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Taking Neuropsychological Test to the Next Level: Commercial Virtual Reality Video Games for the Assessment of Executive Functions
Abstract
Virtual reality and video games are increasingly considered as potentially effective tools for the assessment of several cognitive abilities, including executive functions. However, thus far, only non-commercial contents have been tested and virtual reality contents and video games have been investigated separately. Within this context, this study aimed to explore the effectiveness in the assessment of executive functions using a new type of interactive content - commercial virtual reality games - which combines the advantages of virtual reality with that of commercial video games. Thirty-eight participants completed the Trial Making Test as traditional commonly used assessments of executive functions and then played the virtual reality game Audioshield using an HTC Vive systems. Scores on the Trial Making Test (i.e., time to complete part A and B) were compared to scores obtained on Audioshield (i.e., number of orbs hit by the players and technical score). The results showed that: (a) performance on the Trial Making Test correlated significantly with performance on the virtual reality video game; (b) scores on Audioshield can be used as a reliable estimator of the results of Trial Making Test.
... Interestingly, scientific studies have recently started to recognize the potential positive impact of virtual reality video games on people's health (eg, [16,17]) and cognitive abilities (eg, [18,19]). For example, a previous study [18] has reported the efficacy of a virtual reality exercise-based dance game, DANCE, that was created ad hoc by researchers for the training of executive functions in older people. ...
... For example, a previous study [18] has reported the efficacy of a virtual reality exercise-based dance game, DANCE, that was created ad hoc by researchers for the training of executive functions in older people. In addition, another recent study [19] showed the feasibility of using a commercial virtual reality game to assess executive functions and cognitive abilities, as measured by a traditional neuropsychological test, the Trial Making Test (TMT) [20]. The results showed that user performance in the dance game Audioshield (Dylan Fitterer) predicted the TMT scores (ie, time to complete TMT-A and TMT-B) [19]. ...
... In addition, another recent study [19] showed the feasibility of using a commercial virtual reality game to assess executive functions and cognitive abilities, as measured by a traditional neuropsychological test, the Trial Making Test (TMT) [20]. The results showed that user performance in the dance game Audioshield (Dylan Fitterer) predicted the TMT scores (ie, time to complete TMT-A and TMT-B) [19]. ...
Background
In the last few years, the introduction of immersive technologies, especially virtual reality, into the gaming market has dramatically altered the traditional concept of video games. Given the unique features of virtual reality in terms of interaction and its ability to completely immerse the individual into the game, this technology should increase the propensity for video games to effectively elicit positive emotions and decrease negative emotions and anxiety in the players. However, to date, few studies have investigated the ability of virtual reality games to induce positive emotions, and the possible effect of this new type of video game in diminishing negative emotions and anxiety has not yet been tested. Furthermore, given the critical role of body movement in individuals’ well-being and in emotional responses to video games, it seems critical to investigate how body involvement can be exploited to modulate the psychological benefits of virtual reality games in terms of enhancing players’ positive emotions and decreasing negative emotions and anxiety.
Objective
This within-subjects study aimed to explore the ability of commercial virtual reality games to induce positive emotions and diminish negative emotions and state anxiety of the players, investigating the effects of the level of body involvement requested by the game (ie, high vs low).
MethodsA total of 36 young adults played a low body-involvement (ie, Fruit Ninja VR) and a high body-involvement (ie, Audioshield) video game in virtual reality. The Visual Analogue Scale (VAS) and the State-Trait Anxiety Inventory, Form-Y1 (STAI-Y1) were used to assess positive and negative emotions and state anxiety.
ResultsResults of the generalized linear model (GLM) for repeated-measures multivariate analysis of variance (MANOVA) revealed a statistically significant increase in the intensity of happiness (P
... In the work done by Pallavicini et al [6], a commercial game was used as an alternative for the Trail Making Test, a neuropsychological test of visual attention (and task switching). In the original test, subjects are required to connect a set of 25 dots as quickly and as accurate as possible. ...
... Since the aim of this study is to validate the accuracy of the system and investigate the effects that the 3 view modes can have in the performance of the stepping task, we opted for recruiting a younger sample size in order to push the system to its limits, similarly to [4][5][6][7]. Ethics Approval Number: HREC ETH19-3452 / CSS 2021-1. ...
... Pallavicini et al. explored the effectiveness in assessing EFs using a commercial VR game -Audioshield -a VR-based dance game that combines the advantages of VR and video games (Pallavicini et al., 2019). Audioshield is a dance game in which balls fly towards the player, who must follow the beat of the music to hit them successfully. ...
... Outcome measures were: (a) the technical score (i.e., how many balls players hit -from 0 to 10.00), (b) the number of balls the player missed, and (c) the numbers of orbs the player hit. The validation study involved 38 healthy young adults and showed that the performance of VR video games correlated significantly with one at traditional neuropsychological test (TMT), suggesting that a VR game was able to measure (and treat) the same components of executive functioning (e.g., inhibition) (Pallavicini et al., 2019). Further studies will have to deepen this promising result, evaluating the efficacy of Audioshield in discriminating between clinical and healthy samples. ...
Introduction
Executive dysfunctions constitute a significant public health problem: their high impact on everyday life makes it a priority to identify early strategies for evaluating and rehabilitating these disorders in a real-life context. The ecological limitation of traditional neuropsychological tests and several difficulties in administering tests or training in real-life scenarios have paved the way to use Virtual Reality-based tools to evaluate and rehabilitate Executive Functions (EFs) in real-life.
Objective
This work aims to conduct a systematic review to provide a detailed description of the VR-based tools currently developed for the evaluation and rehabilitation of EFs.
Methods
We systematically searched for original manuscripts regarding VR tools and EFs by looking for titles and abstracts in the PubMed, Scopus, PsycInfo, and Web of Science databases up to November 2021 that contained the following keywords “Virtual Reality” AND “Executive function * .”
Results and Conclusion
We analyzed 301 articles, of which 100 were included. Our work shows that available VR-based tools appear promising solutions for an ecological assessment and treatment of EFs in healthy subjects and several clinical populations.
... Additionally, 11 out of 40 participants reported having experienced a mild degree of motion sickness. Seven studies, however, did not disclose any information about user experiences [47,55,57,62,66,77]. ...
BACKGROUND
Neuropsychological assessments have traditionally focused on executive functioning (EF) due to the significant role it plays in everyday life and its association with a variety of mental disorders. Although traditional assessment methods of EF are well established, they lack ecological validity and are limited to evaluating a single cognitive process. While these traditional EF assessment tools may be appropriate for clinical populations, they provide less information about EF in healthy individuals. Recognizing these limitations, there has been a growing interest in Virtual Reality (VR)-based assessments of EF due to their potential to increase test sensitivity, ecological validity, and accessibility to neuropsychological assessment.
