Being in the Past and Perform the Future in a Virtual World: VR Applications to Assess and Enhance Episodic and Prospective Memory in Normal and Pathological Aging

The process of aging commonly features a gradual deterioration in cognitive performance and, in particular, the decline of memory. Despite the increased longevity of the world's population, the prevalence of neurodegenerative conditions, such as dementia, continues to be a major burden on public health, and consequently, the latest research has been focused on memory and aging. Currently, the failure of episodic and Prospective memory (PM) is one of the main complaints in the elderly, considered among the early symptoms of dementia. It is therefore increasingly important to define more clearly the boundaries between normal and pathological aging. Recently, researchers have begun to build and apply Virtual Environments (VE) to the explicit purpose of better understanding the performance of episodic and PM in complex and realistic contexts, with the perspective of further developing effective training procedures that depend on reliable cognitive assessment methods. Virtual technology offers higher levels of realism than "pen and paper" testing and at the same time more experimental control than naturalistic settings. In this mini-review article, we examine the outcomes of recently available studies on virtual reality technology applications developed for the assessment and improvement of episodic and/or PM. To consider the latest technology, we selected 29 articles that have been published in the last 10 years. These documents show that VR-based technologies can provide a valid basis for screening and treatment and, through increased sensory stimulation and enriched environments reproducing the scenarios of everyday life, could represent effective stimulating experiences even in pathological aging

Visualization and Interaction Technologies in Serious and Exergames for Cognitive Assessment and Training: A Survey on Available Solutions and Their Validation

Exergames and serious games, based on standard personal computers, mobile devices and gaming consoles or on novel immersive Virtual and Augmented Reality techniques, have become popular in the last few years and are now applied in various research fields, among which cognitive assessment and training of heterogeneous target populations. Moreover, the adoption of Web based solutions together with the integration of Artificial Intelligence and Machine Learning algorithms could bring countless advantages, both for the patients and the clinical personnel, as allowing the early detection of some pathological conditions, improving the efficacy and adherence to rehabilitation processes, through the personalisation of training sessions, and optimizing the allocation of resources by the healthcare system. The current work proposes a systematic survey of existing solutions in the field of cognitive assessment and training. We evaluate the visualization and interaction technologies commonly adopted and the measures taken to fulfil the need of the pathological target populations. Moreover, we analyze how implemented solutions are validated, i.e. The chosen experimental designs, data collection and analysis. Finally, we consider the availability of the applications and raw data to the large community of researchers and medical professionals and the actual application of proposed solutions in the standard clinical practice. Despite the potential of these technologies, research is still at an early stage. Although the recent release of accessible immersive virtual reality headsets and the increasing interest on vision-based techniques for tracking body and hands movements, many studies still rely on non-immersive virtual reality (67.2%), mainly mobile and personal computers, and standard gaming tools for interactions (41.5%). Finally, we highlight that although the interest of research community in this field is increasingly higher, the sharing of dataset (10.6%) and implemented applications (3.8%) should be promoted and the number of healthcare structures which have successfully introduced the new technological approaches in the treatment of their host patients is limited (10.2%)

Virtual Reality for Enhanced Ecological Validity and Experimental Control in the Clinical, Affective and Social Neurosciences

This article highlights the potential of virtual reality environments for enhanced ecological validity in the clinical, affective, and social neurosciences

Recommendations for the Design and Implementation of Virtual Reality for Acquired Brain Injury Rehabilitation: Systematic Review

Background: Virtual reality (VR) is increasingly being used for the assessment and treatment of impairments arising from acquired brain injuries (ABIs) due to perceived benefits over traditional methods. However, no tailored options exist for the design and implementation of VR for ABI rehabilitation and, more specifically, traumatic brain injury (TBI) rehabilitation. In addition, the evidence base lacks systematic reviews of immersive VR use for TBI rehabilitation. Recommendations for this population are important because of the many complex and diverse impairments that individuals can experience. Objective: This study aims to conduct a two-part systematic review to identify and synthesize existing recommendations for designing and implementing therapeutic VR for ABI rehabilitation, including TBI, and to identify current evidence for using immersive VR for TBI assessment and treatment and to map the degree to which this literature includes recommendations for VR design and implementation. Methods: This review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive search of 11 databases and gray literature was conducted in August 2019 and repeated in June 2020. Studies were included if they met relevant search terms, were peer-reviewed, were written in English, and were published between 2009 and 2020. Studies were reviewed to determine the level of evidence and methodological quality. For the first part, qualitative data were synthesized and categorized via meta-synthesis. For the second part, findings were analyzed and synthesized descriptively owing to the heterogeneity of data extracted from the included studies. Results: In the first part, a total of 14 papers met the inclusion criteria. Recommendations for VR design and implementation were not specific to TBI but rather to stroke or ABI rehabilitation more broadly. The synthesis and analysis of data resulted in three key phases and nine categories of recommendations for designing and implementing VR for ABI rehabilitation. In the second part, 5 studies met the inclusion criteria. A total of 2 studies reported on VR for assessment and three for treatment. Studies were varied in terms of therapeutic targets, VR tasks, and outcome measures. VR was used to assess or treat impairments in cognition, balance, and anxiety, with positive outcomes. However, the levels of evidence, methodological quality, and inclusion of recommendations for VR design and implementation were poor. Conclusions: There is limited research on the use of immersive VR for TBI rehabilitation. Few studies have been conducted, and there is limited inclusion of recommendations for therapeutic VR design and implementation. Future research in ABI rehabilitation should consider a stepwise approach to VR development, from early co-design studies with end users to larger controlled trials. A list of recommendations is offered to provide guidance and a more consistent model to advance clinical research in this area

