Development of a Search Task Using Immersive Virtual Reality: Proof-of-Concept Study

Knobel, Samuel E. J.; Kaufmann, Brigitte Charlotte; Gerber, Stephan M.; Urwyler, Prabitha; Cazzoli, Dario; Müri, René M.; Nef, Tobias; Nyffeler, Thomas · 2021 · OpenAlex-citations

DOI: 10.2196/29182

archive: archived pipeline: cataloged verified

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Summary

This proof-of-concept study addresses the need for engaging, ecologically valid tools in neurorehabilitation, specifically for patients with hemispatial neglect following stroke. The authors developed an immersive virtual reality (iVR) serious game called the "bird search task" to assess and train visual exploration behavior. The primary motivation was to create a standardized, adaptive task that maintains patient motivation through self-adjusting difficulty while providing objective performance metrics comparable to clinical assessments. The study employed a two-step development and testing process. First, the game mechanics were derived from a 2D game and transferred into a 3D iVR environment using Unity3D and an HTC Vive headset. Participants searched for and tagged moving bird targets within a virtual landscape. The system featured 15 difficulty levels, adjusting target speed and lifetime based on performance thresholds. Second, the task was refined for clinical use by simplifying the visual environment and lowering minimum target speeds. The task was tested on three groups: 21 healthy young adults, 23 healthy elderly adults, and 11 patients with hemispatial neglect after right-hemispheric stroke. Usability, side effects, immersion, and game experience were assessed via validated questionnaires (SUS, SSQ, IPQ, PGTQ). For stroke patients, game performance was correlated with objective neglect severity measured by the Sensitive Neglect Test. Results indicated high usability across all groups, with mean scores above 4.5 on a 5-point scale. Side effects were infrequent and low-intensity, with mean Simulator Sickness Questionnaire scores below 1.5. All participants rated the task as highly motivating and entertaining. Crucially, the adaptive difficulty scaling functioned effectively, maintaining engagement without causing frustration. In the stroke patient group, game performance revealed a lateralized increase in search time consistent with neglect symptoms. This performance metric showed a strong correlation with objective neglect severity, demonstrating that the game could accurately capture impaired visual exploration patterns. The study concludes that the iVR bird search task is a feasible, motivating, and immersive tool suitable for diverse populations, including those with cognitive impairments. Its adaptive nature allows it to adjust to individual skill levels, ensuring optimal challenge. The significant correlation between game performance and clinical neglect severity suggests that this serious game can serve as a valid complementary measure for assessing visual exploration deficits. This supports the potential of iVR serious games to enhance therapy adherence and provide objective, ecologically valid data for neurorehabilitation.

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• simulator sickness