OBJECTIVE
This systematic review aims to explore the literature on VR assessments of EF. Specifically, we intended to identify: (1) the EF components being assessed, (2) how these assessments are validated, and (3) the monitoring strategies for potential adverse (cybersickness) and beneficial (immersion) effects.
METHODS
EBSCOHost, Scopus, and Web of Science (WoS) were searched using keywords that reflected the main themes of Virtual Reality, Neuropsychological Tests and Executive Function. The search retrieved 555 unique articles, of which 19 met the inclusion criteria. Articles had to be an English written peer-reviewed manuscript published after 2013 that detailed an empirical, clinical or proof of concept study where a virtual environment using a head-mounted display was employed to assess EF in an adult population.
RESULTS
The reviewed articles comprised a range of EF constructs, including inhibitory control, cognitive flexibility, working memory, planning, and attention. Although VR paradigms were typically validated against gold-standard traditional tasks, some studies did not report a-priori planned correlations, others did not detail the target EF constructs to be assessed by the VR paradigm, and there was often incomplete reporting of results. Further, cybersickness was assessed by only four of the 19 studies.
CONCLUSIONS
The authors propose several recommendations to improve the theory and practice of VR assessments of EF. A key conclusion is the critical need to address the methodological and psychometric properties during the development of these assessments to ensure their validity and reliability. Furthermore, we suggest an increased focus on potential adverse effects such as cybersickness. Future research should consider the integration of biosensors into VR systems, and the potential of VR in assessing spatial navigation. While VR assessments show promising potential, their adoption must be systematic and validated to ensure their utility in real-world applications.
EFs are a set of processes that supports many cognitive domains as goal setting, monitoring, planning, and cognitive-behavioural flexible control. Currently, many standardized paper-and-pencil tests or scales are used to assess EFs. These tests are easy to administer, score, and interpret but present some limitations in terms of generalizability of behaviours in real life. More recently, Information and Communication Technology has provided a higher ecological validity in the EFs assessment. In order to increase the ecological validity, we have developed a serious game (SG), named EXPANSE, which aim was to compare the participants’ game performance (latency times, and correct answers) with the results obtained in the traditional tasks and scales. 354 healthy subjects participated to the study and the findings showed significant correlations among standard tasks and the serious game. The exploratory nature of the present study, on one hand, highlighted that SG could be an additional behavioral tool to assess EFs and, on the other, we need further investigations, including clinical populations, for better defining the game sensitivity toward EF components. Finally, the results show that serious games are a promising technology for the evaluation of real cognitive behavior along with traditional evaluation.
Background: Although several excellent reviews and meta-analyses have investigated the effect of video game trainings as tools to enhance well-being, most of them specifically focused on the effects of digital games on brain plasticity or cognitive decline in children and seniors. On the contrary, only one meta-analysis results to be focused on the adult population, and it is restricted to examining the effects of training with a particular genre of games (action video games) on cognitive skills of healthy adults.
Objectives: This systematic review was aimed to identify research evidences about the impact on cognitive [i.e., processing and reaction times (RTs), memory, task-switching/multitasking, and mental spatial rotation] and emotional skills of video games training in the healthy adult population.
Methods: A multi-component analysis of variables related to the study, the video games, and the outcomes of the training was made on the basis of important previous works. Databases used in the search were PsycINFO, Web of Science (Web of Knowledge), PubMed, and Scopus. The search string was: [(“Video Games” OR “Computer Games” OR “Interactive Gaming”)] AND [(“Cognition”) OR (“Cognitive”) OR (“Emotion”) OR (“Emotion Regulation”)] AND [“Training”].
Results: Thirty-five studies met the inclusion criteria and were further classified into the different analysis' variables. The majority of the retrieved studies used commercial video games, and action games in particular, which resulted to be the most commonly used, closely followed by puzzle games. Effect sizes for training with video games on cognitive skills in general ranged from 0.06 to 3.43: from 0.141 to 3.43 for processing and RTs, 0.06 to 1.82 for memory, 0.54 to 1.91 for task switching/multitasking, and 0.3 to 3.2 for mental spatial rotation; regarding video games for the training of emotional skills, effect sizes ranged from 0.201 to 3.01.
Conclusion: Overall, findings give evidences of benefits of video games training on cognitive and emotional skills in relation to the healthy adult population, especially on young adults. Efficacy has been demonstrated not only for non-commercial video games or commercial brain-training programs, but for commercial video games as well.
Computer games are ubiquitous and can be utilized for serious purposes such as health and education. “Applied games” including serious games (in brief, computerized games for serious purposes) and gamification (gaming elements used outside of games) have the potential to increase the impact of mental health internet interventions via three processes. First, by extending the reach of online programs to those who might not otherwise use them. Second, by improving engagement through both game-based and “serious” motivational dynamics. Third, by utilizing varied mechanisms for change, including therapeutic processes and gaming features. In this scoping review, we aim to advance the field by exploring the potential and opportunities available in this area. We review engagement factors which may be exploited and demonstrate that there is promising evidence of effectiveness for serious games for depression from contemporary systematic reviews. We illustrate six major categories of tested applied games for mental health (exergames, virtual reality, cognitive behavior therapy-based games, entertainment games, biofeedback, and cognitive training games) and demonstrate that it is feasible to translate traditional evidence-based interventions into computer gaming formats and to exploit features of computer games for therapeutic change. Applied games have considerable potential for increasing the impact of online interventions for mental health. However, there are few independent trials, and direct comparisons of game-based and non-game-based interventions are lacking. Further research, faster iterations, rapid testing, non-traditional collaborations, and user-centered approaches are needed to respond to diverse user needs and preferences in rapidly changing environments.
The development of rehabilitation has traditionally focused on measurements of motor disorders and
measurements of the improvements produced during the therapeutic process; however, physical
rehabilitation sciences have not focused on understanding the philosophical and scientific principles
in clinical intervention and how they are interrelated. The main aim of this paper is to explain the
foundation stones of the disciplines of physical therapy, occupational therapy, and speech/language
therapy in recovery from motor disorder. To reach our goals, the mechanistic view and how it is
integrated into physical rehabilitation will first be explained. Next, a classification into mechanistic
therapy based on an old version (automaton model) and a technological version (cyborg model) will
be shown. Then, it will be shown how physical rehabilitation sciences found a new perspective in
motor recovery, which is based on functionalism, during the cognitive revolution in the 1960s.
