National Institutes of Health initiatives for advancing scientific developments in clinical neuropsychology

High-dimensional Metaverse Platforms and the Virtually Extended Self

The study of cognition has traditionally used low-dimensional measures and stimulus presentations that emphasize laboratory control over high-dimensional (i.e., ecologically valid) tools that reflect the activities and interactions in everyday living. Although controlled experimental presentations in laboratories have enhanced our understanding of cognition for both healthy and clinical cohorts, high dimensionality may extend reality and cognition. High-dimensional Metaverse approaches use extended reality (XR) platforms with dynamic stimulus presentations that couple humans and simulation technologies to extend cognition. The plan for this paper is as follows: The "Extending from low to high-dimensional studies of cognition" section discusses current needs for high-dimensional stimulus presentations that reflect everyday cognitive activities. In the "Algorithmic devices and digital extension of cognition" section, technologies of the extended mind are introduced with the Metaverse as a candidate cognitive process for extension. Next, in the "A neurocognitive framework for understanding technologies of the extended mind" section, a framework and model are proposed for understanding the neural correlates of human technology couplings in terms of automatic algorithmic processes (limbic-ventral striatal loop); reflective cognition (prefrontal-dorsal striatal loop); and algorithmic processing (insular cortex). The algorithmic processes of human-technology interactions can, over time, become an automated and algorithmic coupling of brain and technology. The manuscript ends with a brief summary and discussion of the ways in which the Metaverse can be used for studying how persons respond to high-dimensional stimuli in simulations that approximate real-world activities and interactions.

An Immersive and Interactive Platform for Cognitive Assessment and Rehabilitation (bWell): Design and Iterative Development Process

BACKGROUND

Immersive technologies like virtual reality can enable clinical care that meaningfully aligns with real-world deficits in cognitive functioning. However, options in immersive 3D environments are limited, partly because of the unique challenges presented by the development of a clinical care platform. These challenges include selecting clinically relevant features, enabling tasks that capture the full breadth of deficits, ensuring longevity in a rapidly changing technology landscape, and performing the extensive technical and clinical validation required for digital interventions. Complicating development, is the need to integrate recommendations from domain experts at all stages.

OBJECTIVE

The Cognitive Health Technologies team at the National Research Council Canada aims to overcome these challenges with an iterative process for the development of bWell, a cognitive care platform providing multisensory cognitive tasks for adoption by treatment providers.

METHODS

The team harnessed the affordances of immersive technologies while taking an interdisciplinary research and developmental approach, obtaining active input from domain experts with iterative deliveries of the platform. The process made use of technology readiness levels, agile software development, and human-centered design to advance four main activities: identification of basic requirements and key differentiators, prototype design and foundational research to implement components, testing and validation in lab settings, and recruitment of external clinical partners.

RESULTS

bWell was implemented according to the findings from the design process. The main features of bWell include multimodal (fully, semi, or nonimmersive) and multiplatform (extended reality, mobile, and PC) implementation, configurable exercises that pair standardized assessment with adaptive and gamified variants for therapy, a therapist-facing user interface for task administration and dosing, and automated activity data logging. bWell has been designed to serve as a broadly applicable toolkit, targeting general aspects of cognition that are commonly impacted across many disorders, rather than focusing on 1 disorder or a specific cognitive domain. It comprises 8 exercises targeting different domains: states of attention (Egg), visual working memory (Theater), relaxation (Tent), inhibition and cognitive control (Mole), multitasking (Lab), self-regulation (Butterfly), sustained attention (Stroll), and visual search (Cloud). The prototype was tested and validated with healthy adults in a laboratory environment. In addition, a cognitive care network (5 sites across Canada and 1 in Japan) was established, enabling access to domain expertise and providing iterative input throughout the development process.

CONCLUSIONS

Implementing an interdisciplinary and iterative approach considering technology maturity brought important considerations for the development of bWell. Altogether, this harnesses the affordances of immersive technology and design for a broad range of applications, and for use in both cognitive assessment and rehabilitation. The technology has attained a maturity level of prototype implementation with preliminary validation carried out in laboratory settings, with next steps to perform the validation required for its eventual adoption as a clinical tool.

Assessing Psychometrists' Practices to Inform Neuropsychological Services

OBJECTIVE

Quality of life (QOL) is a broad-ranging concept affecting an individual's physical health, psychological state, social relationships, and relationship to their environment. Although the role of psychometrists in clinical neuropsychology is integral to the delivery of services, little is known about their QOL. The current study assessed psychometrists' workload and aspects related to work QOL (e.g., physical and emotional exhaustion, social and work satisfaction).

METHOD

Psychometrists (N = 164) from 38 states completed a nationally distributed survey. Participants averaged eight years of experience, ~29% completed board certification, and worked primarily in general hospitals (~36%), academic medical centers (~21%), private practice (~15%), veterans/military hospitals (~13%), and rehabilitation hospitals (~12%).

RESULTS

Respondents saw 5.6±2.4 (Mean±Standard Deviation) patients and spent 18.8±6.9 and 9.4±4.9 hours administering and scoring, respectively, per week. Although the majority of respondents felt satisfied with their work QOL, approximately 49% experienced emotional exhaustion, 42% experienced burnout, and 62% reported that fatigue interfered with work, family, or social life. Correlational analyses found a significant relationship between QOL variables and professional activities, particularly with time spent scoring. Additionally, patient load, time spent administering/scoring, and QOL factors varied depending on work setting.

CONCLUSION

The current study provides a novel characterization of psychometrists' QOL. Specifically, the prevalence of emotional exhaustion and fatigue appears to be higher than in the general working population in the United States. In addition, these findings highlight the current variability of job responsibilities and QOL across work settings. Ongoing advocacy and practice adjustments for this field are indicated.

