Virtual exertions: evoking the sense of exerting forces in virtual reality using gestures and muscle activity

Virtual reality-enhanced rehabilitation for improving musculoskeletal function and recovery after trauma

Orthopedic trauma remains a critical challenge in modern healthcare, often resulting in severe mobility limitations, acute pain, and delayed recovery. Conventional rehabilitation techniques, though effective, fail to address the individualized, high-precision interventions needed for musculoskeletal injuries like fractures, joint instability, ligament tears, and muscular atrophy. Virtual reality (VR) technologies, such as Apple Vision Pro and HTC Vive Pro, offer a transformative approach by enhancing diagnostic precision, rehabilitation effectiveness, and patient engagement through interactive, immersive environments that improve clinical outcomes. These VR technologies provide real-time biomechanical data, such as joint mechanics, muscle coordination, and movement patterns, allowing clinicians to design personalized rehabilitation programs. These technologies can thus facilitate neuromuscular re-education, improve muscle proprioception, and enhance muscle coordination. Studies have shown that VR-based rehabilitation advances functional recovery, improves pain management, and reduces psychological barriers associated with immobility. VR also facilitates telemedicine, increasing accessibility for patients with geographic or mobility issues. However, while VR may provide biomechanical data, it is important to note that they fall short in accurate motion tracking, particularly in fine motor control tasks. This scoping review follows PRISMA guidelines to explore the potential of VR in orthopedic rehabilitation, analyzing its diagnostic capabilities, personalized interventions, and real-time feedback systems. Despite this, barriers remain, including regulatory challenges, limitations in haptic feedback, high cost, and patient compliance. By presenting a balanced perspective on the landscape of VR in orthopedic care, this paper emphasizes the need for rigorous clinical validation, regulatory advancements, and interdisciplinary collaboration. Ultimately, VR offers the potential to significantly improve recovery outcomes, enhance patient engagement, and streamline rehabilitation protocols, but its successful integration into clinical practice must be approached with both optimism and caution.

Alterations in Physical Demands During Virtual/Augmented Reality-Based Tasks: A Systematic Review

The digital world has recently experienced a swift rise in worldwide popularity due to Virtual (VR) and Augmented Reality (AR) devices. However, concrete evidence about the effects of VR/AR devices on the physical workload imposed on the human body is lacking. We reviewed 27 articles that evaluated the physical impact of VR/AR-based tasks on the users using biomechanical sensing equipment and subjective tools. Findings revealed that movement and muscle demands (neck and shoulder) varied in seven and five studies while using VR, while in four and three studies during AR use, respectively, compared to traditional methods. User discomfort was also found in seven VR and three AR studies. Outcomes indicate that interface and interaction design, precisely target locations (gestures, viewing), design of virtual elements, and device type (location of CG as in Head-Mounted Displays) influence these alterations in neck and shoulder regions. Recommendations based on the review include developing comfortable reach envelopes for gestures, improving wearability, and studying temporal effects of repetitive movements (such as effects on fatigue and stability). Finally, a guideline is provided to assist researchers in conducting effective evaluations. The presented findings from this review could benefit designers/evaluations working towards developing more effective VR/AR products.

Task-Oriented and Imitation-Oriented Movements in Virtual Reality Exercise Performance and Design

OBJECTIVE

This study investigated the influence of game features and practice type on human kinematic and muscular performance in a virtual reality exercise (VRE). Participants demonstrated changes in shoulder flexion angle and muscle activation under different virtual scenarios.

BACKGROUND

Conventional VRE studies often compared the outcomes between an experimental group that underwent exercise in VR and a real-world exercise control group, whereas comparisons between VRE programs are lacking. Besides, the attributes of VREs received little attention.

METHOD

Thirteen able-bodied participants performed upper extremity exercise movements in immersive VR using a head-mounted display. Participants performed task-oriented and imitation-oriented movements with different game features. Shoulder muscle activity (the deltoid, supraspinatus, and infraspinatus) and shoulder motion were collected.

RESULTS

Practice type (task-oriented, imitation-oriented) significantly influenced the flexion angle of the shoulder complex (F(1,11) = 9.53, p = .01), and the muscle activity of the supraspinatus (F(1,9) = 12.61, p = .006) and the infraspinatus (F(1,9) = 12.71, p = .006). Game features did not have a statistically significant effect on shoulder flexion angle or shoulder muscles' activations.

CONCLUSIONS

Compared to imitation-oriented practice, task-oriented practice elicited more intensive shoulder movements and muscular efforts but also induced greater movement variations. Substantial differences across game features levels should be further investigated to have significant effects.

APPLICATIONS

This research may help guide the design of future VREs. For strength training or rehabilitation where intensive practice is required, task-oriented practice should be considered; for movement learning where movement consistency is required, imitation oriented practice should be adopted.

