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Aspen Pub./JHTR AS132-02 September 4, 2002 17:43 Char Count= 0

Virtual Reality and

Neuropsychology: Upgrading

the Current Tools

Background:Virtual reality (VR) is an evolving technology that has been applied in various aspects of medicine, including the treatment of phobia disorders, pain distraction interventions, surgical training, and medical education. These applications have served to demonstrate the various assets offered through the use of VR.Objective:To provide a background and rationale for the application of VR to neuropsy-chological assessment.Methods:A brief introduction to VR technology and a review of current ongoing neuropsychological research that integrates the use of this technology.Conclusions:VR offers numer-ous assets that may enhance current neuropsychological assessment protocols and address many of the limitations faced by our traditional methods. Key words:neuropsychological tests,technology,virtual reality

Maria T. Schultheis, PhD

Clinical Research Scientist

Neuropsychology & Neuroscience

Laboratory

Kessler Medical Rehabilitation Research

& Education Corporation

Department of Physical Medicine

& Rehabilitation

University of Medicine & Dentistry

of New Jersey-New Jersey Medical School

West Orange, New Jersey

Jessica Himelstein, MA

Postdoctoral Fellow

Department of Physical Medicine &

Rehabilitation

University of Medicine & Dentistry of

New Jersey-New Jersey Medical School

West Orange, New Jersey

Albert A. Rizzo, PhD

Assistant Research Professor

Integrated Media Systems Center

School of Gerontology

University of Southern California

Los Angeles

I

N THE PAST few years, virtual reality (VR)

has undergone a transition that has taken

it out of the realm of expensive toy and into

that of functional technology. Continuing

ad-vances in VR technology, along with

concomi-tant system cost reductions, have supported

the development of more usable, useful, and

accessible VR systems. These systems have

the potential to uniquely target a wide range

of physical, cognitive, and behavioral human

issues and research questions.

Neuropsychol-ogy is one discipline that may clearly

ben-efit from the application of VR technology.

Address correspondence and requests for reprints to Maria T. Schultheis, PhD, Neuropsychology and Neuroscience Laboratory, Kessler Medical Rehabil-itation Research & Education Corporation, 1199 Pleasant Valley Way, West Orange, NJ 07052. Tele-phone: (973) 324–3528; Fax: (973)243–6984. E-mail: mschultheis@kmrrec.org.

Supported in part by grant #HD08589–01 from the Na-tional Institute of Child Health and Human Develop-ment, grant #H133G000073 from the National Insti-tute on Disability and Rehabilitation Research, and by the Integrated Media Systems Center, a National Science Foundation Engineering Research Center, Cooperative Agreement No. EEC-9529152.

J Head Trauma Rehabil2002;17(5):378–394 c

°2002 Lippincott Williams & Wilkins, Inc.

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Virtual Reality and Neuropsychology

379

The application of VR in neuropsychology

is so distinctively important because it

rep-resents more than a simple linear extension

of existing computer technology for human

use. VR offers the potential to deliver

system-atic human testing and training environments

that allow for the precise control of

com-plex dynamic three-dimensional (3D)

stimu-lus presentations, where sophisticated

behav-ioral recording is possible. When combining

these assets within the context of

function-ally relevant, ecologicfunction-ally valid virtual

environ-ments, a fundamental advancement emerges

in how human behavior can be addressed in

many scientific disciplines.

In the broadest sense neuropsychology can

be defined as an applied science that

evalu-ates how specific activities in the brain are

expressed in observable behaviors.

1

Effective

neuropsychological assessment is often a key

component in both the treatment and the

sci-entific analysis of many central nervous

sys-tem disorders and can serve a number of

func-tions. These include the use of psychometric

evaluation tools for diagnostic purposes, the

provision of normative data for comparison

with impaired cognitive and functional

abil-ities, the specification of cognitive strengths

and weaknesses to help inform the design

of rehabilitative strategies, and provision of

metrics to assess treatment efficacy or plot

neurodegenerative decline.

