Klinger, Evelyne (2006) Virtual Reality and its contribution to the assessment and treatment of cognitive and behavioral disorders. PhD thesis Informatique, ENST - INFRES Informatique et Réseaux, ENST.

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Abstract

La réalité virtuelle offrant de nouveaux moyens d'évaluer et de réhabiliter les fonctions cognitives de l'individu, la contribution de cette recherche concerne l'adéquation de l'approche réalité virtuelle au diagnostic, à la thérapie et à l'évaluation en psychiatrie et neuropsychologie.
Deux thèmes ont retenu notre attention: le traitement de la phobie sociale et l'évaluation de la planification de l'action. Notre premier objectif de recherche a été de concevoir une application fondée sur la réalité virtuelle pour chacun de ces thèmes et d'en évaluer la faisabilité. Le second a été de dégager les apports de la réalité virtuelle à la prise en charge de dysfonctionnements de l'individu.
La mise en place d'une thérapie de la phobie sociale fondée sur la réalité virtuelle nous a amenés à créer des situations d'interaction sociale suscitant des réactions émotionnelles chez des patients phobiques sociaux et à investiguer les différentes facettes du trouble. Les résultats de l'étude clinique ont conclu à l'efficacité de la thérapie par réalité virtuelle.
La conception d'un système de réalité virtuelle dédié à la prise en charge de dysfonctionnements cognitifs nous a conduits à aborder l'évaluation de la planification. Elle est fondée sur la création d'une tâche et d'un monde virtuel écologiques. L'étude menée auprès de sujets âgés et de patients parkinsoniens montre la pertinence et les potentialités de la réalité virtuelle.
Les études menées nous permettent ainsi de dégager des apports conséquents de la réalité virtuelle qui ouvrent la voie à une réflexion concernant le rôle de la réalité virtuelle dans le processus clinique ainsi que dans la relation patient-thérapeute.

