Neuropsychological assessment has always been a matter of pen-to-paper clinical tests. While they did evolve towards computerised versions, it’s only recently with the fidelity of virtual reality that a new kind of testing emerged.
Real-world tests are tricky without simulation. A patient can be asked to do a memory test for example, but can you capture the stimulation of a busy supermarket as a condition for the test? VR solves this to some degree by throwing the patient into different scenarios while undergoing tests.
The ecological validity in neuropsychology
The concept of ecological validity is important to clinical practice. Traditional tests often used abstract stimuli, like repeating strings of digits or memorising lists of unrelated words. They’re a good way of measuring the purity of a cognitive construct, but they lack dynamic variables of real-world conditions that distract humans. Being unable to juggle thoughts in a stressful environment hasn’t got all that much to do with raw memory ability, for example.
The more we learn about neurology and psychology, the more holistic our understanding of brain function becomes. Testing is slowly but surely beginning to replicate this.
Advanced software is allowing clinicians to place patients in controlled, three-dimensional environments that mimic daily life. For example, the implementation of virtual reality neuropsychological assessment is an example of testing executive function and attention of both children and adults. By placing them in an aquarium, motor activity and working memory can be measured in the dynamic, novel underwater environment. In some ways, this is more effective than real-world testing in, for example, a supermarket, because it’s even more spontaneous and stimulating. Here, ADHD, depression, schizophrenia, and many more conditions can be tested.
Why immersive environments outperform
The growing success of Virtual Reality lies in its ability to balance experimental control with environmental realism. In a traditional clinical setting, a clinician cannot easily introduce a ringing telephone or a passing car – or perhaps a group of whispering peers to test a patient’s distractibility in a standardised way. This would require hiring actors, for a start. In a VR simulation, these variables are precisely calibrated and repeatable in a highly measured way.
In assessments designed to mimic a classroom or an aquarium, the patient is required to interact with a dynamic environment. In a simulated classroom, for example, a child might be asked to complete a task while various visual and auditory distractors, such as a student walking past or a siren outside, occur at specific intervals. Ultimately, the more dynamic the stimulation, the less achievable it is in traditional testing.
It allows the neuropsychologist to measure not only whether the patient can complete the task, but how their attention shifts or recovers in the face of interruptions.
Objective behavioural data through motion
VR has a second benefit – quantifiable, recorded data. It can track your hands, head and eyes, providing data points for improving research, understanding, and testing efficacy. Traditional tests often hinge on an observer, which is prone to subjective interpretations and human error. Micro-movements are hugely important to diagnoses and testing.
By turning behavioural observations into data points (where specific movement variables now serve as objective predictors of hyperactivity) VR can reduce the risk of observer bias. Diagnosis can become more objective, helping improve the science field itself.
The patient experience
Another significant, though often overlooked, benefit of VR-based assessment is the impact it has on patient engagement. Traditional neuropsychological testing can be long and repetitive – they’re anxiety-inducing in and of themselves, especially for children or elderly patients. This can impact results, as high levels of test anxiety can alter behaviour and lead to a false representation of the patient’s actual cognitive capacity. Reducing false positives can improve the confidence and extent of the support (e.g., welfare payments) provided to diagnosed patients.
The VR environments are simply more engaging and with greater scope for gamification. A simulated and engaging environment, like a virtual aquarium, can lower the barrier of resistance and help patients enter a state of flow. Ironically, many patients experience it as more natural, despite it being virtual.
Clinical cognitive mapping
VR hardware is becoming more accessible, while the software more sophisticated. While they’ve not hit the consumer market (for various reasons), it’s clear that clinically-approved VR testing has now matured and is readily available. Patients can return after trying medication and see how their score has changed from the previous time under the exact same conditions.
Furthermore, VR isn’t only for testing, but also for treating. There have been developments in exposure therapy, such as treating phobias, by placing patients into simulated environments that they are not comfortable with and turning up the “volume”, slowly. For example, agoraphobia and panic disorder can be treated by catching a bus or train in a VR setting and getting used to the situation. While there is more research to be conducted within treatment, it’s clear that there is a broad and growing application of VR within mental health and neurology.
Adam Mulligan, a psychology graduate from the University of Hertfordshire, has a keen interest in the fields of mental health, wellness, and lifestyle.
