Can Simulator Sickness Be Avoided? A Review on Temporal Aspects of Simulator Sickness

A randomized controlled trial of a self-led, virtual reality-based cognitive behavioral therapy on sick role adaptation in colorectal cancer patients: study protocol

BACKGROUND

Significant concomitants of the sick role maladaptation in colorectal cancer (CRC) patients include inappropriate cognitions, emotional states, and overt conducts associated to disease. This protocol was developed to implement and evaluate the effects of a self-led, virtual reality-based cognitive behavioral therapy (VR-CBT) on the sick role adaptation among working-age CRC patients.

METHODS

This is an assessor-blinded, randomized controlled trail that adheres to the SPIRIT 2013 Statement guidelines. A total of 60 working-age CRC patients will be recruited from the colorectal wards of a cancer center and randomly assigned to the VR-CBT group or attention control (AC) group. The VR-CBT group will receive a 7-sessions VR-CBT targeted to sick role adaptation, while the AC group will receive weekly attention at the same time the VR-CBT group receives the intervention. The sick role adaptation, anxiety and depression, illness perceptions, and quality of life will be measured at baseline, 1, 2 and 3-month after completion of the intervention. Side-effects related to VR in the VR-CBT group will be measured at the end of each session. The participants will receive invitations to participate in semi-structured interviews to explore their experiences with the intervention.

DISCUSSION

The positive outcomes and user experience of VR-CBT will advance researches on the effectiveness of psychosocial interventions that aims to promote adaptation to the unexpected sick role on cancer populations. This protocol can be tested as an accessible and feasible alternative to traditional high-cost treatment in a randomized controlled study to improve the outcomes of younger cancer survivors.

TRIAL REGISTRATION

The protocol was registered on 21 June, 2023 in Chinese Clinical Trial Registry (No.: ChiCTR2300072699) at https://www.chictr.org.cn/ .

Using a mixed-reality headset to elicit and track clinically relevant movement in the clinic

Background

21st century neurology will require scalable and quantitative tools that can improve neurologic evaluations over telehealth and expand access to care. Commercially available mixed-reality headsets allow for simultaneous presentation of stimuli via holograms projected into the real world and objective and quantitative measurement of hand movement, eye movement, and phonation.

Methods

We created 6 tasks designed to mimic standard neurologic assessments and administered them to a single participant via the Microsoft HoloLens 2 mixed-reality headset. The tasks assessed postural hand tremor, finger tapping, pronation and supination of hands, hand and eye tracking of a center-out task, hand and eye tracking of a random motion task, and vocal assessment.

Findings

We show the utility of the HoloLens for commonly used neurological exams. First, we demonstrate that headset-derived holograms can project hand movements and objects in 3D space, providing a method to accurately and reproducibly present test stimuli to reduce test-test variability. Second, we found that participant hand movements closely matched holographic stimuli using a variety of metrics calculated on recorded movement data. Third, we showed that the HoloLens can record and playback exam tasks for visual inspection, sharing with other medical providers, and future analysis. Fourth, we showed that vocal recordings and analysis could be used to profile vocal characteristics over time. Together, this demonstrates the versatility of mixed reality headsets and possible applications for neurological assessment.

Interpretation

Administering components of the neurologic exam via a self-contained and commercially available mixed-reality headset has numerous benefits including detailed kinematic quantification, reproducible stimuli presentation from test to test, and can be self-administered expanding access to neurological care and saving hospital time and money.

Virtual Reality Action Observation and Motor Imagery to Enhance Neuroplastic Capacity in the Human Motor Cortex: A Pilot Double-blind, Randomized Cross-over Trial

Neuroplasticity is important for learning, development and recovery from injury. Therapies that can upregulate neuroplasticity are therefore of interest across a range of fields. We developed a novel virtual reality action observation and motor imagery (VR-AOMI) intervention and evaluated whether it could enhance the efficacy of mechanisms of neuroplasticity in the human motor cortex of healthy adults. A secondary question was to explore predictors of the change in neuroplasticity following VR-AOMI. A pre-registered, pilot randomized controlled cross-over trial was performed. Twenty right-handed adults (13 females; mean age: 23.0 ± 4.53 years) completed two experimental conditions in separate sessions; VR-AOMI and control. We used intermittent theta burst stimulation (iTBS) to induce long term potentiation-like plasticity in the motor cortex and recorded motor evoked potentials at multiple timepoints as a measure of corticospinal excitability. The VR-AOMI task did not significantly increase the change in MEP amplitude following iTBS when compared to the control task (Group × Timepoint interaction p = 0.17). However, regression analysis identified the change in iTBS response following VR-AOMI was significantly predicted by the baseline iTBS response in the control task. Specifically, participants that did not exhibit the expected increase in MEP amplitude following iTBS in the control condition appear to have greater excitability following iTBS in the VR-AOMI condition (r = -0.72, p < 0.001). Engaging in VR-AOMI might enhance capacity for neuroplasticity in some people who typically do not respond to iTBS. VR-AOMI may prime the brain for enhanced neuroplasticity in this sub-group.

