An immersive virtual reality system for ecological assessment of peripersonal and extrapersonal unilateral spatial neglect (original) (raw)
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Neurorehabilitation and neural repair, 2018
Unilateral spatial neglect (USN) is a highly prevalent and disabling poststroke impairment. USN is traditionally assessed with paper-and-pencil tests that lack ecological validity, generalization to real-life situations and are easily compensated for in chronic stages. Virtual reality (VR) can, however, counteract these limitations. We aimed to examine the feasibility of a novel assessment of USN symptoms in a functional shopping activity, the Ecological VR-based Evaluation of Neglect Symptoms (EVENS). EVENS is immersive and consists of simple and complex 3-dimensional scenes depicting grocery shopping shelves, where joystick-based object detection and navigation tasks are performed while seated. Effects of virtual scene complexity on navigational and detection abilities in patients with (USN+, n = 12) and without (USN-, n = 15) USN following a right hemisphere stroke and in age-matched healthy controls (HC, n = 9) were determined. Longer detection times, larger mediolateral deviati...
2009
Unilateral spatial neglect is a disabling condition frequently occurring after stroke. People with neglect suffer from various spatial deficits in several modalities, which in many cases impair everyday functioning. A successful treatment is yet to be found. Several techniques have been proposed in the last decades, but only a few showed long-lasting effects and none could completely rehabilitate the condition. Diagnostic methods of neglect could be improved as well. The disorder is normally diagnosed with pen-and-paper methods, which generally do not assess patients in everyday tasks and do not address some forms of the disorder. Recently, promising new methods based on virtual reality have emerged. Virtual reality technologies hold great opportunities for the development of effective assessment and treatment techniques for neglect because they provide rich, multimodal, and highly controllable environments. In order to stimulate advancements in this domain, we present a review and an analysis of the current work. We describe past and ongoing research of virtual reality applications for unilateral neglect and discuss the existing problems and new directions for development.
BACKGROUND: Unilateral Spatial Neglect, or neglect, is a common behavioral syndrome in patients following unilateral brain damage, such as stroke. In recent years, new technologies, such as computer-based tools and virtual reality have been used in order to solve some limitations of the traditional neglect evaluation. Within this perspective, also mobile devices such as tablets seems to be promising tools, being able to support interactive virtual environments and, at the same time, allowing to easily reproduce traditional paper-and-pencil test. OBJECTIVE: In this context, the aim of our study was to investigate the potentiality of a new mobile application (Neglect App) designed and developed for tablet (iPad) for screening neglect symptoms. METHODS: To address this objective, we divided a sample of 16 right-damaged patients according to the presence or absence of neglect and we administered assessment test in their traditional and Neglect App version. RESULTS: Results showed that the cancellation tests developed within Neglect App were equally effective to traditional paper- and-pencil tests (Line cancellation test and Star Cancellation test) in detecting neglect symptoms. Secondly, according to our results, the Neglect App Card Dealing task was more sensitive in detecting neglect symptoms than traditional functional task. CONCLUSIONS: Globally, results gives preliminary evidences supporting the feasibility of Neglect App for the screening of USN symptoms.
Brain Impairment
Background: Deficits in visuospatial attention, known as neglect, are common following brain injury, but underdiagnosed and poorly treated, resulting in long-term cognitive disability. In clinical settings, neglect is often assessed using simple pen-and-paper tests. While convenient, these cannot characterise the full spectrum of neglect. This protocol reports a research programme that compares traditional neglect assessments with a novel virtual reality attention assessment platform: The Attention Atlas (AA). Methods/design: The AA was codesigned by researchers and clinicians to meet the clinical need for improved neglect assessment. The AA uses a visual search paradigm to map the attended space in three dimensions and seeks to identify the optimal parameters that best distinguish neglect from non-neglect, and the spectrum of neglect, by providing near-time feedback to clinicians on system-level behavioural performance. A series of experiments will address procedural, scientific, p...
Frontiers in Psychology
Unilateral spatial neglect (USN) is a disorder characterized by the failure to report, respond to, or orient toward the contralateral side of space to a brain lesion. Current assessment methods often fail to discover milder forms, cannot differentiate between unilateral spatial neglect subtypes and lack ecological validity. There is also a need for treatment methods that target subtypes. Immersive virtual reality (VR) systems in combination with eye-tracking (ET) have the potential to overcome these shortcomings, by providing more naturalistic environments and tasks, with sensitive and detailed measures. This systematic review examines the state of the art of research on these technologies as applied in the assessment and treatment of USN. As we found no studies that combined immersive VR and ET, we reviewed these approaches individually. The review of VR included seven articles, the ET review twelve. The reviews revealed promising results. (1) All included studies found significant...
