In this initial pilot study, a controlled clinical comparison was made of attention perforance in children with attention deficit-hyperactivity disorder (ADHD) in a virtual reality (VR) classroom. Ten boys diagnosed with ADHD and ten normal control boys participated in the study. Groups did not significantly differ in mean age, grade level, ethnicity, or handedness. No participants reported simulator sickness following VR exposure. Children with ADHD exhibited more omission errors, commission errors, and overall body movement than normal control children in the VR classroom. Children with ADHD were more impacted by distraction in the VR classroom. VR classroom measures were correlated with traditional ADHD assessment tools and the flatscreen CPT. Of note, the small sample size incorporated in each group and higher WISC-III scores of normal controls might have some bearing on the overall interpretation of results. These data suggested that the Virtual Classroom had good potential for controlled performance assessment within an ecologically valid environment and appeared to parse out significant effects due to the presence of distraction stimuli.
Treatment and rehabilitation of the cognitive, psychological, and motor sequelae of central nervous system dysfunction often relies on assessment instruments to inform diagnosis and to track changes in clinical status. Typically, these assessments employ paper-and-pencil psychometrics, hands-on analog/computer tests, and rating of behavior within the context of real-world functional environments. Virtual reality offers the option to produce and distribute identical “standard” simulation environments in which performance can be measured and rehabilitated. Within such digital scenarios, normative data can be accumulated for performance comparisons needed for assessment/diagnosis and for treatment/rehabilitation purposes. In this manner, reusable archetypic virtual environments constructed for one purpose can also be applied for applications addressing other clinical targets. This article will provide a review of such a retooling approach using a virtual classroom simulation that was originally developed as a controlled stimulus environment in which attention processes could be systematically assessed in children with attention-deficit/hyperactivity disorder. This system is now being applied to other clinical targets including the development of tests that address other cognitive functions, eye movement under distraction conditions, social anxiety disorder, and the creation of an earthquake safety training application for children with developmental and learning disabilities.
Virtual reality (VR) technology offers new options for the creation of sophisticated tools that could be applied in the areas of assessment and rehabilitation of cognitive and functional processes. VR systems allow for the precise presentation and control of dynamic, multisensory, three-dimensional (3-D) stimulus environments, as well as the recording of all behavioral responses that occur within them. Assessment and rehabilitation scenarios that would be difficult if not impossible to deliver using conventional neuropsychological methods are now being developed that take advantage of these VR assets. If empirical studies demonstrate effectiveness, virtual environments (VEs) could be of considerable value for better understanding, measuring, and treating persons with impairments due to traumatic brain injury, neurological disorders, and learning disabilities. This article describes the progress of a VR research program at the USC Integrated Media Systems Center and Information Sciences Institute that has developed and investigated the use of a series of VEs designed to target (i) molecular visuospatial skills using a 3-D, projection-based ImmersaDesk system, and (ii) attention (and soon memory and executive functioning) processes within ecologically valid functional scenarios utilizing a head-mounted display (HMD). Results from completed research, rationales and methodology of works in progress, and our plan for future work is presented. Our primary vision has been to develop VR systems that target cognitive processes and functional skills that are of relevance to a wide range of patient populations with central nervous system (CNS) dysfunction, as well as for the assessment of unimpaired performance. We have also sought to select cognitive/functional targets that intuitively appear well matched to the specific assets available with currently available VR technology.
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