Personalised virtual reality in palliative care: clinically meaningful symptom improvement for some

OBJECTIVES

This study examined the effects of virtual reality (VR) among palliative care patients at an acute ward. Objectives included evaluating VR therapy benefits across three sessions, assessing its differential impact on emotional versus physical symptoms and determining the proportion of patients experiencing clinically meaningful improvements after each session.

METHODS

A mixed-methods design was employed. Sixteen palliative inpatients completed three personalised 20 min VR sessions. Symptom burden was assessed using the Edmonton Symptom Assessment Scale-Revised and quality of life with the Functional Assessment of Chronic Illness Therapy (FACIT-Pal-14). Standardised criteria assessed clinically meaningful changes. Quantitative data were analysed using linear mixed models.

RESULTS

Quality of life improved significantly pre-VR to post-VR with a large effect size (Cohen's d: 0.98). Total symptom burden decreased after 20 min VR sessions (Cohen's d: 0.75), with similar effect sizes for emotional (Cohen's d: 0.67) and physical symptoms (Cohen's d: 0.63). Over 50% of patients experienced clinically meaningful improvements per session, though substantial individual variability occurred.

CONCLUSIONS

This study reveals the nuanced efficacy of personalised VR therapy in palliative care, with over half of the patients experiencing meaningful benefits in emotional and physical symptoms. The marked variability in responses underscores the need for realistic expectations when implementing VR therapy.

Low vision devices for age-related macular degeneration: a systematic review

PURPOSE

Age-related macular degeneration (AMD) is a degenerative condition impacting central vision. Evaluating the effectiveness of low vision devices provides empirical evidence on how devices can rehabilitate and overcome deficits caused by AMD. This evidence could help to facilitate discussion on necessary future improvements to vision enhancement technology.

METHODS

A systematic review of the literature was conducted on low vision device use in AMD populations. Relevant peer-reviewed research articles from six databases were screened.

RESULTS

The findings of thirty-five studies revealed a significant positive impact of low vision devices leading to improvements in visual acuity, reading performance, facial recognition, and more. While the studies were found to have moderate risks of bias, a GRADE assessment of the evidence suggested the certainty of the evidence was low-moderate.

DISCUSSION

Simple hand-held low vision devices (e.g., magnifiers) appear to currently have greater preferential support than newer visual enhancement technology (e.g., head mounted devices). Financial, comfort or usability reasons may influence preferences more than performance-based findings. However, there is a lack of studies examining newer technologies in AMD populations, which future research should address. Moreover, given the presence of bias across the studies and limited controlled experiments, confidence in the results may be low.

CONCLUSIONS

Most studies indicated that low vision devices have positive impacts on reading and visual performance. But, even though they are reported to be a valuable asset to AMD populations, more rigorous research is required to draw conclusive evidence. IMPLICATIONS FOR REHABILITATIONLow vision devices can improve patient outcomes (e.g., vision, reading ability) for age-related macular degeneration populations.A multidisciplinary combination of low vision devices and rehabilitative services (i.e., eccentric viewing training, counselling, education) may enhance quality of life.

Cross-sectional associations between short and mid-term blood pressure variability, cognition, and vascular stiffness in older adults

Background

High blood pressure variability (BPV), particularly in older age, appears to be an independent risk factor for incident dementia. The current study aimed to investigate the association between different BPV measures (short- and mid-term BPV including circadian patterns) and cognitive functioning as well as vascular stiffness measures to better understand the role that BPV plays in cognitive impairment.

Methods

70 older adults (60-80-year-olds) without dementia completed a cognitive test battery and had their blood pressure (BP) assessed via a 24-hour ambulatory BP monitor (divided into sleep and wake for short-term BPV) and 4-day morning and evening home-based BP monitor (for day-to-day BPV). Arterial stiffness was evaluated via pulse wave analysis and pulse wave velocity (PWV) and cerebrovascular pulsatility was assessed via transcranial doppler sonography of the middle cerebral arteries.

Results

High systolic as well as diastolic short- and mid-term BPV were associated with poorer cognitive functioning, independent of the mean BP. Higher short-term BPV was associated with poorer attention and psychomotor speed, whilst day-to-day BPV was negatively linked with executive functioning. Circadian BP patterns (dipping and morning BP surge) showed no significant relationships with cognition after adjusting for covariates. Higher systolic short-term BPV was associated with higher arterial stiffness (PWV) and higher diastolic day-to-day BPV was linked with lower arterial stiffness. No significant associations between BPV measures and cerebrovascular pulsatility were present.

Conclusion

High BPV, independently of the mean BP, is associated with lower cognitive performance and increased arterial stiffness in older adults without clinically-relevant cognitive impairment. This highlights the role of systolic and diastolic BPV as a potential early clinical marker for cognitive impairment.

Improving real-world skills in people with intellectual disabilities: an immersive virtual reality intervention

Virtual reality (VR) is a promising tool for training life skills in people with intellectual disabilities. However, there is a lack of evidence surrounding the implementation, suitability, and effectiveness of VR training in this population. The present study investigated the effectiveness of VR training for people with intellectual disabilities by assessing (1) their ability to complete basic tasks in VR, (2) real-world transfer and skill generalisation, and (3) the individual characteristics of participants able to benefit from VR training. Thirty-two participants with an intellectual disability of varying severity completed a waste management training intervention in VR that involved sorting 18 items into three bins. Real-world performance was measured at pre-test, post-test, and delayed time points. The number of VR training sessions varied as training ceased when participants met the learning target (≈ 90% correct). A survival analysis assessed training success probability as a function of the number of training sessions with participants split by their level of adaptive functioning (as measured on the Adaptive Behaviour Assessment System Third Edition). The learning target was met by 19 participants (59.4%) within ten sessions (Mdn = 8.5, IQR 4-10). Real-world performance significantly improved from pre- to post-test and pre- to delayed test. There was no significant difference from post- to delayed test. Further, there was a significant positive relationship between adaptive functioning and change in the real-world assessment from the pre-test to the post- and delayed tests. VR facilitated the learning of most participants, which led to demonstrations of real-world transfer and skill generalisation. The present study identified a relationship between adaptive functioning and success in VR training. The survival curve may assist in planning future studies and training programs.

The psychological impact of instrumental activities of daily living on people with simulated age-related macular degeneration

BACKGROUND

People with age-related macular degeneration (AMD) can report reduced mental health. There is also evidence that they struggle with daily tasks because of vision loss.

AIMS

The purpose of this study was to assess the psychological impact of instrumental activities of daily living on people with simulated AMD.

METHOD

Twenty-four normally sighted participants completed 12 household tasks, in a simulated home environment, under a moderate-to-severe AMD simulation. Participants' psychological state was measured through self-report questionnaires and physiological measurements related to anxiety and stress. Tasks were completed twice, under counterbalanced vision conditions (normal and simulated AMD).

RESULTS

Linear mixed models on vision condition (normal versus simulated AMD) and trial order (trial 1 versus trial 2) revealed a significant large negative effect of the AMD simulation on time to complete tasks, and the anxiety, task engagement and distress self-reports (all P < 0.024, all ω² > 0.177). There were also significant medium-large effects of trial order on time, task incompletion, task errors, and the anxiety and task engagement self-reports (all P < 0.047, all ω² > 0.130), whereby the results improved during the second attempt at the tasks. No physiological measures were significant (all P > 0.05).

CONCLUSIONS

Completing instrumental activities of daily living under an AMD simulation had a negative impact on participants' self-reported mental state. The observed trial order effects also illuminated how practice with tasks could ease anxiety and stress over time.

