the vap-s: a virtual supermarket for the assessment of executive functioning Évelyne klinger laval,...
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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, Weiss P.L.3, Hof, E.3, and Josman N.3
1 ELHIT, P&I Laboratory Arts et Métiers ParisTech Angers-Laval, France2 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
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Plan
RationalThe VAP-S projectTwo clinical applicationsConclusion
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Executive Functions
Executive FunctionsHigher-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 AgeingNeurological diseasesBrain damage
ObservationsDecreased ability to perform basic and instrumental ADL Impact on people independenceNecessity of Assessment of Executive Functions
Modification of the frontal areas of the cerebral cortex
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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 generationNo action (Abbott et al., 1985)
WCST
Interest in functional virtual environments The VAP-S
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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
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First Person Perspective
Navigation with cursor movement keys or game pad
Participant = Subjective camera
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Task of Shopping List
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 screenMarié et al., 2003
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The userSelects items by using the mouse
The itemsAppear in the cartDisappear from the icon list
Record of positions, time and actions
Assessment Session
Feedback cues
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Payement
PayingReaching the exit
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Record of Data
Departure
Cash desks
Record of positions, time, actions
Duration : 4 min, Distance : 124 m, Stops : 9
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The participant is screened with the traditional assessments (inclusion criteria/cognitive evaluation)
The participant sits in front of a PC screen monitorTwo preliminary sessions
First, participant = passive observer (5 minutes)Second, participant = active attitude (no limit)
Assessment sessionNo time limitExecution of the task
Performance reviewTherapist with/without participant
Procedure
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Plan
RationalThe VAP-S projectTwo clinical applicationsConclusion
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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 peopleTo investigate the capacity of the VAP-S to discriminate between patients with PD and age-matched control subjects
Traditional psychometric assessmentGlobal intellectual efficiency : Mattis (Mattis, 1975)Exploration of executive functions: Wisconsin, Stroop, Brown-Peterson, Verbal fluency
Performance comparison
Control :
Duration : 8 min
Distance : 215 m
Stops : 25
Patient with PD :
Duration : 25 min
Distance : 469 m
Stops : 67
Klinger et al., 2006
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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 PDThe behavioral difference between patients and controls: spatio-temporal organizationThe impact of the review of the trajectory
Klinger et al., 2006
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Stroke patients
Each year in France, approximately 130 000 people suffer from stroke with disabling consequences (ANAES, 2002)
Among the symptomsSensory & 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 patientsTo examine the relationships between performance within the VAP-S and standard outcome measures of Executive Functions
Traditional psychometric assessmentMini Mental State Examination, Clock drawing, Star cancellation testExploration of executive functions: 6 subtests of the Behavioral Assessment of Dysexecutive Syndrome (BADS) (Wilson et al., 1996)
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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
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The Hebrew version of the VAP-S
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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 betweenMean 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 strokeThe relationships between performance within the VAP-S and the key search sub tests from the BADS, which requires planning ability
Josman et al., 2006
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Table of VAP-S results
VAP-Svariables
PDElderly
ControlsStroke
Number, GenderN= 5
(2 F, 3 M)N= 5
(4 F, 1 M)N= 26
(3 F, 23 M)
Age 74.0 ± 5.4 66.6 ± 7.7 56.9 ± 8.9
Trajectory (m) 343.1 ± 113.9 224.8 ± 36.4 209.5 ± 84.2
TrajectoryDuration (min)
20.7 ± 8.3 10.5 ± 1.4 11.0 ± 4.4
Number of pauses 56.6 ± 32.9 25.4 ± 3.5 26.0 ± 13.2
Time to Pay (s) 14 ± 12 5 ± 8 3.9 ± 3.9
Correct Actions 11.4 ± 1.3 12.0 ± 0.0 10.7 ± 2.5
Incorrect actions 3.6 ± 3.3 2.0 ± 0.7 3.2 ± 3.6
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The VMall for the treatment of Executive Functions
The VMallBased on the video-capture GestureTek VR systemMotor input Potential for Executive Functions assessment and treatment
But Relatively expensive VR system that requiresChroma key backdropGood lightingEnough room
GestureTek
Rand et al., 2005
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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-SInvestigation of inhibition and sequence Low cost attractive and feasible tool for wide implementationRehabilitation: first attempts
Further developmentsExamination of the VAP-S as a training tool
