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Updated: Jul 16, 2026
Development of a Virtual Reality Assessment of Everyday Living Skills
Published on: April 23, 2014
Neurocognitive Scores and Performance on Virtual Reality-Based Return-to-Duty Scenarios: A Pilot Study in Reserve
Chelsea Manetta1, Susan L Whitney1, Sridhar Ramakrishnan2
1Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, United States.
Introduction:
Cognitive impairments resulting from traumatic brain injury (TBI) may be detected using the Automated Neuropsychological Assessment Metrics (ANAM) test. Following mild TBI, the Progressive Return to Activity pathway requires exertional testing before ANAM testing, yet there is currently a lack of simulated military operational demands before return to duty (RTD) clearance. RehabXR (formerly Praxis; BlueHalo, Germantown, MD, United States), a novel virtual reality (VR) system, can deliver VR-based, immersive first-person shooting scenarios that may be clinically useful; however its relationship to established neuropsychological assessments has not been well characterized. Therefore, the purpose of this feasibility and exploratory convergent-validity pilot study was to (1) explore the correlations between ANAM scores and performance on 2 RehabXR VR-based RTD scenarios (Stroop Target Shoot and Directional Memorization) and (2) determine tolerance to RehabXR testing in healthy Reserve Officers' Training Corps (ROTC) cadets.
Materials And Methods:
Twenty-six healthy ROTC cadets (16 male, 10 female; age 20.2 ± 1.2 years) completed the ANAM and 4 rounds of 2 RehabXR scenarios. The relationship between select ANAM scores (from 8 tests) and performance on RehabXR VR-based joint cognitive and sensory RTD training scenarios were explored using the Spearman's rank correlation coefficient (r). To control for multiple comparisons, a false-discovery rate (FDR) correction was applied. Participants reported symptoms (headache, dizziness, nausea, and fogginess) before and after each RehabXR scenario.
Results:
Performance on 5 of the ANAM tests (Spatial Processing, Matching to Sample, Simple Reaction Time, Code Substitution with Delay, and Procedural Reaction Time) correlated with the mean response time (RT) metric on the RehabXR scenarios (|r| = 0.42-0.48; P < .05); for example, mean RT in Stroop Target Shoot correlated with mean RT and throughput (number of correct responses per minute) in Spatial Processing with an r of 0.48 and -0.46, respectively. However, when corrected for multiple comparisons, correlations remained statistically significant only under a lenient FDR threshold (≥0.4), indicating a higher tolerance for false-positive findings. These findings may suggest that the small sample size influenced these exploratory findings. Four healthy cadets reported mild transient symptoms of headache/dizziness after the RehabXR scenarios.
Conclusions:
These results provide preliminary evidence that RehabXR VR-based RTD scenarios may correlate with the ANAM test, particularly measures of RT, memory, and spatial processing. Healthy cadets tolerated RehabXR testing well, with minimal self-reported symptoms. Although these findings provide preliminary insight into potential relationships between traditional neuropsychological measures and VR-based cognitive performance metrics, the results should be interpreted cautiously given the small sample size and lack of statistical significance after conventional FDR correction. Further studies in larger samples and in individuals with mTBI are needed to determine the clinical relevance of VR-based cognitive assessments.
