivos e interfaces adaptadas para el uso de la modalidad sensorial requerida e integrada en el entorno virtual; (5) introduce características recreativas o elementos dentro de entornos virtuales como un medio para aumentar la motivación y el rendimiento; (6) puede integrar representaciones humanas de carácter virtual (avatares) para aplicaciones sis-pp • 108-124 temáticas para aumentar la interacción social. De igual manera, se podría considerar la disminución del número de errores propios de la calificación de las pruebas de lápiz y papel. ...
Los instrumentos de evaluación neuropsicológica deben cumplir con varias características como la validez ecológica; así, la realidad virtual busca satisfacer la necesidad de crear instrumentos que tengan correlación con su funcionamiento en la vida diaria. El objetivo del trabajo es precisar el tipo de realidad virtual implementada en la generación de plataformas de evaluación neuropsicológica publicadas durante el periodo de 2017-2021 en la plataforma Pubmed. Se incluyen un total de catorce trabajos: el 71,4% de las plataformas publicadas utilizaron Realidad Virtual Inmersiva y el 28,6% utilizan Realidad Virtual No Inmersiva; el 35,7% de las plataformas diseñadas buscan evaluar la memoria, seguido de las funciones ejecutivas (21,4%), la atención (21,4%) y el diseño de baterías de evaluación (21,4%). La sensación de inmersión permite que la evaluación, por medio de estas plataformas, cause mayor validez ecológica por la alta demanda cognitiva que presenta y por la capacidad de generar diferentes respuestas.
... Indeed, VR has been used to analyse the influence of light on human beings in various study areas and to compare results obtained in studies examining illuminance conditions in VR and real environments. When carefully calibrated, IVEs provide simulations that can be modified dynamically, and which are compatible with the monitoring of behaviours and the measurement of cognitive performance [45,46]. VR can be an effective tool through which to study users' behaviours as it provides a satisfactory representation of the real physical environment [47]. ...
Classroom lighting conditions affect students' academic performance due to the influence of light on learning. Illuminance is a lighting parameter recognised as an important factor in interior lighting. The objective of this study is to analyse the effect that a classroom's illuminance exerts on university students' memories; memory is one of the fundamental cognitive processes in learning. Forty subjects performed a psychological memory task in three immersive virtual environments (IVEs) with different illuminance levels, 100 lx, 300 lx and 500 lx. Their neurophysiological responses were monitored during the tasks through electroencephalogram, heart rate variability and electrodermal activity analysis. The results showed that classroom illuminance influences students' memories at psychological and neurophysiological levels. As illuminance increased, their performance in the memory tests deteriorated, and neurophysiological activation diminished; the best results were obtained with an illuminance level of 100 lx. These results may have important consequences for the energy efficiency of educational centres and provide information about the cognitive implications of lighting for learning in virtual environments.
... In some cases, the applications take advantage of the ability to adapt virtual environment to simulate real life activities such as meal preparation 26 or crossing a street . 27,28 A conceptual model was developed within the context of terminology established by the International Classification of Functioning, Disability and Health (ICF) 18 and the rehabilitation process 29,30 . The process of using VR in rehabilitation is modeled via three nested circles, the inner "Interaction Space", the intermediate "Transfer Phase" and the outer "Real World". ...
Background: Stroke is the world's third most frequent cause of death, with more than half of neurological
... The latest advances in computer-generated images simulate light, texture and atmospheric effects to such a degree of photorealism that it is possible to produce a virtual image that is indistinguishable, to the naked eye, from a photograph of a real-world scene (Morinaga et al., 2018). These representations can be dynamically altered, and allow behaviour to be monitored and cognitive performance to be recorded (Parasuraman & Rizzo, 2006;Rizzo et al., 2002). Moreover, VR allows the time and costeffective isolation and modification of variables under controlled laboratory conditions (Vince, 2004), unfeasible in real space (Alcañiz et al., 2003). ...
