Usability and Validity of a Virtual Reality Cognitive Assessment Tool for Pediatric Traumatic Brain Injury

Purpose/Objective: Deficits in executive functions are prevalent among children with traumatic brain injury (TBI). Assessing cognitive impairment is critical for evaluating and monitoring recovery. The present article reports a pilot study to evaluate the preliminary usability and validity of a virtual reality cognitive assessment tool (VR-CAT) specifically designed for children with TBI. Research Method/Design: A total of 54 children, 24 with TBI and 30 with orthopedic injury, participated in a cross-sectional cohort study at a Level-1 trauma center. The VR-CAT was evaluated in terms of user experience as well as preliminary psychometric properties including test-retest reliability, face validity, concurrent validity with two standard executive function assessment tools, and utility in distinguishing the TBI and orthopedic injury groups. Results: Children in both groups reported high levels of usability (i.e., enjoyment and motivation). The VR-CAT composite and scores on tests of inhibitory control and working memory demonstrated modest test-retest reliability across two independent assessment visits, as well as acceptable face validity, modest concurrent validity, and clinical utility. Conclusions/Implications: The present study is among the first to evaluate the applicability of an immersive VR-CAT in children with TBI. The findings support high usability, adequate psychometric properties, and satisfactory clinical utility of the VR-CAT, suggesting it is a promising tool for assessing executive functions in this vulnerable population. Impact and Implications The virtual reality cognitive assessment tool (VR-CAT) is among the first virtual reality assessment tools for measuring executive functions specifically designed for children with traumatic brain injury (TBI). The study employed an age- and sex-matched control group of non-TBI patients for rigorous evaluation of the VR-CAT. The study found high usability and promising psychometric properties of the VR-CAT. Future research should continue refining the VR-CAT as a promising tool for early detection of executive function impairment among pediatric brain injuries.