Advances and Innovations in Ablative Head and Neck Oncologic Surgery Using Mixed Reality Technologies in Personalized Medicine

The benefit of computer-assisted planning in head and neck ablative and reconstructive surgery has been extensively documented over the last decade. This approach has been proven to offer a more secure surgical procedure. In the treatment of cancer of the head and neck, computer-assisted surgery can be used to visualize and estimate the location and extent of the tumor mass. Nowadays, some software tools even allow the visualization of the structures of interest in a mixed reality environment. However, the precise integration of mixed reality systems into a daily clinical routine is still a challenge. To date, this technology is not yet fully integrated into clinical settings such as the tumor board, surgical planning for head and neck tumors, or medical and surgical education. As a consequence, the handling of these systems is still of an experimental nature, and decision-making based on the presented data is not yet widely used. The aim of this paper is to present a novel, user-friendly 3D planning and mixed reality software and its potential application for ablative and reconstructive head and neck surgery.

A Systematic Review of Attentional Focus Strategies in Weightlifting

The way an athlete focuses their attention when lifting a weight has the potential to influence strength development during training and performance outcomes during competition. The effects of attentional focus strategies during weightlifting tasks was investigated through a systematic review. Major databases (SportDISCUS, PsycINFO, Scopus) were searched using key terms relevant to attentional focus and weightlifting and reference lists of identified articles were also searched. Following screening, 16 articles were retained for analysis. The review showed that researchers have recruited experienced and novice weightlifters of both genders in their studies, although male experienced weightlifters are the most commonly studied demographic. Weightlifting tasks have varied from bench press, biceps curls, squats, and leg extensions with some studies using measures of force production against a force plate. The predominant manipulations have been between internal-associative and external-associative foci. An external attentional focus has shown to be beneficial in terms of movement economy as reflected in a variety of outcome measures. The results are interpreted within the framework provided by the Constrained Action Hypothesis and more generally the advantages of an external attentional focus for motor skill learning. An external focus of attention promotes automatic control of actions, thus preventing the motor system being constrained by conscious cognitive control. Implications for informing training programs for athletes and for advising athletes to maximize performance during competition are discussed.

Affective and Attentional States When Running in a Virtual Reality Environment

Engaging in physical exercise in a virtual reality (VR) environment has been reported to improve physical effort and affective states. However, these conclusions might be influenced by experimental design factors, such as comparing VR environments against a non-VR environment without actively controlling for the presence of visual input in non-VR conditions. The present study addressed this issue to examine affective and attentional states in a virtual running task. Participants (n = 40), completed a 21 min run on a treadmill at 70% of Vmax. One group of participants ran in a computer-generated VR environment that included other virtual runners while another group ran while viewing neutral images. Participants in both conditions showed a pattern of reduced positive affect and increased tension during the run with a return to high positive affect after the run. In the VR condition, higher levels of immersive tendencies and attention/absorption in the virtual environment were associated with more positive affect after the run. In addition, participants in the VR condition focused attention more on external task-relevant stimuli and less to internal states than participants in the neutral images condition. However, the neutral images condition produced less negative affect and more enjoyment after the run than the VR condition. The finding suggest that the effects of exercising in a VR environment will depend on individual difference factors (e.g., attention/absorption in the virtual world) but it may not always be better than distracting attention away from exercise-related cues.

Evaluation of older driver head functional range of motion using portable immersive virtual reality

BACKGROUND

The number of drivers over 65 years of age continues to increase. Although neck rotation range has been identified as a factor associated with self-reported crash history in older drivers, it was not consistently reported as indicators of older driver performance or crashes across previous studies. It is likely that drivers use neck and trunk rotation when driving, and therefore the functional range of motion (ROM) (i.e. overall rotation used during a task) of older drivers should be further examined.

OBJECTIVE

Evaluate older driver performance in an immersive virtual reality, simulated, dynamic driving blind spot target detection task.

METHODS

A cross-sectional laboratory study recruited twenty-six licensed drivers (14 young between 18 and 35 years, and 12 older between 65 to 75 years) from the local community. Participants were asked to detect targets by performing blind spot check movements while neck and trunk rotation was tracked. Functional ROM, target detection success, and time to detection were analyzed.

RESULTS

In addition to neck rotation, older and younger drivers on average rotated their trunks 9.96° and 18.04°, respectively. The younger drivers generally demonstrated 15.6° greater functional ROM (p<.001), were nearly twice as successful in target detection due to target location (p=.008), and had 0.46 s less target detection time (p=.016) than the older drivers.

CONCLUSION

Assessing older driver functional ROM may provide more comprehensive assessment of driving ability than neck ROM. Target detection success and time to detection may also be part of the aging process as these measures differed between driver groups.