Assessment and Treat Neglect Patients With a VR Application

The Broken Hearts Cancellation Test is a paper-and-pencil assessment used to measure searching performance and spatial neglect. Participants are asked to identify and cancel out complete heart shapes among distractor stimuli (broken hearts) within a fixed time frame. Performance is evaluated based on the number of correct cancellations and errors (false positives and omissions).

The total score is calculated as:

Total Correct Hits: Number of correctly cancelled complete hearts (max score: 50) Errors: Number of incorrectly marked broken hearts or missed targets Higher total correct scores indicate better performance. Improvement is defined as an increase in correct hits and/or a reduction in errors.

The Schenkenberg Line Bisection Test assesses visuospatial neglect by requiring participants to mark the perceived midpoint of horizontal lines printed on a sheet. The test evaluates the presence and severity of spatial attention deficits, particularly following brain injury or stroke.

Performance is quantified as the average deviation (in millimeters) from the true midpoint of each line:

Positive values indicate a rightward deviation Negative values indicate a leftward deviation A score closer to 0 mm indicates better spatial accuracy

The Catherine Bergego Scale (CBS) is a standardized observational tool used to assess the presence and severity of unilateral spatial neglect in activities of daily living. A set of 10 real-life tasks (e.g., grooming, navigating through doorways) will be scored from 0 to 3:

0 = No neglect

• = Mild neglect
• = Moderate neglect
• = Severe neglect The total score ranges from 0 to 30, with higher scores indicating more severe neglect.

The Computerized Visual Search Time Test assesses visual attention and processing speed by requiring participants to locate and identify a target stimulus among distractors on a computer screen. The test records the response time (in milliseconds) needed to correctly identify the target.

Shorter reaction times indicate better visual processing and attention.

To assess neglect in our application, we will extract Embedded game parameters from SpatialSense, the maximal rightward angle is compared with the maximal leftward angle on low, medium, and high difficulty levels: the trajectory of the gaze ray (GR), head movement (HR), and eye movement (ER). The maximum angles are added to form the search area middle (SAM) which should be close to 0. A positive SAM indicates the participant searched further to the right than to the left, and a negative SAM means the participant searched further to the left than to the right.

The Trunk Impairment Scale (TIS) assesses motor impairment of the trunk after neurological injury, especially stroke. It includes three subscales: Static Sitting Balance (0-7); Dynamic Sitting Balance (0-10); Coordination (0-6).

The total score ranges from 0 to 23, with higher scores indicating better trunk function and postural control.

The Berg Balance Scale (BBS) is a performance-based measure of balance and fall risk. It consists of 14 functional tasks (e.g., standing up, reaching forward, turning) that are each scored from 0 to 4, based on performance.

Total score range: 0 to 56. Higher scores indicate better balance. A score below 45 is associated with increased fall risk.

The Subjective Postural Vertical (SPV) test evaluates a person's ability to perceive upright body orientation. During the assessment, the participant is seated on a tilting chair with arms folded across the chest, feet off the ground, and the trunk secured with belts. The head and legs remain free. The examiner tilts the chair at a constant speed of ±1.5°/s. The participant is asked to indicate when they perceive themselves as being in a vertical position.

Performance is measured in degrees (°) of deviation from true vertical. Lower deviation values indicate better accuracy in vertical perception. Normative values for SPV are approximately 0.12° ± 1.49°.

The Subjective Visual Vertical (SVV) test assesses an individual's ability to perceive gravitational vertical using visual cues. In this assessment, participants are seated 1.5 to 2 meters away from a display showing a tilted line. The examiner adjusts the line's angle until the participant indicates that it appears vertically aligned.

This is commonly administered using the bucket test or a computerized visual display. Performance is measured as the angular deviation (in degrees) from true vertical. Smaller deviations indicate more accurate vertical perception. Normative SVV values typically range between -2.5° and +2.5°.

The Mini-Mental State Examination (MMSE) is a widely used 30-point questionnaire that assesses global cognitive function. It evaluates: Orientation, Registration, Attention and calculation, Recall, Language, and Visual construction.

The total score ranges from 0 to 30, with higher scores indicating better cognitive function. A score below 24 typically suggests cognitive impairment.

The SS-QOL scale is a patient-centered outcome measure designed to evaluate health-related quality of life in individuals who have experienced a stroke. This self-report instrument consists of 49 items distributed across 12 domains, including energy, upper extremity function, work/productivity, mood, self-care, social roles, family roles, vision, language, cognition, and personality. Each item is rated on a 5-point Likert scale, ranging from 1 (unable to perform the activity, requiring total assistance) to 5 (no difficulty, no assistance required). Higher scores reflect better functional outcomes.

The FIM is used to assess functional performance in essential daily living skills, including independence in self-care, sphincter control, transfers, mobility, communication, and social cognition. The instrument consists of 18 items, categorized into two subscales: motor and cognitive. Each item is rated on a 7-point ordinal scale, with scores ranging from 1 (total assistance, client expends <25% of the effort) to 7 (complete independence). A higher score indicates a greater level of independence in performing the task related to that item. The total FIM score spans from 18 (complete dependence) to 126 (complete independence).

The SSQ is a subjective assessment tool used to evaluate the severity of symptoms associated with the use of virtual reality (VR) technology. It comprises 16 items that measure three primary symptom categories: nausea, oculomotor disturbances, and disorientation. The SSQ utilizes a 4-point Likert scale, ranging from 0 (no symptoms) to 3 (severe symptoms), and symptom severity is categorized as negligible (< 5), minimal (5-10), significant (10-15), or concerning (15-20). A total score exceeding 20 is indicative of a "poor " simulator experience.

Mini-BESTest is a quantitative assessment tool for measuring balance and gait functions. It has 14 items, including 4 sections (anticipatory postural adjustments, reactive postural control, sensory orientation, and dynamic gait) with a maximum score of 28. Each item will be rated on a 3-point scale, with 0 indicating severe to 2 indicating normal. Higher scores indicate better balance performance.