Immersive virtual reality reveals that visuo-proprioceptive discrepancy enlarges the hand-centred peripersonal space

Sensorimotor Uncertainty of Immersive Virtual Reality Environments for People in Pain: Scoping Review

INTRODUCTION

Decision making and action execution both rely on sensory information, and their primary objective is to minimise uncertainty. Virtual reality (VR) introduces uncertainty due to the imprecision of perceptual information. The concept of "sensorimotor uncertainty" is a pivotal element in the interplay between perception and action within the VR environment. The role of immersive VR in the four stages of motor behaviour decision making in people with pain has been previously discussed. These four processing levels are the basis to understand the uncertainty that a patient experiences when using VR: sensory information, current state, transition rules, and the outcome obtained.

METHODS

This review examines the different types of uncertainty that a patient may experience when they are immersed in a virtual reality environment in a context of pain. Randomised clinical trials, a secondary analysis of randomised clinical trials, and pilot randomised clinical trials related to the scope of Sensorimotor Uncertainty in Immersive Virtual Reality were included after searching.

RESULTS

Fifty studies were included in this review. They were divided into four categories regarding the type of uncertainty the intervention created and the stage of the decision-making model.

CONCLUSIONS

Immersive virtual reality makes it possible to alter sensorimotor uncertainty, but studies of higher methodological quality are needed on this topic, as well as an exploration into the patient profile for pain management using immersive VR.

Spatial proximity to others induces plastic changes in the neural representation of the peripersonal space

Peripersonal space (PPS) is a highly plastic "invisible bubble" surrounding the body whose boundaries are mapped through multisensory integration. Yet, it is unclear how the spatial proximity to others alters PPS boundaries. Across five experiments (N = 80), by recording behavioral and electrophysiological responses to visuo-tactile stimuli, we demonstrate that the proximity to others induces plastic changes in the neural PPS representation. The spatial proximity to someone else's hand shrinks the portion of space within which multisensory responses occur, thus reducing the PPS boundaries. This suggests that PPS representation, built from bodily and multisensory signals, plastically adapts to the presence of conspecifics to define the self-other boundaries, so that what is usually coded as "my space" is recoded as "your space". When the space is shared with conspecifics, it seems adaptive to move the other-space away from the self-space to discriminate whether external events pertain to the self-body or to other-bodies.

Multisensory-driven facilitation within the peripersonal space is modulated by the expectations about stimulus location on the body

Compelling evidence from human and non-human studies suggests that responses to multisensory events are fastened when stimuli occur within the space surrounding the bodily self (i.e., peripersonal space; PPS). However, some human studies did not find such effect. We propose that these dissonant voices might actually uncover a specific mechanism, modulating PPS boundaries according to sensory regularities. We exploited a visuo-tactile paradigm, wherein participants provided speeded responses to tactile stimuli and rated their perceived intensity while ignoring simultaneous visual stimuli, appearing near the stimulated hand (VTNear) or far from it (VTFar; near the non-stimulated hand). Tactile stimuli could be delivered only to one hand (unilateral task) or to both hands randomly (bilateral task). Results revealed that a space-dependent multisensory enhancement (i.e., faster responses and higher perceived intensity in VTNear than VTFar) was present when highly predictable tactile stimulation induced PPS to be circumscribed around the stimulated hand (unilateral task). Conversely, when stimulus location was unpredictable (bilateral task), participants showed a comparable multisensory enhancement in both bimodal conditions, suggesting a PPS widening to include both hands. We propose that the detection of environmental regularities actively shapes PPS boundaries, thus optimizing the detection and reaction to incoming sensory stimuli.

Vision of haptics tunes the somatosensory threshold

The interaction between different sensory modalities represents a crucial issue in the neuroscience of consciousness: when the processing of one modality is deficient, the concomitant presentation of stimuli of other spared modalities may sustain the restoring of the damaged sensory functions. In this regard, visual enhancement of touch may represent a viable tool in the rehabilitation from tactile disorders, yet the specific visual features mostly modulating the somatosensory experience remain unsettled. In this study, healthy subjects underwent a tactile detection task during the observation of videos displaying different contents, including static gratings, meaningless motions, natural or point-lights reach-to-grasp-and-manipulate actions. Concurrently, near-threshold stimuli were delivered to the median nerve at different time-points. Subjective report was collected after each trial; the sensory detection rate was computed and compared across video conditions. Our results indicate that the specific presence of haptic contents (i.e., vision of manipulation), either fully displayed or implied by point-lights, magnifies tactile sensitivity. The notion that such stimuli prompt an aware tactile experience opens to novel rehabilitation approaches for tactile consciousness disorders.

Wearing a Mask Shapes Interpersonal Space during COVID-19 Pandemic

Social distancing norms have been promoted after the COVID-19 pandemic. In this work, we tested interpersonal space (IPS) in 107 subjects through a reaching-comfort distance estimation task. In the main experiment, subjects had to estimate the comfort and reach space between an avatar wearing or not wearing a face mask. We found that IPS was greater between avatars not wearing a mask with respect to stimuli with the mask on, while reaching space was not modulated. IPS increment in the NoMask condition with respect to the Mask condition correlated with anxiety traits, as shown with the State-Trait Anxiety Inventory, rather than with transient aspects related to the pandemic situation. In the control experiment, the avatars with a mask were removed to further explore the conditioning effect provided by the presence of the facial protection in the main experiment. We found a significant difference comparing this condition with the same condition of the main experiment, namely, the distances kept between avatars not wearing a mask in the main experiment were greater than those between the same stimuli in the control experiment. This showed a contextual adaptation of IPS when elements related to the actual pandemic situation were relevant. Additionally, no significant differences were found between the control experiment and the Mask condition of the main experiment, suggesting that participants had internalized social distancing norms and wearing a mask has become the new normal. Our results highlight the tendency of people in underestimating the risk of contagion when in the presence of someone wearing a mask.