Through this cognitive theory, physical rehabilitation incorporated into motor recovery of those
therapeutic strategies that solicit the activation of the brain and/or symbolic processing; aspects
that were not taken into account in mechanistic therapy. In addition, a classification into functionalist
rehabilitation based on a computational therapy and a brain therapy will be shown. At the end of the
article, the methodological principles in physical rehabilitation sciences will be explained. It will allow
us to go deeper into the differences and similarities between therapeutic mechanism and therapeutic
functionalism.
In this longitudinal intervention study with experimental and control groups, we investigated the effects of video game training on the visuospatial working memory and episodic memory of healthy older adults. Participants were 19 volunteer older adults, who received 15 1-hr video game training sessions with a series of video games selected from a commercial package (Lumosity), and a control group of 20 healthy older adults. The results showed that the performance of the trainees improved significantly in all the practiced video games. Most importantly, we found significant enhancements after training in the trained group and no change in the control group in two computerized tasks designed to assess visuospatial working memory, namely the Corsi blocks task and the Jigsaw puzzle task. The episodic memory and short-term memory of the trainees also improved. Gains in some working memory and episodic memory tasks were maintained during a 3-month follow-up period. These results suggest that the aging brain still retains some degree of plasticity, and that video game training might be an effective intervention tool to improve working memory and other cognitive functions in older adults.
Researchers have proved immersive Virtual Reality (VR) to be an effective method and non-pharmacological analgesic for distracting acute pain and chronic pain, and for reducing anxiety levels. VR has been developed and deployed in pain management contexts in medical settings for dental and medical procedures, as well to manage cancer and burn pain. Often, what patients are distracted by can typically be described as immersive VR games. Although this is promising, and although the cost of VR has dramatically fallen in the past few years, most VR systems are still comparatively expensive in terms of accessibility for patients in their everyday contexts, such as at home or at work. For most patients — especially chronic pain patients — it is important that pain-related VR is accessible when it is needed, or " just " needed. However, the so-called Cardboard VR is affordable enough for everyday use. It provides a low-cost stereoscopic display that patients attached to smartphones. Therefore, a mobile VR game has been designed, developed and tested for this purpose. This paper describes the game design and game mechanics of Cryoblast, a mobile VR game for self-managing pain. We introduce the design of the gameplay and pain metaphors, and believe it will inspire more mobile VR games for healthcare.
The most commonly used method to test an indirect effect is to divide the estimate of the indirect effect by its standard error and compare the resulting z statistic with a critical value from the standard normal distribution. Confidence limits for the indirect effect are also typically based on critical values from the standard normal distribution. This article uses a simulation study to demonstrate that confidence limits are imbalanced because the distribution of the indirect effect is normal only in special cases. Two alternatives for improving the performance of confidence limits for the indirect effect are evaluated: (a) a method based on the distribution of the product of two normal random variables, and (b) resampling methods. In Study 1, confidence limits based on the distribution of the product are more accurate than methods based on an assumed normal distribution but confidence limits are still imbalanced. Study 2 demonstrates that more accurate confidence limits are obtained using resampling methods, with the bias-corrected bootstrap the best method overall.
Stress related medical disorders such as cardiovascular disease, diabetes and depression are serious medical issues that can cause disability and death. Techniques to prevent their development and exacerbation are needed. Casual video games (CVGs) are fun, easy to play, spontaneous and are tremendously popular. In this randomized controlled study we tested the effects of CVGs on mood and stress by comparing people playing CVGs with control subjects under similar conditions. Electroencephalography (EEG) changes during game play were consistent with increased mood and corroborated findings on psychological reports. Moreover, heart rate variability (HRV) changes were consistent with autonomic nervous system relaxation or decreased physical stress. In some cases CVGs produced different brain wave, heart rate variability and psychological effects. These finding have broad implications which include the potential development of prescriptive interventions using casual video games to prevent and treat stress related medical disorders.
The assessment of executive functions is an integral task of neuropsychological assessment. Traditional measures of executive function are often based on hypothetical constructs that may have little relevance to real-world behaviours. In fact, some traditional tests utilised today were not originally developed for clinical use. Recently, researchers have been arguing for a new generation of "function-led" neuropsychological assessments that are developed from directly observable everyday behaviours. Although virtual environments (VEs) have been presented as potential aides in enhancing ecological validity, many were modelled on construct-driven approaches found in traditional assessments. In the current paper, we review construct-driven and function-led VE-based neuropsychological assessments of executive functions. Overall, function-led VEs best represent the sorts of tasks needed for enhanced ecological validity and prediction of real-world functioning.
Background: Cognitive impairment is a health problem that concerns almost every second elderly person. Physical and cognitive training have differential positive effects on cognition, but have been rarely applied in combination. This study evaluates synergistic effects of mul- ticomponent physical exercise complemented with novel simultaneous cognitive training on cognition in older adults. We hypothesized that simultaneous cognitive–physical components would add training specific cognitive benefits compared to exclusively physical training. Methods: Seniors, older than 70 years, without cognitive impairment, were randomly assigned to either: 1) virtual reality video game dancing (DANCE), 2) treadmill walking with simultane- ous verbal memory training (MEMORY), or 3) treadmill walking (PHYS). Each program was complemented with strength and balance exercises. Two 1-hour training sessions per week over 6 months were applied. Cognitive performance was assessed at baseline, after 3 and 6 months, and at 1-year follow-up. Multiple regression analyses with planned comparisons were calculated. Results: Eighty-nine participants were randomized to the three groups initially, 71 completed the training, while 47 were available at 1-year follow-up. Advantages of the simultaneous cognitive–physical programs were found in two dimensions of executive function. “Shifting attention” showed a time×intervention interaction in favor of DANCE/MEMORY versus PHYS (F[2, 68] =1.95, trend P=0.075, r=0.17); and “working memory” showed a time×intervention interaction in favor of DANCE versus MEMORY (F[1, 136] =2.71, trend P=0.051, R2=0.006). Performance improvements in executive functions, long-term visual memory (episodic memory), and processing speed were maintained at follow-up in all groups.
Conclusion: Particular executive functions benefit from simultaneous cognitive–physical training compared to exclusively physical multicomponent training. Cognitive–physical training programs may counteract widespread cognitive impairments in the elderly.
