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ClinicaVR: Classroom-CPT: A virtual reality tool for assessing attention and inhibition in children and adolescents
Abstract
Having garnered interest both in clinic and research areas, the Virtual Classroom (Rizzo et al., 2000) assesses children's attention in a virtual context. The Digital MediaWorks team (www.dmw.ca) has evolved the original basic classroom concept over a number of iterations to form the ClinicaVR Suite containing the Classroom-CPT as one of its components. The present study has three aims: investigate certain validity and reliability aspects of the tool; examine the relationship between performance in the virtual test and the attendant sense of presence and cybersickness experienced by participants; assess potential effects of gender and age on performance in the test. The study was conducted with 102 children and adolescents from Grade 2 to Grade 10. All participants were enrolled in a regular school program. Results support both concurrent and construct validity as well as temporal stability of ClinicaVR: Classroom-Continuous Performance Test (CPT). Gender exerted no effect on performance, while age did. The test did not cause much cybersickness. We recommend ClinicaVR: Classroom-CPT as an assessment tool for selective and sustained attention, and inhibition, in clinic and research domains.
... Female participants comprised 46 % of the overall sample. Regarding developmental stages, one study included preschool children (Bailey, 2021), fifteen studies included elementary school children and adolescents (Adams et al., 2009;Areces et al., 2018;Chen et al., 2023;Fernández-Martín et al., 2024;Hong et al., 2020;Iriarte et al., 2016;Lalonde et al., 2013;Mangalmurti et al., 2020;Muhlberger et al., 2020;Neguț et al., 2016;Nolin et al., 2012Nolin et al., , 2016Parsons et al., 2007a;Rodrigues, 2016;Shen et al., 2022), one study included adolescents (Camacho-Conde and Climent, 2022), thirteen studies included adults (Alexander et al., 2024;Areces et al., 2019;Chicchi Giglioli et al., 2021;Climent et al., 2021;Donahue and Shrestha, 2019;Henry et al., 2012a;Parsons et al., 2013;Barnett, 2019, 2018;Parsons and Carlew, 2016;Wiebe et al., 2023) and one study included older adults (Parsons and Barnett, 2019). Some studies did not report the mean age of participants Nolin et al., 2016), the exact age ranges (Bailey et al., 2019;Chen et al., 2023;Fernández-Martín et al., 2024;Hong et al., 2022;Muhlberger et al., 2020;Nolin et al., 2012;Parsons and Barnett, 2019;Rodríguez et al., 2018) nor the gender split of the sample and these are not included in the calculations. ...
... Regarding developmental stages, one study included preschool children (Bailey, 2021), fifteen studies included elementary school children and adolescents (Adams et al., 2009;Areces et al., 2018;Chen et al., 2023;Fernández-Martín et al., 2024;Hong et al., 2020;Iriarte et al., 2016;Lalonde et al., 2013;Mangalmurti et al., 2020;Muhlberger et al., 2020;Neguț et al., 2016;Nolin et al., 2012Nolin et al., , 2016Parsons et al., 2007a;Rodrigues, 2016;Shen et al., 2022), one study included adolescents (Camacho-Conde and Climent, 2022), thirteen studies included adults (Alexander et al., 2024;Areces et al., 2019;Chicchi Giglioli et al., 2021;Climent et al., 2021;Donahue and Shrestha, 2019;Henry et al., 2012a;Parsons et al., 2013;Barnett, 2019, 2018;Parsons and Carlew, 2016;Wiebe et al., 2023) and one study included older adults (Parsons and Barnett, 2019). Some studies did not report the mean age of participants Nolin et al., 2016), the exact age ranges (Bailey et al., 2019;Chen et al., 2023;Fernández-Martín et al., 2024;Hong et al., 2022;Muhlberger et al., 2020;Nolin et al., 2012;Parsons and Barnett, 2019;Rodríguez et al., 2018) nor the gender split of the sample and these are not included in the calculations. ...
... Muhlberger et al. (2020) found negligeable to moderate correlations between the CPT VR task and experimenter and parent reports, including omission errors in the VR task and attention measured by the experimenter (r=.029, p<.05) in the ADHD group, head movements in the VR task and hyperactivity measured by the experimenter (r=.51, p<.001) and parents (r=.32, p<.05) in the ADHD group, and between head movements in VR and hyperactivity measured by the experimenter (r=.44, p<.01). Nolin et al. (2016) reported low and moderate correlations between the CPT VR task and a computer CPT, including significant correlations between correct responses (r=.63, p<.001), commissions (r=.50, p<.001) and RT (r=.82, p<.001). Parsons and Barnett (2018) reported negligible correlations between accuracy scores in the VR Stroop task and scores on a standard Stroop task (r =.29, p<.01) and scores on the D-KEFS scale (r=.22, ...
... The main focus of this research stream is learning effectiveness. Our review showed that teaching in interactive VR environments provides either on par or better learning effectiveness compared to traditional teaching (Dube and Ince, 2019;Frydenberg and Andone, 2018;Nolin et al., 2016;Stull et al., 2013). The transformational effect of immersive VR in education has mainly been in the medical field through the recreation of traditional methods in VR for health professions (Blumstein et al., 2020;Brusamento et al., 2019;Kyaw et al., 2019), and even patients . ...
... Aircraft maintenance (Oviatt et al., 2000;Sutcliffe et al., 2005); review of industrial VR training (Stone, 2001); human-centered design in VR training (Stedmon and Stone, 2001) Interactivity Navigability Medical training Dental motor skill training (Perry et al., 2017); blended learning for interprofessional training (Liaw et al., 2019); advanced cardiac life support (Katz et al., 2020); trauma training (Patel et al., 2020) Interactivity Navigability Other training applications Scenario-based prototyping (Strohmann et al., 2019) Create-ability Interactivity Education applications Medical education Health professions education (Brusamento et al., 2019;Kyaw et al., 2019); medicine (Zajtchuk and Satava, 1997); gamification (Chávez et al., 2020); nursing education (Chen et al., 2020) Create-ability Interactivity Navigability Other education applications Choreography (Dube and ˙I nce, 2019); organic chemistry (Stull et al., 2013); neuropsychological assessment in a virtual classroom (Nolin et al., 2016); VR educational systems (Hachaj and Baraniewicz, 2015;Frydenberg and Andone, 2018;Sanchez-Sepulveda et al., 2020); technology acceptance (George et al., 2020) Create-ability Interactivity ...
... VR is considered a potential methodology to enhance ecological validity by creating realistic experimental settings that allow participants to be immersed with the stimuli rather than being passive observers (Bernard et al., 2018). However, VR-based behavioral research can also be subject to issues related to ecological validity due to poor experimental design, interpretation, and potential differences between the real world and the virtual environment (Cao et al., 2019;Nolin et al., 2016;Simon and Greitemeyer, 2019). ...
Immersive virtual reality (VR) that utilizes head-mounted displays (HMD) is one of the key emerging technologies of the 21st century and has drawn keen attention from consumers, practitioners, and scholars in various disciplines. Nevertheless, the information systems (IS) discipline has neglected immersive VR, given that only a handful of studies have been published in mainstream IS journals. However, the recent advancements in immersive VR technology provide new opportunities for organizations and IS researchers. In light of these points, we reviewed the immersive VR literature to provide a holistic view of opportunities and challenges for organizations and future research directions for the IS field. By examining the technical capabilities of immersive VR and the previous literature, we identified five affordances: embodiment, interactivity, navigability, sense-ability, and create-ability. Our review of the 151 studies from the IS and related fields synthesized how these affordances were utilized in various research domains. Guided by the affordance-actualization theory, we also identified the strategic opportunities and challenges that come with implementing VR. The actualization of immersive VR affordances in organizations is indeed a fruitful area for IS scholars as there are various venues to move the IS field as well as the VR research in the organizational context forward.
... As also reported by [236], eye movements should be examined along with head movements to understand attention and interaction more in-depth, since eyes can move differently. In addition, [237] studied the relationship between performance, sense of presence, and cybersickness, whereas [238] examined attention, more particularly ADHD with continuous performance task in a virtual classroom. However, both works are more in the clinical domain, which are relatively different from an everyday classroom setup. ...
... Bailenson et al. [232] and Blume et al. [233] studied learning outcomes according to sitting positions and offer compelling evidence that students seated in the front have better learning outcomes. Few studies, however, took head movements into consideration [253,235,237,236] in such setups. In [235], the immersive VR classroom was used as a tool to study attention measures for attention deficit/hyperactivity disorder (ADHD), whereas in [237] reliability of virtual reality and attention was studied with continuous performance task (CPT) for clinical research. ...
... Few studies, however, took head movements into consideration [253,235,237,236] in such setups. In [235], the immersive VR classroom was used as a tool to study attention measures for attention deficit/hyperactivity disorder (ADHD), whereas in [237] reliability of virtual reality and attention was studied with continuous performance task (CPT) for clinical research. Social interaction using head movements was studied in [236] with users' head movements found to shift between the interaction partner and target. ...
With developments in computer graphics, hardware technology, perception engineering, and human-computer interaction, virtual reality and virtual environments are becoming more integrated into our daily lives. Head-mounted displays, however, are still not used as frequently as other mobile devices such as smart phones and watches. With increased usage of this technology and the acclimation of humans to virtual application scenarios, it is possible that in the near future an everyday virtual reality paradigm will be realized. When considering the marriage of everyday virtual reality and head-mounted displays, eye tracking is an emerging technology that helps to assess human behaviors in a real time and non-intrusive way. Still, multiple aspects need to be researched before these technologies become widely available in daily life. Firstly, attention and cognition models in everyday scenarios should be thoroughly understood. Secondly, as eyes are related to visual biometrics, privacy preserving methodologies are necessary. Lastly, instead of studies or applications utilizing limited human participants with relatively homogeneous characteristics, protocols and use-cases for making such technology more accessible should be essential. In this work, taking the aforementioned points into account, a significant scientific push towards everyday virtual reality has been completed with three main research contributions.
... 33 Attention assessments embedded in a virtual classroom have exhibited stronger discriminant power than traditional computerised assessments in distinguishing children with ADHD from typically developing controls. 34 35 This finding has been linked to enhanced ecological validity and task complexity owing to the presence of distractors (eg, school bell ringing, someone walking into the Open access classroom), which maximises the similarities between the real and virtual worlds. 35 However, few studies have explored the applicability of VR and its effects on NFT. ...
... Moreover, little is known about whether the treatment effects can be sustained over time or the extent to which skills are transferable to daily life. In addition, despite evidence from Nolin et al indicating minimal cybersickness among children aged 7-16 after VR-based attention assessment, 34 this aspect has not been studied extensively. ...
Background
The rise in the number of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) highlights the need for effective interventions targeting attentional control. Although recent research has demonstrated the potential of neurofeedback training (NFT) for children with ADHD, most studies have been conducted in laboratory settings, raising questions about their real-world applicability. To address this issue, virtual reality (VR) may offer a solution to the ecological validity challenges encountered in NFT. By coupling NFT with VR, individuals can engage in self-regulating brain activity within a simulated, realistic environment. This study aims to investigate the efficacy of near-infrared spectroscopy (NIRS)-based NFT combined with VR in alleviating ADHD symptoms among children, addressing the need for interventions with practical relevance and effectiveness.
