Virtual reality for the assessment and rehabilitation of neglect: where are we now? A 6-year review update

Abstract

Unilateral spatial neglect (USN) is a frequent repercussion of a cerebrovascular accident, typically a stroke. USN patients fail to orient their attention to the contralesional side to detect auditory, visual, and somatosensory stimuli, as well as to collect and purposely use this information. Traditional methods for USN assessment and rehabilitation include paper-and-pencil procedures, which address cognitive functions as isolated from other aspects of patients’ functioning within a real-life context. This might compromise the ecological validity of these procedures and limit their generalizability; moreover, USN evaluation and treatment currently lacks a gold standard. The field of technology has provided several promising tools that have been integrated within the clinical practice; over the years, a “first wave” has promoted computerized methods, which cannot provide an ecological and realistic environment and tasks. Thus, a “second wave” has fostered the implementation of virtual reality (VR) devices that, with different degrees of immersiveness, induce a sense of presence and allow patients to actively interact within the life-like setting. The present paper provides an updated, comprehensive picture of VR devices in the assessment and rehabilitation of USN, building on the review of Pedroli et al. (2015). The present paper analyzes the methodological and technological aspects of the studies selected, considering the issue of usability and ecological validity of virtual environments and tasks. Despite the technological advancement, the studies in this field lack methodological rigor as well as a proper evaluation of VR usability and should improve the ecological validity of VR-based assessment and rehabilitation of USN.

An immersive virtual reality system for ecological assessment of peripersonal and extrapersonal unilateral spatial neglect

“…We also obtained conclusive positive feedback about the quality of the employed technology and the feelings of presence and ownership/agency over the virtual avatar in the iVR-based near space task. All in all, this study thoroughly confirmed the usability of the presented tasks, being one of the critical aspects to be considered when validating new solutions [31].…”

“…Within this regard, in a recent review Cavedoni et al concluded that the usability of such solutions is not properly evaluated and recommends careful evaluation when validating new solutions [ 31 ]. Therefore, despite recent progress in developing complex VR tools, some limitations persist in such tools, including lack of complete evaluations using naturalistic tasks reflecting daily life activities, task difficulty tailored to clinical contexts and extensive feasibility tests.…”

Effects of an HMD-based Attention System on Head and Eye Movement Strategies of Patients with Spatial Neglect

“…Collaborators showed neglect symptoms of the left space on either or both the BIT and CBS tests (Table 1). Although the sample for this study was relatively small, previous studies on spatial neglect were conducted with similarly sized samples [17,19,[22][23][24][25][26][27].…”

“…However, it is necessary to examine how to induce eye movement on the neglected side. Recently, virtual reality (VR) applications have been investigated for evaluation and training of unilateral spatial neglect [17][18][19][20][21][22][23]. Evaluation of hemispatial neglect using VR enables evaluation of each subtype of neglect symptoms by controlling the stimulus conditions, indicating the potential usefulness of training using VR.…”

The Arrival of the Metaverse in Neurorehabilitation: Fact, Fake or Vision?

“…Unilateral spatial neglect is another neurological deficit that would benefit from the improvement of VR-related immersive experiences. Indeed, thanks to the possibility to boost embodied cognition using different virtual environments, this may lead to better outcomes in improving neglect and associated symptoms [ 22 , 46 ]. The use of the metaverse, thanks to the realistic experience of “being there” with the therapist, might better work on the attention deficit, not only by potentiating the visual and spatial neglect but also by acting on the body representation, thus potentially improving anosognosia and personal neglect.…”