Keywords: elderly, executive function, transfer, cognitive impairment, dance, video game
Recently there has been a growing interest in employing serious games (SGs) for the assessment and rehabilitation of elderly people with mild cognitive impairment (MCI), Alzheimer's disease (AD), and related disorders. In the present study we examined the acceptability of 'Kitchen and cooking' - a SG developed in the context of the EU project VERVE (http://www.verveconsortium.eu/) - in these populations. In this game a cooking plot is employed to assess and stimulate executive functions (such as planning abilities) and praxis. The game is installed on a tablet, to be flexibly employed at home and in nursing homes. Twenty one elderly participants (9 MCI and 12 AD, including 14 outpatients and 7 patients living in nursing homes, as well as 11 apathetic and 10 non-apathetic) took part in a 1-month trail, including a clinical and neuropsychological assessment, and 4-week training where the participants were free to play as long as they wanted on a personal tablet. During the training, participants met once a week with a clinician in order to fill in self-report questionnaires assessing their overall game experience (including acceptability, motivation, and perceived emotions). The results of the self reports and of the data concerning game performance (e.g., time spent playing, number of errors, etc) confirm the overall acceptability of Kitchen and cooking for both patients with MCI and patients with AD and related disorders, and the utility to employ it for training purposes. Interestingly, the results confirm that the game is adapted also to apathetic patients.
Video games contain elaborate reinforcement and reward schedules that have the potential to maximize motivation. Neuroimaging studies suggest that video games might have an influence on the reward system. However, it is not clear whether reward-related properties represent a precondition, which biases an individual toward playing video games, or if these changes are the result of playing video games. Therefore, we conducted a longitudinal study to explore reward-related functional predictors in relation to video gaming experience as well as functional changes in the brain in response to video game training. Fifty healthy participants were randomly assigned to a video game training (TG) or control group (CG). Before and after training/control period, functional magnetic resonance imaging (fMRI) was conducted using a non-video game related reward task. At pretest, both groups showed strongest activation in ventral striatum (VS) during reward anticipation. At posttest, the TG showed very similar VS activity compared to pretest. In the CG, the VS activity was significantly attenuated. This longitudinal study revealed that video game training may preserve reward responsiveness in the VS in a retest situation over time. We suggest that video games are able to keep striatal responses to reward flexible, a mechanism which might be of critical value for applications such as therapeutic cognitive training.
Gamification and serious games are becoming increasingly important for training, wellness, and other applications. How can games be developed for non-traditional gaming populations such as the elderly, and how can gaming be applied in non-traditional areas such as cognitive assessment? The application that we were interested in is detection of cognitive impairment in the elderly. Example use cases where gamified cognitive assessment might be useful are: prediction of delirium onset risk in emergency departments and postoperative hospital wards; evaluation of recovery from stroke in neuro-rehabilitation; monitoring of transitions from mild cognitive impairment to dementia in long-term care. With the rapid increase in cognitive disorders in many countries, inexpensive methods of measuring cognitive status on an ongoing basis, and to large numbers of people, are needed. In order to address this challenge we have developed a novel game-based method of cognitive assessment. In this paper, we present findings from a usability study conducted on the game that we developed for measuring changes in cognitive status. We report on the game's ability to predict cognitive status under varying game parameters, and we introduce a method to calibrate the game that takes into account differences in speed and accuracy, and in motor coordination. Recommendations concerning the development of serious games for cognitive assessment are made, and detailed recommendations concerning future development of the whack-a-mole game are also provided.
Background:
Recent research advocates the potential of virtual reality (VR) applications in assessing cognitive functions highlighting the possibility of using a VR application for mild cognitive impairment (MCI) screening.
Objective:
The aim of this study is to investigate whether a VR cognitive training application, the virtual supermarket (VSM), can be used as a screening tool for MCI.
Methods:
Two groups, one of healthy older adults (n = 21) and one of MCI patients (n = 34), were recruited from day centers for cognitive disorders and administered the VSM and a neuropsychological test battery. The performance of the two groups in the VSM was compared and correlated with performance in established neuropsychological tests. At the same time, the effectiveness of a combination of traditional neuropsychological tests and the VSM was examined.
Results:
VSM displayed a correct classification rate (CCR) of 87.30% when differentiating between MCI patients and healthy older adults, while it was unable to differentiate between MCI subtypes. At the same time, the VSM correlates with various established neuropsychological tests. A limited number of tests were able to improve the CCR of the VSM when combined with the VSM for screening purposes.
Discussion:
VSM appears to be a valid method of screening for MCI in an older adult population though it cannot be used for MCI subtype assessment. VSM's concurrent validity is supported by the large number of correlations between the VSM and established tests. It is considered a robust test on its own as the inclusion of other tests failed to improve its CCR significantly.
Introduction: Several recent studies have pointed out that early impairment of executive functions (EFs) in Parkinson’s Disease (PD) may be a crucial marker to detect patients at risk for developing dementia. The main objective of this study was to compare the performances of PD patients with mild cognitive impairment (PD-MCI) with PD patients with normal cognition (PD-NC) and a control group (CG) using a traditional assessment of EFs and the Virtual Multiple Errands Test (VMET), a virtual reality (VR)-based tool. In order to understand which subcomponents of EFs are early impaired, this experimental study aimed to investigate specifically which instrument best discriminates among these three groups.
Materials and methods: The study included three groups of 15 individuals each (for a total of 45 participants): 15 PD-NC; 15 PD-MCI, and 15 cognitively healthy individuals (CG). To assess the global neuropsychological functioning and the EFs, several tests (including the Mini Mental State Examination (MMSE), Clock Drawing Test, and Tower of London test) were administered to the participants. The VMET was used for a more ecologically valid neuropsychological evaluation of EFs.
Results: Findings revealed significant differences in the VMET scores between the PD-NC patients vs. the controls. In particular, patients made more errors in the tasks of the VMET, and showed a poorer ability to use effective strategies to complete the tasks. This VMET result seems to be more sensitive in the early detection of executive deficits because these two groups did not differ in the traditional assessment of EFs (neuropsychological battery).
Conclusion: This study offers initial evidence that a more ecologically valid evaluation of EFs is more likely to lead to detection of subtle executive deficits.
Worldwide, more than one in three adults suffers by a form of a cardiovascular disease. According to the World Health Organization, 15 million people suffer stroke worldwide each year and, of these, 5 million are permanently disabled. The current limitations of traditional rehabilitation methods push towards the design of personalized tools that can be used intensively by patients and therapists, in a clinical or at-home environment. In this paper we present RehabCity, an online game designed for the rehabilitation of cognitive deficits through a gamified approach on activities of daily living (ADLs). In this paper we present the design, implementation and validation of RehabCity. Among other findings, our results show a strong correlation between the RehabCity scoring system and the Mini Mental State Examination test for clinical assessment of cognitive function in several domains. We therefore show that RehabCity is a valid tool for the quantitative assessment of patients with cognitive deficits derived from a brain lesion.
