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Uimonen J, Villarreal S, Laari S, Arola A, Ijäs P, Salmi J, Hietanen M. Virtual reality tasks with eye tracking for mild spatial neglect assessment: a pilot study with acute stroke patients. Front Psychol 2024; 15:1319944. [PMID: 38348259 PMCID: PMC10860750 DOI: 10.3389/fpsyg.2024.1319944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/03/2024] [Indexed: 02/15/2024] Open
Abstract
Objective Increasing evidence shows that traditional neuropsychological tests are insensitive for detecting mild unilateral spatial neglect (USN), lack ecological validity, and are unable to clarify USN in all different spatial domains. Here we present a new, fully immersive virtual reality (VR) task battery with integrated eye tracking for mild visual USN and extinction assessment in the acute state of stroke to overthrow these limitations. Methods We included 11 right-sided stroke patients and 10 healthy controls aged 18-75 years. Three VR tasks named the Extinction, the Storage and the Shoot the target tasks were developed to assess USN. Furthermore, neuropsychological assessment examining various parts of cognitive functioning was conducted to measure general abilities. We compared VR and neuropsychological task performance in stroke patients - those with (USN+, n = 5) and without USN (USN-, n = 6) - to healthy controls (n = 10) and tentatively reported the usability of VR system in the acute state of stroke. Results Patients had mostly mild neurological and USN symptoms. Nonetheless, we found several differences between the USN+ and healthy control groups in VR task performance. Compared to controls, USN+ patients showed visual extinction and asymmetry in gaze behavior and detection times in distinct spatial locations. Extinction was most evident in the extrapersonal space and delayed detection times on the extreme left and on the left upper parts. Also, USN+ patients needed more time to complete TMT A compared with USN- patients and TMT B compared with controls. VR system usability and acceptance were rated high; no relevant adverse effects occurred. Conclusion New VR technology with eye tracking enables ecologically valid and objective assessment methods with various exact measures for mild USN and thus could potentially improve future clinical assessments.
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Affiliation(s)
- Jenni Uimonen
- Department of Neuropsychology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sanna Villarreal
- Department of Neuropsychology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Siiri Laari
- Department of Neuropsychology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anne Arola
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Petra Ijäs
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha Salmi
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Marja Hietanen
- Department of Neuropsychology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Thomasson M, Perez-Marcos D, Crottaz-Herbette S, Brenet F, Saj A, Bernati T, Serino A, Tadi T, Blanke O, Ronchi R. An immersive virtual reality tool for assessing left and right unilateral spatial neglect. J Neuropsychol 2024. [PMID: 38225801 DOI: 10.1111/jnp.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/13/2023] [Accepted: 12/30/2023] [Indexed: 01/17/2024]
Abstract
The reported rate of the occurrence of unilateral spatial neglect (USN) is highly variable likely due to the lack of validity and low sensitivity of classical tools used to assess it. Virtual reality (VR) assessments try to overcome these limitations by proposing immersive and complex environments. Nevertheless, existing VR-based tasks are mostly focused only on near space and lack analysis of psychometric properties and/or clinical validation. The present study evaluates the clinical validity and sensitivity of a new immersive VR-based task to assess USN in the extra-personal space and examines the neuronal correlates of deficits of far space exploration. The task was administrated to two groups of patients with right (N = 28) or left (N = 11) hemispheric brain lesions, also undergoing classical paper-and-pencil assessment, as well as a group of healthy participants. Our VR-based task detected 44% of neglect cases compared to 31% by paper-and-pencil tests in the total sample. Importantly, 30% of the patients (with right or left brain lesions) with no clear sign of USN on the paper-and-pencil tests performed outside the normal range in the VR-based task. Voxel lesion-symptom mapping revealed that deficits detected in VR were associated with lesions in insular and temporal cortex, part of the neural network involved in spatial processing. These results show that our immersive VR-based task is efficient and sensitive in detecting mild to strong manifestations of USN affecting the extra-personal space, which may be undetected using standard tools.
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Affiliation(s)
- Marine Thomasson
- Laboratory for Behavioral Neurology and Imaging of Cognition, University of Geneva, Geneva, Switzerland
- Neuropsychology Unit, Neurology Department, University Hospital of Geneva, Geneva, Switzerland
- Cognitive and Experimental Neuropsychology Laboratory, University of Geneva, Geneva, Switzerland
| | | | - Sonia Crottaz-Herbette
- MindMaze SA, Lausanne, Switzerland
- Neuropsychology and Neurorehabilitation Service, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | - Arnaud Saj
- Laboratory for Behavioral Neurology and Imaging of Cognition, University of Geneva, Geneva, Switzerland
- Department of Psychology, University of Montréal, Montréal, Quebec, Canada
- CRIR/Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, Quebec, Canada
- Spectre Biotech, Paris, France
| | - Thérèse Bernati
- Laboratory for Behavioral Neurology and Imaging of Cognition, University of Geneva, Geneva, Switzerland
| | - Andrea Serino
- MindMaze SA, Lausanne, Switzerland
- MySpace Lab, Department of Clinical Neurosciences, Lausanne, University of Lausanne, Lausanne, Switzerland
- Laboratory of Cognitive Neuroscience, Neuro-X Institute and Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
| | - Tej Tadi
- MindMaze SA, Lausanne, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Neuro-X Institute and Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Neurosurgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Roberta Ronchi
- Laboratory for Behavioral Neurology and Imaging of Cognition, University of Geneva, Geneva, Switzerland
- Neuropsychology Unit, Neurology Department, University Hospital of Geneva, Geneva, Switzerland
- Laboratory of Cognitive Neuroscience, Neuro-X Institute and Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
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Martin J, Vuilleumier P, Assal F, Ronchi R. Neglecting the bottom space: an object-based disorder? A two-case observational study. Neurocase 2023; 29:121-131. [PMID: 38406985 DOI: 10.1080/13554794.2024.2315860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024]
Abstract
Altitudinal neglect is an atypical form of spatial neglect where brain-damaged patients neglect the lower, or sometimes the upper, part of the space. Our understanding of this phenomena is limited, with unknown occurrence across different reference frames, such as distance (peripersonal vs. extrapersonal) and system of reference (egocentric vs. allocentric). Two patients with acute bilateral (P1) or right hemispheric (P2) stroke, with signs of bottom altitudinal neglect, underwent an extensive evaluation of neglect within 10 days post-stroke. Assessments involved altitudinal neglect and unilateral spatial neglect (USN) in peripersonal space, exploring egocentric and allocentric signs and in extrapersonal space. Compared to a control group of 15 healthy age-matched subjects, patients showed allocentric and egocentric left USN in peripersonal space, and mostly allocentric signs of altitudinal neglect. No signs of neglect were evidenced in extrapersonal space. Altitudinal neglect could thus present as an allocentric form of spatial neglect, suggesting that allocentric representations may not only affect the deployment of attentional resources along horizontal dimensions but also operate along vertical dimensions. Future studies should deepen our understanding of altitudinal neglect, eventually leading to further unravel spatial processes that control attention, their corresponding brain mechanisms, and implications for patients' rehabilitation and functional outcome.
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Affiliation(s)
- Jennifer Martin
- Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Patrik Vuilleumier
- Laboratory of Behavioral Neurology and Imaging of Cognition, Department of Neuroscience, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
- Faculty of Medecine, University of Geneva, Geneva, Switzerland
| | - Frédéric Assal
- Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medecine, University of Geneva, Geneva, Switzerland
| | - Roberta Ronchi
- Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
- Laboratory of Behavioral Neurology and Imaging of Cognition, Department of Neuroscience, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
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