Three Virtual Reality Environments for the Assessment of Executive Functioning Using Performance Scores and Kinematics: An Embodied and Ecological Approach to Cognition.

Virtual reality (VR) is an attractive technology for cognitive assessment, as it provides a more embodied experience compared with typical test situations, such as those using paper and pencil. In addition, VR can immerse individuals in complex situations similar to real-life ones, thereby improving the ecological validity (i.e., face validity) of the assessment. VR also offers improved scoring of tests as it facilitates the tracking of kinematic information and the temporal tracking of activities. This study assesses the correlation between scores on executive function assessments using standard neuropsychological tasks in paper-and-pencil format, on a tablet, and in three immersive VR environments, each designed to involve specific aspects of executive function. This study also aims to assess the correlation between these performance scores and a set of kinematic measures (speed, duration, and distance traveled by the hand) collected in VR. The outcomes, including performance scores and kinematic measures, correlate both with traditional assessment methods (such as paper and pencil, and computerized 2D tests) and with each other, suggesting their potential usefulness in clinical and research contexts. The discussion focuses on the advantages of embodied, situated, and spatialized tests for cognitive assessment and the benefits of kinematic tracking in VR tests for the quality of this assessment.

Feasibility of Combining Transcranial Direct Current Stimulation and Active Fully Embodied Virtual Reality for Visual Height Intolerance: A Double-Blind Randomized Controlled Study.

BACKGROUND: Transcranial Direct Current Stimulation (tDCS) and Virtual Reality Exposure Therapy (VRET) are individually increasingly used in psychiatric research. OBJECTIVE/HYPOTHESIS: Our study aimed to investigate the feasibility of combining tDCS and wireless 360° full immersive active and embodied VRET to reduce height-induced anxiety. METHODS: We carried out a pilot randomized, double-blind, controlled study associating VRET (two 20 min sessions with a 48 h interval, during which, participants had to cross a plank at rising heights in a building in construction) with online tDCS (targeting the ventromedial prefrontal cortex) in 28 participants. The primary outcomes were the sense of presence level and the tolerability. The secondary outcomes were the anxiety level (Subjective Unit of Discomfort) and the salivary cortisol concentration. RESULTS: We confirmed the feasibility of the association between tDCS and fully embodied VRET associated with a good sense of presence without noticeable adverse effects. In both groups, a significant reduction in the fear of height was observed after two sessions, with only a small effect size of add-on tDCS (0.1) according to the SUD. The variations of cortisol concentration differed in the tDCS and sham groups. CONCLUSION: Our study confirmed the feasibility of the association between wireless online tDCS and active, fully embodied VRET. The optimal tDCS paradigm remains to be determined in this context to increase effect size and then adequately power future clinical studies assessing synergies between both techniques.

Examining the Academic Trends in Neuropsychological Tests for Executive Functions Using Virtual Reality: Systematic Literature Review.

BACKGROUND: In neuropsychology, fully immersive virtual reality (VR) has been spotlighted as a promising tool. It is considered that VR not only overcomes the existing limitation of neuropsychological tests but is also appropriate for treating executive functions (EFs) within activities of daily living (ADL) due to its high ecological validity. While fully immersive VR offers new possibilities of neuropsychological tests, there are few studies that overview the intellectual landscape and academic trends in the research related to mainly targeted EFs with fully immersive VR. OBJECTIVE: The objective of this study is to get an overview of the research trends that use VR in neuropsychological tests and to analyze the research trends using fully immersive VR neuropsychological tests with experimental articles. METHODS: This review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were searched in three web databases using keywords related to VR, EFs, and cognitive abilities. The study was conducted in two steps, keyword analysis and in-depth systematic review. In the web database search from 2000 to 2019, 1167 articles were initially collected, of which 234 articles in the eligibility phase were used to conduct keyword analysis and a total of 47 articles were included for systematic review. RESULTS: In keyword analysis, the number of articles focused on dementia including the keywords "MCI," "SCD," and "dementia" were highlighted over the period, rather than other symptoms. In addition, we identified that the use of behavioral and physiological data in virtual environments (VEs) has dramatically increased in recent studies. In the systematic review, we focused on the purpose of study, assessment, treatment, and validation of usability and structure. We found that treatment studies and uncategorized studies including presence and cybersickness issues have emerged in the recent period. In addition, the target symptoms and range of participants were diversified. CONCLUSIONS: There has been a continuously increasing interest in dealing with neuropsychology by using fully immersive VR. Target cognitive abilities have been diversified, as well as target symptoms. Moreover, the concept of embodied cognition was transplanted in this research area.