Immersive virtual reality has become increasingly popular to improve the assessment and treatment of health problems. This rising popularity is likely to be facilitated by the availability of affordable headsets that deliver high quality immersive experiences. As many health problems are more prevalent in older adults, who are less technology experienced, it is important to know whether they are willing to use immersive virtual reality. In this study, we assessed the initial attitude towards head-mounted immersive virtual reality in 76 older adults who had never used virtual reality before. Furthermore, we assessed changes in attitude as well as self-reported cybersickness after a first exposure to immersive virtual reality relative to exposure to time-lapse videos. Attitudes towards immersive virtual reality changed from neutral to positive after a first exposure to immersive virtual reality, but not after exposure to time-lapse videos. Moreover, self-reported cybersickness was minimal and had no association with exposure to immersive virtual reality. These results imply that the contribution of VR applications to health in older adults will neither be hindered by negative attitudes nor by cybersickness.

Immersive virtual reality (IVR) may boost neglect recovery, as it can provide an engaging experience in a 3D environment. We designed an IVR rehabilitation game for neglect patients using the Oculus Rift.Multisensory cues were presented in the neglected visual field in a patient-tailored way. We acquired pilot data in 15 neurologically healthy controls and 7 stroke patients. First, we compared cybersickness before and after VR exposure. Second, we assessed the user experience through a questionnaire. Third, we tested whether neglect symptoms corresponded between the VR game and a computerized cancellation task. Fourth, we evaluated the effect of the multisensory cueing on target discrimination.Last, we tested two algorithms to tailor the game to the characteristics of the neglected visual field.Cybersickness significantly reduced after VR exposure in six stroke patients and was low in healthy controls. Patients rated the user experience neutral to positive. In addition, neglect symptoms were consistent between a computerized cancellation and VR rehabilitation task. The multisensory cue positively affected target discrimination in the game and we successfully presented sensory stimulation to the neglected visual field in a patient-tailored way. Our results show that it is promising to use gamified patient-tailored immersive VR for neglect rehabilitation.

BackgroundThe Embedded Figures Test (EFT, developed by Witkin and colleagues (1971)) has been used extensively in research on individual differences, particularly in the study of autism spectrum disorder. The EFT was originally conceptualized as a measure of field (in)dependence, but in recent years performance on the EFT has been interpreted as a measure of local versus global perceptual style. Although many have used the EFT to measure perceptual style, relatively few have focused on understanding the stimulus features that cause a shape to become embedded. The primary aim of this work was to investigate the relation between the strength of embedding and perceptual grouping on a group level.MethodNew embedded figure stimuli (both targets and contexts) were developed in which stimulus features that may influence perceptual grouping were explicitly manipulated. The symmetry, closure and complexity of the target shape were manipulated as well as its good continuation by varying the number of lines from the target that continued into the context. We evaluated the effect of these four stimulus features on target detection in a new embedded figures task (Leuven Embedded Figures Test, L-EFT) in a group of undergraduate psychology students. The results were then replicated in a second experiment using a slightly different version of the task.ResultsStimulus features that influence perceptual grouping, especially good continuation and symmetry, clearly affected performance (lower accuracy, slower response times) on the L-EFT. Closure did not yield results in line with our predictions.DiscussionThese results show that some stimulus features, which are known to affect perceptual grouping, also influence how effectively a stimulus becomes embedded in different contexts. Whether these results imply that the EFT measures individual differences in perceptual grouping ability must be further investigated.

A large body of research reports individual differences in local and global visual processing in relation to expertise, culture and psychopathology. However, recent research has suggested that various different measures of local-global processing are not strongly associated with one another, calling its construct validity into question. The current study sought to further explore the validity of local-global processing biases in perception by developing three tasks based on two existing paradigms: the Embedded Figures Test (EFT) and the Navon hierarchical letters task. The newly developed tasks aimed to control for stimulus and response factors that may have impacted upon the reliability of previous research. They were administered to a large sample of undergraduate students (N>100). The results of two new versions of the EFT indicated that disembedding performance is influenced by the structure of the embedding context. In addition, global precedence and interference in the Navon task remained present even when local attentional approaches to global hierarchical stimuli were restricted. Inter-task correlations within the EFT were high but low between the EFT and the Navon task, lending support to the notion that local-global processing is not a monolithic construct, but representative of a number of distinct perceptual abilities and biases. Future research may use these task distinctions to pinpoint more precisely which aspects of perceptual processing characterise specific (clinical) participant populations.

