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

The VESPA Project: Virtual Reality Interventions for Neurocognitive and Developmental Disorders

VESPA is a financed project supported by the Sicilian Regional Research and Development funds, and it is structured by the development, research and validation of Virtual Reality (VR) based application for the diagnosis and treatment of neurocognitive conditions. In particular, this article presents its characteristics, referred to as the first (2013-2015) and second (2021-ongoing) generations of VESPA, with particular reference to literature regarding the VR technology application and development, the VR treatment of neurocognitive conditions and prior versions of this intervention. Through a comprehensive review of the research conducted over the last 5 years, evidence has emerged supporting VESPA’s aim and scopes, highlighting how the application of VR can be considered to add value to typical rehabilitation/therapeutic paths. VESPA project generations are then presented in detail, including specific session/task battery characteristics, 2.5D, 3D and 5D typologies, system usability and architecture and pathological domain-based dynamics and features. The discussion about VESPA will highlight the current advantages along with limitations and future directions

Odontology & artificial intelligence

Neste trabalho avaliam-se os três fatores que fizeram da inteligência artificial uma tecnologia essencial hoje em dia, nomeadamente para a odontologia: o desempenho do computador, Big Data e avanços algorítmicos. Esta revisão da literatura avaliou todos os artigos publicados na PubMed até Abril de 2019 sobre inteligência artificial e odontologia. Ajudado com inteligência artificial, este artigo analisou 1511 artigos. Uma árvore de decisão (If/Then) foi executada para selecionar os artigos mais relevantes (217), e um algoritmo de cluster k-means para resumir e identificar oportunidades de inovação. O autor discute os artigos mais interessantes revistos e compara o que foi feito em inovação durante o International Dentistry Show, 2019 em Colónia. Concluiu, assim, de forma crítica que há uma lacuna entre tecnologia e aplicação clínica desta, sendo que a inteligência artificial fornecida pela indústria de hoje pode ser considerada um atraso para o clínico de amanhã, indicando-se um possível rumo para a aplicação clínica da inteligência artificial.There are three factors that have made artificial intelligence (AI) an essential technology today: the computer performance, Big Data and algorithmic advances. This study reviews the literature on AI and Odontology based on articles retrieved from PubMed. With the help of AI, this article analyses a large number of articles (a total of 1511). A decision tree (If/Then) was run to select the 217 most relevant articles-. Ak-means cluster algorithm was then used to summarize and identify innovation opportunities. The author discusses the most interesting articles on AI research and compares them to the innovation presented during the International Dentistry Show 2019 in Cologne. Three technologies available now are evaluated and three suggested options are been developed. The author concludes that AI provided by the industry today is a hold-up for the praticioner of tomorrow. The author gives his opinion on how to use AI for the profit of patients

가상현실 내 정보 불일치를 활용한 인지기능 평가: 탐색적 고찰