Neuropsycholog-ical assessment also serves to create data for

the scientific understanding of brain

function-ing through the examination of measurable

se-quelae that occur after brain damage or

dys-function. To date, most neuropsychological

research has focused on increasing our

under-standing of component cognitive processes,

such as attention, executive functions,

mem-ory, and language spatial abilities. More

re-cently, understanding the role of cognitive

processes during functionally relevant tasks

(i.e., instrumental activities of daily living) has

evolved as an area of focus within

neuropsy-chological research. VR offers the potential to

integrate these two aspects of

neuropsychol-ogy and provide an innovative approach to

un-derstanding brain–behavior relationships.

In view of the promising benefits that

VR can offer neuropsychological assessment,

treatment, and research, this article seeks to

(1) provide a brief introduction to VR

tech-nology and the potential benefits of the

ap-plication of VR to the field of

neuropsychol-ogy, (2) provide a brief overview of recent

studies that have successfully applied VR to

the assessment of component cognitive

abili-ties and functional evaluations, and (3) discuss

important considerations in the application of

VR.

WHAT IS VR TECHNOLOGY?

VR can be viewed as an advanced form

of human–computer interface that allows the

user to “interact” with and become

“im-mersed” in a computer-generated

environ-ment in a naturalistic fashion.

2

By analogy,

much like an aircraft simulator serves to test

and train piloting ability, computer-generated

interactive virtual environments (VEs) can be

designed to assess and rehabilitate cognitive

and functional abilities by means of

expo-sure to simulated “real world” and/or analog

tasks. Interaction in three dimensions is a key

characteristic that distinguishes a VR

expe-rience from other technologies. The

believ-ability of the virtual experience (or “sense

of presence”) is fostered by the use of such

specialized technology as head-mounted

dis-plays (HMDs), tracking systems, earphones,

gesture-sensing gloves, and haptic-feedback

devices. An HMD is an image display system

worn on the head (like a diving mask) that

remains optically coupled to the user’s eyes

as he or she turns and moves. A tracking

sys-tem senses the position and orientation of the

user’s head (and HMD) and reports that

in-formation to a computer that updates (in real

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Fig 1.

Person in a virtual environment wearing an HMD and head tracker.

time) the images for display in the HMD. In

most cases full-color stereo image pairs are

produced, and earphones may deliver

rele-vant 3D sound. The combination of an HMD

and tracking system allows the computer to

generate images and sounds in any

computer-modeled (virtual) scene that corresponds to

what the user would see and hear from

their current position if the scene were real

(Figure 1). The user may walk and turn around

to survey a virtual landscape or inspect a

vir-tual object by moving toward it and

peer-ing around its sides or back. Although HMDs

are most commonly associated with VR, other

methods incorporating 3D projection walls

and rooms (known as CAVES), as well as basic

flat-screen computer systems, have been used

to create interactive scenarios. Methods for

navigation and interaction such as data gloves,

joysticks, and some high-end “force feedback”

mechanisms that can provide haptic feedback

are also available and can be used to further

enhance realism and the “suspension of

dis-belief” required to generate the sense of

pres-ence within a VR environment.

Although VR remains a developing

tech-nology, it is not a new addition to the

medi-cal field. Various studies have served to

docu-ment the successful integration of VR to

myr-iad aspects of medicine, including surgical

training,

3

education of patients and medical

students,

4

and treatment of sensory mobility

deficits.

5

Treatment of psychological

dysfunc-tion, including anxiety disorders and phobia,

has been successfully reported by numerous

researchers who have applied the use of VR

for treating fear of flying and fear of heights.

6,7

VR has also been applied to the treatment

of posttraumatic stress disorder (PTSD),

8

eat-ing disorders,

9

and pain management.

10

Re-sults from these studies have served to

un-derscore some of the specific assets afforded

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Virtual Reality and Neuropsychology

393

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Figure

Fig 1. Person in a virtual environment wearing an HMD and head tracker.

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