Virtual Reality Experience: Immersion, Sense of Presence, and Cybersickness

Assessing the Feasibility and Acceptability of Virtual Reality for Remote Group-Mediated Physical Activity in Older Adults: Pilot Randomized Controlled Trial

BACKGROUND

Physical inactivity represents a major health concern for older adults. Most social, at-home physical activity (PA) interventions use videoconference, email, or telephone communication for program delivery. However, evidence suggests that these platforms may hinder the social connection experienced by users. Recent advancements in virtual reality (VR) suggest that it may be a rich platform for social, at-home interventions because it offers legitimate options for intervention delivery and PA.

OBJECTIVE

This pilot study aims to determine the feasibility and acceptability of VR compared to videoconference as a medium for remote group-mediated behavioral intervention for older adults. The information generated from this investigation will inform the use of VR as a medium for intervention delivery.

METHODS

Nine low-active older adults (mean age 66.8, SD 4.8 y) were randomized to a 4-week home-based, group-mediated PA intervention delivered via VR or videoconference. Feasibility (ie, the total number of sessions attended and the number of VR accesses outside of scheduled meetings) and acceptability (ie, the number of participants reporting high levels of nausea, program evaluations using Likert-style prompts with responses ranging from -5=very difficult or disconnected to 5=very easy or connected, and participant feedback on immersion and social connection) are illustrated via descriptive statistics and quotes from open-ended responses.

RESULTS

None of the participants experienced severe VR-related sickness before randomization, with a low average sickness rating of 1.6 (SD 1.6) out of 27 points. Attendance rates for group meetings were 98% (59/60) and 96% (46/48) for the VR and videoconference groups, respectively. Outside of scheduled meeting times, participants reported a median of 5.5 (IQR 5.3-5.8, range 0-27) VR accesses throughout the entire intervention. Program evaluations suggested that participants felt personally connected to their peers (VR group: median 3.0, IQR 2.5-3.5; videoconference group: median 3.0, IQR 2.7-3.3), found that goals were easy to accomplish (VR group: median 3.0, IQR 2.8-3.3; videoconference group: median 3.0, IQR 2.6-3.4), and had ease in finding PA options (VR group: median 4.0, IQR 3.5-4.3; videoconference group: median 2.0, IQR 1.6-2.4) and engaging in meaningful dialogue with peers (VR group: median 4.0, IQR 4.0-4.0; videoconference group: median 3.5, IQR 3.3-3.8). Open-ended responses regarding VR use indicated increased immersion experiences and intrinsic motivation for PA.

CONCLUSIONS

These findings suggest that VR may be a useful medium for social PA programming in older adults, given it was found to be feasible and acceptable in this sample. Importantly, all participants indicated low levels of VR-related sickness before randomization, and both groups demonstrated very high attendance at meetings with their groups and behavioral coaches, which is promising for using VR and videoconference in future interventions. Modifications for future iterations of similar interventions are provided. Further work using larger samples and longer follow-up durations is needed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04756245; https://www.clinicaltrials.gov/study/NCT04756245.

Classification of EEG evoked in 2D and 3D virtual reality: traditional machine learning versus deep learning

Backgrounds. Virtual reality (VR) simulates real-life events and scenarios and is widely utilized in education, entertainment, and medicine. VR can be presented in two dimensions (2D) or three dimensions (3D), with 3D VR offering a more realistic and immersive experience. Previous research has shown that electroencephalogram (EEG) profiles induced by 3D VR differ from those of 2D VR in various aspects, including brain rhythm power, activation, and functional connectivity. However, studies focused on classifying EEG in 2D and 3D VR contexts remain limited.Methods. A 56-channel EEG was recorded while visual stimuli were presented in 2D and 3D VR. The recorded EEG signals were classified using two machine learning approaches: traditional machine learning and deep learning. In the traditional approach, features such as power spectral density (PSD) and common spatial patterns (CSP) were extracted, and three classifiers-support vector machines (SVM), K-nearest neighbors (KNN), and random forests (RF)-were used. For the deep learning approach, a specialized convolutional neural network, EEGNet, was employed. The classification performance of these methods was then compared.Results. In terms of accuracy, precision, recall, and F1-score, the deep learning method outperformed traditional machine learning approaches. Specifically, the classification accuracy using the EEGNet deep learning model reached up to 97.86%.Conclusions. EEGNet-based deep learning significantly outperforms conventional machine learning methods in classifying EEG signals induced by 2D and 3D VR. Given EEGNet's design for EEG-based brain-computer interfaces (BCI), this superior classification performance suggests that it can enhance the application of 3D VR in BCI systems.

Neuroimaging and perceptual-cognitive expertise in sport: A narrative review of research and future directions

Perceptual-cognitive expertise is crucial in domains that require rapid extraction of information for anticipation (e.g., sport, aviation, warfighting). Yet, published reports on the neuroscience of perceptual-cognitive expertise in such dynamic performance environments focus almost exclusively on biological motion processing (i.e., action observation network), leaving gaps in knowledge about the neural mechanisms underlying other frequently cited perceptual-cognitive skills, such as pattern recognition, the use of contextual priors, and global processing. In this paper, we provide a narrative review of research on the neural mechanisms underlying perceptual-cognitive expertise in sport, a domain where individuals possess highly specialized perceptual-cognitive skills (i.e., expertise) that enable successful performance in dynamic environments. Additionally, we discuss how work from domains with more static, predictable stimuli for perception and decision-making (e.g., radiology, chess) can enhance understanding of the neuroscience of expertise in sport. In future, efforts are needed to address the neural mechanisms underpinning less studied perceptual-cognitive skills (i.e., pattern recognition, contextual priors, global processing) and to explore how experts prioritize these skills within different contexts, thereby enhancing our understanding of perceptual-cognitive expertise across numerous professional domains.

Preregistered test of whether a virtual nose reduces cybersickness

Recent findings suggest that adding a visual depiction of a nose to virtual reality displays (virtual nose) can reduce motion sickness. If so, this would be a simple intervention that could improve the experience of a variety of VR applications. However, only one peer-reviewed study has reported a benefit from a virtual nose, and the effect was observed in a single low-powered experiment. To further test the effectiveness of a virtual nose for mitigating motion sickness in VR, we performed a preregistered experiment with higher power and better control. Subjects were presented with simulated movement in a virtual environment using a head-mounted display, and the resulting motion sickness was measured using the Fast Motion Sickness Scale (FMS) and the Simulator Sickness Questionnaire (SSQ). Conditions with and without a virtual nose were tested in separate sessions on different days, and the mean habituation effects were removed analytically. Awareness of the manipulation was assessed with a funnel debriefing procedure. The sample size (n = 32) was chosen to have over 90% power to detect the estimated effect size based on previous data (dz = 0.6). We found no significant difference between motion sickness in conditions with and without the virtual nose. The estimated effect size was close to zero, dz = - 0.02, with a 95% credible interval [- 0.37, 0.33]. Results from a Bayesian analysis imply that any benefit from a virtual nose is unlikely to be more than a 26% reduction in FMS scores, and any cost is unlikely to be more than a 23% increase. Our results do not support the hypothesis that a virtual nose is a general and effective way to relieve motion sickness in virtual reality.

How Does Virtual Reality Technology Affect Suicidal Ideation in Society?

