Virtual Reality Balance Games Provide Little Muscular Challenge to Prevent Muscle Weakness in Healthy Older Adults

Experiences and perceptions of palliative care patients receiving virtual reality therapy: a meta-synthesis of qualitative studies

BACKGROUND

The combination of virtual reality (VR) and palliative care potentially represents a new opportunity for palliative care. Many previous studies have evaluated the application of VR therapy to patients with advanced disease receiving palliative care. However, patient-perspective reviews to comprehensively understand the actual experiences and feelings of patients and provide practical guidance for designing future studies are currently lacking. This review of qualitative evidence aimed to explore the experiences and perceptions of patients receiving VR therapy in palliative care.

METHODS

This study was conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement guidelines. Ten databases, namely, PubMed, Web of Science, EBSCO, OVID MEDLINE, Scopus, John Wiley, ProQuest, CNKI, WANFANG DATA, and SinoMed, were searched, and qualitative and mixed studies from the establishment of each database to June 30, 2023 were included. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the quality of the included studies. The data included in the literature were analyzed and integrated by "thematic synthesis" to formalize the identification and development of themes.

RESULTS

The nine selected studies altogether included 156 participants from seven hospice care facilities of different types and two oncology centers. Three key themes were identified: experiences of palliative care patients in VR therapy, the perceived value that palliative care patients gain in VR therapy, and perspectives of palliative care patients toward using VR therapy.

CONCLUSIONS

The patients' feedback covered discomfort caused by VR devices, good sense of experiences, and situations that affected the interactive experience. Some patients were unable to tolerate VR therapy or reported newer forms of discomfort. The findings indicated that VR therapy may be an effective approach to relieve patients' physical and psychological pain and help them gain self-awareness. Moreover, patients showed a preference for personalized VR therapy.

Exploring the Psychological Nexus of Virtual and Augmented Reality on Physical Activity in Older Adults: A Rapid Review

With the global population of older adults projected to double to 2.1 billion by 2050, it becomes crucial to promote healthy aging to alleviate the associated disease burden. In this context, technology, particularly virtual reality (VR) and augmented reality (AR), has garnered attention for its potential to augment physical activity in older adults. These immersive technologies offer interactive and enjoyable exercise experiences, making physical activity more appealing. However, the effectiveness of these interventions is not solely attributed to technology itself but is deeply intertwined with psychological processes. This rapid review examines the effectiveness of VR and AR interventions in enhancing physical exercise among healthy older adults while exploring the role of psychological variables, including mood, self-efficacy, and motivation. The results of the study show that technology-enhanced physical activity interventions hold great promise but call attention to the need for a comprehensive understanding of psychological dynamics that will pave the way for more tailored and effective interventions. Future research endeavors should aim to bridge these gaps in knowledge to optimize the impact of technology on healthy aging.

Lower back muscle activity during weight-shifting is affected by ageing and dual-tasking

PURPOSE

Postural control deteriorates with age, especially under dual-task conditions. It is currently unknown how a challenging virtual reality weight-shifting task affects lower back muscle activity. Hence, this study investigated erector spinae neuromuscular control during mediolateral weight-shifting as part of an exergame during single- (ST) and dual-task (DT) conditions in young and older adults.

METHODS

Seventeen young and 17 older adults performed mediolateral weight-shifts while hitting virtual wasps in a virtual environment with and without a serial subtraction task (DT). Center of mass position was recorded in real-time using 3D motion capturing. Electromyography recorded bilateral activation of the lumbar longissimus and iliocostalis muscles.

RESULTS

Weight-shifting (p < 0.03) and targeting the wasps (p < 0.005) deteriorated with age and DT. Relative muscle activation during both quiet stance and weight-shifting increased with age, while the DT-effect did not differ consistently between age-groups. However, bilateral muscle co-contraction decreased with DT in young adults only. When switching direction and targeting the wasps, variability of muscle activation increased with age and DT and proved related to worse targeting performance. These effects were mainly visible at the non-dominant body side.

