Abstracts from CyberTherapy 2006 (2006)

The main characteristic of virtual reality (VR) dwells in carrying spatial information in an analogical mode preserving most of space-time dimensions and interaction modalities that humans usually have in natural contexts. According to this, the spatial nature of virtual environments revealed an advantageous opportunity for the evaluation of residual perceptual abilities and motor-explorative behaviours in patients with cognitive impairment. In particular, it has been suggested that VR can be effectively used to evaluate how cognitive impaired users, such as patients affected by visuo-spatial neglect, are able to explore and memorize the environment in which they are able to interact. Neglect patients present difficulties in attending to stimuli placed in the contralesional space (typically the left hemispace). Several kinds of task can be used to assess and to modulate neglect behavior. These tasks should address the whole range of cognitive domains in which the disorder could be manifested (perception and mental representation, personal/ extrapersonal space, navigation abilities). Since standard evaluation of neglect syndrome is mainly carried out using paper-based tests within the laboratory, the assessment of patient’s behavior impairments in everyday contexts tends to be overlooked. Drawing on these premises, we introduced a Vrsituated approach for the evaluation of neglect patient’s perceptive, memory, and explorative residual abilities in coping with daily contexts. We designed two virtual environments: a small-scale, closed environment within which neglect patients could position objects and navigate; and a large-scale, open one, which patients explored freely. The main goal of the first virtual environment provided is to evaluate patients’ ability in memorizing, recognizing, and replacing objects within all the field of vision. The main aim of the second one is to evaluate patients’ exploration strategies and to analyze their description of context they are engaged with. We tested the environments in four brain-damaged patients. They were requested to immersively explore the environments in order to memorize, replace, and recognize familiar objects. Patients included in the study were previously evaluated with “paper and pencil” neuropsychological assessment which revealed respectively a neglect syndrome, an overcome neglect, a right brain damage without neglect and frontal brain injury (with slight attentional neglect). Results showed that, compared with standard evaluation (that is mainly grounded on the detection and recognition of motionless target objects) patients’ interaction with virtual environments (in which target objects are situated in a dynamical scene) exhibited peculiar explorative behaviors, such as perseverations and/or right-side navigation tendencies, that could be addressed to their specific cognitive impairments. In addition, from a methodological point of view, the introduction of a VR-based assessment allowed us to deliver the complexity of stimulus challenges of naturalistic settings, as well as to monitor them in order to identify what constitute patients’ main troubles in managing daily activities.