Virtual reality (VR) offers many opportunities for post-stroke rehabilitation. However, “VR” can refer to several types of computer-based rehabilitation systems. Since these systems may impact the feasibility and the efficacy of VR interventions, consistent terminology is important. In this study, we aimed to optimize the terminology for VR-based post-stroke rehabilitation by assessing whether and how review papers on this topic defined VR and what types of mixed reality systems were discussed. In addition, this review can inspire the use of consistent terminology for other researchers working with VR. We assessed the use of the term VR in review papers on post-stroke rehabilitation extracted from Scopus, Web of Science and PubMed. We also developed a taxonomy distinguishing 16 mixed reality systems based on three factors: immersive versus semi-immersive displays, the way in which real and virtual information is mixed, and the main input device. 64% of the included review papers (N = 121) explicitly defined VR and 33% of them described different subtypes of VR, with immersive and non-immersive VR as the most common distinction. The most frequently discussed input devices were motion-capture cameras and handheld devices, while regular 2D monitors were the most frequently mentioned output devices. Our analysis revealed that reviews on post-stroke VR rehabilitation did not or only broadly defined “VR” and did not focus on a specific system. Since the efficacy and feasibility of rehabilitation may depend on the specific system, we propose a new data-driven taxonomy to distinguish different systems, which is expected to facilitate communication amongst researchers and clinicians working with virtual reality.

The Oxford Cognitive Screen (OCS) is a screening tool specifically designed for acute stroke patients, assessing 5 domains: attention and executive functions, language, praxis, numeric cognition and memory. Here we present norms for the Dutch version of the OCS (OCS-NL). We evaluated whether age and socio-economic status were linked to OCS-NL performance, since stroke prevalence and recovery are associated to these characteristics. We acquired normative data of the OCS-NL version A in 246 neurologically healthy participants and a subset of 179 participants also completed parallel version B. Socio-economic status was measured using three indicators: education, income and occupation. Data were analyzed in a Bayesian way and we report credible intervals of effect sizes. There were no systematic differences in OCS-NL global performance between low, middle and high income groups, nor between manual and non-manual workers. There were small differences between low and middle and between low and high education groups, and the association of education and OCS-NL performance did not vary across subtests. The association of age and OCS-NL performance varied across subtests. The naming, praxis, verbal memory and executive task had the strongest association with age. These data suggest that normative data for the OCS-NL do not need to be stratified on income and occupation, that age-specific cut-off scores are especially recommended for the naming, praxis, executive function and verbal memory tasks and that education must be considered when interpreting OCS-NL test scores.

Objective: To diagnose egocentric neglect after stroke, the spatial bias of performance on cancellation tasks is typically compared to a single cutoff. This standard procedure relies on the assumption that the measurement error of cancellation performance does not depend on non-spatial impairments affecting the total number of cancelled targets. Here we assessed the impact of this assumption on false-positive diagnoses. Method: We estimated false positives by simulating cancellation data using a binomial model. Performance was summarised by the difference in left and right cancelled targets (R-L) and the Centre of Cancellation (CoC). Diagnosis was based on a fixed cutoff versus cutoffs adjusted for the total number of cancelled targets and on single test performance versus unanimous or proportional agreement across multiple tests. Finally, we compared the simulation findings to empirical cancellation data acquired from 651 stroke patients. Results: Using a fixed cutoff, the rate of false positives depended on the total number of cancelled targets and ranged from 10% to 30% for R-L scores and from 10% to 90% for CoC scores. The rate of false positives increased even further when diagnosis was based on proportional agreement across multiple tests. Adjusted cutoffs and unanimous agreement across multiple tests were effective at controlling false positives. For empirical data, fixed versus adjusted cutoffs differ in estimation of neglect prevalence by 13%, and this difference was largest for patients with non-spatial impairments. Conclusions: Our findings demonstrate the importance of considering non-spatial impairments when diagnosing neglect based on cancellation performance.

Despite the proliferation of research on immersive virtual reality (IVR) technologies for older adults, comprehensive guidelines on designing immersive and engaging VR for older adults remain sparse. Therefore, we first compounded 67 guidelines based on published literature. Next, to empirically ground these design recommendations, we provided 37 older adults of diverse ages, education levels, and cognitive abilities with a first VR experience. Analyzing interviews with the 37 older adults via the Laddering method, we found that they generally reported positive experiences with their first VR exposure. With these deepened insights, we reflect on, nuance, and contextualize existing design guidelines, and formulate points to bear in mind when designing accessible and engaging VR experiences for older persons.