The application of virtual reality to document coping deficits after a stroke: Report of a case

An immersive virtual reality (IVR) paradigm to assess cognitive flexibility and problem solving was used to document everyday life-coping failures in a patient with cognitive sequelae of an anterior left thalamic stroke. Three years after the ischemic event, the patient was showing clear signs of frontal lobe dysfunction when left unsupervised in real-life settings, yet his performance on traditional neuropsychological tests tapping frontal functions was unremarkable. We speculated, and provided evidence, that his conduct was influenced by the setting and the presence of an examiner who would strengthen his impaired ability to self-generate control over a number of higher order cognitive activities. Thanks to the immersive effect and nonverbal aspects of the interaction provided by IVR, we could document our patient's cognitive difficulties on two separate occasions. The reasons why IVR was superior to traditional tests are analyzed with reference to well-known cognitive models of the way frontal networks modulate behavior in nonroutine circumstances.