Learning My Way: A Pilot Study of Navigation Skills in Cerebral Palsy in Immersive Virtual Reality

Abstract

Purpose: Human navigation skills are essential for everyday life and rely on several cognitive abilities, among which visual-spatial competences that are impaired in subjects with cerebral palsy (CP). In this work, we proposed navigation tasks in immersive virtual reality (IVR) to 15 children with CP and 13 typically developing (TD) peers in order to assess the individual navigation strategies and their modifiability in a situation resembling real life.Methods: We developed and adapted to IVR an application based on a 5-way maze in a playground that was to be navigated to find a reward. The learning process, navigation strategies, and adaptation to changes were compared between participants with CP and their TD peers and correlated with visual-spatial abilities and cognitive competences.Results: Most participants with CP needed more attempts than TD participants to become proficient in navigation. Furthermore, the learning phase was correlated to visual-spatial memory but not with cognitive competences. Interestingly, navigation skills were comparable between groups after stabilization. While TD participants mainly relied on allocentric strategies based on environmental cues, egocentric (self-centered) strategies based on body motion prevailed in participants with CP. Furthermore, participants with CP had more difficulties in modifying their navigation strategies, caused by difficulties in executive processes beyond the visual-perceptual impairment, with an inefficient shift between implicit and explicit competences.Conclusions: The navigation abilities in participants with CP seem to be different from their TD peers in terms of learning and adaptation to new conditions; this could deeply affect their everyday life and ultimately participation and inclusion. A regular assessing and focused rehabilitative plans could help to better navigate the environment and affect self-perception.

Could an Immersive Virtual Reality Training Improve Navigation Skills in Children with Cerebral Palsy? A Pilot Controlled Study

“…The participants with CP underwent two assessments, at the beginning of the training program (T0) and after 4 weeks (T1). In particular, we assessed the navigational skills and visual–spatial abilities at T0 and T1 (see Section 2.2 and Section 2.3 for details), while the cognitive competences were measured only at T0, using Raven’s progressive matrices [ 82 ], as in Biffi et al [ 12 ]. During the interposed 4 weeks, they performed 18 daily IVR training sessions, according to the program appropriate for the membership group.…”

“…Navigation skills were assessed at T0 and T1, as described in Biffi et al [ 12 ], using an IVR application, the “Star-Maze” app (described below) on the GRAIL system, which integrates IVR environments projected on a 180° cylindrical screen, a Vicon motion-capture system (Oxford Metrics, Oxford, UK), and a two-degree of freedom platform. Each participant had to navigate in a 5-way maze in a playground ( Figure 2 ) to find a reward.…”

“…In the last few years, several authors have tried to correlate visual–spatial abilities in patients with CP with their navigational skills [ 9 , 10 , 11 , 12 ]. Spatial navigation is the ability to maintain a sense of direction/location while moving in space.…”

“…In these interactive settings, the patient is in front of an ordinary display reproducing a virtual environment, and the individual interacts with the VR environment through a videogame-like controller. Only a few studies propose IVR systems to investigate navigation [ 12 , 37 , 41 , 42 , 43 ], except for the work of Biffi and collaborators [ 12 ], and they mainly focus on ageing and dementia. Despite its less common use with respect to non-immersive VR, IVR is an ideal setting to study navigation abilities.…”

“…In this context, Berthoz and Zaoui [ 11 ] suggested several potential paradigms for studying specific deficits in spatial tasks in the developmental age and namely in CP. On the other hand, in 2020, we proposed the assessment of the navigation abilities of young participants with CP [ 12 ] using an IVR application which was specifically developed for this scope and based on a 5-way maze located within a playground. We used this application in a pilot study to assess the navigational skills of people with CP and in typically developing (TD) children, who had to navigate and find a reward placed within the maze.…”