Immersive 3D Virtual Reality Cancellation Task for Visual Neglect Assessment: A Pilot Study

Knobel, Samuel E. J.; Kaufmann, Brigitte C.; Gerber, Stephan M.; Cazzoli, Dario; Müri, René M.; Nyffeler, Thomas; Nef, Tobias (2020). Immersive 3D Virtual Reality Cancellation Task for Visual Neglect Assessment: A Pilot Study. Frontiers in human neuroscience, 14, p. 180. Frontiers Research Foundation 10.3389/fnhum.2020.00180

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Background: Unilateral spatial neglectis an attention disorder frequently occurring after a right-hemispheric stroke. Neglect results in a reduction in qualityof life and performance in activities of daily living. With current technical improvements in virtual reality (VR) technology, trainingwith stereoscopic head-mounted displays (HMD) has become a promising new approach for the assessment and the rehabilitation of neglect. The focus of this pilot study was to develop and evaluate a simple visual search task in VR for HMD. The VR system was tested regarding feasibility, acceptance, and potential adverse effects in healthy controls and right-hemispheric stroke patients with and without neglect.

Methods: The VR system consisted of two main components, a head-mounted display to present the virtual environment, and a hand-held controller for the interaction with the latter. The task followed the rationale of diagnostic paper-pencil cancellation tasks; i.e., the participants were asked to search targets among distractors. However, instead of a two-dimensional setup, the targets and distractors were arranged in three dimensions, in a sphere around the subject inside its field of view. Usability and acceptance of the task, as well as the performance in the latter, were tested in 15 right-hemispheric subacute stroke patients (10 of whom with and five of whom without unilateral spatial neglect; mean age: 67.1 ± 10.5 years) and 35 age-matched healthy controls.

Results: System usability and acceptance were rated as high both in stroke patients and healthy controls, close to the maximum score of the questionnaire scale. No relevant adverse effects occurred. There was a high correlation (r = 0.854, p = 0.002) between the Center of Cancellation [an objective neglect measure) calculated from a paper-pencil cancellation task (Sensitive Neglect Test (SNT)] and the newly developed VR cancellation task.

Conclusion: Overall, the developed visual search task in the tested VR system is feasible, well-accepted, enjoyable, and does not evoke any significant negative effects, both for healthy controls and for stroke patients. Findings for task performance show that the ability of the VR cancellation to detect neglect in stroke patients is similar to paper-pencil cancellation tasks.

Item Type:

Journal Article (Original Article)


10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research > ARTORG Center - Gerontechnology and Rehabilitation
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DCR Unit Sahli Building > Forschungsgruppe Neurologie
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)
Graduate School for Health Sciences (GHS)

UniBE Contributor:

Knobel, Samuel Elia Johannes; Gerber, Stephan Moreno; Cazzoli, Dario; Müri, René Martin and Nef, Tobias


600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology




Frontiers Research Foundation




Marceline Brodmann

Date Deposited:

09 Jul 2020 10:41

Last Modified:

26 Oct 2021 23:12

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

cancellation task; head-mounted display; immersive virtual reality; stroke; visual neglect




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