Mental health issues such as anxiety and depression are on the rise in communities. Ignoring severe mental health issues can lead to suicide, which is a global public health issue. The use of advanced tools and methods to prevent suicide can help save human lives. Visual tools and virtual technologies have multiple applications in the medical and educational fields. The aim of this study was to investigate the effect of using virtual reality (VR) technology on suicidal thoughts. A quasi-experimental study was conducted, in which 189 individuals who had a history of suicide were tested. These individuals were divided into three groups: one control group and two intervention groups that received traditional and VR-based training for 90 days. The Beck Scale for Suicide Ideation was used. The posttest results after the training period showed that conducting the training course had a statistically significant effect on individuals' suicidal behaviour and those who participated in the VR-based training course had better improvements in suicidal thoughts. Therefore, the use of 3D simulation and visualisation tools can have a significant impact on individuals' thoughts and perceptions. The results of this study have practical implications for hospital managers and counsellors in healthcare centres to use VR technology in counselling and training courses to improve the behaviour of individuals with a history of suicide.

Junior and senior students possess differential preferences towards multimodal digital anatomy resources

Digital technologies are changing how anatomy is taught tremendously. However, little is known about the effective integration of multimodal digital resources when concurrently provided in an anatomy course. To address this question, an array of digital anatomy resources including Augmented Reality (AR) and Virtual Reality (VR) anatomy resources were concurrently trialed by a total of 326 undergraduate and postgraduate students across three undergraduate (systemic anatomy, neuroanatomy, and regional anatomy) and one postgraduate anatomy (applied musculoskeletal anatomy) curricula in 2022. A five-point Likert scale learning and teaching survey was conducted to evaluate students' experiences, preferences, and perceptions. Most undergraduate (81% systemic anatomy, 76% neuroanatomy, and 87% regional anatomy) and postgraduate (97%) participants across the four cohorts felt confident in studying anatomy using digital resources and the majority (>80% undergraduate and >90% postgraduate) found the multimodal digital anatomy resources interactive and stimulating. The response showed that undergraduate (77% systemic anatomy, 81% neuroanatomy, and 97% regional anatomy) and postgraduate students (92%) consistently enjoyed their experience of using multimodal digital anatomy resources and thought that these resources enhanced their interest in studying anatomy. However, there are significant differences in ratings of specific digital resources among the junior (first-year undergraduates) and senior (third-year undergraduates and postgraduates) students. The virtual dissection table was uniformly preferred by the four cohorts of students across the board. Interestingly, however, VR anatomy and radiographic-based digital anatomy resources received diverse ratings. VR anatomy was valued most by junior undergraduate students (84%) who studied systemic anatomy compared to their senior counterparts (73%) who studied regional anatomy, whereas radiographic-based digital anatomy resources were more valued by the postgraduate students (93%) compared to undergraduates (65% systemic anatomy, 73% neuroanatomy, and 48% regional anatomy). This study identifies that while students uniformly appreciate the value of multimodal digital anatomy teaching, there is a clear difference in their perceptions towards individual resources, likely in a course-specific manner. We conclude that the selection and adoption of digital anatomy tools must be tailored as part of course design and that digital anatomy tools should be used in combination to provide an effective learning experience for students.

Examining the applicability of virtual battle space for stress management training in military personnel-A validation study

Military personnel are often exposed to high levels of both physical and psychological challenges in their work environment and therefore it is important to be trained on how to handle stressful situations. The primary aim of this study was to examine whether military-specific virtual battle space (VBS) scenarios could elicit a physiological and subjective stress response in healthy military personnel, as compared to that of a virtual reality height exposure (VR-HE) stress task that has shown to reliably increase stress levels. Twenty participants engaged in two VBS scenarios and the VR-HE during separate sessions, while measurements of heart rate (HR), heart rate variability (HRV), respiration rate, and subjective stress levels were collected. Contrary to our initial expectations, analysis revealed that neither of the VBS scenarios induced a significant stress response, as indicated by stable HR, HRV, and low subjective stress levels. However, the VR-HE task did elicit a significant physiological stress response, evidenced by increased HR and HRV changes, aligning with previous research findings. Moreover, no discernible alterations were detected in cognitive performance subsequent to these stressors. These results suggest that the current VBS scenarios, despite their potential, may not be effective for stress-related training activities within military settings. The absence of a significant stress response in the VBS conditions points to the need for more immersive and engaging scenarios. By integrating interactive and demanding elements, as well as physical feedback systems and real-time communication, VBS training might better mimic real-world stressors and improve stress resilience in military personnel. The findings of this study have broader implications for stress research and training, suggesting the need for scenario design improvements in virtual training environments to effectively induce stress and improve stress management across various high-stress professions.

Development of neonatal Apgar scoring training program utilizing contactless hand tracking in immersive virtual reality

BACKGROUND

The rapid and accurate assessment of neonatal asphyxia is critical to preventing potentially fatal outcomes. Therefore, nursing students must acquire the skills to assess newborn conditions immediately after birth and implement appropriate interventions. Virtual reality (VR) simulation education has emerged as a promising tool for nursing education, offering repetitive and customizable clinical training while ensuring patient safety and overcoming spatiotemporal limitations.

AIM

This study investigated the effects of a contactless hand-tracking-based immersive VR neonatal Apgar scoring program, adapted from experiential learning theory.

DESIGN

A non-randomized controlled trial with a pre-post-test, quasi-experimental design was conducted.

SETTINGS

The study was conducted at two nursing schools from July to October 2023.

PARTICIPANTS

Participants comprised nursing students holding bachelor's degrees in nursing, with three or four years of experience and successful completion of a neonatal nursing theory course. Additionally, individuals with at least six months of experience working in a neonatal ward or delivery room before enrolling in nursing school were eligible.

METHODS

The participants were divided into three groups: the VR group (n = 27) received contactless hand-tracking-based immersive VR neonatal Apgar scoring training; the simulation group (n = 28) received face-to-face Apgar scoring simulation training; and the control group (n = 26) received instruction on the Apgar scoring criteria. Changes in scores among the VR, simulation, and control groups were statistically compared using ANOVA with SPSS-WIN 27.0.

RESULTS

The VR group exhibited significant improvements in knowledge, learning satisfaction, self-confidence, immersion, and motivation compared to the simulation and control groups. Moreover, satisfaction was significantly higher in the VR group than in the simulation group.

CONCLUSIONS

The hand-tracking-based immersive VR neonatal Apgar scoring program represents an innovative and effective educational tool, prioritizing the privacy and rights of mothers and infants. It can potentially replace traditional delivery-room clinical training, which is observation-based and limited.

Multidisciplinary Design-Based Multimodal Virtual Reality Simulation in Nursing Education: Mixed Methods Study

BACKGROUND

The COVID-19 pandemic underscored the necessity for innovative educational methods in nursing. Our study takes a unique approach using a multidisciplinary simulation design, which offers a systematic and comprehensive strategy for developing virtual reality (VR) simulations in nursing education.

OBJECTIVE

The aim of this study is to develop VR simulation content for a pediatric nursing module based on a multidisciplinary simulation design and to evaluate its feasibility for nursing education.

METHODS

This study used a 1-group, posttest-only design. VR content for pediatric nursing practice was developed by integrating the technological characteristics of a multimodal VR system with the learning elements of traditional nursing simulation, combining various disciplines, including education, engineering, and nursing. A user test was conducted with 12 nursing graduates (preservice nurses) followed by post hoc surveys (assessing presence, VR systems, VR sickness, and simulation satisfaction) and in-depth, one-on-one interviews.

RESULTS

User tests showed mean scores of 4.01 (SD 1.43) for presence, 4.91 (SD 0.81) for the VR system, 0.64 (SD 0.35) for VR sickness, and 5.00 (SD 1.00) for simulation satisfaction. In-depth interviews revealed that the main strengths of the immersive VR simulation for pediatric pneumonia nursing were effective visualization and direct experience through hands-on manipulation; the drawback was keyword-based voice interaction. To improve VR simulation quality, participants suggested increasing the number of nursing techniques and refining them in more detail.