Methods
This study aims to recruit 138 children aged 7–12 diagnosed with ADHD. Following baseline assessment, participants will be randomly assigned to one of three conditions: (1) NIRS-based NFT in a VR classroom setting; (2) conventional computerised cognitive training (active control) or (3) a waitlist control group. On completion of intervention sessions in the two training groups, all groups will undergo an assessment at time 2, with a follow-up assessment scheduled 2 months post-training for all participants. Primary outcomes will include measures of executive function, such as attentional control, response inhibition and working memory, along with changes in oxygenated and deoxygenated haemoglobin levels monitored by functional NIRS. Secondary outcome measures will comprise ratings of children’s ADHD symptoms and executive function behaviours in daily life, reported by parents and teachers.
Discussion
The three-arm randomised controlled trial will address research gaps regarding the effectiveness of NIRS-based NFT for children with ADHD, particularly when integrated with immersive VR technology. By combining NFT and VR, this study aims to simulate a real-world environment, potentially amplifying intervention effects. The findings from the study will provide evidence for the efficacy of this innovative intervention in improving executive function and alleviating ADHD symptoms.
Ethics and dissemination
Ethical approval was obtained from the Human Research Ethics Committee at the University of Hong Kong (Reference: EA200247). Results will be published in peer-reviewed journals and presented at conferences.
Trial registration number
NCT05906485 .
... IVRs-once programmed-provide cost-and time-efficient, highly reproducible testing settings with maximum control of confounding and manipulated variables while simultaneously providing an authentic experience (for examples in the classroom context, see Refs. [43][44][45] ). Advocates of IVR as an experimental tool highlight evidence that users' behaviour in IVR settings is similar to real-life behaviour 46,47 . ...
... To this end, there are empirical findings that support the idea that IVR can provide an authentic and valid research environment. For instance, there is evidence that students' individually different reactions to distractions in real-world classrooms are similar in an IVR classroom, and the respective differences (e.g., associated with ADHD diagnoses) can be reproduced in an IVR classroom simulation 45,74,75 . More generally speaking, children have been found to be particularly (both cognitively and behaviourally) responsive to IVR environments and tend to perceive the simulations as more real and feel a higher level of presence, which makes them act more spontaneously while thinking less about the world outside of the IVR environment 48,76,77 . ...
Higher-achieving peers have repeatedly been found to negatively impact students’ evaluations of their own academic abilities (i.e., Big-Fish-Little-Pond Effect). Building on social comparison theory, this pattern is assumed to result from students comparing themselves to their classmates; however, based on existing research designs, it remains unclear how exactly students make use of social comparison information in the classroom. To determine the extent to which students (N = 353 sixth graders) actively attend and respond to social comparison information in the form of peers’ achievement-related behaviour, we used eye-tracking data from an immersive virtual reality (IVR) classroom. IVR classrooms offer unprecedented opportunities for psychological classroom research as they allow to integrate authentic classroom scenarios with maximum experimental control. In the present study, we experimentally varied virtual classmates’ achievement-related behaviour (i.e., their hand-raising in response to the teacher’s questions) during instruction, and students’ eye and gaze data showed that they actively processed this social comparison information. Students who attended more to social comparison information (as indicated by more frequent and longer gaze durations at peer learners) had less favourable self-evaluations. We discuss implications for the future use of IVR environments to study behaviours in the classroom and beyond.
... One meta-analysis went further and reported not only data on clinical efficacy but synthesized and presented descriptively data on safety, enjoyment and sense of presence reported in the included studies (Gilboa et al. 2018). In terms of safety, many studies conducted to date which have used the VR classroom to assess attention among children reported no or minimal adverse effects (Adams et al. 2009;Bioulac et al. 2012;Mühlberger et al. 2020;Nolin et al. 2009Nolin et al. , 2016Pollak et al. 2010Pollak et al. , 2009Rizzo et al. 2000). A few did not report data on safety Diaz-Orueta et al. 2014;Iriarte et al. 2016;Rodriguez et al. 2018), and one reported that two children experienced simulator sickness symptoms, as they reported at least one severe symptom (Negut et al. 2017). ...
... A few did not report data on safety Diaz-Orueta et al. 2014;Iriarte et al. 2016;Rodriguez et al. 2018), and one reported that two children experienced simulator sickness symptoms, as they reported at least one severe symptom (Negut et al. 2017). Of the above studies, one study included measures of presence and reported no significant correlations between attention performance and presence (Nolin et al. 2016). Pollak et al. (2009Pollak et al. ( , 2010 included several items to measure enjoyment, success, discomfort and perceived difficulty between VR classroom and computerized CPT. ...
Attention is the ability to actively process specific information within one’s environment over longer periods of time while disregarding other details. Attention is an important process that contributes to overall cognitive performance from performing every day basic tasks to complex work activities. The use of virtual reality (VR) allows study of the attention processes in realistic environments using ecological tasks. To date, research has focused on the efficacy of VR attention tasks in detecting attention impairment, while the impact of the combination of variables such as mental workload, presence and simulator sickness on both self-reported usability and objective attention task performance in immersive VR has not been examined. The current study tested 87 participants on an attention task in a virtual aquarium using a cross-sectional design. The VR task followed the continuous performance test paradigm where participants had to respond to correct targets and ignore non-targets over 18 min. Performance was measured using three outcomes: omission (failing to respond to correct targets), commission errors (incorrect responses to targets) and reaction time to correct targets. Measures of self-reported usability, mental workload, presence and simulator sickness were collected. The results showed that only presence and simulator sickness had a significant impact on usability. For performance outcomes, simulator sickness was significantly and weakly associated with omission errors, but not with reaction time and commission errors. Mental workload and presence did not significantly predict performance. Our results suggest that usability is more likely to be negatively impacted by simulator sickness and lack of presence than performance and that usability and attention performance are linked. They highlight the importance of considering factors such as presence and simulator sickness in attention tasks as these variables can impact usability.
... Concurrent validity has been demonstrated through significant correlations of virtual-classroom error and accuracy scores with parent ratings of attention and hyperactivity symptoms (Adams et al., 2009;Parsons et al., 2007) and measures from a traditional CPT task administered outside the virtual classroom (e.g., Conners' s CPT II; Parsons et al., 2007). Retest reliability after 1 month was strong in a group of healthy children (Nolin et al., 2016), but reliability studies in clinical groups are lacking. Importantly, most studies have shown that participants generally reported no or minimal discomfort or cybersickness (Adams et al., 2009;Moreau et al., 2006) and a moderate sense of presence (Nolin et al., 2016) in the virtual classroom. ...
... Retest reliability after 1 month was strong in a group of healthy children (Nolin et al., 2016), but reliability studies in clinical groups are lacking. Importantly, most studies have shown that participants generally reported no or minimal discomfort or cybersickness (Adams et al., 2009;Moreau et al., 2006) and a moderate sense of presence (Nolin et al., 2016) in the virtual classroom. ...
... 52 53 Adults with ASD have been found to experience social isolation, loneliness and so-54 cial anxiety (e.g., [5]) due to their deficient social skills such as atypical gaze/poor eye 55 contact, less conversational involvement, appropriate affect, reduced verbal fluency 56 (e.g., [6], [7]), poor understanding of social cues, and difficulties in initiating and main- 57 taining social conversation/communication [8]. The social skills deficits in individuals 58 with high-functioning ASD are mainly attributed to impairments in cognitive compo- 59 nents such as Executive Functions (EF) (e.g., [9]) or cognitive processing speed (e.g., [10]). 60 Indeed impaired EF is another salient characteristic of the spectrum [11] which refers to 61 high-order, goal-directed cognitive processes that control behaviour, thought and emo- 62 tions. ...
... The VR Everyday Assessment Lab assesses every-144 day memory (prospective and episodic), attention (visuospatial and auditory), and EF 145 (planning and multitasking), and has been found a valid and substantially more pleas-146 ant testing experience [48], which indicates everyday functionality of adults [49], [50]. 147 The ClinicaVR: Classroom-CPT is a VR classroom that examines selective and sustained 148 attention, and inhibition, which has been validated in children and adolescents [59]. Re-149 garding interventions in ASD, there is preliminary evidence postulating its feasibility 150 for being adopted in clinical and educational environments [54], [60]. ...
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 proximal to real life, however, more research is needed for elucidating 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, incorporating 5 social scenarios with three difficulty levels for each. 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 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 in ASD. Planning ability substantially predicted performance in social scenarios, postulating an implication in social skills. Immersive VR social skills training appears effective in individuals with ASD, yet an error-less approach, which is adaptive to the individual’s needs, should be preferred.
... Virtual environments provide patients with tasks that mimic everyday challenges, such as navigating a virtual store or solving a puzzle, while multimodal sensors monitor their cognitive performance. The system can adjust the difficulty level based on the patient's responses, creating a personalized rehabilitation plan that supports both cognitive recovery and patient engagement [48], [59]. ...
This scoping review examines the broad applications, risks, and ethical challenges associated with Extended Reality (XR) technologies, including Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR), within the context of Metaverse. XR is revolutionizing fields such as immersive learning in education, medical and professional training, neuropsychological assessment, therapeutic interventions, arts, entertainment, retail, e-commerce, remote work, sports, architecture, urban planning, and cultural heritage preservation. The integration of multimodal technologies such as haptics, eye-tracking, face- and body-tracking, and brain-computer interfaces, enhances user engagement and interactivity, playing a key role in shaping the immersive experiences in the Metaverse. However, XR's expansion raises serious concerns, including data privacy risks, cybersecurity vulnerabilities, cybersickness, addiction, dissociation, harassment, bullying, and misinformation. These psychological, social, and security challenges are further complicated by intense advertising, manipulation of public opinion, and social inequality, which could disproportionately affect vulnerable individuals and social groups. This review emphasizes the urgent need for robust ethical frameworks and regulatory guidelines to address these risks while promoting equitable access, privacy, autonomy, and mental well-being. As XR technologies increasingly integrate with artificial intelligence, responsible governance is essential to ensure the safe and beneficial development of the Metaverse and the broader application of XR in enhancing human development.
... Virtual environments provide patients with tasks that mimic everyday challenges, such as navigating a virtual store or solving a puzzle, while multimodal sensors monitor their cognitive performance. The system can adjust the difficulty level based on the patient's responses, creating a personalized rehabilitation plan that supports both cognitive recovery and patient engagement [81,91]. ...
This scoping review explores the intersection of Extended Mind Theory and Extended Reality (XR) technologies, focusing on how Virtual Reality, Augmented Reality, and Mixed Reality reshape human cognition and interaction. XR enables users to offload cognitive tasks and engage in embodied experiences, extending cognition beyond the brain into digital environments. The review highlights a wide range of XR applications, from immersive learning in STEM education and medical training, neuropsychological assessment to therapeutic interventions, arts and entertainment, professional skills development, retail and e-commerce, remote work, sports training, architecture and urban planning, and cultural heritage preservation. XR's integration with modalities like haptics, eye-tracking, face- and body-tracking, and brain-computer interfaces further enhances cognitive extension and user engagement. However, alongside these advancements come significant ethical, psychological, and societal challenges, such as data privacy concerns, the psychological effects of prolonged immersion, and social inequality arising from disparate access to XR technologies. This review emphasizes the need for robust ethical frameworks that address these challenges, ensuring that XR technologies enhance human development while maintaining autonomy, privacy, and mental well-being. As XR continues to evolve and integrate with artificial intelligence and other emerging technologies, its role in expanding human cognition will depend on responsible implementation and governance.