Virtual Reality in Palliative Care: A Systematic Review

Background: Virtual reality (VR) using head-mounted displays (HMDs) has demonstrated to be an effective tool for treating various somatic and psychological symptoms. Technological advances and increased affordability of VR technology provide an interesting option for delivering psychological interventions to patients in palliative care. The primary aim of this systematic review was to synthesise the available research on the use of VR for enhancing psychological and somatic outcomes for palliative care patients. Secondary aims included assessing general satisfaction and overall usability. Method: A pre-registered systematic literature search was conducted according to PRISMA guidelines using OVID Emcare, Cochrane Library, Embase, Medline, PsycINFO, and PubMed Care Search: Palliative Care Knowledge Network. Peer-reviewed experimental, quasi-experimental, observational, case, and feasibility studies consisting of single or multiple VR sessions using HMDs that reported psychological and/or somatic outcomes were included. Results: Eight studies published between 2019 and 2021 were included, representing 138 patients. While the reported quantitative psychological and somatic outcomes were ambiguous, the qualitative outcomes were largely positive. Participants were generally satisfied with VR, and most studies reported the VR interventions as usable, feasible, and acceptable. Conclusions: VR shows promise in palliative care and generally addresses a range of symptoms with few adverse effects. Future research should consist of adequately powered RCTs evaluating dosage and focusing on providing meaningful activities to enhance outcomes further.

Posttraumatic Stress Symptoms and Correlates in Women and Children From Backgrounds of Domestic Violence

Ongoing research has continued to inform our understanding of the effects of living with domestic violence on both women and children. The majority of this research, however, has tended to focus on each population separately, with only a relatively few studies to date assessing the relationship between maternal and child emotional functioning, particularly for symptoms of posttraumatic stress (PTSS). This study was designed to investigate trauma symptomatology in mother-child dyads from backgrounds of domestic violence, where the children are able to self-report on their own symptoms. In addition, the study examined anxiety and depression as important correlates of PTSD in children. Participants were recruited by staff at two metropolitan Domestic Violence Services and interviewed by the first author using standardised PTSD scales and trauma inventories. Results found no significant relationship between trauma symptoms in the mother and those in her child. With respect to children who met the criteria for a diagnosis of posttraumatic stress disorder (PTSD), they were more likely to have higher levels of anxiety and depression when compared to children who did not meet PTSD criteria. Results suggest that the emotional responses of older children may tend to reflect their own experiences rather than being a reflection of maternal distress as seems more likely with younger children. Implications of these findings include the importance of independent assessments of older children, and that older children may profit from early therapeutic interventions in their own right.

The effect of age-related macular degeneration on cognitive test performance

The reliable assessment of cognitive functioning is critical to the study of brain-behaviour relationships. Yet conditions that are synchronous which ageing, including visual decline, are easily overlooked when interpreting cognitive test scores. The purpose of this study was to demonstrate the negative consequences of visual impairments on cognitive tests performance. Moderate to severe levels of age-related macular degeneration were simulated, with a set of goggles, in a sample of twenty-four normally sighted participants while they completed two cognitive tasks: a vision-dependent reaction time task and a vision-independent verbal fluency test. Performance on the reaction time task significantly decreased (p < 0.001) in the simulated age-related macular degeneration condition, by as much as 25 percentile ranks. In contrast, performance on the verbal fluency test were not statistically different between the simulated and normal vision conditions (p = 0.78). The findings highlight the importance of considering visual functioning when assessing cognitive function. When vision is not accounted for, low test scores may inaccurately indicate poor cognition. Such false attributions may have significant ramification for diagnosis and research on cognitive functioning.

Spatial Neglect Subtypes, Definitions and Assessment Tools: A Scoping Review

Objective: The objective of this scoping review was to capture the reported definitions for the subtypes of neglect post stroke and map the range of assessment tools employed for each neglect subtype.

Methods: EMBASE, Emcare, Medline, and psychINFO were searched from database inception. Searching included all allied terms and mesh headings for stroke, spatial neglect, measurement, screening tools, psychometric properties. Two reviewers independently screened studies for inclusion. Primary studies with documented protocols of a spatial neglect tool for adults post stroke, with some aspect of validity or reliability were included. Two reviewers independently reviewed the documented protocols of each tool to determine the underlying subtypes and disagreements were resolved through discussion.

Results: There were 371 articles included with 292 tools used for the screening or diagnosis of neglect. The majority of studies (67%) included a tool that did not specify the neglect subtype being assessed, therefore an analysis of the underlying subtypes for each tool is presented.

Conclusions: There is no consistency with the terms used to refer to the syndrome of spatial neglect with over 200 different terms used within the included studies to refer to the syndrome as a whole or one of its subtypes. It is essential to unify the terminology and definition for each neglect subtype. There are hundreds of neglect tools available, however many are not able to differentiate presenting subtypes. It is important for clinicians and researchers to critically evaluate the neglect tools being used for the screening and diagnosis of neglect.

Using virtual reality to improve classroom behaviour in people with Down syndrome: An experimental study (Preprint)

Background

People with Down syndrome face various learning challenges. Introducing new and enjoyable experiences in learning settings may improve learning outcomes. Immersive and interactive technologies such as virtual reality can be used to deliver rich visual experiences in classrooms.

Objective

The aim of this study was to investigate the feasibility and benefits of virtual reality exposure for people with Down syndrome in learning settings.

Methods

To address this aim, we used a within-subjects design to assess the effect of a brief virtual reality drawing experience and conventional drawing experience on subsequent behavior in 16 participants.

Results

Large positive effects were found for virtual reality drawing (t₁₅=5.020, P<.001) and conventional drawing (t₁₅=3.720, P=.002) in improving subsequent behavior in a learning setting. Irrespective of the intervention, the participant’s mood, attention, and overall behavior significantly improved. No significant differences were found between the interventions (t₁₅=–0.648; P=.53).

Conclusions

This study’s results are encouraging for researchers and educators interested in using virtual reality for people with Down syndrome, as virtual reality was found to be highly feasible. Recommendations are made for researchers and educators interested in providing virtual reality experiences for people with Down syndrome.

Rest Intervals during Virtual Reality Gaming Augments Standing Postural Sway Disturbance

Immersive virtual reality (VR) can cause acute sickness, visual disturbance, and balance impairment. Some manufacturers recommend intermittent breaks to overcome these issues; however, limited evidence examining whether this is beneficial exists. The aim of this study was to examine whether taking breaks during VR gaming reduced its effect on postural sway during standing balance assessments. Twenty-five people participated in this crossover design study, performing 50 min of VR gaming either continuously or with intermittent 10 min exposure/rest intervals. Standing eyes open, two-legged balance assessments were performed immediately pre-, immediately post- and 40 min post-exposure. The primary outcome measure was total path length; secondary measures included independent axis path velocity, amplitude, standard deviation, discrete and continuous wavelet transform-derived variables, and detrended fluctuation analysis. Total path length was significantly (p < 0.05) reduced immediately post-VR gaming exposure in the intermittent rest break group both in comparison to within-condition baseline values and between-condition timepoint results. Conversely, it remained consistent across timepoints in the continuous exposure group. These changes consisted of a more clustered movement speed pattern about a lower central frequency, evidenced by signal frequency content. These findings indicate that caution is required before recommending rest breaks during VR exposure until we know more about how balance and falls risk are affected.

Parietal Cortex Connectivity as a Marker of Shift in Spatial Attention Following Continuous Theta Burst Stimulation

Non-invasive brain stimulation is a useful tool to probe brain function and provide therapeutic treatments in disease. When applied to the right posterior parietal cortex (PPC) of healthy participants, it is possible to temporarily shift spatial attention and mimic symptoms of spatial neglect. However, the field of brain stimulation is plagued by issues of high response variability. The aim of this study was to investigate baseline functional connectivity as a predictor of response to an inhibitory brain stimulation paradigm applied to the right PPC. In fourteen healthy adults (9 female, aged 24.8 ± 4.0 years) we applied continuous theta burst stimulation (cTBS) to suppress activity in the right PPC. Resting state functional connectivity was quantified by recording electroencephalography and assessing phase consistency. Spatial attention was assessed before and after cTBS with the Landmark Task. Finally, known determinants of response to brain stimulation were controlled for to enable robust investigation of the influence of resting state connectivity on cTBS response. We observed significant inter-individual variability in the behavioral response to cTBS with 53.8% of participants demonstrating the expected rightward shift in spatial attention. Baseline high beta connectivity between the right PPC, dorsomedial pre-motor region and left temporal-parietal region was strongly associated with cTBS response (R² = 0.51). Regression analysis combining known cTBS determinants (age, sex, motor threshold, physical activity, stress) found connectivity between the right PPC and left temporal-parietal region was the only significant variable (p = 0.011). These results suggest baseline resting state functional connectivity is a strong predictor of a shift in spatial attention following cTBS. Findings from this study help further understand the mechanism by which cTBS modifies cortical function and could be used to improve the reliability of brain stimulation protocols.