학위논문(박사) -- 서울대학교대학원 : 인문대학 협동과정 인지과학전공, 2022.2. 이경민.본 박사논문의 목적은 가상현실 내에서 발생하는 정보불일치에 대해서 알아보고, 정보 불일치로 인한 인지적 반응을 인지기능 평가에 활용할 수 있는 방안을 고찰하고자 함이다. 가상현실 주방과제를 구현하여 과제 수행 중 나타나는 움직임과 인지작용의 특성을 알아보고자 하였다. 또한 VR에서 과제수행 시 나타나는 인지 부하의 요인을 탐색하였다. 특히, 감각운동 조절 측면에서 가상현실 내 발생하는 정보불일치로 인한 인지 과부하를 살펴보았다. 첫째, 가상현실과 실제환경에서 작동하는 인지과정이 어떻게 다른지 알아보기 위해 두 환경 간의 과제 수행 차이를 비교하였다. 젊은 성인 그룹에서는 어려운 주방과제 수행 시 가상현실과 실제환경 간의 수행시간에 유의한 차이가 있었지만 쉬운 주방 과제에서는 차이가 없었다. 반면 노인 집단에서는 과제의 난이도와 관계없이 두 환경 간의 수행 시간에 상당한 차이가 있었다. 노인의 경우 가상현실에서 감각운동 조절의 어려움을 보였다. 즉 노인의 경우 젊은 성인에 비해 가상현실 내에서의 감각운동 조절이 더 어렵기 때문에 이로 인한 인지적 부하가 과제 수행 자체의 인지적 부하에 가중되어 과제 난이도가 어려워지면 인지용량의 한계를 초과하게 된다. 둘째, 가상 주방과제 수행 시 인지기능이 저하됨에 따라 갑자기 휙 움직이는(jerky) 패턴을 보이는 것으로 나타났다. 이는 인지기능이 저하된 노인의 경우 환경에 대한 예측력이 저하되어 최소 저크운동 조절(minimal jerk movement control)에 어려움이 있음을 시사한다. 또한 인지기능이 높은 그룹보다 인지기능이 낮은 노인 그룹의 경우 과제가 완료될 때까지의 일련의 움직임 단계가 더 많았다. 인지기능이 저하됨에 따라 비효율적이고 분주한 움직임을 보인다고 할 수 있다. 또한 다중회귀분석 결과, 노인이 가상현실 주방과제를 효율적으로 수행함에 있어 연령 및 학력 보다는 인지기능이 가장 영향을 미치는 요인으로 나타났다. 즉 가상현실 기반 과제수행은 순수 인지기능만을 평가하는 새로운 대안으로 제시할 수 있다. 마지막으로 감각운동 피드백의 예측불가능성(unpredictability)이 가상현실에서 인지부하를 유발하는 방식을 알아보고자 하였다. 섭동의 예측 가능성에 따른 반응 시간과 이동 속도를 암묵적 5°와 명시적 15° 섭동 조건에서 각각 측정하였다. 그 결과 암묵적 운동 제어 시 섭동의 변화를 예측할 수 없을 때 움직임의 정확도를 높이기 위해 움직임이 느려지는 전략(accuracy and speed trade-off)을 사용하는 것으로 나타났다. 즉, 감각운동조절 과정 상에서 정보 불일치로 인한 예측 불가능성에 대해 우리의 뇌는 다른 인지전략을 취한다고 설명할 수 있다. 결론적으로 가상현실은 기술적 충실도(fidelity) 문제로 인해 감각 피드백이 예측 불가능하고 가변적이기 때문에 실제 환경보다 더 많은 인지 부하를 유발한다. 특히 가상현실에서의 감각운동 조절은 실제환경에서 인간의 운동 시스템이 적응된 방식과는 다르다고 볼 수 있다. 즉 가상현실 내에서는 감각운동 시스템이 예측할 수 없는 환경에 적응하기 위해 다른 인지 전략을 취하게 된다. 환경에 따른 효율적인 인지전략의 전환은 중앙 집행기능(central executive)과 관련 있으며, 이러한 특징을 활용한 가상현실기반 과제는 새로운 인지기능 평가의 대안으로 제시할 수 있다.The purpose of this dissertation was to investigate information mismatch in virtual reality (VR) and explore the possibility of using the cognitive reaction arising from information mismatch for cognitive evaluation. The virtual kitchen task was used to observe the subjects’ behaviors while performing the task, and to investigate the characteristics of movement and cognitive processes appearing during the performance of the virtual task. In addition, an attempt was made to explore the factors of cognitive overload in VR that determine the difference compared to a performance in the real environment. In particular, this study aimed to investigate how information mismatch occurring in VR causes cognitive overload in terms of sensorimotor control. First, it questioned how the cognitive process in VR differs from the real environment and also investigated the factors affecting the performance of tasks in VR. In the young adult group, while there was a significant difference between the execution time in VR and in the real environment in the difficult kitchen task, there was no such difference in the easy kitchen task. Meanwhile, among the elderly, there was a significant difference between the execution time in VR and in the real environment regardless of whether the task was difficult or easy. It was thought that cognitive load was caused due to difficulties in sensorimotor control in VR. It was found that the cognitive capacity is challenged when the task is difficult because the load of task performance itself and the load of sensorimotor control are doubling. Second, it was found that as the cognitive function decreased, an abrupt and jerky movement pattern was exhibited during the virtual kitchen task. The number of sequences in movement until the task was completed was also busier in the elderly group with lower cognitive function in contrast with those with higher cognitive function. In the case of the elderly with deteriorated cognitive function, it is suggested that there is difficulty in minimal jerk movement control because the predictive ability responding to environment is decreased. In addition, according to the results of multiple regression, cognitive function of the elderly is the most influential factor in performing VR tasks, other than age and educational background, which means that purely evaluating cognitive function may be suggested. Third, an attempt was made to verify how the unpredictability of sensorimotor feedback causes cognitive load in VR. The reaction time and speed of movement depending on the predictability of perturbation were measured in implicit 5 degrees and explicit 15 degrees perturbation. When the subject was unable to predict the variation of perturbation only in implicit motor