Intended for healthcare professionals

Clinical Review Science, medicine, and the future

Virtual reality in surgery

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7318.912 (Published 20 October 2001) Cite this as: BMJ 2001;323:912

Virtual Reality in Neuropsychological Assessment and Rehabilitation

EDITOR – Recently your journal published two reviews
describing the potential of virtual reality in health care
[1-2]. However, to provide a complete description of this
emerging research field we would like to point out a
clinical area that could benefit from the use of virtual
reality: neuropsychological assessment and
rehabilitation.

Virtual reality technology could have a strong impact on
neuropsychological assessment and rehabilitation.
The key characteristics of virtual environments for these
applications are the high level of control of the
interaction with the tool without the constraints usually
found in computer systems, and the enriched
experience provided to the patient.

Virtual environments are highly flexible and
programmable. They enable the therapist to present a
wide variety of controlled stimuli and to measure and
monitor a wide variety of responses made by the user.
This flexibility can be used to provide systematic
restorative training that optimize the degree of transfer
of training or generalization of learning to the person's
real world environment [3-4].

Moreover, virtual reality systems open the input channel
to the full range of human gestures: it is possible to
monitor movements or actions from any body part or
many body parts at the same time. All properties of the
movement can be captured, not just contact of a body
part with an effector. On the other side, feedbacks and
prompts can be translated into alternate and/or multiple
senses. For the patient with some sensory impairment,
multimodal feedback ensures that information is
presented in alternate ways and in more than one way.
Sensory redundancy promotes learning and integration
of concepts.

Up to now, virtual reality is mainly used in
neuropsychology for the development of testing
environments that allow better detection and diagnosis
of the functional deficits following a brain injury. For
instance, our Institute has recently developed VETO –
Virtual Environments for Topographical Orientation –
used both for the assessment of topographical
orientation disorders, and to increase the possibilities
of management of patients from a rehabilitative point of
view (fig. 1, to be submitted on request). Compared to
traditional pencil-and-paper neuropsychological tests,
VETO makes it possible to explore in greater depth the
functionality of the higher cognitive skills (attention,
memory, planning) and to infer the degree of integrity of
the underlying neural processes implicated in the tasks
of topographical orientation.

However, at this stage, a number of obstacles exist
which have slowed the development of active research
specifically testing persons with cognitive impairments.
These obstacles include problems with acquiring
funding for an almost untested new treatment modality,
the lack of reference standards, the non-interoperability
of the VR systems and, last but not least, the relative
lack of familiarity with the technology from researchers
working in these fields.

1. Székely G, Satava RM. Virtual reality in medicine. BMJ
1999;319:1305

2. McCloy R, Stone R. Science, medicine, and the
future. Virtual reality in surgery. BMJ 2001; 323:
912-915.

3. Riva G. Virtual environments in neuroscience. IEEE
Trans Inf Technol Biomed 1998 Dec;2(4):275-81

4. Rizzo A, Buckwalter, JG. Virtual Reality and Cognitive
Assessment and Rehabilitation: The State of the Art. In
Riva G, ed. Virtual reality in neuro-psycho-physiology:
Cognitive, clinical and methodological issues in
assessment and rehabilitation. Amsterdam: IOS Press,
2001:123-145.
http://www.psicologia.net/pages/book1.htm (Accessed
17 Mar 2002).

Competing interests: No competing interests

18 March 2002
Giuseppe Riva
Head Researcher
Andrea Gaggioli, Gianluca Castelnuovo, Enrico Molinari
Istituto Auxologico Italiano, Casella Postale 1, 28900, Verbania, Italy