CONCLUSIONS

This VR simulation content for a pediatric nursing practice using a multidisciplinary educational design model was confirmed to have positive educational potential. Further research is needed to confirm the specific learning effects of immersive nursing content based on multidisciplinary design models.

SAFEvR MentalVeRse.app: Development of a Free Immersive Virtual Reality Exposure Therapy for Acrophobia and Claustrophobia

Background: Specific phobias impact over 400 million people worldwide. Digitalizing mental health could alleviate the burden. Still, although the corporate-driven Metaverse is expanding rapidly, there needs to be more momentum in harnessing virtual reality exposure therapy uptake. Objective: This study aims to conceptualize, develop, and deploy a free Virtual Reality Exposure Therapy (VRET) application specifically designed for treating acrophobia and claustrophobia. This pilot study, which holds the promise of a future where mental health is more accessible and effective, explores the feasibility of leveraging transdisciplinary collaboration among specialists to create a safe, accessible, and effective VRET solution. Methods: We conducted a Delphi heuristic approach involving bioethicists, neuroscientists, and tech developers. Second, we reviewed the existing psychological theories and therapeutic strategies for addressing phobias in VR. Third, we conceptualized a thematic analysis-derived framework for a safe, adaptive-gamified free exposure to virtual reality acrophobia and claustrophobia (SAFEvR ACT). Finally, we provide an overview of the iterative improvements made during 12 workshops and 76 weekly briefings on developmental implementations. Results: We developed the SAFEvR ACT into a proof-of-concept application freely deployed on the MentalVerse app platform. Our safety-focused approach can benefit from prevalidation perspectives within future randomized control trials. Conclusions: The resulting application derived from the SAFEvR ACT framework represents a blueprint to counter the current lack of iVR mental health uptake by offering a free VRET alternative. Future research should aim towards developing similar free platforms to lessen mental health burdens and gather quantitative data. We conclude with a call to action to researchers to fine-tune our current approach and take a stand for free digital mental health within MentalVeRse.app.

Virtual reality as an engaging and enjoyable method for delivering emergency clinical simulation training: a prospective, interventional study of medical undergraduates

BACKGROUND

It is a requirement that medical students are educated in emergencies and feel well prepared for practice as a doctor, yet national surveys show that many students feel underprepared. Virtual reality (VR), combined with 360-degree filming, provides an immersive, realistic, and interactive simulation experience. Unlike conventional in-person simulation, it is scalable with reduced workforce demands. We sought to compare students' engagement and enjoyment of VR simulation to desktop computer-based simulation.

METHODS

We conducted a prospective, interventional, evaluation study. The study was carried out on final year medical students undertaking their Pre-Foundation Assistantship (n = 116) at Imperial College School of Medicine (ICSM) in London. We compared objective engagement, subjective engagement, and subjective enjoyment of VR simulation to desktop computer-based simulation using cardiac arrest and life-threatening asthma scenarios. Engagement was measured objectively using students' physiological parameters, including heart rate and eye tracking, and facilitator observations using the validated 'Behavioural Engagement Related to Instruction' (BERI) protocol. Students' subjective engagement and enjoyment levels were measured using a post-session survey.

RESULTS

Students' maximum heart rates were significantly higher during VR simulation with a mean difference of 4.2 beats per minute (3.2 to 5.2, p < 0.001), and eye tracking showed they spent a significantly greater mean percentage of time of 6.4% (5.1 to 7.7, p < 0.001) focusing on the scenarios in VR compared to standard desktop. Qualitative data showed students enjoyed and felt engaged with the sessions, which provided a safe space for learning.

CONCLUSIONS

Our study shows that students found VR simulations enjoyable and were more engaged compared to standard desktop simulation. This suggests that 360-degree VR simulation experiences provide students with immersive, realistic training, which is scalable, giving them the unique opportunity to manage emergencies and work within emergency teams, which would not typically occur during traditional training.

Immersive VR for upper-extremity rehabilitation in patients with neurological disorders: a scoping review

BACKGROUND

Neurological disorders, such as stroke and chronic pain syndromes, profoundly impact independence and quality of life, especially when affecting upper extremity (UE) function. While conventional physical therapy has shown effectiveness in providing some neural recovery in affected individuals, there remains a need for improved interventions. Virtual reality (VR) has emerged as a promising technology-based approach for neurorehabilitation to make the patient's experience more enjoyable. Among VR-based rehabilitation paradigms, those based on fully immersive systems with headsets have gained significant attention due to their potential to enhance patient's engagement.

METHODS

This scoping review aims to investigate the current state of research on the use of immersive VR for UE rehabilitation in individuals with neurological diseases, highlighting benefits and limitations. We identified thirteen relevant studies through comprehensive searches in Scopus, PubMed, and IEEE Xplore databases. Eligible studies incorporated immersive VR for UE rehabilitation in patients with neurological disorders and evaluated participants' neurological and motor functions before and after the intervention using clinical assessments.

RESULTS

Most of the included studies reported improvements in the participants rehabilitation outcomes, suggesting that immersive VR represents a valuable tool for UE rehabilitation in individuals with neurological disorders. In addition, immersive VR-based interventions hold the potential for personalized and intensive training within a telerehabilitation framework. However, further studies with better design are needed for true comparison with traditional therapy. Also, the potential side effects associated with VR head-mounted displays, such as dizziness and nausea, warrant careful consideration in the development and implementation of VR-based rehabilitation programs.

CONCLUSION

This review provides valuable insights into the application of immersive VR in UE rehabilitation, offering the foundation for future research and clinical practice. By leveraging immersive VR's potential, researchers and rehabilitation specialists can design more tailored and patient-centric rehabilitation strategies, ultimately improving the functional outcome and enhancing the quality of life of individuals with neurological diseases.

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.

Collaborative virtual reality environment in disaster medicine: moving from single player to multiple learners

BACKGROUND

The use of virtual reality (VR) in healthcare education is on the increase. In disaster medicine, it could be a solution to the cost and logistic constraints for a "full-scale" scenarios. However, VR is mainly designed for single players, which is not appropriate for the objectives pursued in disaster medicine. We decided to evaluate the educational value of using individual VR simulation in disaster medicine on a group of learners.

METHODS

The VR scenario used was a reproduction of a major train crash, with 21 victims and whose objectives were START triage and first aid techniques. The sessions were carried out in multi-participant groups with different roles (active and immersed with headset, paper triage without headset, and active for communications not immersed in the headset). Their perceived self-efficacy was assessed before (T0), after (T1) and 2 months (T2) after the training. Satisfaction and confidence in learning were also measured.

RESULTS

The median levels of satisfaction and confidence in learning were of 21/25 and 32/40 respectively. Their perceived self-efficacy increased significantly between T0 and T1 (p < 0.001), and remained stable until T2. The different roles of participant showed no difference in terms of satisfaction, confidence in learning or changes in perceived self-efficacy. One third of the participants agreed that the number of participants had interfered with their learning. A significant negative correlation (rS = -0.51, p = 0.002) was found between satisfaction and the fact of having been hindered by the number of participants. Around 90% of participants found the activity entertaining and found the new technologies appropriate for learning technical skills.

CONCLUSIONS

This first experience of VR in a group setting is satisfactory and shows its positive effects. The limitations highlighted here will enable areas of improvement to be identified for the use of VR in disaster medicine, pending the development of multi-player tools. It would now be appropriate to analyse the impact of this type of simulation on learning and its retention over time.