The Effect of Reminiscence Therapy Using Virtual Reality on Apathy in Residential Aged Care: Multisite Nonrandomized Controlled Trial

Background

Apathy is a frequent and underrecognized neurological disorder symptom. Reduced goal-directed behavior caused by apathy is associated with poor outcomes for older adults in residential aged care. Recommended nonpharmacological treatments include person-centered therapy using information and communication technology. Virtual reality (VR) in the form of head-mounted displays (HMDs) is a fully immersive technology that provides access to a wide range of freely available content. The use of VR as a therapy tool has demonstrated promise in the treatment of posttraumatic stress disorder and anxiety. In addition, VR has been used to improve conditions including depression, anxiety, cognitive function, and balance in older adults with memory deficits, Alzheimer disease, and Parkinson disease. Research using VR for the symptoms of apathy in older adults living in residential aged care facilities is limited.

Objective

This study aims to examine whether using HMDs as a tool for reminiscence therapy improves the symptoms of apathy compared with using a laptop computer and physical items with older adults living in residential aged care.

Methods

In this multisite trial, 43 participants were allocated to one of three groups: reminiscence therapy intervention using VR in the form of HMDs, reminiscence therapy using a laptop computer supplemented by physical items if required (active control), and a usual care (passive control) group. The primary outcome was apathy, and the secondary outcomes included cognition and depression. The side effects of using HMDs were also measured in the VR group.

Results

Mixed model analyses revealed no significant group interaction over time in outcomes between the VR and laptop groups (estimate=−2.24, SE 1.89; t₄₀=−1.18; P=.24). Pooled apathy scores in the two intervention groups compared with the passive control group also revealed no significant group interaction over time (estimate=−0.26, SE 1.66; t₄₀=−0.16; P=.88). There were no significant secondary outcomes. Most participants in the VR group stated that they would prefer to watch content in VR than on a flat screen (Χ²₂=11.2; P=.004), side effects from HMD use were negligible to minimal according to the Simulator Sickness Questionnaire cutoff scores.

Conclusions

Although there were no significant results in outcome measures, this study found that participants engaged in the research and enjoyed the process of reminiscing using both forms of technology. It was found that VR can be implemented in an aged care setting with correct protocols in place. Providing residents in aged care with a choice of technology may assist in increasing participation in activities. We cannot dismiss the importance of immediate effects while the therapy was in progress, and this is an avenue for future research.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12619001510134; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378564.

International Registered Report Identifier (IRRID)

RR2-DOI: 10.1136/bmjopen-2020-046030

Simulating Macular Degeneration to Investigate Activities of Daily Living: A Systematic Review

Purpose: Investigating difficulties during activities of daily living is a fundamental first step for the development of vision-related intervention and rehabilitation strategies. One way to do this is through visual impairment simulations. The aim of this review is to synthesize and assess the types of simulation methods that have been used to simulate age-related macular degeneration (AMD) in normally sighted participants, during activities of daily living (e.g., reading, cleaning, and cooking).

Methods: We conducted a systematic literature search in five databases and a critical analysis of the advantages and disadvantages of various AMD simulation methods (following PRISMA guidelines). The review focuses on the suitability of each method for investigating activities of daily living, an assessment of clinical validation procedures, and an evaluation of the adaptation periods for participants.

Results: Nineteen studies met the criteria for inclusion. Contact lenses, computer manipulations, gaze contingent displays, and simulation glasses were the main forms of AMD simulation identified. The use of validation and adaptation procedures were reported in approximately two-thirds and half of studies, respectively.

Conclusions: Synthesis of the methodology demonstrated that the choice of simulation has been, and should continue to be, guided by the nature of the study. While simulations may never completely replicate vision loss experienced during AMD, consistency in simulation methodology is critical for generating realistic behavioral responses under vision impairment simulation and limiting the influence of confounding factors. Researchers could also come to a consensus regarding the length and form of adaptation by exploring what is an adequate amount of time and type of training required to acclimatize participants to vision impairment simulations.

Identifying New Factors Associated With Cognitive Decline and Delirium After Transcatheter Aortic Valve Implantation: A Study Protocol

Background: Transcatheter aortic valve implantation (TAVI) has become the standard-of-care for treatment of severe symptomatic aortic stenosis and is also being increasingly recommended for low-risk patients. While TAVI boasts positive post-procedural outcomes, it is also associated with cognitive complications, namely delirium and cognitive decline. There is a pressing need for accurate risk tools which can identify TAVI patients at risk of delirium and cognitive decline, as risk scores designed for general cardiovascular surgery fall short. The present effect-finding exploratory study will assess the utility of various measures in the context of aging and frailty in predicting who will and who will not develop delirium or cognitive impairment following TAVI. The measures we propose include gait, visual symptoms, voice, swallowing, mood and sleep. Methods: This is an observational prospective cohort study focused on identifying pre-procedural risk factors for the development of delirium and cognitive decline following TAVI. Potential risk factors will be measured prior to TAVI. Primary outcomes will be post-procedure cognitive decline and delirium. Secondary outcomes include activities of daily living, quality of life, and mortality. Delirium presence will be measured on each of the first 2 days following TAVI. All other outcomes will be assessed at 3-, 6-, and 12-months post-operatively. A series of logistic regressions will be run to investigate the relationship between potential predictors and outcomes (presence vs. absence of either delirium or cognitive decline). Discussion: This study will assess the strengths of associations between a range of measures drawn from frailty and aging literature in terms of association with cognitive decline and delirium following TAVI. Identified measures can be used in future development of TAVI risk prediction models, which are essential for the accurate identification of cognitive at-risk patients and successful application of pre-procedural interventions. Clinical Trial Registration: This trial is registered with the Australian New Zealand Clinical Trials Registry. [https://bit.ly/2PAotP5], [ACTRN12618001114235].

Vocational Training in Virtual Environments for People With Neurodevelopmental Disorders: A Systematic Review

People with neurodevelopmental disorders are often considered unsuitable or incapable of working in open employment. When employment is available, tasks are often limited, and opportunities for career development are restricted. Policy and funding constraints leave people with disabilities without an opportunity to develop skills due to the additional time and costs for employers. To overcome these barriers, virtual environments have been proposed as a safe and reliable solution for training. An important prerequisite for a wider uptake of training in virtual environments are demonstrations that the training leads to improved performance in the real world. This is particularly true for people with neurodevelopmental disorders, as transferring learnings from one context to another can be challenging. A systematic review was conducted to assess whether training in virtual environments can be used to improve real-world vocational skills in people with neurodevelopmental disorders. After a systematic search in six databases, eight out of the initially identified 1,806 articles met the inclusion criteria. The findings from these eight studies demonstrate that people with neurodevelopmental disorders can transfer vocational skills from virtual environments to real-world settings. With substantial technological improvements, a surge in accessibility, and improved affordability, there is a need to build upon the promising results identified in this review.

Cognitive training interventions for dementia and mild cognitive impairment in Parkinson's disease - A cochrane review summary with commentary

BACKGROUND

The majority of people living with Parkinson's disease will develop impairments in cognition. These impairments are associated with a reduced quality of life.

OBJECTIVE

The Cochrane Review aimed to investigate whether cognitive training improves cognition in people with Parkinson's disease and mild cognitive impairments or dementia.

METHODS

A Cochrane Review by Orgeta et al. was summarized with comments.

