Virtual reality games add a new dimension to neuropsychology treatments.
Difficulties with attention, organizing and planning, and self-regulation are behaviours that are often a sign of executive function deficits. Associated with attention deficit hyperactivity disorder (ADHD) neurodevelopmental conditions such as autism and other brain-based disorders, these deficits can result in impairments that persist throughout life.
Executive functions are cognitive processes that help control behaviour by governing our ability to plan, focus attention, remember instructions—and stop what we are doing when circumstances or goals change. The good news is that research is investigating how executive functions can be trained to change behaviour. And researchers at The Hospital for Sick Children (SickKids) in Toronto and the National Research Council of Canada (NRC) are exploring how these processes can be altered with novel intervention approaches.
The collaboration has led to an innovative technology-based approach to improve cognitive ability using virtual reality (VR) and games. "Over the last 3 years at the NRC, we have created a bank of exercises based on cognitive functions and developed a software platform to help clinicians use them," says Dr. Patricia Debergue, Section Head, Simulation and Digital Health, at the NRC's Medical Devices Research Centre. "We reached out to SickKids because they have world-renowned knowledge of cognitive deficits in children with a variety of neurological disorders—and they are interested in technology that can change the way things are being done."
With their combined areas of expertise, the research teams are adapting VR as a novel intervention to improve executive functions.
"VR creates imaginative, immersive experiences that allow us to engage children in games that exercise executive functions," says Dr. Russell Schachar, Senior Scientist in the Neurosciences & Mental Health program at SickKids. "Immersive VR games train the brain to improve real-world scenarios."
To conduct the research and development, the hospital has a dedicated space where children who are patients can interact with the games and provide researchers with feedback. The research group's youth advisors have also provided valuable input into the design and content of the VR approach.
Dr. Jennifer Crosbie, Clinical Psychologist and Associate Scientist in the Neurosciences & Mental Health program at SickKids, adds that it takes time to test systems, make adjustments and move through iterations before a trusted tool emerges that shows evidence of truly effecting change. "The NRC comes with cutting-edge technical expertise and resources for altering their suite of games, while we contribute the clinical and neuroscience background from lab results. We realized very quickly in our collaboration just how nimble the NRC is in both responding to our evolving needs and anticipating them," she says.
The NRC tracks performance in milliseconds in a variety of dimensions to gather evidence that children are getting better at the game. "At the same time, the experiments outside the VR games will evaluate behaviour and learning to see how well the effects transfer to other aspects of the children's lives," shares Dr. Crosbie.
Moving up the levels
The 5-year collaboration with the NRC is working toward the creation of next-generation games to help patients improve their executive functions.
"The ultimate objective is to package the interventions so families can train kids at home," says Dr. Debergue. "They could follow a plan and attend scheduled visits to the lab for mini-assessments and progress reports."
If the product is proven to be effective after undergoing the required clinical testing, the team hopes the project will attain the final level: commercialization. At that point, the NRC would work with industry to move it onto the market and propose a solution to enable it to be affordable and widely accessible.
"Families crave non-drug interventions for their children," says Dr. Debergue. "The VR solution, which builds on current methods, is a giant step toward that end."