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

Virtual Reality as an Emerging Methodology for Leadership Assessment and Training

[EN] In developed countries, companies are now substantially reliant on the skills and abilities of their leaders to tackle a variety of complex issues. There is a growing consensus that leadership development training and assessment methods should adopt more holistic methodologies, including those associated with the emotional and neuroendocrine aspects of learning. Recent research into the assessment of leadership competencies has proposed the use of objective methods and measurements based on neuroscience. One of the challenges to be faced in the development of a performance-based methodology to measure leadership skills is how to generate real-life situations with triggers that allow us to study management competencies under controlled laboratory conditions. A way to address this question is to take advantage of virtual environments to recreate real-life situations that might arise in performance-based assessments. We propose virtual reality (VR) as a very promising tool to observe various leadership related behavioral patterns during dynamic, complex and realistic situations. By seamlessly embedding assessment methods into virtual learning environments, VR can provide objective assessment methods with high ecological validity. VR also holds unlimited opportunities for leadership training providing subjects with intelligent tutoring systems that adapts situations in real time according to the observed behaviors.This work was supported by the Spanish Ministry of Economy, Industry and Competitiveness funded project "Advanced Therapeutic Tools for Mental Health" (DPI2016-77396-R).Alcañiz Raya, ML.; Parra Vargas, E.; Chicchi-Giglioli, IA. (2018). Virtual Reality as an Emerging Methodology for Leadership Assessment and Training. Frontiers in Psychology. 9. https://doi.org/10.3389/fpsyg.2018.01658S

Why do we take risks? Perception of the situation and risk proneness predict domain-specific risk taking

[EN] Risk taking (RT) is a component of the decision-making process in situations that involve uncertainty and in which the probability of each outcome - rewards and/or negative consequences - is already known. The influence of cognitive and emotional processes in decision making may affect how risky situations are addressed. First, inaccurate assessments of situations may constitute a perceptual bias in decision making, which might influence RT. Second, there seems to be consensus that a proneness bias exists, known as risk proneness, which can be defined as the propensity to be attracted to potentially risky activities. In the present study, we take the approach that risk perception and risk proneness affect RT behaviours. The study hypothesises that locus of control, emotion regulation, and executive control act as perceptual biases in RT, and that personality, sensation seeking, and impulsivity traits act as proneness biases in RT. The results suggest that locus of control, emotion regulation and executive control influence certain domains of RT, while personality influences in all domains except the recreational, and sensation seeking and impulsivity are involved in all domains of RT. The results of the study constitute a foundation upon which to build in this research area and can contribute to the increased understanding of human behaviour in risky situations.This work was supported by the European Union's Horizon 2020 funded project "Modelling and predicting human decision making using measures of subconscious brain processes through mixed reality interfaces and biometric signals (RHUMBO)" (No 813234), the Spanish Ministry of Economy, Industry and Competitiveness funded project "Assessment and training on decision making in risk environments (ATEMIN)" (RTC-20176523-6; MINECO/AEI/FEDER, UE), and by the Generalitat Valenciana funded project "Mixed reality and brain decision (REBRAND)" (PROMETEO/2019/105).Juan-Ripoll, CD.; Chicchi-Giglioli, IA.; Llanes-Jurado, J.; Marín-Morales, J.; Alcañiz Raya, ML. (2021). Why do we take risks? Perception of the situation and risk proneness predict domain-specific risk taking. Frontiers in Psychology. 12:1-12. https://doi.org/10.3389/fpsyg.2021.562381S1121

An Immersive Virtual Reality Game for Predicting Risk Taking through the Use of Implicit Measures

[EN] The tool presented in this article can be applied as an ecological measure for evaluating decision-making processes in risky situations. It can be used in different contexts from both Occupational Safety and Health practices and for research purposes. Risk taking (RT) measurement constitutes a challenge for researchers and practitioners and has been addressed from different perspectives. Personality traits and temperamental aspects such as sensation seeking and impulsivity influence the individual's approach to RT, prompting risk-seeking or risk-aversion behaviors. Virtual reality has emerged as a suitable tool for RT measurement, since it enables the exposure of a person to realistic risks, allowing embodied interactions, the application of stealth assessment techniques and physiological real-time measurement. In this article, we present the assessment on decision making in risk environments (AEMIN) tool, as an enhanced version of the spheres and shield maze task, a previous tool developed by the authors. The main aim of this article is to study whether it is possible is to discriminate participants with high versus low scores in the measures of personality, sensation seeking and impulsivity, through their behaviors and physiological responses during playing AEMIN. Applying machine learning methods to the dataset we explored: (a) if through these data it is possible to discriminate between the two populations in each variable; and (b) which parameters better discriminate between the two populations in each variable. The results support the use of AEMIN as an ecological assessment tool to measure RT, since it brings to light behaviors that allow to classify the subjects into high/low risk-related psychological constructs. Regarding physiological measures, galvanic skin response seems to be less salient in prediction models.This research was funded by the Spanish Ministry of Economy and Competitiveness funded project "Assessment and Training on Decision Making in Risk Environments", grant number RTC-2017-6523-6, by the Gerenaliat Valenciana funded project "Rebrand", grant number PROMETEU/2019/105, and by the European Union ERDF (European Regional Development Fund) program of the Valencian Community 2014-2020 funded project "Interfaces de realidad mixta aplicada a salud y toma de decisiones", grant number IDIFEDER/2018/029.Juan-Ripoll, CD.; Llanes-Jurado, J.; Chicchi-Giglioli, IA.; Marín-Morales, J.; Alcañiz Raya, ML. (2021). An Immersive Virtual Reality Game for Predicting Risk Taking through the Use of Implicit Measures. Applied Sciences. 11(2):1-21. https://doi.org/10.3390/app11020825S12111