Classroom design influences the cognitive processes that determine learning. However, the effects of classroom geometry have been little studied, in part due to the difficulty of modifying physical spaces for experimental purposes. Today, virtual reality allows researchers to very closely control many environmental conditions while collecting psychological and neurophysiological metrics of the user experience. The objective of the present study is to analyse the influence of classroom width on the attention and memory performance of university students. The performance of 90 subjects in three classroom width settings (8.80, 8.20, and 7.60 m), implemented in virtual reality, was evaluated through measures of their attention- and memory-related psychological and neurophysiological responses. The results showed that wider classrooms are associated with poorer performance and lower emotional arousal. This demonstrates a link between the geometric variables of classrooms and the cognitive and physiological responses of students. In general, the present study and its methodology can help architects and researchers develop design guidelines that can improve students’ cognitive processes.
... Innovators of computer virtual environments for medical purposes have long recognized that innovative technology solutions should not be designed for their own sake; interventions should be planned with an eye toward the affordances of the technology and the manner in which these characteristics are a fit with the need to be addressed [17]. Regarding training, nearly 50 years ago, academics recognized that adults approach learning differently than children and relevant andragogy emerged [18]. ...
Purpose of Review
The training of psychiatrists and other mental health professionals requires education on a range of interpersonal, communication, and psychotherapy techniques. Classroom and workshop training must be augmented by experiential learning with feedback for skill implementation with fidelity. Virtual standardized patients (VSPs) are computerized conversational agents that can support experiential learning through standardized, consequence-free training environments at reduced costs.
Recent Findings
Research on mental health VSPs is rife with feasibility and acceptability pilot studies across various training populations and settings. Users have generally reported positive reactions to training with VSPs, though frustrations with some VSP speech recognition or VSP response relevance has been reported. Several studies have demonstrated a promising transfer of clinical skills from VSP training to human standardized patients and randomized trials supporting improved skill relative to reading or academic study are encouraging.
Summary
As technology improves and natural language processing and accurate computer response generation for broad ranging conversational topics emerges, the field would benefit from research on the characteristics of effective VSPs for a range of purposes and trainee populations. Well-designed randomized evaluations of VSPs relative to best practices in education are needed, particularly regarding the impact of VSPs on clinical practice among actual patients.
... PlayMancer (Fernández-Aranda et al., 2012) has been proven able to change underlying attitudinal, behavioral, and emotional processes of patients with impulse-related disorders, which are similar to ADHD. The Virtual Classroom (Rizzo et al., 2002;Coleman et al., 2019) was developed for the study, assessment, and rehabilitation of cognitive processes in patients with different forms of central nervous system dysfunction. It offers an assessment in a real-world dynamic simulation with distractors that mimic situations typically occurring in a classroom (Parsons et al., 2019). ...
... PlayMancer (Fernández-Aranda et al., 2012) has been proven able to change underlying attitudinal, behavioral, and emotional processes of patients with impulse-related disorders, which are similar to ADHD. The Virtual Classroom (Rizzo et al., 2002;Coleman et al., 2019) was developed for the study, assessment, and rehabilitation of cognitive processes in patients with different forms of central nervous system dysfunction. It offers an assessment in a real-world dynamic simulation with distractors that mimic situations typically occurring in a classroom (Parsons et al., 2019). ...
The design and implementation of a serious game (SG) concerning inhibition skills in children are presented. The SG consists of a set of activities, each eliciting the tendency to respond in an immediate and inappropriate (wrong) way. The SG is based on the Dual Pathway model of attention-deficit/hyperactivity disorder (ADHD) proposed by Sonuga-Barke and on the Unity/Diversity model of executive functions proposed by Miyake. In the SG, children must block impulsive tendencies, reflect upon the situation, inhibit irrelevant thoughts, and find the non-immediate solution. A study was carried out by testing the SG on typically developing primary school children (30 children, 16 boys; age, M = 9.30 years, SD = 0.87) to verify that it measures the same variables addressed by tests usually employed to assess attention ability in children and to diagnose ADHD. Three standardized tasks belonging to the Italian Battery for ADHD were administered, as well as an ad hoc questionnaire devised to check the acceptability, usability, and comprehensibility of the SG. Positive correlations between impulsiveness as measured by standard tests and impulsiveness scores in the SG emerged. These findings support the notion that skills associated with the control of impulsivity are involved in the SG. Furthermore, self-report ratings in the questionnaire showed that the SG is easy to be understood, is engaging, and elicits positive reactions in children.
