Virtual Reality Assessment of Executive Decision Making in Paediatrics: a Longitudinal Study of Feasibility
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The identification of sports related paediatric concussive injuries has become an important general public health issue, as current neurocognitive computer based assessments are unable to measure baseline changes in executive decision making (EDM) in children that result following a concussion. This is because the brain areas associated with EDM vulnerable to pediatric concussion are also maturing and improving with time. The feasibility of the Object Hit task to detect change in EDM attributes with respect to age was assessed. The Object Hit task was implemented on the virtual reality assessment platform of the KINARM exoskeleton robot. Twenty children aged five to eighteen years with typical health and development that completed the Object Hit task between three to five times over the past three years were included in the analysis. Five attributes of the Object Hit task were selected (targets hit, median error, mean hand speed, hand movement area, and hand selection overlap) for assessing distinctive components of EDM; processing time, reaction time, working memory, and action planning. Linear regression analysis was calculated for each of the five selected performance attributes with respect to age. The results from this study indicate that overall measures of performance on the Object Hit task are responsive to longitudinal age related changes in EDM from five to eighteen years of age. The overall performance measures were able to identify age related improvements over the entire age range with 84% of the change in targets hit accounted for by age, and 72% of the change in median error accounted for by age. Performance attributes specific to working memory (hand movement area), reaction time (hand speed), and action planning (hand selection overlap), were not responsive to age. The regression trend line with 95% confidence boundaries calculated for targets hit results has characteristics that allow it to establish a normative profile of change in EDM with age; however the results would benefit from a study including greater participant numbers. Future research should be completed evaluating the sensitivity of task to detect declined EDM following a concussion.