Novel supports to the assessment of cognitive functions through the combined use of technologies and subjective and objective measurements

Tesis por compendio[ES] Las funciones cognitivas incluyen todos los procesos a través de los cuales un individuo percibe, registra, mantiene, manipula, usa y expresa información que está involucrada en cualquier actividad cotidiana. Las principales herramientas estandarizadas se pueden dividir en tres grupos principales: escalas cortas de pruebas de seguimiento cognitivo: cuestionarios, baterías neuropsicológicas generales y pruebas específicas. Estas herramientas están bien validadas y son confiables, pero, en la última década, varias investigaciones han demostrado que algunos pacientes pueden realizar bien estas pruebas neuropsicológicas, incluso cuando tienen dificultades significativas para adaptar sus comportamientos a las actividades de la vida diaria. De acuerdo con esto, más recientemente, un nuevo enfoque ha aumentado sustancialmente, lo que podría proporcionar una mayor validez ecológica en la evaluación de las capacidades cognitivas funcionales que el enfoque estandarizado: el uso de sistemas tecnológicos avanzados para la evaluación neuropsicológica (STAEN). STAEN se refiere a un conjunto de dispositivos y aplicaciones de software tales como pruebas computarizadas, juegos divertidos e interactivos de fantasía (JS) y / o sistemas de realidad virtual simulada (RV) y / o aumentada (RA) que van más allá de las pruebas de evaluación tradicionales y que Brindar la posibilidad de entregar estímulos controlados y dinámicos, en entornos ecológicamente válidos y seguros. Partiendo de estas premisas, el objetivo principal de la tesis era diseñar, desarrollar y validar un SG 2D no inmersivo versus un JS 3D inmersivo y una actividad de la vida diaria en un entorno 3D RV inmersivo versus un RA para la evaluación de funciones cognitivas, comparando la eficacia y efectividad de ellos. El primer estudio 2D incluyó 354 sujetos sanos y se encontraron correlaciones entre el juego y los métodos tradicionales, lo que sugiere que el juego podría ser una herramienta válida para evaluar las funciones cognitivas en adultos. El segundo estudio, comparó la versión 2D versus una versión 3D STAEN, involucró a 94 sujetos sanos y mostró que la versión 3D fue capaz de generar tiempos más bajos y respuestas correctas más altas que la 2D, lo que sugiere evidencia inicial de la eficacia de un sistema más inmersivo en comparación con un sistema no-inmersivo. Aunque este resultado destaca una posible limitación en el uso de diferentes sistemas tecnológicos debido a las diferencias en los dos métodos de interacción (el sistema 2D aplicó el mouse y el teclado; los controladores de dos manos virtuales 3D) y el registro de datos de latencia de hardware y software. Con respecto a la variabilidad individual en edad, género y educación, los hallazgos mostraron consistencia con la literatura de referencia. Específicamente, los más jóvenes mostraron un mayor rendimiento que los mayores; niveles educativos más altos reflejados en una mejor puntuación y sobre género, los resultados mostraron un panorama más compuesto. Además, para mejorar la validez ecológica de la evaluación, el último estudio de esta tesis comparó el rendimiento conductual y las respuestas fisiológicas, durante una tarea de cocina ecológica, entre un sistema virtual y un sistema aumentado en 50 sujetos sanos. La tarea de cocinar consistió en 4 niveles que aumentaron en dificultad. A medida que el nivel aumentó, aparecieron actividades adicionales. Los resultados de comportamiento mostraron que los tiempos son siempre más bajos en realidad virtual que en RA, aumentando constantemente de acuerdo con la dificultad de las tareas. Con respecto a las respuestas fisiológicas, los hallazgos mostraron que la condición RA produjo más excitación y activación individual que la realidad virtual. Para concluir, STAEN está demostrando ser herramientas confiables y efectivas para la evaluación de las funciones cognitivas en adultos, proporcionando más validez ec[CA] Les funcions cognitives inclouen tots els processos a través dels quals un individu percep, registra, manté, manipula, usa i expressa informació que està involucrada en qualsevol activitat quotidiana. Les principals ferramentes estandarditzades es poden dividir en tres grups principals: escales curtes de proves de seguiment cognitiu: qüestionaris, bateries neuropsicológiques generals i proves específiques. Estes ferramentes estan ben validades i són confiables, però, en l'última dècada, diverses investigacions han demostrat que alguns pacients poden realitzar bé estes proves neuropsicológiques, inclús quan tenen dificultats significatives per a adaptar els seus comportaments a les activitats de la vida diària. D'acord amb açò, més recentment, un nou enfocament ha augmentat substancialment, la qual cosa podria proporcionar una major validesa ecològica en l'avaluació de les capacitats cognitives funcionals que l'enfocament estandarditzat: l'ús de sistemes tecnològics avançats per a l'avaluació neuropsicológica (STAEN). STAEN es referix a un conjunt de dispositius i aplicacions de software com ara proves computaritzades, jocs divertits i interactius de fantasia (JS) i / o sistemes de realitat virtual simulada (RV) i / o augmentada (RA) que van més enllà de les proves d'avaluació tradicionals i que brinden la possibilitat de presentar estímuls controlats i dinàmics, en entorns ecològicament vàlids i segurs. Partint d'estes premisses, l'objectiu principal de la tesi era dissenyar, desenrotllar i validar un SG 2D no inmersiu versus un JS 3D inmersiu i una activitat de la vida diària en un entorn 3D RV inmersiu versus un RA per a l'avaluació de funcions cognitives, comparant l'eficàcia i efectivitat d'ells. El primer estudi 2D va incloure 354 subjectes sans i es van trobar correlacions entre el