Cyber sickness in low-immersive, semi-immersive, and fully immersive virtual reality

The Effects of Virtual Reality-Based Reminiscence Therapies for Older Adults With Cognitive Impairment: Systematic Review

BACKGROUND

Reminiscence therapy (RT) is a commonly used nonpharmaceutical treatment for cognitive impairment. Artifacts or conversations are used in RT to recall individuals' memories and past experiences. Virtual reality (VR) has increasingly been used as an assistive technology during RT. However, the effects of VR-based RT (VR-RT) methods remain unclear, and insights into the related benefits and challenges are urgently needed.

OBJECTIVE

The study aims to systematically review the effects of VR-RTs for older adults with cognitive impairment.

METHODS

Seven databases (MEDLINE, Academic Search Premier, CINAHL, Web of Science, PubMed, the Cochrane Central Register of Controlled Trials, and ScienceDirect) were searched to identify relevant articles published from inception to August 10, 2023. Peer-reviewed publications that assessed the effect of VR-RTs (ie, using virtual clues to evoke participants' memories or past experiences) on cognitive-related outcomes were included. Two independent researchers conducted the literature search, review, and data extraction processes. A narrative synthesis approach was used to analyze the extracted data.

RESULTS

Of the 537 identified articles, 22 were ultimately included in the data analysis. The results revealed that VR-RTs could maintain cognitive status (4/4, 100%) and reduce anxiety (2/2, 100%) in older adults with cognitive impairment. Nevertheless, one study found a cognitive improvement after VR-RTs, whereas cognitive degradation was observed at a 3- to 6-month follow-up measure. Around 88% (7/8) of the included studies indicated that VR-RTs improved memory; however, the evidence regarding the beneficial effects of VR-RTs was limited in improving quality of life (1/4, 25%) and reducing apathy (0/2, 0%) and depression (1/3, 33%). The results indicated that VR-RTs are safe, engaging, acceptable, and satisfying for older adults with cognitive impairment. In VR scenarios, personalized stimulus materials related to the users' youth experiences were more effective for treating cognitive impairment than other stimulus materials.

CONCLUSIONS

The results of this systematic review demonstrate the potential benefits of VR-RT for older adults with cognitive impairment, especially in improving emotion and memory and maintaining cognitive status. VR-RT is also safe and enjoyable for older adults. However, due to the trial heterogeneity of included studies, we can only provide qualitative results instead of performing meta-analysis to quantify the effect size of VR-RTs. Thus, more randomized controlled trials are required to examine the designs and effects of VR-RTs for groups of older adults with specific needs.

Exposure to simulated nature promotes positive body image irrespective of the presentation modality: A comparison of images, 2-dimensional film, and 360° immersive film

Previous studies have shown that exposure to simulated natural environments can elevate state body appreciation, but stimulus sets have been limited to the use of images and 2-dimensional (2D) film. To extend this work, we examined the relative impact of images, 2D film, and a 360° immersive film on immediate, state body appreciation. A total of 136 German-speaking adults from Austria (71.3 % women; age range 18-69 years) were randomly assigned to one of three conditions, in which they viewed an image set, a 2D film, or a 360° film depicting the same natural environment. Before and after viewing the stimuli, they completed measures of state body appreciation, affect, and desire for aesthetics. Our results showed that state body appreciation improved in all three conditions, with effect sizes ranging from Cohen's d = 0.26 (2D film) to 0.52 (360° film). Presentation modality did not significantly shape improvements in state body appreciation; that is, the elevation in state body appreciation was equivalent across all three groups. Participants also experienced improvements in feelings of pleasantness, but again this was independent of the experimental group. These results suggest exposure to simulated nature may improve state body appreciation irrespective of the presentation modality.

Effects of online and offline trigeminal nerve stimulation on visuomotor learning

Introduction

A current thrust in neurology involves using exogenous neuromodulation of cranial nerves (e.g, vagus, trigeminal) to treat the signs and symptoms of various neurological disorders. These techniques also have the potential to augment cognitive and/or sensorimotor functions in healthy individuals. Although much is known about the clinical effects of trigeminal nerve stimulation (TNS), effects on sensorimotor and cognitive functions such as learning have received less attention, despite their potential impact on neurorehabilitation. Here we describe the results of experiments aimed at assessing the effects of TNS on motor learning, which was behaviorally characterized using an upper extremity visuomotor adaptation paradigm.

Objective

Assessing the effects of TNS on motor learning.

Methods

Motor learning was behaviorally characterized using an upper extremity visuomotor adaptation paradigm. In Experiment 1, effects of offline TNS using clinically tested frequencies (120 and 60 Hz) were characterized. Sixty-three healthy young adults received TNS before performing a task that involved reaching with perturbed hand visual feedback. In Experiment 2, the effects of 120 and 60 Hz online TNS were characterized with the same task. Sixty-three new participants received either TNS or sham stimulation concurrently with perturbed visual feedback.

Results

Experiment 1 results showed that 60 Hz stimulation was associated with slower rates of learning than both sham and 120 Hz stimulation, indicating frequency-dependent effects of TNS. Experiment 2 however showed no significant differences among stimulation groups. A post-hoc, cross-study comparison of the 60 Hz offline and online TNS results showed a statistically significant improvement in learning rates with online stimulation relative to offline, pointing to timing-dependent effects of TNS on visuomotor learning.

Discussion

The results indicate that both the frequency and timing of TNS can influence rates of motor learning in healthy adults. This suggests that optimization of one or both parameters could potentially increase learning rates, which would provide new avenues for enhancing performance in healthy individuals and augmenting rehabilitation in patients with sensorimotor dysfunction resulting from stroke or other neurological disorders.