control, reaching became slower and it took more time due to the accuracy and speed trade-off. In other words, unpredictability due to information mismatch leads to the use of different cognitive strategies in brain mechanisms. In conclusion, VR induces more cognitive load than the real environment because the sensory feedback is unpredictable and variable due to technical fidelity problems. The sensorimotor control in VR is challenged by the way the human motor system is adapted. Further, it was found that an unpredictable environment requires different cognitive strategies for the sensorimotor system to adapt to it. The manner in which effective cognitive strategies are taken represents an efficient central executive function. From this perspective, VR-based cognitive evaluation, using such attributes, is thought to be an alternative method for early screening of cognitive decline.Chapter 1. Introduction 7 1.1 Research motivation and introductory overview 7 1.2 Research goal and questions 7 1.2.1 Overall research goal 7 1.2.2 Research questions 8 1.2.3 Research contributions 8 1.3 Thesis structure 8 Chapter 2. Literature Review 10 2.1 Virtual Reality (VR) as ecological method for cognitive evaluation 10 2.2 Sub-types of VR based tasks according to target cognitive function 12 2.2.1. VR task for spatial navigation 13 2.2.2. VR task for memory 14 2.2.3. VR task for executive function 16 2.3 Factors affecting on VR performance 19 2.3.1. General 19 2.3.2. Age effects on VR performance 20 2.3.3. Cognitive challenges in VR 21 2.3.4. Feasibility of VR task for dementia 22 2.4 Cognitive load in VR 23 2.4.1. Immersive versus non-immersive VR 23 2.4.2. Sense of presence and situated cognition 26 2.4.3. Sensorimotor adaptation in VR 28 2.5 Sensorimotor control in VR 29 2.5.1 Predictive brain and internal model for motor control 29 2.5.2 Explicit and implicit process in motor control 31 2.5.3 Accuracy & speed tradeoff in cognitive control 31 2.6 Executive control for information mismatch in information processing 32 Chapter 3. Differences in Cognitive Load Between Real and VR Environment 34 3.1 Introduction 34 3.2 Method 37 3.3 Results 40 3.4 Discussion 45 Chapter 4. The Efficiency of Movement Trajectory and Sequence in VR According to Cognitive Function in the Elderly 50 4.1 Introduction 50 4.2 Method 52 4.3 Results 53 4.4 Discussion 56 Chapter 5. Factors that Affect the Performance of Immersive Virtual Kitchen Tasks in the Elderly 59 5.1 Introduction 59 5.2 Method 62 5.3 Results 64 5.4 Discussion 70 Chapter 6. Effect of Predictability of Sensorimotor Feedback on Cognitive Load in VR 74 6.1 Introduction 74 6.2 Method 77 6.3 Results 79 6.4 Discussion 84 Chapter 7. Conclusion 88 7.1 Summary of findings 88 7.2 Future direction of research 90 References 92박

Common Issues of Virtual Reality in Neuro-Rehabilitation

2010-2011 > Academic research: not refereed > Chapter in an edited book (author)201803 bcwhVersion of RecordPublishe

Cognitive and cognitive-motor interventions affecting physical functioning: A systematic review

Background Several types of cognitive or combined cognitive-motor intervention types that might influence physical functions have been proposed in the past: training of dual-tasking abilities, and improving cognitive function through behavioral interventions or the use of computer games. The objective of this systematic review was to examine the literature regarding the use of cognitive and cognitive-motor interventions to improve physical functioning in older adults or people with neurological impairments that are similar to cognitive impairments seen in aging. The aim was to identify potentially promising methods that might be used in future intervention type studies for older adults. Methods A systematic search was conducted for the Medline/Premedline, PsycINFO, CINAHL and EMBASE databases. The search was focused on older adults over the age of 65. To increase