Diametrical modulation of tactile and visual perceptual thresholds during the rubber hand illusion: a predictive coding account

During the rubber hand illusion (RHI), the synchronous stroking of the participants' concealed hand and a visible rubber hand induces a conflict among visuo-tactile inputs, leading healthy subjects to perceive the illusion of being touched on the rubber hand, as if it were part of their body. The predictive coding theory suggests that the RHI emerges to settle the conflict, attenuating somatosensory inputs in favour of visual ones, which "capture" tactile sensations. Here, we employed the psychophysical measure of perceptual threshold to measure a behavioural correlate of the somatosensory and visual modulations, to better understand the mechanisms underpinning the illusion. Before and after the RHI, participants underwent a tactile (Experiment 1) and a visual (Experiment 2) task, wherein they had to detect stimuli slightly above the perceptual threshold. According to the predictive coding framework, we found a significant decrease of tactile detection (i.e. increased tactile perceptual threshold) and a significant increase of visual detection (i.e.  decreased visual perceptual threshold), suggesting a diametrical modulation of somatosensory and visual perceptual processes. These findings provide evidence of how our system plastically adapts to uncertainty, attributing different weights to sensory inputs to restore a coherent representation of the own body.

Visuo-proprioceptive integration and recalibration with multiple visual stimuli

To organize the plethora of sensory signals from our environment into a coherent percept, our brain relies on the processes of multisensory integration and sensory recalibration. We here asked how visuo-proprioceptive integration and recalibration are shaped by the presence of more than one visual stimulus, hence paving the way to study multisensory perception under more naturalistic settings with multiple signals per sensory modality. We used a cursor-control task in which proprioceptive information on the endpoint of a reaching movement was complemented by two visual stimuli providing additional information on the movement endpoint. The visual stimuli were briefly shown, one synchronously with the hand reaching the movement endpoint, the other delayed. In Experiment 1, the judgments of hand movement endpoint revealed integration and recalibration biases oriented towards the position of the synchronous stimulus and away from the delayed one. In Experiment 2 we contrasted two alternative accounts: that only the temporally more proximal visual stimulus enters integration similar to a winner-takes-all process, or that the influences of both stimuli superpose. The proprioceptive biases revealed that integration—and likely also recalibration—are shaped by the superposed contributions of multiple stimuli rather than by only the most powerful individual one.

Precision control for a flexible body representation

Adaptive body representation requires the continuous integration of multisensory inputs within a flexible 'body model' in the brain. The present review evaluates the idea that this flexibility is augmented by the contextual modulation of sensory processing 'top-down'; which can be described as precision control within predictive coding formulations of Bayesian inference. Specifically, I focus on the proposal that an attenuation of proprioception may facilitate the integration of conflicting visual and proprioceptive bodily cues. Firstly, I review empirical work suggesting that the processing of visual vs proprioceptive body position information can be contextualised 'top-down'; for instance, by adopting specific attentional task sets. Building up on this, I review research showing a similar contextualisation of visual vs proprioceptive information processing in the rubber hand illusion and in visuomotor adaptation. Together, the reviewed literature suggests that proprioception, despite its indisputable importance for body perception and action control, can be attenuated top-down (through precision control) to facilitate the contextual adaptation of the brain's body model to novel visual feedback.

Remote hand: Hand-centered peripersonal space transfers to a disconnected hand avatar

The space surrounding our body is called peripersonal space (PPS). It has been reported that visuo-tactile facilitation occurs more strongly within PPS than outside PPS. Furthermore, previous research has revealed several methods by which PPS can be extended. The present study provides the first behavioral evidence of the transfer of PPS in a virtual environment by a novel technique. PPS representation was investigated using a remote-controlled hand avatar presented far from the body in a virtual environment. Participants showed strongest visuo-tactile facilitation at the far space around the remote hand and no facilitation at the near space around the real hand, suggesting that PPS transfers from near the body to the space around the hand avatar. The present results extend previous findings of the plasticity of PPS and demonstrate flexibility of PPS representation beyond the physical and anatomical limits of body representation.

Interpersonal Motor Interactions Shape Multisensory Representations of the Peripersonal Space

This perspective review focuses on the proposal that predictive multisensory integration occurring in one's peripersonal space (PPS) supports individuals' ability to efficiently interact with others, and that integrating sensorimotor signals from the interacting partners leads to the emergence of a shared representation of the PPS. To support this proposal, we first introduce the features of body and PPS representations that are relevant for interpersonal motor interactions. Then, we highlight the role of action planning and execution on the dynamic expansion of the PPS. We continue by presenting evidence of PPS modulations after tool use and review studies suggesting that PPS expansions may be accounted for by Bayesian sensory filtering through predictive coding. In the central section, we describe how this conceptual framework can be used to explain the mechanisms through which the PPS may be modulated by the actions of our interaction partner, in order to facilitate interpersonal coordination. Last, we discuss how this proposal may support recent evidence concerning PPS rigidity in Autism Spectrum Disorder (ASD) and its possible relationship with ASD individuals' difficulties during interpersonal coordination. Future studies will need to clarify the mechanisms and neural underpinning of these dynamic, interpersonal modulations of the PPS.