Effect of Outdoor Cycling, Virtual and Enhanced Reality Indoor Cycling on Heart Rate, Motivation, Enjoyment and Intention to Perform Green Exercise in Healthy Adults

Background: Despite the benefits of physical activity (PA), Italy ranks low in leisure-time PA among European countries. Integrating virtual (VR)/enhanced (ER) reality with exercise equipment could boost PA engagement. Limited studies have explored how VR/ER-integrated cycling activity, compared to outdoor settings, influences PA among university students. Therefore, this study aimed to evaluate the acute effects of a brief cycling session outdoors and indoors on psychological and physiological outcomes, and secondly, investigate the potential of VR/ER-mediated nature experiences as a tool to promote green exercise. Methods: In February 2024, thirty-one subjects (20 M and 11 F; age 24.3 ± 3.2 years; BMI 23.5 ± 3.6 kg/m2) were involved in this randomized crossover-controlled trial, where they were assigned to three different conditions: ER cycling (ERC), VR cycling (VRC), and outdoor cycling (OUTC). Heart rate (HR), Physical Activity Enjoyment (PACE), Intrinsic Motivation Inventory (IMI), and Intention to Perform Green Exercise (INT-GE) were assessed at the end of each condition. Results: The OUTC condition showed significantly greater PACE, IMI, and INT-GE than ERC/VRC (p < 0.001), lower HRmean than ERC/VRC (p < 0.001 and p < 0.05, respectively), and lower HRmax than ERC (p < 0.05). Conclusions: VRC and ERC enhanced engagement and physiological responses during indoor cycling, but outdoor cycling offered superior benefits in motivation, enjoyment, and future engagement intentions. No significant differences were found between VRC and ERC in promoting intentions for outdoor activities, suggesting both technologies could be equally effective.

Virtual reality training versus conventional rehabilitation for chronic neck pain: A systematic review and meta-analysis

OBJECTIVE

To identify, critically appraise, and quantitatively synthesize current randomized controlled trials to compare the effects of virtual reality and dose-matched conventional exercises in patients with chronic neck pain.

LITERATURE SEARCH

PubMed, Embase, CINAHL, PsycINFO, and Scopus were searched for studies published prior to April 15, 2023. The search strategies combined controlled vocabularies and title/abstract keywords on search themes of virtual reality and neck pain.

METHODS

A systematic review and meta-analysis of randomized controlled trials was conducted. Two independent reviewers conducted study selection, data extraction, and quality assessment. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Meta-analyses were performed using random-effects models.

SYNTHESIS

Six randomized controlled trials including 243 participants with chronic neck pain met the inclusion criteria. Four studies were evaluated as good quality and two as fair. Pooled analysis revealed that virtual reality demonstrated significantly better improvements in the Neck Disability Index in both the short term (mean difference [MD] = -2.16; 95% confidence interval [CI]: -3.50 to -0.82) and long term (MD = -2.95; 95% CI: -4.93 to -0.97), and pain intensity in the short term (MD = -0.94, 95% CI: -1.31 to -0.58). No significant between-group differences were found in pain in the long term and kinesiophobia.

CONCLUSIONS

Virtual reality is a promising intervention to address disability and pain in patients with chronic neck pain. This review supports the clinical significance of augmenting conventional exercise with virtual reality as part of conservative management of chronic neck pain.

Examining the Feasibility, Acceptability, and Preliminary Efficacy of an Immersive Virtual Reality-Assisted Lower Limb Strength Training for Knee Osteoarthritis: Mixed Methods Pilot Randomized Controlled Trial

Background

Knee osteoarthritis prevalently causes significant pain, activity limitations, psychological distress, and reduced quality of life. Despite lower limb strength training being a core treatment for knee osteoarthritis, adherence remains a challenge, prompting the exploration of virtual reality (VR) to improve exercise compliance. Recent research suggests the potential of VR in providing enhanced pain management and functional outcomes for knee osteoarthritis, necessitating further exploration of immersive VR technology.

Objective

We aimed to study the feasibility, acceptability, and preliminary efficacy of an immersive VR-assisted lower limb strength training for knee osteoarthritis (VRiKnee).

Methods

A convergent, parallel, mixed methods study was conducted in 30 participants with knee osteoarthritis. After 1:1 randomization, the VRiKnee group (n=15) was assigned to perform repetitive concentric quadriceps and isometric vastus medialis oblique exercise in an immersive environment using a head-mounted display for 12 weeks. The control group (n=15) completed the same exercises without VRiKnee. VRiKnee participants were interviewed at week 12 to study VRiKnee acceptability and user experience. Quantitative data included feasibility outcomes such as recruitment, dropout, and exercise adherence rates, and effectiveness outcomes such as the numeric rating scale, the Western Ontario and McMaster Universities Osteoarthritis Index (100 points) pain and function subscales, and objective physical activity measured by metabolic equivalents of task using an ActivPAL accelerometer. Qualitative data were analyzed by thematic analysis, followed by integration with quantitative data using joint displays.

Results

The recruitment rate was 100% (N=30), with enrollment of 30 participants in 7.57 weeks. The median age was 63.5 (IQR 61.8-66.3) years, with 76% (n=23) being female. The response rates were 80% and 93% for the VRiKnee and control groups. Dropout rates were 13% for VRiKnee and 7% for the control group. Median exercise adherence was 77% (IQR 37-104%) for VRiKnee and 62% (IQR 40-166%) for the control group, respectively, with adherence reduction over this study's period and no significant intergroup differences (P=.82). No statistically significant differences were observed in primary and secondary outcomes, though positive trends were observed in pain and stiffness. Cybersickness was reported by 5 (33%) participants in the VRiKnee group. In the qualitative analysis, 4 themes, 11 subthemes, and 16 quotes were generated, identifying facilitators and barriers with practical suggestions to enhance the usability of VRiKnee.

Conclusions

VRiKnee demonstrated feasibility, acceptability, and potential efficacy in managing knee osteoarthritis. Future trials of larger sample sizes and better VR designs will confirm its role in clinical practice.

Immersive simulation in nursing and midwifery education: a systematic review

PURPOSE

Immersive simulation is an innovative training approach in health education that enhances student learning. This study examined its impact on engagement, motivation, and academic performance in nursing and midwifery students.

METHODS

A comprehensive systematic search was meticulously conducted in 4 reputable databases—Scopus, PubMed, Web of Science, and Science Direct—following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research protocol was pre-registered in the PROSPERO registry, ensuring transparency and rigor. The quality of the included studies was assessed using the Medical Education Research Study Quality Instrument.

RESULTS

Out of 90 identified studies, 11 were included in the present review, involving 1,090 participants. Four out of 5 studies observed high post-test engagement scores in the intervention groups. Additionally, 5 out of 6 studies that evaluated motivation found higher post-test motivational scores in the intervention groups than in control groups using traditional approaches. Furthermore, among the 8 out of 11 studies that evaluated academic performance during immersive simulation training, 5 reported significant differences (P<0.001) in favor of the students in the intervention groups.

CONCLUSION

Immersive simulation, as demonstrated by this study, has a significant potential to enhance student engagement, motivation, and academic performance, surpassing traditional teaching methods. This potential underscores the urgent need for future research in various contexts to better integrate this innovative educational approach into nursing and midwifery education curricula, inspiring hope for improved teaching methods.