joc i els mètodes tradicionals, la qual cosa suggerix que el joc podria ser una ferramenta vàlida per a avaluar les funcions cognitives en adults. El segon estudi, va comparar la versió 2D versus una versió 3D STAEN, va involucrar a 94 subjectes sans i va mostrar que la versió 3D va ser capaç de generar temps més baixos i respostes correctes més altes que la 2D, la qual cosa suggerix evidència inicial de l'eficàcia d'un sistema més inmersiu en comparació amb un sistema no-inmersiu. Encara que este resultat destaca una possible limitació en l'ús de diferents sistemes tecnològics a causa de les diferències en els dos mètodes d'interacció (el sistema 2D va aplicar el ratolí i el teclat; els controladors de dos mans virtuals 3D) i el registre de dades de latència de hardware i software. Respecte a la variabilitat individual en edat, gènere i educació, les troballes van mostrar consistència amb la literatura de referència. Específicament, els més jóvens van mostrar un major rendiment que els majors; nivells educatius més alts reflectits en una millor puntuació i sobre gènere, els resultats van mostrar un panorama més compost. A més, per a millorar la validesa ecològica de l'avaluació, l'últim estudi d'esta tesi va comparar el rendiment conductual i les respostes fisiològiques, durant una tasca de cuina ecològica, entre un sistema virtual i un sistema augmentat en 50 subjectes sans. La tasca de cuinar va consistir en 4 nivells que van augmentar en dificultat. A mesura que el nivell va augmentar, van aparéixer activitats addicionals. Els resultats de comportament van mostrar que els temps són sempre més baixos en realitat virtual que en RA, augmentant constantment d'acord amb la dificultat de les tasques. Respecte a les respostes fisiològiques, les troballes van mostrar que la condició RA va produir més excitació i activació individual que la realitat virtual. Per a concloure, STAEN està demostrant ser ferramentes confiables i efectives per a l'avaluació de les funcions cognitives en adults, proporcionant més validesa ecològica i objectivitat que els mètodes tradicio[EN] Cognitive functions include all the processes through which an individual perceives, records, maintains, manipulates, uses and expresses information that are involved in any everyday activity. The main standardized tools can be divided in three main groups: short scales of cognitive tracking tests - questionnaires, general neuropsychological batteries, and specific tests. These tools are well-validated and reliable but, in the last decade, several research have shown that some patients can perform these neuropsychological tests well, even when they have significant difficulties in adapting their behaviours to daily life activities. According to this, more recently, a new approach has substantially increased, potentially providing a higher ecological validity in functional cognitive abilities assessment than standardized approach: the use of advanced technological systems for neuropsychological assessment (ATSNA). ATSNA refer to a set of devices and software applications such as computerized tests, fun and interactive fantasy serious games (SG), and/or simulated virtual (VR) and/or augmented (AR) reality systems that go beyond traditional assessment tests and that supply the possibility to deliver controlled and dynamic stimuli, in ecologically valid, and secure environments. Starting from these premises, the main objective of the thesis was to design, develop, and validate a non-immersive 2D SG versus an immersive 3D SG and a daily life activity in an immersive 3D VR environment versus an AR for the assessment of cognitive functions, comparing the efficacy and effectiveness of them. The first 2D study involved 354 healthy subjects and correlations were found between the game and traditional methods, suggesting that the game could be a valid tool for assessing cognitive functions in adults. The second study, compared 2D versus a 3D ATSNA version, it involved 94 healthy subjects and showed that 3D version was able to generate lower times and higher correct answers that the 2D, suggesting initial evidence of efficacy of a more immersive system compared to a non-immersive system. Although this result highlights a potential limitation on using different technological systems due to the differences on the two interaction methods (the 2D system applied mouse and keyboard; the 3D two virtual hands' controllers) and hardware and software latency data recording. Regarding individual variability on age, gender, and education, the findings showed consistency with the reference literature. Specifically, younger showed higher performance that older; higher educational levels reflected on a better score and about gender, results showed a more composite panorama. Furthermore, to enhance the ecological validity of assessment, the last study of this thesis compared the behavioural performance and physiological responses, during an ecological cooking task, between a virtual and an augmented system on 50 healthy subjects. The cooking task consisted of 4 levels that increased in difficulty. As the level increased, additional activities appeared. The behavioural results showed that times are always lower in VR than in AR, increasing constantly in accordance with the difficulty of the tasks. Regarding physiological responses, the findings showed that AR condition produced more individual excitement and activation than VR. To conclude, ATSNA are proving to be reliable and effective tools for the assessment of cognitive functions in adults, providing more ecological validity and objectivity than traditional methods of assessment.Chicchi Giglioli, IAM. (2020). Novel supports to the assessment of cognitive functions through the combined use of technologies and subjective and objective measurements [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/139075TESISCompendi