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Table of content

Chapitre 1 Introduction - 11
Chapitre 2 La Réalité Virtuelle en Psychiatrie et Neuropsychologie - 13
2.1 La Réalité Virtuelle - 13
2.1.1 Acception de la réalité virtuelle - 13
2.1.2 Conception d'un environnement virtuel - 14
2.2 La Réalité Virtuelle en Psychiatrie et Neuropsychologie - 16
2.2.1 La conception et la création d'une application - 16
2.2.2 Les interfaces utilisées - 17
2.2.3 Réalisme et pertinence du monde virtuel - 17
2.2.4 Les précautions à prendre - 18
2.3 La Réalité Virtuelle et nos applications - 19
Chapitre 3 État de l'art de l'utilisation de la réalité virtuelle en psychiatrie et neuropsychologie - 21
3.1 Exploitation de la réalité virtuelle en psychiatrie - 21
3.1.1 Quelques théories concernant le traitement des troubles anxieux - 21
3.1.2 Thérapies cognitives et comportementales - 22
3.1.3 Principes des thérapies d'exposition - 23
3.1.3.1. Les thérapies d'exposition traditionnelles - 23
3.1.3.2. Les thérapies d'exposition par réalité virtuelle - 23
3.1.4 Les applications en psychothérapie - 25
3.1.4.1. Les phobies - 25
3.1.4.2. Les autres troubles anxieux - 38
3.1.4.3. Les troubles des conduites alimentaires - 39
3.1.4.4. Les troubles sexuels masculins - 40
3.1.4.5. L'autisme - 41
3.1.4.6. Les addictions - 42
3.1.5 Bilan des applications en psychiatrie - 43
3.2 Des techniques de distraction de la douleur - 48
3.3 Exploitation de la réalité virtuelle en neuropsychologie - 51
3.3.1 L'évaluation en neuropsychologie - 51
3.3.1.1. Les tests traditionnels - 51
3.3.1.2. L'évaluation fondée sur la réalité virtuelle - 52
3.3.2 Les applications relatives aux fonctions cognitives - 52
3.3.2.1. Les processus attentionnels - 52
3.3.2.2. Les fonctions exécutives - 57
3.3.2.3. La mémoire - 60
3.3.3 Les autres applications en neuropsychologie - 67
3.3.3.1. Les activités de la vie quotidienne - 67
3.3.3.2. La réhabilitation cognitive - 70
3.3.4 Bilan des applications en neuropsychologie - 75
3.4 Exploitation de la réalité virtuelle en psychophysiologie - 81
3.4.1 Exploration objective des réactions - 81
3.4.2 Investigation des performances et des comportements - 82
3.4.3 Bilan des applications en psychophysiologie - 83
3.5 Conclusion - 83
Chapitre 4 Expérimentation 1: Le traitement de la phobie sociale - 85
4.1 Le contexte: Le projet européen VEPSY - 85
4.2 La phobie sociale - 86
4.3 Les traitements traditionnels - 87
4.3.1 Les traitements médicamenteux - 87
4.3.2 Les thérapies cognitives et comportementales - 88
4.4 Le nouveau traitement fondé sur la réalité virtuelle - 89
4.4.1 Présentation des études relatives à la phobie sociale - 89
4.4.2 Présentation de l'essai "Phobie Sociale et Réalité Virtuelle" - 91
4.5 La conception et la création des environnements virtuels - 91
4.5.1 Cadre du projet VEPSY - 91
4.5.2 Conception des situations virtuelles - 92
4.5.3 Création des environnements virtuels - 92
4.5.3.1. Les outils et les principes - 92
4.5.3.2. Les environnements virtuels - 93
4.5.4 Interfaçage - 95
4.6 Méthodologie de l'essai clinique "Phobie Sociale et Réalité Virtuelle" - 95
4.6.1 Population - 95
4.6.2 Mesures - 96
4.6.2.1. Sélection des participants - 96
4.6.2.2. Mesure d'efficacité principale: la phobie sociale - 97
4.6.2.3. Mesures d'efficacité secondaires: le fonctionnement social - 97
4.6.2.4. Mesures d'efficacité exploratoires: le fonctionnement général - 97
4.6.3 Traitement - 98
4.6.3.1. La thérapie par réalité virtuelle (TRV) - 98
4.6.3.2. La thérapie cognitive et comportementale (TCC) - 100
4.6.3.3. Description des tâches à mener entre les séances de thérapie - 100
4.6.3.4. Vue d'ensemble des analyses statistiques - 101
4.7 Résultats - 101
4.7.1 Mesure d'efficacité principale - 101
4.7.2 Mesures d'efficacité secondaires - 104
4.7.3 Mesure d'efficacité exploratoires - 104
4.8 Discussion et conclusion - 104
Chapitre 5 Expérimentation 2: L'évaluation de la planification de l'action - 109
5.1 Le contexte: Le Projet Hospitalier de Recherche Clinique - 109
5.2 Le processus de planification - Application à la maladie de Parkinson - 109
5.2.1 Description du processus de planification - 109
5.2.2 Modèles de la planification - 110
5.2.3 La maladie de Parkinson - 110
5.3 L'évaluation traditionnelle de la planification de l'action - 111
5.3.1 Les tests cognitifs standard - 111
5.3.2 Les tests écologiques - 111
5.3.3 Les tests de scripts - 111
5.3.4 Limites de l'évaluation traditionnelle - 112
5.4 L'évaluation de la planification de l'action fondée sur la réalité virtuelle - 112
5.4.1 Présentations d'études abordant l'évaluation cognitive - 113
5.4.2 Présentation de l'essai "Planification et Réalité Virtuelle" - 114
5.5 La conception et la création de l'application virtuelle - 114
5.5.1 Conception de l'application virtuelle - 115
5.5.2 Conception de la tâche - 115
5.5.3 Création de l'application virtuelle - 115
5.5.3.1. Le Supermarché Virtuel - 115
5.5.3.2. La tâche - 117
5.5.3.3. L'enregistrement des données - 118
5.5.3.4. L'analyse des données - 118
5.5.4 Interfaçage - 119
5.6 Méthodologie de l'essai clinique Planification et Réalité Virtuelle - 119
5.6.1 Population - 119
5.6.2 Évaluation cognitive - 120
5.6.2.1. Évaluation de l'efficience intellectuelle globale - 120
5.6.2.2. Exploration des processus exécutifs - 120
5.6.3 Évaluation par la réalité virtuelle - 121
5.6.4 Analyse des données - 122
5.6.4.1. Connaissance sémantique liée à la tâche - 122
5.6.4.2. Vitesse de traitement de l'information - 122
5.6.4.3. Organisation spatio-temporelle - 123
5.7 Résultats - 124
5.7.1 Connaissance sémantique liée à la tâche - 124
5.7.2 Vitesse de traitement de l'information - 124
5.7.3 Organisation spatio-temporelle - 125
5.7.4 Analyse décisionnelle des résultats - 125
5.8 Discussion et Conclusion - 128
Chapitre 6 Apports de la réalité virtuelle à la prise en charge des troubles cognitifs et comportementaux - 133
6.1 Apports de la réalité virtuelle - 133
6.1.1 Apports provenant des techniques - 133
6.1.1.1. Apports informatiques - 134
6.1.1.2. Apports propres à la réalité virtuelle - 135
6.1.2 Apports liés aux fonctions intrinsèques de la réalité virtuelle - 138
6.1.3 Apports au contexte humain - 140
6.2 Raisons de l'efficacité et de l'intérêt de la réalité virtuelle - 140
6.3 Limites de la réalité virtuelle - 142
6.3.1 Limites de fond - 142
6.3.2 Limites techniques - 142
6.3.3 Limites éthiques et culturelles - 143
6.4 Discussion - 144
6.4.1 Processus clinique fondé sur la RV - 144
6.4.2 Relation "Patient - Thérapeute - Système virtuel" - 145
Chapitre 7 Conclusion et Perspectives - 147
7.1 Conclusion - 147
7.2 Perspectives - 148
7.2.1 Expérimentation d'un utilisateur dans un EV: inclusion d'un agent virtuel - 149
7.2.2 Induction d'émotions dans un EV - 150
7.2.3 Réhabilitation cognitive - 150
7.2.4 Monitoring physiologique - 151
7.2.5 Automatisation de traitement - 152
7.2.6 Auto entraînement - 153
7.3 Bilan - 154
Table des figures - 155
Table des tableaux - 157
Glossaire - 159
Annexes - 161
Publications - 203
Bibliographie - 205
Index - 225

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