... Virtual environments provide patients with tasks that mimic everyday challenges, such as navigating a virtual store or solving a puzzle, while multimodal sensors monitor their cognitive performance. The system can adjust the difficulty level based on the patient's responses, creating a personalized rehabilitation plan that supports both cognitive recovery and patient engagement [81,91]. ...
This scoping review explores the intersection of Extended Mind Theory and Extended Reality (XR) technologies, focusing on how Virtual Reality, Augmented Reality, and Mixed Reality reshape human cognition and interaction. XR enables users to offload cognitive tasks and engage in embodied experiences, extending cognition beyond the brain into digital environments. The review highlights a wide range of XR applications, from immersive learning in STEM education and medical training, neuropsychological assessment to therapeutic interventions, arts and entertainment, professional skills development, retail and e-commerce, remote work, sports training, architecture and urban planning, and cultural heritage preservation. XR's integration with modalities like haptics, eye-tracking, face- and body-tracking, and brain-computer interfaces further enhances cognitive extension and user engagement. However, alongside these advancements come significant ethical, psychological, and societal challenges, such as data privacy concerns, the psychological effects of prolonged immersion, and social inequality arising from disparate access to XR technologies. This review emphasizes the need for robust ethical frameworks that address these challenges, ensuring that XR technologies enhance human development while maintaining autonomy, privacy, and mental well-being. As XR continues to evolve and integrate with artificial intelligence and other emerging technologies, its role in expanding human cognition will depend on responsible implementation and governance.
... For all these reasons, alternative cognitive assessment mechanisms were explored in recent years, including the straightforward digitization of classic tests [15], gamification [16], virtual reality [17]- [24], as well as the identification of biomarkers for the early detection of cognitive impairment [25]- [28]. This research is focused on the study of speech alterations, as they are one of earliest signs of cognitive decline [29], and they are part of the diagnosis in current clinical practice [30]. ...
The objective of this work is to determine whether speech obtained from interactions with a smart speaker can be used to predict the level of cognitive impairment (CI). We use a voice assistant to administer a cognitive test in Spanish, and we record the conversations in order to extract features that could potentially be used as voice biomarkers. A total of 21 participants (14 patients and 7 healthy controls) between the ages of 68 and 86 are included in the study (15 were women). Using just speech we are able to perform a regression with machine learning models, in order to predict the Global Deterioration Scale (GDS) of cognitive functions. Then, we measure the performance of the estimations with standard metrics - an R of 0.74 was obtained in the best case using Support Vector Machine (SVM) algorithms. Despite needing a bigger sample of participants in future studies, this is a positive and promising result for such a non-intrusive procedure, which could potentially be used as a screening tool for automatic cognitive impairment assessment.
... Many studies have provided evidence of notable correlations between performance on VR tasks and traditional neuropsychological assessments that measure the same cognitive functions (Matheis et al., 2007;Armstrong et al., 2013;Lalonde et al., 2013;Nolin et al., 2016;Pedroli et al., 2020Pedroli et al., , 2022. This evidence confirmed that VR protocols effectively demonstrated construct validity. ...
Introduction
The evaluation of memory is a crucial aspect of both cognitive research and clinical applications, as it offers valuable insights into an individual’s cognitive wellbeing and performance. Conventional neuropsychological assessments represent the established method for assessing different aspects of memory. Recent technological advancements, specifically in the field of virtual reality (VR), have introduced novel methods for evaluating memory.
Objective
This systematic review aims to examine the current state of memory assessment using VR technologies, assessing the degree of convergence and divergence between VR-based memory assessments and conventional neuropsychological tests.
Method
A systematic review of the literature was conducted searching PubMed, PsycINFO, Web of Science databases, leading to the incorporation of 24 studies. Studies were grouped according to the examined memory domain (episodic, prospective, spatial domain). Convergence and divergence validity were examined for each, and information on software and hardware features was collected.
Results
This review demonstrates a notable alignment between VR-based memory assessments and conventional neuropsychological tests. Moreover, VR tasks have shown to exhibit associations with executive functions and overall cognitive performance. The inclusion of various ecological contexts, such as residential environments, commercial establishments, and simulated scenarios, serves to augment the ecological validity of memory evaluations conducted in VR.
Discussion
The findings indicate that VR assessments demonstrate a functional perspective by effectively capturing the dynamic relationship between memory, executive functions, and overall cognitive performance. Nevertheless, it is imperative to acknowledge and tackle certain constraints that may hinder the widespread adoption and utilization of VR tasks. These limitations encompass factors such as restricted accessibility to VR tasks and the presence of heterogeneity in VR hardware and software. The dynamic and ever-changing nature of VR technology presents a range of potential avenues for future investigation and utilization in the domain of memory evaluation.
... In addition, it has been shown that IVRs are appropriate for collecting the psychological evaluations of participants in the procedures [116] as they produce similar responses to those generated by real environments [90]. IVR has been validated and used to measure students' attentional processes [117] and performance [118]. Nevertheless, to the best of the authors' knowledge, few studies have attempted to identify combinations of ILL and CCT to assess their impact on cognitive performance. ...
This study uses immersive virtual reality technology to evaluate the effects of lighting environments on cognitive performance. Interaction effects of the variables illuminance (ILL) (100 lx, 300 lx and 500 lx) and correlated colour temperature (CCT) (3000 K, 4000 K, 6500 K and 10500 K) are analysed through the psychological responses of 192 participants in an attention task. The results reveal significant differences in psychological metrics. The lighting environment that most enhances attention is a combination of 300 lx + 6500 K. This work shows that ILL and CCT have a significant interaction effect, and thus, analysing them in isolation may not provide a complete understanding of their impact. Lighting conditions with combinations of 500 lx + 6500 K, 300 lx + 3000 K, and 100 lx + 65000 K produce comparable results in the attention task. Nevertheless, these different lighting levels could significantly affect the energy efficiency of educational centres. The findings reveal that changes in lighting conditions within virtual environments can significantly impact attention responses. These results highlight the potential benefits of optimising lighting environments to enhance cognitive functions.
... Additionally, these virtual environments can be created to mimic any everyday setting while still being fully controlled by the examiner, which would allow for psychological assessment with sufficient standardization to meet empirical criteria (Knight & Titov, 2009;Parsons, 2015;Teel et al., 2016). Furthermore, virtual reality has already been successfully applied to other areas of psychological assessment Parsons & Barnett, 2017;Roberts et al., 2019), and such virtual assessment tools have been found to adequately reflect real life tasks and correlate sufficiently with traditional assessment measures (Barnett et al., 2021;McGeorge et al., 2001;Nolin et al., 2016;Roberts et al., 2019). Initial virtual reality applications to prospective memory assessment have demonstrated some ability to differentiate between healthy and clinical populations, but many of these tests are highly limited in their ability to measure both event-based and timebased prospective memory over multiple time delayswhich limits their utility in a clinical setting (Banville et al., 2010, Dong et al., 2017Nolin et al., 2013;Parsons & Barnett, 2017). ...
... As the CCPT-II in its original design seem to fail in distinguishing reliably between children with ADHD and other clinical groups, several attempts to modify both its application and interpretation has been described. For example, by introducing the test to a virtual classroom [43,44] or bringing task-unrelated movements (measured via actigraphy) into the CCPT, the test results seem to provide a far more detailed or accurate basis for interpretation [45]. Berger and Cassuto [46] run CCPT with ongoing auditive and visual disturbances, and adolescents with an ADHD diagnosis made significantly more omission errors with distractions present during the test than without distractors, while distracting stimuli did not affect the CPT performance of non-ADHD adolescents. ...
ABSTRACT
Background: Despite lacking validation for Norwegian populations, the Conners Continuous Performance Test II (CCPT-II) is applied to almost one-third of children receiving an ADHD diagnosis. However, evidence of the CCPT-II’s ability to differentiate between children with and without ADHD is contradictory. Thus, this study examines how CCPT-II results correlate with ADHD symptoms reported by mothers and teachers in a sample representing ordinary child and adolescent mental health services and explores the extent to which the CCPT-II influences the diagnostic result.
Methods: Correlations between CCPT-II results and ADHD Rating Scale scores and a clinical diagnosis of ADHD were analysed in children aged 6–15 years (N=69) referred to a child and adolescent psychiatric outpatient clinic.
Results: Total ADHD symptom scores rated by mothers correlated with hit reaction time (HRT) block change (.260), HRT inter-stimulus interval (ISI) change (.264) and CCPT-II overall index (.263), while hyperactivity subscale scores correlated with omissions (.285), HRT (.414) and variability (.400). In teachers’ ratings, total ADHD and both subscale scores correlated with commissions (.280–.382), while hyperactivity scores correlated with variability (.265). A higher number of commissions was the only significant difference in CCPT-II performance between children diagnosed with and children without ADHD.
Conclusions: Correlations between CCPT-II results and ADHD symptoms were all small to moderate. As such, CCPT-II results should be interpreted with caution, because they correspond to a limited degree with other sources of information.
... In these stages, various spatial, projection, depth, and temporal errors are introduced in the source-generated VR content. All these errors substantially contribute to degrading the perceptual quality of experience (QoE) of a VR user and may lead to asthenopia (especially dizziness, headache, transient diplopia, and eyelid tic), sleep disorders [12], [13], cybersickness [14], [15], etc. Many works [16], [17] studied the potential risks of VR in children's physical development. ...
With the rapid proliferation of virtual reality (VR) technologies, the usage of VR in multimedia, education, and social media platforms has increased due to realistic and immersive 3D viewing experiences. In particular, VR refers to a computer-generated synthetic environment where the users can experience 180 × 360° spherical VR content through head-mounted displays (HMD). Due to the 180 × 360° viewing range, the quality assessment (QA) of VR images becomes quite difficult compared to conventional 2D image quality assessment (IQA) models. To alleviate this problem, in this paper, we propose a supervised no-reference (NR) VR IQA model based on global and local natural scene statistics (NSS) of a VR image. The global features are computed based on joint dependencies between adjacent pixels of equirectangular projection (ERP) VR image using generalized Gaussian distributions (GGD). Specifically, we compute the model parameters of GGDs at multiple scales and show that the model parameters are distortion discriminable. Further, we compute local features based on statistical properties of spatial and spectral entropy maps of cube map projection (CMP) faces of a VR image. Since the local feature extraction is carried out at the CMP face level, we compute the average of the face-level features to obtain the overall local feature set of a VR image. Finally, global and local feature sets are combined and given to support vector regressor (SVR) to map the quality-aware feature set to VR image quality with labels as human assessment scores. The performance of the proposed VR IQA model is verified on three omnidirectional VR IQA datasets, such as CVIQD, OIQA, ODIQA, and one stereoscopic VR IQA dataset, namely, LIVE S3D-VR. Experimental results show that the predicted scores of the proposed VR IQA model correlate very well with the subjective scores of the aforementioned VR IQA datasets and achieved state-of-the-art performance numbers compared to the existing 2D and 3D IQA models.
