717734 research-article2017
EXN0010.1177/1179069517717734Journal of Experimental NeuroscienceFerro et al
Letter To Editor
Neurocognitive Treatment Using Virtual Reality
Journal of Experimental Neuroscience Volume 11: 1–2 © The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1179069517717734 https://doi.org/10.1177/1179069517717734
Karyry Nascimento Ferro1, Thiago Mazzoli Moraes2, Ana Luiza Zaninotto1,2 and Wellingson Silva Paiva2,3 1Division
of Psychology, University of São Paulo Medical School, São Paulo, Brazil. 2Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil. 3Neurology Center, Samaritano Hospital, São Paulo, Brazil.
Dear Editor
We read with great interest the recent study by White and Moussavi1 published in the Journal of Experimental Neuroscience. The authors used virtual reality navigation (VRN) to increase cognitive reserve in a patient with mild cognitive impairment (MCI) at the onset to develop Alzheimer disease (AD). Alzheimer disease is a dementia commonly found in the elderly that can cause cognitive impairment in memory and spatial navigation.2 This disease has phases with physical and cognitive impairments of different intensities and complexities that make treatment difficult.3 The author’s hypothesis is that cognitive training and physical activities increase brain-derived neurotrophic factor, promoting cognitive reserve that may decrease or delay AD symptoms.4 Virtual reality (VR) is a computerized 3-dimensional environment that responds in real time to the interaction of the individual.5 The case report of White and Moussavi1 was focused on using their existing VRN task,6 a type of VR, as a cognitive treatment for a patient with MCI and AD. In this environment, the participant had to develop a cognitive map in a building. Error scores and 2 types of training were used. The intervention was performed 3 sessions weekly, during 7 weeks, 2 hours per session. The results showed improvement on spatial navigation scores and decreased number of errors by trials in the VRN Building Assessment.6 Some alteration in the VRN task,6 such as different colors on floors, could standardize the intervention with less interference of the examiner. This could increase the difficulty of the task throughout the sessions leading to benefits to the patients.7 The authors used the Montreal Cognitive Assessment to screen the cognition of the patient. For a clinical trial with larger sample, we suggest a neuropsychological assessment focused on visuospatial memory and navigation changes. Some possibilities are as follows: block design test (Wechsler Adult Intelligence Scale, fourth edition [WAIS-IV]), Corsi blocktapping test, complex figures of Rey,8 Visual Object and Space Perception Battery,9,10 and also ecological assessments, such as spatial planning task and maze tasks. A strong point of this study was the development of a custom input system based on a wheelchair to make the navigation more natural for elderly patients without the need of previous training. Despite the interesting wheelchair input system, this can be hard to replicate and newer studies could use the HTC Vive and Oculus Rift (CV1) motion controllers to walk in the real world naturally. The use of physical motion in real life
while immersive and moving with a head-mounted display can negate the symptoms of cybersickness.11 A negative point of this study was the lack of the Simulator Sickness Questionnaire12 to evaluate symptoms of cybersickness throughout the sessions. An interesting point in this study was the wife’s positive perception of the results of this treatment in the daily living of her husband. However, this is subjective to the wife and does not necessarily indicate the husband’s feelings about the effects of treatment. Therefore, they could have used Daily Living Scale Pfeffer13 and Beck Depression Inventory14 to have more reliable data. As described in this pilot study, the VRN task7 shows promises as a possible treatment to delay or diminish the negative effects of AD. These small caveats, however, do not take away the main message raised by White and Moussavi.1 In this way, AD patients can benefit from the standardized and replicable virtual environments that VR can provide,15 however, some variables that can be controlled in other to have a stronger evidence of the benefits of the VRN in MCI and AD population.
Author Contributions
KNF - conception or design of the work, interpretation, drafting the article, final approval of the version to be published. TMM - conception or design of the work, interpretation, drafting the article, final approval of the version to be published. ALZ - conception or design of the work, revision of the manuscript, and final approval of the version to be published. WSP - conception or design of the work, revision of the manuscript, and final approval of the version to be published. References
1. White PJ, Moussavi Z. Neurocognitive treatment for a patient with Alzheimer’s disease using a Virtual Reality Navigational Environment. J Exp Neurosci. 2016;10:129–135. 2. Finch CE, Cohen DM. Aging, metabolism, and Alzheimer disease: review and hypotheses. Exp Neurol. 1997;143:82–102. 3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. 4. Stern Y. Cognitive reserve. Neuropsychologia. 2009;47:2015–2028. 5. Moraes TM, de Andrade AF, Paiva WS. Virtual reality for the treatment of posttraumatic disorders. Neuropsychiatr Dis Treat. 2016;12:785–786. 6. Byagowi A, Moussavi Z. Design of a virtual reality navigational (VRN) experiment for assessment of egocentric spatial cognition. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:4812–4815. 7. Larson EB, Feigon M, Gagliardo P, Dvorkin AY. Virtual reality and cognitive rehabilitation: a review of current outcome research. NeuroRehabilitation. 2014;34:759–772.
Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
2
Journal of Experimental Neuroscience
8. Meyers JE, Meyers KR. Rey Complex Figure Test and Recognition Trial Professional Manual. Lutz, FL: Psychological Assessment Resources; 1995. 9. Warrington EK, James M. The Visual Object and Space Perception Battery. Bury St Edmunds: Thames Valley Test Company; 1991. 10. Rapport LJ, Millis SR, Bonello PJ. Validation of the Warrington theory of visual processing and the Visual Object and Space Perception Battery. J Clin Exp Neuropsychol. 1998;20:211–220. 11. LaViola JJ Jr. A discussion of cybersickness in virtual environments. ACM SIGCHI Bull. 2000;32:47–56.
12. Kennedy RS, Lane NE, Berbaum KS, Lilienthal MG. Simulator sickness questionnaire: an enhanced method for quantifying simulator sickness. Int J Aviat Psychol. 1993;3:203–220. 13. Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol. 1982;37:323–329. 14. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–571. 15. Hofmann M, Rösler A, Schwarz W, et al. Interactive computer-training as a therapeutic tool in Alzheimer’s disease. Compr Psychiatry. 2003;44:213–219.
RECEIVED: March 12, 2017. ACCEPTED: May 5, 2017. PEER REVIEW: Zero peer reviewers contributed to the peer review report. Reviewers’ reports totaled zero words, excluding any confidential comments to the academic editor. TYPE: Letter to Editor FUNDING: The author(s) received no financial support for the research, authorship, and/or publication of this article. DECLARATION OF CONFLICTING INTERESTS: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
EXN0010.1177/1179069517717734Journal of Experimental NeuroscienceFerro et al
Letter To Editor
Neurocognitive Treatment Using Virtual Reality
Journal of Experimental Neuroscience Volume 11: 1–2 © The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1179069517717734 https://doi.org/10.1177/1179069517717734
Karyry Nascimento Ferro1, Thiago Mazzoli Moraes2, Ana Luiza Zaninotto1,2 and Wellingson Silva Paiva2,3 1Division
of Psychology, University of São Paulo Medical School, São Paulo, Brazil. 2Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil. 3Neurology Center, Samaritano Hospital, São Paulo, Brazil.
Dear Editor
We read with great interest the recent study by White and Moussavi1 published in the Journal of Experimental Neuroscience. The authors used virtual reality navigation (VRN) to increase cognitive reserve in a patient with mild cognitive impairment (MCI) at the onset to develop Alzheimer disease (AD). Alzheimer disease is a dementia commonly found in the elderly that can cause cognitive impairment in memory and spatial navigation.2 This disease has phases with physical and cognitive impairments of different intensities and complexities that make treatment difficult.3 The author’s hypothesis is that cognitive training and physical activities increase brain-derived neurotrophic factor, promoting cognitive reserve that may decrease or delay AD symptoms.4 Virtual reality (VR) is a computerized 3-dimensional environment that responds in real time to the interaction of the individual.5 The case report of White and Moussavi1 was focused on using their existing VRN task,6 a type of VR, as a cognitive treatment for a patient with MCI and AD. In this environment, the participant had to develop a cognitive map in a building. Error scores and 2 types of training were used. The intervention was performed 3 sessions weekly, during 7 weeks, 2 hours per session. The results showed improvement on spatial navigation scores and decreased number of errors by trials in the VRN Building Assessment.6 Some alteration in the VRN task,6 such as different colors on floors, could standardize the intervention with less interference of the examiner. This could increase the difficulty of the task throughout the sessions leading to benefits to the patients.7 The authors used the Montreal Cognitive Assessment to screen the cognition of the patient. For a clinical trial with larger sample, we suggest a neuropsychological assessment focused on visuospatial memory and navigation changes. Some possibilities are as follows: block design test (Wechsler Adult Intelligence Scale, fourth edition [WAIS-IV]), Corsi blocktapping test, complex figures of Rey,8 Visual Object and Space Perception Battery,9,10 and also ecological assessments, such as spatial planning task and maze tasks. A strong point of this study was the development of a custom input system based on a wheelchair to make the navigation more natural for elderly patients without the need of previous training. Despite the interesting wheelchair input system, this can be hard to replicate and newer studies could use the HTC Vive and Oculus Rift (CV1) motion controllers to walk in the real world naturally. The use of physical motion in real life
