Key Points
The paper presents a systematic review of the use of virtual reality (VR) technology for neuropsychological assessment. The key findings are:
The paper makes a case for VR tests as a complementary evaluation methodology alongside traditional tests. But, it also highlights the need for further evidence of ecological validity, clinical utility, and accessibility before widespread implementation.
Rationale
Prior research has questioned the ecological validity of paper-and-pencil neuropsychological tests in relating test performance to real-world functioning (Chaytor & Schmitter-Edgecombe, 2003).
VR technology offers greater immersion and control to simulate realistic environments and tasks. This could help address concerns over ecological validity.
Further, VR setups allow the collection of objective digital measures like reaction times and motion data that may inform assessment.
However, despite increasing research on VR assessment tools over the past two decades, few studies have presented complete psychometric evidence or normative data to support clinical adoption (Climent et al., 2021; Iriarte et al., 2016). The systematic review addresses this research gap.
Method
The authors searched three databases – PubMed, Web of Science, and PsycINFO using the terms “virtual reality” and “neuropsychological assessment.”
They included peer-reviewed English articles from 2000-2021 describing VR paradigms for neuropsychological testing.
Case studies, reviews, rehabilitation protocols, and non-VR tests were excluded.
Data extracted included sample details, cognitive domain, test availability, normative data, and technological specifications. Tests were classified as immersive or non-immersive.
Sample
The reviewed studies had varying sample sizes ranging from single cases to over a thousand healthy and clinical participants. The tools showing adequate normative data had sample sizes between 243 to 1469.
Statistical measures
Correlational analyseswere frequently done to demonstrateconvergent validitywith traditional tests.
Between groupscomparisons helped establishdiscriminant validityand sensitivity.
Results
The review process resulted in 287 eligible studies, with 134 published since 2016, highlighting increasing research attention on immersive VR tests.
However, only 3 tools provided robust psychometric profiles and normative data for clinical consideration – Nesplora AULA, Aquarium, and Systemic Lisbon Battery. These tools assessed attention and memory.
Spatial navigation, executive functions, attention, and memory were the most researched domains. However, language functions were relatively less studied through VR tests.
Both simulated adaptations of traditional tests and virtual equivalents of real-life tasks were designed across domains.
Insight and Depth
Thesystematic reviewoffers useful insights into the emerging landscape of VR-based neuropsychological assessment.
It highlights the spectrum of cognitive domains where digitally rendered simulations offer value.
At the same time, it points to the significant research-to-clinical translation gap despite two decades of preliminary feasibility studies.
Strengths
Limitations
Implications
The insights on VR’s advantages over traditional tests can guide the development of more engaging, sensitive, and ecologically valid tools.
However, the persisting issues of cybersickness susceptibility and access to advanced VR systems imply that traditional tests will continue retaining value in assessment.
Rather than a substitution, VR tests can complement traditional batteries pending stronger psychometric evidence.
This also highlights the need for greater interdisciplinary collaboration between neuropsychology researchers, human-computer interaction experts, and VR developers to create clinically useful solutions.
Conclusions
The review comprehensively captures the possibilities and challenges of incorporating VR technology in neuropsychological assessment.
VR-based testing paradigms are starting to address concerns over artificial sterile environments of traditional tests.
However, most proposed tools are still far from clinical reality. Converging efforts to conduct robust validation studies on promising tools can help build the 3.0 wave of assessment.
Overall, there is an exciting scope for VR tests to become a mainstay of comprehensive neuropsychological evaluations in the near future. But more problems need to be solved before they can translate from benches to bedsides.
References
Chaytor, N., & Schmitter-Edgecombe, M. (2003). The ecological validity of neuropsychological tests: A review of the literature on everyday cognitive skills.Neuropsychology Review, 13, 181–197.https://doi.org/10.1023/B:NERV.0000009483.91468.f
Climent, G., Rodríguez, C., García, T., Areces, D., Mejías, M., Aierbe, A., Moreno, M., Cueto, E., Castellá, J., & Feli González, M. (2021). New virtual reality tool (Nesplora Aquarium) for assessing attention and working memory in adults: A normative study.Applied Neuropsychology:Adult, 6, 1–13.https://doi.org/10.1080/23279095.2019.1646745
Iriarte, Y., Diaz-Orueta, U., Cueto, E., Irazustabarrena, P., Banterla, F., & Climent, G. (2016). AULA—Advanced virtual reality tool for the assessment of attention: Normative study in Spain.Journal of Attention Disorders, 20(6), 542–568.https://doi.org/10.1177/1087054712465335
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.Systematic reviews, 10(1), 1–11.https://doi.org/10.1136/bmj.n71
Learning check
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
