Julia Belger | Clinical application of immersive Virtual Reality in neuropsychological rehabilitation of visuospatial neglect

Unilateral spatial neglect is a disabling neurological condition caused predominantly by right-hemisphere brain damage. Patients typically fail to report, respond, or orient to stimuli on the contralesional, often left side. Even subtle forms of hemispatial neglect negatively affect the performance of daily tasks, increase the risk of injury and are associated with poor rehabilitation outcomes. Conventional paper-and-pencil assessment tools, however, often inadequately detect discrete or well-compensated forms of neglect.

The application of immersive Virtual Reality (VR) is a promising solution to improve the detection of discrete forms of neglect by simulating tasks relevant to everyday life, thereby assessing functional performance. To demonstrate the potential clinical use of VR in neuropsychological rehabilitation, the presentation consists of two parts: (1) the immersive Virtual Road Crossing task (iVRoad) for the assessment of neglect and ( 2) Virtual Optokinetic Stimulation (VR-OKS) for neglect training. As a first step towards a systematic evaluation, we assessed the effectiveness of iVRoad with a focus on identifying and quantifying discrete neglect symptoms in chronic stroke patients. We applied decision trees and random forest models to predict the respective groups (neglect, no neglect, healthy control) based on the results of the VR task. Furthermore, the VR-OKS involves visual scanning training and optokinetic stimulation therapy implemented in immersive VR. Virtual everyday objects move from the right to the left side, utilizing real-time eye tracking to interact with the virtual environment. If the patient's behavior deviates, the program provides immediate and automatic visual and auditory feedback to aid the patients in adapting their behavior. As the training study is ongoing, preliminary data and first insights will be presented. Based on these two tasks, the applicability of VR in neuropsychological rehabilitation will be discussed.