Effects of immersive virtual reality training on balance, gait and mobility in older adults: A systematic review and meta-analysis

OBJECTIVE

To examine whether immersive virtual reality (VR) can improve balance, gait, mobility and fear of falling in older people.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, PsycINFO, ProQuest Central (Engineering and Computer Science) and reference lists of included articles.

STUDY SELECTION

Randomised controlled trials that administered immersive VR training and assessed balance, gait and mobility outcomes in older adults without neurological disorders (mean age ≥ 65). Primary outcomes were standing balance (e.g. postural sway), multi-item balance scales (e.g. Berg Balance Scale), gait (e.g. gait speed) and mobility (e.g. Timed Up and Go test). Secondary outcomes comprised measures of enjoyment, fear of falling, adherence (e.g. dropout rate), feasibility/usability and adverse effects (e.g. motion sickness).

RESULTS

Meta-analyses showed that immersive VR training significantly improved standing balance (SMD: 0.51, 95% CI: .15, 0.86, p = 0.005, I2 = 28% - 3 studies, n = 79) and performance on the Berg Balance Scale (MD: 2.36, 95% CI: 1.17, 3.56, p=0.0001, I2=0% - 4 studies, n = 190). No significant improvement in gait, mobility or fear of falling was found. Subgroup analyses revealed higher training doses (≥4.5 total hours) and VR interventions using non-head mounted displays were more likely to improve standing balance. No meta-analyses were conducted for enjoyment, adherence, feasibility/usability and adverse events.

CONCLUSIONS

The findings indicate immersive VR has beneficial effects on balance, but not gait, mobility or fear of falling. Further research is required to examine these outcomes in trials that also include quantitative measurements of enjoyment, adherence, clinical feasibility, usability and adverse effects.

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.

Evaluation of power wheelchair driving performance in simulator compared to driving in real-life situations: the SIMADAPT (simulator ADAPT) project-a pilot study

OBJECTIVE

The objective of this study was to evaluate users' driving performances with a Power Wheelchair (PWC) driving simulator in comparison to the same driving task in real conditions with a standard power wheelchair.

METHODS

Three driving circuits of progressive difficulty levels (C1, C2, C3) that were elaborated to assess the driving performances with PWC in indoor situations, were used in this study. These circuits have been modeled in a 3D Virtual Environment to replicate the three driving task scenarios in Virtual Reality (VR). Users were asked to complete the three circuits with respect to two testing conditions during three successive sessions, i.e. in VR and on a real circuit (R). During each session, users completed the two conditions. Driving performances were evaluated using the number of collisions and time to complete the circuit. In addition, driving ability by Wheelchair Skill Test (WST) and mental load were assessed in both conditions. Cybersickness, user satisfaction and sense of presence were measured in VR. The conditions R and VR were randomized.

RESULTS

Thirty-one participants with neurological disorders and expert wheelchair drivers were included in the study. The driving performances between VR and R conditions were statistically different for the C3 circuit but were not statistically different for the two easiest circuits C1 and C2. The results of the WST was not statistically different in C1, C2 and C3. The mental load was higher in VR than in R condition. The general sense of presence was reported as acceptable (mean value of 4.6 out of 6) for all the participants, and the cybersickness was reported as acceptable (SSQ mean value of 4.25 on the three circuits in VR condition).

CONCLUSION

Driving performances were statistically different in the most complicated circuit C3 with an increased number of collisions in VR, but were not statistically different for the two easiest circuits C1 and C2 in R and VR conditions. In addition, there were no significant adverse effects such as cybersickness. The results show the value of the simulator for driving training applications. Still, the mental load was higher in VR than in R condition, thus mitigating the potential for use with people with cognitive disorders. Further studies should be conducted to assess the quality of skill transfer for novice drivers from the simulator to the real world. Trial registration Ethical approval n∘ 2019-A001306-51 from Comité de Protection des Personnes Sud Mediterranée IV. Trial registered the 19/11/2019 on ClinicalTrials.gov in ID: NCT04171973.

