The ecological validity of two novel non-immersive virtual reality tests of attention and executive functions in an mTBI population.

Introduction: Within the realm of mild traumatic brain injury (mTBI) research, it has been argued that current test measures of attention are not sufficiently sensitive to assess the various aspects of attention involved in everyday life. The literature indicates that virtual reality (VR) test measures that resemble real-life situations have good ecological validity. Novel VR assessment tools were developed and their predictive ability investigated as it pertains to return to work (RTW) in a sample of patients in the post-acute recovery period of mTBI.

Methods: 50 participants who had sustained an mild traumatic brain injury (mTBI) were recruited. Their clinical evaluation included an intake interview, standardized neuropsychological battery, psychological questionnaires. Two virtual reality tests (VRTs) were developed and also given to the participants.

Results: Tests of attention (VR and traditional tests) significantly predicted group membership at 82% accuracy, with 82.6% sensitivity and 81.5% specificity. The second difficulty level attention shift trial of the VRT and to a lesser degree the total speed score of the Ruff 2 & 7 were predictive of employment status.

Discussion: These findings provide a starting point for future studies to determine which particular parameters and combination of tests would comprise an 'ecological battery' in an effort to place clinical neuropsychological diagnostic decision making as it pertains to employability on firmer scientific grounds.