Kirkham Rebecca, Kooijman Lars, Albertella Lucy, Myles Dan, Yücel Murat, Rotaru Kristian
Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Clayton, Australia.
Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, Australia.
JMIR Serious Games. 2024 Feb 26;12:e50282. doi: 10.2196/50282.
Neuropsychological assessments traditionally include tests of executive functioning (EF) because of its critical role in daily activities and link to mental disorders. Established traditional EF assessments, although robust, lack ecological validity and are limited to single cognitive processes. These methods, which are suitable for clinical populations, are less informative regarding EF in healthy individuals. With these limitations in mind, immersive virtual reality (VR)-based assessments of EF have garnered interest because of their potential to increase test sensitivity, ecological validity, and neuropsychological assessment accessibility.
This systematic review aims to explore the literature on immersive VR assessments of EF focusing on (1) EF components being assessed, (2) how these assessments are validated, and (3) strategies for monitoring potential adverse (cybersickness) and beneficial (immersion) effects.
EBSCOhost, Scopus, and Web of Science were searched in July 2022 using keywords that reflected the main themes of VR, neuropsychological tests, and EF. Articles had to be peer-reviewed manuscripts written in English and published after 2013 that detailed empirical, clinical, or proof-of-concept studies in which a virtual environment using a head-mounted display was used to assess EF in an adult population. A tabular synthesis method was used in which validation details from each study, including comparative assessments and scores, were systematically organized in a table. The results were summed and qualitatively analyzed to provide a comprehensive overview of the findings.
The search retrieved 555 unique articles, of which 19 (3.4%) met the inclusion criteria. The reviewed studies encompassed EF and associated higher-order cognitive functions such as inhibitory control, cognitive flexibility, working memory, planning, and attention. VR assessments commonly underwent validation against gold-standard traditional tasks. However, discrepancies were observed, with some studies lacking reported a priori planned correlations, omitting detailed descriptions of the EF constructs evaluated using the VR paradigms, and frequently reporting incomplete results. Notably, only 4 of the 19 (21%) studies evaluated cybersickness, and 5 of the 19 (26%) studies included user experience assessments.
Although it acknowledges the potential of VR paradigms for assessing EF, the evidence has limitations. The methodological and psychometric properties of the included studies were inconsistently addressed, raising concerns about their validity and reliability. Infrequent monitoring of adverse effects such as cybersickness and considerable variability in sample sizes may limit interpretation and hinder psychometric evaluation. Several recommendations are proposed to improve the theory and practice of immersive VR assessments of EF. Future studies should explore the integration of biosensors with VR systems and the capabilities of VR in the context of spatial navigation assessments. Despite considerable promise, the systematic and validated implementation of VR assessments is essential for ensuring their practical utility in real-world applications.
神经心理学评估传统上包括执行功能（EF）测试，因为其在日常活动中起着关键作用且与精神障碍相关。既定的传统EF评估虽然可靠，但缺乏生态效度，且仅限于单一认知过程。这些适用于临床人群的方法，对于健康个体的EF提供的信息较少。考虑到这些局限性，基于沉浸式虚拟现实（VR）的EF评估因其有可能提高测试敏感性、生态效度以及神经心理学评估的可及性而受到关注。
本系统评价旨在探讨关于EF的沉浸式VR评估的文献，重点关注：（1）所评估的EF成分；（2）这些评估如何进行验证；（3）监测潜在不良（晕动症）和有益（沉浸感）效应的策略。
2022年7月，在EBSCOhost、Scopus和Web of Science数据库中进行检索，使用反映VR、神经心理学测试和EF等主要主题的关键词。文章必须是英文撰写的同行评审手稿，且发表于2013年之后，详细描述了实证、临床或概念验证研究，其中使用头戴式显示器的虚拟环境来评估成年人群的EF。采用表格综合法，将每项研究的验证细节，包括比较评估和分数，系统地整理在一个表格中。对结果进行汇总并进行定性分析，以全面概述研究结果。
检索到555篇独特文章，其中19篇（3.4%）符合纳入标准。所审查的研究涵盖了EF以及相关的高阶认知功能，如抑制控制、认知灵活性、工作记忆、计划和注意力。VR评估通常对照金标准传统任务进行验证。然而，观察到存在差异，一些研究缺乏预先计划的相关性报告，遗漏了使用VR范式评估的EF结构的详细描述，且经常报告不完整的结果。值得注意的是，19项研究中只有4项（21%）评估了晕动症，19项研究中有5项（26%）纳入了用户体验评估。
尽管认识到VR范式在评估EF方面的潜力，但证据存在局限性。纳入研究的方法学和心理测量特性处理不一致，引发了对其效度和信度的担忧。对晕动症等不良反应的监测较少，样本量差异较大，可能会限制解释并阻碍心理测量评估。提出了几项建议以改进EF的沉浸式VR评估的理论和实践。未来的研究应探索生物传感器与VR系统的整合以及VR在空间导航评估背景下的能力。尽管前景广阔，但VR评估的系统且经过验证的实施对于确保其在实际应用中的实用性至关重要。