CONCLUSION

Older adults showed a higher erector spinae muscle contribution to perform weight-shifts with increased variability at the end of a shift, whereby muscle activity was modulated less well in older than in young adults in response to DT. Hence, the current findings point to the potential for developing postural training in which older adults learn to fine-tune trunk muscle activity to improve weight-shifting and reduce fall risk.

Research Status and Emerging Trends in Virtual Reality Rehabilitation: Bibliometric and Knowledge Graph Study

BACKGROUND

Virtual reality (VR) technology has been widely used in rehabilitation training because of its immersive, interactive, and imaginative features. A comprehensive bibliometric review is required to help researchers focus on future directions based on the new definitions of VR technologies in rehabilitation, which reveal new situations and requirements.

OBJECTIVE

Herein, we aimed to summarize effective research methods for and potential innovative approaches to VR rehabilitation by evaluating publications from various countries to encourage research on efficient strategies to improve VR rehabilitation.

METHODS

The SCIE (Science Citation Index Expanded) database was searched on January 20, 2022, for publications related to the application of VR technology in rehabilitation research. We found 1617 papers, and we created a clustered network, using the 46,116 references cited in the papers. CiteSpace V (Drexel University) and VOSviewer (Leiden University) were used to identify countries, institutions, journals, keywords, cocited references, and research hot spots.

RESULTS

A total of 63 countries and 1921 institutes have contributed publications. The United States of America has taken the leading position in this field; it has the highest number of publications; the highest h-index; and the largest collaborative network, which includes other countries. The reference clusters of SCIE papers were divided into the following nine categories: kinematics, neurorehabilitation, brain injury, exergames, aging, motor rehabilitation, mobility, cerebral palsy, and exercise intensity. The research frontiers were represented by the following keywords: video games (2017-2021), and young adults (2018-2021).

CONCLUSIONS

Our study comprehensively assesses the current research state of VR rehabilitation and analyzes the current research hot spots and future trends in the field, with the aims of providing resources for more intensive investigation and encouraging more researchers to further develop VR rehabilitation.

Virtual and augmented reality applications to improve older adults’ quality of life: A systematic mapping review and future directions

Objective

The use of virtual reality and augmented reality to improve older adults’ quality of life has rapidly increased in recent years. This systematic mapping review aimed to provide a comprehensive overview of existing research that identifies and classifies current virtual reality and augmented reality applications that enhance the quality of life of older adults to increase the understanding of the impact of these technologies.

Methods

To reach this objective, a systematic mapping review was conducted of the studies published between 2009 and 2020 in major scientific databases, such as IEEE Xplore, Web of Science, Scopus, and PubMed. A total of 57 studies were analyzed and classified into four main quality of life domains: physical, cognitive, psychological, and social well-being.

Results

The findings showed that virtual reality and augmented reality have found their places in many quality of life studies of older adults. Although virtual reality and augmented reality applications are notably growing in the physical and cognitive well-being domains in training and rehabilitation settings, they are still in the early stages of development in psychological and social well-being research as well as healthcare settings. Our findings also revealed that virtual reality games, particularly motion-based exergames, and 3D augmented reality systems are the most common virtual reality and augmented reality types among the reviewed studies. Moreover, balance and attention were the most prevalent physical and cognitive functions when using motion-based and immersive virtual reality exergames and augmented reality systems and games, respectively, while confidence and interaction were the most dominant psychological and social functions.

Conclusion

This mapping review provides a comprehensive overview of potential areas for further research in this field, thereby assisting researchers, technologists, and health practitioners in expanding this field of research.