Exploring the perceptions of former ICU patients and clinical staff on barriers and facilitators to the implementation of virtual reality exposure therapy: A qualitative study

BACKGROUND

Virtual reality (VR) as a digital technology has developed rapidly, becoming more realistic, portable, sensory and easier to navigate. Although studies have found VR to be effective for many clinical applications, patients and clinicians have described several barriers to the successful implementation of this technology. To remove barriers for implementation of VR in health care, a greater understanding is needed of how VR can integrate into clinical environments, particularly complex settings such as an intensive care unit.

AIM

This study aimed to explore the perceived barriers and facilitators for the implementation of VR exposure therapy for intensive care patients and clinical staff.

STUDY DESIGN

A qualitative study using an Interpretative Description approach was undertaken. Semi-structured focus groups were conducted with 13 participants: nine patients and four health care professionals. Focus groups explored barriers and facilitators of using virtual reality (VR) exposure therapy in intensive care. Thematic analysis was employed to produce codes and themes.

RESULTS

In total, eight themes describing the perceived barriers and facilitators to implementing VR exposure therapy were identified. Four themes related to the perceived barriers of implementing VR exposure therapy in intensive care were identified: psychological, sensory, environmental and staff competency and confidence. There were a further four themes related to the perceived facilitators to the implementation of VR exposure therapy: staff training, patient capacity, orientation to technology and support during the intervention.

CONCLUSIONS

This study identified novel barriers and facilitators that could be expected when implementing VR exposure therapy for patients' post-intensive care unit stay. The findings suggest that psychological barriers of fear and apprehension were expected to provoke patient avoidance of exposure therapy. Perceived barriers for staff focused on preparedness to deliver the VR exposure therapy and a lack of technological competence. Both patients and staff stated that a comprehensive induction, orientation and training could facilitate VR exposure therapy, improving engagement.

RELEVANCE TO CLINICAL PRACTICE

This study has identified that with appropriate staff training, resources, and integration into current patient care pathways, VR exposure therapy may be a valuable intervention to support patient recovery following critical illness. Prior to undertaking VR exposure therapy, patients often need reassurance that side-effects can be managed, and that they can easily control their virtual exposure experience.

Gait patterns during overground and virtual omnidirectional treadmill walking

BACKGROUND

Omnidirectional treadmills (ODTs) offer a promising solution to the virtual reality (VR) locomotion problem, which describes the mismatch between visual and somatosensory information and contributes to VR sickness. However, little is known about how walking on ODTs impacts the biomechanics of gait. This project aimed to compare overground and ODT walking and turning in healthy young adults.

METHODS

Fifteen young adults completed forward walk, 180° turn, and 360° turn tasks under three conditions: (1) overground, (2) on the Infinadeck ODT in a virtual environment without a handrail, and (3) on the ODT with a handrail. Kinematic data for all walking trials were gathered using 3D optical motion capture.

RESULTS

Overall, gait speed was slower during ODT walking than overground. When controlling for gait speed, ODT walking resulted in shorter steps and greater variability in step length. There were no significant differences in other spatiotemporal metrics between ODT and overground walking. Turning on the ODT required more steps and slower rotational speeds than overground turns. The addition of the stability handrail to the ODT resulted in decreased gait variability relative to the ODT gait without the handrail.

CONCLUSION

Walking on an ODT resembles natural gait patterns apart from slower gait speed and shorter step length. Slower walking and shorter step length are likely due to the novelty of physically navigating a virtual environment which may result in a more conservative approach to gait. Future work will evaluate how older adults and those with neurological disease respond to ODT walking.

Effects of immersive virtual nature on nature connectedness: A systematic review and meta-analysis

Objective

This study systematically summarizes the extant literature on the impacts of immersive virtual nature (IVN) on nature connectedness in the general population.

Methods

Papers were considered eligible if peer-reviewed, in English language, comprising experimental or quasi-experimental trials, including at least one outcome relative to nature connectedness in the general population. Database search was conducted on Scopus, Web of Science, Google Scholar, Medline, and GreenFILE (22-28 November 2021). Risk of bias was established by the Cochrane RoB 2 tool. Data synthesis was conducted through meta-analysis according with the Cochrane Consumers and Communication Group guidelines.