Early and reliable detection of cognitive decline is one of the most important challenges of current healthcare. In this project, we developed an approach whereby a frequently played computer game can be used to assess a variety of cognitive processes and estimate the results of the pen-and-paper trail making test (TMT)–-known to measure executive function, as well as visual pattern recognition, speed of processing, working memory, and set-switching ability. We developed a computational model of the TMT based on a decomposition of the test into several independent processes, each characterized by a set of parameters that can be estimated from play of a computer game designed to resemble the TMT. An empirical evaluation of the model suggests that it is possible to use the game data to estimate the parameters of the underlying cognitive processes and using the values of the parameters to estimate the TMT performance. Cognitive measures and trends in these measures can be used to identify individuals for further assessment, to provide a mechanism for improving the early detection of neurological problems, and to provide feedback and monitoring for cognitive interventions in the home.
Brain training programs have proliferated in recent years, with claims that video games or computer-based tasks can broadly enhance cognitive function. However, benefits are commonly seen only in trained tasks. Assessing generalized improvement and practicality of laboratory exercises complicates interpretation and application of findings. In this study, we addressed these issues by using active control groups, training tasks that more closely resemble real-world demands and multiple tests to determine transfer of training. We examined whether casual video games can broadly improve cognition, and selected training games from a study of the relationship between game performance and cognitive abilities. A total of 209 young adults were randomized into a working memory-reasoning group, an adaptive working memory-reasoning group, an active control game group, and a no-contact control group. Before and after 15 h of training, participants completed tests of reasoning, working memory, attention, episodic memory, perceptual speed, and self-report measures of executive function, game experience, perceived improvement, knowledge of brain training research, and game play outside the laboratory. Participants improved on the training games, but transfer to untrained tasks was limited. No group showed gains in reasoning, working memory, episodic memory, or perceptual speed, but the working memory-reasoning groups improved in divided attention, with better performance in an attention-demanding game, a decreased attentional blink and smaller trail-making costs. Perceived improvements did not differ across training groups and those with low reasoning ability at baseline showed larger gains. Although there are important caveats, our study sheds light on the mixed effects in the training and transfer literature and offers a novel and potentially practical training approach. Still, more research is needed to determine the real-world benefits of computer programs such as casual games.
Video games are a ubiquitous part of almost all children's and adolescents' lives, with 97% playing for at least one hour per day in the United States. The vast majority of research by psychologists on the effects of "gaming" has been on its negative impact: the potential harm related to violence, addiction, and depression. We recognize the value of that research; however, we argue that a more balanced perspective is needed, one that considers not only the possible negative effects but also the benefits of playing these games. Considering these potential benefits is important, in part, because the nature of these games has changed dramatically in the last decade, becoming increasingly complex, diverse, realistic, and social in nature. A small but significant body of research has begun to emerge, mostly in the last five years, documenting these benefits. In this article, we summarize the research on the positive effects of playing video games, focusing on four main domains: cognitive, motivational, emotional, and social. By integrating insights from developmental, positive, and social psychology, as well as media psychology, we propose some candidate mechanisms by which playing video games may foster real-world psychosocial benefits. Our aim is to provide strong enough evidence and a theoretical rationale to inspire new programs of research on the largely unexplored mental health benefits of gaming. Finally, we end with a call to intervention researchers and practitioners to test the positive uses of video games, and we suggest several promising directions for doing so. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Most neuropsychological assessments include at least one measure that is administered, scored, or interpreted by computers or other technologies. Despite supportive findings for these technology-based assessments, there is resistance in the field of neuropsychology to adopt additional measures that incorporate technology components. This literature review addresses the research findings of technology-based neuropsychological assessments, including computer- and virtual reality-based measures of cognitive and functional abilities. We evaluate the strengths and limitations of each approach, and examine the utility of technology-based assessments to obtain supplemental cognitive and behavioral information that may be otherwise undetected by traditional paper-and-pencil measures. We argue that the potential of technology use in neuropsychological assessment has not yet been realized, and continued adoption of new technologies could result in more comprehensive assessment of cognitive dysfunction and in turn, better informed diagnosis and treatments. Recommendations for future research are also provided.
In two freestanding volumes, Textbook of Neural Repair and Rehabilitation provides comprehensive coverage of the science and practice of neurological rehabilitation. Revised throughout, bringing the book fully up to date, this volume, Medical Neurorehabilitation, can stand alone as a clinical handbook for neurorehabilitation. It covers the practical applications of the basic science principles presented in Volume 1, provides authoritative guidelines on the management of disabling symptoms, and describes comprehensive rehabilitation approaches for the major categories of disabling neurological disorders. New chapters have been added covering genetics in neurorehabilitation, the rehabilitation team and the economics of neurological rehabilitation, and brain stimulation, along with numerous others. Emphasizing the integration of basic and clinical knowledge, this book and its companion are edited and written by leading international authorities. Together they are an essential resource for neuroscientists and provide a foundation of the work of clinical neurorehabilitation professionals.
L’esame neuropsicologico dell’adulto con lesioni cerebrali o patologie neurodegenerative è oggi considerato indispensabile a fini diagnostici, prognostici, peritali e riabilitativi: è una conditio sine qua non per una completa valutazione psicologica dell’individuo. L’ENB-2 si colloca fra il materiale che non può non essere presente fra gli strumenti psicometrici più aggiornati e affidabili dell’indagine neuropsicologica. Rispetto alla precedente versione, l’ENB-2 presenta rilevanti cambiamenti riguardo ai dati normativi e alla correzione dei punteggi. Il campione è stato ampliato e presenta ora 702 individui adulti di età, sesso e scolarità diversi. Particolare attenzione è stata rivolta alle fasce di età più avanzata rappresentate da un gruppo di soggetti fra i 70 e gli 80 anni e da un gruppo con età superiore agli 80 anni. È ora possibile calcolare, per ogni individuo, un punteggio globale di funzionamento cognitivo, un indice che in ambito clinico fornisce in modo immediato il livello generale di funzionamento. È possibile ora somministrare la batteria ENB-2 anche a distanza di un solo mese allo stesso individuo. L’introduzione di questo nuovo calcolo del punteggio test-retest ha indubbiamente dei vantaggi nella pratica clinica, oltre che nella ricerca di base. Tutto il materiale, i protocolli di valutazione, gli strumenti testistici e le tabelle per la correzione dei punteggi vengono forniti attraverso risorse elettroniche disponibili online sul sito internet della casa editrice.