Appraising Virtual Technologies' Impact on Older Citizens' Mental Health-A Comparative between 360° Video and Virtual Reality

Aging populations across the world are facing a number of challenges in the context of health and healthcare. These challenges are driven by the aging process and the illnesses associated with aging. Healthcare for older people has become a point of concern with most health organizations, and this is particularly the case with palliative care. In this instance, the movement of the patient may be restricted to a room with no or limited access to the outdoors. This research focuses on the active integration of immersive technologies with healthcare. By addressing the problem of providing patients with the experience of being present in an outdoors space, the associated psychological and physiological benefits can be identified. In this mixed methods research paper, the impact of a crossover study to discern technology preferences in relation to immersive technologies among a sample of older people is reported. In addition, the study highlights factors that contribute to a meaningful immersive experience that can improve psychological and physiological wellbeing. The study identifies that there are two significant categorical aspects that contribute to such immersive experiences, technological aspects (including, for example, the weight of headsets, visual impairment, pixelation, and gamification) and emotive aspects (for example, joy, anger, and fear). The study suggests that older people prefer immersive Virtual Reality (VR) environments rather than 360 video experiences. This can be attributed to the greater flexibility in the provision of interactivity in virtual reality systems.

Overground Walking in a Fully Immersive Virtual Reality: A Comprehensive Study on the Effects on Full-Body Walking Biomechanics

Virtual reality (VR) is an emerging technology offering tremendous opportunities to aid gait rehabilitation. To this date, real walking with users immersed in virtual environments with head-mounted displays (HMDs) is either possible with treadmills or room-scale (overground) VR setups. Especially for the latter, there is a growing interest in applications for interactive gait training as they could allow for more self-paced and natural walking. This study investigated if walking in an overground VR environment has relevant effects on 3D gait biomechanics. A convenience sample of 21 healthy individuals underwent standard 3D gait analysis during four randomly assigned walking conditions: the real laboratory (RLab), a virtual laboratory resembling the real world (VRLab), a small version of the VRlab (VRLab-), and a version which is twice as long as the VRlab (VRLab+). To immerse the participants in the virtual environment we used a VR-HMD, which was operated wireless and calibrated in a way that the virtual labs would match the real-world. Walking speed and a single measure of gait kinematic variability (GaitSD) served as primary outcomes next to standard spatio-temporal parameters, their coefficients of variant (CV%), kinematics, and kinetics. Briefly described, participants demonstrated a slower walking pattern (-0.09 ± 0.06 m/s) and small accompanying kinematic and kinetic changes. Participants also showed a markedly increased gait variability in lower extremity gait kinematics and spatio-temporal parameters. No differences were found between walking in VRLab+ vs. VRLab-. Most of the kinematic and kinetic differences were too small to be regarded as relevant, but increased kinematic variability (+57%) along with increased percent double support time (+4%), and increased step width variability (+38%) indicate gait adaptions toward a more conservative or cautious gait due to instability induced by the VR environment. We suggest considering these effects in the design of VR-based overground training devices. Our study lays the foundation for upcoming developments in the field of VR-assisted gait rehabilitation as it describes how VR in overground walking scenarios impacts our gait pattern. This information is of high relevance when one wants to develop purposeful rehabilitation tools.

Implementation of an Expanded Decision-Making Technique to Comment on Sweden Readiness for Digital Tourism

Tourism provides many advantages for Sweden and the whole world, as well as its travelers. Since almost all types of tourism are currently in crisis as a result of the current COVID-19 pandemic, information and communication technology is expected to play a role, not only during the crisis but also in the post-COVID-19 era. Thus, with no expectations from types of tourism, Sweden needs to broaden its digital tours. As a result, this letter aims to classify the transition readiness of industry clusters for this digitalization move. An extended version of the TOPSIS technique was formulated and validated, plus a new framework for measuring digitalization readiness for this purpose. Lastly, analysis of the collected data proves that business tourism could lead the change, though adventure and rural tourism are at the farthest point from being considered ready to change.

Can Exergames Be Improved to Better Enhance Behavioral Adaptability in Older Adults? An Ecological Dynamics Perspective

Finding effective training solutions to attenuate the alterations of behavior and cognition in the growing number of older adults is an important challenge for Science and Society. By offering 3D computer-simulated environments to combine perceptual-motor and cognitive exercise, exergames are promising in this respect. However, a careful analysis of meta-analytic reviews suggests that they failed to be more effective than conventional motor-cognitive training. We analyzed the reasons for this situation, and we proposed new directions to design new, conceptually grounded, exergames. Consistent with the evolutionary neuroscience approach, we contend that new solutions should better combine high level of metabolic activity with (neuro)muscular, physical, perceptual-motor, and cognitive stimulations. According to the Ecological Dynamics rationale, we assume that new exergames should act at the agent-environment scale to allow individuals to explore, discover, and adapt to immersive and informationally rich environments that should include cognitively challenging tasks, while being representative of daily living situations.

