Real-world virtual reality task with eye tracking for the detection of residual visuospatial attention deficits: a pilot study

Abstract Traditional methods for evaluating spatial neglect or milder lateralized visuospatial attention deficits have been criticized for limited ecological relevance, narrow scope, and overly simplistic design. To address this, we introduce a new version of the Executive Performance in Everyday LIving (EPELI) virtual reality task. In the EPELI, participants perform cognitively demanding everyday chores in a home-like environment, while precise behavioral data capturing diverse aspects of visual attention is recorded. Fourteen healthy controls and ten right-sided stroke patients with spatial neglect diagnosed in the acute phase participated in this pilot study three months post-stroke. At that time, patients (aged 39–75) were considered to have either a history of or mild spatial neglect when assessed using traditional methods. EPELI-related eye, head, and hand movements, and task performance (e.g., execution time and the number of subtasks completed) were compared between the groups. Adverse effects, usability, and user experience were also reported. While group differences in eye movements were no longer statistically significant after corrections for multiple comparisons, the exploratory uncorrected p-values and effect sizes suggested a possible trend: patients with mild spatial neglect, or a history of it, exhibited a subtle ipsilesional (right-sided) bias in eye movements and made fewer first saccades to the contralesional (left) side. Compared to healthy controls, patients also showed reduced head rotations and velocity, were slower at completing subtasks, finished fewer subtasks, and performed fewer actions overall. Adverse effects were negligible, and technical usability was reasonably good. Our preliminary findings cautiously suggest that the EPELI task, reflecting goal-directed behavior in a naturalistic environment, may have potential to detect residual visuospatial attention deficits in patients with a history of or current mild spatial neglect three months post-stroke. This highlights the opportunities of ecologically valid methods to assess spatial neglect or milder lateralized visuospatial attention deficits.