Table 5.
Virtual reality-based technologies in a city environment for assessment and rehabilitation of acquired brain injury.
| Methods/Study design | Participants | Domain | Interaction and display/Instrumentation | Assessment/Treatment | Measures | Conclusions | |
|---|---|---|---|---|---|---|---|
| Gamito et al. (2011a,b) | Non-experimental | 1 TBI | Working Memory and Attention. | HMD, keyboard and mouse. | Small town populated with digital robots. The town comprised several buildings arranged in eight squared blocks, along with a 2-room apartment and a mini-market, where the participant was able to move freely around and to grab objects. | Instruments: PASAT. Performance: Completion time of each task as an indicator of task performance speed. |
Satisfactory level of performance after some practice, with an average time for each task of 5 min. These data revealed a significant increase in working memory and attention levels, suggesting an improvement on patient cognitive function. |
| Gamito et al. (2011a,b) | Non-experimental | 2 stroke | Memory and Attention. | HMD, keyboard and mouse. | Activities of daily living such as: morning hygiene, taking the breakfast, finding the way to the minimarket and buying several items from a shopping list. | Instruments: WMS-III; TP; PQ; Immersion and Cybersickness. Performance: Completion time of each task as an indicator of task performance speed. |
Increase in memory and attention/concentration skills, which can suggest a higher level of executive functioning after the VR training. |
| Jovanovski et al. (2012) | Experimental | 11 stroke, 2 TBI and 30 HC | Evaluate the ecological validity of the MCT and other standardized executive function tests. | Joystick and computer screen | The MCT consists of a post office, drug store, stationery store, coffee shop, grocery store, optometrist’s office, doctor’s office, restaurant and pub, bank, dry cleaner, pet store, and the participant’s home. | Instruments: WTAR; TOMM; COWAT; WCST; BADS-MSE; TMT A and B; WAIS-III (Block Design, and Digit Span); JLO; ROCF; CVLT-II; WMS-III (Logical Memory); BDI-II and BAI. Performance: Completion Time; number of Tasks Completed; and Task Repetitions. Qualitative errors: Task Failures, Task Repetitions, or Inefficiencies. |
VR technology, designed with ecological validity in mind, are valuable tools for neuropsychologists attempting to predict real-world functioning in participants with ABI. |
| Gamito et al. (2014) | Non-experimental | 17 stroke | Memory and attention | HMD, desktop screenplay, keyboard and mouse. | Small town with a 2-room apartment and a minimarket in the vicinity. | Instruments: WMS-III; ROCF; TP. Performance: a therapist assessed the session outcome. |
Increased working memory and sustained attention from initial to final assessment regardless of the VR device used. |
| Vourvopoulos et al. (2014) | Non-experimental | 7 stroke, 2 TBI and 1 MCI | Visuospatial orientation, Attention and Executive functions. | Joystick and computer screen | Simulations of several activities of daily living (supermarket, post-office, pharmacy and bank) within a city. | Instruments: MMSE; SIS and SUS. Performance: Total score and execution time. |
Strong correlation between the Reh@City performance and the MMSE score. High usability scores (M = 77%). |
| Gamito et al. (2015) | Experimental | 20 stroke | Memory and Attention | HMD, keyboard and mouse. | The VR scenario comprised several daily life activities: buying several items, finding the way to the minimarket, finding a virtual character dressed in yellow, recognition of outdoor advertisements and digit retention. | Instruments: WMS-III; ROCF; TP. |
Significant improvements in attention and memory functions in the intervention group, but not in the controls. |
| Faria et al. (2016) | Experimental | 18 stroke | Global cognitive functioning | Joystick and computer screen | Reh@City v1.0: an immersive three-dimensional environment with streets, sidewalks, commercial buildings, parks and moving cars. Participants have to accomplish some common ADL’s in four places: supermarket, post office, bank, and pharmacy. | Instruments: ACE; TMT A and B; WAIS III (Picture Arrangement); SIS 3.0; SUS. Performance: Total score and execution time. |