Results

Six eligible papers (9 studies; n = 730) were selected, in which IVN was compared to (i) non-immersive virtual nature, (ii) immersive virtual built environments, (iii) non-immersive virtual built environments, and (iv) actual nature. The risk of bias was predominantly "low" or of "some concerns." Meta-analyses showed a statistically significant overall effect for the first (g = 0.26; 95% CI = 0.06-0.45; I2 = 35%) and fourth group (g = -1.98; 95% CI = -3.21 to -0.75; I2 = 96%), the former in favor of IVN and the latter in favor of actual nature. Subgroup analyses were conducted for the first and second groups of studies to explore possible sources of heterogeneity. The small number of studies available limits the validity of the outcomes of the meta-analyses.

Conclusion

The findings indicate that IVN may be an effective tool for the promotion of nature connectedness, although the evidence in this field is still limited and largely mixed. Recommendations for future research are discussed.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Design and User Experience of VirNE Application: Deep Breathing Exercise in a Virtual Natural Environment to Reduce Treatment Anxiety in Pediatrics

Treatment anxiety is a serious problem among child patients. A few studies have addressed this issue with virtual reality solutions, with promising results; however, the applications used have generally been designed for entertainment instead of this purpose. This article studies the potential of using deep breathing exercises in a virtual natural environment to address this issue, with a focus on design approach and user experience. It presents the VirNE-Virtual Natural Environments relaxation application, which is based on known stress-reduction methods, and a feasibility study conducted with it in a local hospital. The study had a within-subjects design, and it included 21 eight to twelve-year-old child patients, who used the application during an intravenous cannulation procedure related to their treatment. The study found good user acceptance and user experience both among the child patients and pediatricians, with the perceived usefulness of the method being higher among the patients with increased levels of anxiety or needle phobia. In addition, a clear stress-reducing effect was found. This offers proof-of-concept for the multidisciplinary design approach based on existing scientific knowledge regarding the desired effect for pediatric virtual reality applications for this use context.

Anxiety and Depressive Traits in the Healthy Population Does Not Affect Spatial Orientation and Navigation

The ability to navigate and orient in spatial surroundings is critical for effective daily functioning. Such ability is perturbed in clinically diagnosed mood and anxiety disorders, with patients exhibiting poor navigational skills. Here, we investigated the effects of depression and anxiety traits (not the clinical manifestation of the disorders) on the healthy population and hypothesized that greater levels of depression and anxiety traits would manifest in poorer spatial orientation skills and, in particular, with a poor ability to form mental representations of the environment, i.e., cognitive maps. We asked 1237 participants to perform a battery of spatial orientation tasks and complete two questionnaires assessing their anxiety and depression traits. Contrary to our hypothesis, we did not find any correlation between participants' anxiety and depression traits and their ability to form cognitive maps. These findings may imply a significant difference between the clinical and non-clinical manifestations of anxiety and depression as affecting spatial orientation and navigational abilities.

Immersive virtual reality gameplay detects visuospatial atypicality, including unilateral spatial neglect, following brain injury: a pilot study

BACKGROUND

In neurorehabilitation, problems with visuospatial attention, including unilateral spatial neglect, are prevalent and routinely assessed by pen-and-paper tests, which are limited in accuracy and sensitivity. Immersive virtual reality (VR), which motivates a much wider (more intuitive) spatial behaviour, promises new futures for identifying visuospatial atypicality in multiple measures, which reflects cognitive and motor diversity across individuals with brain injuries.

METHODS

In this pilot study, we had 9 clinician controls (mean age 43 years; 4 males) and 13 neurorehabilitation inpatients (mean age 59 years; 9 males) recruited a mean of 41 days post-injury play a VR visual search game. Primary injuries included 7 stroke, 4 traumatic brain injury, 2 other acquired brain injury. Three patients were identified as having left sided neglect prior to taking part in the VR. Response accuracy, reaction time, and headset and controller raycast orientation quantified gameplay. Normative modelling identified the typical gameplay bounds, and visuospatial atypicality was defined as gameplay beyond these bounds.

RESULTS

The study found VR to be feasible, with only minor instances of motion sickness, positive user experiences, and satisfactory system usability. Crucially, the analytical method, which emphasized identifying 'visuospatial atypicality,' proved effective. Visuospatial atypicality was more commonly observed in patients compared to controls and was prevalent in both groups of patients-those with and without neglect.

CONCLUSION

Our research indicates that normative modelling of VR gameplay is a promising tool for identifying visuospatial atypicality after acute brain injury. This approach holds potential for a detailed examination of neglect.

