Using immersive Virtual Reality to train cognitive abilities of children: recent advances and future challenges

March 30, 2022

Imagine sitting on your seat while waiting for your plane to take off, relaxing in a tropical place with sea view, or playing your favourite sport with friends. As awkward as it might sound, these true-to-life scenarios can be experienced through the use of immersive Virtual Reality (iVR) from the comfort of one’s home. In its most typical form, iVR enables the users to immerse themselves into a three-dimensional (3D) simulated environment. Equipped with an iVR head mounted display (HMD) and motion controllers, users can be transported into a virtual environment where they can move around freely, interact with objects and other people as well as perform tasks that would have otherwise been expensive, dangerous or impossible to do. Thanks to the use of specific electronic equipment (e.g. HMDs, haptic gloves, headphones, motion-capture sensors), virtual environments stimulate multiple sensory channels (vision, audition, haptics), thus tricking the brain to behave as it would in a real-life situation (Bailey & Bailenson, 2017a; Bashiri et al., 2017; Bouchard & Rizzo, 2019). That being said, iVR environments create a new simulated experience while allowing for minimal to no interaction with the external physical environment. The users are surrounded by a sensory rich virtual environment that blocks out the physical world – a condition known as immersion (Bouchard & Rizzo, 2019; Slater, 2009; Wand & Reid, 2011).

The concept of VR technology is not something new, but rather has been around for quite a few decades (McLellan, 1996; Milgram & Kishino, 1994; Sutherland, 1965, 1968; Hoiling, 1961). In the last decade, though, the popularity of iVR has been increasing steadily due to the availability of new VR hardware and software, rendering the technology more affordable, user friendly and accessible than before. These advancements have disrupted a wide range of fields spanning from gaming and entertainment to education, fitness, training, medicine, research and applications (Anton et al., 2009; Bashiri et al., 2017; Krämer, 2017). Especially in the context of behavioral research and applications, this technology has opened up new ways of experimentation and interactive solutions. Let’s take the example of a researcher interested in how multimodal distraction, that is, irrelevant visual and auditory stimuli, affects children’s learning in the classroom. This kind of research would require visits to several physical classrooms or the construction of a dedicated testing classroom. Furthermore, the researcher would have to come up with ideas on how to deliver visual/auditory distraction within these environments. Apart from the economic burden, this approach would fall short of the researcher’s efforts to systematically control important aspects of the testing environments. Instead, the development of an iVR classroom environment would allow for more flexibility and control, thus giving the opportunity for the recreation of any type of situation and interaction. For example, the researcher could customize distraction-related aspects of the virtual classroom (e.g. presentation, type and timing of stimuli) while maintaining systematic control over all the other variables that could potentially influence students’ learning in this setting (Bioulac et al., 2020; Coleman et al., 2019; Rizzo et al., 2006).

From the above, it becomes evident that iVR offers the potential to create simulated assessment and training environments in which relevant variables can be precisely controlled and performance can be tracked in a systematic fashion. Leveraging these strengths of iVR technology, several researchers and practitioners have developed clinical and cognitive applications to evaluate, intervene and manage various medical conditions (Bashiri et al., 2017; Bouchard & Rizzo, 2019; Cho et al., 2019; Fodor et al., 2018; Freeman et al., 2018; Mesa-Gresa et al., 2018). Although iVR-based protocols for children have been around from the beginning of this century (Rizzo 2000, 2006), recent advancements in iVR

have accelerated the use of this medium in developmental research (Araiza-Alba et al., 2020) and in pediatric programmes related to pain and anxiety (for a review see, Won et al, 2017), social skills training (Moon & Ke, 2021), problem-solving skills (Araiza-Alba et al., 2021), and cognitive training (Bioulac et al., 2020; Romero-Ayuso et al., 2021).

Of particular interest is the use of iVR in pediatric cognitive training (CT). CT can be defined as the process of enhancing cognitive functions, such as attention and working memory, through the intensive repetition, practice, feedback and steady increase of cognitive difficulty in a set of standardized tasks (Jolles & Crone, 2012). Recent research on this topic has focused on the development of CT interventions for clinical populations, such as children with attention-deficit hyperactivity disorder. In that case, the use of iVR ensures that cognitive abilities are being assessed and/or trained in realistic virtual environments that mimic real-life situations where natural behavior typically occurs. In other words, the use of iVR increases ecological validity (i.e., whether the study’s conclusions are generalizable to real-world contexts) compared to conventional methods, like paper-and-pencil assessments or tasks in flat screens (2D) (Li et al., 2020). In addition, children have the ability to reproduce complex interactions within the virtual environments as many times as necessary until they reach a required level, while their progress is being monitored and evaluated constantly. These elements together with the fun aspect that these kind of programmes incorporate, are crucial especially in case of children with learning difficulties and neurodevelopmental dysfunctions, as they are groups with heterogeneous characteristics and different training needs (Anton et al., 2009; Bouchard & Rizzo, 2019; Cieślik et al., 2020; Slater, 2017; Valentine et al., 2020).

Although recent assessment and training interventions for children have seen the light of the day, the field of evidence-based iVR interventions is still in its infancy. As noted earlier, the new generation of iVR is a relatively new technology and its suitability and effects in children have been relatively underexplored (Bailey & Bailenson, 2017a, 2017b). Since the use of iVR is expected to grow immensely in the next few years, especially in the field of digital therapeutics, it is of utmost importance to understand and address the challenges associated with the use of iVR in children. Together with existing attempts (Yamada-Rice et al., 2017; Aubrey et al., 2018), two of the Neo-Prism-C projects (ESR 12 and ESR 15) will explore the possibilities that this technology holds for 8-12 year olds. These projects will examine the usability, safety and acceptance of this new type of media either in the context of feasibility or CT efficacy studies in typically developing and clinical pediatric populations. We hope that this line of research will contribute to the growing body of evidence showing the potential of iVR programmes for children and will yield new insights on the sensible use of this new medium. Stay tuned for more!

Iouliani Pachiti, University of Crete, Greece  and Christos Gkoumas, Silversky 3D Virual Reality Technologies LTD, Cyprus

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