Treatment and recovery of the intellectual, mental, and engine sequela of focal sensory system brokenness regularly depends on appraisal instruments to illuminate conclusion and to follow changes in clinical status. Regularly, these evaluations utilize paper-and-pencil psychometrics, involved simple/PC tests, and rating of conduct inside the setting of true useful conditions. The current survey talks about the utilization of virtual reality (VR) innovation in clinical medication, particularly in careful preparing, torment the board and restorative treatment of psychological maladjustment. We present the regular kinds of VR test systems and their operational standards in previously mentioned fields. The clinical impacts are additionally talked about. In pretty much every examination that managed VR test systems, scientists have come to a similar end result that the two specialists and patients could profit by this novel innovation. In addition, favourable circumstances and burdens of the use of VR innovation in each field were talked about, and the future exploration headings were proposed
The Virtual Environments Laboratory at the University of Southern California (USC) has ini- tiated a research program aimed at developing virtual reality (VR) technology applications for the study, assessment, and rehabilitation of cognitive/functional processes. This technol- ogy is seen to offer many advantages for these aims and an introductory section of this arti- cle will discuss the specific rationale for VR applications in the area of clinical neuropsy- chology. A discussion of attention processes will follow and issues for the development of a head-mounted display (HMD) VR system for the study, assessment, and possible rehabilita- tion of attention disorders will then be presented. Our efforts to target this cognitive process are supported by the widespread occurrence and relative significance of attention impair- ments seen in a variety of clinical conditions across the human lifespan. Most notably, at- tention difficulties are seen in persons with Attention Deficit Hyperactivity Disorders (ADHD), Traumatic Brain Injury (TBI), and as a feature of various neurodegenerative disor- ders (i.e., Alzheimer' s Disease, Vascular Dementia, etc.). Virtual Environment (VE) technol- ogy appears to provide specific assets for addressing these impairments that are not available using existing methods. VEs delivered via HMDs are well suited for these types of applica- tions as they serve to provide a controlled stimulus environment where cognitive challenges can be presented along with the precise delivery and control of " distracting" auditory and vi- sual stimuli. This level of experimental control allows for the development of attention as- sessment tasks that are more similar to what is found in the real world and could improve on the ecological validity of measurement and treatment in this area. A recent project in our lab has involved the development of a virtual " classroom" specifically aimed at the assess- ment of Attention Deficit Hyperactivity Disorder (ADHD). The system uses a Virtual Re- search V8 HMD, Ascension Systems head, hand, and leg tracking, and is run on an SGI Onyx platform. The scenario consists of a standard rectangular classroom environment containing student desks, a teacher' s desk, a virtual teacher, a blackboard, a large window looking out onto a playground with buildings, vehicles, and people, and a pair of doorways on each end
Virtual reality (VR) is an emerging technology with a variety of potential benefits for many aspects of rehabilitation assessment, treatment, and research. Through its capacity to allow the creation and control of dynamic 3-dimensional, ecologically valid stimulus environments within which behavioral responding can be recorded and measured, VR offers clinical assessment and rehabilitation options that are not available with traditional methods. Initial applications of VR in other aspects of medicine and psychology have yielded encouraging results, but continued research and understanding of this evolving technology will be crucial for its effective integration into rehabilitation. This article provides a brief introduction to VR technology, examines the specific benefits VR offers consumers and providers of rehabilitation services and discusses potential areas of application and important considerations in applying this technology. Finally, 2 examples of current Vr applications are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Recent years have seen tremendous advances in understanding and treating Attention-Deficit/Hyperactivity Disorder (ADHD). Now in a revised and expanded third edition, this authoritative handbook brings the field up to date with current, practical information on nearly every aspect of the disorder. Drawing on his own and others' ongoing, influential research - and the wisdom gleaned from decades of front-line clinical experience - Russell A. Barkley provides insights and tools for professionals working with children, adolescents, or adults. Part I presents foundational knowledge about the nature and developmental course of ADHD and its neurological, genetic, and environmental underpinnings. The symptoms and subtypes of the disorder are discussed, as are associated cognitive and developmental challenges and psychiatric comorbidities. In Parts II and III, Barkley is joined by other leading experts who offer state-of-the-art guidelines for clinical management. Assessment instruments and procedures are described in detail, with expanded coverage