Virtual reality technology in neuropsychological testing: A systematic review

Abstract

Neuropsychological testing aims to measure individuals' cognitive abilities (e.g. memory, attention), analysing their performance on specific behavioural tasks. Most neuropsychological tests are administered in the so-called 'paper-and-pencil' modality or via computerised protocols. The adequacy of these procedures has been recently questioned, with more specific concerns about their ecological validity, i.e. the relation between test scores observed in the laboratory setting and the actual everyday cognitive functioning. In developing more ecological tasks, researchers started to implement virtual reality (VR) technology as an administration technique focused on exposing individuals to simulated but realistic stimuli and environments, maintaining at the same time a controlled laboratory setting and collecting advanced measures of cognitive functioning. This systematic review aims to present how VR procedures for neuropsychological testing have been implemented in the last years. We initially explain the rationale for supporting VR as an advanced assessment tool, but we also discuss the challenges and risks that can limit the widespread implementation of this technology. Then, we systematised the large body of studies adopting VR for neuropsychological testing, describing the VR tools' distribution amongst different cognitive functions through a PRISMA-guided systematic review. The systematic review highlighted that only very few instruments are ready for clinical use, reporting psychometric proprieties (e.g. validity) and providing normative data. Most of the tools still need to be standardised on large cohorts of participants, having published only limited data on small samples up to now. Finally, we discussed the possible future directions of the VR neuropsychological test development linked to technological advances.

Exploring the Impact of Body Position on Attentional Orienting

“…Yet, with advances in virtual reality technology, the research landscape has expanded considerably. Virtual reality provides a more naturalistic framework for investigating cognitive processes [12,13] and attentional orienting [14] and enables a deeper understanding of how attentional processes work by exploring previously unexplored influencing factors. Thus, in a virtual reality cueing paradigm, it has been observed that when attention is directed forward or backward, response times are shorter for targets located in the front space than for those located in the rear space.…”

Assessing goal-directed behavior in virtual reality with the neuropsychological task EPELI: children prefer head-mounted display but flat screen provides a viable performance measure for remote testing

“…There are several studies on naturalistic VR tasks that simulate daily functions and activities. Some have used FSDs (e.g., Rand et al, 2009;Jovanoski et al, 2012;Raspelli et al, 2012;Cipresso et al, 2014;Ruse et al, 2014) while others have employed HMDs (e.g., Barnett et al, 2021;Chicchi Giglioli et al, 2021;Ouellet et al, 2018;Parsons & Barnett, 2017;Porffy et al, 2022; see also the reviews by Neguţ et al, 2016;Parsons, 2015;and Pieri et al, 2023). Regarding the Multiple Errands Test that was at first devised to be performed in reallife environments (Shallice & Burgess, 1991; see also Rotenberg et al, 2020), there are several desktop FSD versions have been implemented (Rand et al, 2009;Jovanoski et al, 2012;Raspelli et al, 2012;Cipresso et al, 2014), as well as a simplified tablet version to serve as a brief screening tool (Webb et al, 2021).…”