Methodological approaches and competence areas of nursing students in virtual reality simulation research - A scoping review

OBJECTIVES

To analyze methodological approaches (theoretical frameworks, study designs, methods) and competence areas of nursing students in research on virtual reality simulations (VRS) with a high level of immersion.

METHODS

A scoping review was performed. A systematic search of the literature was conducted on MEDLINE, CINAHL and ERIC databases on 30/11/22. In addition, a manual search was utilized. The extracted data relating to the research questions was descriptively analyzed and results were narratively summarized.

RESULTS

In total 23 studies were included in the review. Selected studies employed a wide range of theoretical frameworks and research designs. The studies aimed to develop competences both through complex interventions where team-based skills are required in acute situations, and they described basic nursing interventions where individual skills are required in non-acute nursing care.

CONCLUSIONS

A significant amount of the selected studies did not utilize a learning theory or an instructional design framework as a basis for their research. More knowledge was found on training specific skills compared to facilitating the attitudes and values of the participants. Therefore, there is a need for further research on whether nursing students' attitudes and values can be supported through VRS with a high level of immersion.

Is it getting hot in here? The effects of VR headset microclimate temperature on perceived thermal discomfort, VR sickness, and skin temperature

Thermal discomfort is a driver of negative user experiences with modern VR headsets since they are similar to head-worn gaming computers. Here, we examined the effect of microclimate temperature (MCT; i.e., the air between headset and user) and the effect of standing and seated use on thermal discomfort for a goggle style headset. Users played VR games across three 48-min sessions with different thermal profiles ranging between 28°-43 °C. Perceived thermal and weight discomfort were rated by participants every 12-min. Thermal, but not weight comfort declined during the study period as MCT increased. Users sweat more and had greater forehead temperatures while standing with the lowest thermal profile, suggesting thermal management is more critical for active experiences. Overall, this study recommends MCT should be kept below 36 °C. Finally design for thermal comfort should be tailored to the individual, experience duration and activity level.

Use of Virtual Reality Simulations to Embody a Patient: Exploring the Impact on Nursing Students' Confidence, Feelings, and Perceptions

BACKGROUND

Using immersive virtual reality (VR), students are able to physically and emotionally embody patients while interacting in simulated environments with family and health care providers.

PURPOSE

This pilot study explored how embodying patients with Alzheimer disease and terminal cancer at end of life using highly immersive VR impacted nursing students' confidence, feelings, and perceptions.

METHODS

A quasi-experimental design was used with a convenience sample of bachelor of science in nursing students who completed pre/posttest scaled and open-ended questions.

RESULTS

Participants (N = 32) reported significant confidence increases; feelings about dying and hospice were also significantly changed. The majority described how the simulations would impact their future nursing care.

CONCLUSION

Using VR, students experienced disease, dying, and health care from the patient's perspective reporting differences in confidence, feelings, and perceptions. Immersive VR simulations warrant further study and have the potential to transform nursing education and impact health care.

Prebrief Time for Immersive Virtual and Augmented Reality Simulation: An Integrative Review

BACKGROUND

Virtual reality and augmented technology are rapidly advancing and hold the potential to transform nursing education by offering a convenient, efficient, learner-centered way to educate students. A comprehensive and time-oriented prebrief is essential to the process.

PURPOSE

This review analyzes the status of scientific exploration regarding the prebrief and time allotments for virtual and augmented reality simulation.

METHODS

Whittemore and Knafl's 5-stage method guided this integrative review. The authors searched 6 databases and selected 7 articles based on inclusion criteria.

RESULTS

The findings from this review demonstrated objectives, a safe learning environment, orientation, preparation materials, and time in the prebrief; yet, inconsistencies persist in the virtual and augmented reality prebrief.

CONCLUSIONS

Defining a comprehensive and consistent prebrief is essential for high-quality simulation. A more standardized process, including time allotments, must be established for virtual and augmented reality.

Virtual reality and critical care education in nursing: A cross-sectional study

BACKGROUND

The nursing care of a critically ill patient in the intensive care unit requires specific training. Virtual reality can facilitate the nursing assessment of critically ill patients.

OBJECTIVE

To evaluate the utility of virtual reality as a tool for teaching nursing assessment of critically ill patients.

DESIGN

This is a cross-sectional study.

SETTING

University of the Balearic Islands (Spain) during the 2022 academic year.

PARTICIPANTS

Third-year nursing students.

METHODS

A specific environment was designed for virtual reality immersion using a BNEXT head-mounted display. Data were collected using three questionnaires: perception of self-efficacy regarding skill-acquisition in the nursing care process; immersivity; utility and tool satisfaction.

RESULTS

A total of 111 undergraduated nursing students responded, 86.8 % of whom had no previous intensive care units experience. They rated the virtual reality experience positively for learning the nursing care process, emphasising the need for skin and mucosal hygiene, patient mobilisation and family care, as well as an understanding of the therapeutic technology required. A total of 67.6 % felt as though they were physically present. They reported a high degree of acceptance and satisfaction.

CONCLUSIONS

Virtual reality has facilitated the exposure of students to an unfamiliar environment such as the intensive care units, proving to be useful, satisfying, and motivating in teaching the nursing care process.

What factors influence continuous usage intention of head-mounted display-based virtual reality content?: a cross-sectional survey

PURPOSE

The aim of this study was to explore the continuous usage intention of head-mounted display-based virtual reality (HMD-based VR) content among college students. The study also sought to understand how this intention is influenced by factors related to personal cognition, social aspects, VR content, and HMD-related elements.

METHODS

This descriptive correlational study used a self-report questionnaire to survey 217 students from two universities in Korea who had prior experience with HMD-based VR content.

RESULTS

The mean score for continuous usage intention of HMD-based VR content was 2.59±0.57 points (range, 1-5 points). Regarding the average frequency of HMD-based VR content usage, 64.5% of participants reported using it 1 to 2 times, while 91.7% indicated a total HMD-based VR usage period of less than 6 months. Factors such as personal cognition, VR content, social aspects, and HMD-related elements had explanatory power of 35.1%, 10.7%, 4.4%, and 2.5%, respectively, for the continuous usage intention of HMD-based VR content. Additionally, engagement (β=.45, p<.001), influential others (β=.37, p<.001), environmental support (β=-.18, p=.030), and cyber sickness (β=-.21, p=.001) were identified as having a significant influence.

CONCLUSION

When developing HMD-based VR content, strategies to improve users' personal cognition should be included. Additionally, it is necessary to develop strategies that enhance enjoyment and interest in the content, while also facilitating ongoing social support. Furthermore, coping strategies should be devised that take into account cyber sickness, a potential side effect of these devices.

A study on how to improve users' perceived playfulness in and continuance intention with VR technology to paint in virtual natural landscapes

COVID-19 has adversely affected public access to public green spaces. As a means of interacting with nature, parks and green spaces are an important aspect of residents' daily lives. In this study, the focus is on new digital solutions, such as the experience of painting in virtual natural settings through virtual reality technologies. This study examines factors that affect the user's perceived playfulness and continuance intention to paint in a virtual environment. A total of 732 valid samples were collected through a questionnaire survey, and a theoretical model was developed through structural equation model by analyzing attitude, perceived behavioral control, behavioral intention, continuance intention, and perceived playfulness. Results demonstrate that perceived novelty and perceived sustainability increase the positive attitude of users toward VR painting functions, whereas perceived interactivity and aesthetics have no impact on it within VR painting context. As users use VR painting, they are more concerned about time and money than equipment compatibility. This makes resource facilitating conditions a more influential factor for perceived behavior control than technology facilitating conditions.

