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Exploration of social rule violation in patients with focal prefrontal neurosurgical lesions using a virtual reality simulation

Social rule violation was explored in 22 patients with prefrontal neurosurgical lesions and 22 normal controls. The patients were split into those with neurosurgical lesions impinging on the either the orbitofrontal (OF), dorsolateral (DL) or mesial (M) region of the prefrontal cortex. The study used a virtual reality ‘bar’ in which participants walked from the entrance to the bar counter, ordered drinks and returned to the entrance, with the choice of moving between other people (socially inappropriate) or around the people (social appropriate). There was a significant increase in socially inappropriate behaviour in the patients whose lesions were in other prefrontal regions than the dorsolateral prefrontal cortex.