Virtual Reality Assessment and Treatment of Spatial Neglect (VR@SN)

Question
Can the design and development of an engaging virtual reality (VR) training game improve assessment and treatment of patients with spatial neglect (SN)?

Conventional rehabilitation activities are time-consuming and resource-intensive for sufficient treatment effect; however some activities may be replaced by self-training in VR. VR training could be introduced during admission to inpatient or outpatient neurorehabilitation and carried on after discharge, consequently increasing the specificity and intensity of SN treatment.

Methods
Development of a cross-platform, open-source, training game using off-the-shelf VR (i.e. HTC Vive) and eye-tracking (i.e. Pupils Labs) hardware applied to assessment and treatment of SN.

Results
A prototype whack-a-mole VR training game has been developed for assessment and treatment of SN (Fig. 1). The game can present stimuli targets in the entire visual field and allows for uni- or bimanual user interaction and individual adjustable difficulty levels. A web-based therapist dashboard facilitates data analysis on assessment and progress of treatment and allows for individual goal-setting of training (Fig. 2).

Four evidence-based neurorehabilitation techniques (prismatic shift, mirror therapy, half-field eye-patching, and constraint induced motor therapy) can be applied one at a time or in combinations as therapeutic modifications of the training game. This allows for faster and more effective combination of therapeutic methods and the tailoring of treatment to the individual patients' SN symptoms and capabilities.

Usability and feasibility of the prototype is currently being tested on SN patients at an inpatient neurorehabilitation hospital while continuously adjusting and developing the assessment and treatment capabilities. Future research on the diagnostic accuracy and treatment effects is in the planning.

Conclusion
The project is pioneering VR-based neurorehabilitation of SN and possibly paving the way for self-training and future tele-rehabilitation. Successful VR-based neurorehabilitation of SN should be individually tailored, combine several treatment techniques, and aim to increase specificity and intensity of the treatment.