Artificial intelligence in virtual reality simulation for interprofessional communication training: Mixed method study

BACKGROUND

Virtual reality simulations are shown to be an effective approach for interprofessional nurse-physician communication training. However, its scalability is constrained by unequal medical-nursing cohort size, rendering a great challenge for all nursing students to form an interprofessional team with medical students. With the evolution of artificial intelligence (AI), an AI medical team player can be integrated into virtual reality simulations for more nursing students to engage in interprofessional team training.

OBJECTIVES

To describe the development of a novel AI-enabled virtual reality simulation (AI-enabled VRS) and to evaluate nursing students' competencies and experiences in communicating with an AI medical doctor.

METHODS

A mixed-methods design using a one-group pretest-posttest design and focus group discussions were employed in the evaluation phase. Nursing students from a university were recruited to undertake the 2-hour AI-enabled VRS. Pre-test and post-tests were administered to evaluate the participants' communication knowledge and self-efficacy. Survey questionnaires were administered to examine their experiences with the virtual reality environment and the AI doctor. Five focus group discussions were conducted to gain deeper insight into their learning experiences.

RESULTS

The participants demonstrated significant improvements in communication knowledge and interprofessional communication self-efficacy after the learning. They reported positively on the acceptability, feasibility and usability of the AI-enabled VRS. The subscale of "human-like" feature of the AI medical doctor was rated the lowest. Three themes surrounding participants' experiences of the virtual learning emerged: "relate to the real world", "artificial intelligence versus human intelligence" and "complement with face-to-face learning".

CONCLUSIONS

This study demonstrates initial evidence on the potential of AI-enabled VRS in fostering nursing students' learning on interprofessional communication skills. The findings have also provided insights on how to improve the AI-enabled VRS, in particular, the expressiveness of the AI pedagogical agent and facilitating more dialogue trainings with learner-agent conversations.

Virtual reality does not fool the brain only: spinal excitability changes during virtually simulated falling

Virtual reality (VR) is known to induce substantial activation of brain's motor regions. It remains unclear to what extent virtual reality can trigger the sensorimotor system, and more particularly, whether it can affect lower nervous levels. In this study, we aimed to assess whether VR simulation of challenging and stressful postural situations (Richie's plank experience) could interfere with spinal excitability of postural muscles in 15 healthy young participants. The H-reflex of the triceps surae muscles was elicited with electrical nerve stimulation while participants were standing and wearing a VR headset. Participants went through several conditions, during which stimulations were evoked: standing still (noVR), standing in VR on the ground (groundVR), standing on the edge of a building (plankVR), and falling from the building (fallingVR). Myoelectrical activity of the triceps surae muscles was measured throughout the experiment. Leg and head movements were also measured by means of accelerometers to account for body oscillations. First, no differences in head rotations and myoelectrical activity were to be noted between conditions. Second, triceps H-reflex (H_MAX/M_MAX) was not affected from noVR to groundVR and plankVR. The most significant finding was a drastic decrease in H-reflex during falling (-47 ± 26.9% between noVR and fallingVR, P = 0.015). It is suggested that experiencing a postural threat in VR efficiently modulates spinal excitability, despite remaining in a quiet standing posture. This study suggests that simulated falling mimics the neural adjustments observed during actual postural challenge tasks.NEW & NOTEWORTHY The present study showed a modulation of spinal excitability induced by virtual reality (VR). In the standing position, soleus H-reflex was downmodulated during a simulated falling, in the absence of apparent changes in body oscillations. Since the same behavior is usually observed during real falling, it was suggested that the visual cues provided by VR were sufficiently strong to lead the neuromuscular system to mimic the actual modulation.

Determinants of Learning Anatomy in an Immersive Virtual Reality Environment - A Scoping Review

Given the decline of cadavers as anatomy teaching tools, immersive virtual reality (VR) technology has gained popularity as a potential alternative. To better understand how to maximize the educational potential of VR, this scoping review aimed to identify potential determinants of learning anatomy in an immersive VR environment. A literature search yielded 4523 studies, 25 of which were included after screening. Six common factors were derived from secondary outcomes in these papers: cognitive load, cybersickness, student perceptions, stereopsis, spatial understanding, and interactivity. Further objective research investigating the impact of these factors on anatomy examination performance is required.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01701-y.

The affordances of clinical simulation immersive technology within healthcare education: a scoping review

Whilst clinical simulation is established as an effective education tool within the healthcare community, the inability to offer authentic educational learning environments remains problematic. Advances in technology such as immersive virtual reality offer new opportunities to enhance traditional practice to an extent that may transform learning. However, with traditional clinical simulation stress and anxiety can both hinder performance and learning, yet it is unknown what nuances are applicable within a clinical virtual simulation environment. Determining potential benefits, drawbacks (including related stress and anxiety) and affordances of immersive technology clinical simulation designs may help provide an understanding of its usefulness. The aim of this scoping review is to investigate the range and nature of evidence associated with immersive virtual reality clinical simulation and education design. In addition, the review will describe authentic immersive technology clinical simulation use and reported stress response measurements. A search of seven electronic database and grey literature was performed in accordance with the Joanna Briggs Institute methodology. A key term search strategy was employed with five themes identified and investigated: (1) Healthcare professionals, (2) Clinical simulation, (3) Immersive virtual reality, (4) Stress/anxiety and (5) Authentic learning design. Application of the search strategy resulted in a hit total of 212 articles. Twelve articles met inclusion criteria. With most literature focusing on procedural performance and non-transferable education needs, there was a paucity of research that specifically investigated immersive virtual reality clinical simulation education and related stress. Therefore, this scoping review contributes new understandings by providing valuable insight and potential research gaps into current immersive virtual reality clinical simulation, its relationship to stress and the education design models currently being utilised to develop these concepts.

Virtual Reality for Vision Science

Virtual reality (VR) allows us to create visual stimuli that are both immersive and reactive. VR provides many new opportunities in vision science. In particular, it allows us to present wide field-of-view, immersive visual stimuli; for observers to actively explore the environments that we create; and for us to understand how visual information is used in the control of behaviour. In contrast with traditional psychophysical experiments, VR provides much greater flexibility in creating environments and tasks that are more closely aligned with our everyday experience. These benefits of VR are of particular value in developing our theories of the behavioural goals of the visual system and explaining how visual information is processed to achieve these goals. The use of VR in vision science presents a number of technical challenges, relating to how the available software and hardware limit our ability to accurately specify the visual information that defines our virtual environments and the interpretation of data gathered in experiments with a freely moving observer in a responsive environment.

"Sense of Presence" in Immersive Virtual Reality Environment: An Evolutionary Concept Analysis

There is no concept analysis in the literature about "sense of presence" in immersive virtual reality environment in the context of nursing clinical education. The purpose of this article is to explore the meaning and derive an operational definition of the concept of sense of presence within the context of immersive virtual reality environment in nursing clinical education. Using Rodgers' approach, this evolutionary concept analysis will clarify the concept's surrogate and related terms, attributes, antecedents, and consequences. A clearer conceptualization is paramount to help provide knowledge for nurses and other health care professionals, thus guiding their practice, theory, and research.

Effect of Visually Induced Motion Sickness from Head-Mounted Display on Cardiac Activity

Head-mounted display (HMD) virtual reality devices can facilitate positive experiences such as co-presence and deep immersion; however, motion sickness (MS) due to these experiences hinders the development of the VR industry. This paper proposes a method for assessing MS caused by watching VR content on an HMD using cardiac features. Twenty-eight undergraduate volunteers participated in the experiment by watching VR content on a 2D screen and HMD for 12 min each, and their electrocardiogram signals were measured. Cardiac features were statistically analyzed using analysis of covariance (ANCOVA). The proposed model for classifying MS was implemented in various classifiers using significant cardiac features. The results of ANCOVA reveal a significant difference between 2D and VR viewing conditions, and the correlation coefficients between the subjective ratings and cardiac features have significant results in the range of -0.377 to -0.711 (for SDNN, pNN50, and ln HF) and 0.653 to 0.677 (for ln VLF and ln VLF/ln HF ratio). Among the MS classification models, the linear support vector machine achieves the highest average accuracy of 91.1% (10-fold cross validation) and has a significant permutation test outcome. The proposed method can contribute to quantifying MS and establishing viewer-friendly VR by determining its qualities.