the number of articles for review, we also included those discussing adult patients with neurological impairments due to trauma, as these cognitive impairments are similar to those seen in the aging population. The search was restricted to English, German and French language literature without any limitation of publication date or restriction by study design. Cognitive or cognitive-motor interventions were defined as dual-tasking, virtual reality exercise, cognitive exercise, or a combination of these. Results 28 articles met our inclusion criteria. Three articles used an isolated cognitive rehabilitation intervention, seven articles used a dual-task intervention and 19 applied a computerized intervention. There is evidence to suggest that cognitive or motor-cognitive methods positively affects physical functioning, such as postural control, walking abilities and general functions of the upper and lower extremities, respectively. The majority of the included studies resulted in improvements of the assessed functional outcome measures. Conclusions The current evidence on the effectiveness of cognitive or motor-cognitive interventions to improve physical functioning in older adults or people with neurological impairments is limited. The heterogeneity of the studies published so far does not allow defining the training methodology with the greatest effectiveness. This review nevertheless provides important foundational information in order to encourage further development of novel cognitive or cognitive-motor interventions, preferably with a randomized control design. Future research that aims to examine the relation between improvements in cognitive skills and the translation to better performance on selected physical tasks should explicitly take the relation between the cognitive and physical skills into account.ISSN:1471-231

Multipurpose virtual reality environment for biomedical and health applications

Virtual reality is a trending, widely accessible, and contemporary technology of increasing utility to biomedical and health applications. However, most implementations of virtual reality environments are tailored to specific applications. We describe the complete development of a novel, open-source virtual reality environment that is suitable for multipurpose biomedical and healthcare applications. This environment can be interfaced with different hardware and data sources, ranging from gyroscopes to fMRI scanners. The developed environment simulates an immersive (first-person perspective) run in the countryside, in a virtual landscape with various salient features. The utility of the developed VR environment has been validated via two test applications: an application in the context of motor rehabilitation following injury of the lower limbs and an application in the context of real-time functional magnetic resonance imaging neurofeedback, to regulate brain function in specific brain regions of interest. Both applications were tested by pilot subjects that unanimously provided very positive feedback, suggesting that appropriately designed VR environments can indeed be robustly and efficiently used for multiple biomedical purposes. We attribute the versatility of our approach on three principles implicit in the design: selectivity, immersiveness, and adaptability. The software, including both applications, is publicly available free of charge, via a GitHub repository, in support of the Open Science Initiative. Although using this software requires specialized hardware and engineering know-how, we anticipate our contribution to catalyze further progress, interdisciplinary collaborations and replicability, with regards to the usage of virtual reality in biomedical and health applications.Peer ReviewedPostprint (author's final draft

A virtual versus an augmented reality cooking task based-tools: a behavioral and physiological study on the assessment of executive functions.