RESULTS

The review included seven studies with a total of 225 participants. There was no evidence for improvements in global cognition when cognitive training was compared to control conditions. Observed improvements in attention and verbal memory measures after cognitive training could not be confirmed in a subsequent sensitivity analysis. There was no evidence for benefits in other cognitive domains or quality of life measures. The certainty of the evidence was low for all comparisons.

CONCLUSIONS

The effectiveness of cognitive training for people with Parkinson's disease and cognitive impairments remains inconclusive. There is a pressing need for adequately powered trials with higher methodological quality.

Monotonous driving induces shifts in spatial attention as a function of handedness

Current evidence suggests that the ability to detect and react to information under lowered alertness conditions might be more impaired on the left than the right side of space. This evidence derives mainly from right-handers being assessed in computer and paper-and-pencil spatial attention tasks. However, there are suggestions that left-handers might show impairments on the opposite (right) side compared to right-handers with lowered alertness, and it is unclear whether the impairments observed in the computer tasks have any real-world implications for activities such as driving. The current study investigated the alertness and spatial attention relationship under simulated monotonous driving in left- and right-handers. Twenty left-handed and 22 right-handed participants (15 males, mean age = 23.6 years, SD = 5.0 years) were assessed on a simulated driving task (lasting approximately 60 min) to induce a time-on-task effect. The driving task involved responding to stimuli appearing at six different horizontal locations on the screen, whilst driving in a 50 km/h zone. Decreases in alertness and driving performance were evident with time-on-task in both handedness groups. We found handedness impacts reacting to lateral stimuli differently with time-on-task: right-handers reacted slower to the leftmost stimuli, while left-handers showed the opposite pattern (although not statistically significant) in the second compared to first half of the drive. Our findings support suggestions that handedness modulates the spatial attention and alertness interactions. The interactions were observed in a simulated driving task which calls for further research to understand the safety implications of these interactions for activities such as driving.

What do the public really know about dementia and its risk factors?

Dementia has become a major public health concern globally. With no cure available and strong evidence for modifiable risk factors, it is imperative that the public are knowledgeable about dementia and to reduce their risk. The aim of this study was to measure the knowledge of dementia and its risk factors in the Australian public, as well as the number and type of information sources used. An online survey promoted through various social media platforms was completed by 596 Australian adults aged 18-78 years (59% aged 18-44 years; 78% female). Eighty-eight percent of respondents were able to recognise dementia from a vignette, more so from a moderate than from a mild symptom vignette. Only 19% of respondents had a good understanding of dementia, that is describing impairment in both cognition and function. Ninety-five percent of respondents recognised that genetics and old age contributed to a person getting dementia. However, respondents had poor knowledge of empirically supported modifiable risk factors, with most viewed as likely contributors to dementia at chance levels (50%) or below. Respondents reported using informal information sources more often than formal information sources to learn about dementia. The public appear to be able to recognise the symptoms of dementia but lack understanding of how dementia impacts both a person's cognitive functioning and ability to perform everyday tasks. Furthermore, the public remain largely unaware of empirically supported modifiable risk factors that contribute to the development of dementia. It is imperative that the public are educated on how to access and evaluate dementia-related information sources in order to increase their knowledge and understanding of dementia.

Virtual reality intervention to improve apathy in residential aged care: protocol for a multisite non-randomised controlled trial

INTRODUCTION

Apathy is a prevalent neuropsychiatric symptom for older adults residing in aged care. Left untreated, apathy has been associated with accelerated cognitive decline and increased risk of mortality. Reminiscence therapy is commonly used in aged care and has demonstrated to reduce apathy. Traditional methods of reminiscence use physical objects and more recently technology including tablets and laptop computers have demonstrated potential. Virtual reality (VR) has successfully been used to treat psychological disorders; however, there is little evidence on using VR for behavioural symptoms such as apathy in older adults. Using VR to deliver reminiscence therapy provides an immersive experience, and readily available applications provide access to a large range of content allowing easier delivery of therapy over traditional forms of therapy. This study aims to identify changes in apathy after a reminiscence therapy intervention using head-mounted displays (HMDs).

METHODS AND ANALYSIS

Participants will be allocated to one of three groups; reminiscence therapy using VR; an active control using a laptop computer or physical items and a passive control. A total of 45 participants will be recruited from residential aged care (15 in each group). The three groups will be compared at baseline and follow-up. The primary outcome is apathy, and secondary outcomes include cognition and depression. Side effects from using HMDs will also be examined in the VR group. Primary and secondary outcomes at baseline and follow-up will be analysed using linear mixed modelling.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the University of South Australia Human Research Ethics Committee. The results from this study will be disseminated through manuscript publications and national/international conferences.

TRIAL REGISTRATION NUMBER

ACTRN12619001510134.

Exergaming With Beat Saber: An Investigation of Virtual Reality Aftereffects

BACKGROUND

Virtual reality (VR) exergaming has the potential to target sedentary behavior. Immersive environments can distract users from the physical exertion of exercise and can motivate them to continue exergaming. Despite the recent surge in VR popularity, numerous users still experience VR sickness from using head-mounted displays (HMDs). Apart from the commonly assessed self-reported symptoms, depth perception and cognition may also be affected. Considering the potential benefits of VR exergaming, it is crucial to identify the adverse effects limiting its potential and continued uptake.

OBJECTIVE

This study aims to investigate the consequences of playing one of the most popular VR exergames for 10 and 50 min on aspects of vision, cognition, and self-reported VR sickness.

METHODS

A total of 36 participants played an exergame, called Beat Saber, using an HMD. A repeated measures within-subject design was conducted to assess changes in vision, cognition, and well-being after short (10 min) and long (50 min) durations of VR exposure. We measured accommodation, convergence, decision speed, movement speed, and self-reported sickness at 3 test periods-before VR, immediately after VR, and 40 min after VR (late).

RESULTS

Beat Saber was well tolerated, as there were no dropouts due to sickness. For most participants, any immediate aftereffects were short-lived and returned to baseline levels after 40 min of exiting VR. For both short and long exposures, there were changes in accommodation (F1,35=8.424; P=.006) and convergence (F1,35=7.826; P=.008); however, in the late test period, participants returned to baseline levels. Measures on cognition revealed no concern. The total simulator sickness questionnaire (SSQ) scores increased immediately after VR (F1,35=26.515; P<.001) and were significantly higher for long compared with short exposures (t35=2.807; P=.03), but there were no differences in exposure duration in the late test period, with scores returning to baseline levels. Although at a group level, participants' sickness levels returned to baseline 40 min after VR exposure, approximately 14% of the participants still reported high levels of sickness in the late test period after playing 50 min of Beat Saber. We also showed that the participants who experienced a high level of sickness after a short exposure were almost certain to experience a high level of symptoms after a longer exposure.

CONCLUSIONS

Irrespective of the duration of exposure, this study found no strong evidence for adverse symptoms 40 min after exiting VR; however, some individuals still reported high levels of VR sickness at this stage. We recommend that users commit to a waiting period after exiting VR to ensure that any aftereffects have deteriorated. Exergames in HMDs have the potential to encourage people to exercise but are understudied, and the aftereffects of exergaming need to be closely monitored to ensure that VR exergames can reach their full potential.

The relationship between alertness and spatial attention under simulated shiftwork

Higher and lower levels of alertness typically lead to a leftward and rightward bias in attention, respectively. This relationship between alertness and spatial attention potentially has major implications for health and safety. The current study examined alertness and spatial attention under simulated shiftworking conditions. Nineteen healthy right-handed participants (M = 24.6 ± 5.3 years, 11 males) completed a seven-day laboratory based simulated shiftwork study. Measures of alertness (Stanford Sleepiness Scale and Psychomotor Vigilance Task) and spatial attention (Landmark Task and Detection Task) were assessed across the protocol. Detection Task performance revealed slower reaction times and higher omissions of peripheral (compared to central) stimuli, with lowered alertness; suggesting narrowed visuospatial attention and a slight left-sided neglect. There were no associations between alertness and spatial bias on the Landmark Task. Our findings provide tentative evidence for a slight neglect of the left side and a narrowing of attention with lowered alertness. The possibility that one’s ability to sufficiently react to information in the periphery and the left-side may be compromised under conditions of lowered alertness highlights the need for future research to better understand the relationship between spatial attention and alertness under shiftworking conditions.