Visuospatial functions play a crucial role in human cognition, which has elicited over years a great deal of research focusing on their assessment, training and restoration. Interestingly , although our visuospatial capacities allow us to understand and infer relationships of 3D objects in space, these 3D aspects of visuospatial processing are profoundly neglected in laboratory tests, and instead, 2D designs are commonly used. Aiming to increase the ecological validity of such tests, we propose an experiment to evaluate the capacity of a 3D virtual space to stimulate cognitive functions. The experiment involves cognitive testing, EEG measurements, and cognitively stimulating tasks in an immersive 3D virtual environment rendered by a unique CAVE system. This paper focuses primarily on two game prototypes that will serve as the virtual environment and describes a natural movement control using the Myo armband, incorporated into one of the games. We also briefly discuss cognitive testing design using the selected brain electrophysiological variables measured on human subjects before and after the virtual reality game use, in order to assess the potential effect of the game.
Survival horror games played in virtual reality can trigger intense fright and anxiety in the players. Such unique characteristics can thus be exploited not only as a source of entertainment, but also as a tool for both emotion elicitation and emotional training. However, studies investigating the players’ experience and the emotional activation while playing virtual reality video games are still very limited and horror games represent an even more limited number of these. Within this context, this study was aimed to compare a horror game Resident Evil 7: Biohazard, experienced through virtual reality as opposed to a non-immersive display modality (i.e. console system), and exploring differences in the usability and the emotional activation. In order to answer to such objectives, the game was played by a sample of 26 young adults, half of which played using Playstation VR, while the other half through a more traditional non-immersive console setup (PS4 Pro). The usability and the emotional impact of the game was assessed through self-report questionnaires and the recording of physiological indexes (heart rate, skin conductance response). Results showed that: (a) playing a horror video game in virtual reality was not more difficult than playing in a non-immersive display modality; (b) players showed an increased perceived anxiety both after playing the horror video game in virtual reality and playing in a non-immersive display modality; interestingly, the perceived sense of happiness significantly increased only after playing in virtual reality; finally the sense of presence resulted to be greater in virtual reality as opposed to the non-immersive condition.
The assessment of functional status is a critical component of clinical neuropsychological evaluations used for both diagnostic and therapeutic purposes in patients with cognitive brain disorders. There are, however, no widely adopted neuropsychological tests that are both ecologically valid and easily administered in daily clinical practice. This discrepancy is a roadblock to the widespread adoption of functional assessments. In this paper, we propose a novel approach using a serious game authoring platform (eAdventure) for creating screen-based simulated functional assessments. We created a naturalistic functional task that consisted of preparing a cup of tea (SBS-COT) and applied the assessment in a convenience sample of eight dyads of therapists/patients with mild executive dysfunction after traumatic brain injury. We had three main aims. First, we performed a comprehensive review of executive function assessment in activities of daily living. Second, we were interested in measuring the feasibility of this technology with respect to staffing, economic and technical requirements. Third, a serious game was administered to patients to study the feasibility of this technology in the clinical context (pre-screening test). In addition, quantitative (Technology Acceptance Model (TAM) questionnaires) and qualitative (semistructured interviews) evaluations were applied to obtain user input. Our results suggest that the staffing, economic and technical requirements of the SBS-COT are feasible. The outcomes of the pre-screening test provide evidence that this technology is useful in the functional assessment of patients with executive dysfunction. In relation to subjective data, the TAM questionnaire showed good user acceptability from a professional perspective. Interview analyses with professionals and patients showed positive experiences related to the use of the SBS-COT. Our work indicates that the use of these types of authoring platforms could have positive long-term implications for neuropsychological research, opening the door to more reproducible, cooperative and efficient research by allowing the facilitated production, reuse and sharing of neuropsychological assessment tools.
The objective of the present study was to determine whether it is possible to design a video game that could help students improve their executive function skill of shifting between competing tasks, and the conditions under which playing the game would lead to improvements on cognitive tests of shifting. College students played a custom video game, Alien Game, which required the executive function skill of shifting between competing tasks. When students played for 2 hours over 4 sessions they developed significantly better performance on cognitive shifting tests compared to a control group that played a different game (d = 0.62), but not when they played for 1 hour over 2 sessions. Students who played Alien Game at a high level of challenge (i.e., reaching a high level in the game) developed significantly better performance on cognitive shifting tests compared to controls when they played for 2 hours (Experiment 1, d = 1.44), but not when they played for 1 hour (Experiment 2). Experiment 3 replicated the results of Experiment 1 using an inactive control group, showing that playing Alien Game for 2 hours resulted in significant improvements in shifting skills (d = 0.78). Results show the effectiveness of playing a custom-made game that focuses on a specific executive function skill for sufficient time at an appropriate level of challenge. Results support the specific transfer of general skills theory, in which practice of a cognitive skill in a game context transferred to performance on the same skill in a non-game context.
Despite the rapid and significant growth of virtual reality based video games, scientific studies have not yet been conducted to highlight the outstanding differences of this kind of immersive video games as compared to the more traditional kind (i.e. not immersive, for instance tablet or console games). Peculiarly, very little information is provided about the players' experience during a virtual reality game. On the basis of these observations, the paper presents an exploratory study aimed to compare the players' experience while performing a video game in an immersive (virtual reality) and in a non-immersive (tablet) condition. In order to address this objective, 10 participants, within the age range of 18 to 35 years old, were asked to play Smash Hit, a first person game in which the player is provided with an inventory of metallic spheres with which to aim and break glass obstacles. The video game was played by participants on to different display modalities: immersive (virtual reality) and non-immersive (tablet) condition. Psychometric (self-report questionnaires assessing emotional responses and usability of the video game) and physiological (heart rate) measures were used as quantitative dependent variables. The experimental design and results of this exploratory study will be presented and discussed.
Objective
This study investigated immersive virtual reality (IVR), as a novel technique to test executive function of healthy younger and older adults. We predicted IVR tasks to have greater predictive power than traditional measures when assessing age-related cognitive functioning due to the real-world validity of the tasks.
Methods
Participants ( n =40) completed the Stroop colour–word test and the trail-making test (TMT) as traditional and commonly used assessments of executive functioning. Participants then completed three IVR tasks; a seating arrangement task, an item location task (both set in a virtual chemistry lab), and a virtual parking simulator.