[EN] Virtual reality (VR) and augmented reality (AR) are two novel graphics immersive techniques (GIT) that, in the last decade, have been attracting the attention of many researchers, especially in psychological research. VR can provide 3D real-life synthetic environments in which controllers allow human interaction. AR overlays synthetic elements to the real world and the human gaze to target allow hand gesture to act with synthetic elements. Both techniques are providing more ecologically environments than traditional methods, and most of the previous researches, on one side, have more focused on the use of VR for treatment and assessment showing positive effectiveness results. On the other, AR has been proving for the treatment of specific disorders but there are no studies that investigated the feasibility and effectiveness of augmented reality in the neuropsychological assessment. Starting from these premises, the present study aimed to compare the performance and sense of presence using both techniques during an ecological task, such as cooking. The study included 50 cognitively healthy subjects. The cooking task consisted of 4 levels that increased in difficulty. As the level increased, additional activities appeared. The order of presentation of each exposure condition (AR and VR) was counterbalanced for each participant. The virtual reality-cooking task has been performed through ¿HTC/VIVE¿ and augmented reality through ¿Microsoft HoloLens¿.¿Furthermore, the study recorded and compared the psychophysiological changes (heart rate and skin conductance response) during the cooking task in both conditions. To measure the sense of presence occurring during the two exposure conditions, subjects completed the SUSQ and the ITC-SOPI immediately after each condition. The behavioral 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. Finally, VR was able to produce higher levels of sense of presence than AR condition. The overall results support that VR currently represents the GIT with greater usability and feasibility compared to AR, probably due to the differences in the human-computer interaction between the two techniques.Chicchi-Giglioli, IA.; Bermejo Vidal, C.; Alcañiz Raya, ML. (2019). A virtual versus an augmented reality cooking task based-tools: a behavioral and physiological study on the assessment of executive functions. Frontiers in Psychology. 1-12. https://doi.org/10.3389/fpsyg.2019.02529S112Barratt, E. S. (1959). Anxiety and Impulsiveness Related to Psychomotor Efficiency. Perceptual and Motor Skills, 9(3), 191-198. doi:10.2466/pms.1959.9.3.191Bohil, C. J., Alicea, B., & Biocca, F. A. (2011). Virtual reality in neuroscience research and therapy. Nature Reviews Neuroscience, 12(12), 752-762. doi:10.1038/nrn3122Chaytor, N., & Schmitter-Edgecombe, M. (2003). The Ecological Validity of Neuropsychological Tests: A Review of the Literature on Everyday Cognitive Skills. Neuropsychology Review, 13(4), 181-197. doi:10.1023/b:nerv.0000009483.91468.fbCHAYTOR, N., SCHMITTEREDGECOMBE, M., & BURR, R. (2006). Improving the ecological validity of executive functioning assessment. Archives of Clinical Neuropsychology, 21(3), 217-227. doi:10.1016/j.acn.2005.12.002Chicchi Giglioli, I. A., Pallavicini, F., Pedroli, E., Serino, S., & Riva, G. (2015). Augmented Reality: A Brand New Challenge for the Assessment and Treatment of Psychological Disorders. Computational and Mathematical Methods in Medicine, 2015, 1-12. doi:10.1155/2015/862942Cipresso, P., Albani, G., Serino, S., Pedroli, E., Pallavicini, F., Mauro, A., & Riva, G. (2014). Virtual