Virtual reality and neuropsychological assessment: The reliability of a virtual kitchen to assess daily-life activities in victims of traumatic brain injury.

Traumatic brain injury (TBI) causes impairments affecting instrumental activities of daily living (IADL). However, few studies have considered virtual reality as an ecologically valid tool for the assessment of IADL in patients who have sustained a TBI. The main objective of the present study was to examine the use of the Nonimmersive Virtual Coffee Task (NI-VCT) for IADL assessment in patients with TBI. We analyzed the performance of 19 adults suffering from TBI and 19 healthy controls (HCs) in the real and virtual tasks of making coffee with a coffee machine, as well as in global IQ and executive functions. Patients performed worse than HCs on both real and virtual tasks and on all tests of executive functions. Correlation analyses revealed that NI-VCT scores were related to scores on the real task. Moreover, regression analyses demonstrated that performance on NI-VCT matched real-task performance. Our results support the idea that the virtual kitchen is a valid tool for IADL assessment in patients who have sustained a TBI.

Detecting everyday action deficits in Alzheimer's disease using a nonimmersive virtual reality kitchen.

Alzheimer's disease (AD) causes impairments affecting instrumental activities of daily living (IADL). Transdisciplinary research in neuropsychology and virtual reality has fostered the development of ecologically valid virtual tools for the assessment of IADL, using simulations of real life activities. Few studies have examined the benefits of this approach in AD patients. Our aim was to examine the utility of a non-immersive virtual coffee task (NI-VCT) for assessment of IADL in these patients. We focus on the assessment results obtained from a group of 24 AD patients on a task designed to assess their ability to prepare a virtual cup of coffee, using a virtual coffee machine. We compared performance on the virtual task to an identical daily living task involving the actual preparation of a cup of coffee, as well as to global cognitive, executive, and caregiver-reported IADL functioning. Relative to 32 comparable, healthy elderly (HE) controls, AD patients performed worse than HE controls on all tasks. Correlation analyses revealed that NI-VCT measures were related to all other neuropsychological measures. Moreover, regression analyses demonstrated that performance on the NI-VCT predicted actual task performance and caregiver-reported IADL functioning. Our results provide initial support for the utility of our virtual kitchen for assessment of IADL in AD patients.

Assessment of executive function in adolescence: a comparison of traditional and virtual reality tools.

Paper-pencil type tests are traditionally used in the assessment of executive functions (EF); however, concerns have been raised as to whether these represent actual functioning in everyday life. Virtual reality (VR) environments offer a novel alternative for the assessment of cognitive function and therefore have the potential to enhance the evaluation of EF by presenting individuals with stimuli that come closer to reproducing everyday situations. The aims of this study were to (1) establish which traditional paper-pencil EF tests from the Delis-Kaplan Executive Function System (D-KEFS) are associated with performance on a VR-Stroop task and (2) compare D-KEFS tests and the VR-Stroop task in their ability to predict everyday EF and behavior, as measured by the Behavioral Rating Inventory of Executive Function (BRIEF) and the Child Behavior Checklist (CBCL). Thirty-eight typically developing adolescents aged between 13 and 17 years completed the ClinicaVR: Classroom-Stroop, and five D-KEFS subtests (Trail Making, Tower, Twenty Questions, Verbal Fluency and Color-Word Interference). Their parents completed the BRIEF and CBCL questionnaires. The results indicate that performance on the VR-Stroop task correlates with both traditional forms of EF assessment (D-KEFS, BRIEF). In particular, performance on the VR-Stroop task was closely associated with performance on a paper-pencil inhibition task. Furthermore, VR-Stroop performance more accurately reflected everyday behavioral EF than paper-pencil tasks. VR appears to offer an ecological perspective on everyday functioning and could be seen as complementary to traditional tests in the assessment of complex cognitive abilities.

Development and initial assessment of a new paradigm for assessing cognitive and motor inhibition: the bimodal virtual-reality Stroop.

