Development of a Search Task Using Immersive Virtual Reality: Proof-of-Concept Study

Abstract

Background Serious games are gaining increasing importance in neurorehabilitation since they increase motivation and adherence to therapy, thereby potentially improving its outcome. The benefits of serious games, such as the possibility to implement adaptive feedback and the calculation of comparable performance measures, can be even further improved by using immersive virtual reality (iVR), allowing a more intuitive interaction with training devices and higher ecological validity. Objective This study aimed to develop a visual search task embedded in a serious game setting for iVR, including self-adapting difficulty scaling, thus being able to adjust to the needs and ability levels of different groups of individuals. Methods In a two-step process, a serious game in iVR (bird search task) was developed and tested in healthy young (n=21) and elderly (n=23) participants and in a group of patients with impaired visual exploration behavior (ie, patients with hemispatial neglect after right-hemispheric stroke; n=11). Usability, side effects, game experience, immersion, and presence of the iVR serious game were assessed by validated questionnaires. Moreover, in the group of stroke patients, the performance in the iVR serious game was also considered with respect to hemispatial neglect severity, as assessed by established objective hemispatial neglect measures. Results In all 3 groups, reported usability of the iVR serious game was above 4.5 (on a Likert scale with scores ranging from 1 to 5) and reported side effects were infrequent and of low intensity (below 1.5 on a Likert scale with scores ranging from 1 to 4). All 3 groups equally judged the iVR serious game as highly motivating and entertaining. Performance in the game (in terms of mean search time) showed a lateralized increase in search time in patients with hemispatial neglect that varied strongly as a function of objective hemispatial neglect severity. Conclusions The developed iVR serious game, “bird search task,” was a motivating, entertaining, and immersive task, which can, due to its adaptive difficulty scaling, adjust and be played by different populations with different levels of skills, including individuals with cognitive impairments. As a complementary finding, it seems that performance in the game is able to capture typical patterns of impaired visual exploration behavior in hemispatial neglect, as there is a high correlation between performance and neglect severity as assessed with a cancellation task.

Effects of Virtual Reality–Based Multimodal Audio-Tactile Cueing in Patients With Spatial Attention Deficits: Pilot Usability Study

“…In line with our first hypothesis, patients rated the device’s usability as very high and did not report any relevant side effects. The high usability of our new VR setting, including tactile stimulation, is similar to that in one of the few previous studies in stroke patients with a similar visual and auditory setting, which however did not entail any tactile stimulation [ 14 , 37 ]. Moreover, similar levels of usability have been reported by healthy participants using new VR tools including visual and auditory stimulation, but without tactile stimulation [ 36 , 50 , 51 ].…”

“…Skills learned in VR have been shown to be transferable to the real world [ 7 , 12 , 13 ], leading to a broad spectrum of possibilities, from training to rehabilitation. Virtual environments have the advantage of being fully customizable, and therefore, they are potentially adaptable to different situations and even different user abilities [ 14 , 15 ]. Particularly in the field of rehabilitation of neurological disorders, VR has been shown to be a promising approach because of this adaptability and the inclusion of different sensory information [ 16 ].…”

Virtual Reality and Eye-Tracking Assessment, and Treatment of Unilateral Spatial Neglect: Systematic Review and Future Prospects

“…VR-ET systems can replicate conventional USN tests, e.g., cancelation and line-bisection, thus, providing more fine-grained analysis of the attentional processes during the tasks, such as the field of view, distribution of gaze, and response time. Novel VR-based visual search and cancellation tests reveal a high correlation with conventional USN tests ( Knobel et al, 2020 , 2021 ) and may improve our understanding of the field of perception (FOP) and field of regard (FOR) in stroke patients with and without USN ( Kim et al, 2021 ).…”

Visualization and Interaction Technologies in Serious and Exergames for Cognitive Assessment and Training: A Survey on Available Solutions and Their Validation

“…Immersive HMDs [6], [14], [17], [20], [27], [29], [35], [42], [46], [47], [52], [174] Touchful devices comprise the widely diffused tools for gaming (N=181) and physiotherapic devices (N=17), e.g. treadmills, cycle-ergometers and pressure sensitive plates, which are particularly suitable for rehabilitation programs aimed at improving motor skills in subjects with age-related disorders [15], [50], [88], [94], [111], [146]- [149], [203], [208], major neurocognitive disorders (MNCD) [23], stroke [115], [151] and multiple sclerosis (MS) [22] patients.…”

“…Controller, joystick or gamepad [6], [14], [15], [17], [20], [35], [42], [50], [52], [54]- [56], [62], [65], [70], [79],…”