Meta-Analysis of Prevalence and Risk Factors for Cognitive Decline and Improvement After Transcatheter Aortic Valve Implantation

Changes to cognition, both decline and improvement, are commonly reported after transcatheter aortic valve implantation (TAVI). However, previous systematic reviews and meta-analyses have missed these subgroups by assessing whole-group-averages for cognitive outcomes. We sought to pool estimates to identify the prevalence of cognitive decline and improvement after TAVI, as well as associated factors for these outcomes. A systematic review identified 15 articles appropriate for meta-analysis. When robust cognitive change definitions were employed, the pooled prevalence of incident cognitive impairment up to 1-, 1 to 6-, and ≥6-months post-TAVI was 7%, 14%, and 12%, respectively. For cognitive improvement, the prevalence from 1 to 6 months and ≥6 months after TAVI was estimated to be 19% and 11%, respectively. Two factors were associated with these cognitive outcomes: (1) using a cerebral embolic protection device was associated with decreased prevalence of cognitive decline up to 1-week post-TAVI; (2) baseline cognitive impairment had a large association with post-TAVI cognitive improvement. In conclusion, cognitive decline and cognitive improvement are experienced by approximately 7% to 19% of patients after TAVI, respectively. Those with the lowest cognitive performance pre-TAVI appear to have the most to gain in terms of cognitive improvement post-TAVI. Identifying further predictive factors for cognitive decline and improvement post-TAVI will facilitate a personalized-medicine approach for cognitive care and prognosis.

A RE-AIM Analysis of an Intergenerational Dementia Education Program

Objectives: Children often have a lack of dementia understanding and poor attitudes toward people with dementia. Intergenerational programs are increasingly common, but the effects on knowledge and attitudes related to dementia are mixed, especially in the long-term (6 months). Using a RE-AIM framework, we quantitatively evaluated the effects of an educational dementia program (with and without an intergenerational program) on dementia attitudes in the short and long-term, and qualitatively, which elements of the program facilitated this change.

Methods: Eighty-one children (9.63 ± 0.52 years, 35 males) from three classes participated in an 8-week dementia education program and 52 also interacted with older adults through an intergenerational experience. Program reach was measured as the percentage of children who participated in the study. The Kids Insight into Dementia Survey (KIDS) was implemented to measure dementia knowledge and attitudes: efficacy and maintenance. Qualitative interviews with all participant groups informed both adoption and implementation. Cost-benefit analysis was used as a secondary outcome measure for efficacy.

Results: The program demonstrated strong levels of impact reaching 93% of school children across the three included classes. Efficacy was demonstrated by a positive change in children's dementia knowledge and attitudes immediately post program, which remained increased (as compared to baseline) 6- months post intervention; there were no differences between groups (those who interacted with older adults and those who did not). Interviews identified positive changes in children's empathy and improved community awareness. Barriers to adoption included the project scope, time constraints incurred by school terms and the management of children-to-adult ratios.

Conclusions: These findings provide the first evidence that school-based dementia education improves knowledge of and attitudes toward people with dementia long-term. We demonstrated programs such as this can be successful in both primary school and wider community settings, with support from school and community partners key to the success.

Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study

Background

Apathy is a common symptom in neurological disorders, including dementia, and is associated with a faster rate of cognitive decline, reduced quality of life, and high caregiver burden. There is a lack of effective pharmacological treatments for apathy, and nonpharmacological interventions are a preferred first-line approach to treatment. Virtual reality (VR) using head-mounted displays (HMDs) is being successfully used in exposure- and distraction-based therapies; however, there is limited research on using HMDs for symptoms of neurological disorders.

Objective

This feasibility study aimed to assess whether VR using HMDs could be used to deliver tailored reminiscence therapy and examine the willingness to participate, response rates to measures, time taken to create tailored content, and technical problems. In addition, this study aimed to explore the immediate effects between verbal fluency and apathy after exposure to VR.

Methods

A mixed methods study was conducted in a sample of older adults residing in aged care, and 17 participants were recruited. Apathy was measured using the Apathy Evaluation Scale (AES), and verbal fluency was used as a proxy measure of improvements in apathy and debriefing interviews to assess feedback from participants. Side effects that can occur from using HMDs were also measured.

Results

We recruited participants from a high socioeconomic status setting with a high education level, and the participation rate was 85% (17/20); most responses to measures were positive. Access to a wide range of freely available content and the absence of technical difficulties made the delivery of a VR reminiscence intervention highly feasible. Participants had improved semantic scores (t₁₄=−3.27; P=.006) but not phonemic fluency scores (t₁₄=0.55; P=.59) immediately after the intervention. Those with higher levels of apathy demonstrated the greatest cognitive improvements after a VR reminiscence experience, which was indicated by a strong positive relationship between the AES and semantic verbal fluency change scores postminus pre-VR (r=0.719; 95% CI 0.327 to 0.900; P=.003). All participants enjoyed the experience despite 35% (6/17) of participants experiencing temporary side effects.

Conclusions

This study provides initial evidence that it is feasible to use VR with HMDs for therapy to treat symptoms of apathy in older adults in residential aged care. However, there is a need to closely monitor the side effects of HMD use in older adults. Further research is needed using an active control group to compare the use of VR with traditional forms of reminiscence therapy.

Factors Associated With Virtual Reality Sickness in Head-Mounted Displays: A Systematic Review and Meta-Analysis

The use of head-mounted displays (HMD) for virtual reality (VR) application-based purposes including therapy, rehabilitation, and training is increasing. Despite advancements in VR technologies, many users still experience sickness symptoms. VR sickness may be influenced by technological differences within HMDs such as resolution and refresh rate, however, VR content also plays a significant role. The primary objective of this systematic review and meta-analysis was to examine the literature on HMDs that report Simulator Sickness Questionnaire (SSQ) scores to determine the impact of content. User factors associated with VR sickness were also examined. A systematic search was conducted according to PRISMA guidelines. Fifty-five articles met inclusion criteria, representing 3,016 participants (mean age range 19.5–80; 41% female). Findings show gaming content recorded the highest total SSQ mean 34.26 (95%CI 29.57–38.95). VR sickness profiles were also influenced by visual stimulation, locomotion and exposure times. Older samples (mean age ≥35 years) scored significantly lower total SSQ means than younger samples, however, these findings are based on a small evidence base as a limited number of studies included older users. No sex differences were found. Across all types of content, the pooled total SSQ mean was relatively high 28.00 (95%CI 24.66–31.35) compared with recommended SSQ cut-off scores. These findings are of relevance for informing future research and the application of VR in different contexts.

Cognitive rehabilitation for attention deficits following stroke

BACKGROUND

Many survivors of stroke report attentional impairments, such as diminished concentration and distractibility. However, the effectiveness of cognitive rehabilitation for improving these impairments is uncertain.This is an update of the Cochrane Review first published in 2000 and previously updated in 2013.

OBJECTIVES

To determine whether people receiving cognitive rehabilitation for attention problems 1. show better outcomes in their attentional functions than those given no treatment or treatment as usual, and 2. have a better functional recovery, in terms of independence in activities of daily living, mood, and quality of life, than those given no treatment or treatment as usual.

SEARCH METHODS

We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PsycBITE, REHABDATA and ongoing trials registers up to February 2019. We screened reference lists and tracked citations using Scopus.

SELECTION CRITERIA

We included controlled clinical trials (CCTs) and randomised controlled trials (RCTs) of cognitive rehabilitation for impairments of attention for people with stroke. We did not consider listening to music, meditation, yoga, or mindfulness to be a form of cognitive rehabilitation. We only considered trials that selected people with demonstrable or self-reported attentional deficits. The primary outcomes were measures of global attentional functions, and secondary outcomes were measures of attentional domains (i.e. alertness, selective attention, sustained attention, divided attention), functional abilities, mood, and quality of life.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials, extracted data, and assessed the risk of bias. We used the GRADE approach to assess the certainty of evidence for each outcome.

