A Simulated Reality Scenario Compared with the Computerized Wisconsin Card Sorting Test: An Analysis of Preliminary Results

Neuropsychologists and other clinicians often comment on the minimal relationship that frequently exists between formal assessments of executive functions, analysis of findings, recommendations, and the person's real-life functioning. The authors' believe that current assessments of executive functions do not transfer easily to real-world behavior. There are limitations in the current examinations and in the settings in which they are given. The tests are artificial and the test settings lack the usual stresses, distractions, and multiple demands common to real life. The interactions are unlike what they experience in everyday life. The examiner often, but unintentionally orients the participant to relevant information that in turn can help the person compensate for the difficulties with executive control processes and bias the findings. We believe that virtual reality (VR) more closely approximates real life settings, the distractions, and the common interchanges (VR) provides a "life-like," three-dimensional (3-D) highly interactive environment, and safety from potential dangers that could arise in actual situations. VR can increase motivation because of its gaming, interactive, and immersive qualities and features are easily modified and allow for multiple applications. Our goal is to develop VR assessments that can be administered under controlled and safe conditions, but which are more sensitive to difficulties with executive control processes critical to safe, independent living. This initial study compares several functions assessed by the Wisconsin Card Sorting Test (WCST) with our three-dimensional, stereographic scenario, Look for a Match (LFAM) Study participants completed questionnaires, alternately began with either the WCST or LFAM, and then took the second test. All participants completed motion sickness and follow-up questionnaires. The results demonstrated that the study participants found LFAM to be more enjoyable and interesting, but found the WCST to be easier. While there is an effect of order with participants doing relatively better on the assessment tool administered second, overall the LFAM performance was inferior to that on the WCST. However, even considering the order effect, LFAM seemed to be more difficult than the WCST.