Efficacy of Multisensory Technology in Post-Stroke Cognitive Rehabilitation: A Systematic Review

Post-stroke, in addition to sensorimotor signs and symptoms, could lead to cognitive deficits. Theories of embodiment stress the role of sensorimotor system and multisensory integration in sustaining high-order cognitive domains. Despite conventional post-stroke cognitive rehabilitation being effective, innovative technologies could overcome some limitations of standard interventions and exploit bodily information during cognitive rehabilitation. This systematic review aims to investigate whether ‘multisensory technologies’ compared to usual care treatment can be a viable alternative for cognitive rehabilitation. By applying PRISMA guidelines, we extracted data and assessed the bias of 10 studies that met the required criteria. We found that multisensory technologies were at least comparable to standard treatment but particularly effective for attention, spatial cognition, global cognition, and memory. Multisensory technologies consisted principally of virtual reality alone or combined with a motion tracking system. Multisensory technologies without motion tracking were more effective than standard procedures, whereas those with motion tracking showed balanced results for the two treatments. Limitations of the included studies regarded the population (e.g., no study on acute stroke), assessment (e.g., lack of multimodal/multisensory pre-post evaluation), and methodology (e.g., sample size, blinding bias). Recent advancements in technological development and metaverse open new opportunities to design embodied rehabilitative programs

The effectiveness of virtual reality interventions for improvement of neurocognitive performance post-traumatic brain injury: a systematic review

Objective: To evaluate current evidence for the effectiveness of virtual reality (VR) interventions in improving neurocognitive performance in individuals who have sustained a traumatic brain injury (TBI). Methods: A systematic literature search across multiple databases (PubMed, EMBASE, Web of Science) for articles of relevance. Studies were evaluated according to study design, patient cohort, VR intervention, neurocognitive parameters assessed, and outcome. VR interventions were evaluated qualitatively with respect to methodology and extent of immersion and quantitatively with respect to intervention duration. Outcomes: Our search yielded 324 articles, of which only 13 studies including 132 patients with TBI met inclusion criteria. A wide range of VR interventions and cognitive outcome measures is reported. Cognitive measures included learning and memory, attention, executive function, community skills, problem solving, route learning, and attitudes about driving. Several studies (n = 10) reported statistically significant improvements in outcome, and 2 studies demonstrated successful translation to real-life performance. Conclusions: VR interventions hold significant potential for improving neurocognitive performance in patients with TBI. While there is some evidence for translation of gains to activities of daily living, further studies are required to confirm the validity of cognitive measures and reliable translation to real-life performance