Time in schizophrenia: a link between psychopathology, psychophysics and technology

It has been widely demonstrated that time processing is altered in patients with schizophrenia. This perspective review delves into such temporal deficit and highlights its link to low-level sensory alterations, which are often overlooked in rehabilitation protocols for psychosis. However, if temporal impairment at the sensory level is inherent to the disease, new interventions should focus on this dimension. Beyond more traditional types of intervention, here we review the most recent digital technologies for rehabilitation and the most promising ones for sensory training. The overall aim is to synthesise existing literature on time in schizophrenia linking psychopathology, psychophysics, and technology to help future developments.

Effect of Immersive Virtual Reality on Post-Baccalaureate Nursing Students’ In-Dwelling Urinary Catheter Skill and Learning Satisfaction

A fundamental skill required from nursing students is how to manage the insertion of in-dwelling urinary catheters, and this skill is a core competency for nurses. However, practice with conventional test models is insufficient for learning this skill and leads to inadequate proficiency among students. To address this problem, this study created an immersive virtual reality (IVR) scheme, based on the theory of situated learning, to simulate clinical situations. Innovative approaches were adopted to design clinical cases, construct three-dimensional environments, design character dialogs, and integrate artificial intelligence voice recognition. The effect of these design elements on students’ in-dwelling urinary catheter skills and learning satisfaction was explored. First, nursing experts assessed the quality of the IVR scheme. Over a 4-week period, 43 students in a post-baccalaureate nursing program used conventional test models to practice the management of in-dwelling urinary catheters in female patients, and their learning was supplemented by at least two practice sessions with IVR. Data were collected from in-class observation records, a questionnaire survey on student satisfaction, and focused group interviews. The results showed that the participating students were highly satisfied with the IVR scheme and stated that it provided a pleasurable learning experience and exerted a positive impact on them. The IVR scheme provided situations closely resembling real clinical environments, helping the students to memorize the steps for catheter management. The students also noted that the IVR scheme should incorporate other nursing skills, such as empathetical and solicitous care and patient companionship. This enables nursing students to fulfill their role and care for patients in clinical settings.

The Advances of Immersive Virtual Reality Interventions for the Enhancement of Stress Management and Relaxation among Healthy Adults: A Systematic Review

The rapid changes in human contacts due to the COVID-19 crisis have not only posed a huge burden on the population’s health but may have also increased the demand for evidence-based psychological programs delivered through digital technology. A systematic review, following the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines, was therefore conducted to explore the advances in stress management interventions utilizing VR and suggest up-to-date directions for future practice. The relevant literature was screened and the search resulted in 22,312 records, of which 16 studies were considered for analysis. The Methodological Index for Non-Randomized Studies (MINORS) was also employed to assess the quality of the included studies. The results suggest that VR-based interventions can facilitate positive changes in subjective stress levels and stress-related biomarkers. However, special attention should be paid to the development of rigorous VR protocols that embrace natural elements and concepts deriving from traditional treatment approaches, such as cognitive behavioral therapy techniques. Overall, this review aims to empower future researchers to grasp the opportunity that the COVID-19 pandemic generated and utilize digital technologies for strengthening individuals’ mental health. Future projects need to conduct large-scale VR studies to evaluate their effectiveness compared to other mental health interventions.

The use of virtual reality in patient education related to medical somatic treatment: A scoping review

OBJECTIVE

To map the available evidence on the context, content and outcome of VR in patient education in situations related to preparation for medical somatic treatment.

METHODS

A Scoping review. In October 2020, the Embase, CINAHL, MEDLINE and PsycINFO databases were searched with the terms 'Virtual Reality' and 'Patient Education'. The literature was synthesised and mapped with a narrative approach.

RESULTS

17 studies published between 2015 and 2020 were included in the qualitative synthesis. VR was applied in (paediatric) surgery and radiation therapy treatment. VR interventions were heterogeneous regarding technical applications, context of implementation, guidance by healthcare professionals and integration in education sessions. Anxiety reduction was demonstrated significantly in some studies. Patients experienced VR education useful; it enhanced understanding, improved communication with healthcare professionals and encouraged treatment compliance.

CONCLUSIONS

The application of VR in patient education is a promising technology. Patients are highly satisfied and experience enhanced understanding. VR education was not effective in reducing all anxiety, pain and stress and improving preparedness for treatment. Practice implications It is important to develop VR interventions profoundly. The application of a methodological framework for VR development is recommended. Involve patients, educationalists and technology professionals in the development of technology interventions.

Effects of Restorative Environment and Presence on Anxiety and Depression Based on Interactive Virtual Reality Scenarios

Anxiety and depression have been growing global mental health problems. The following studies explored the effect of interactive VR scenarios to find a low-cost and high-efficiency solution. Study 1 designed a 2 (anxiety and depression state) × 4 (interactive VR scenarios) experiment, the results of 20 participants showed that the designed scenarios had good restoration and presence, assisting to improve depression mood for people with mild to moderate anxiety and depression. Study 2 further investigated the intervention effects of two environment types (urban and park) and four interactive activities (automatic viewing, free-roaming, fishing, and watering plants in the park environment), based on data from a 10-minute experiment conducted by 195 participants with mild to moderate anxiety and depression. The subjective scales, EEG and EMG, and scenario experience were analyzed and the results showed that: (1) the restorative and present VR scenarios were beneficial in alleviating state anxiety and depression; (2) the restorative environment and presence were significantly and positively related to the reduction of anxiety and depression respectively, moreover, presence mediated the restorative environment on the recovery from anxiety and depression; (3) the environmental settings, the complexity of interaction, human factors, and maturity of VR devices and technology were also key factors that influenced the effects of interactive VR scenario experience and intervention. These studies revealed VR psychological intervention scenarios could be designed with comprehensive factors. Moreover, they might help pave the way for future study in exploring the physiology and psychology mode in virtual and real spaces, enhancing intervention effectiveness.

Immersive media experience: a survey of existing methods and tools for human influential factors assessment

Virtual reality (VR) applications, especially those where the user is untethered to a computer, are becoming more prevalent as new hardware is developed, computational power and artificial intelligence algorithms are available, and wireless communication networks are becoming more reliable, fast, and providing higher reliability. In fact, recent projections show that by 2022 the number of VR users will double, suggesting the sector was not negatively affected by the worldwide COVID-19 pandemic. The success of any immersive communication system is heavily dependent on the user experience it delivers, thus now more than ever has it become crucial to develop reliable models of immersive media experience (IMEx). In this paper, we survey the literature for existing methods and tools to assess human influential factors (HIFs) related to IMEx. In particular, subjective, behavioural, and psycho-physiological methods are covered. We describe tools available to monitor these HIFs, including the user's sense of presence and immersion, cybersickness, and mental/affective states, as well as their role in overall experience. Special focus is placed on psycho-physiological methods, as it was found that such in-depth evaluation was lacking from the existing literature. We conclude by touching on emerging applications involving multiple-sensorial immersive media and provide suggestions for future research directions to fill existing gaps. It is hoped that this survey will be useful for researchers interested in building new immersive (adaptive) applications that maximize user experience.