An Immersive Serious Game for the Behavioral Assessment of Psychological Needs

[EN] Motivation is an essential component in mental health and well-being. In this area, researchers have identified four psychological needs that drive human behavior: attachment, self-esteem, orientation and control, and maximization of pleasure and minimization of distress. Various self-reported scales and interviews tools have been developed to assess these dimensions. Despite the validity of these, they are showing limitations in terms of abstractation and decontextualization and biases, such as social desirability bias, that can affect responses veracity. Conversely, virtual serious games (VSGs), that are games with specific purposes, can potentially provide more ecologically valid and objective assessments than traditional approaches. Starting from these premises, the aim of this study was to investigate the feasibility of a VSG to assess the four personality needs. Sixty subjects participated in five VSG sessions. Results showed that the VSG was able to recognize attachment, self-esteem, and orientation and control needs with a high accuracy, and to a lesser extent maximization of pleasure and minimization of distress need. In conclusion, this study showed the feasibility to use a VSG to enhance the assessment of psychological behavioral-based need, overcoming biases presented by traditional assessment.This work was supported by the Spanish Ministry of Economy, Industry and Competitiveness funded project "Advanced Therapeutically Tools for Mental Health" (DPI2016-77396-R) and by the European Union through the Operational Program of the European Regional Development Fund (ERDF) on the Valencian Community 2010-2020 (IDIFEDER/2018/029)Chicchi-Giglioli, IA.; Carrasco-Ribelles, LA.; Parra Vargas, E.; Marín-Morales, J.; Alcañiz Raya, ML. (2021). An Immersive Serious Game for the Behavioral Assessment of Psychological Needs. Applied Sciences. 11(4):1-17. https://doi.org/10.3390/app11041971S11711

How priming with body odors affects decision speeds in consumer behavior

To date, odor research has primarily focused on the behavioral efects of common odors on consumer perception and choices. We report a study that examines, for the frst time, the efects of human body odor cues on consumer purchase behaviors. The infuence of human chemosignals produced in three conditions, namely happiness, fear, a relaxed condition (rest), and a control condition (no odor), were examined on willingness to pay (WTP) judgments across various products. We focused on the speed with which participants reached such decisions. The central fnding revealed that participants exposed to human odors reached decisions signifcantly faster than the no odor control group. The main driving force is that human body odors activate the presence of others during decision-making. This, in turn, afects response speed. The broader implications of this fnding for consumer behavior are discussed.Comunidade Europeia e Generalitat Valencianainfo:eu-repo/semantics/publishedVersio

Machine Learning and Virtual Reality on Body Movements¿ Behaviors to Classify Children with Autism Spectrum Disorder

[EN] Autism spectrum disorder (ASD) is mostly diagnosed according to behavioral symptoms in sensory, social, and motor domains. Improper motor functioning, during diagnosis, involves the qualitative evaluation of stereotyped and repetitive behaviors, while quantitative methods that classify body movements' frequencies of children with ASD are less addressed. Recent advances in neuroscience, technology, and data analysis techniques are improving the quantitative and ecological validity methods to measure specific functioning in ASD children. On one side, cutting-edge technologies, such as cameras, sensors, and virtual reality can accurately detect and classify behavioral biomarkers, as body movements in real-life simulations. On the other, machine-learning techniques are showing the potential for identifying and classifying patients' subgroups. Starting from these premises, three real-simulated imitation tasks have been implemented in a virtual reality system whose aim is to investigate if machine-learning methods on movement features and frequency could be useful in discriminating ASD children from children with typical neurodevelopment. In this experiment, 24 children with ASD and 25 children with typical neurodevelopment participated in a multimodal virtual reality experience, and changes in their body movements were tracked by a depth sensor camera during the presentation of visual, auditive, and olfactive stimuli. The main results showed that ASD children presented larger body movements than TD children, and that head, trunk, and feet represent the maximum classification with an accuracy of 82.98%. Regarding stimuli, visual condition showed the highest accuracy (89.36%), followed by the visual-auditive stimuli (74.47%), and visual-auditive-olfactory stimuli (70.21%). Finally, the head showed the most consistent performance along with the stimuli, from 80.85% in visual to 89.36% in visual-auditive-olfactory condition. The findings showed the feasibility of applying machine learning and virtual reality to identify body movements' biomarkers that could contribute to improving ASD diagnosis.This work was supported by the Spanish Ministry of Economy, Industry, and Competitiveness funded project "Immersive virtual environment for the evaluation and training of children with autism spectrum disorder: T Room" (IDI-20170912) and by the Generalitat Valenciana funded project REBRAND (PROMETEO/2019/105). Furthermore, this work was co-founded by the European Union through the Operational Program of the European Regional development Fund (ERDF) of the Valencian Community 2014-2020 (IDIFEDER/2018/029).Alcañiz Raya, ML.; Marín-Morales, J.; Minissi, ME.; Teruel Garcia, G.; Abad, L.; Chicchi-Giglioli, IA. (2020). 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Applying machine learning to a virtual serious game for neuropsychological assessment.