The Influence of Audiovisual Distraction on Pain Reduction During Transcatheter Aortic Valve Implantation Under Monitored Anesthesia Care: A Prospective Randomized Trial

OBJECTIVES

To investigate the effect of an audiovisual distraction system on the dose of remifentanil for perioperative sedation during transcatheter aortic valve implantation under monitored anesthesia care.

DESIGN

Single-center prospective randomized nonblinded study.

SETTING

Tertiary referral academic hospital.

PARTICIPANTS

Ninety patients who underwent transfemoral transcatheter aortic valve implantation between July 2019 and July 2021.

INTERVENTIONS

Patients were randomized to use either a novel audiovisual distraction system during the intervention (n = 45) or standard care without an audiovisual distraction system (n = 45).

MEASUREMENTS AND MAIN RESULTS

Standardized questionnaires were given to each patient at admission and before and after the intervention to assess their levels of anxiety. Primary endpoints were the average and peak infusion rates of remifentanil. All patients were considered for the final analysis according to an intention-to-treat design. No relevant differences in pre- and postinterventional anxiety status were observed between the groups. Similarly, there were no significant differences in reported pain scores (p = 0.364). The average infusion rate (p = 0.028) and peak infusion rate (p = 0.025) of remifentanil were lower in the group with an audiovisual distraction system.

CONCLUSIONS

Audiovisual distraction is a useful adjunct to reduce the dose of remifentanil under monitored anesthesia care during transcatheter aortic valve implantation. Larger studies are needed to evaluate potential positive effects on patient satisfaction, incidence of delirium, and possible economic benefits.

The efficacy of virtual reality for upper limb rehabilitation in stroke patients: a systematic review and meta-analysis

BACKGROUND

Stroke frequently gives rise to incapacitating motor impairments in the upper limb. Virtual reality (VR) rehabilitation has exhibited potential for augmenting upper extremity recovery; nonetheless, the optimal techniques for such interventions remain a topic of uncertainty. The present systematic review and meta-analysis were undertaken to comprehensively compare VR-based rehabilitation with conventional occupational therapy across a spectrum of immersion levels and outcome domains.

METHODS

A systematic search was conducted in PubMed, IEEE, Scopus, Web of Science, and PsycNET databases to identify randomized controlled trials about upper limb rehabilitation in stroke patients utilizing VR interventions. The search encompassed studies published in the English language up to March 2023. The identified studies were stratified into different categories based on the degree of immersion employed: non-immersive, semi-immersive, and fully-immersive settings. Subsequent meta-analyses were executed to assess the impact of VR interventions on various outcome measures.

RESULTS

Of the 11,834 studies screened, 55 studies with 2142 patients met the predefined inclusion criteria. VR conferred benefits over conventional therapy for upper limb motor function, functional independence, Quality of life, Spasticity, and dexterity. Fully immersive VR showed the greatest gains in gross motor function, while non-immersive approaches enhanced fine dexterity. Interventions exceeding six weeks elicited superior results, and initiating VR within six months post-stroke optimized outcomes.

CONCLUSIONS

This systematic review and meta-analysis demonstrates that adjunctive VR-based rehabilitation enhances upper limb motor recovery across multiple functional domains compared to conventional occupational therapy alone after stroke. Optimal paradigms likely integrate VR's immersive capacity with conventional techniques.

TRIAL REGISTRATION

This systematic review and meta-analysis retrospectively registered in the OSF registry under the identifier [ https://doi.org/10.17605/OSF.IO/YK2RJ ].

Evaluation of an exercise program incorporating an international cycling competition: a multimodal intervention model for physical, psychological, and social wellbeing in residential aged care

BACKGROUND

The transition into residential aged care is frequently associated with a reduction in physical activity, social engagement, and emotional wellbeing. Our aim was to evaluate the impact of a 26-day international cycling competition (Road Worlds Competition for Seniors), incorporating elements of exercise, audiovisual cycling footage, social engagement, and gamification, on the physical, psychological, and social well-being of aged care residents. We aimed to use findings to inform the development of a multi-modal intervention model to maximise wellbeing for older adults.

METHODS

Residents (N = 32) participated in a mixed-methods single-group intervention pilot study that compared pre-and post-competition measures for the following wellbeing domains; physical, psychological, and social. In addition, interviews were conducted with residents (n = 27) and staff (n = 6) to explore their experiences.

RESULTS

Measures identified significant improvements across multiple wellbeing domains, including functional fitness, depression, self-efficacy, and social network sizes. Findings from the interview data indicated that the multimodal components involved in the program delivery were valued by staff and residents who enjoyed the gamification, audiovisual cycling footage, social engagement, opportunities for reminiscence, and camaraderie between peers, staff, and volunteers.

CONCLUSIONS

Findings highlight a constellation of benefits across physical, psychological, and social domains of wellbeing and inform a model for innovative multidimensional programs in residential aged care. The benefits for residents with varying physical and cognitive abilities support the use of creative strategies that maximise inclusion and engagement for residents.

VR.net: A Real-world Dataset for Virtual Reality Motion Sickness Research

Researchers have used machine learning approaches to identify motion sickness in VR experience. These approaches would certainly benefit from an accurately labeled, real-world, diverse dataset that enables the development of generalizable ML models. We introduce 'VR.net', a dataset comprising 165-hour gameplay videos from 100 real-world games spanning ten diverse genres, evaluated by 500 participants. VR.net accurately assigns 24 motion sickness-related labels for each video frame, such as camera/object movement, depth of field, and motion flow. Building such a dataset is challenging since manual labeling would require an infeasible amount of time. Instead, we implement a tool to automatically and precisely extract ground truth data from 3D engines' rendering pipelines without accessing VR games' source code. We illustrate the utility of VR.net through several applications, such as risk factor detection and sickness level prediction. We believe that the scale, accuracy, and diversity of VR.net can offer unparalleled opportunities for VR motion sickness research and beyond.We also provide access to our data collection tool, enabling researchers to contribute to the expansion of VR.net.

