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.
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°2002 Lippincott Williams & Wilkins, Inc.
Virtual Reality and Neuropsychology
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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.
1Effective
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.
2By 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,
3education of patients and medical
students,
4and treatment of sensory mobility
deficits.
5Treatment 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.
6,7VR has also been applied to the treatment
of posttraumatic stress disorder (PTSD),
8eat-ing disorders,
9and pain management.
10Re-sults from these studies have served to
un-derscore some of the specific assets afforded
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