Cognitive Performance in Immersive Environments After Acquired Brain Injury

Introduction

Immersive technologies like virtual reality (VR) and augmented reality (AR) are growing exponentially and have seemingly endless potential for assessment, learning, and entertainment (Allcoat & von Mühlenen, 2018; Lee et al. 2010; Molina-Carmona et al., 2018, Navarro & Sundstedt, 2020). Applications come in many forms, and are beginning to take on substantial roles in education, training, and healthcare programmes, worldwide. The recent need for social distancing has further stimulated a surge in virtual solutions, for instance for museum visits (Kunjir & Patil, 2020), to stimulate international student collaboration in education (de Back et al., 2020), and to provide healthcare digitally (Papara et al., 2020) Where initial applications mainly concerned entertainment, more recent developments include implementation within education and healthcare settings. For instance, Bogomolova and colleagues (2020) describe an application where medical students can use AR by wearing a HoloLens head mounted display. Through this device, the users can view three dimensional human anatomy and moreover, they are able to interact with the AR projection through hand movement, by e.g. resizing or rotating the image or to tap on certain option buttons. Also specific patient groups can benefit from IEs. A number of studies show that exposure therapy can be highly effective when the object of a specific phobia, e.g. being in an airplane, can be realistically recreated, without actually being exposed to it (Parsons & Rizzo, 2008).

Despite the inherent appeal of these examples, some caution also seems appropriate. Immersive environments are still distinctly different from real environments and therefore present their users with cognitive challenges. Especially neuropsychological patients may present particular challenges in using IEs. Often, immersive learning is used to convey visuospatially complex information, ranging from geometric-shape learning in augmented reality for children (Gecu-Parmaksiz & Delialioglu, 2020) to augmented reality medical education for adult students (Bogomolova et al., 2020). Immersive environments (IEs) also allow for full control over the characteristics of the environment, which can be useful for example, for training navigation ability in virtual environments for stroke patients (van der Kuil et al., 2018) in a secure environment. However, a clear understanding of what drives learning effectiveness in these immersive applications is still lacking.

Reports on IE learning effectiveness are limited and diverse. Immersive learning can even lead to adverse effects in some situations, e.g. when users lack the required spatial skills to accurately process the immersive environment (Price & Lee, 2010), are hindered by stereotypical beliefs about using immersive technologies (Chang et al., 2019), or an entirely different spatial function is trained because of the three dimensional depiction (Kozhevnikov & Dhond, 2012). Moreover, application in vulnerable populations such as patients with acquired brain injury may pose substantial problems, such as cybersickness and cognitive demands that are too high (Weech et al., 2019). It is imperative to understand what is required to obtain a beneficial effect of learning in IEs and how this differs across individuals.