Uses of Virtual Reality for Diagnosis, Rehabilitation and Study of Unilateral Spatial Neglect: Review and Analysis

Abstract

Unilateral spatial neglect is a disabling condition frequently occurring after stroke. People with neglect suffer from various spatial deficits in several modalities, which in many cases impair everyday functioning. A successful treatment is yet to be found. Several techniques have been proposed in the last decades, but only a few showed long-lasting effects and none could completely rehabilitate the condition. Diagnostic methods of neglect could be improved as well. The disorder is normally diagnosed with pen-and-paper methods, which generally do not assess patients in everyday tasks and do not address some forms of the disorder. Recently, promising new methods based on virtual reality have emerged. Virtual reality technologies hold great opportunities for the development of effective assessment and treatment techniques for neglect because they provide rich, multimodal, and highly controllable environments. In order to stimulate advancements in this domain, we present a review and an analysis of the current work. We describe past and ongoing research of virtual reality applications for unilateral neglect and discuss the existing problems and new directions for development.

Common Issues of Virtual Reality in Neuro-Rehabilitation

“…For instances, VR has been used in unilateral neglect and hemineglect in stroke (Myers & Bierig, 2000;Tsirlin, et al, 2009), brain injury assessment and rehabilitation Rizzo et al, 2000;Rose et al, 2005), physical rehabilitation in stroke (Saposnik, et al, 2010) and spinal cord injury (Kizony et al, 2003), functional evaluation and training (Lee et al, 2003), as well as tele-rehabilitation (Tam et al, 2003;Rizzo, et al, 2004). There are also precedents for use of VR in memory rehabilitation (Brooks & Rose, 2003), executive dysfunction , perceptual disorders and learning difficulties (Wann et al, 1997).…”

Clinical Validation of a Virtual Environment Test for Safe Street Crossing in the Assessment of Acquired Brain Injury Patients with and without Neglect

“…The main feature of USN is the inability of patients to pay attention to stimuli located on the contralateral side of injury, and these symptoms are not related to sensorial or motor deficits [3] [4]. This alteration may have important functional consequences for patients in their daily lives that make recovery more arduous.…”

“…Patients who suffer symptoms usually fail to attend to their left/right side thereby disturbing their personal space (for example, shaving only half of their face), peripersonal space (reading one side of the two pages of a newspaper), and extrapersonal space (bumping into objects when walking) [5]. The complexity and heterogeneity of the symptoms of USN cause a lack of consensus on suitable tools for evaluation and treatment [4]. Although many cases of USN can be detected by observation, certain specific diagnoses require a specific evaluation to measure the severity of symptoms and possible progression.…”

“…Traditional tools for assessment are based on pencil-and-paper tests as well as behavioral batteries [5] [6]. The effectiveness of evaluation tests of this kind have been proved, although there are some limitations that must be taken into account such as the difficulty of interpreting the results, the extrapolation of results to daily life tasks, the difficulty of differentiating between sensory deficits, the lack of attention that is typical of USN, and the absence of assessment of changes in personal space [4] [5].…”

“…VR is a new technology based on computerized-generated stimulation that immerses the user in a realistic 3D world with multisensory stimuli and that offers the possibility to interact with the elements and receive feedback [4][7] [8]. This technology, which has demonstrated its validity in the area of neuropsychology [2], can overcome some of the limitations of traditional evaluation methods.…”