Maria T. Schultheis

Analysis of assets for virtual reality applications in neuropsychology

Abstract 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 influence of cognitive impairment on driving performance in multiple sclerosis

Objective: To examine the influence of impaired cognitive processing on measures of driving skills in persons with MS. Methods: Twenty-eight subjects with documented MS were divided into two groups—with [MS(+), n = 13] and without [MS(−), n = 15] cognitive impairment—based on neuropsychological performance. Healthy control (HC) subjects (n = 17) matched on age and driving experience were also studied. Driving-related skills were compared between the groups based on performance on two computerized driving tests: the Useful Field of Vision (UFOV) and the Neurocognitive Driving Test (NDT). Results: The MS(+) group performed significantly worse than both the MS(−) and HC groups in the latency to perform several driving-specific functions on the NDT, but no overall group differences were observed in actual errors on the NDT. On the UFOV, when compared to MS(−) and HC subjects, the MS(+) group demonstrated poorer performance on two of the three subtests. Additionally, a significantly higher percentage of MS(+) individuals were rated within the high risk (probability of crash involvement) category, relative to the MS(−) and HC groups. Conclusions: Cognitive impairment can negatively affect driving-related skills in persons with MS and should be considered in the determination of driving ability.

Virtual reality and neuropsychology: upgrading the current tools.

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 limitations faced by our traditional methods.

Is Learning and Memory Different in a Virtual Environment

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.

Divided attention and driving: A pilot study using virtual reality technology.

Background:Virtual reality (VR) was used to investigate the influence of divided attention (simple versus complex) on driving performance (speed control). Design:Three individuals with traumatic brain injury (TBI) and three healthy controls (HC), matched for age, education, and gender, were examined. Results:Preliminary results revealed no differences on driving speed between TBI and HC. In contrast, TBI subjects demonstrated a greater number of errors on a secondary task performed while driving. Conclusion:The findings suggest that VR may provide an innovative medium for direct evaluation of basic cognitive functions (ie, divided attention) and its impact on everyday tasks (ie, driving) not previously available through traditional neuropsychological measures.

Applications of Functional Near-Infrared Spectroscopy (fNIRS) to Neurorehabilitation of Cognitive Disabilities

Functional Near-Infrared Spectroscopy (fNIRS) is a neuroimaging technique that utilizes light in the near-infrared spectrum (between 700 and 1000 nm) to detect hemodynamic changes within the cortex when sensory, motor, or cognitive activation occurs. FNIRS principles have been used to study brain oxygenation for several decades, but have more recently been applied to study cognitive processes. This paper provides a description of basic fNIRS techniques, and provides a review of the rehabilitation-related literature. The authors discuss strengths and weaknesses of this technique, assert that fNIRS may be particularly beneficial to neurorehabilitation of cognitive disabilities, and suggest future applications.

Driving behaviors following brain injury: self-report and motor vehicle records.

Background:This study examined both objective and subjective measures of driving behaviors occurring in the past 5 years for 47 individuals with traumatic brain injury (TBI) and 22 healthy controls (HC), matched for age, gender, education, and years of driving experience. Results:Overall, subtle descriptive differences in driving characteristics were observed between the two groups. However, comparison of self-reported and documented reports of aberrant driving behaviors did not reveal a significantly greater number of accidents or violations among TBI participants compared with HC drivers. The results suggest that individuals with TBI, who successfully complete a driving evaluation program, are able to reintegrate into the driving community with minimal difficulty.

Electrographic status epilepticus and long-term outcome in critically ill children

Objective: Electrographic seizures (ES) and electrographic status epilepticus (ESE) are common in children in the pediatric intensive care unit (PICU) with acute neurologic conditions. We aimed to determine whether ES or ESE was associated with worse long-term outcomes. Methods: Three hundred children with an acute neurologic condition and encephalopathy underwent clinically indicated EEG monitoring and were enrolled in a prospective observational study. We aimed to obtain follow-up data from 137 subjects who were neurodevelopmentally normal before PICU admission. Results: Follow-up data were collected for 60 of 137 subjects (44%) at a median of 2.7 years. Subjects with and without follow-up data were similar in clinical characteristics during the PICU admission. Among subjects with follow-up data, ES occurred in 12 subjects (20%) and ESE occurred in 14 subjects (23%). Multivariable analysis indicated that ESE was associated with an increased risk of unfavorable Glasgow Outcome Scale (Extended Pediatric Version) category (odds ratio 6.36, p = 0.01) and lower Pediatric Quality of Life Inventory scores (23 points lower, p = 0.001). Among subjects without prior epilepsy diagnoses ESE was associated with an increased risk of subsequently diagnosed epilepsy (odds ratio 13.3, p = 0.002). ES were not associated with worse outcomes. Conclusions: Among children with acute neurologic disorders who were reported to be neurodevelopmentally normal before PICU admission, ESE but not ES was associated with an increased risk of unfavorable global outcome, lower health-related quality of life scores, and an increased risk of subsequently diagnosed epilepsy even after adjusting for neurologic disorder category, EEG background category, and age.

Virtual Reality and Driving: The Road to Better Assessment for Cognitively Impaired Populations

Individuals with cognitive impairments can be faced with difficulties that may challenge their ability to drive an automobile, and this impairment is often very disruptive to vocational, social, and domestic activities. Rehabilitation specialists are often given the task of determining capacity to drive. However, traditional assessment methods are fraught with various limitations, including dependence on subjective interpretation of behaviors, nonstandardized procedures, and few ecologically valid measures. A virtual reality-based driving-assessment system (VR-DAS) offers the opportunity to overcome many of the limitations of current methodologies. Specifically, a VR-DAS permits the development of relevant driving scenarios that can provide objective and quantifiable measures of driving behaviors, allowing for increasing standardization and consistency of protocols. VR-DAS also allows for the creation of realistic and interactive driving scenarios at varying levels of challenge and complexity. When coupled with the immersive features offered through a headmounted display (HMD), the VR-DAS may allow drivers to experience the sense of real-life driving, resulting in behavior and responsiveness that may be more predictive of actual driving ability. To examine these potential benefits and the validity of a VR-DAS, a collaborative study is presently being conducted, comparing VR-DAS performance and actual behind-the-wheel performance in adults with acquired brain injury (such as traumatic brain injury and stroke).

Assessment of Cognitive Neural Correlates for a Functional Near Infrared-Based Brain Computer Interface System

Functional Near Infrared Spectroscopy (fNIR) is a promising brain imaging technology that relies on optical techniques to detect changes of hemodynamic responses within the prefrontal cortex in response to sensory, motor, or cognitive activation. fNIR is safe, non-invasive, affordable, and highly portable. The objective of this study is to determine if biomarkers of neural activity generated by intentional cognitive activity, as measured by fNIR, can be used to communicate directly from the brain to a computer. A bar-size-control task based on a closed-loop system was designed and tested with 5 healthy subjects across two days. Comparisons of the average task and rest period oxygenation changes are significantly different (p<0.01). The average task completion time (reaching +90%) decreases with practice: day1 (mean 52.3 sec) and day2 (mean 39.1 sec). These preliminary results suggest that a closed-loop fNIR-based BCI can allow for a human-computer interaction with a mind switch task.