Virtual Reality Technology as an Educational and Intervention Tool for Children with Autism Spectrum Disorder: Current Perspectives and Future Directions

The worldwide rising trend of autism spectrum disorder (ASD) calls for innovative and efficacious techniques for assessment and treatment. Virtual reality (VR) technology gains theoretical support from rehabilitation and pedagogical theories and offers a variety of capabilities in educational and interventional contexts with affordable products. VR is attracting increasing attention in the medical and healthcare industry, as it provides fully interactive three-dimensional simulations of real-world settings and social situations, which are particularly suitable for cognitive and performance training, including social and interaction skills. This review article offers a summary of current perspectives and evidence-based VR applications for children with ASD, with a primary focus on social communication, including social functioning, emotion recognition, and speech and language. Technology- and design-related limitations, as well as disputes over the application of VR to autism research and therapy, are discussed, and future directions of this emerging field are highlighted with regards to application expansion and improvement, technology enhancement, linguistic diversity, and the development of theoretical models and brain-based research.

Predictors of the Sense of Embodiment of a Female Victim of Sexual Harassment in a Male Sample Through 360-Degree Video-Based Virtual Reality

The sense of embodiment refers to the set of sensations related to having (i.e., ownership), being located in (i.e., location), and controlling (i.e., agency) a virtual body. Recently, 360-degree video-based Virtual Reality (VR) has been used to manipulate the sense of embodiment, generating the body-swap illusion, that is, the illusionary switch from the real body to a virtual one. However, the psychological mechanisms involved in this illusion are still unknown. The present study is a secondary analysis of the study by Ventura et al. (2021) investigating the feasibility of 360-degree video to induce the body swap from a male's real body to a female virtual body in a sexual harassment virtual environment. In addition, the study explores whether the sense of presence and psychological trait variables related to sexual harassment (i.e., machismo, chivalry, alexithymia, empathic abilities) predict the illusion of owning the body of a female victim of sexual harassment. Forty-four men participated in the study, and the results indicate that the 360-degree video is able to induce the body-swap illusion for location and ownership, but not for agency. Multiple regression analyses showed that the sense of presence was a predictor of the three dimensions of embodiment, but specific psychological traits (i.e., low scores on machismo, high scores on difficulties expressing feelings, and high scores on perspective taking) were also predictor variables of experiencing a greater sense of location and agency in the female virtual body. This study shows that both technological issues and participants' psychological traits are involved in the experience of the body-swap illusion in a sexual harassment scenario using 360-degree video-based VR.

A Pilot Study to Investigate the Role of Virtual Reality in the Preservice Training of Nursing Staff in Isolation Wards

Healthcare providers without working experience in isolation wards experience enormous challenges. Traditional ward orientation is constrained by space, time, and even infection risk in particular periods (eg, the coronavirus disease 2019 pandemic). Virtual reality has been used widely, but rarely in wards. This study aimed to explore the experience of utilizing virtual reality for isolation ward training among nurses. In this study, nurses completed virtual reality training via an online platform and were then trained in isolation wards, after which their perceptions were explored by questionnaire and interviews. A total of 1868 participants completed the training. Most participants thought the preservice training was important and believed the virtual reality experience was consistent with the in-person training. Virtual reality was found not only to be convenient and valuable for training but also to have the benefits of occupational protection. However, whereas 50.48% of participants wanted to learn the ward via virtual reality, 87.21% of participants wanted to learn via in-person training before working in the wards. As a substitute for in-person training, virtual reality is a feasible and practical instrument to provide preservice training in particular periods. However, there is room for improvement due to general discomfort and technological problems.

Vibrotactile feedback in virtual motor learning: A systematic review

Vibrotactile feedback can be effectively applied to motor (physical) learning in virtual environments, as it can provide task-intrinsic and augmented feedback to users, assisting them in enhancing their motor performance. This review investigates current uses of vibrotactile feedback systems in motor learning applications built upon virtual environments by systematically synthesizing 24 peer-reviewed studies. We aim to understand: (1) the current state of the science of using real-time vibrotactile feedback in virtual environments for aiding the acquisition (or improvement) of motor skills, (2) the effectiveness of using vibrotactile feedback in such applications, and (3) research gaps and opportunities in current technology. We used the Sensing-Analysis-Assessment-Intervention framework to assess the scientific literature in our review. The review identifies several research gaps in current studies, as well as potential design considerations that can improve vibrotactile feedback systems in virtual motor learning applications, including the selection and placement of feedback devices and feedback designs.

Comparing Direct and Indirect Methods of Audio Quality Evaluation in Virtual Reality Scenes of Varying Complexity

Many quality evaluation methods are used to assess uni-modal audio or video content without considering perceptual, cognitive, and interactive aspects present in virtual reality (VR) settings. Consequently, little is known regarding the repercussions of the employed evaluation method, content, and subject behavior on the quality ratings in VR. This mixed between- and within-subjects study uses four subjective audio quality evaluation methods (viz. multiple-stimulus with and without reference for direct scaling, and rank-order elimination and pairwise comparison for indirect scaling) to investigate the contributing factors present in multi-modal 6-DoF VR on quality ratings of real-time audio rendering. For each between-subjects employed method, two sets of conditions in five VR scenes were evaluated within-subjects. The conditions targeted relevant attributes for binaural audio reproduction using scenes with various amounts of user interactivity. Our results show all referenceless methods produce similar results using both condition sets. However, rank-order elimination proved to be the fastest method, required the least amount of repetitive motion, and yielded the highest discrimination between spatial conditions. Scene complexity was found to be a main effect within results, with behavioral and task load index results implying more complex scenes and interactive aspects of 6-DoF VR can impede quality judgments.

Implementation and Evaluation of a Virtual Reality Simulation: Intravenous Injection Training System

In nursing education, virtual reality simulation (VRS) is recognized as an effective learning method as it overcomes limitations in practical training and positively influences learning ability and satisfaction levels. The purpose of this study was to develop VRS for intravenous (IV) injection and investigate how it affects nursing students' academic knowledge, performance confidence, and clinical practice competencies. A quasi-experimental control group pretest and post-test design was used. Participants were nursing students who either received a training system for an IV injection through VRS (experimental group; n = 20) or who received an IV arm simulator (control group; n = 20). The results revealed significantly higher knowledge (U = 156.5, p = 0.024) and clinical performance competency (U = 87.5, p = 0.002) with the procedure of using a training system of VRS for IV injection compared to having training via an IV arm simulator. This study verified that VRS for IV injection was more effective than an IV arm simulator for practical training on IV injection. Thus, VRS for IV injection, an effective teaching method used to improve learning ability and satisfaction levels, can be used as a training method in the future.

An Exploratory EEG Analysis on the Effects of Virtual Reality in People with Neuropathic Pain Following Spinal Cord Injury

Neuropathic pain in people with spinal cord injury is thought to be due to altered central neuronal activity. A novel therapeutic intervention using virtual reality (VR) head-mounted devices was investigated in this study for pain relief. Given the potential links to neuronal activity, the aim of the current study was to determine whether use of VR was associated with corresponding changes in electroencephalography (EEG) patterns linked to the presence of neuropathic pain. Using a within-subject, randomised cross-over pilot trial, we compared EEG activity for three conditions: no task eyes open state, 2D screen task and 3D VR task. We found an increase in delta activity in frontal regions for 3D VR with a decrease in theta activity. There was also a consistent decrease in relative alpha band (8-12 Hz) and an increase in low gamma (30-45 Hz) power during 2D screen and 3D VR corresponding, with reduced self-reported pain. Using the nonlinear and non-oscillatory method of extracting fractal dimensions, we found increases in brain complexity during 2D screen and 3D VR. We successfully classified the 3D VR condition from 2D screen and eyes opened no task conditions with an overall accuracy of 80.3%. The findings in this study have implications for using VR applications as a therapeutic intervention for neuropathic pain in people with spinal cord injury.