Results
Younger adults completed significantly more parking simulator levels ( p <0.001), placed significantly more objects ( p <0.001), and located significantly more items than older adults ( p <0.01), demonstrating higher levels of performance. Significant correlations were found between performance on traditional neuropsychological measures and IVR measures. For example, Stroop CW performance significantly correlated with the number of parking simulator levels completed (τ=0.43, p <0.01). This suggests that IVR measures assess the same underlying cognitive constructs as traditional tasks. In addition, IVR measures contributed a significant percentage of the explained variance in age.
Conclusion
IVR measures (i.e. number of parking simulator levels completed and number of objects placed in the seating arrangement task) were found to be stronger contributors than existing traditional neuropsychological tasks in predicting age-related cognitive decline. Future research should investigate the implementation of these real-world-based tasks in clinical groups given this promising initial work.
This study explores players’ fright reactions and coping strategies in an immersive virtual reality (VR) horror game. Based on Slater’s theory of virtual reality, two dimensions of fear elements in the VR game−the fear of place illusion (PI) and the plausibility illusion (PSI) −were identified by playing a virtual reality survival horror game with a sample of 145 students. Participants reported greater fear toward PSI elements than toward PI elements. Fear of PSI elements positively and strongly predicted disengagement coping strategies and overall fear. Among coping strategies, players mainly adopted approach strategies, followed by avoidance (disengagement and denial), and self-help strategies. A “self-talk” strategy, newly identified in this study, has been reported as an effective means to cope with mediated threat in VR games. Regarding individual differences, sensation seeking and neuroticism influenced participants’ coping strategies and fear. Additionally, males and females employed different coping strategies. Very few students experienced next-day fright, which consists mostly of cognitive reactions and VR-related reactions, such as the Tetris effect and the fear of being attacked from the back. Theoretical frameworks regarding fear elements and coping reactions are proposed to aid future research. Implications for academia, fear conditioning for training, and marketing campaigns are discussed.
Background:
The dramatic technological advances witnessed in recent years have resulted in a great opportunity for changing the way neuropsychological evaluations may be performed in clinical practice. Particularly, serious games have been posed as the cornerstone of this still incipient paradigm-shift, as they have characteristics that make them especially advantageous in trying to overcome limitations associated with traditional pen-and-paper based neuropsychological tests: they can be easily administered and they can feature complex environments for the evaluation of neuropsychological constructs that are difficult to evaluate through traditional tests. The objective of this study was to conduct a scoping literature review in order to map rapidly the key concepts underpinning this research area during the last 25 years on the use of serious games for neuropsychological evaluation.
Methods:
MEDLINE, PsycINFO, Scopus and IEEE Xplore databases were systematically searched. The main eligibility criteria were to select studies published in a peer-reviewed journal; written in English; published in the last 25 years; focused on the human population, and classified in the neuropsychological field. Moreover, to avoid risk of bias, studies were selected by consensus of experts, focusing primarily in psychometric properties. Therefore, selected studies were analyzed in accordance with a set of dimensions of analysis commonly used for evaluating neuropsychological tests.
Results:
After applying the selected search strategy, 57 studies -including 54 serious games- met our selection criteria. The selected studies deal with visuospatial capabilities, memory, attention, executive functions, and complex neuropsychological constructs such as Mild Cognitive Impairment (MCI). Results show that the implementation of serious games for neuropsychological evaluation is tackled in several different ways in the selected studies, and that studies have so far been mainly exploratory, just aiming at testing the feasibility of the proposed approaches.
Discussion:
It may be argued that the limited number of databases used might compromise this study. However, we think that the finally included sample is representative, in spite of how difficult is to achieve an optimum and maximum scope. Indeed, this review identifies other research issues related to the development of serious games beyond their reliability and validity. The main conclusion of this review is that there is a great interest in the research community in the use of serious games for neuropsychological evaluation. This scoping review is pertinent, in accordance with the increasing number of studies published in the last three years, they demonstrate its potential as a serious alternative to classic neuropsychological tests. Nevertheless, more research is needed in order to implement serious games that are reliable, valid, and ready to be used in the everyday clinical practice.
Dementia cases are on the rise and researchers seek innovative ways to prevent or ameliorate cognitive impairment in later life. Some research has reported that combining mental and physical exercise may benefit cognition more than either alone. This randomized pilot trial examined the feasibility and cognitive benefit for older adults (n = 30) of a single bout of neuro-exergaming (physical activity with cognitive training), using an interactive physical and cognitive exercise system (iPACES™), compared to that of exergaming or neurogaming alone. Intent-to-treat and sensitivity analyses were conducted using repeated measures ANOVA, controlling for age, sex, and education. A significant interaction effect was found for executive function (Color Trails 2), with a significant improvement in the neuro-exergaming condition. Results demonstrate feasibility for older adults to use a novel and theoretically-derived neuro-exergame, and also provide promising new evidence that neuro-exergaming can yield greater cognitive benefit than either of its component parts.
The importance of assessing executive functions (EF) using ecologically valid assessments has been discussed extensively. Due to the difficulty of carrying out such assessments in real-world settings on a regular basis, virtual reality has been proposed as a technique to provide complex functional tasks under a variety of differing conditions while measuring various aspects of performance and controlling for stimuli. The main goal of this study was to examine the discriminant, construct-convergent and ecological validity of the Adapted Four-Item Shopping Task, an assessment of the Instrumental Activity of Daily Living (IADL) of shopping. Nineteen people with stroke, aged 50-85 years, and 20 age- and gender-matched healthy participants performed the shopping task in both the SeeMe Virtual Interactive Shopping environment and a real shopping environment (the hospital cafeteria) in a counterbalanced order. The shopping task outcomes were compared to clinical measures of EF. The findings provided good initial support for the validity of the Adapted Four-Item Shopping Task as an IADL assessment that requires the use of EF for people with stroke. Further studies should examine this task with a larger sample of people with stroke as well as with other populations who have deficits in EF.
Continuing interest in digital games indicated that it would be useful to update Connolly et al.'s (2012) systematic literature review of empirical evidence about the positive impacts and outcomes of games. Since a large number of papers was identified in the period from 2009 to 2014, the current review focused on 143 papers that provided higher quality evidence about the positive outcomes of games. Connolly et al.'s multidimensional analysis of games and their outcomes provided a useful framework for organising the varied research in this area. The most frequently occurring outcome reported for games for learning was knowledge acquisition, while entertainment games addressed a broader range of affective, behaviour change, perceptual and cognitive and physiological outcomes. Games for learning were found across varied topics with STEM subjects and health the most popular. Future research on digital games would benefit from a systematic programme of experimental work, examining in detail which game features are most effective in promoting engagement and supporting learning.