Virtual Reality Sickness Reduces Attention During Immersive Experiences

In this paper, we show that Virtual Reality (VR) sickness is associated with a reduction in attention, which was detected with the P3b Event-Related Potential (ERP) component from electroencephalography (EEG) measurements collected in a dual-task paradigm. We hypothesized that sickness symptoms such as nausea, eyestrain, and fatigue would reduce the users' capacity to pay attention to tasks completed in a virtual environment, and that this reduction in attention would be dynamically reflected in a decrease of the P3b amplitude while VR sickness was experienced. In a user study, participants were taken on a tour through a museum in VR along paths with varying amounts of rotation, shown previously to cause different levels of VR sickness. While paying attention to the virtual museum (the primary task), participants were asked to silently count tones of a different frequency (the secondary task). Control measurements for comparison against the VR sickness conditions were taken when the users were not wearing the Head-Mounted Display (HMD) and while they were immersed in VR but not moving through the environment. This exploratory study shows, across multiple analyses, that the effect mean amplitude of the P3b collected during the task is associated with both sickness severity measured after the task with a questionnaire (SSQ) and with the number of counting errors on the secondary task. Thus, VR sickness may impair attention and task performance, and these changes in attention can be tracked with ERP measures as they happen, without asking participants to assess their sickness symptoms in the moment.

Virtual reality to improve low-back pain and pelvic pain during pregnancy: a pilot RCT for a multicenter randomized controlled trial

A significant proportion of women experience low back and pelvic pain during and after pregnancy, which can negatively impact their daily lives. Various factors are attributed to these complaints, and many affected women do not receive adequate healthcare. However, there is evidence to support the use of different physiotherapeutic interventions to alleviate these conditions. Virtual reality is a promising complementary treatment to physiotherapy, particularly in improving pain perception and avoidance. The primary objective of this study is to evaluate the efficacy of a four-week program combining VR and physiotherapy compared to standard physiotherapy in pregnant women with low back and pelvic pain, in terms of improving pain avoidance, intensity, disability, and functional level. The study also aims to investigate patient satisfaction with the VR intervention. This research will be conducted through a multi-center randomized controlled clinical trial involving pregnant patients residing in the provinces of Seville and Malaga with a diagnosis of low back and pelvic pain during pregnancy. The alternative hypothesis is that the implementation of a Virtual Reality program in combination with standard physiotherapy will result in better clinical outcomes compared to the current standard intervention, which could lead to the development of new policies and interventions for these pathologies and their consequences. Clinical trial registration: clinicaltrials.gov, identifier NCT05571358.

The contribution of image minification to discomfort experienced in wearable optics

Wearable optics have a broad range of uses, for example, in refractive spectacles and augmented/virtual reality devices. Despite the long-standing and widespread use of wearable optics in vision care and technology, user discomfort remains an enduring mystery. Some of this discomfort is thought to derive from optical image minification and magnification. However, there is limited scientific data characterizing the full range of physical and perceptual symptoms caused by minification or magnification during daily life. In this study, we aimed to evaluate sensitivity to changes in retinal image size introduced by wearable optics. Forty participants wore 0%, 2%, and 4% radially symmetric optical minifying lenses binocularly (over both eyes) and monocularly (over just one eye). Physical and perceptual symptoms were measured during tasks that required head movement, visual search, and judgment of world motion. All lens pairs except the controls (0% binocular) were consistently associated with increased discomfort along some dimension. Greater minification tended to be associated with greater discomfort, and monocular minification was often-but not always-associated with greater symptoms than binocular minification. Furthermore, our results suggest that dizziness and visual motion were the most reported physical and perceptual symptoms during naturalistic tasks. This work establishes preliminary guidelines for tolerances to binocular and monocular image size distortion in wearable optics.

Design guidelines for limiting and eliminating virtual reality-induced symptoms and effects at work: a comprehensive, factor-oriented review

Virtual reality (VR) can induce side effects known as virtual reality-induced symptoms and effects (VRISE). To address this concern, we identify a literature-based listing of these factors thought to influence VRISE with a focus on office work use. Using those, we recommend guidelines for VRISE amelioration intended for virtual environment creators and users. We identify five VRISE risks, focusing on short-term symptoms with their short-term effects. Three overall factor categories are considered: individual, hardware, and software. Over 90 factors may influence VRISE frequency and severity. We identify guidelines for each factor to help reduce VR side effects. To better reflect our confidence in those guidelines, we graded each with a level of evidence rating. Common factors occasionally influence different forms of VRISE. This can lead to confusion in the literature. General guidelines for using VR at work involve worker adaptation, such as limiting immersion times to between 20 and 30 min. These regimens involve taking regular breaks. Extra care is required for workers with special needs, neurodiversity, and gerontechnological concerns. In addition to following our guidelines, stakeholders should be aware that current head-mounted displays and virtual environments can continue to induce VRISE. While no single existing method fully alleviates VRISE, workers' health and safety must be monitored and safeguarded when VR is used at work.