Assessing and predicting inhibition in adults is a common assignment for clinicians. However, there is no single measure of inhibition that is complete, sensitive and enjoyable. The main goal of this study was to develop a virtual reality neuropsychological task (the bimodal VR-Stroop) capable of measuring both cognitive (control of internal and external interference) and motor inhibition (a go no-go paradigm with reaction time variation, commission errors and omissions). Preliminary data obtained with 71 healthy adult participants confirmed that the VR-Stroop is capable of eliciting the Stroop effect with bimodal stimuli. Initial validation data also suggested that measures of the VR-Stroop significantly correlate with measures of the Elevator counting with distracters, the Continuous Performance Task (CPT-II), and the Stop-it task. Finally, regression analyses indicated that commission errors and variability of reaction times at the VR-Stroop were significantly predicted by scores of the Elevator task and the CPT-II. These preliminary results suggest that the VR-Stroop is an interesting measure of cognitive and motor inhibition for adults, although confirmatory investigations are warranted.

Virtual reality as a screening tool for sports concussion in adolescents.

PRIMARY OBJECTIVE: There is controversy surrounding the cognitive effects of sports concussion. This study aimed to verify whether the technique of virtual reality could aid in the identification of attention and inhibition deficits in adolescents. STUDY DESIGN: A prospective design was used to assess 25 sports-concussed and 25 non-sports-concussed adolescents enrolled in a sport and education programme. METHODS AND PROCEDURES: Participants were evaluated in immersive virtual reality via ClinicaVR: Classroom-CPT and in real life via the traditional VIGIL-CPT. MAIN OUTCOMES AND RESULTS: The neuropsychological assessment using virtual reality showed greater sensitivity to the subtle effects of sports concussion compared to the traditional test, which showed no difference between groups. The results also demonstrated that the sports concussion group reported more symptoms of cybersickness and more intense cybersickness than the control group. CONCLUSIONS: Sports concussion was associated with subtle deficits in attention and inhibition. However, further studies are needed to support these results.

Assessment of inhibition deficits with the virtual classroom in children with traumatic brain injury: a pilot-study.

This study compared the performance of 8 children who have sustained a traumatic brain injury on the traditional VIGIL Continuous Performance Test and the Continuous Performance Test included in the Virtual Classroom. Results supported the hypothesis, showing that the Continuous Performance Test from the Virtual Classroom showed more sensitivity concerning inhibition deficits. More precisely, children showed more commission errors and longer reaction time. These results can be explained by the ecological character of the Virtual Classroom, meaning that this instrument is close to real-life experiences and requires more attention and inhibition resources.

Comparative study of the cognitive sequelae of school-aged victims of Shaken Baby Syndrome.

OBJECTIVE: Shaken Baby Syndrome (SBS) is now recognized as being the main cause of severe traumatic brain injury in infancy. However, our understanding of the impact of this type of abuse on child development remains sketchy. The main objective of the current study was therefore to shed light on the cognitive dysfunctions that are particular to SBS victims once they are school-aged. METHOD: A clinical group was formed of 11 children diagnosed with SBS who had been admitted between 1988 and 1999 to a tertiary pediatric hospital in Quebec, Canada. The children were matched for age, gender, socio-economic status, and family composition to 11 healthy Quebec children, who made up the control group. A battery of composite tests was developed to assess the children's main cognitive functions and was administered individually to the 22 children. A univariate t-test was used to compare the performances of the two groups. RESULTS: The mean age of the children in the clinical and control groups at the time of the assessment was 87.64 months and 90.18 months, respectively. Pairing and birth data were equivalent for both groups. Significant weaknesses were noted in the clinical group for intelligence quotient (IQ), working memory, mental organization, alternation, and inhibition. These deficits seemed to have a greater impact on the verbal sphere of the children's mental functioning. CONCLUSION: Primary results point to the anterior cerebral regions of the brain as the principal site of dysfunctions that persist years post-trauma. It is important to consider these results longitudinally, even in children apparently less extensively affected, since the frontal regions only reach maturity at the end of adolescence.

Using neuropsychological profiles to classify neglected children with or without physical abuse.