Virtual Reality Therapy in Palliative Care: A Case Series

OBJECTIVES

Virtual reality (VR) opens a variety of therapeutic options to improve symptom burden in patients with advanced disease. Until to date, only few studies have evaluated the use of VR therapy in the context of palliative care. This case series aims to evaluate the feasibility and acceptability of VR therapy in a population of palliative care patients.

METHODS

In this single-site case series, we report on six palliative care patients undergoing VR therapy. The VR therapy consisted of a one-time session ranging between 20 to 60 minutes depending on the patient's needs and the content chosen for the VR sessions. A semi-structured survey was conducted and the Edmonton Symptom Assessment System (ESAS) and the Distress Thermometer were performed pre- and post-intervention.

RESULTS

Overall, VR therapy was well accepted by all patients. Five out of six patients reported having appreciated VR therapy. There were individual differences of perceived effects using VR therapy. The semi-structured survey revealed that some patients felt a temporary detachment from their body and that patients were able to experience the VR session as a break from omnipresent worries and the hospital environment ("I completely forgot where I am"). There was a considerable reduction in the total ESAS score post-treatment (T0 ESASTot = 27.2; T1 ESASTot = 18.8) and a slightly reduction in distress (T0 DTTot = 4.4; T1 DTTot = 3.8). However, two patients were more tired after the intervention.Significance of Results: Our preliminary results demonstrate that VR therapy is acceptable, feasible and safe for use within a palliative care population and appears to be a viable treatment option. Clinical trials are both warranted and necessary to confirm any therapeutic effects of VR therapy, as is the need to tailor VR systems better for use in palliative care settings.

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.

The Impact of Virtual Reality Exposure on Stress Level and Sense of Competence in Ambulance Workers

Virtual reality (VR) exposure is used in clinical psychology to treat anxiety disorders. It is also used to enhance resilience in soldiers by allowing them to confront virtual combat environments to help fortify them against the negative consequences of trauma exposure. Most VR studies have focused on military and emergency medical staff; however, thus far, none have investigated VR in ambulance workers (AWs), who are confronted with traumatic situations daily. The current study aimed to assess the impact of a single VR exposure session on self-perceived competence and stress level in a sample of AWs. Participants (N = 40) were randomly assigned to either a VR immersion (i.e., experimental group, n = 20) or an audio immersion (i.e., control group, n = 20) of a shooting attack situation. We hypothesized that compared to controls, VR participants would report decreased anxiety, as measured using visual analog scales, as well as an increased sense of competence. The results showed a significant reduction in fear in both groups, d = 0.33, and an increased sense of competence in VR participants, d = 0.35. Although our hypotheses were only partially confirmed, the observed beneficial effects of VR and the audio immersion on stress levels in AWs suggest that VR exposure could be a useful way to increase resilience in AWs.

The impact of three-dimensional visualisation on midwifery student learning, compared with traditional education for teaching the third stage of labour: A pilot randomised controlled trial

BACKGROUND

Complex physiological processes are often difficult for midwifery students to comprehend when using traditional teaching and learning approaches. Face to face instructional workshops using simulation have had some impact on improving understanding. However, in the 21st century new technologies offer the opportunity to provide alternative learning approaches.

AIM

To investigate the impact of using three-dimensional (3D) visualisation in midwifery education on student's experience of learning, and retention of knowledge at three points in time.

DESIGN

A pilot study involving a two-armed parallel Randomised Controlled Trial (RCT) comparing the retention of knowledge scores between the control and intervention groups.

SETTING

An Australian University in the Northern Territory.

PARTICIPANTS

The sample included second year Bachelor of Midwifery students (n = 38). All received traditional midwifery education before being randomly allocated to either the intervention (n = 20) or control (n = 18) group.

METHODS

A new immersive virtual environment was introduced to complement existing traditional midwifery education on the third stage of labour. This intervention was evaluated using a demographic survey and multiple-choice questionnaire to collect baseline information via Qualtrics. To measure change in knowledge and comprehension, participants completed the same multiple-choice knowledge questionnaire at three time points; pre, immediately post and at 1 month post intervention. In addition, the intervention group completed a 3D student satisfaction survey.

RESULTS

Baseline knowledge scores were similar between the groups. A statistically significant increase in knowledge score was evident immediately post intervention for the intervention group, however there was no significant difference in knowledge score at one month.

CONCLUSIONS

The results support the creation of further three-dimensional visualisation teaching resources for midwifery education. However, a larger randomised controlled study is needed to seek generalisation of these findings to confirm enhanced student learning and retention of knowledge post 3DMVR, beyond the immediate exposure time.

Feasibility and safety of an immersive virtual reality-based vestibular rehabilitation programme in people with multiple sclerosis experiencing vestibular impairment: a protocol for a pilot randomised controlled trial

INTRODUCTION

Vestibular system damage in patients with multiple sclerosis (MS) may have a central and/or peripheral origin. Subsequent vestibular impairments may contribute to dizziness, balance disorders and fatigue in this population. Vestibular rehabilitation targeting vestibular impairments may improve these symptoms. Furthermore, as a successful tool in neurological rehabilitation, immersive virtual reality (VRi) could also be implemented within a vestibular rehabilitation intervention.

METHODS AND ANALYSIS

This protocol describes a parallel-arm, pilot randomised controlled trial, with blinded assessments, in 30 patients with MS with vestibular impairment (Dizziness Handicap Inventory ≥16). The experimental group will receive a VRi vestibular rehabilitation intervention based on the conventional Cawthorne-Cooksey protocol; the control group will perform the conventional protocol. The duration of the intervention in both groups will be 7 weeks (20 sessions, 3 sessions/week). The primary outcomes are the feasibility and safety of the vestibular VRi intervention in patients with MS. Secondary outcome measures are dizziness symptoms, balance performance, fatigue and quality of life. Quantitative assessment will be carried out at baseline (T0), immediately after intervention (T1), and after a follow-up period of 3 and 6 months (T2 and T3). Additionally, in order to further examine the feasibility of the intervention, a qualitative assessment will be performed at T1.

ETHICS AND DISSEMINATION

The study was approved by the Andalusian Review Board and Ethics Committee, Virgen Macarena-Virgen del Rocio Hospitals (ID 2148-N-19, 25 March 2020). Informed consent will be collected from participants who wish to participate in the research. The results of this research will be disseminated by publication in peer-reviewed scientific journals.

TRIAL REGISTRATION NUMBER

NCT04497025.

Testing the Effects of a Virtual Reality Game for Aggressive Impulse Management: A Preliminary Randomized Controlled Trial among Forensic Psychiatric Outpatients

Prior laboratory experiments among healthy samples found that training avoidance movements to angry faces may lower anger and aggression, especially people high in trait anger. To enrich this training and make it more suitable for clinical applications, the present researchers developed it into a Virtual Reality Game for Aggressive Impulse Management (VR-GAIME). The current study examined the effects of this training in a randomized controlled trial among forensic psychiatric outpatients with aggression regulation problems (N = 30). In addition to the aggression replacement training, patients played either the VR-GAIME or a control game. Aggressive behavior was measured pre-, half-way, and post-treatment via self-report and clinicians ratings. No difference was found between the VR-GAIME and the control game. However, the participants reported gaining more insight into their own behavior and that of others. Future VR intervention tools in clinical settings may capitalize more on their benefits for self-reflection within interpersonal settings.