... Likewise, its use could improve cognitive and daily skills, besides academic results. • Nolin et al. [20] recommended virtual reality as an assessment tool because of the selective and sustained attention it creates in children. • Passig et al. [21] indicate that teaching in a virtual reality environment contributes to children's cognitive modifiability. ...
Designing serious games in virtual reality (VR) may raise a health and safety concern as to whether children should use this technology. This paper attempts to clarify this issue by studying VR impact on children’s physical, cognitive and psychosocial development. With a supervised and controlled use over time, it is found that VR could cause physical problems as motion sickness and visual fatigue. To avoid these issues, a series of VR design guidelines are collected so researchers can follow them to develop serious games for children. To avoid motion sickness, developers have to: 1) regulate free movement in the virtual environment and add visual effects or references, 2) help to maintain a stable body posture during the game, 3) bring interactive objects closer and allow their manipulation in non-gravity condition, 4) adjust the difficulty of the tasks and make them as interactive as possible, and 5) implement quality visual and sound content. Regarding the reduction of visual fatigue, developers need to: 1) regulate and supervise the game time, 2) choose an HMD that offers good graphic definition, and 3) design the user interface to be easily understandable and legible.KeywordsVirtual realityChildrenMotion sicknessVisual fatigue
... Another advantage of IVEs is that they provoke similar responses from participants as are generated in real environments [103], thus, they are a significant contribution to the lighting and architectural field. Although IVEs have been used, and validated, to measure students' performance [138] and memory [139,140], to the best of the authors' knowledge few studies that have tried to identify combinations of lighting variables which will improve cognitive performance. Based on the results of this research, it can be concluded that IVEs can be used to identify the combination of lighting variables that produce better cognitive performance in a memory task. ...
The global energy crisis has created an urgent demand to decrease the energy that buildings consume. In universities, the situation is complicated as campuses need to have a high level of comfort and, therefore, consume more energy than other building types. Lighting accounts for a high percentage of this energy expenditure and urgent measures are required to reduce this consumption and, thus, costs. A further complication is that lighting has been shown to have an important influence on cognitive learning processes. One such process is memory, which has a fundamental influence on modern society. In this study, we analyse the psychological responses of 143 students in a memory task in a virtual classroom using three illuminance levels (100 lx, 300 lx and 500 lx) and four colour temperatures (3000 K, 4000 K, 6500 K and 10500 K). The results showed that lighting conditions influence memory. The combination of 100 lx and 6500 K produced the best memory performance. The results showed that varying lighting parameters can significantly reduce the energy expenditure of educational centres and, in turn, provide better cognitive outcomes for students.
... The VR Everyday Assessment Lab assesses everyday memory (prospective and episodic), attention (visuospatial and auditory), and EF (planning and multitasking), and has been found a valid and substantially more pleasant testing experience [53], which indicates everyday functionality of adults [54], [55]. The ClinicaVR: Classroom-CPT is a VR classroom that examines selective and sustained attention, and inhibition, which has been validated in children and adolescents [64]. Regarding interventions in ASD, there is preliminary evidence postulating its feasibility for being adopted in clinical and educational environments [59], [65]. ...
p>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 proximal to real life, however, more research is needed for elucidating 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, incorporating 5 social scenarios with three difficulty levels for each. 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 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 in ASD. Planning ability substantially predicted performance in social scenarios, postulating an implication in social skills. Immersive VR social skills training appears effective in individuals with ASD, yet an error-less approach, which is adaptive to the individual’s needs, should be preferred. </p
... The VR Everyday Assessment Lab assesses everyday memory (prospective and episodic), attention (visuospatial and auditory), and EF (planning and multitasking), and has been found a valid and substantially more pleasant testing experience [53], which indicates everyday functionality of adults [54], [55]. The ClinicaVR: Classroom-CPT is a VR classroom that examines selective and sustained attention, and inhibition, which has been validated in children and adolescents [64]. Regarding interventions in ASD, there is preliminary evidence postulating its feasibility for being adopted in clinical and educational environments [59], [65]. ...
p>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 proximal to real life, however, more research is needed for elucidating 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, incorporating 5 social scenarios with three difficulty levels for each. 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 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 in ASD. Planning ability substantially predicted performance in social scenarios, postulating an implication in social skills. Immersive VR social skills training appears effective in individuals with ASD, yet an error-less approach, which is adaptive to the individual’s needs, should be preferred. </p
... The VR Everyday Assessment Lab assesses everyday memory (prospective and episodic), attention (visuospatial and auditory), and EF (planning and multitasking), and has been found a valid and substantially more pleasant testing experience [53], which indicates everyday functionality of adults [54], [55]. The ClinicaVR: Classroom-CPT is a VR classroom that examines selective and sustained attention, and inhibition, which has been validated in children and adolescents [64]. Regarding interventions in ASD, there is preliminary evidence postulating its feasibility for being adopted in clinical and educational environments [59], [65]. ...
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 proximal to real life, however, more research is needed for elucidating 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, incorporating 5 social scenarios with three difficulty levels for each. 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 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, postulating an implication in social skills. Immersive VR social skills training in individuals with ASD appears an appropriate service, yet an error-less approach, which is adaptive to the individual’s needs, should be preferred.
... The VR Everyday Assessment Lab assesses everyday memory (prospective and episodic), attention (visuospatial and auditory), and EFs (planning and multitasking) and has been found to be a valid and substantially more pleasant testing experience [53] that is representative of the everyday functionality of adults [54,55]. The ClinicaVR: Classroom-CPT is a VR classroom that examines selective and sustained attention and inhibition, and it has been validated in children and adolescents [64]. Regarding interventions in ASD, there is preliminary evidence postulating its feasibility for being adopted in clinical and educational environments [59,65]. ...
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 .
... First developed in the 1960s, VR is increasingly used in education and training worldwide from teaching mathematical concepts (e.g. [28,29]), to learning about thermodynamics [30], to enhancing writing skills of pupils with English as an Additional Language (EAL) [31], as an intervention tool for pupils with autism [32], as an assessment tool for pupils with ADHD [20] and as an effective tool for demonstrating vocational skills [33]. ...
This small-scale study explores the attitudes of fifty initial teacher education (ITE) subject methods tutors towards the use of virtual reality (VR) in education and considers whether VR could be a catalyst for reviewing the partnership model within ITE programmes. In addition, this study offers a novel solution to ITE tutors’ challenges when managing their own technological and pedagogical development alongside preparing student teachers for technology-enhanced learning (TEL). Building on previous research on ITE tutors’ use of TEL across the island of Ireland, this paper discusses the synergy between the cognitive apprenticeship model and reverse mentoring that upends the classic co-operating teacher/student teacher hierarchy and positions all partners in ITE programmes as learning leaders at key points in the partnership process. An online survey comprising 51 items was administered to a purposive sample of 50 ITE tutors from four ITE providers, two in Ireland and two in Northern Ireland (NI), who were selected due to their developing interest in the use of virtual reality in teacher education. Data analysis using SPSS combined with thematic analysis of open-ended responses revealed that although the majority of ITE subject methods tutors conveyed open-minded and willing attitudes to embrace VR in the future, they identified a number of systemic issues that need to be addressed first. These include the disconnect between innovative pedagogical practices presented in university-based modules and the stark reality of technological deficits in some classrooms; the pedagogical and resource-based ‘readiness’ of ITE tutors to embed VR in their subject-specific teaching; and the need for curriculum-focused, VR resources for school-based use. As a result of this study, an incremental, cyclical approach to growing the body of knowledge around VR pedagogy is proposed in conjunction with new forms of collaboration between the partners in ITE.
... Nechita and Rezeanu (2019) report that multisensory-enhanced museum spaces can enhance empathy by allowing learners to experience a variety of historical settings from a first-hand perspective. Teaching in interactive VR environments provides equal or better learning outcomes compared to traditional teaching (Newman and McLean, 2004;Stull et al., 2013;Nolin et al., 2016;Frydenberg and Andone, 2018;Felnhofer et al., 2018;Dube and Ince, 2019). However, the transformative effect of immersive VR in education has mainly been reported in the medical field (Thompson, 2009;Kim et al., 2015;Kim et al., 2017;Brusamento et al., 2019;Kyaw et al., 2019;Blumstein et al., 2020). ...
This article reviews the potential functions and approaches of museum education in alleviating psychological anxiety, particularly the psychological anxiety experienced by adolescents during the COVID-19 pandemic. We outline the main forms of museum education, highlighting how it supports the potential functions of art therapy for psychological anxiety. Thereafter, we review the representative research on museum art therapy practice for different populations to invite discussion, dialogue, and awareness of future directions for museum education and suggest gaps in the research that require further study.
... In addition, the development of information technology has improved the quality of virtual tourism experience (González-Rodríguez et al., 2020), attracting more virtual tourists (Sigala, 2020). Virtual tourism provides a convenient choice for tourists to visit protected historical sites or hard-to-reach places (such as space) through the way of immersion, imagination, and interaction (Nolin et al., 2016;Wagler and Hanus, 2018), especially creating barrier-free tourism activities for the disabled, the elderly, and other restricted people (Cho et al., 2002), which break through time and space constraints and economic shackles to a certain extent (Ritchie et al., 2011;Bonetti et al., 2018;. ...
The Metaverse is a new application of the internet and social form which integrates a myriad of new technologies. It can not only create a parallel space that is closely connected to the real world while highly independent, but also bring the immersive experience of virtual scenarios without delay. The virtual tourism space situations that integrate realistic visual, audio, and temperature sensations can restore the real tourism environment to the greatest extent, and improve tourists’ perception and satisfaction with the experience. The purpose of this experimental lab study is to examine the effects of the virtual tourism audio-visual conditions and environmental temperature on tourists’ thermal sensation and temperature comfort. VR equipment and microclimate simulation technology was applied in a 3 × 2 × 2 experimental design (n = 180), simulating the virtual tourism scenarios. Electrocardiogram devices were also employed to assess participants’ physiological indicators. Study results suggest that: (1) Virtual tourism spatial situations (environmental temperature and audio-visual conditions) significantly affect participants’ thermal sensation and part of the physiological indicators; (2) Virtual tourism spatial situations (environmental temperature and audio-visual conditions) significantly affect participants’ temperature comfort; and (3) Physiological responses (indicators) mediate the effect from tourism spatial situations to temperature comfort. The study mainly contributes to the literature about virtual tourism experience and spatial situations under the concept of the Metaverse, as well as provides theoretical and managerial implications for the development of “immersive” virtual tourism scenarios.
... It is due to visual fatigue that problems with focusing, far vision, and near vision are created. As a result of motion sickness, you may feel sleepy, nauseated, or dizzy (Nolin et al., 2016). ...
The use of extended reality (XR) technologies, namely Augmented Reality (AR), Virtual Reality (VR) and Mixed Reality(MR) in education, has attracted much attention in recent years. Since the middle of the 20th century, virtual reality (VR) has been a part of our lives. Today, technology has made virtual reality accessible to everyone. In the last ten years, virtual reality equipment has become suitable for individual use and has started to be used by large numbers of people. Virtual reality can now be used for educational purposes, including education virtual laboratories. The studies were carried out to reveal the advantages of virtual reality compared to traditional media tools, as well as the conclusion that a successful instructional design process plays a major role in the success of technology in education. In line with what has been mentioned, we review in this paper the historical development of virtual reality technologies, followed by the use of Extended reality technology in the field of education, including virtual laboratories. This paper is to argue and present evidence from extensive research that VR can be a valuable tool in engineering, such as virtual laboratories. As a result of the review we conducted, we were able to conclude that VR has a positive pedagogical and cognitive impact on engineering education, thus increasing students' understanding of the subjects, their grades and performance, and overall satisfaction with their education. Furthermore, VR, as a replacement for physical laboratories, can reduce university liability, infrastructure, and costs. It was also discovered that VR applications for education currently lack the integration of learning theories and objectives in engineering education. In this research, we aim to provide recommendations and guidelines for researchers who want to work in the field of virtual reality and to offer suggestions for virtual laboratories.