[Otros] Neuropsychological assessment has been traditionally made through paper-and-pencil batteries which usually are time-consuming, decontextualized, and nonecological. These abilities play a critical role in education since they are very related to learning capacity, academic achievement, social functioning, as well as the inhibition of maladaptive behaviors. Meanwhile, serious games are being used in education and psychology to achieve assessments without these limitations, including neuropsychological assessments. While traditional tests can be analyzed with classical statistics, a large number of variables can be extracted from serious games, the analysis of which can be more complex. Machine learning can handle this large amount of information and find patterns that allow us to recognize behaviors. This study aimed to investigate whether machine learning could be used to improve predictive validity in applying a serious game for neuropsychological assessment. Results were based on 60 subjects, including 42 cognitive activities. The validation process showed best results on attention, memory, planning, and cognitive flexibility, achieving accuracies higher or equal to 0.8 and Cohen¿s Kappas higher than 0.55, which implies that the Virtual Serious Game could be a valid tool to perform a neuropsychological evaluation along with traditional tests.This work was supported by the Spanish Ministry of Economy, Industry and Competitiveness funded project Advanced Therapeutically Tools for Mental Health (DPI2016-77396-R) and by the European Union through the Operational Program of the European Regional Development Fund (ERDF) on the Valencian Community 2010-2020 (IDIFEDER/2018/029).Marín-Morales, J.; Carrasco-Ribelles, LA.; Alcañiz Raya, ML.; Chicchi-Giglioli, IA. (2021). Applying machine learning to a virtual serious game for neuropsychological assessment. IEEE. 951-954. https://doi.org/10.1109/EDUCON46332.2021.9454138S95195

Pilot study on effectiveness of a virtual game training on executive functions

[Otros] Attention, control inhibition, and visual-spatial working memory represent the three basic sets of cognitive processes involving on executive functions (EF). Basic EF are relevant abilities in daily life that allow to control and monitor adapted behaviors in order to achieve specific goals. In the educational field, EF are related to academic achievement, social functioning, as well as the inhibition of maladaptive behaviors. Their impairment often leads to an incapacity to perform multiple and simultaneous mental activities, as well as to plan and monitor learning. The main aim of cognitive neuropsychology intervention is to identify effective methods that allow transferring trained strategies and abilities to daily life. Accordingly, virtual reality games (VRG) are showing ecological validity effectiveness in EF training. In this framework, the aim of this study was to examine the effectiveness of a VRG cooking-based for improving basic EF processing. 31 healthy subjects (M=24.3; SD=2.51) participated to 3 training sessions of 25 minutes each. Each session involved 6 VRG characterized by different levels of difficulties. Three traditional measures were administered to participants pre- and post- VRG: The Corsi test for assessing visual-spatial working memory, the Dual-task, and the Flanker task for attention and inhibition control respectively. The results reported a significant improvement of the three EF abilities after training, showing the potential effectiveness of a VRG along with the traditional measures. Future studies on students with learning disabilities are needed to compare performance and effectiveness.Chicchi-Giglioli, IA.; Mussoni, S.; Cipresso, P.; Marín-Morales, J.; Riva, G.; Alcañiz Raya, ML. (2021). Pilot study on effectiveness of a virtual game training on executive functions. IEEE. 956-960. https://doi.org/10.1109/EDUCON46332.2021.9453899S95696

Evaluación ecológica mediante Realidad Virtual de las necesidades psicológicas básicas

Pese a que las técnicas de evaluación psicológica comúnmente utilizadas en lápiz y papel son una estrategia elegida por su adecuada validez, se presentan algunas limitaciones importantes que pueden superarse por los avances recientes en Realidad Virtual (RV), al permitir la evaluación de constructos psicológicos en entornos inmersivos, como una forma de evaluación ecológica. Es así que el propósito de la presente investigación fue determinar la eficacia de una herramienta de realidad virtual en la evaluación de cuatro necesidades psicológicas básicas: apego, autoestima, autoeficacia, maximización del placer/minimización del dolor. La muestra la conformaron 61 participantes, quienes fueron expuestos a entornos virtuales centrados en la evaluación conductual de cada uno de estos constructos. Los resultados mostraron una adecuada precisión de los entornos de RV en cuanto al reconocimiento de las necesidades evaluadas. En conclusión, los hallazgos permitieron contar con mayor evidencia en cuanto al uso de la RV como una alternativa válida para la medición de los constructos, se reconocen limitaciones importantes referentes al número limitado de participantes y a la ausencia de población clínica.