Virtual Reality Assessment of Cognitive Functions: A Promising Tool to Improve Ecological Validity (bibtex)
	title = {Virtual {Reality} {Assessment} of {Cognitive} {Functions}: {A} {Promising} {Tool} to {Improve} {Ecological} {Validity}},
	volume = {7},
	url = {},
	abstract = {Military service in Iraq and Afghanistan comes with the risk of exposure to improvised explosive devices (IEDs), vehicle borne IEDs, rockets, mortars and other blasts. Vehicle roll-over accidents, small arms fire and other non-battle injuries also occur. Accordingly, service members deployed in support of Operation Iraqi Freedom and Operation Enduring Freedom are at increased risk of traumatic brain injuries (TBIs). Since 2000, over 169,000 service members have been diagnosed with a TBI1 (Department of Defense, 2010) and the RAND Corporation reported that nearly one in five service members who deployed to Iraq or Afghanistan reported a probable TBI (Tanielian and Jaycox, 2008).2 Although mild TBIs, or concussions, typically result in full recovery following a brief period of time, more serious injuries can result in new symptoms or changes in functioning and behavior. Some of these changes occur in cognitive domains such as attention, memory, executive functions, language, spatial abilities and psychomotor skills. These changes are usually documented with paper and pencil tests that compare the service member's cognitive performance to that of their peers. For the comparison to be valid, these tests must be administered in a similar manner to that used to determine the norms – typically quiet, well-controlled environments that minimize distractions and maximize best effort. Cognitive tests can serve a number of clinical purposes including accurate diagnosis, informing the level of care a patient requires, treatment planning and treatment evaluation (Lezak, et al., 2004).3 Repeated assessments can also characterize the nature of the injury and document any changes over time. Providers in both civilian and military contexts have increasingly been asked to use neuropsychological test performances to make recommendations about patients' everyday functioning (Lynch, 2008).4 In the civilian sector, these questions may relate to driving or activities of daily living, whereas clinicians working in the deployed environment or at military treatment facilities may use cognitive assessments to inform questions related to fitness for duty. For example, deployed commanders may have referral questions related to the safety of personnel to perform basic tactical skills. On the home front, military neuropsychologists may be consulted as part of a "fitness for duty" evaluation that is conducted when impairments significantly interfere with work performance. In addition, there is increasing interest in the assessment of the severity of functional impairment following TBI. The complexity and lethality of modern warfare place great demands on a service member's neurocognitive resources. At varying levels of threat, service members must be able to exercise control of cognitive functions. It may be challenging to interpret the results of traditional cognitive assessment tools to answer military specific questions. With tremendous individual variability in responses to stress, how well does performance during a well-controlled cognitive assessment predict performance during the stresses of war? It is not known, for example, how well a service member with low average mental efficiency or processing speed following a TBI will react to fire during a tactical convoy. Is this individual fit for combat duty? What kind of performance is required on cognitive tests for a service member to be judged fit to man an automatic weapon during a convoy? Following a mild TBI, how do we assess the functional impairment of service members whose occupational environment has significant, unpredictable low and high intensity stress? Hence, for a measure to be relevant to an assessment of service member neurocognitive functioning, it should provide some indication of a service member's cognitive performance within high and low threat settings. Questions such as these relate to concerns about tests' ecological validity – the degree to which performance on cognitive tests accurately predict future behavior in the real world. Although some tests have demonstrated evidence of ecological validity5 (Strauss, et al., 2006). developments in the area of virtual reality may offer new opportunities to improve ecological validity and inform key questions related to the post- TBI assessment of service members.},
	journal = {Brain Injury Professional},
	author = {Reger, Greg and Parsons, Thomas D. and Gahm, Greg and Rizzo, Albert},
	year = {2011},
	keywords = {MedVR, Virtual Humans},
	pages = {24--26}
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