... As also reported by [192], eye movements should be examined along with head movements to understand attention and interaction more in-depth, since eyes can move differently. In addition, [193] studied the relationship between performance, sense of presence, and cybersickness, whereas [194] examined attention, more particularly ADHD with continuous performance task in a virtual classroom. However, both works are more in the clinical domain, which are relatively different from an everyday classroom setup. ...
Virtual reality (VR) is not a new technology but has been in development for decades, driven by advances in computer technology. Currently, VR technology is increasingly being used in applications to enable immersive, yet controlled research settings. Education and entertainment are two important application areas, where VR has been considered a key enabler of immersive experiences and their further advancement. At the same time, the study of human behavior in such innovative environments is expected to contribute to a better design of VR applications. Therefore, modern VR devices are consistently equipped with eye-tracking technology, enabling thus further studies of human behavior through the collection of process data. In particular, eye-tracking technology in combination with machine learning techniques and explainable models can provide new insights for a deeper understanding of human behavior during immersion in virtual environments. In this work, a systematic computational framework based on eye-tracking and behavioral user data and state-of-the-art machine learning approaches is proposed to understand human behavior and individual differences in VR contexts. This computational framework is then employed in three user studies across two different domains. In the educational domain, two different immersive VR classrooms were created where students can learn and teachers can train. In terms of VR entertainment, eye movements open a new avenue to evaluate VR locomotion techniques from the perspective of user cognitive load and user experience. This work paves the way for assessing human behavior in VR scenarios and provides profound insights into the way of designing, evaluating, and improving interactive VR systems. In particular, more effective and customizable virtual environments can be created to provide users with tailored experiences.
... Therefore, this allows to collect the complete response of the subjects in this virtual environment. In this sense, although VR has been used, and validated, to measure memory [106] and student performance [107], very few studies have identified VR-based lighting design guidelines that can improve students' cognitive performance. However, this study establishes that VR can be used to analyse subjects' cognitive performance in a memory task using different lighting scenarios. ...
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.
... For all these reasons, alternative cognitive assessment mechanisms were explored in recent years, including the digitization of classic tests [12], gamification [13] or virtual reality [14][15][16][17][18][19][20][21], among others. In particular, our proposal is based on the introduction of serious games, immersive virtual reality and artificial intelligence (AI), more specifically machine learning algorithms [22,23]. ...
The high prevalence of Alzheimer-type dementia and the limitations of traditional neuropsychological tests motivate the introduction of new cognitive assessment methods. We discuss the validation of an all-digital, ecological and non-intrusive e-health application for the early detection of cognitive impairment, based on artificial intelligence for patient classification, and more specifically on machine learning algorithms. To evaluate the discrimination power of this application, a cross-sectional pilot study was carried out involving 30 subjects: 10 health control subjects (mean age: 75.62 years); 14 individuals with mild cognitive impairment (mean age: 81.24 years) and 6 early-stage Alzheimer’s patients (mean age: 80.44 years). The study was carried out in two separate sessions in November 2021 and January 2022. All participants completed the study, and no concerns were raised about the acceptability of the test. Analysis including socio-demographics and game data supports the prediction of participants’ cognitive status using machine learning algorithms. According to the performance metrics computed, best classification results are obtained a Multilayer Perceptron classifier, Support Vector Machines and Random Forest, respectively, with weighted recall values >= 0.9784 ± 0.0265 and F1-score = 0.9764 ± 0.0291. Furthermore, thanks to hyper-parameter optimization, false negative rates were dramatically reduced. Shapley’s additive planning (SHAP) applied according to the eXplicable AI (XAI) method, made it possible to visually and quantitatively evaluate the importance of the different features in the final classification. This is a relevant step ahead towards the use of machine learning and gamification to early detect cognitive impairment. In addition, this tool was designed to support self-administration, which could be a relevant aspect in confinement situations with limited access to health professionals. However, further research is required to identify patterns that may help to predict or estimate future cognitive damage and normative data
... However, in our study, no significant differences were observed in task-irrelevant movements between the two groups. This result is inconsistent with previously published meta-analytic results, indicating a higher level of movement in children with ADHD (Parsons et al., 2007;Diaz-Orueta et al., 2014;Nolin et al., 2016). The reason for these inconsistent results is unclear, but may be because VR generally enhances the attention level of children with ADHD through motivation and entertainment (Rizzo et al., 2004;Dovis et al., 2012;Larson et al., 2014), and the inclusion or exclusion of distractions causes or diminishes performance differences between ADHD and HC participants (Mansfield et al., 2003;Rizzo et al., 2004;Rizzo et al., 2006;Mazurek and Engelhardt, 2013;Eom et al., 2019). ...
Background
Attention deficit hyperactivity disorder (ADHD) is clinically diagnosed; however, quantitative analysis to statistically analyze the symptom severity of children with ADHD via the measurement of head movement is still in progress. Studies focusing on the cues that may influence the attention of children with ADHD in classroom settings, where children spend a considerable amount of time, are relatively scarce. Virtual reality allows real-life simulation of classroom environments and thus provides an opportunity to test a range of theories in a naturalistic and controlled manner. The objective of this study was to investigate the correlation between participants’ head movements and their reports of inattention and hyperactivity, and to investigate how their head movements are affected by different social cues of different sensory modalities.
Methods
Thirty-seven children and adolescents with ( n = 20) and without ( n = 17) ADHD were recruited for this study. All participants were assessed for diagnoses, clinical symptoms, and self-reported symptoms. A virtual reality-continuous performance test (VR-CPT) was conducted under four conditions: (1) control, (2) no-cue, (3) visual cue, and (4) visual/audio cue. A quantitativecomparison of the participants’ head movements was conducted in three dimensions (pitch [head nods], yaw [head turns], and roll [lateral head inclinations]) using a head-mounted display (HMD) in a VR classroom environment. Task-irrelevant head movements were analyzed separately, considering the dimension of movement needed to perform the VR-CPT.
Results
The magnitude of head movement, especially task-irrelevant head movement, significantly correlated with the current standard of clinical assessment in the ADHD group. Regarding the four conditions, head movement showed changes according to the complexity of social cues in both the ADHD and healthy control (HC) groups.
Conclusion
Children and adolescents with ADHD showed decreasing task-irrelevant movements in the presence of social stimuli toward the intended orientation. As a proof-of-concept study, this study preliminarily identifies the potential of VR as a tool to understand and investigate the classroom behavior of children with ADHD in a controlled, systematic manner.
... In particular, several video game versions of the CPT are available, such as MOXO-CPT (29), Kinect-based CPT (30), virtual reality-based CPT (31), the virtual classrooms ClinicaVR: Classroom CPT (32), and AULA Nesplora (33), as well as general purpose games such as EndeavorRX (34), Empowered Brain, and The Secret Trail of the Moon (35). ...
Objective
To carry out a quasi-systematic review of the use of serious video games for health as a cognitive rehabilitative tool in patients diagnosed with attention-deficit hyperactivity disorder.
Method
A quasi-systematic review of serious video games used as an evaluative and rehabilitative tool in patients with ADHD was conducted. It included behavioral patterns in the use of video games and addiction problems in this population. For its elaboration the PRISMA GUIDES were followed. The search was carried out in three PubMed databases, MEDLINE, and PsycInfo using the keywords: [game OR serious game OR computer game) AND (psychotherapy OR rehabilitation OR intervention OR mental disorders) AND (adhd)], [(adhd) AND (Video game addiction)]. All articles written in English, Spanish, or Portuguese from January 1970 to June 2021 were included: those in which reference was made to the use of video games and/or new technologies as a therapeutic and evaluative tool in children and adults diagnosed with ADHD, as well as those that referred to behavioral and clinical patterns in the use of video games.
Results
We found 605 articles of which 128 were reviewed (44 observational studies, 26 quasi-experimental studies, 26 experimental studies, 8 systematic reviews, 9 narrative texts, 6 case reports, 7 pilot studies, 8 systematic reviews, and 2 meta-analyses). Serious video games can be used to ameliorate ADHD symptoms while improving adherence to treatment. Some serious video games show high accuracy properties assessing ADHD features.
Conclusion
Serious video games for health are increasingly being used as a cognitive rehabilitation tool in patients with attention-deficit hyperactivity disorder (ADHD).
Systematic Review Registration
[www.crd.york.ac.uk/prospero], identifier [CRD42021247784].
... Researchers and practitioners alike are looking for alternative ways to support young adults and children with ADHD cope with the challenges that come with their neurodiversity. However, the majority of studies in relation to games and ADHD that can be found in literature report on the use of these tools for assessment rather than support or intervention (Rizzo et al., 2001;Nolin, Stipanicic, Henry, Lachapelle, Lussier-Desrochers & Allain, 2016;Parsons, Duffield, & Asbee, 2019). ...
Mental health and neurodevelopmental disorders are common among children and young adults. They can negatively affect children's social behaviour, development, and performance in school. This chapter discusses three common mental health and neurodevelopmental disorders and how serious immersive games could support this group. Serious immersive games are games that are designed with a certain purpose in mind and make use of immersive technologies like virtual or augmented reality. As games are a vital element of youth culture, the authors claim that immersive game elements could be utilized to engage a larger group with the health system and offer safe and motivating environments. This chapter shows that work exists to explore the use of games or immersive technologies in mental health support. However, the authors also show that there are shortcomings in the current research and propose research directions to address those.
This scoping review examines the broad applications, risks, and ethical challenges associated with Extended Reality (XR) technologies, including Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR), within the context of Metaverse. XR is revolutionizing fields such as immersive learning in education, medical and professional training, neuropsychological assessment, therapeutic interventions, arts, entertainment, retail, e-commerce, remote work, sports, architecture, urban planning, and cultural heritage preservation. The integration of multimodal technologies—haptics, eye-, face-, and body tracking, and brain–computer interfaces—enhances user engagement and interactivity, playing a key role in shaping the immersive experiences in the Metaverse. However, XR’s expansion raises serious concerns, including data privacy risks, cybersecurity vulnerabilities, cybersickness, addiction, dissociation, harassment, bullying, and misinformation. These psychological, social, and security challenges are further complicated by intense advertising, manipulation of public opinion, and social inequality, which could disproportionately affect vulnerable individuals and social groups. This review emphasizes the urgent need for robust ethical frameworks and regulatory guidelines to address these risks while promoting equitable access, privacy, autonomy, and mental well-being. As XR technologies increasingly integrate with artificial intelligence, responsible governance is essential to ensure the safe and beneficial development of the Metaverse and the broader application of XR in enhancing human development.
