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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 8 of 18) Page 8 of 18

5. The capacity for complete performance capture and the availability of a more naturalistic/intuitive performance record for review and analysis.

The review of a client's performance in any assessment and training activity typically involves examination of numeric data and subsequent translation of that information into graphic representations in the form of tables and graphs. Sometimes videotaping of the actual event is used for a more naturalistic review and for behavior rating purposes. These methods, while of some value, are typically quite labor intensive to produce and sometimes deliver a less than intuitive method for visualizing and understanding a complex performance record. These challenges are compounded when the goal of the review is to provide feedback and insight to clients whose cognitive impairments may preclude a useful understanding of traditional forms of data presentation. VR offers the capability to capture and review a complete digital record of performance in a virtual environment from many perspectives. For example, performance in a VE can be later observed from the perspective of the user, from the view of a third party or position within the VE and from what is sometimes termed, a "God's eye view", from above the scene with options to adjust the position and scale of the view. This can allow a client to observe their performance from multiple perspectives and repeatedly review their performance. Options for this review also include the modulation of presentation as in allowing the client to slow down rate of activity and observe each behavioral step in the sequence in "slow motion".

Advanced programs to do this have already been developed by the military to conduct what is termed After Action Reviews (Morrison & Meliza, 1999). In military VR applications that often include multiple participants in a shared virtual space, a computerized After Action Review tool can allow the behavior of any participant to be reviewed from multiple vantage points at any temporal point in the digital training exercise. This is now standard procedure for military simulation training, but has had limited application in traditional NP approaches. With the exception of less naturalistic review of paper and pencil results and the occasionally review of a client's video taped performance from a single fixed position, the capacity to provide more intuitive "first-person" perspective views to clients has not been feasible with existing technology.

Thus far, this VR asset has begun to appear as a feature for reviewing navigational performance in a number of wayfinding and place learning applications (Astur, Oriz & Sutherland, 1998; Jacobs, Laurance & Thomas, 1997; Skelton et al., 2000). This has mainly been used in applications where a tracked movement record is vital for measuring the dependent variable of exploratory behavior. Systematic studies of the clinical use of this form of performance record review have yet to appear in the literature, although the capacity to present this information exists with most applications, but requires additional programming to extract and display it. In this regard, the first author's lab has developed a visual record review method for replaying children's head movements while they are tracking stimuli within a virtual classroom. This application (Rizzo et al., 2000; 2002b) takes data from a magnetic field tracking device positioned on top of the head mounted display and represents the captured movement via a virtual representation of a person's head. The head faces outward on the screen and "straightforward" head position represents the attentive gaze at the virtual blackboard where target hit stimuli are displayed to the child. During playback, it is possible to observe the child's head movements during discrete periods when distracting stimuli are presented around the classroom. Head movements away from the center of the screen represent the child's actual movements to follow the distracting stimuli on each side of the classroom instead of the face forward position required to view the target stimuli. This presentation format delivers an extremely intuitive understanding of the distractibility of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) during VR classroom performance testing. In the initial prototype of this system, we can deliver side-by-side concurrent performance of both a non-diagnosed and ADHD child and observe the stark contrast in their head turning away from the target stimuli during distraction periods. Thus far in selected case comparisons, the non-diagnosed children are noticed to turn in the direction of the distraction very briefly, but nearly immediately return to the on-task position. By contrast, the children with ADHD are often observed to look away and then continue off task for varying extended periods of time resulting in subsequent omission performance errors. The "head to head" playback of these head movements serves to underscore in an intuitive manner, the significant findings of off task head position that were revealed from the complex statistical analyses of this movement data. Integration of this form of intuitive performance record review could serve to provide insight for understanding the behavior of ADHD children to professionals, parents and perhaps even the tested child, in a manner not possible with graphs and data tables. This is an asset in which VR may add value across all areas of performance testing and training that is not readily available with existing traditional tools.

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

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