CyPVICS: A framework to prevent or minimise cybersickness in immersive virtual clinical simulation

Cybersickness is a global issue affecting users of immersive virtual reality. However, there is no agreement on the exact cause of cybersickness. Taking into consideration how it can differ greatly from one person to another, it makes it even more difficult to determine the exact cause or find a solution. Because cybersickness excludes so many prospective users, including healthcare professionals, from using immersive virtual reality as a learning tool, this research sought to find solutions in existing literature and construct a framework that can be used to prevent or minimise cybersickness during immersive virtual clinical simulation (CyPVICS). The Bestfit Framework by Carrol and authors were used to construct the CyPVICS framework. The process started by conducting two separate literature searchers using the BeHEMoTh (for models, theories, and frameworks) and SPIDER (for primary research articles) search techniques. Once the literature searches were completed the models, theories and framework were used to construct a priori framework. The models' theories and frameworks were analysed to determine aspects relevant to causes, reducing, eliminating, and detecting cybersickness. The priori framework was expanded by, first coding the findings of the primary research study into the existing aspects of the priori framework. Once coded the aspects that could not be coded were added in the relevant category, for example causes. After reviewing 1567 abstracts and titles as part of the BeHEMoTh search string,19 full text articles, a total of 15 papers containing models, theories, and frameworks, were used to construct the initial CyPVICS framework. Once the initial CyPVICS was created, a total 904 primary research studies (SPIDER) were evaluated, based on their titles and abstracts, of which 100 were reviewed in full text. In total, 67 articles were accepted and coded to expand the initial CyPVICS framework. This paper presents the CyPVICS framework for use, not only in health professions' education, but also in other disciplines, since the incorporated models, theories, frameworks, and primary research studies were not specific to virtual clinical simulation.

iVR-fNIRS: studying brain functions in a fully immersive virtual environment

Immersive virtual reality (iVR) employs head-mounted displays or cave-like environments to create a sensory-rich virtual experience that simulates the physical presence of a user in a digital space. The technology holds immense promise in neuroscience research and therapy. In particular, virtual reality (VR) technologies facilitate the development of diverse tasks and scenarios closely mirroring real-life situations to stimulate the brain within a controlled and secure setting. It also offers a cost-effective solution in providing a similar sense of interaction to users when conventional stimulation methods are limited or unfeasible. Although combining iVR with traditional brain imaging techniques may be difficult due to signal interference or instrumental issues, recent work has proposed the use of functional near infrared spectroscopy (fNIRS) in conjunction with iVR for versatile brain stimulation paradigms and flexible examination of brain responses. We present a comprehensive review of current research studies employing an iVR-fNIRS setup, covering device types, stimulation approaches, data analysis methods, and major scientific findings. The literature demonstrates a high potential for iVR-fNIRS to explore various types of cognitive, behavioral, and motor functions in a fully immersive VR (iVR) environment. Such studies should set a foundation for adaptive iVR programs for both training (e.g., in novel environments) and clinical therapeutics (e.g., pain, motor and sensory disorders and other psychiatric conditions).

The effect of Immersive Virtual Reality on balance: an exploratory study on the feasibility of head-mounted displays for balance evaluation

Global interest in applying virtual reality (VR) in research and medicine has grown significantly, with potential benefits for patients suffering from balance disorders, instability, and a high risk of falling. This exploratory study assesses the impact of immersive VR (IVR) delivered through a head-mounted display (HMD) on balance and explores the feasibility of using the HMD VR unit as a standalone posturography tool. Using the Meta Quest 2 HMD and a mid-range Android smartphone equipped with standard sensors, the research employed a VR environment that simulated a ship at sea, with thirty-eight healthy participants with no otoneurologic abnormalities. Measurements were conducted in repeated trials, including static assessments on both stable ground and foam, as well as a 3-m walk. This was conducted in two settings: one within a VR environment with three different intensity levels and the other in non-VR settings. Statistical analysis and clinical evaluation revealed that IVR with HMD influences head-level sway velocity, which correlates with increased visual disturbance, suggesting its potential as a low-risk standalone posturography tool.

Assessment of a virtual prosthetic case planning environment for dental education - A multicentric analysis

OBJECTIVES

The aim of the present study was the multicentric assessment of the virtual prosthetic case planning environment (VCPE), which relocates patient planning into the virtual space in dental education.

MATERIALS AND METHODS

The VCPE is separated into two rooms: a virtual entry area where the user can choose between 10 different prosthetic case plans of ascending complexity, and a virtual patient case planning room. In spring term 2022, the use of virtual case planning was voluntarily assessed in four different German dental schools (DSs) from the perspective of both lecturers and students. The assessment was performed afterwards using a questionnaire. Data were analysed using Kolmogorov-Smirnov test, exploratory data analysis, Fisher-Freeman-Halton test, and exact Fisher test. Reliability was assessed with Cronbach Alpha test (α < 0.05).

RESULTS

A total of 59 lecturers and 63 students were included. There were 38.5% male, 60.7% female, and 0.8% diverse participants. The mean age of the lecturers was 36.2 ± 9.0 years and of the students 24.3 ± 3.0 years. The VCPE was assessed as good, yet the evaluations between either the DSs or between the lecturers and students were significantly different.

CONCLUSIONS

Even though for some assessment criteria significantly different results between the four DS were observed, the majority of participants evaluated the VCPE positively and recommended them for teaching. The virtual reality as a teaching method for teaching prosthetic case planning for the further preparation of the students for the later professional life can be considered as helpful.

Being in Virtual Reality and Its Influence on Brain Health-An Overview of Benefits, Limitations and Prospects

BACKGROUND

Dynamic technological development and its enormous impact on modern societies are posing new challenges for 21st-century neuroscience. A special place is occupied by technologies based on virtual reality (VR). VR tools have already played a significant role in both basic and clinical neuroscience due to their high accuracy, sensitivity and specificity and, above all, high ecological value.

OBJECTIVE

Being in a digital world affects the functioning of the body as a whole and its individual systems. The data obtained so far, both from experimental and modeling studies, as well as (clinical) observations, indicate their great and promising potential, but apart from the benefits, there are also losses and negative consequences for users.

METHODS

This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework across electronic databases (such as Web of Science Core Collection; PubMed; and Scopus, Taylor & Francis Online and Wiley Online Library) to identify beneficial effects and applications, as well as adverse impacts, especially on brain health in human neuroscience.

RESULTS

More than half of these articles were published within the last five years and represent state-of-the-art approaches and results (e.g., 54.7% in Web of Sciences and 63.4% in PubMed), with review papers accounting for approximately 16%. The results show that in addition to proposed novel devices and systems, various methods or procedures for testing, validation and standardization are presented (about 1% of articles). Also included are virtual developers and experts, (bio)(neuro)informatics specialists, neuroscientists and medical professionals.