MAIN RESULTS

We included no new trials in this update. The results are unchanged from the previous review and are based on the data of six RCTs with 223 participants. All six RCTs compared cognitive rehabilitation with a usual care control. Meta-analyses demonstrated no convincing effect of cognitive rehabilitation on subjective measures of attention either immediately after treatment (standardised mean difference (SMD) 0.53, 95% confidence interval (CI) -0.03 to 1.08; P = 0.06; 2 studies, 53 participants; very low-quality evidence) or at follow-up (SMD 0.16, 95% CI -0.23 to 0.56; P = 0.41; 2 studies, 99 participants; very low-quality evidence). People receiving cognitive rehabilitation (when compared with control) showed that measures of divided attention recorded immediately after treatment may improve (SMD 0.67, 95% CI 0.35 to 0.98; P < 0.0001; 4 studies, 165 participants; low-quality evidence), but it is uncertain that these effects persisted (SMD 0.36, 95% CI -0.04 to 0.76; P = 0.08; 2 studies, 99 participants; very low-quality evidence). There was no evidence for immediate or persistent effects of cognitive rehabilitation on alertness, selective attention, and sustained attention. There was no convincing evidence for immediate or long-term effects of cognitive rehabilitation for attentional problems on functional abilities, mood, and quality of life after stroke.

AUTHORS' CONCLUSIONS

The effectiveness of cognitive rehabilitation for attention deficits following stroke remains unconfirmed. The results suggest there may be an immediate effect after treatment on attentional abilities, but future studies need to assess what helps this effect persist and generalise to attentional skills in daily life. Trials also need to have higher methodological quality and better reporting.

Using Virtual Environments to Improve Real-World Motor Skills in Sports: A Systematic Review

In many settings, sports training can be difficult to organize, logistically complicated and very costly. Virtual environments (VE) have garnered interest as a tool to train real-world sports skills due to the realism and flexibility that they can deliver. A key assumption of VE-based training is that the learned skills and experiences transfer to the real world, but do they? Using PRISMA guidelines, this systematic review evaluated the available evidence regarding the transfer of motor skills from VE training to real-world sporting contexts. The initial search identified 448 articles, but only 4 of these articles met basic criteria necessary to assess real-world transfer. Key factors regarding the study design, learner characteristics and training environment of these studies are considered. In a relatively new area of research, the findings from these 4 articles are encouraging and provide initial support for the notion that skills training in a VE can improve real-world performance in sports. However, for a wider uptake of VEs in sports training, it is important that more research demonstrates real-world transfer. Study design recommendations are suggested for researchers, developers or trainers who are considering demonstrating real-world transfers from virtual to real-world environments.

Getting your game on: Using virtual reality to improve real table tennis skills

Objective

The present study investigates skill transfer from Virtual Reality (VR) sports training to the real world, using the fast-paced sport of table tennis.

Background

A key assumption of VR training is that the learned skills and experiences transfer to the real world. Yet, in certain application areas, such as VR sports training, the research testing this assumption is sparse.

Design

Real-world table tennis performance was assessed using a mixed-model analysis of variance. The analysis comprised a between-subjects (VR training group vs control group) and a within-subjects (pre- and post-training) factor.

Method

Fifty-seven participants (23 females) were either assigned to a VR training group (n = 29) or no-training control group (n = 28). During VR training, participants were immersed in competitive table tennis matches against an artificial intelligence opponent. An expert table tennis coach evaluated participants on real-world table tennis playing before and after the training phase. Blinded regarding participant's group assignment, the expert assessed participants’ backhand, forehand and serving on quantitative aspects (e.g. count of rallies without errors) and quality of skill aspects (e.g. technique and consistency).

Results

VR training significantly improved participants’ real-world table tennis performance compared to a no-training control group in both quantitative (p < .001, Cohen’s d = 1.08) and quality of skill assessments (p < .001, Cohen’s d = 1.10).

Conclusions

This study adds to a sparse yet expanding literature, demonstrating real-world skill transfer from Virtual Reality in an athletic task.

Visual compensation in cervical dystonia

Introduction: Visual-spatial processing can be affected in people with cervical dystonia (CD). These impairments have almost exclusively been observed in laboratory studies, but the impact of visuo-spatial impairments on daily activities is unclear. Here, we investigated how people living with CD visually explore the environment. Method: 21 participants (10 patients and 11 controls) walked a designated course searching for targets while their eye movements were tracked by the means of eye tracking glasses. In addition, all participants performed an extensive battery of spatial neglect tests. Results: People with CD visually compensated for their lateral head position. That is, they made more eye movements towards the side opposite their lateral head position. No evidence for or against spatial asymmetries were detected in a range of behavioral measures (target detection, standard neglect battery tests) on a group level. Yet, single patients showed a neglect-like pattern. One patient with a right torticollis failed to detect most left-sided targets when walking. Conclusion: In general, participants seem to adequately compensate for the deviated head posture when judging spatial stimuli. However, the insufficient spatial exploration in one patient with a valid driving license should raise awareness in clinicians to potential visuo-spatial problems in people living with CD. An interesting question arising from our findings is whether people with CD and marked visuo-spatial deficits would benefit from scanning training, as is employed in stroke rehabilitation.

Interactions between spatial attention and alertness in healthy adults: A meta-analysis

Attending to the visuospatial field is paramount for safety. The inability to sufficiently allocate attention in the environment could lead to unfavourable consequences. One's ability to attend quickly to left- and right-sided stimuli can vary depending on the person's level of alertness. A dominant model of this relationship proposes that low alertness is associated with a rightward bias in attention, with increases in alertness shifting attention leftward. The current study sought to synthesise the literature on spatial attention and alertness and identify modulators of this relationship in healthy adults. Nineteen articles meeting inclusion criteria were identified for meta-analysis. A small effect of alertness on spatial bias (d = .302) with no evidence for a systematic publication bias was found. Of the five investigated modulators, namely, the experimental design relative to alertness, direction of alertness manipulation, measurement of alertness, the nature of the spatial task, and handedness, only the latter was identified as a significant modulator of the relationship between alertness and spatial attention. The review's findings tie in with the influential framework by Corbetta and Shulman (2011) and support the idea to increase alertness as a rehabilitation approach to reduce inattention to the left side in neglect patients. Findings also suggest a need for future research to investigate neurological processes that underlie the alertness and spatial attention relationship, and a need to examine the transfer effects of laboratory-based experiments for real-world implications.

Reduced vision-related quality of life in people living with dystonia

Purpose: Dystonia is a neurological movement disorder with negative impact on function and quality of life. It is currently unclear whether vision-related quality of life is affected. The aim of this study was to determine whether vision-related quality of life is reduced by dystonia.Materials and methods: A vision-related quality of life questionnaire was delivered online to probe visual function in people living with dystonia. Scores for each of six domains were compared to normative data of 819 healthy participants using one sample t-tests. Respondents were divided into two groups based on whether they had botulinum toxin injections and compared using independent samples t-tests.Results: There were 42 completed responses. There was a difference from norm for two domains; ocular symptoms (t(41) = 2.31, p = 0.026) and role performance (t(41) = 2.85, p = 0.007). There was variation in responses for all six domains. No difference in scores for the botulinum toxin injection group was found for either domain (both p > 0.74).Conclusions: Some people with dystonia experience reduced vision-related quality of life, which has potential to contribute to their disability. Health professionals should be aware of vision-related issues when managing people with dystonia and consider appropriate rehabilitative interventions to reduce disability and enhance quality of life.Implications for rehabilitationDystonia is a neurological movement disorder resulting in abnormal postures and movements.Vision-related quality of life is reduced by dystonia which may contribute to disability and reduced function.Strategies to improve vision-related quality of life should be included in rehabilitation programmes for people living with dystonia.

