Neuropsychological tests of executive function have limited real-world predictive and functional relevance. An emerging solution for this limitation is to adapt the tests for implementation in virtual reality (VR). We thus developed two VR-based versions of the classic Color-Trails Test (CTT), a well-validated pencil-and-paper executive function test assessing sustained (Trails A) and divided (Trails B) attention—one for a large-scale VR system (DOME-CTT) and the other for a portable head-mount display VR system (HMD-CTT). We then evaluated construct validity, test–retest reliability, and age-related discriminant validity of the VR-based versions and explored effects on motor function. Healthy adults (n = 147) in three age groups (young: n = 50; middle-aged: n = 80; older: n = 17) participated. All participants were administered the original CTT, some completing the DOME-CTT (14 young, 29 middle-aged) and the rest completing the HMD-CTT. Primary outcomes were Trails A and B completion times (tA, tB). Spatiotemporal characteristics of upper-limb reaching movements during VR test performance were reconstructed from motion capture data. Statistics included correlations and repeated measures analysis of variance. Construct validity was substantiated by moderate correlations between the’gold standard’ pencil-and-paper CTT and the VR adaptations (DOME-CTT: tA 0.58, tB 0.71; HMD-CTT: tA 0.62, tB 0.69). VR versions showed relatively high test–retest reliability (intraclass correlation; VR: tA 0.60–0.75, tB 0.59–0.89; original: tA 0.75–0.85, tB 0.77–0.80) and discriminant validity (area under the curve; VR: tA 0.70–0.92, tB 0.71–0.92; original: tA 0.73–0.95, tB 0.77–0.95). VR completion times were longer than for the original pencil-and-paper test; completion times were longer with advanced age. Compared with Trails A, Trails B target-to-target VR hand trajectories were characterized by delayed, more erratic acceleration and deceleration, consistent with the greater executive function demands of divided vs. sustained attention; acceleration onset later for older participants. The present study demonstrates the feasibility and validity of converting a neuropsychological test from two-dimensional pencil-and-paper to three-dimensional VR-based format while preserving core neuropsychological task features. Findings on the spatiotemporal morphology of motor planning/execution during the cognitive tasks may lead to multimodal analysis methods that enrich the ecological validity of VR-based neuropsychological testing, representing a novel paradigm for studying cognitive-motor interactions.

中文翻译：

---

多模式沉浸式轨迹制作-虚拟现实范式，用于研究认知-运动相互作用

执行功能的神经心理学测试在现实世界中的预测和功能相关性有限。针对此限制的一种新兴解决方案是使测试适应虚拟现实（VR）的实现。因此，我们开发了两种基于VR的经典颜色足迹测试（CTT）版本，这是一种经过充分验证的铅笔和纸执行功能测试，用于评估持续（足迹A）和分散（足迹B）的注意力-其中一个是针对大型规模的VR系统（DOME-CTT），另一个用于便携式头戴式显示器VR系统（HMD-CTT）。然后，我们评估了基于VR的版本的结构效度，重测信度和与年龄相关的判别效度，并探讨了其对运动功能的影响。参加了三个年龄段（年轻：n = 50；中年：n = 80；年龄较大：n = 17）的健康成年人（n = 147）。所有参与者都接受了原始的CTT，一些完成了DOME-CTT（14岁，中年29岁），其余完成了HMD-CTT。主要结果是试验A和B的完成时间（tA，tB）。从运动捕捉数据中重建了VR测试表现期间上肢到达运动的时空特征。统计数据包括相关性和方差的重复测量分析。构造标准的有效性通过“黄金标准”铅笔和纸质CTT与VR适应之间的适度相关性得到证实（DOME-CTT：tA 0.58，tB 0.71； HMD-CTT：tA 0.62，tB 0.69）。VR版本显示出相对较高的重测信度（类内相关性； VR：tA 0.60-0.75，tB 0.59-0.89；原始：tA 0.75-0.85，tB 0.77-0.80）和判别有效性（曲线下面积； VR：tA 0.70 –0.92，tB 0.71-0.92；原始值：tA 0.73-0.95，tB 0.77-0.95）。VR完成时间比原始的纸笔测试更长；随着年龄的增长，完成时间会更长。与轨迹A相比，轨迹B目标到目标的VR手轨迹具有延迟，更不稳定的加速和减速特性，这与分散注意力和持续注意力的更大执行功能要求是一致的。较晚的参与者加速发作。本研究证明了在保留核心神经心理学任务特征的同时，将神经心理学测试从二维纸笔转换为基于VR的三维格式的可行性和有效性。在认知任务期间进行运动计划/执行的时空形态的​​发现可能会导致多模式分析方法，从而丰富基于VR的神经心理学测试的生态学有效性，