CONCLUSIONS

VR environments allow for expanding the field of research on perception and cognitive and motor imagery, both in healthy and patient populations. In this context, research on neuroplasticity phenomena, including mirror neuron networks and the effects of applied virtual (mirror) tasks and training, is of interest in virtual prevention and neurogeriatrics, especially in neurotherapy and neurorehabilitation in basic/clinical and digital neuroscience.

Non-immersive virtual reality based treatment for children with unilateral cerebral palsy: Preliminary results

PURPOSE

Unilateral cerebral palsy (UCP) represents about 30-40% of overall cerebral palsy diagnoses. Upper limb impairment has a significant negative impact on activities of daily living (ADL), and recent studies have shown that the use of virtual reality (VR) can increase motivation and promote an improvement in ADL. This preliminary study was aimed at exploring the acceptability and usability of a VR rehabilitation treatment, using the VITAMIN Platform, for children with UCP. A secondary goal of the study was to compare the results of usual standardized clinical scales and questionnaires with kinematic results as well as with the quantitative measures acquired by the VITAMIN platform in each exercise of the rehabilitation sessions.

METHODS

Six children with UCP (aged 7-15) were recruited for a preliminary investigation in using a non-immersive VR system. The treatment was composed of 10 weekly sessions of 45 minutes. Each child played five types of exergames, using the impaired upper limb to hit virtual objects projected on a wide screen. Standardized clinical scales, kinematic analysis, and questionnaires were used to extensively assess upper limb function before and at the end of treatment. Five typically-developing children provided a reference for the instrumented kinematic assessment.

RESULTS

At the end of the treatment, Melbourne Assessment 2 (MA2) scores increased for all the participants (mean increase in range of movement (ROM) + 19.1%, accuracy + 4.6%, dexterity + 13.1%, fluency + 10.3%). Shoulder flexion-extension ROM also improved (mean increase + 10.5°), and according to the kinematic analysis, shoulder movements became more similar to reference profiles. These results were confirmed by a general improvement in performing ADL, assessed by the ABILHAND-Kids questionnaire. Finally, a general agreement among the different measures and indexes emerged from the acquired data.

CONCLUSION

The results show that VR treatment with the VITAMIN platform could be engaging and functional for rehabilitation of children with UCP. The good agreement among the qualitative and quantitative measures and indexes confirms the potential of such novel treatment. However, due to the limited sample size and small number of sessions, further and larger investigations are required to evaluate the effectiveness and to generalize the results.

Virtual reality applications based on instrumental activities of daily living (iADLs) for cognitive intervention in older adults: a systematic review

BACKGROUND

In recent years, the use of virtual reality (VR) as a complementary intervention in treating cognitive impairment has significantly increased. VR applications based on instrumental activities of daily living (iADL-VR) could offer a promising approach with greater ecological validity for intervention in groups with cognitive impairments. However, the effectiveness of this approach is still debated.

OBJECTIVE

This systematic review aims to synthesize the effects of iADL-VR interventions to rehabilitate, train, or stimulate cognitive functions in healthy adults and people with mild cognitive impairment (MCI) and different types of dementia.

METHODS

A systematic search was performed in the Scopus, PubMed, IEEE Xplore, Web of Science, and APA PsycNet databases until September 2022 and repeated in April 2023. The selected studies met the search terms, were peer-reviewed, included an iADL-VR intervention, and were written in English. Descriptive, qualitative studies, reviews, cognitive assessment, non-intervention studies, those unrelated to VR or iADL, those focused on motor aspects, and non-degenerative disorders were excluded. The PEDro scale was used to assess the methodological quality of the controlled studies. To present and synthesize the results, we organized the extracted data into three tables, including PEDro scores, participant characteristics, and study characteristics.

RESULTS

Nineteen studies that met the inclusion and exclusion criteria were included. The total sample reached 590 participants, mostly women (72.67%). Approximately 30% were diagnosed with Alzheimer's disease or dementia, and 20% had mild cognitive impairment. Variables such as authors and year of publication, study design, type of intervention and VR applied, duration of the intervention, main findings, and conclusions were extracted. Regarding demographic characteristics, the sample size, age, sex, years of education, neurological diagnosis, dropouts, and the city and country where the intervention took place were recorded. Almost all studies showed improvements in some or all the outcomes after the intervention, generally greater in the iADL-VR group than in the control group.

CONCLUSION

iADL-VR interventions could be beneficial in improving the performance of cognitive functions in older adults and people with MCI and different types of dementia. The ecological component of these tasks makes them very suitable for transferring what has been learned to the real world. However, such transfer needs to be confirmed by further studies with larger and more homogeneous samples and longer follow-up periods. This review had no primary funding source and was registered with PROSPERO under registration ID: 375166.

Effectiveness of the Combined Use of a Brain-Machine Interface System and Virtual Reality as a Therapeutic Approach in Patients with Spinal Cord Injury: A Systematic Review

Spinal cord injury has a major impact on both the individual and society. This damage can cause permanent loss of sensorimotor functions, leading to structural and functional changes in somatotopic regions of the spinal cord. The combined use of a brain-machine interface and virtual reality offers a therapeutic alternative to be considered in the treatment of this pathology. This systematic review aimed to evaluate the effectiveness of the combined use of virtual reality and the brain-machine interface in the treatment of spinal cord injuries. A search was performed in PubMed, Web of Science, PEDro, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and Medline, including articles published from the beginning of each database until January 2023. Articles were selected based on strict inclusion and exclusion criteria. The Cochrane Collaboration's tool was used to assess the risk of bias and the PEDro scale and SCIRE systems were used to evaluate the methodological quality of the studies. Eleven articles were selected from a total of eighty-two. Statistically significant changes were found in the upper limb, involving improvements in shoulder and upper arm mobility, and weaker muscles were strengthened. In conclusion, most of the articles analyzed used the electroencephalogram as a measurement instrument for the assessment of various parameters, and most studies have shown improvements. Nonetheless, further research is needed with a larger sample size and long-term follow-up to establish conclusive results regarding the effect size of these interventions.