of adult assessment. Treatment chapters then review the full array of available approaches - parent training programs, family-focused intervention for teens, school- and classroom-based approaches, psychological counseling, and pharmacotherapy - integrating findings from hundreds of new studies. The volume also addresses such developments as once-daily sustained delivery systems for stimulant medications and a new medication, atomoxetine. Of special note, a new chapter has been added on combined therapies. Chapters in the third edition now conclude with user-friendly Key Clinical Points. This comprehensive volume is intended for a broad range of professionals, including child and adult clinical psychologists and psychiatrists, school psychologists, and pediatricians. It serves as a scholarly yet accessible text for graduate-level courses. Note: Practitioners wishing to implement the assessment and treatment recommendations in the Handbook are advised to purchase the companion Workbook, which contains a complete set of forms, questionnaires, and handouts, in a large-size format with permission to photocopy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(jacket)
Simulator sickness (SS) in high-fidelity visual simulators is a byproduct of modem simulation technology. Although it involves symptoms similar to those of motion-induced sickness (MS), SS tends to be less severe, to be of lower incidence, and to originate from elements of visual display and visuo-vestibular interaction atypical of conditions that induce MS. Most studies of SS to date index severity with some variant of the Pensacola Motion Sickness Questionnaire (MSQ). The MSQ has several deficiencies as an instrument for measuring SS. Some symptoms included in the scoring of MS are irrelevant for SS, and several are misleading. Also, the configural approach of the MSQ is not readily adaptable to computer administration and scoring. This article describes the development of a Simulator Sickness Questiomaire (SSQ), derived from the MSQ using a series of factor analyses, and illustrates its use in monitoring simulator performance with data from a computerized SSQ survey of 3,691 simulator hops. The database used for development included more than 1,100 MSQs, representing data from 10 Navy simulators. The SSQ provides straightforward computer or manual scoring, increased power to identify "problem" simulators, and improved diagnostic capability.
The potential use of virtual reality (VR) in neurological rehabilitation has frequently been discussed. This paper relates current thinking on the subject to the clinically defined concepts of impairment, disability and handicap. It is concluded that VR has a contribution to make to reducing all three, as well as in the initial assessment of the consequences of traumatic brain injury.
The authors have previously presented a methodology to guide the development of virtual learning environments (VLEs) for use by people with learning disabilities (Brown, Neale, Cobb, & Reynolds 1999). This paper presents the results of two sets of studies and shows how these studies enhance this methodology. The first set of studies are user-centered designs for VLE to teach horticultural-related employment, leisure, travel, and public presentation skills to young people with learning disabilities. These projects have allowed us for the first time to distill a set of design guidelines for the production of VLEs for use by people with a learning disability. The second set of studies aims to determine the tutoring strategies employed by support workers, teachers, and care providers when supporting people with learning disabilities using VLEs. These strategies will be embedded in the VLEs to further scaffold the learning process of our target users and allow us to expand the guidance given within the implementation component of the development methodology. These enhancements of the existing methodology are clearly developed within the paper and illustrated diagrammatically.
To better understand the nature of the memory deficit in patients with multiple sclerosis, we designed a study to compare automatic vs effortful memory processes. Forty-one patients with definite multiple sclerosis and 45 demographically matched normal control subjects were administered two tasks designed to assess both automatic (monitoring frequency and modality) and effortful (free and cued-recall) processing. Results indicated that patients with multiple sclerosis, as expected, were significantly impaired on memory measures requiring effort, but performed normally on automatic measures. Performance on the memory indexes did not correlate with self-reported depression. The implications of these findings for delineating the locus of the memory impairment in multiple sclerosis is discussed.
Sixteen patients with a definitive diagnosis of multiple sclerosis (MS) and an equal number of matched controls were administered tests of memory and information processing speed. Results indicated a significant long-term verbal memory impairment in patients with MS, with spared short-term memory and memory scanning. Speed of information processing was evaluated with the Paced Auditory Serial Addition Test. The results for the two highest rates of presentation revealed significantly impaired processing in the MS group. Performance at the higher rates and retrieval of information from long-term memory were significantly correlated. These results suggest that slowed information processing is a deficit that contributes to long-term memory impairment in patients with MS.