A within groups analysis revealed significant improvements in global cognitive functioning, attention, memory, visuo-spatial abilities, executive functions, emotion and overall recovery in the VR group. The control group only improved in self-reported memory and social participation. Between groups analysis, showed significantly greater improvements in global cognitive functioning, attention and executive functions when comparing VR to conventional therapy. |
| Claessen et al. (2016) | Experimental | 68 stroke and 44 HC | Spatial navigation | Not defined. | Each route contained 11 decision points. Eight subtasks were used to assess the participants’ knowledge of the studied route in the testing phase. | Instruments: NART; CORSI; TMT A and B; WAIS-III (Digit Span). Performance: Scene Recognition. |
Moderate overlap of the total scores between the two navigation tests indicates that virtual testing of navigation ability is a valid alternative to navigation tests that rely on real-world route exposure. |
| Faria et al. (2019) | Experimental | 31 stroke | Global cognitive functioning | Customized handle with a tracking pattern. | Reh@City v2.0: an immersive three-dimensional environment with streets, sidewalks, commercial buildings, parks and moving cars. Participants have to accomplish some common ADL’s in eight places: supermarket, post office, bank, pharmacy, fashion store, kiosk, home and park. | Instruments: MoCA. Performance: Total score and execution time. |
Both groups performed at the same level and there was not an effect of the training methodology in overall performance. However, Reh@City enabled a more intensive training, which may translate in more cognitive improvements. |
| Faria et al. (2020) | Experimental | 36 stroke | Global cognitive functioning | Customized handle with a tracking pattern. | Reh@City v2.0: an immersive three-dimensional environment with streets, sidewalks, commercial buildings, parks and moving cars. Participants have to accomplish some common ADL’s in eight places: supermarket, post office, bank, pharmacy, fashion store, kiosk, home and park. | Instruments: MoCA; TMT A and B; WMS-III Verbal Paired Associates; WAIS-III Digit Symbol Coding, Symbol Search, Digit Span and Vocabulary subtests, and PRECiS. | Within-groups Reh@City v2.0 improved general cognitive functioning, attention, visuospatial ability and executive functions. These improvements generalized to verbal memory, processing speed and self-perceived cognitive deficits assessments. TG only improved MoCA orientation, and processing speed and verbal memory outcomes. Between-groups Reh@City v2.0 was superior in MoCA general cognitive functioning, visuospatial ability, and executive functions. |
| Oliveira et al. (2020) | Experimental | 30 stroke | Global cognitive functioning | Mouse and computer screen | City with tasks as using a toothbrush, following the steps of a recipe to bake a cake, or by watching news on a television and recollect pieces of this information on latter tasks. Outside the tasks consist of buying products in the grocery store or to perform visual search tasks in a virtual art gallery. | Instruments: MoCA, FAB, WMS-III, and CTT. | Improvements were found in the assessed cognitive domains at 6 to 10 post-treatment sessions. In-depth analysis through reliable change scores has suggested larger treatment effects on global cognition. |
ACE, Addenbrooke Cognitive Examination; BADS-MSE, Behavioral Assessment of the Dysexecutive Syndrome–Modified Six Elements Test; BAI, Beck Anxiety Inventory; BDI-II, The Beck Depression Inventory-Second Edition; CORSI, The Corsi Block-Tapping Task; COWAT, Controlled Oral Word Association Test; CTT, Colors Trail Test; CVLT-II, California Verbal Learning Test-Second Edition; Cybersickness, Simulator Sickness Questionnaire; FAB, Frontal Assessment Battery; Immersion, Immersion Tendencies Questionnaire; JLO, Judgment of Line Orientation; MMSE, Mini-Mental State Examination test; MoCA, Montreal Cognitive Assessment; NART, National Adult Reading Test; PASAT, The Paced Auditory Serial Addition Task; PQ, Presence Questionnaire; PRECiS, Patient-Reported Evaluation of Cognitive State; ROCF, Rey-Osterreith Complex Figure Test; SIS, Stroke Impact Scale 3.0; SUS, System Usability Scale; TMT A and B, Trail-Making Test Parts A and B; TOMM, Test of Memory Malingering; TP, Toulouse–Pieron; WAIS-III, Wechsler Adult Intelligence Scale-Third Edition; WCST, Wisconsin Card-Sorting Test; WMS-III, Wechsler Memory Scale – 3rd edition; WTAR, The Wechsler Test of Adult Reading.