Objectives To describe the results from a research program examining the feasibility of using virtual reality (VR) to map, in 3-dimensional (3D), a brain-injured patient's attention and spatial attention; to explore if VR can assess for hemispatial neglect; and to provide clinically relevant visual outputs.

Methods Patients were consecutively recruited through 2 hospital rehabilitation departments in Southeast Queensland, Australia, and performance on the VR game was compared against healthy controls. Following consent, patients completed traditional pen-paper neuropsychological tests for neglect including the clock drawing, line cancellation, and letter cancellation. Later in the week, they completed the VR game. The game involved patients finding targets (L's) amongst distractors (T's) through various levels of a 3D VR space. Levels increased in difficulty through increasing the number of distractors and the field of vision required. Reaction time and accuracy data were collected. Attention maps were created by tracking eye-gaze, controller, and head set movement. Acceptability was measured through motion sickness and gaming experience surveys.

Results All healthy controls and patients reported the VR as acceptable; motion sickness was minimal and enjoyment high. Patient and healthy control performance was significantly different on reaction times but not accuracy. Various analyses indicated the Attention Atlas was able to identify spatial biases in patients. Attention maps were a visually effective way to present a patient's spatial attention strengths and weakness to clinicians.

Conclusions The Attention Atlas was an enjoyable, low-risk method for assessing for attention issues and for hemispatial neglect. The system identified patient outliers with potential attention problems, given normative control and patient data. The Attention Atlas produces a visual, clinically relevant assessment of a patient's spatial attention. Implications for improved assessment and rehabilitation for both patients and clinicians are significant. The Attention Atlas may be useful for more subtle cases of neglect, which may be more difficult to detect on pen-paper methods but that have significant impact on functional activities such as driving. This approach also suggests that VR can identify potential attention problems in those deemed intact by the current standard.