Exploring the Feasibility and Clinical Utility of a Fully Immersive Virtual Reality Shopping Tool for Training Instrumental Activities of Daily Living (IADLs): A Pilot Study in Older Adults and Adults with Neurological and Visual Impairments

VR Shopping application (Brief name: ShopWell VR): A custom-made, fully immersive virtual reality (VR) shopping application, ShopWell VR, will be used for this study. It has been purpose-built to simulate a realistic, fully immersive supermarket environment where participants can practise meaningful daily activities in a controlled setting. The platform is designed to support functional rehabilitation by offering tasks that can be systematically graded in complexity. Designed to support functional rehabilitation, ShopWell VR allows therapists to systematically grade task complexity while tailoring activities to each participant’s goals and abilities. The shopping experience includes a series of customisable tasks that simulate real-world challenges and promote skill development relevant to community reintegration. To achieve this, the application incorporates a progressive difficulty framework spanning four key domains: 1. Physical interaction (navigateing the aisle, reaching items, and avoiding hazards) 2. Cognitive demand (route planning, selecting required items, and managing a budget) 3. Visual complexity (scanning, locating, and recognising items with varying levels of design and contrast, and reading labels) 4. Environmental distractions (background noise and other shoppers in the supermarket) Each domain consists of four graded levels of difficulty. These levels can be individually selected and adjusted within each domain to meet the specific needs and functional capacity of each participant. All participant groups will be exposed to all four domains (physical interaction, cognitive demand, visual complexity, and environmental distractions). However, the level of difficulty within each domain will be tailored according to the participant’s abilities and rehabilitation goals. This ensures that the intervention remains appropriately challenging while accommodating individual limitations. For example, participants with vision impairment may engage in higher levels of cognitive demand, while beginning with lower levels of visual complexity and phyaical interaction, which can be progressively increased over time. In contrast, participants with acquired brain injury may initially require lower levels of cognitive demand and environmental distractions, with gradual progression as their capacity improves. Adherence to the intervention will be monitored through clinician supervision and in-application tracking of task completion and performance. Clinicians will observe participant engagement during sessions and adjust task difficulty as required to maintain an optimal level of challenge. The intervention is individually tailored by clinicians at the start of each session and reviewed continuously throughout the program. Tailoring occurs by selecting the appropriate difficulty level within each domain based on the participant’s current performance, goals, and clinical presentation. Adjustments are made in response to participant progress, ensuring that the intervention remains goal-directed, adaptive, and clinically relevant. Training program: The 4-week training program using ShopWell VR will consist of two sessions per week (8 sessions in total), each lasting approximately 30 minutes, divided into two 15-minute segments with a rest period in between. Training will take place at one of the following locations, depending on participant needs: the Susan Wakil Health Building at the USYD Camperdown campus, Guide Dogs NSW/ACT head office, or the participants’ homes. At the beginning of the program, participants will view a video demonstration of ShopWell VR. In-person instruction and guidance will be provided during each session, supported by the VR system’s casting function (which allows facilitators to view the participant’s experience in real time). Participants will receive immediate feedback on their performance at the end of each session. The difficulty level will be progressively adjusted in response to each individual’s performance and progression throughout the program.