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Analysis of Assets for Virtual Reality Applications in Neuropsychology Albert A. Rizzo, Maria Schultheis, Kimberly A. Kerns, and Catherine Mateer, Neuropsychological Rehabilitation (page 2 of 18) Page 2 of 18

When discussion of the potential for VR applications in neuropsychology first emerged in the mid-1990s (Pugnetti, Mendozzi, Motta, Cattaneo, Barbieri, & Brancotti 1995; Rizzo, 1994; Rose, Attree & Johnson, 1996), the technology to deliver on the anticipated "visions" was not in place. Consequently, during these early years VR suffered from a somewhat imbalanced "expectation-to-delivery" ratio, as most users trying systems during that time will attest. The "real" thing never quite measured up to expectations generated by some of the initial media hype, as delivered for example in the films "The Lawnmower Man" and "Disclosure"! Yet the idea of producing simulated virtual environments that allowed for the systematic delivery of ecologically relevant cognitive challenges was compelling and made intuitive sense. As well, a long and rich history of encouraging findings from the aviation simulation literature lent support to the concept that testing and training in highly proceduralized VR simulation environments would be a useful direction for neuropsychology to explore (Johnston, 1995; Rizzo, 1994). Within this context, a small group of researchers began the initial work of exploring the use of VR technology for applications designed to target cognitive/functional performance in populations with CNS dysfunction. While a good deal of this early work employed non-head mounted display flatscreen environments, these less immersive systems produced encouraging results (Cromby et al., 1996; Rose et al., 2001; Stanton, Foreman & Wilson, 1998). This work demonstrated the unique value of the technology, served to inform future applications and created a demand for the assets available with more immersive VR approaches.

Over the last few years, revolutionary advances in the underlying VR enabling technologies (i.e., computation speed and power, graphics and image rendering technology, display systems, interface devices, immersive audio, haptics tools, wireless tracking, voice recognition, intelligent agents, and authoring software) have supported development resulting in more powerful, low-cost PC-driven VR systems. Such advances in technological "prowess" and accessibility have provided the hardware platforms needed for the conduct of human research within more usable and useful VR scenarios. From this, current research efforts to develop more accessible VR systems have produced applications that are delivering encouraging results on a wide range of cognitive, physical, emotional, social, vocational and psychological human issues and research questions (Blascovich et al., 2002; Rizzo, Buckwalter & van der Zaag, 2002a; Weiss & Jessel, 1998; Zimand et al., in press).

III. Analysis of VR Assets

What makes VR application development in this area so distinctively important is that it represents the potential for more than a simple linear extension of existing computer technology for human use. This was recognized early on in a visionary article ("The Experience Society") by VR pioneer, Myron Kruegar (1993), in his prophetic statement that, "…Virtual Reality arrives at a moment when computer technology in general is moving from automating the paradigms of the past, to creating new ones for the future". (p. 163). By way of VRs capacity to place a person within an immersive, interactive computer generated simulation environment, new possibilities exist that go well beyond simply automating the delivery of existing paper and pencil testing and training tools on a personal computer. However, while encouraging on a theoretical level, the value of this technology for neuropsychology still needs to be substantiated via systematic empirical research with normal and clinical populations that can be replicated by others. To accomplish this first requires specification as to the real assets that VR offers that add value over existing methodologies, as well as further exploration of its current limitations. Non-immersive computerized testing and training tools have been available for some time and a case can be made that they offer some of the same features found with immersive head mounted display VR. As well, in spite of the many claims that computers would revolutionize cognitive rehabilitation in the late 1980's, the manifested value of these tools have been questioned by some (Robertson, 1990). Therefore it becomes imperative that research be conducted to determine the incremental value of VR-specific assets (i.e., immersive, naturalistic and/or supra-normal human computer interaction) over already existing methods. To address these issues we will discuss the assets that are available with VR along with examples of NP assessment and rehabilitation research and findings from related fields that illustrate the relevance of these assets. Challenges that still need to be addressed will also be discussed.

1. The capacity to systematically deliver and control dynamic, interactive 3D stimuli within an immersive environment that would be difficult to present using other means.

One of the cardinal assets of any advanced form of simulation technology involves the capacity for systematic delivery and control of stimuli. This asset provides significant opportunities for advancing NP methods. In fact, one could conjecture that the basic foundation of all human research methodology requires the systematic delivery and control of an environment and the subsequent capture and analysis of the behavior that occurs within the environment. In this regard, an ideal match appears to exist between the stimulus delivery assets of VR simulation approaches and the requirements of NP assessment and rehabilitation. Much like an aircraft simulator serves to test and train piloting ability, VEs can be developed to present simulations that assess and rehabilitate human cognitive and functional processes under a range of stimulus conditions that are not easily controllable in the real world. This "Ultimate Skinner Box" asset can be seen to provide value across the spectrum of NP approaches, from analysis at a molecular level targeting component cognitive processes (e.g., selective attention performance contingent on varying levels of stimulus intensity exposure), to the complex targeting of more molar functional behaviors (e.g., planning and initiating the steps required to prepare a meal in a chaotic setting).

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

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