Visual Cues for a Steadier You: Visual Feedback Methods Improved Standing Balance in Virtual Reality for People with Balance Impairments

Users of head-mounted displays (HMDs) for virtual reality (VR) sometimes have balance issues since HMDs impede their view of the outside world. This has a greater impact on people with balance impairments since many rely more heavily on their visual cues to keep their balance. This is a significant obstacle to the universal usability and accessibility of VR. Although previous studies have verified the imbalance issue, not much work has been done to diminish it. In this study, we investigated how to increase VR balance by utilizing additional visual cues. To examine how different visual approaches (static, rhythmic, spatial, and center of pressure (CoP) based feedback) affect balance in VR, we recruited 100 people (50 with balance impairments due to multiple sclerosis and 50 without balance impairments) across two different geographic locations (United States and Bangladesh). All people completed both standing visual exploration as well as standing reach and grasp tasks. Results demonstrated that static, rhythmic, and CoP visual feedback approaches enhanced balance significantly ( ) in VR for people with balance impairments. The methods described in this study could be applied to design more accessible virtual environments for people with balance impairments.

Association between anxiety and skin conductance according to the intensity of shaking of virtual reality images

Introduction

Despite the advantages of virtual reality (VR), cyber sickness makes it difficult to apply VR to those who are already anxious and in distress. Skin conductance (SC) is widely used as a bio-signal reflecting anxiety. It is positively correlated with anxiety. The objective of this study was to determine the association between SC and anxiety in VR.

Methods

Healthy volunteers with moderate-to-high stress defined as a Perceived Stress Scale-10 (PSS-10) score ≥20 were enrolled. STAI-X-1 was used to measure anxiety, and galvanic skin response was used to measure SC. This study used an open, randomized, crossover design. In this study, 360° videos consisted of two types, namely, less dizzying video (G1) and more dizzying video (G2). We randomized subjects into two groups according to video exposure order: G1 after watching G2 (Order 1) and G2 after watching G1 (Order 2). Of 81 subjects, the average age (±SD) was 39.98 ± 10.94 years for the Order 1 group and 36.54 ± 12.44 years for the Order 2 group.

Results

Anxiety was significantly decreased in the Order 2 group (p < 0.035) after watching videos, whereas there was no significant change in anxiety in the Order 1 group. In both groups, SC was significantly increased after exposure to a dizzying video. Mean difference (SD) between the second VR video and baseline SC was 1.61 (1.07) (p < 0.0001) in the Order 1 group and 0.92 (0.90) (p < 0.0001) in the Order 2 group, showing a significant difference between the two groups (p < 0.003). However, there was no significant difference between the two groups (p < 0.077) after baseline correction.

Conclusion

Anxiety was decreased significantly in the Order 2 group. The Order 1 group showed a high rate of change in skin conductivity. It is possible to reduce SC and anxiety by viewing a less dizzying VR video first and then viewing a more dizzying video later.

Adverse Effects of Virtual and Augmented Reality Interventions in Psychiatry: Systematic Review

BACKGROUND

Virtual reality (VR) and augmented reality (AR) are emerging treatment modalities in psychiatry, which are capable of producing clinical outcomes broadly comparable to those achieved with standard psychotherapies.

OBJECTIVE

Because the side effect profile associated with the clinical use of VR and AR remains largely unknown, we systematically reviewed available evidence of their adverse effects.

METHODS

A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework across 3 mental health databases (PubMed, PsycINFO, and Embase) to identify VR and AR interventions targeting mental health diagnoses.

RESULTS

Of 73 studies meeting the inclusion criteria, 7 reported worsening clinical symptoms or an increased fall risk. Another 21 studies reported "no adverse effects" but failed to identify obvious adverse effects, mainly cybersickness, documented in their results. More concerningly, 45 of the 73 studies made no mention of adverse effects whatsoever.

CONCLUSIONS

An appropriate screening tool would help ensure that VR adverse effects are correctly identified and reported.

Design of a Desktop Virtual Reality-Based Collaborative Activities Simulator (ViRCAS) to Support Teamwork in Workplace Settings for Autistic Adults

Autistic adults possess many skills sought by employers, but may be at a disadvantage in the workplace if social-communication differences negatively impact teamwork. We present a novel collaborative virtual reality (VR)-based activities simulator, called ViRCAS, that allows autistic and neurotypical adults to work together in a shared virtual space, offering the chance to practice teamwork and assess progress. ViRCAS has three main contributions: 1) a new collaborative teamwork skills practice platform; 2) a stakeholder-driven collaborative task set with embedded collaboration strategies; and 3) a framework for multimodal data analysis to assess skills. Our feasibility study with 12 participant pairs showed preliminary acceptance of ViRCAS, a positive impact of the collaborative tasks on supported teamwork skills practice for autistic and neurotypical individuals, and promising potential to quantitatively assess collaboration through multimodal data analysis. The current work paves the way for longitudinal studies that will assess whether the collaborative teamwork skill practice that ViRCAS provides also contributes towards improved task performance.

Impact of Virtual Reality Cognitive and Motor Exercises on Brain Health

Innovative technologies of the 21st century have an extremely significant impact on all activities of modern humans. Among them, virtual reality (VR) offers great opportunities for scientific research and public health. The results of research to date both demonstrate the beneficial effects of using virtual worlds, and indicate undesirable effects on bodily functions. This review presents interesting recent findings related to training/exercise in virtual environments and its impact on cognitive and motor functions. It also highlights the importance of VR as an effective tool for assessing and diagnosing these functions both in research and modern medical practice. The findings point to the enormous future potential of these rapidly developing innovative technologies. Of particular importance are applications of virtual reality in basic and clinical neuroscience.

Home-based immersive virtual reality physical rehabilitation in paediatric patients for upper limb motor impairment: a feasibility study

Upper limb motor impairment (ULMI) rehabilitation is a long-term, demanding and challenging process to recover motor functionality. Children and adolescents may be limited in daily life activities due to reduced functions such as decreased joint movement or muscle weakness. Home-based therapy with Immersive Virtual Reality can offer greater accessibility, delivery and early rehabilitation to significantly optimise functional outcomes and quality of life. This feasibility study aimed to explore the perceptions and impacts of an immersive and interactive VR scenario suitable for ULMI rehabilitation for children at home. It was analysed using mixed methods (quantitative and qualitative) and from a multidirectional perspective (patients, clinicians and family members). Amongst the main results, it was found that IVR for ULMI home rehabilitation (1) is easy to learn and acceptable; (2) improves motor function; (3) reduces the difficulty in the reproduction of therapeutic movements; (4) is motivating and enjoyable and (5) improves quality of life. This study is the first study on the use of IVR applied to home rehabilitation of ULMI in children. These results suggested that similar outcomes may be possible with self-directed IVR home rehabilitation compared to face to face conventional rehabilitation, which can be costly to both the patient and the healthcare system, decreasing the length of stay at the hospital and treatment duration. It has also presented an innovative solution to the Covid-19 emergency where children could not receive their clinic therapy. Further research is recommended to understand better the mechanisms involved in physiotherapeutic recovery and how IVR rehabilitation helps to improve conventional treatments. Trial Registration Protocol ID NCT05272436. Release Date: 9th March 2022.

