Impact fonctionnel des troubles cognitifs dans les activités de la vie quotidienne chez les personnes cérébrolésées adultes : apports de la réalité virtuelle

Virtual Reality (VR) seems to open promising ways to research, particularly regarding the impact of cognitive deseases among people with acquired brain injury (ABI) immersed in simulated daily life situations. The use of VR raises or brings up to date concerns about the ecological validity of neuropsychological tests and the links between functional performance and cognitive processes. Aim: This thesis aims to study the ecological validity of virtual environments and relationships between functional performance and cognitive processes using two simulated tasks of daily life among people with ABI. Apparatus and method: Experimentation 1 Study population: 27 patients with Traumatic Brain Injury had been consecutively included and divided into two groups.Method: the first group including 13 subjects learned a route in an urban district near from the hospital of Bordeaux. In the second group 14 subjects had to do the same procedure in a virtual district that replicated the real environment. All subjects had to complete spatial representation tests at the end of the delayed recall route. Experiment 2 Study population: 95 patients with ABI (essentially including people with TBI or Cerebral Vascular Desease) were included. Method: Subjects had to do errands in the virtual supermarket VAP-S (Marie et al 2003, Klinger et al 2004). Among the initial group 50 subjects had a neuropsychological battery.Results Experiment 1 No significant difference has been found between the two groups according to demographic data and TBI severity. There was no effect of the real or virtual environement on the recall of route and the number of error was the same wathever was the environmental condition [(1, 25) = 0.679; p = 0.4176)]. Among the spatial representation tests, only the scene arrangement test were higher in the real environment [U = 32.5; p = 0.01]. Experiment 2 No significant difference between the two groups has been found according to demographic data, neuropsychological tests, mood, and social integration. A Principal Componant Analysis (PCA) on the results of the 50 subjects who had completed the whole neuropsychological battery raised a four factor solution that accounts for 69.4% of the variance. Among these factors, episodic memory, prospective memory and perceptual organization showed as many relationships with VAP-S indicators as attention and executive componants (inhibition and updating). The factor 3 is linked to social integration. It is an argument in favor of the ecological validity of the VAP-S Discussion In the first experiment, despite the fact that spatial representations seemed different between the real and virtual environments, learning results were the same. RV is a reliable and safe to assess the topographical performance which is important in the daily life and notably in social and vocational rehabilitation. The second experiment suggested that VR simulated activity of daily living as shopping in a virtual supermarket bring together cognitive resources within interactions probably close than daily life. This result overcomes the limits of the splitting cognitive functioning in neuropsychology with a good ecological validity. However these results must be examined with caution due to large individual variation. Conclusion This thesis confirms the ecological validity of RV simulated activities of daily living close to the complexity of the relationships between the performance observed in the daily life and cognitive processes that are underlying it. It opens interesting perspectives to assessment and cognitive rehabilitation using RV of people with ABI and cognitive deseases with the purpose to improve autonomy in daily life.