Estimating everyday risk: Subjective judgments are related to objective risk, mapping of numerical magnitudes and previous experience

We aimed to investigate individual differences that associate with peoples' acute risk perception for activities such as walking and giving birth, including objective risk and the mapping of numerical magnitudes. The Amazon Mechanical Turk platform was used, with 284 participants recruited (40% female) ranging between 19 and 68 years. Participants had to indicate the positions of (1) the relative death risk of activities on a horizontal-line with 'very low risk of death' and 'very high risk of death' as left and right anchors respectively and (2), numerical magnitudes on a horizontal-line ranging 0-1000. The MicroMort framework was used to index acute risk of death (one/million chance of dying from an accident). Previous experience with the activities, handedness, along with risk propensity and unrealistic optimism were also measured. Linear mixed-effects modelling was used to investigate predictors of subjective MicroMort judgments. Individuals subjectively judged activities to be riskier if the activity was objectively riskier, if they over-estimated on the numerical task (more so for low-risk activities as compared to high-risk), or if they had not experienced the activity previously. The observed relationship between the number line task and everyday risk judgments is in keeping with the idea of a common magnitude representation system. In conclusion, individuals are able to discriminate between activities varying in risk in an absolute sense, however intuition for judging the relative differences in risk is poor. The relationship between the misjudging of both risks and numerical magnitudes warrants further investigation, as may inform the development of risk communication strategies.

Meta-analysis of Prevalence and Risk Factors for Delirium After Transcatheter Aortic Valve Implantation

Delirium is a severe and common complication following transcatheter aortic valve implantation (TAVI). We sought to identify the prevalence and risk factors associated with the development of postprocedural delirium in patients aged over 60 years who underwent elective TAVI for aortic stenosis. Overall, 1,051 articles were searched, from which 9 studies were included. The prevalence of delirium following TAVI was higher in studies that assessed delirium for a minimum of 3 consecutive days (24.9%) compared with the studies that did not (2%). There were large effect sizes (d > 0.8) for 3 risk factors: acute kidney injury (odds ratio [OR] 5, p < 0.001), transapical approach (OR 4, p < 0.001) and carotid artery disease (OR 4, p < 0.001), whilst small effect sizes were found for a history of atrial fibrillation, prior stroke/transient ischemic attack, peripheral artery disease, hypertension, and prior cognitive impairment. In conclusion, 23% of patients 60 years and over who underwent TAVI experience delirium, a preventative cause of cognitive impairment and dementia. Recognition of risk factors for delirium after TAVI, such as a history of carotid artery disease, development of acute kidney injury, or use of a transapical approach, provides an opportunity to implement proven delirium preventative measures.

Eye Movements During Everyday Behavior Predict Personality Traits

Besides allowing us to perceive our surroundings, eye movements are also a window into our mind and a rich source of information on who we are, how we feel, and what we do. Here we show that eye movements during an everyday task predict aspects of our personality. We tracked eye movements of 42 participants while they ran an errand on a university campus and subsequently assessed their personality traits using well-established questionnaires. Using a state-of-the-art machine learning method and a rich set of features encoding different eye movement characteristics, we were able to reliably predict four of the Big Five personality traits (neuroticism, extraversion, agreeableness, conscientiousness) as well as perceptual curiosity only from eye movements. Further analysis revealed new relations between previously neglected eye movement characteristics and personality. Our findings demonstrate a considerable influence of personality on everyday eye movement control, thereby complementing earlier studies in laboratory settings. Improving automatic recognition and interpretation of human social signals is an important endeavor, enabling innovative design of human–computer systems capable of sensing spontaneous natural user behavior to facilitate efficient interaction and personalization.

Mapping of non-numerical domains on space: a systematic review and meta-analysis

The spatial numerical association of response code (SNARC) effect is characterized by low numbers mapped to the left side of space and high numbers mapped to the right side of space. In addition to numbers, SNARC-like effects have been found in non-numerical magnitude domains such as time, size, letters, luminance, and more, whereby the smaller/earlier and larger/later magnitudes are typically mapped to the left and right of space, respectively. The purpose of this systematic and meta-analytic review was to identify and summarise all empirical papers that have investigated horizontal (left-right) SNARC-like mappings using non-numerical stimuli. A systematic search was conducted using EMBASE, Medline, and PsycINFO, where 2216 publications were identified, with 57 papers meeting the inclusion criteria (representing 112 experiments). Ninety-five of these experiments were included in a meta-analysis, resulting in an overall effect size of d = .488 for a SNARC-like effect. Additional analyses revealed a significant effect size advantage for explicit instruction tasks compared with implicit instructions, yet yielded no difference for the role of expertise on SNARC-like effects. There was clear evidence for a publication bias in the field, but the impact of this bias is likely to be modest, and it is unlikely that the SNARC-like effect is a pure artefact of this bias. The similarities in the response properties for the spatial mappings of numerical and non-numerical domains support the concept of a general higher order magnitude system. Yet, further research will need to be conducted to identify all the factors modulating the strength of the spatial associations.

The Mobility Assessment Course for the Diagnosis of Spatial Neglect: Taking a Step Forward?

Spatial neglect after stroke can be a challenging syndrome to diagnose under standard neuropsychological assessment. There is now sufficient evidence that those affected might demonstrate neglect behavior in everyday settings despite showing no signs of neglect during common neglect tasks. This discrepancy is attributed to the simplified and unrealistic nature of common pen and paper based tasks that do not match the demanding, novel, and complex environment of everyday life. As such, increasing task demands under more ecologically valid scenarios has become an important method of increasing test sensitivity. The main aim of the current study was to evaluate the diagnostic utility of the Mobility Assessment Course (MAC), an ecological task, for the assessment of neglect. If neglect becomes more apparent under more challenging task demands the MAC could prove to be more diagnostically accurate at detecting neglect than conventional methods, particularly as the time from initial brain damage increases. Data collected by Guide Dogs of SA/NT were retrospectively analyzed. The Receiver Operating Characteristic (ROC) curve, a measure of sensitivity and specificity, was used to investigate the diagnostic utility of the MAC and a series of paper and pencil tests in 67 right hemisphere stroke survivors. While the MAC proved to be a more sensitive neglect test (74.2%) when compared to the Star Cancellation (43.3%) and Line Bisection (35.7%) tests, this was at the expense of relatively low specificity. As a result, the ROC curve analysis showed no statistically discernable differences between tasks (p > 0.12), or between subacute and chronic groups for individual tasks (p > 0.45). It is concluded that, while the MAC is an ecologically valid alternative for assessing neglect, regarding its diagnostic accuracy, there is currently not enough evidence to suggest that it is a big step forward in comparison to the accuracy of conventional tests.

Exergaming: Feels good despite working harder

Strategies to encourage exercise have led to research on cycle ergometer ‘exergaming’, as a means of enhancing exercise enjoyment. This research has typically prescribed the exercise intensity and used one exercise mode. The aim of this study was to compare self-selected exercise intensity on a cycle ergometer with and without exergaming modes activated. A total of 20 participants aged between 18–40 years (M = 24.2 ± 5.9) completed a sub-maximal exercise test. Participants returned two days later to complete one 45 minute session of self-selected exercise with 15 minutes in each of ‘control’ (standard ergometer), ‘track’, and ‘game’ modes, with order randomized. Heart rate, work rate, perceived exertion, and affective valence were recorded during exercise. Dissociation and enjoyment were recorded in the rest interval between each mode. Participants exercised above ventilatory threshold (VT) in all three modes (track, M = 9.5 ± 12%; game, M = 6.2 ± 12%; and control, M = 4.4 ± 14% above VT) and at higher work rates (P < 0.05) exergaming (track, M = 94.5 ± 27.9; game, M = 96.2 ± 32.8 watts) than control (M = 86.6 ± 26.5 watts). Despite exercising at a higher intensity, participants perceived exercise during the exergaming modes to be most pleasant (P < 0.01), with greater enjoyment (P < 0.01) and dissociation (P < 0.01) in the game than track mode, and both modes higher on these variables than the control mode. Findings support the use of exergaming as a strategy to encourage individuals to exercise, with participants choosing to work harder physiologically, but reporting more positive psychological responses during and following the exercise.