Assessment and rehabilitation of neglect using virtual reality: a systematic review
Frontiers in Behavioral Neuroscience, 2015
After experiencing a stroke in the right hemisphere, almost 50% of patients showed Unilateral Spatial Neglect (USN). In recent decades, Virtual Reality (VR) has been used as an effective tool both for the assessment and rehabilitation of USN. Indeed, this advanced technology allows post-stroke patients to interact with ecological and engaging environments similar to real ones, but in a safe and controlled way. To provide an overview of the most recent VR applications for the assessment and rehabilitation of USN, a systematic review has been carried out. Since 2010, 13 studies have proposed and tested innovative VR tools for USN. After a wide description of the selected studies, we discuss the main features of these VR tools in order to provide crucial indications for future studies, neurorehabilitation interventions, and clinical practice.
Virtual Reality is one of the most promising tools in the development of new methods for neuropsychological assessment and rehabilitation. Neuropsychological assessment is typically carried out by administering paper-and-pencil tests to patients. However, these tests have some limitations, due to the fact that they are not effectively able to evaluate the subject’s performance of daily activities. To cope with this void, neuropsychologists base their evaluation on their clinical experience, often successfully. Nevertheless, this is not an evidence-based practice, thus it is not considered optimal from a medical decision-making perspective. More recently, however, the increasing accessibility of advanced technology such as virtual reality has opened new possibilities for neuropsychological assessment and rehabilitation. Starting with this frame, the chapter explores the changes that have occurred over time in the neuropsychological assessment and rehabilitation up to the most recent VR-based tools. In particular, we will present a VRbased PC tool for the assessment of executive functions, and a VR-based mobile tool for the assessment and rehabilitation of unilateral spatial neglect. In accordance with the literature, we show the potential for virtual reality, highlighting the advantages, limitations, and the possible future challenges.
Towards a Dynamic Assessment of Unilateral Spatial Neglect
The Open Psychology Journal, 2017
Background: The traditional paper and pencil tests are often inadequate to detect the mild forms of Unilateral Spatial Neglect (USN). Objective: To verify the effectiveness of a touchscreen-based cancellation test in assessing individuals with USN. Methods: Seven individuals, six with right and one with left brain damage, who showed moderate to severe USN at admission, were involved in the study. Besides classic paper and pencil tests, participants were presented with a new, “user-friendly”, device consisting of an interactive “table” that integrates the principles of ecologic interaction and sophisticated technology. Such a touch screen table made possible to analyse the spatial and temporal evolution of the participants’ performance, providing a set of indices related to “how” the different tasks have been fulfilled, rather than simple raw scores. Results: This new technological approach turned out to be much more sensitive than the classic paper and pencil tests to detect the sli...
Journal of neuroengineering and rehabilitation, 2018
Unilateral spatial neglect (USN), a highly prevalent and disabling post-stroke impairment, has been shown to affect the recovery of locomotor and navigation skills needed for community mobility. We recently found that USN alters goal-directed locomotion in conditions of different cognitive/perceptual demands. However, sensorimotor post-stroke dysfunction (e.g. decreased walking speed) could have influenced the results. Analogous to a previously used goal-directed locomotor paradigm, a seated, joystick-driven navigation experiment, minimizing locomotor demands, was employed in individuals with and without post-stroke USN (USN+ and USN-, respectively) and healthy controls (HC). Participants (n = 15 per group) performed a seated, joystick-driven navigation and detection time task to targets 7 m away at 0°, ±15°/30° in actual (visually-guided), remembered (memory-guided) and shifting (visually-guided with representational updating component) conditions while immersed in a 3D virtual rea...
Virtual Reality Technology In the Assessment and Rehabilitation of Unilateral Visual Neglect
Proc. 1 st European …, 1996
Unilateral visual neglect affects a very large proportion of patients immediately after stroke. The presence of neglect has been found to be the major determinant of recovery of everyday function (Denes, Semenza, Stoppa & Lis, 1982). Interventions for the rehabilitation of neglect are not very effective. Picking up from the suggestions of Robertson, Halligan & Marshall (1993) potential ways forward employing VR technology are discussed.