Analysis of Assets for Virtual Reality Applications in Neuropsychology Albert A. Rizzo, Maria Schultheis, Kimberly A. Kerns, and Catherine Mateer, Neuropsychological Rehabilitation (page 1 of 18) Page 1 of 18

More Information

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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 behavioral 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 VEs, fundamental advancements can emerge in how human cognition and functional behavior is assessed and rehabilitated.

I. Introduction

The field of neuropsychology has grown exponentially over the last three decades. Neuropsychologists have been leaders in providing an understanding of brain organization and brain behavior relationships, giving new insight into the nature and consequences of brain damage, disease and developmental disorders, as well as normal aging processes. Neuropsychologists have developed a wide range of measures to assess cognitive, sensory, and motor abilities, as well as behavioral and self-regulatory functions. The field has maintained high standards with regard to ensuring that neuropsychological (NP) measures are reliable and have adequate construct validity. However, a continuing and important challenge for neuropsychologists has been to find ways to better measure, understand, and predict everyday functional capacities (Wilson, 1997). Borrowing principals and themes from cognitive neuroscience, there has been a tendency to explain behavior by attempting to break it down into separate cognitive abilities or component parts. As a result, though perhaps theoretically useful, many NP tasks themselves appear quite dissimilar to the demands of everyday life. Given the potential mismatch between NP test demands and those of everyday functioning, the predictability of many commonly used NP measures for aspects of adaptive functioning and real life performance has been called into question. Some neuropsychologists have advocated 'top down' tasks, which require integration of a number of cognitive abilities and higher levels of self monitoring (Shallice & Burgess, 1991) to better emulate real life demands. Though such tasks are a step in the right direction, they fail to assess the impact of precise presentation and timing of subtle changes to stimuli and do not analyze response characteristics in any detail. Control or measurement of these aspects of tasks and task performance may be quite important in the prediction of actual everyday abilities and real life function.

Another domain in which cognitive and behavioral assessment play a critical role is in rehabilitation. The identification of useful rehabilitation goals and the measurement of meaningful rehabilitation outcomes are critically dependent on an accurate and reliable assessment of real-world adaptive functioning. Whereas NP assessment may be undertaken for multiple purposes, including diagnosis and description, rehabilitation planning and rehabilitation outcome assessment are critically dependent on tools and techniques that closely predict the individual's ability to function within natural contexts, with all their attendant stimuli and multiplicity of demands. Indeed, the most consistent concern with respect to rehabilitation techniques has been limitations in the ecological validity of the actual rehabilitation activities and resultant limitations in generalization of new abilities, knowledge, and/or skills (Carney, et al. 1999; Park & Ingles, 2001; Ylvisaker & Feeney, 1998).

II. Why Virtual Reality?

The development of virtual reality (VR) technology holds the potential to address many of these areas of concern. By its nature, VR is designed to simulate naturalistic environments. Within these environments, researchers and clinicians can present more ecologically relevant stimuli imbedded in a meaningful and familiar context. Rather than try to predict functional implications from a decontextualized measure of attention, for example, one can look at the effects of systematically increasing ecologically relevant attentional demands in a virtual environment (VE), such as a classroom, office, or store. VR technology allows for exquisite timing and control over distractions, stimulus load and complexity, and can alter these variables in a dynamic way contingent on the response characteristics of the client. Response characteristics in terms of accuracy, timing, and consistency can also be collected to allow a finer and detailed analysis of responses.

From Neuropsychological Rehabilitation, 2004. 14(1/2), 207-239. Reprinted with permission from Albert Rizzo. All rights reserved.

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