Development of a new computer simulated environment to screen cognition: assessing the feasibility and acceptability of Leaf Café in younger and older adults.

BACKGROUND: Existing traditional cognitive screening tools for dementia have various limitations, including overreliance on tests assessing verbal memory and, to a lesser extent, on some aspects of executive functioning. Comprehensive neuropsychological assessment is sensitive to impairment but time-intensive and expensive. Virtual reality may provide a dynamic and unique understanding of cognitive performance and increase the ecological validity of cognitive assessment. The use of virtual reality in screening for cognitive function in older persons is promising, but evidence for its use remains sparse. OBJECTIVE: Our primary aim was to examine the feasibility and acceptability of a newly developed, virtual reality assessment module, 'Leaf Café', a computer-based program that assesses cognition in an engaging, efficient, and ecologically relevant way. The secondary aim was to assess the ability of the module to discriminate between performances of younger and older adults. METHODS: A cross-sectional study was carried out in Sydney, Australia, targeting adults aged 18 years and above. Participants completed a traditional cognitive screening tool (Telephone Interview for Cognitive Status-Modified, TICS-M) and Leaf Café, a low-immersive virtual reality module designed to evaluate learning and memory, perceptual-motor function, and executive functioning. The total performance score for each participant, ranging from 0 to 180, was correlated with their cognitive performance assessed by TICS-M, using Pearson's correlation coefficient. Following module completion, participants were presented with an open and closed-question survey to capture their perceptions, attitudes, and feedback on the module, encompassing practicality, acceptability, and enjoyment. Both descriptive and content analyses were employed to interpret the obtained data. RESULTS: A sample of 131 participants (mean age 54.9 years, SD = 20.8, range 20-85) took part. The majority were female (71.8%) and born in an English-speaking country (75.8%). The mean amount of time spent in the module was 32.8 min (SD = 13.3) with a mean module score of 107.6 (SD = 38.7). Most participants completed the highest level (5; 80.5%). There was a significant correlation between Leaf Café total scores with TICS-M cognitive scores overall, and for both younger (aged 18-64 years) and older adult (aged 65 + years) groups. No significant difference was found on performance between age groups on TICS-M performance, however, younger adults had significantly better performance on the Leaf Café module than older adults (M = 124.1 vs 95.9; p < .001). Participants had similar response proportions regarding user experience with most agreeing that the module was easy to use (84%) and to navigate (85%). Compared with younger adults, older adults had lower rates of agreement on the module's design (36.8% vs 64.3%; p = .020) and support experienced (20.5% vs 53.6%; p = .007). Participants highlighted the significance of practicality and the cognitive challenges presented by the module, in terms of memory strain and user interface concerns. Feedback encompassed different opinions on the usefulness of music, with suggestions for improvements centred around clearer instructions, varied game dynamics, and considerations for diverse user needs. CONCLUSIONS: Leaf Café is a feasible and acceptable tool to be used for screening for cognitive impairment in older adults and has real-world assessment value. Further verification on the game's utility in detecting cognitive impairment is required.

Cue utilization and pool lifeguarding.

INTRODUCTION: Amongst pool lifeguards, the capacity to identify drowning swimmers quickly and accurately depends on the interpretation of critical cues. However, assessing the capacity for cue utilization amongst lifeguards at present is costly, time-consuming, and largely subjective. The aim of this study was to test the relationship between cue utilization and the detection of drowning swimmers in a series of virtual public swimming pool scenarios. METHOD: Eighty-seven participants with or without lifeguarding experience engaged in three virtual scenarios, two of which were target scenarios where drowning events occurred within a 13 minute or 23 minute period of watch. Cue utilization was assessed using the pool lifeguarding edition of the EXPERTise 2.0 software following which 23 participants were classified with higher cue utilization, while the remaining participants were classified with lower cue utilization. RESULTS: The results revealed that participants with higher cue utilization were more likely to have acquired experience as a lifeguard, were more likely to detect the drowning swimmer within a three minute period, and, in the case of the 13 minute scenario, recorded a greater dwell time on the drowning victim prior to the drowning event. CONCLUSION: The results suggest that cue utilization is associated with drowning detection performance in a simulated environment and could be employed as a basis for assessments of performance amongst lifeguards in the future. PRACTICAL IMPLICATIONS: Measures of cue utilization are associated with the timely detection of drowning victims in virtual pool lifeguarding scenarios. Employers and trainers of lifeguards can potentially augment existing lifeguarding assessment programs to quickly and cost-effectively identify the capabilities of lifeguards. This is especially useful for new lifeguards or where pool lifeguarding is a seasonal activity that might be associated with skill decay.

Virtual reality lifeguarding scenarios as a potential training solution for pool lifeguards.

BACKGROUND: Ensuring that pool lifeguards develop the skills necessary to detect drowning victims is challenging given that these situations are relatively rare, unpredictable and are difficult to simulate accurately and safely. Virtual reality potentially provides a safe and ecologically valid approach to training since it offers a near-to-real visual experience, together with the opportunity to practice task-related skills and receive feedback. As a prelude to the development of a training intervention, the aim of this research was to establish the construct validity of virtual reality drowning detection tasks. METHOD: Using a repeated measures design, a total of 38 qualified lifeguards and 33 non-lifeguards completed 13 min and 23 min simulated drowning detection tasks that were intended to reflect different levels of sustained attention. During the simulated tasks, participants were asked to monitor a virtual pool and identify any drowning targets with accuracy, response latency, and dwell time recorded. RESULTS: During the simulated scenarios, pool lifeguards detected drowning targets more frequently and spent less time than non-lifeguards fixating on the drowning target prior to the drowning onset. No significant differences in response latency were evident between lifeguards and non-lifeguards nor for first fixations on the drowning target. CONCLUSION: The results provide support for the construct validity of virtual reality lifeguarding scenarios, thereby providing the basis for their development and introduction as a potential training approach for developing and maintaining performance in lifeguarding and drowning detection. APPLICATION: This research provides support for the construct validity of virtual reality simulations as a potential training tool, enabling improvements in the fidelity of training solutions to improve pool lifeguard competency in drowning detection.