The authors summarize developments in the concept of working memory as a multicomponent system, beginning by contrasting this approach with alternative uses of the term working memory. According to a 3-component model, working memory comprises a phonological loop for manipulating and storing speech-based information and a visuospatial sketchpad that performs a similar function for visual and spatial information. Both are supervised by a central executive, which functions as an attentional control system. A simple trace-decay model of the phonological loop provides a coherent account of the effects of word length, phonemic similarity, irrelevant speech, and articulatory suppression in verbal short-term memory tasks. This model of the loop has also proved useful in the analysis of neuropsychological, developmental and, cross-cultural data. The notion of the sketchpad is supported by selective interference with imagery in normal adults and by specific neuropsychological impairment. Analysis of the central executive is illustrated by work on deficits in the ability to coordinate subproccesses in Alzheimer's disease.
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
Many mechanistic rules of thumb for evaluating the goodness of fit of structural equation models (SEM) emphasize model parsimony; all other things being equal, a simpler, more parsimonious model with fewer estimated parameters is better than a more complex model Although this is usually good advice, in the present article a heuristic counterexample is demonstrated in which parsimony as typically operationalized in indices of fit may be undesirable. Specifically, in simplex models of longitudinal data, the failure to include correlated uniquenesses relating the same indicators administered on different occasions will typically lead to systematically inflated estimates of stability. Although simplex models with correlated uniquenesses are substantially less parsimonious and may be unacceptable according to mechanistic decision rules that penalize model complexity, it can be argued a priori that these additional parameter estimates should be included. Simulated data . are used to support this claim and to evaluate the behavior of a variety of fit indices and decision rules. The results demonstrate the validity of Bollen and Long’s (1993) conclusion that “test statistics and fit indices are very beneficial, but they are no replacement for sound judgment and substantive expertise” (p. 8).
Although performance validity testing is becoming fairly routine in clinical settings, research protocols involving neuropsychological tests infrequently include assessments of performance validity. The current study utilized an embedded measure of effort over two administrations of CNS Vital Signs to determine the frequency of poor effort in non-clinical healthy undergraduate students participating in a research study for course credit. Results indicate that more than 1 in 10 college students participating in a cognitive test battery for research showed test scores consistent with inadequate effort, which was associated with poor performance on testing across many domains. This conclusion was supported by poor performance on many other subtests. Healthy college students with suboptimal effort (n = 11) had an overall score in the 15th percentile on average compared to the 48th percentile in the rest of the students (n = 66). Those who failed validity indicators on the baseline administration were more likely to fail validity indicators on the repeat administration. Those who were tested in the morning were also more likely to fail validity indicators. The current study provides evidence for the potential limitations of conducting research using neuropsychological tests with healthy college student volunteers in the absence of performance validity testing. Revised college-level cutoffs are proposed.
-Recent studies suggest that even short-term video game training may transfer to other cognitive tasks. With the popularity of the Nintendo Wii with women, more of them might be exposed to the games that will increase their mental rotation skills. Because performance on mental rotation tests (MRT) has been linked to math performance in women, and thus may ultimately contribute to the underrepresentation of women in STEM fields, it is important to continue to explore ways to decrease or eliminate the robust sex difference in mental rotation. The present study of 30 men and 30 women provides additional evidence that women may benefit from short-term (1 hour) training on either a Nintendo Wii™ or GameCube console to increase their mental rotation skills. One hour of video game training not only increased women's MRT scores to a level similar to men's scores, but also produced greater average improvement for women, even when controlling for experiential factors such as spatial and masculine childhood activities that could contribute to the sex difference in spatial ability.
From the Publisher:
This in-depth review of current virtual reality technology and its applications provides a detailed analysis of the engineering, scientific and functional aspects of virtual reality systems and the fundamentals of VR modeling and programming. It also contains an exhaustive list of present and future VR applications in a number of diverse fields. Virtual Reality Technology is the first book to include a full chapter on force and tactile feedback and to discuss newer interface tools such as 3-D probes and cyberscopes. Supplemented with 23 color plates and more than 200 drawings and tables which illustrate the concepts described.
impaired stepping and reduced cognitive functioning have both been identified as fall-risk factors in older people. We developed a Stroop Stepping Test (SST) that combines stepping and response inhibition using low-cost computer game technology to provide a functional measure that reflects real-life behaviour and determined whether this test discriminates between older fallers and non-fallers.
a cross-sectional study, including 103-independent living cognitively intact older people (70-93 years), was conducted. Participants were assessed on the SST and other outcome measures associated with fall-risk. The SST presented arrows on a computer screen with words written within them. Participants were asked to step in the direction indicated by the word and ignore the arrow orientation. Participants also reported whether they had fallen or not in the past 12 months.
twenty-eight percent of participants reported falling in the past year. SST mean time per trial [OR: 1.72 (95% confidence interval 1.02-2.91) and SST errors (OR: 1.53 (1.14-2.07)] were associated with falls. After adjusting for other fall-risk factors in a multivariate logistic regression analysis, each error made during SST increased the odds of falling by a factor 1.7 [OR: 1.65 (1.17-2.34)].
this study shows the SST-a low-cost video game device-is feasible for older people to undertake. The SST was able to distinguish fallers from non-fallers, providing a novel way to explore cognitive mechanisms for fall-risk in older people.
Virtual reality (VR) is an emerging computer-driven simulation technology that appears to be well matched to the assessment and rehabilitation needs of persons with cognitive impairments and functional disabilities. Persons with these difficulties due to acquired brain injuries, neurological disorders, and developmental disabilities could benefit from the development of VR testing and training environments. VR technology is capable of delivering cognitive and functional scenarios that allow for complex, dynamic stimulus presentations and the capacity to record and measure all responses precisely within the virtual environment. In this regard, VR's capacity to improve on the experimental control available in these applications is a neuropsychologist's dream! However, several basic issues need to be considered for the rational and measured development of VR applications for the study, assessment, and rehabilitation of cognitive impairments and functional disabilities. This article begins with brief introductions to the concepts of VR, cognitive and functional abilities, neuropsychological assessment, and cognitive rehabilitation with rationales provided for the applicability of VR in these areas. Basic pragmatic and theoretical issues for these applications are then presented, followed by a description of our ongoing work developing a VR mental rotation and spatial skills cognitive assessment and training system.