JMIR Publications

ABSTRACT

Background:

Virtual reality (VR) devices are increasingly used in medicine and other areas for a broad spectrum of applications, from training to rehabilitation. One of the possible applications of VR is an environment manipulated in a way that helps patients with disturbances in the spatial allocation of visual attention, so-called hemispatial neglect. One approach to ameliorate neglect is to apply cross-modal cues (i.e., cues in other sensory modalities than the visual one) to guide visual attention towards the neglected space. So far, no study investigated the effects of audio-tactile cues in VR on the spatial deployment of visual attention in neglect patients.

Objective:

This pilot study thus aims to investigate the feasibility and usability of multimodal (audio-tactile) cueing, as implemented in a three-dimensional VR setting, in patients suffering from neglect, as well as obtaining preliminary results concerning the effects of different types of cues compared to non-cued conditions on visual attention allocation in these patients.

Methods:

In our bird search task, the patients were placed in a virtual environment using a head-mounted display (HMD). The inlay of the HMD was equipped in order to be able to deliver tactile feedback to the forehead. The task was to find and flag appearing birds. The birds could appear at four different presentation angles (lateral and paracentral, on the left and the right), and either with (auditory, tactile, audio-tactile) or without (no cue) a spatially meaningful cue (cue type). The task usability, feasibility and two simple in-task measures (performance, early orientation) were assessed in 12 right-hemispheric stroke patients with neglect, 5 with and 7 without additional somatosensory impairment (group).

Results:

The new setup showed high usability (10.2±1.85 ; max=12) and no relevant side effects (0.833±0.834 ; max=21). A repeated-measures ANOVA on task performance data, with presentation angle, cue type and group as factors, revealed a significant main effect of cue type (F30,3=9.863, p<0.001) and a significant three-way interaction (F90,9=2.057, p=0.042). Post-hoc analyses revealed that for patients without somatosensory impairment, any cue led to a better performance than no cue for targets on the left side; audio-tactile cues did not seem to have additive effects. In patients with somatosensory impairment, performance was better with both auditive and audio-tactile cueing than with no cue, at every presentation angle; conversely, tactile cueing alone had no significant effect at any presentation angle. Analysis of early orientation data showed that any type of cue (auditory, tactile or audio-tactile) triggered better orientation in both groups for the lateral presentation angles, possibly reflecting an early alerting effect.

Conclusions:

Overall, audio-tactile cueing seems to be a promising method to guide patients’ attention. For instance, this could be used in the future as an add-on supporting attentional orientation during established therapeutic approaches. Clinical Trial: none