Developing a virtual reality for people with dementia in nursing homes based on their psychological needs: a feasibility study

Background

The purpose of this study was (1) to develop a virtual reality (VR) intervention program based on the psychological needs of patients residing in nursing facilities in South Korea to alleviate their behavioral and psychological symptoms and (2) to confirm the possibility of utilizing VR in patients with dementia.

Methods

In the first phase, patients with dementia residing in nursing homes and experiencing behavioral and psychological symptoms were recruited. Surveys and questionnaires were used to identify activities that alleviated the behavioral and psychological symptoms of dementia (BPSD) among the patients. These activities were classified into five types of psychological needs. In the second phase, a fully immersive, interactive, easy-to-use VR platform was developed that reflected these psychological needs. Patients with dementia experienced the VR content. The researchers assessed the level of the participants’ immersion, preference, and interaction with the VR using a 5-point Likert scale.

Results

In the feasibility test, 10 nursing home residents were recruited. The mean immersion score was 4.93 ± 0.16 points, the mean preference score was 4.35 ± 0.41 points, and the mean interaction score was 3.84 ± 0.43 points using a 5-point Likert scale. Higher mean scores indicated a more positive outcome. Six of the 10 participants required assistance while using the VR. The mean VR experience duration was 10.00 ± 3.46 min.

Conclusions

The VR-based intervention program that was developed to reduce BPSD was feasible for the participants and provided them with a high degree of satisfaction and immersion. Furthermore, this study also confirmed the convenience and safety of the program. These findings support the potential use of VR-based BPSD intervention programs to treat patients with dementia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02125-w.

Does a novel exergame challenge balance and activate muscles more than existing off-the-shelf exergames?

BACKGROUND

Novel balance-targeting exergames controlled with off-the-shelf hardware, were developed based on current recommendations for balance training in healthy older adults and documented shortcomings of existing games. The aim of this study was to explore the feasibility of these novel exergames as training tool for elderly and, more specifically whether these games can elicit more challenging weight shifts and higher levels of muscle activity compared to existing off-the-shelf exergames. Furthermore, the motivational pull in these new games was studied.

METHODS

Sixteen healthy older adults were recruited to play the novel games and two reference games that were found to be the most challenging ones in terms of weight shifts or muscle activity in previous studies. Weight shifts were expressed relative to participants' Functional Limits of Stability (FLOS). Muscular challenge of the games was quantified by dividing the signal into 200 ms blocks and determining the average muscle activity within these blocks. The muscle activity was normalized to maximal voluntary contractions (MVC) to categorize the blocks in zones of < 40, 40-60, 60-80 and > 80% MVC. Subsequently, the number of blocks per intensity level and the number of consecutive blocks above 40% were determined. Motivation to play the games was assessed using the Intrinsic Motivation Inventory (IMI) and scores between the games were analyzed using Generalized Estimated Equations (GEE).

RESULTS

The novel exergames successfully elicited center of mass (COM) displacements with medians of around 80% of FLOS or higher for all directions. Furthermore, the COM displacements in the novel games were larger for each direction than in the reference games, although for one game the sideward left direction reached significance only at the third trial. Compared to the existing games, longer blocks of muscle activation above 40% MVC were found, but overall intensity remained low. IMI scores were high on all subscales, indicating that older adults experienced the games as motivating.

CONCLUSION

We conclude that affordable hardware can be used to create challenging and enjoyable balance training programs using exergames. The exergames that were successful in eliciting challenging weight shifts and muscle activity should now be further studied in longitudinal randomized controlled interventions, to assess effects on balance, muscle strength and eventually fall risk in healthy older adults.