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The VAP-S: A Virtual Supermarket for the Assessment of Executive Functioning

The VAP-S: A Virtual Supermarket for the Assessment of Executive Functioning. Évelyne Klinger Laval, April 10, 2008. The VAP-S: A Virtual Supermarket for the Assessment of Metacognitive Executive Functioning. Klinger E. 1 , Marié R.M. 2 , Lebreton S. 2 ,

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The VAP-S: A Virtual Supermarket for the Assessment of Executive Functioning

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  1. The VAP-S: A Virtual Supermarket for the Assessment of Executive Functioning Évelyne Klinger Laval, April 10, 2008

  2. The VAP-S: A Virtual Supermarket for the Assessment of Metacognitive Executive Functioning Klinger E.1, Marié R.M.2, Lebreton S.2, Weiss P.L.3, Hof, E.3, and Josman N.3 1 ELHIT, P&I Laboratory Arts et Métiers ParisTech Angers-Laval, France 2 University of Caen- Basse Normandie, UPRES-EA 3917, Caen, France 3 Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel

  3. Plan • Rational • The VAP-S project • Two clinical applications • Conclusion VRIC’08, April 10, 2008

  4. Executive Functions • Executive Functions • Higher-order functions that are needed for performing complex, new, or non routine tasks (Godefroy, 2003) • Planning: Ability to organize a behavior in a spatio-temporal context (Lezak, 1990) • Clinical Context of dysexecutive syndrome • Normal and Pathological Ageing • Neurological diseases • Brain damage • Observations • Decreased ability to perform basic and instrumental ADL • Impact on people independence • Necessity of Assessment of Executive Functions • Modification of the frontal areas of the cerebral cortex VRIC’08, April 10, 2008

  5. WCST Traditional Assessment’s Procedures • Standard neurocognitive tests: • Lack of sensitivity • Far away from everyday life situations (Godefroy et al., 2004) • Ecological neurocognitive tests: • Real time, Real situation (MET) • Limited use for patients without autonomy (Shallice & Burgess, 1991) • Test of scripts : • Plan generation • No action (Abbott et al., 1985) • Interest in functional virtual environments  The VAP-S VRIC’08, April 10, 2008

  6. VAP-S: Virtual Action Planning Supermarket Designed with two main softwares 3DStudioMax and Virtools Klinger E., Marié R.M. et al., 2002-2005, GREYC-ENSICAEN, CHU de Caen VRIC’08, April 10, 2008

  7. First Person Perspective Participant = Subjective camera Navigation with cursor movement keys or game pad VRIC’08, April 10, 2008

  8. Verbal information : In the supermarket, you should buy: one baguette; green apples; a 2kg drum of washing powder; one kilo of flour; a t-shirt for child; two  artichokes; and beige socks. You may pay by clicking on the purse icon that is on the screen. List display on the screen Task of Shopping List Marié et al., 2003 VRIC’08, April 10, 2008

  9. Feedback cues Assessment Session • The user • Selects items by using the mouse • The items • Appear in the cart • Disappear from the icon list Record of positions, time and actions VRIC’08, April 10, 2008

  10. Payement • Paying • Reaching the exit VRIC’08, April 10, 2008

  11. Record of Data Departure Cash desks Record of positions, time, actions Duration : 4 min, Distance : 124 m, Stops : 9 VRIC’08, April 10, 2008

  12. Procedure • The participant is screened with the traditional assessments (inclusion criteria/cognitive evaluation) • The participant sits in front of a PC screen monitor • Two preliminary sessions • First, participant = passive observer (5 minutes) • Second, participant = active attitude (no limit) • Assessment session • No time limit • Execution of the task • Performance review • Therapist with/without participant VRIC’08, April 10, 2008

  13. Plan • Rational • The VAP-S project • Two clinical applications • Conclusion VRIC’08, April 10, 2008

  14. Elderly and Parkinson’s Disease • Approximately 2% of the French population beyond the age of sixty-five suffer from Parkinson’s Disease (De Rijk et al., 1997) • Parkinson ’s Disease: 90%: Executive dysfunction (Owen, Doyon 1999) • Objectives of the study (CHU Caen) • To test the feasibility of the VAP-S for elderly people • To investigate the capacity of the VAP-S to discriminate between patients with PD and age-matched control subjects • Traditional psychometric assessment • Global intellectual efficiency : Mattis (Mattis, 1975) • Exploration of executive functions: Wisconsin, Stroop, Brown-Peterson, Verbal fluency VRIC’08, April 10, 2008

  15. Performance comparison Control : Duration : 8 min Distance : 215 m Stops : 25 Klinger et al., 2006 Patient with PD : Duration : 25 min Distance : 469 m Stops : 67

  16. Parkinson’s Conclusion • 5 patients with PD (2 F, 3 M) / 5 age-matched healthy controls (4 F, 1 M) • Results show • The feasibility of the VAP-S for use with patients who have PD • The behavioral difference between patients and controls: spatio-temporal organization • The impact of the review of the trajectory Klinger et al., 2006 VRIC’08, April 10, 2008

  17. Stroke patients • Each year in France, approximately 130 000 people suffer from stroke with disabling consequences (ANAES, 2002) • Among the symptoms • Sensory & cognitive deficits which result in a decreased ability to perform basic and instrumental ADL (Woodson, 1995) • Deficits in Executive Functions (Pohjasvaara et al., 2002) • Objectives of the study (Israel) • To test the feasibility of the VAP-S for post-stroke patients • To examine the relationships between performance within the VAP-S and standard outcome measures of Executive Functions • Traditional psychometric assessment • Mini Mental State Examination, Clock drawing, Star cancellation test • Exploration of executive functions: 6 subtests of the Behavioral Assessment of Dysexecutive Syndrome (BADS) (Wilson et al., 1996) VRIC’08, April 10, 2008

  18. Behavioral Assessment of Dysexecutive Syndrome (BADS) • The assessment consists of 6 subtests and a questionnaire: • The rule shift card test, • Action program test, • Key search test, • Temporal judgment test, • Zoo map test, • Modified six elements test Wilson et al., 1996 VRIC’08, April 10, 2008

  19. The Hebrew version of the VAP-S VRIC’08, April 10, 2008

  20. Stroke’s Conclusion • 26 post-stroke participants (3 F and 23 M) • Large variance of scores within the VAP-S • Significant positive correlations were found between • Mean number of items purchased and key search subtest from the BADS • Number of correct actions and key search subtest from the BADS • Results show • The feasibility of the VAP-S for use with patients who had a stroke • The relationships between performance within the VAP-S and the key search sub tests from the BADS, which requires planning ability Josman et al., 2006 VRIC’08, April 10, 2008

  21. Table of VAP-S results VRIC’08, April 10, 2008

  22. GestureTek The VMall for the treatment of Executive Functions • The VMall • Based on the video-capture GestureTek VR system • Motor input • Potential for Executive Functions assessment and treatment • But • Relatively expensive VR system that requires • Chroma key backdrop • Good lighting • Enough room Rand et al., 2005 VRIC’08, April 10, 2008

  23. Final Conclusion • Validity of the VAP-S as an assessment tool for executive functions • New studies have been carried out: results will be soon published • Potential of the VAP-S • Investigation of inhibition and sequence • Low cost  attractive and feasible tool for wide implementation • Rehabilitation: first attempts • Further developments • Examination of the VAP-S as a training tool VRIC’08, April 10, 2008

  24. Thanks for your attention evelyne.klinger@angers.ensam.fr Tel / Fax: +33 243 567 994

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