Sequential effects modulate spatial biases

Healthy individuals usually display a bias toward the left side of space. This effect can be measured in a line bisection task or, alternatively, in a landmark task where prebisected lines are presented to participants. Several factors have been shown to influence pseudoneglect, that is, to vary the magnitude of the left side bias. We performed 2 landmark experiments: 1 online (n = 801) and a 2nd in the laboratory (n = 20). Our results demonstrate that pseudoneglect is strongly modulated by the sequence of trials in a landmark task. Of particular relevance is the fact that, for some histories of responses, pseudoneglect is inverted such that apparently there is a preference for the right side. In addition, we show that the way in which the point of subjective equality depends on the previous sequence of trials is well approximated by an exponential filter, well known from the literature of sequential effects to be related to motor control. In other words, the type of sequential effects we encountered in the landmark task is consistent with a purely motor contribution, further deepening our understanding of the way motor control influences pseudoneglect. (PsycINFO Database Record

Reading on the right when there's nothing left? Probabilistic tractography reveals hemispheric asymmetry in pure alexia

We present a patient with reading inexpertise and right hemianopia following left posterior cerebral artery (PCA) stroke. We examine the extent of disruption to reading performance and the extent of white matter tract damage relative to a patient with more limited PCA infarction and isolated right hemianopia. We show white matter disconnection of the temporal occipital fusiform cortex in our pure alexia patient. Connectivity-based laterality indices revealed right hemisphere laterality in the alexia patient; this was not associated with improved reading function. We speculate that the degree of premorbid laterality may be a critical factor affecting the extent of reading dysfunction in alexia.

Perceptual Biases in the Horizontal and Vertical Dimensions are Driven by Separate Cognitive Mechanisms

Perceptual attention in healthy participants is characterized by two biases, one operating in the horizontal plane, which draws attention leftward, and the other operating in the vertical plane, which draws attention upward. Given that these biases are reliably found in the same individual, and appear similar at a surface level, a number of researchers have investigated the relationship between horizontal and vertical attentional biases. To date, these investigations have failed to find an association, and this may be due to the fact that one-dimensional vertical and horizontal stimuli were presented separately rather than being measured from a single, two-dimensional stimulus. Across three experiments, two dimensional stimuli were presented, and participants marked the centre of the stimuli. In addition, the shapes of the stimuli were manipulated to determine whether this produced the same modulation of the two biases. Across 13 stimuli and three experiments there were no correlations between the vertical and horizontal biases. In addition, manipulations of stimulus shape, which affected biases in one dimension, did not affect biases in the other dimension. There were, however, consistent correlations between the degree of bias within each dimension across the different stimuli. This study has produced converging evidence that horizontal and vertical biases in spatial judgments rely on separate cognitive mechanisms. To account for these results we discuss a model whereby horizontal asymmetries rely more on space-based mechanisms whereas vertical asymmetries rely more on object-based mechanisms.

Morningness/eveningness and the synchrony effect for spatial attention

There is evidence that a decrease in alertness is associated with a rightward shift of attention. Alertness fluctuates throughout the day and peak times differ between individuals. Some individuals feel most alert in the morning; others in the evening. Our aim was to investigate the influence of morningness/eveningness and time of testing on spatial attention. It was predicted that attention would shift rightwards when individuals were tested at their non-optimal time as compared to tests at peak times. A crowdsourcing internet marketplace, Amazon Mechanical Turk (AMT) was used to collect data. Given questions surrounding the quality of data drawn from such virtual environments, this study also investigated the sensitivity of data to demonstrate known effects from the literature. Five-hundred and thirty right-handed participants took part between 6 am and 11 pm. Participants answered demographic questions, completed a question from the Horne and Östberg Morningness/Eveningness Scale, and performed a spatial attentional task (landmark task). For the landmark task, participants indicated whether the left or right segment of each of 72 pre-bisected lines was longer (longer side counterbalanced). Response bias was calculated by subtracting the 'number of left responses' from the 'number of right responses', and dividing by the number of trials. Negative values indicate a leftward attentional bias, and positive values a rightward bias. Well-supported relationships between variables were reflected in the dataset. Controlling for age, there was a significant interaction between morningness/eveningness and time of testing (morning=6 am-2.30 pm, evening=2.30 pm-11 pm) (p<0.05) such that there was a relative rightward shift of attention from peak to off-peak times of testing for those identifying as morning types, but not evening types. Findings support the utility of crowdsourcing internet marketplaces as data collection vehicles for research. Results also suggest that the deployment of spatial attention is modulated by an individual's peak time (morningness/eveningness) and time of testing.

Visual asymmetries for relative depth judgments in a three-dimensional space

Our ability to process information about an object's location in depth varies along the horizontal and vertical axes. These variations reflect functional specialisation of the cerebral hemispheres as well as the ventral/dorsal visual streams for processing stimuli located in near and far space. Prior research has demonstrated visual field superiorities for processing near space in the lower and right hemispaces and for far space in the upper and left hemispaces. No research, however, has directly tested whether the functional specialisation of the visual fields actually makes objects look closer when presented in the lower or right visual fields. To measure biases in the perception of depth, we employed anaglyph stimuli where participants made closer/further judgments about the relative location of two spheres in a three-dimensional virtual space. We observed clear processing differences in this task where participants perceived the right and lower spheres to be closer and the left and upper spheres to be further away. Furthermore, no relationship between the horizontal and vertical dimensions was observed suggesting separate cognitive/neural mechanisms. Not only does this methodology clearly demonstrate differences in perceived depth across the visual field, it also opens up many possibilities for studying functional asymmetries in three-dimensional space.

A study on the natural history of scanning behaviour in patients with visual field defects after stroke

Background

A visual field defect (VFD) is a common consequence of stroke with a detrimental effect upon the survivors’ functional ability and quality of life. The identification of effective treatments for VFD is a key priority relating to life post-stroke. Understanding the natural evolution of scanning compensation over time may have important ramifications for the development of efficacious therapies.

The study aims to unravel the natural history of visual scanning behaviour in patients with VFD. The assessment of scanning patterns in the acute to chronic stages of stroke will reveal who does and does not learn to compensate for vision loss.

Methods/Design

Eye-tracking glasses are used to delineate eye movements in a cohort of 100 stroke patients immediately after stroke, and additionally at 6 and 12 months post-stroke. The longitudinal study will assess eye movements in static (sitting) and dynamic (walking) conditions.

The primary outcome constitutes the change of lateral eye movements from the acute to chronic stages of stroke. Secondary outcomes include changes of lateral eye movements over time as a function of subgroup characteristics, such as side of VFD, stroke location, stroke severity and cognitive functioning.

Discussion

The longitudinal comparison of patients who do and do not learn compensatory scanning techniques may reveal important prognostic markers of natural recovery. Importantly, it may also help to determine the most effective treatment window for visual rehabilitation.

Keeping your distance: attentional withdrawal in individuals who show physiological signs of social discomfort

Being in close social proximity to a stranger is generally perceived to be an uncomfortable experience, which most people seek to avoid. In circumstances where crowding is unavoidable, however, people may seek to withdraw their attention from the other person. This study examined whether social discomfort, as indexed by electrodermal activity, is related to a withdrawal of attention in 28 (m=8, f=20) university students. Students performed a radial line bisection task while alone or together with a stranger facing them. Physiological arousal was indexed by a wrist monitor, which recorded electrodermal activity. Correlational analyses showed that individuals who displayed physiological discomfort when together showed a withdrawal of the perceived midpoint of the line towards them (and away from the stranger). Conversely, individuals who showed no discomfort exhibited an expansion of the perceived midpoint away from them. We propose that participants shift their attention away from the stranger to increase interpersonal distance and reduce anxiety/arousal.