Introduction
In spite of rapid advances in evidence-based treatments for attention deficit hyperactivity disorder (ADHD), community access to rigorous gold-standard diagnostic assessments has lagged far behind due to barriers such as the costs and limited availability of comprehensive diagnostic evaluations. Digital assessment of attention and behavior has the potential to lead to scalable approaches that could be used to screen large numbers of children and/or increase access to high-quality, scalable diagnostic evaluations, especially if designed using user-centered participatory and ability-based frameworks. Current research on assessment has begun to take a user-centered approach by actively involving participants to ensure the development of assessments that meet the needs of users (e.g., clinicians, teachers, patients).
Methods
The objective of this mapping review was to identify and categorize digital mental health assessments designed to aid in the initial diagnosis of ADHD as well as ongoing monitoring of symptoms following diagnosis.
Results
Results suggested that the assessment tools currently described in the literature target both cognition and motor behaviors. These assessments were conducted using a variety of technological platforms, including telemedicine, wearables/sensors, the web, virtual reality, serious games, robots, and computer applications/software.
Discussion
Although it is evident that there is growing interest in the design of digital assessment tools, research involving tools with the potential for widespread deployment is still in the early stages of development. As these and other tools are developed and evaluated, it is critical that researchers engage patients and key stakeholders early in the design process.
Purpose
With an increasing array of new technologies and devices emerging as novel approaches to museum narratives, scholars are intrigued by the narrative effect they produce. Within this context, this study aims to conduct a quantitative case study on the influencing mechanisms among technology embodiment, technology attachment, museum narrative effect and perceived museum image based on embodied cognitive theory (ECT).
Design/methodology/approach
By introducing the Opium War Museum, Dongguan City, Guangdong Province, China, as an empirical case study, the authors collected data, through questionnaires, from 425 visitors who had experienced virtual reality (VR) technology in the museum. The data was then analyzed by using the maximum likelihood estimate for structural equation modeling.
Findings
Technology embodiment and technology attachment have significant positive correlations with the museum narrative effect. Technology attachment provides a partial mediating effect between technology embodiment and the museum narrative effect. The perceived museum image moderates such mediating effects of technology attachment.
Originality/value
This study brings the emerging idea of developing visitor experiences with VR through expanding the applications of ECT in the museum scenario. First, the authors identified the underlying interaction patterns between various factors that influence the museum narrative effect. Second, the authors verified that technology can optimize the museum narrative effect and help the creative transformation of cultural relics and culture. This study also provides practical recommendations to improve the technological service experience and strengthen the “audience-centric” management concept of museums
Introduction
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder where hyperactivity often manifests as fidgeting, a non-goal-directed motoric action. Many studies demonstrate fidgeting varies under different conditions as a self-regulating mechanism for attention and alertness during cognitively demanding tasks. Fidgeting has also been associated with reaction time variability. However, a lack of standard variables to define and quantify fidgeting can lead to discrepancies in data and interpretability issues across studies. Furthermore, little is known about fidgeting in adults with ADHD compared to youth. This study aims to design a framework to quantify meaningful fidgeting variables and to apply them to test the relation between fidgeting and performance on a cognitive task, the Flanker, in adults with ADHD.
Method
Our study included 70 adult participants diagnosed with ADHD, aged 18–50 years (30.5 ± 7.2 years). Screening included a structured clinical interview, childhood, current self and current observer ratings of ADHD symptoms. Actigraphy devices were attached to the left wrist and right ankle during completion of a cognitive control, attention task (the Flanker). Laboratory testing was subsequently completed on a single day. The relation between task performance, reaction time variability and fidgeting was examined.
Results and Discussion
Our analysis revealed increased fidgeting during correct trials as defined by our new variables, consistent with previous observations. Furthermore, differences in fidgeting were observed between early and later trials while the percentage of correct trials were not significantly different. This suggests a relation between the role of fidgeting and sustaining attention. Participants with low reaction time variability, that is, those with more consistent reaction times, fidgeted more during later trials. This observation supports the theory that fidgeting aids arousal and improves sustained attention. Finally, a correlation analysis using ADHD-symptom rating scales validated the relevance of the fidget variables in relation to ADHD symptom severity. These findings suggest fidgeting may be a compensatory mechanism that aids in sustained attention for those with ADHD, although alternative explanations exist.
Conclusion
Our study suggests that fidgeting may aid in sustained attention during the attention-demanding, cognitive control processes for adults with ADHD, with more fidgeting observed during correct trials and among participants with lower reaction time variability. Furthermore, the newly defined fidget variables were validated through a significant correlation with ADHD rating scales. By sharing our implementation of fidget variables, we hope to standardize and encourage further quantitative research into the role of fidgeting in ADHD.
The metaverse, a burgeoning virtual reality realm, has garnered substantial attention owing to its multifaceted applications. Rapid advancements and widespread acceptance of metaverse technologies have birthed a dynamic and intricate digital landscape. As various platforms, virtual worlds, and social networks within the metaverse increase, there is a growing imperative for a comprehensive analysis of its implications across societal, technological, and business dimensions. Notably, existing review studies have, for the past decade, primarily overlooked a metaverse‐based multidomain approach. A meticulous examination encompassing 207 research studies delves into the technological innovation of the metaverse, elucidating its future trajectory and ethical imperatives. Additionally, the article introduces the term “MetaWarria” to conceptualize potential conflicts arising from metaverse dynamics. The study discerns that healthcare (45%) and education (22%) are pivotal sectors steering metaverse developments, while the entertainment sector (9%) reshapes the corporate landscape. Artificial intelligence (AI) plays a 9% role in enhancing the metaverse's marketing and user experience. Security, privacy, and policy concerns (11%) are addressed due to escalating threats, yielding practical solutions. The analysis underscores the metaverse's profound influence (57%) on the digital realm, a phenomenon accelerated by the COVID‐19 pandemic. The article culminates in contemplating the metaverse's role in future warfare and national security, introducing “MetaWarria” as a conceptual framework for such discussions.
This article is categorized under: Application Areas > Health Care
Application Areas > Science and Technology
Fundamental Concepts of Data and Knowledge > Human Centricity and User Interaction
Symptoms of inattention (IA), hyperactivity, and impulsivity present in school‐aged children are important indications of developmental problems. The assessment of these symptoms largely relies on questionnaires completed by parents, teachers, and the children themselves. However, inherent perceptual biases may lead to inaccuracies in these evaluations. This study investigates the biases among different respondents for 41 elementary‐aged students (19 male and 22 female) by analyzing their responses on the attention‐deficit/hyperactivity disorder‐rating scale (ADHD‐RS) through a novel virtual reality‐based objective measure (AttnKare‐D). Correlation analysis reveals higher agreement between parents and students compared to other informant pairs. Nevertheless, when compared with the objective measure, parents and students do not exhibit distinct separation between high and low‐scoring samples, whereas teachers demonstrate significant separation on various objective measure factors. This discrepancy suggests that teachers may possess a more accurate baseline for peer‐related measurements, leading to a more objective evaluation of ADHD symptoms. However, it is essential to acknowledge that teachers are not entirely exempt from biases. Gender‐specific comparisons reveal notable differences, with male children showing the largest separation in distractibility and female children in movement. In conclusion, this study emphasizes the significance of recognizing and addressing potential biases when interpreting questionnaires assessing symptoms of IA, hyperactivity, and impulsivity in children.
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder that affects children. However, the traditional scale-based diagnosis methods rely more on subjective experiences, leading to a demand of objective biomarkers and quantified diagnostic methods. This study proposes a quantitative approach for identifying ADHD tendency based on fingertip pressing force control paradigm with immersive visual feedback. By extracting nine behavioral features from reaction time and dynamic force fluctuation features with high temporal and amplitude resolution, the proposed method can effectively capture the continuous changes in attention levels for ADHD diagnosis. The extracted features were analyzed using independent sample t-test and Pearson correlation to determine their association with ADHD-RS scale scores. Results showed that 12 statistical indicators were effective for distinguishing ADHD children from typically developed children, and several features of force control ability were also associated with core ADHD symptoms. A support vector machine (SVM) based classifier is trained for ADHD diagnosis and achieved an accuracy of 78.5%. This work provides an objective and quantitative approach for identifying ADHD tendency within a short testing time, and reveals the inherent correlation between the attention levels and the extracted features of reaction time and force fluctuation dynamics.
The metaverse has the potential to expand our understanding of the physical world by enabling seamless avatar-based interaction between users in both real and virtual contexts. Based on current insights, it is likely that learning and development methods for the management education in the metaverse will be transformed due to the blurring of lines between the virtual and real worlds. This study, based on systematic literature review, aims to present a framework to con-textualize experiential learning in the metaverse for management education by highlighting the facilitators and potential challenges. The study also identifies 'co-creation' as a distinct dimension of the experiential learning cycle, which extends the existing Kolb's learning cycle to highlight the significance of interaction in the metaverse. The implications of this study are significant for both academics and practitioners, as the metaverse is still in its early stages, and discussions on management education via co-creation provide a rational perspective to consider for the future developmental needs.
This entry reviews common methods for assessing adolescents' mental disorders, including interviews, questionnaires, and observation methods. Cultural issues regarding application of these assessments across ethnic groups are discussed. These cultural considerations include (1) how differences in cultural values may affect the experience and expression of psychopathological symptomatology, (2) how assessment items are framed and understood in specific cultural contexts, (3) how social norms and cultural values may generate specific response biases depending on the response options offered, and (4) concern over the translation and cross‐cultural adaptation of assessment instruments.
According to national health services, between 5–10% of school-aged children are diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). ADHD can influence the well-being and performance of children in formal education. Children with ADHD can show hyperactivity or impulsiveness and might struggle with their executive functioning, including planning of tasks, remembering instructions or focusing their attention. Virtual reality (VR) games can offer realistic, simplified and safe experiences where children with ADHD could experience learning situations tailored to their unique learning needs. Games are already successful in transmitting learning contents for ADHD diagnosed individuals and VR technology is increasingly incorporated in education. The review of literature explores the use of VR games to support learning of children with ADHD in formal education and shows how certain immersive game elements addressing specific ADHD learning needs could be derived, providing insights into possible game requirements and the first prototype.KeywordsExecutive functionHyperactivityImpulsivenessInattentionMultidisciplinary thinkingVirtual realityGames
Natural security refers to all aspects of security related to a reliable, sufficient, affordable and sustainable supply of natural resources, and energy to meet the needs of society by protecting the environment, human health, and living things. Effects derived from climate change are one of the biggest challenges encountered in terms of natural security. Simulation games play a vital role in building a sustainable world. This study investigates the games for topics like natural security, energy security, carbon capture and storage, renewable energy and waste. A review of the literature showed forty-three studies which focused on the objective of the study. Most of the games were used in education and used to transfer knowledge in the field of waste. The paper points out the importance of natural security and the need to develop more games in natural security and its related fields to build a regenerative economy.
Virtual reality is an emerging technology that can support the teaching and learning process by allowing the user to acquire knowledge in an immersive and interactive way. Virtual environments can help students to build their learning through experiences abstracted from reality by representing different concepts and interacting with well-defined elements within virtual scenarios. This work proposes the production and use of virtual reality environments as a support for the acquisition of skills within the teaching-learning process of children in basic education, including children with special educational needs. A proposed model is presented under the instructional design that considers technological platforms, multidisciplinary teams for the production of virtual reality environments according to the needs of users, and thus offers both teachers, parents, and students solutions that can promote the acquisition of learning skills through the execution of various tasks designed to encourage the user to the acquisition of learning skills in an immersive, safe, and fun way.