multiple errands test (VMET): a virtual reality-based tool to detect early executive functions deficit in Parkinson’s disease. Frontiers in Behavioral Neuroscience, 8. doi:10.3389/fnbeh.2014.00405Cipresso, P., Giglioli, I. A. C., Raya, M. A., & Riva, G. (2018). The Past, Present, and Future of Virtual and Augmented Reality Research: A Network and Cluster Analysis of the Literature. Frontiers in Psychology, 9. doi:10.3389/fpsyg.2018.02086De Leeuw, J. R. (2014). jsPsych: A JavaScript library for creating behavioral experiments in a Web browser. Behavior Research Methods, 47(1), 1-12. doi:10.3758/s13428-014-0458-yIriarte, Y., Diaz-Orueta, U., Cueto, E., Irazustabarrena, P., Banterla, F., & Climent, G. (2012). AULA—Advanced Virtual Reality Tool for the Assessment of Attention. Journal of Attention Disorders, 20(6), 542-568. doi:10.1177/1087054712465335Díaz-Orueta, U., Garcia-López, C., Crespo-Eguílaz, N., Sánchez-Carpintero, R., Climent, G., & Narbona, J. (2013). AULA virtual reality test as an attention measure: Convergent validity with Conners’ Continuous Performance Test. Child Neuropsychology, 20(3), 328-342. doi:10.1080/09297049.2013.792332Dunkin, B., Adrales, G. L., Apelgren, K., & Mellinger, J. D. (2006). Surgical simulation: a current review. Surgical Endoscopy, 21(3), 357-366. doi:10.1007/s00464-006-9072-0Elkind, J. S., Rubin, E., Rosenthal, S., Skoff, B., & Prather, P. (2001). A Simulated Reality Scenario Compared with the Computerized Wisconsin Card Sorting Test: An Analysis of Preliminary Results. CyberPsychology & Behavior, 4(4), 489-496. doi:10.1089/109493101750527042Fillmore, M. T., Rush, C. R., & Hays, L. (2006). Acute effects of cocaine in two models of inhibitory control: implications of non-linear dose effects. Addiction, 101(9), 1323-1332. doi:10.1111/j.1360-0443.2006.01522.xFleming, T. M., Bavin, L., Stasiak, K., Hermansson-Webb, E., Merry, S. N., Cheek, C., … Hetrick, S. (2017). Serious Games and Gamification for Mental Health: Current Status and Promising Directions. Frontiers in Psychiatry, 7. doi:10.3389/fpsyt.2016.00215Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). «Mini-mental state». Journal of Psychiatric Research, 12(3), 189-198. doi:10.1016/0022-3956(75)90026-6Freeman, D., Reeve, S., Robinson, A., Ehlers, A., Clark, D., Spanlang, B., & Slater, M. (2017). Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychological Medicine, 47(14), 2393-2400. doi:10.1017/s003329171700040xGermine, L., Nakayama, K., Duchaine, B. C., Chabris, C. F., Chatterjee, G., & Wilmer, J. B. (2012). Is the Web as good as the lab? Comparable performance from Web and lab in cognitive/perceptual experiments. Psychonomic Bulletin & Review, 19(5), 847-857. doi:10.3758/s13423-012-0296-9Germine, L., Reinecke, K., & Chaytor, N. S. (2019). Digital neuropsychology: Challenges and opportunities at the intersection of science and software. The Clinical Neuropsychologist, 33(2), 271-286. doi:10.1080/13854046.2018.1535662Gregg, L., & Tarrier, N. (2007). Virtual reality in mental health. Social Psychiatry and Psychiatric Epidemiology, 42(5), 343-354. doi:10.1007/s00127-007-0173-4Henry, M., Joyal, C. C., & Nolin, P. (2012). Development and initial assessment of a new paradigm for assessing cognitive and motor inhibition: The bimodal virtual-reality Stroop. Journal of Neuroscience Methods, 210(2), 125-131. doi:10.1016/j.jneumeth.2012.07.025Jensen, L., & Konradsen, F. (2017). A review of the use of virtual reality head-mounted displays in education and training. Education and Information Technologies, 23(4), 1515-1529. doi:10.1007/s10639-017-9676-0Juan, M. C., & Pérez, D. (2010). Using augmented and virtual reality for the development of acrophobic scenarios. Comparison of the levels of presence and anxiety. Computers & Graphics, 34(6), 756-766. doi:10.1016/j.cag.2010.08.001Khademi, M., Hondori, H. M., Dodakian, L., Cramer, S., & Lopes, C. V. (2013). Comparing “pick and place” task in spatial Augmented Reality versus non-immersive Virtual Reality for rehabilitation setting. 