Development of a Virtual Reality Assessment of Everyday Living Skills

A challenge for proving treatment efficacy for cognitive impairments in schizophrenia is finding the optimizing measurement of skills related to everyday functioning.  The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is an interactive gaming based computerized measure aimed at skills associated with everyday functioning, including baseline impairments and treatment related changes.

The overall goal of the following computerized assessment is to measure functional capacity. That is the ability to perform critical everyday living skills in a practical, realistic, and easy to use manner for patients with schizophrenia or other severe mental illnesses. The first step in achieving this goal is to set up the assessment in a comfortable, quiet room free of distractions.

This will allow the subjects to be assessed in an optimal environment. If this is the subject's first encounter with the assessment as a second step, the tutorial should be administered. This allows the subject to become comfortable with the computer and program features and ensures that functional capacity is measured and not the subject's familiarity with the computerized task.

Next, the tester should administer the appropriate test version of the assessment in order to measure the subject's functional capacity. The results obtained index the subject's level of performance on skills associated with everyday functioning. Since there are multiple versions, the test can be repeated, allowing for assessment of baseline impairment and treatment related changes.

Functional capacity is clearly impaired in many patients with CNS disorders such as schizophrenia, bipolar disorder, Alzheimer's disease, and older people with mild cognitive impairment or normal age related changes. Assessments of functional capacity set standards for determining whether treatments are providing benefit that really matters to patients who need them. The virtual reality functional capacity assessment tool, B-R-F-C-A-T.

Vcat assesses a variety of skills related to everyday life functioning. It has advantages over other measures of functional capacity since it has multiple versions so that can be used repeatedly. The results are automatically available for databases and it can be used in a variety of different situations and cultures.

Since almost everyone goes shopping and takes public transportation, Visual demonstration of this method is critical as the virtual reality assessment is computer based, and the visual platform allows for researchers and administrators to get a better understanding of the assessment. Begin by installing the assessment on a computer that meets the software's requirements in a quiet room free of distractions. Ensure that the computer is at a table or desk at a comfortable sitting height with a wired mouse on the table with enough room for the subject to rest their arm to prevent fatigue.

Also ensure that the external speakers are plugged in and set to an appropriate volume. Next, set up two chairs, one directly in front of the computer for the subject and one to the side and slightly behind the other chair. For the administrator to sit in a raider should be present at all times during the administration of the assessment.

Once the subject arrives, obtain written and informed consent before administering the assessment and make sure that they do not have access to any materials that can be used to take notes. Then set up the program by double clicking on the play VCAT icon. If assessing a new subject, select new profile and then create a new patient ID and password for the subject and click confirm if assessing a returning subject, enter in the previously created patient ID and password and click confirm.

Next, enter the site number, the subject's date of birth, age, handedness, and gender. Also type in the rater initials. Then select the study the visit number, and finally, click confirm.

To begin the assessment seat the subject in the chair directly in front of the computer. If this is the subject's first assessment, use the default scenario tutorial and the default mini scenario apartment. Note that the tutorial should always be administered before a test version.

If this is a returning subject, select the next test version to be run from the scenario dropdown menu. The rater should remain present during the entire assessment. If the subject asks for direction, instruct them to click on the audio icon in the top left corner.

If the subject stops paying attention or at any point looks away from the screen, redirect their attention back to the task. Take precautions to try to ensure that the subject will not need a break during the administration of the assessment, but if needed, in extreme circumstances, the assessment can be paused and continued at a later time by pressing the escape key. After the short break, simply click main menu.

Type in the admin code and click yes. The assessment will then go back to the screen to select what mini scenario is needed to start the subject on when they return. If the subject is unable to complete the entire version that day and must come back another day, click exit on the game paused menu.

Type in the admin code and click yes. This will shut down program. When the subject returns on a subsequent day, log back into the program with the patient ID and password and select the appropriate scenario and mini scenario from the dropdown menus.

Note that all completed mini scenarios will have turned from green to red. Once the subject has completed all four tutorial mini scenarios, including apartment, bus to store, store, and bus to apartment, a congratulations. Screen will appear.

The tutorial is now complete. Click continue, and then begin. New scenario.

Then enter the admin code and click yes. Next, select the appropriate test version from the scenario dropdown menu and click confirm. The scenario labeled tutorial should now have changed from green to red because the subject has completed the entire scenario.

Then once the subject has completed all four test mini scenarios, the congratulation screen will again appear. Click continue, and then exit the application in the box labeled admin code. Type in admin, click yes and the session is complete.

If the subject attempts to complete any of the objectives out of order, remind them that they must complete the task described in the instructions at the top of the screen before moving onto the next task. If the subject uses up all of his or her virtual change early on and is unable to complete the final objective, this deviation is handled differently in the tutorial versus in the test version. If running the tutorial escape out of the game and return to the scenario selection menu, read minister the tutorial and encourage the subject to try not to use up all of the coins during the early objectives.

If running the test version escape out of the game and return to the scenario selection menu, do not readminister the test version. This data point will be considered missing. The table seen here shows a sample of the data exported from the virtual reality assessment.

This table shows the factor analysis from 46 subjects who completed the test. The analysis explained 91%of the variance and revealed three factors, reasoning and problem solving, speed of processing and working memory. These factors are among the most important determinants of everyday life functioning, and here we can see a scatter plot depicting the correlation between subject's performance at visit one and visit two.

Suggesting a modest but acceptable test, retest reliability as expected. Preliminary results in patient data show an increase in test retest reliability Once masked mastered. This assessment can be completed in about 25 minutes in healthy people and 40 minutes for patient populations for the first assessment, and in about 15 to 20 minutes at subsequent assessments.

While attempting this procedure, it's important to remember to keep the subject engaged in the test at all times. Just because the test is computerized, it does not mean that patients do not need to be observed. The development of this virtual reality assessment helps to pave the way for computer-based assessments used to measure functional capacity.

After watching this video, you should have a good understanding of how to successfully administer the virtual reality assessment and why it is an important new method for measuring functional capacity.