How do we measure attention? Using factor analysis to establish construct validity of neuropsychological tests

We investigated whether standardized neuropsychological tests and experimental cognitive paradigms measure the same cognitive faculties. Specifically, do neuropsychological tests commonly used to assess attention measure the same construct as attention paradigms used in cognitive psychology and neuroscience? We built on the “general attention factor”, comprising several widely used experimental paradigms (Huang et al., 2012). Participants (n = 636) completed an on-line battery (TestMyBrain.org) of six experimental tests [Multiple Object Tracking, Flanker Interference, Visual Working Memory, Approximate Number Sense, Spatial Configuration Visual Search, and Gradual Onset Continuous Performance Task (Grad CPT)] and eight neuropsychological tests [Trail Making Test versions A & B (TMT-A, TMT-B), Digit Symbol Coding, Forward and Backward Digit Span, Letter Cancellation, Spatial Span, and Arithmetic]. Exploratory factor analysis in a subset of 357 participants identified a five-factor structure: (1) attentional capacity (Multiple Object Tracking, Visual Working Memory, Digit Symbol Coding, Spatial Span), (2) search (Visual Search, TMT-A, TMT-B, Letter Cancellation); (3) Digit Span; (4) Arithmetic; and (5) Sustained Attention (GradCPT). Confirmatory analysis in 279 held-out participants showed that this model fit better than competing models. A hierarchical model where a general cognitive factor was imposed above the five specific factors fit as well as the model without the general factor. We conclude that Digit Span and Arithmetic tests should not be classified as attention tests. Digit Symbol Coding and Spatial Span tap attentional capacity, while TMT-A, TMT-B, and Letter Cancellation tap search (or attention-shifting) ability. These five tests can be classified as attention tests.

A Virtual Kitchen Protocol to Measure Everyday Memory Functioning for Meal Preparation

In this study, we developed the Virtual Kitchen Protocol (VKP), a virtual reality-based measure of everyday memory functioning for meal preparation tasks. We investigated the construct validity of the VKP by comparing the performance of young adults (n = 41) and older adults without (n = 52) and with (n = 7) a neurocognitive diagnosis, as well as by examining correlations with standardized measures of verbal and visual memory. The results show that young adults had higher recall than older adults and that the VKP was sensitive to neurocognitive impairment among older adults. The VKP demonstrated moderate to high correlations with other memory tests. These results support the construct validity of the VKP and suggest that it holds promise as a virtual reality-based measure of memory for meal preparation tasks.

Assessing visual search performance using a novel dynamic naturalistic scene

Daily activities require the constant searching and tracking of visual targets in dynamic and complex scenes. Classic work assessing visual search performance has been dominated by the use of simple geometric shapes, patterns, and static backgrounds. Recently, there has been a shift toward investigating visual search in more naturalistic dynamic scenes using virtual reality (VR)-based paradigms. In this direction, we have developed a first-person perspective VR environment combined with eye tracking for the capture of a variety of objective measures. Participants were instructed to search for a preselected human target walking in a crowded hallway setting. Performance was quantified based on saccade and smooth pursuit ocular motor behavior. To assess the effect of task difficulty, we manipulated factors of the visual scene, including crowd density (i.e., number of surrounding distractors) and the presence of environmental clutter. In general, results showed a pattern of worsening performance with increasing crowd density. In contrast, the presence of visual clutter had no effect. These results demonstrate how visual search performance can be investigated using VR-based naturalistic dynamic scenes and with high behavioral relevance. This engaging platform may also have utility in assessing visual search in a variety of clinical populations of interest.

Paradigm Shift Toward Digital Neuropsychology and High-Dimensional Neuropsychological Assessments: Review

Neuropsychologists in the digital age have increasing access to emerging technologies. The National Institutes of Health (NIH) initiatives for behavioral and social sciences have emphasized these developing scientific and technological potentials (eg, novel sensors) for augmented characterization of neurocognitive, behavioral, affective, and social processes. Perhaps these innovative technologies will lead to a paradigm shift from disintegrated and data-poor behavioral science to cohesive and data-rich science that permits improved translation from bench to bedside. The 4 main advances influencing the scientific priorities of a recent NIH Office of Behavioral and Social Sciences Research strategic plan include the following: integration of neuroscience into behavioral and social sciences, transformational advances in measurement science, digital intervention platforms, and large-scale population cohorts and data integration. This paper reviews these opportunities for novel brain-behavior characterizations. Emphasis is placed on the increasing concern of neuropsychology with these topics and the need for development in these areas to maintain relevance as a scientific discipline and advance scientific developments. Furthermore, the effects of such advancements necessitate discussion and modification of training as well as ethical and legal mandates for neuropsychological research and praxes.

Introduction to the special issue: Are modern neuropsychological assessment methods really "modern"? Reflections on the current neuropsychological test armamentarium

OBJECTIVE

We introduce this special issue which focuses on how advances in neuroscience and technology can modernize and transform clinical neuropsychological assessment.

METHOD

We included both invited and solicited papers to reflect on the strengths and weaknesses of currently used, standardized neuropsychological tests and to explore how we might incorporate new technologies and neuroscientific advances to modernize neuropsychological assessment methods.

RESULTS

The papers are organized along the following themes: (1) A critique of the current clinical neuropsychological test armamentarium; (2) A description of new opportunities for collecting neurobehavioral data with technology; (3) Digital science, biomedical big data and the internet; (4) Integrating neuropsychological, neuroimaging, and neurophysiological assessments; (5) Modernization, globalization and culture.

CONCLUSION

The process of modernizing methods of assessment in clinical neuropsychology is laborious and requires a coordinated, sustained effort among clinicians, researchers, and the test industry. While embracing technology is necessary, we must also be aware of unintended consequences as we navigate this exciting new territory.