Effects of Low-Immersive vs. High-Immersive Exercise Environment on Postural Stability and Reaction and Motor Time of Healthy Young Adults

(1) Background: Many young adults spend their time playing games and watching television. This type of spending time should be used effectively, so it's worth adding exercise and immersion to them. Bearing in mind that the video games and physical exercise also improve postural stability, motor time (MT) and reaction time (RT), it is worth reaching for new technologies with immersion that are widely available and can be used, for example, as a remote intervention. This study aimed to compare the effects of a low vs. high-immersive exercise environment on postural stability, RT and MT in young adults. (2) Methods: Ninety-three participants were randomly divided into a control group (CG; n = 48) and experimental group (EG; n = 45). The CG exercised according to the Tabata self-made video display on a television set, and the EG exercised according to the Audio Trip exergame. In addition to the postural stability, RT and MT, we monitored the heart rate, breath rate and energy expenditure for safety reasons and to note any differences. (3) Results: Significant differences were observed for both groups in RT (F(2.182) = 3.14, p = 0.046, η² = 0.03) and MT (F(2.182) = 3.07, p = 0.049, η² = 0.03) and in postural stability in eyes closed (EC): F(2.182) = 3.66, p = 0.028, η² = 0.04 and eyes open in one leg (EO-OL): F(2.182) = 5.814, p = 0.04, η² = 0.07. (4) Conclusions: The inclusion of a higher immersion produces greater improvements in RT, MT. Additionally, after a low-immersive exercise environment, participants have higher center of pressure (COP) path length values with EC and EO-OL tests, which testifies to less postural stability. Regarding COP trajectory, a smaller area surface means better performance for high-immersive participants after 30 min of exercise.

Potential of the omnidirectional walking platform with virtual reality as a rehabilitation tool

Introduction

The combination of virtual reality (VR) with an omnidirectional walking platform (ODWP) may have potential in rehabilitation settings. However, its use, acceptance, safety, and effectiveness are unclear. This preliminary study aims to understand the feasibility, safety, and user experience (including investigating the onset of cybersickness) while walking on the ODWP with fully immersive VR.

Methods

Participants engaged with eight immersive VR walking scenarios. The scenarios were created using 360-degree videos and were programmed to run with the ODWP. Safety modifications for the ODWP were made, with the addition of parallel bars. Quantitative feedback on the perceived safety and acceptance of using VR with an ODWP for rehabilitation was collected. Cybersickness was evaluated using the Simulation Symptoms Questionnaire (SSQ).

Results

Thirty-five participants (n = 8 physiotherapists, n = 27 healthy adults) were recruited for this study. The mean perceived safety score was 78.9/100 and acceptance was 64.5/100. Seventy-one percent of participants experienced mild to moderate symptoms of cybersickness as reported on the SSQ. The SSQ scores were not correlated to participant age or simulation exposure time.

Conclusion

VR while using ODWP has the potential for rehabilitation, however, more consideration is needed to address acceptance and cybersickness.

Measuring Social Modulation of Gaze in Autism Spectrum Condition With Virtual Reality Interviews

Gaze behavior in dyadic conversations can indicate active listening and attention. However, gaze behavior that is different from the engagement expected during neurotypical social interaction cues may be interpreted as uninterested or inattentive, which can be problematic in both personal and professional situations. Neurodivergent individuals, such as those with autism spectrum conditions, often exhibit social communication differences broadly including via gaze behavior. This project aims to support situational social gaze practice through a virtual reality (VR) mock job interview practice using the HTC Vive Pro Eye VR headset. We show how gaze behavior varies in the mock job interview between neurodivergent and neurotypical participants. We also investigate the social modulation of gaze behavior based on conversational role (speaking and listening). Our three main contributions are: (i) a system for fully-automatic analysis of social modulation of gaze behavior using a portable VR headset with a novel realistic mock job interview, (ii) a signal processing pipeline, which employs Kalman filtering and spatial-temporal density-based clustering techniques, that can improve the accuracy of the headset's built-in eye-tracker, and (iii) being the first to investigate social modulation of gaze behavior among neurotypical/divergent individuals in the realm of immersive VR.

Effects of Kilohertz Electrical Stimulation of the Trigeminal Nerve on Motor Learning

Neurological disorders such as stroke remain leading causes of disability worldwide. A current thrust in the neurorehabilitation of such disorders involves exogenous neuromodulation of cranial nerves in order to enhance neuro-plasticity and maximize recovery of function. Here we present preliminary results on the effects of kilohertz range electrical stimulation of the trigeminal nerve (TNS) on motor learning, using an upper extremity visuomotor adaptation paradigm. Twenty-five (25) healthy adult subjects were randomly assigned to 2 groups: 3kHz stimulation ( n=13) and sham ( n=12). Participants performed a visuomotor rotation task that involved center-out reaching movements to eight vertically arranged targets. Four blocks of trials were performed: two baseline blocks with veridical visual feedback, one adaptation block involving a 30° CCW rotation of hand visual feedback, and one washout block with no rotation. TNS was applied for 20 minutes before the 2nd baseline block using two electrodes targeting the ophthalmic branches of the trigeminal nerve. Early in the rotation block, learning rates were similar between the 3kHz and sham groups but gradually diverged, with the 3kHz group demonstrating slightly faster rates than sham later in the rotation block. The results provide new information on the potential use of TNS in neurorehabilitation.