while immersive and moving with a head-mounted display can negate the symptoms of cybersickness.11 A negative point of this study was the lack of the Simulator Sickness Questionnaire12 to evaluate symptoms of cybersickness throughout the sessions. An interesting point in this study was the wife’s positive perception of the results of this treatment in the daily living of her husband. However, this is subjective to the wife and does not necessarily indicate the husband’s feelings about the effects of treatment. Therefore, they could have used Daily Living Scale Pfeffer13 and Beck Depression Inventory14 to have more reliable data. As described in this pilot study, the VRN task7 shows promises as a possible treatment to delay or diminish the negative effects of AD. These small caveats, however, do not take away the main message raised by White and Moussavi.1 In this way, AD patients can benefit from the standardized and replicable virtual environments that VR can provide,15 however, some variables that can be controlled in other to have a stronger evidence of the benefits of the VRN in MCI and AD population.
Author Contributions
KNF - conception or design of the work, interpretation, drafting the article, final approval of the version to be published. TMM - conception or design of the work, interpretation, drafting the article, final approval of the version to be published. ALZ - conception or design of the work, revision of the manuscript, and final approval of the version to be published. WSP - conception or design of the work, revision of the manuscript, and final approval of the version to be published. References
1. White PJ, Moussavi Z. Neurocognitive treatment for a patient with Alzheimer’s disease using a Virtual Reality Navigational Environment. J Exp Neurosci. 2016;10:129–135. 2. Finch CE, Cohen DM. Aging, metabolism, and Alzheimer disease: review and hypotheses. Exp Neurol. 1997;143:82–102. 3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. 4. Stern Y. Cognitive reserve. Neuropsychologia. 2009;47:2015–2028. 5. Moraes TM, de Andrade AF, Paiva WS. Virtual reality for the treatment of posttraumatic disorders. Neuropsychiatr Dis Treat. 2016;12:785–786. 6. Byagowi A, Moussavi Z. Design of a virtual reality navigational (VRN) experiment for assessment of egocentric spatial cognition. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:4812–4815. 7. Larson EB, Feigon M, Gagliardo P, Dvorkin AY. Virtual reality and cognitive rehabilitation: a review of current outcome research. NeuroRehabilitation. 2014;34:759–772.
Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
2
Journal of Experimental Neuroscience
8. Meyers JE, Meyers KR. Rey Complex Figure Test and Recognition Trial Professional Manual. Lutz, FL: Psychological Assessment Resources; 1995. 9. Warrington EK, James M. The Visual Object and Space Perception Battery. Bury St Edmunds: Thames Valley Test Company; 1991. 10. Rapport LJ, Millis SR, Bonello PJ. Validation of the Warrington theory of visual processing and the Visual Object and Space Perception Battery. J Clin Exp Neuropsychol. 1998;20:211–220. 11. LaViola JJ Jr. A discussion of cybersickness in virtual environments. ACM SIGCHI Bull. 2000;32:47–56.
12. Kennedy RS, Lane NE, Berbaum KS, Lilienthal MG. Simulator sickness questionnaire: an enhanced method for quantifying simulator sickness. Int J Aviat Psychol. 1993;3:203–220. 13. Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol. 1982;37:323–329. 14. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–571. 15. Hofmann M, Rösler A, Schwarz W, et al. Interactive computer-training as a therapeutic tool in Alzheimer’s disease. Compr Psychiatry. 2003;44:213–219.
RECEIVED: March 12, 2017. ACCEPTED: May 5, 2017. PEER REVIEW: Zero peer reviewers contributed to the peer review report. Reviewers’ reports totaled zero words, excluding any confidential comments to the academic editor. TYPE: Letter to Editor FUNDING: The author(s) received no financial support for the research, authorship, and/or publication of this article. DECLARATION OF CONFLICTING INTERESTS: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