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). doi:10.1109/embc.2013.6610575Krichenbauer, M., Yamamoto, G., Taketom, T., Sandor, C., & Kato, H. (2018). Augmented Reality versus Virtual Reality for 3D Object Manipulation. IEEE Transactions on Visualization and Computer Graphics, 24(2), 1038-1048. doi:10.1109/tvcg.2017.2658570Ku, J., Cho, W., Kim, J.-J., Peled, A., Wiederhold, B. K., Wiederhold, M. D., … Kim, S. I. (2003). A Virtual Environment for Investigating Schizophrenic Patients’ Characteristics: Assessment of Cognitive and Navigation Ability. CyberPsychology & Behavior, 6(4), 397-404. doi:10.1089/109493103322278781Lessiter, J., Freeman, J., Keogh, E., & Davidoff, J. (2001). A Cross-Media Presence Questionnaire: The ITC-Sense of Presence Inventory. Presence: Teleoperators and Virtual Environments, 10(3), 282-297. doi:10.1162/105474601300343612Martin, M. M., & Rubin, R. B. (1995). A New Measure of Cognitive Flexibility. Psychological Reports, 76(2), 623-626. doi:10.2466/pr0.1995.76.2.623McMahan, R. P., Alon, A. J. D., Lazem, S., Beaton, R. J., Machaj, D., Schaefer, M., … Bowman, D. A. (2010). Evaluating natural interaction techniques in video games. 2010 IEEE Symposium on 3D User Interfaces (3DUI). doi:10.1109/3dui.2010.5444727McMahan, R. P., Bowman, D. A., Zielinski, D. J., & Brady, R. B. (2012). Evaluating Display Fidelity and Interaction Fidelity in a Virtual Reality Game. IEEE Transactions on Visualization and Computer Graphics, 18(4), 626-633. doi:10.1109/tvcg.2012.43Miller, M. A., & Fillmore, M. T. (2010). The effect of image complexity on attentional bias towards alcohol-related images in adult drinkers. Addiction, 105(5), 883-890. doi:10.1111/j.1360-0443.2009.02860.xNeguț, A., Matu, S.-A., Sava, F. A., & David, D. (2016). Virtual reality measures in neuropsychological assessment: a meta-analytic review. The Clinical Neuropsychologist, 30(2), 165-184. doi:10.1080/13854046.2016.1144793Martínez-Loredo, V., Fernández-Hermida, J. R., Fernández-Artamendi, S., Carballo, J. L., & García-Rodríguez, O. (2015). Spanish adaptation and validation of the Barratt Impulsiveness Scale for early adolescents (BIS-11-A). International Journal of Clinical and Health Psychology, 15(3), 274-282. doi:10.1016/j.ijchp.2015.07.002Parsons, T. D. (2015). Virtual Reality for Enhanced Ecological Validity and Experimental Control in the Clinical, Affective and Social Neurosciences. Frontiers in Human Neuroscience, 9. doi:10.3389/fnhum.2015.00660Ming-Zher Poh, Swenson, N. C., & Picard, R. W. (2010). A Wearable Sensor for Unobtrusive, Long-Term Assessment of Electrodermal Activity. IEEE Transactions on Biomedical Engineering, 57(5), 1243-1252. doi:10.1109/tbme.2009.2038487PUGNETTI, L., MENDOZZI, L., ATTREE, E. A., BARBIERI, E., BROOKS, B. M., CAZZULLO, C. L., … Psychol, C. (1998). Probing Memory and Executive Functions with Virtual Reality: Past and Present Studies. CyberPsychology & Behavior, 1(2), 151-161. doi:10.1089/cpb.1998.1.151Ragan, E. D. (2010). The Effects of Higher Levels of Immersion on Procedure Memorization Performance and