Immersive virtual reality (IVR) provides great potential to experimentally investigate effects of peers on student learning in class and to strategically deploy virtual peer learners to improve learning. The present study examined how three social-related classroom configurations (i.e., students' position in the classroom, visualization style of virtual avatars, and virtual classmates' performance-related behavior) affect students' visual attention toward information presented in the IVR classroom using a large-scale eye-tracking data set of N = 274 sixth graders. ANOVA results showed that the IVR configurations were systematically associated with differences in learners' visual attention on classmates or the instructional content and their overall gaze distribution in the IVR classroom (Cohen's d ranging from 0.28 to 2.04 for different IVR configurations and gaze features). Gaze-based attention on classmates was negatively related to students' interest in the IVR lesson (d = 0.28); specifically, the more boys were among the observed peers, the lower students' situational self-concept (d = 0.24). In turn, gaze-based attention on the instructional content was positively related to students' performance after the IVR lesson (d = 0.26). Implications for the future use of IVR classrooms in educational research and practice are discussed.
This study evaluated the predictive value of neuropsychological variables as compared to three other types of variables (demographic, medical, and emotional) in predicting three outcomes (occupational function:OccF; activity impairment:AI; and pension impairment percent) in 483 head-injured ambulatory workers. OccF was equally well-predicted by neuropsychological or demographic variable-families. A1 was best predicted by neuropsychological or emotional variable-families, and pension impairment percent was predicted equally well by all but emotional variable-families. Cross-validation showed good stability of the level of prediction. Discriminant analysis correctly classified 72% of subjects as Un/Employed. Neuropsychological test performance is related to important behavior in outpatient brain-injury survivors.
Virtual reality (VR) technology offers new opportunities for the development of innovative neuropsychological assessment and rehabilitation tools. VR-based 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. If empirical studies continue to demonstrate effectiveness, virtual environment applications could provide new options for targeting cognitive and functional impairments due to traumatic brain injury, neurological disorders, and learning disabilities. This article focuses on specifying the assets that are available with VR for neuropsychological applications along with discussion of current VR-based research that serves to illustrate each asset. VR allows for the precise presentation and control of dynamic multi-sensory 3D stimulus environments, as well as providing advanced methods for recording behavioural responses. This serves as the basis for a diverse set of VR assets for neuropsychological approaches that are detailed in this article. We take the position that when combining these assets within the context of functionally relevant, ecologically valid virtual environments, fundamental advancements can emerge in how human cognition and functional behaviour is assessed and rehabilitated.
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
The assessment of Attention-Deficit/Hyperactivity Disorder (ADHD) in-volves the use of different instruments, and one of the most frequently used is the Continuous Performance Test (CPT). Virtual reality allows for the achiev-ing of the presentation of stimuli with high levels of control. In addition, it fa-cilitates the presentation of distracters with a high level of resemblance to ele-ments which in fact can be found in the real world by placing them in a similar context. Thus, it is possible to assume that a higher ecological validity can be found in CPT tests performed in this manner as compared to the traditional CPT test. During the last years Rizzo developed a virtual reality based CPT called "the Virtual Classroom". Several studies show that "Virtual Class-room" is an effective measure to identify attention difficulties in children with ADHD. Our research team developed a virtual CPT, similar to the "Virtual Classroom", that allows to execute four different tasks: an auditory task with non-distractive stimuli, an auditory task with distractive stimuli, a visual task with non-distractive stimuli and a visual task with distractive stimuli. In this study, we offer additional data supporting the validity of using this type of technology for the assessment of ADHD.
The more replicated findings about gender difference in cognitive performance suggest female superiority on visuomotor speed and language ability and male superiority on mechanical and visuospatial tasks. Generally, group strengths found in the early school years become more established at adolescence and remain stable through adulthood. The current study tested whether the patterns established in the early years remained among 30 adult subjects. We also utilized a series of exploratory analyses to determine if observed gender differences were impacted by the covariance present between all cognitive tests. Results suggest that although the patterns established in the early years remain stable through time for males, the established patterns for females are altered with age. Our findings are compelling in supporting a male advantage on visuospatial tasks among older adults. These findings are discussed in terms of common variance between test instruments as a possible source of difference. Our finding that the gender effect tended to increase when common variance was controlled argues that this meth-odology may enhance the ability to detect domain specific effects.
Psychological tests with a conventional format present the same set of items to each test taker. Such tests have been popular because they are easy to administer in paper-and-pencil form to large groups of test takers at the same time. When testing became computerized in the early 1990s, the initial applications had the same linear format, though it did not take too long for computer-based testing to become adaptive. In an adaptive format, the computer updates the score of the test taker each time (s)he produces a response to an item and automatically adapts the choice of the next item to the last score. Statistically, adaptive testing requires comparability of test scores across different selections of items, and by the time computer-based testing began to mature, item-response theory had already become fully developed and was able to provide just that. As argued in the opening article of this special issue, these first applications in fact returned to the same principles of testing that any proctor involved in the testing of individual subjects followed before testing became fully standardized: immediate judgment of the quality of the responses and avoidance of questions that appear too easy or too difficult for the subject. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In an ironic twist of history, modern psychological testing has returned to an adaptive format quite common when testing was not yet standardized. Important stimuli to the renewed interest in adaptive testing have been the development of item-response theory in psychometrics, which models the responses on test items using separate parameters for the items and test takers, and the use of computers in test administration, which enables us to estimate the parameter for a test taker and select the items in real time. This article reviews a selection from the latest developments in the technology of adaptive testing, such as constrained adaptive item selection, adaptive testing using rule-based item generation, multidimensional adaptive testing, adaptive use of test batteries, and the use of response times in adaptive testing.
This study assesses the influence of body participation on the sense of presence and emotions, and the relationship between the two dependent variables in playing a group game in a virtual environment. A total of 56 volunteers were asked to play a virtual game in a 360-degree stereoscopic immersive interactive visualization environment using either body movement or a joystick. Presence was measured with the post hoc SUS Presence Questionnaire. The pictorial tool of Self-Assessment Manikin was employed for measuring emotions of arousal and valence. Both arousal and valence positively correlated with presence. However, body participation did not significantly affect reported presence or the above-mentioned emotions.
This paper presents the current status and use of virtual reality (VR) for children with attention deficit hyperactivity disorder (ADHD), autism and cerebral palsy. This literature review explores how VR systems have been used as treatment tools to address the primary impairments of these disorders. Three major classes of VR display systems are identified that can be characterized by the type of human-computer interaction provided: (1) feedback-focused interaction, (2) gesture-based interaction, and (3) haptic-based interaction. The demonstrated effectiveness and potential effectiveness of each class are discussed in the context of remediating the primary impairments of children with ADHD, autism and cerebral palsy. Three major themes for future research are discussed to support continued research interest in using VR in pediatric neurorehabilitation.
In Parkinson's disease executive functions are altered. We used a Virtual Reality version of the Multiple Errand Test in order to evaluate decision-making ability in 12 patients and 14 controls. Patients with Parkinson's disease, even if not-demented, showed strategies full of errors, suggesting that impulse control disorder, very frequent in course of disease, could precede cognitive dysfunctions.
Brain damage is a major cause of disability that often leads to deficits in Executive Functions (EF) with dramatic consequences on activities of daily living. While rehabilitation approaches of the dysexecutive syndrome are still limited, Virtual Reality (VR) has shown its potential to propose innovative intervention strategies based on ecologically valid functional tasks. The purpose of this paper is to present the design process of the Therapeutic Virtual Kitchen (TVK) in which ecological and adaptable virtual tasks may be configured by the therapists for patients' assessment and rehabilitation. The outcomes of a preliminary test of feasibility among members of our laboratory and Kerpape Rehabilitation Center are reported and discussed.
This study compared the performance of 8 children who have sustained a traumatic brain injury on the traditional VIGIL Continuous Performance Test and the Continuous Performance Test included in the Virtual Classroom. Results supported the hypothesis, showing that the Continuous Performance Test from the Virtual Classroom showed more sensitivity concerning inhibition deficits. More precisely, children showed more commission errors and longer reaction time. These results can be explained by the ecological character of the Virtual Classroom, meaning that this instrument is close to real-life experiences and requires more attention and inhibition resources.
Continuous performance tests are known to typically measure sustained attention but usually also yield parameters that potentially measure other subprocesses of attention. The aim of the present study was to test the factor structure of the Conners's Continuous Performance Test (CCPT) in a heterogeneous clinical sample consisting of subjects considered to fail in different subfunctions of attention.
CCPT records from 376 patients were factor analyzed, yielding five factors indicating a differentiation between focused attention, hyperactivity-impulsivity, sustained attention, vigilance, and change in control.
The study warns against reducing CCPT performance to one overall score of attention. The study further emphasizes the need to reserve the concept of sustained attention for measures of change as a function of time on task. The differentiation between sustained attention and vigilance and the concept of change in mental control during the test are possible methodological contributions of the study.
Virtual reality (VR) has finally come of age for serious applications in the behavioral neurosciences. After capturing the public imagination a decade ago, enthusiasm for VR flagged due to hardware limitations, an absent commercial market and manufacturers who dropped the mass-market products that normally drive technological development. Recently, however, improvements in computer speed, quality of head-mounted displays and wide-area tracking systems have made VR attractive for both research and real-world applications in neuroscience, cognitive science and psychology. New and exciting applications for VR have emerged in research, training, rehabilitation, teleoperation, virtual archeology and tele-immersion.
Virtual reality (VR) is an evolving technology that has been applied in various aspects of medicine, including the treatment of phobia disorders, pain distraction interventions, surgical training, and medical education. These applications have served to demonstrate the various assets offered through the use of VR.
To provide a background and rationale for the application of VR to neuropsychological assessment.
A brief introduction to VR technology and a review of current ongoing neuropsychological research that integrates the use of this technology.
VR offers numerous assets that may enhance current neuropsychological assessment protocols and address many of the limitations faced by our traditional methods.
Given the high incidence of brain injury in the population, brain damage rehabilitation is still a relatively undeveloped field. Virtual reality (VR) has the potential to assist current rehabilitation techniques in addressing the impairments, disabilities, and handicaps associated with brain damage. The main focus of much of the exploratory research performed to date has been to investigate the use of VR in the assessment of cognitive abilities, but there is now a trend for more studies to encompass rehabilitation training strategies. This review describes studies that have used VR in the assessment and rehabilitation of specific disabilities resulting from brain injury, including executive dysfunction, memory impairments, spatial ability impairments, attention deficits, and unilateral visual neglect. In addition, it describes studies that have used VR to try to offset some of the handicaps that people experience after brain injury. Finally, a table is included which, although not an exhaustive list of everything that has been published, includes many more studies that are relevant to the use of VR in the assessment and rehabilitation of brain damage. The review concludes that the use of VR in brain damage rehabilitation is expanding dramatically and will become an integral part of cognitive assessment and rehabilitation in the future.