OBJECTIVE: The aim of this study is twofold: First, to investigate whether cognitive functions can contribute to differentiating neglected children with or without physical abuse compared to comparison participants; second, to demonstrate the detrimental impact of children being victimized by a combination of different types of maltreatment. METHODOLOGY: Seventy-nine children aged 6-12 years and currently receiving Child Protection Services because of one of two types of maltreatment (neglect with physical abuse, n=56; neglect without physical abuse, n=28) were compared with a control group of 53 children matched for age, gender, and annual family income. The neuropsychological assessment focused on motor performance, attention, memory and learning, visual-motor integration, language, frontal/executive functions, and intelligence. RESULTS: Discriminant analysis identified auditory attention and response set, and visual-motor integration (Function 1), and problem solving, abstraction, and planning (Function 2) as the two sets of variables that most distinguished the groups. Discriminant analysis predicted group membership in 80% of the cases. Children who were neglected with physical abuse showed cognitive deficits in auditory attention and response set, and visual-motor integration (Function 1) and problem solving, abstraction, and planning (Function 2). Children who were neglected without physical abuse differed from the control group in that they obtained lower scores in auditory attention and response set, and visual-motor integration (Function 1). Surprisingly, these same children demonstrated a greater capacity for problem solving, abstraction, and planning (Function 2) than the physically abused neglected and control children. CONCLUSION: The present study underscores the relevance of neuropsychology to maltreatment research. The results support the heterogeneity of cognitive deficits in children based on different types of maltreatment and the fact that neglect with physical abuse is more harmful than neglect alone.

Relations among sociodemographic, neurologic, clinical, and neuropsychologic variables, and vocational status following mild traumatic brain injury: a follow-up study.

OBJECTIVES: To explore the long-term relations among sociodemographic, neurologic, clinical, and neuropsychologic variables, and vocational status in persons with mild traumatic brain injury (MTBI), and to identify the symptoms that determine whether or not these individuals return to work. DESIGN: Longitudinal quasi-experimental between-groups design. PARTICIPANTS: Eighty-five MTBI subjects aged between 16 and 65 years. SETTING: The emergency ward of the Trois-Rivieres Regional Hospital Centre in Quebec, Canada. MAIN OUTCOME MEASURES: Age, gender, Glasgow Coma Scale score, duration of posttraumatic amnesia, duration of retrograde amnesia, total of symptoms at emergency, time elapsed since the trauma, Paced Auditory Serial Addition Task, Stroop Color Word Test, California Verbal Learning Test, and the number of symptoms at follow-up (12 to 36 months posttrauma). RESULTS: Only the total number of symptoms reported at follow-up was related to vocational status. The majority of individuals had returned to work 1 year or more post-MTBI. Individuals who had not returned to work reported the greatest number of symptoms, which could be linked to their affective status. Six affective symptoms, 5 cognitive symptoms, 6 physical symptoms, and 8 symptoms relating to social and daily life activities differentiated the participants who had returned to work from those who had not. CONCLUSIONS: Patient characteristics, injury severity indicators, and cognitive functions were not associated with vocational status. To better understand post-MTBI vocational status, it is important to focus on subjective complaints that arise following the injury.

Executive memory dysfunctions following mild traumatic brain injury.

OBJECTIVES: To explore the contribution of executive dysfunctions to mnemonic problems in adults with mild traumatic brain injury (MTBI). DESIGN: Prospective quasiexperimental between-groups design. PARTICIPANTS: Ninety-nine persons with MTBI were compared to 90 control group participants matched for gender, age, and education. SETTING: Two Canadian brain injury rehabilitation programs. MAIN OUTCOME MEASURE: California Verbal Learning Test. RESULTS: Participants with MTBI showed a significant deficit in free recall on the California Verbal Learning Test but performed similarly to the comparison group on the recognition task. Furthermore, the participants with MTBI were less likely to use semantic clustering as a memorizing strategy and made more intrusion errors and false-positive errors on the recognition task. CONCLUSIONS: While the scores for the participants with MTBI are only slightly lower than the norm, they demonstrate that MTBI has a negative effect on mnemonic performance. The results are explained in terms of a deficit in registration/retrieval processes rather than a malfunction of the storage processes. This supports the initial hypothesis that executive dysfunctions are detrimental to the quality of mnemonic functions in patients with MTBI.