Do we measure up? A systematic review of cognitive assessment during a digital era in acquired brain injury

There is increasing interest in using Virtual and Augmented Reality (VR and AR) to assess cognitive performance in survivors of acquired brain injury (ABI). This study identified the most commonly used outcome measures from Experimental (EXP), Real-Life (RL), VR, and AR tasks targeting memory, attention, and executive functioning in ABI. Studies published between 2010 and 2026 were retrieved from PubMed and Scopus. Additionally, outcome measures were evaluated using a theory-informed classification to assess construct-task alignment. A total of 98 studies were included, of which most (39%) employed experimental (EXP) tasks, only 6% used AR. Attention was studied most frequently (67%). Accuracy was the predominant outcome measure (EXP 63%; RL 90%; VR 81%) followed by temporal measures (EXP 53%; RL 67%; VR 59%). AR showed the opposite pattern (33% and 83%). Almost all measures met construct-task alignment; however, VR had the highest level of misalignment (31%). Cautiously stated, VR/AR may not yet be fully exploited since computerized data can extend beyond accuracy and temporal measures, which showed limited construct-alignment in complex VR tasks. Interdisciplinary collaboration is essential to develop outcome measures better suited to VR/AR technology reflecting daily-life situations.