Treatment and rehabilitation of the cognitive, psychological, and motor sequelae of central nervous system dysfunction often relies on assessment instruments to inform diagnosis and to track changes in clinical status. Typically, these assessments employ paper-and-pencil psychometrics, hands-on analog/computer tests, and rating of behavior within the context of real-world functional environments. Virtual reality offers the option to produce and distribute identical "standard" simulation environments in which performance can be measured and rehabilitated. Within such digital scenarios, normative data can be accumulated for performance comparisons needed for assessment/diagnosis and for treatment/rehabilitation purposes. In this manner, reusable archetypic virtual environments constructed for one purpose can also be applied for applications addressing other clinical targets. This article will provide a review of such a retooling approach using a virtual classroom simulation that was originally developed as a controlled stimulus environment in which attention processes could be systematically assessed in children with attention-deficit/hyperactivity disorder. This system is now being applied to other clinical targets including the development of tests that address other cognitive functions, eye movement under distraction conditions, social anxiety disorder, and the creation of an earthquake safety training application for children with developmental and learning disabilities.
Using electroencephalography (EEG), psychophysiology, and psychometric measures, this is the first study which investigated the neurophysiological underpinnings of spatial presence. Spatial presence is considered a sense of being physically situated within a spatial environment portrayed by a medium (e.g., television, virtual reality). Twelve healthy children and 11 healthy adolescents were watching different virtual roller coaster scenarios. During a control session, the roller coaster cab drove through a horizontal roundabout track. The following realistic roller coaster rides consisted of spectacular ups, downs, and loops. Low-resolution brain electromagnetic tomography (LORETA) and event-related desynchronization (ERD) were used to analyze the EEG data. As expected, we found that, compared to the control condition, experiencing a virtual roller coaster ride evoked in both groups strong SP experiences, increased electrodermal reactions, and activations in parietal brain areas known to be involved in spatial navigation. In addition, brain areas that receive homeostatic afferents from somatic and visceral sensations of the body were strongly activated. Most interesting, children (as compared to adolescents) reported higher spatial presence experiences and demonstrated a different frontal activation pattern. While adolescents showed increased activation in prefrontal areas known to be involved in the control of executive functions, children demonstrated a decreased activity in these brain regions. Interestingly, recent neuroanatomical and neurophysiological studies have shown that the frontal brain continues to develop to adult status well into adolescence. Thus, the result of our study implies that the increased spatial presence experience in children may result from the not fully developed control functions of the frontal cortex.
Evaluating the ecological validity of neuropsychological tests has become an increasingly important topic over the past decade. In this paper, we provide a comprehensive review of the research on the ecological validity of neuropsychological tests, as it pertains to everyday cognitive skills. This review is presented in the context of several theoretical issues facing ecological validity research. Overall, the research suggests that many neuropsychological tests have a moderate level of ecological validity when predicting everyday cognitive functioning. The strongest relationships were noted when the outcome measure corresponded to the cognitive domain assessed by the neuropsychological tests. Several other factors that may moderate the degree of ecological validity established for neuropsychological tests are in need of further exploration. These factors include the effects of the population being tested, the approach utilized (verisimilitude vs. veridicality), the person completing the outcome measure (significant other vs. clinician), illness severity, and time from injury until evaluation. In addition, a standard measurement of outcome for each cognitive domain is greatly needed to allow for comparison across studies.
This study explored how children's sustained attention develops and the effect of manipulating task parameters on sustained attention. The sample comprised 57 children (5-12 years) who completed CogState and Score! (Test of Everyday Attention for Children). Novel variability and traditional indices indicated rapid development from 5-6 to 8-9 years on all measures and a developmental plateau from 8-9 to 11-12, with growth evident on some measures. Findings suggest that sustained attention improves to age 10, then plateaus with only minor improvements. Further, performance was generally poorer on high load tasks compared to low load, with the same developmental pattern uncovered.
Many studies showed the ability of movies and imagery techniques to elicit emotions. Nevertheless, it is less clear how to manipulate the content of interactive media to induce specific emotional responses. In particular, this is true for the emerging medium virtual reality (VR), whose main feature is the ability to induce a feeling of "presence" in the computer-generated world experienced by the user. The main goal of this study was to analyze the possible use of VR as an affective medium. Within this general goal, the study also analyzed the relationship between presence and emotions. The results confirmed the efficacy of VR as affective medium: the interaction with "anxious" and "relaxing" virtual environments produced anxiety and relaxation. The data also showed a circular interaction between presence and emotions: on one side, the feeling of presence was greater in the "emotional" environments; on the other side, the emotional state was influenced by the level of presence. The significance of these results for the assessment of affective interaction is discussed.
It has been suggested that virtual reality may provide a medium for producing neuropsychological measures with greater ecological validity. The present study examined the usefulness of virtual reality (VR) to assess learning and memory in individuals with traumatic brain injury (TBI). A total of 20 TBI participants were compared with 20 healthy controls on their ability to learn and recall 16 target items presented within a VR-based generic office environment. The results indicated that VR memory testing accurately distinguished the TBI group from controls. Additionally, non-memory-impaired TBI participants acquired targets at the same rate as HC participants. Finally, there was a significant relationship between the VR Office and a standard neuropsychological measure of memory, suggesting the construct validity of the task. These findings suggest that the VR Office provides a viable medium for measuring learning and memory. The present results provide preliminary support for the ecological validity of the VR Office, which ultimately can improve assessment of real-world functioning following TBI.
In this initial pilot study, a controlled clinical comparison was made of attention perforance in children with attention deficit-hyperactivity disorder (ADHD) in a virtual reality (VR) classroom. Ten boys diagnosed with ADHD and ten normal control boys participated in the study. Groups did not significantly differ in mean age, grade level, ethnicity, or handedness. No participants reported simulator sickness following VR exposure. Children with ADHD exhibited more omission errors, commission errors, and overall body movement than normal control children in the VR classroom. Children with ADHD were more impacted by distraction in the VR classroom. VR classroom measures were correlated with traditional ADHD assessment tools and the flatscreen CPT. Of note, the small sample size incorporated in each group and higher WISC-III scores of normal controls might have some bearing on the overall interpretation of results. These data suggested that the Virtual Classroom had good potential for controlled performance assessment within an ecologically valid environment and appeared to parse out significant effects due to the presence of distraction stimuli.
Nineteen boys aged 8 to 14 with a diagnosis of ADHD and 16 age-matched controls were compared in a virtual reality (VR) classroom version of a continuous performance task (CPT), with a second standard CPT presentation using the same projection display dome system. The Virtual Classroom included simulated "real-world" auditory and visual distracters. Parent ratings of attention, hyperactivity, internalizing problems, and adaptive skills on the Behavior Assessment System for Children (BASC) Monitor for ADHD confirmed that the ADHD children had more problems in these areas than controls. The difference between the ADHD group (who performed worse) and the control group approached significance (p = .05; adjusted p = .02) in the Virtual Classroom presentation, and the classification rate of the Virtual Classroom was better than when the standard CPT was used (87.5% versus 68.8%). Children with ADHD were more affected by distractions in the VR classroom than those without ADHD. Results are discussed in relation to distractibility in ADHD.
Features of 'virtual reality' (VR) systems and their value for the investigation and rehabilitation of cognitive and perceptual impairments are briefly described. Current and potential applications of VR technology to address six neurorehabilitation issues are discussed: (1) attention and the reduction of distraction, (2) assessment and remediation of executive function deficits, (3) investigation of impairments of coordinated movement, (4) study and rehabilitation of aphasia and other severe disorders of language, (5) task presentation for functional imaging studies of the brain, and (6) the measurement of mental load in the operation of assistive technology. Finally, a virtual reality system integrated with gaze angle sensing technology is described, and its potential for investigation and rehabilitation of face processing by individuals with autism is discussed.
This paper presents a study aimed at developing a tool for the assessment of executive functions in patients with different etiologies by customizing a virtual reality (VR) version of the Multiple Errands Test (MET) (Shallice & Burgess, 1991; Fortin et al., 2003). The MET is an assessment of executive functions in daily life which consists of tasks that abide by certain rules. It is performed in an actual shopping mall-like setting where there are items to be bought and information to be obtained. The specific goal of this study was to conduct a pilot study using the virtual version of MET (VMET) with both control subjects and patients suffering from Parkinson's disease and from stroke. The task was supported by the employment of an advanced technology able to ensure an ecologically valid context for the patient. Specifically, the MET procedure, previously modified according to the requirements of the NeuroVR software system, was presented via a virtual supermarket. Subjects were requested to select and buy various products presented on shelves with the aid of a joy-pad. The procedures developed and employed during this pilot phase, results obtained for the two clinical samples and the implications for the assessment of executive functions are addressed in this paper.
Background: Virtual reality (VR) is an evolving technology that has been applied in various aspects of medicine, including the treatment of phobia disorders, pain distraction interventions, surgical training, and medical education. These applications have served to demonstrate the various assets offered through the use of VR. Objective: To provide a background and rationale for the application of VR to neuropsychological assessment. Methods: A brief introduction to VR technology and a review of current ongoing neuropsychological research that integrates the use of this technology. Conclusions: VR offers numerous assets that may enhance current neuropsychological assessment protocols and address many of the
Neurocognitive assessment of executive functioning represents a principal objective of neuropsychological evaluations. The executive functions revolve around supervisory attentional networks that include: selective attention, inhibitory control, planning, problem solving, and some aspects of short-term memory. We argue that many of the traditional tests of executive function rely on either paper-and-pencil administrations or computer-automated versions of the paper-and-pencil tests that fall short of replicating real-world functioning. Over the course of the last several decades, neuropsychology and assessment of executive functioning have gained increasing recognition as a discipline with relevance to a number of diverse practice areas (e.g., neurology, neurosurgery, psychiatry, and family medicine) as well as neuroscience specific research areas (e.g., behavior, learning, and individual differences). As a result, neuropsychologists must apply a working understanding of psychology, physiology, and neurology to assess, diagnose, and treat patients with dysexecutive syndrome. Although today the procedures for neuropsychological assessment of executive functioning are widely used, clinical neuropsychologists have been slow to embrace technological advancements. Two essential limitations have resulted from this refusal of technological adaptation: First, current neuropsychological assessments of executive functioning represent a technology that has barely changed since the first scales were developed in the early 1900s. Second, while the historical purpose of neuropsychology assessment of executive functioning was differential diagnosis of brain pathology, technological advances in other clinical neurosciences have changed the neuropsychologist's role to that of making ecologically valid predictions about the impact of a given patients dysexecutive symptoms on everyday functioning. This chapter considers the use of virtual reality-based neuropsychological measures as new and better clinical tests of executive function. Virtual reality-based measures of executive function and dysexecutive syndrome could yield tasks bettersuited to the concerns of the clinician because of the increased ecological validity and generalizability. Further, the ability of virtual reality-reality based neuropsychological assessments of executive function to simulate the human context interaction might also provide useful constraints for purely experimental investigations.
The technology of virtual reality (VR) has been used to develop interactive programs that simulate everyday life environments, where healthy subjects and patients with central nervous system dysfunctions are asked to carry out tasks that probe incidental memory and executive functions. The results of three studies support previous claims that VR-based tests overcome several limitations of traditional paper-and-pencil tests, are at least as sensitive to target cognitive impairments, while providing a richer range of opportunities for measuring behavior. Preliminary analyses also suggest that results of VR-based memory tests are replicable across laboratories and subjects samples and that the technology is well-accepted and tolerated by both healthy and impaired subjects.