Implications for Educational Virtual Environments. Presence: Teleoperators and Virtual Environments, 19(6), 527-543. doi:10.1162/pres_a_00016Ragan, E. D., Kopper, R., Schuchardt, P., & Bowman, D. A. (2013). Studying the Effects of Stereo, Head Tracking, and Field of Regard on a Small-Scale Spatial Judgment Task. IEEE Transactions on Visualization and Computer Graphics, 19(5), 886-896. doi:10.1109/tvcg.2012.163Rand, D., Katz, N., & (Tamar) Weiss, P. L. (2007). Evaluation of virtual shopping in the VMall: Comparison of post-stroke participants to healthy control groups. Disability and Rehabilitation, 29(22), 1710-1719. doi:10.1080/09638280601107450Rand, D., Rukan, S. B.-A., (Tamar) Weiss, P. L., & Katz, N. (2009). Validation of the Virtual MET as an assessment tool for executive functions. Neuropsychological Rehabilitation, 19(4), 583-602. doi:10.1080/09602010802469074Reimers, S., & Stewart, N. (2014). Presentation and response timing accuracy in Adobe Flash and HTML5/JavaScript Web experiments. Behavior Research Methods, 47(2), 309-327. doi:10.3758/s13428-014-0471-1Rizzo, A. A., Buckwalter, J. G., Bowerly, T., Van Der Zaag, C., Humphrey, L., Neumann, U., … Sisemore, D. (2000). The Virtual Classroom: A Virtual Reality Environment for the Assessment and Rehabilitation of Attention Deficits. CyberPsychology & Behavior, 3(3), 483-499. doi:10.1089/10949310050078940Rizzo, A. A., Schultheis, M., Kerns, K. A., & Mateer, C. (2004). Analysis of assets for virtual reality applications in neuropsychology. Neuropsychological Rehabilitation, 14(1-2), 207-239. doi:10.1080/09602010343000183Rizzo, A. A., Bowerly, T., Buckwalter, J. G., Klimchuk, D., Mitura, R., & Parsons, T. D. (2009). A Virtual Reality Scenario for All Seasons:The Virtual Classroom. CNS Spectrums, 11(1), 35-44. doi:10.1017/s1092852900024196Saposnik, G., Mamdani, M., Bayley, M., Thorpe, K. E., Hall, J., Cohen, L. G., & Teasell, R. (2010). Effectiveness of Virtual Reality Exercises in STrokeRehabilitation(EVREST): Rationale, Design, and Protocol of a Pilot Randomized Clinical Trial Assessing the Wii Gaming System. International Journal of Stroke, 5(1), 47-51. doi:10.1111/j.1747-4949.2009.00404.xSeymour, N. E. (2007). VR to OR: A Review of the Evidence that Virtual Reality Simulation Improves Operating Room Performance. World Journal of Surgery, 32(2), 182-188. doi:10.1007/s00268-007-9307-9Sequeira, H., Hot, P., Silvert, L., & Delplanque, S. (2009). Electrical autonomic correlates of emotion. International Journal of Psychophysiology, 71(1), 50-56. doi:10.1016/j.ijpsycho.2008.07.009Slater, M. (2009). Place illusion and plausibility can lead to realistic behaviour in immersive virtual environments. Philosophical Transactions of the Royal Society B: Biological Sciences, 364(1535), 3549-3557. doi:10.1098/rstb.2009.0138Slater, M., & Steed, A. (2000). A Virtual Presence Counter. Presence: Teleoperators and Virtual Environments, 9(5), 413-434. doi:10.1162/105474600566925Suso-Ribera, C., Fernández-Álvarez, J., García-Palacios, A., Hoffman, H. G., Bretón-López, J., Baños, R. M., … Botella, C. (2019). Virtual Reality, Augmented Reality, and In Vivo Exposure Therapy: A Preliminary Comparison of Treatment Efficacy in Small Animal Phobia. Cyberpsychology, Behavior, and Social Networking, 22(1), 31-38. doi:10.1089/cyber.2017.0672Valmaggia, L. R., Latif, L., Kempton, M. J., & Rus-Calafell, M. (2016). Virtual reality in the psychological treatment for mental health problems: An systematic review of recent evidence. Psychiatry Research, 236, 189-195. doi:10.1016/j.psychres.2016.01.01