Visual Vestibular Conflict Mitigation in Virtual Reality Using Galvanic Vestibular Stimulation

BACKGROUND: Virtual reality (VR) is an effective technique to reduce cost and increase fidelity in training programs. In VR, visual and vestibular cues are often in conflict, which may result in simulator-induced motion sickness. The purpose of this study is to investigate the integration of Galvanic Vestibular Stimulation (GVS) with a VR flight training simulator by assessing flight performance, secondary task performance, simulator sickness and presence.METHODS: There were 20 participants who performed 2 separate VR flight simulation sessions, with and without GVS (control). Flight performance, secondary task performance, and electrogastrogram were measured during VR flight simulation. The standardized simulator sickness and presence questionnaires were administered.RESULTS: Electrogastrogram measures such as dominant power instability coefficient (DPIC) and percentages of bradygastric waves (%B) were lower in the GVS session than the control session in the flight simulation (DPIC: 0.44 vs. 0.54; %B: 21.2% vs. 30.5%) and postflight (DPIC: 0.38 vs. 0.53; %B: 22.8% vs. 31.4%) periods. Flight performance (#hit-gates) was improved in the GVS session compared to the control (GVS: 17, Control: 15.5). Secondary task performance (%hits) was improved with GVS for the Easy task (GVS: 55.5%, Control: 43.1%).DISCUSSION: This study demonstrates the potential of synchronizing GVS with visual stimuli in VR flight training to reduce visual-vestibular sensory conflict to improve fidelity and performance. These results provide initial evidence, but continued research is warranted to further understand the benefits and applications of GVS in VR simulator training.Pradhan GN, Galvan-Garza RC, Perez AM, Stepanek J, Cevette MJ. Visual vestibular conflict mitigation in virtual reality using galvanic vestibular stimulation. Aerosp Med Hum Perform. 2022; 93(5):406-414.

Focusing on cybersickness: pervasiveness, latent trajectories, susceptibility, and effects on the virtual reality experience

Although virtual reality (VR) usage has become widespread in the last decade, its adoption has been hampered by experiences of user discomfort known as cybersickness. The present study, in line with the "2020 cybersickness R&D agenda", sought to provide a broad examination of the cybersickness phenomenon, assessing its pervasiveness, latent trajectories, impacts on the VR experience, and predictor variables. The study was composed of 92 participants living in the Dominican Republic with ages ranging from 18 to 52 years (M = 26.22), who experienced a 10-min VR immersion in two environments designed for psychotherapy. The results indicated that cybersickness was pervasive, with 65.2% of the participants experiencing it, and 23.9% severely. Additionally, the latent trajectories of cybersickness were positive and curvilinear, with large heterogeneity across individuals. Cybersickness also had a substantive negative impact on the user experience and the intentions to adopt the VR technology. Finally, motion sickness susceptibility, cognitive stress, and recent headaches uniquely predicted greater severity of cybersickness, while age was negatively related. These combined results highlight the critical role that cybersickness plays on the VR experience and underscore the importance of finding solutions to the problems, such as technological advancements or special usage protocols for the more susceptible individuals.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10055-022-00636-4.

A Prototype of an Electronic Pegboard Test to Measure Hand-Time Dexterity with Impaired Hand Functionality

This paper proposes an electronic prototype of the Grooved Pegboard Test (GPT), which is normally used to test the presence of hand dexterity. The prototype imitates the geometrical dimensions of an on-the-market GPT device, but it is electronic, not manual like the one available now for users. The suggested electronic GPT device makes automated time calculation between placing the first and the last peg in their designated locations, instead of manually observing a stopwatch normally used during the GPT. The electronic GPT prototype consists of a fabricated wooden box, electronics (switches and microcontroller), and liquid crystal display (LCD). A set of 40 normal volunteers, 20 females and 20 males, tested the designed prototype. A set of six volunteers with chronic medical conditions also participated in evaluating the proposed model. The results on normal volunteers showed that the proposed electronic GPT device yielded time calculations that match the population mean value of similar calculations by the GPT device. The one-sample t-test showed no significant difference in calculations between the new electronic GPT and the manual GPT device. The p-value was much higher than 0.05, indicating the possible use of the suggested electronic GPT device.

Towards Figurative Expression Enhancement: Effects of the SVVR-Supported Worked Example Approach on the Descriptive Writing of Highly Engaged Students

During the past decades, many researchers have attempted to explore effective teaching methods for developing students’ descriptive writing performance. In this study, the worked example was implemented as an effective way of guiding students to provide step-by-step solutions to learning tasks. Moreover, a spherical video-based virtual reality (SVVR) environment was provided to place students in real-world situations which enabled them to experience the learning contexts in depth. A pretest-posttest quasi experimental study was conducted to explore the influence of the SVVR-supported worked example approach and engagement level on students’ Chinese descriptive writing performance. A total of 79 fourth-grade elementary school students participated in this study. The experimental group used SVVR with worked examples to complete Chinese writing assignments, whereas the control group used videos and worked examples. The results showed no significant effects of the SVVR-supported worked example approach compared with the conventional worked example approach regarding organization, sensory details, or creativity dimensions. As for the figurative expression dimension, students in the SVVR-supported worked example approach condition scored significantly higher. Moreover, high engagement students significantly outperformed low engagement students in all four writing performance dimensions. Additionally, a significant interaction effect between learning approach and engagement level on figurative expression was found.

Access to Nature via Virtual Reality: A Mini-Review

Nature exposure is known to promote physical and mental health. However, actual nature exposure may be difficult to achieve for the population of people with physical disabilities or chronic conditions. Therefore, many attempts have been made to duplicate nature exposure via media devices, and virtual reality (VR) is deemed as a promising technology due to its advantage in creating a sense of immersion. Generally, current studies suggest that being exposed to virtual nature may contribute to psychological and physiological relaxation. Besides, some pieces of evidence indicate that virtual nature may improve attentional resources, cognitive performance, and pain experience. Although VR is deemed as an advanced media, insufficient evidence was found concerning the advantages of VR over traditional two-dimensional media when it comes to simulated nature exposure. On the other hand, computer-generated (CG) scenarios were found to be more beneficial than 360° videos, and mini-games may be useful in creating an interactive VR format for simulated nature exposure. Further research is needed because of the limited relevant studies.

A Novel Perspective for Examining and Comparing Real and Virtual Test Tasks Performed by the Dominant and Non-Dominant Hand in Healthy Adults

This study presents a novel perspective for the study of functional lateralization in a virtual reality environment. In the model study of handedness, the recognition of the dominant and non-dominant hand in real and virtual conditions was assessed using selected tests, such as a real light exposure test of Piórkowski’s apparatus and classical clinical tests, as well as virtual test tasks, in healthy adults. Statistically significant differences between the dominant and non-dominant hand were observed for tests carried out both in classical conditions and the virtual environment. The results and findings of other studies suggest that the virtual reality approach is a very promising and sensitive tool in the research on functional asymmetries in healthy and disease for motor skills and cognition processes.