Investigating and acquiring motor expertise using virtual reality

After just months of simulated training, on January 19, 2019 a 23-year-old E-sports pro-gamer, Enzo Bonito, took to the racetrack and beat Lucas di Grassi, a Formula E and ex-Formula 1 driver with decades of real-world racing experience. This event raised the possibility that practicing in virtual reality can be surprisingly effective for acquiring motor expertise in real-world tasks. Here, we evaluate the potential of virtual reality to serve as a space for training to expert levels in highly complex real-world tasks in time windows much shorter than those required in the real world and at much lower financial cost without the hazards of the real world. We also discuss how VR can also serve as an experimental platform for exploring the science of expertise more generally.

Amblyopia Treatment through Immersive Virtual Reality: A Preliminary Experience in Anisometropic Children

The use of digital devices provides a wide range of possibilities for measuring and improving visual function, including concepts such as perceptual learning and dichoptic therapy. Different technologies can be used to apply these concepts, including, in recent years, the introduction of virtual reality (VR) systems. A preliminary experience in treating anisometropic amblyopia through an immersive VR device and using prototype software is described. A total of 4 children were treated by performing 18 office-based sessions. Results showed that distance VA in amblyopic eyes remained constant in two subjects, whereas the younger subjects improved after the training. Near VA improved in three subjects. All subjects showed an increase in the stereopsis of at least one step, with three subjects showing a final stereopsis of a 60 s arc. A total of three subjects showed an increase of approximately 0.5 CS units for the spatial frequency of 3 cpd after the training. Results from this pilot study suggest that visual training based on perceptual learning through an immersive VR environment could be a viable treatment for improving CS, VA, and stereopsis in some children with anisometropic amblyopia. Future studies should support these preliminary results.

Adding virtual plants leads to higher cognitive performance and psychological well-being in virtual reality

Previous research has shown the positive effects of exposure to real and virtual nature. To investigate how such benefits might generalize to ever-more-prevalent virtual workplaces, we examined the effects of the absence or presence of virtual plants in an office environment in Virtual Reality (VR) on users' cognitive performance and psychological well-being. The results of our user study with 39 participants show that in the presence of virtual plants, participants performed significantly better in both short-term memory and creativity tasks. Furthermore, they reported higher psychological well-being scores, including positive affect and attentive coping, whilst reporting lower feelings of anger and aggression after exposure to virtual plants in VR. The virtual office with plants was also perceived as more restorative and induced a higher sense of presence. Overall, these results highlight how the presence of virtual plants in VR can have positive influences on users, and therefore, constitute important design considerations when developing future working and learning spaces.

Respiratory entrainment of the locus coeruleus modulates arousal level to avoid physical risks from external vibration

Slow rocking chairs can easily put people to sleep, while violent shaking, such as during earthquakes, may lead to rapid awakening. However, the influence of external body vibrations on arousal remains unclear. Herein, a computational model of a locus coeruleus (LC)-norepinephrine (NE) system and cardio-respiratory system were used to show that respiratory entrainment of the LC modulates arousal levels, which is an adaptation to avoid physical risks from external vibration. External vibrations of sinusoidal waves with different frequencies ranging from 0.1 to 20 [Hz] were applied to the LC based on the results of previous studies. We found that respiratory entrainment of the LC decreased the breathing rate (BR) and heart rate (HR) to maintain the HR within its normal range. Furthermore, 1:1 phase locking enhanced arousal level while phase-amplitude coupling decreased it for larger vibration stimuli. These findings suggest that respiratory entrainment of the LC might automatically modulate cardio-respiratory system homeostasis and arousal levels for performance readiness (fight/flight or freeze) to avoid physical risks from larger external vibrations.

Viewpoint-Controllable Telepresence: A Robotic-Arm-Based Mixed-Reality Telecollaboration System

In mixed-reality (MR) telecollaboration, the local environment is remotely presented to a remote user wearing a virtual reality (VR) head-mounted display (HMD) via a video capture device. However, remote users frequently face challenges in naturally and actively manipulating their viewpoints. In this paper, we propose a telepresence system with viewpoint control, which involves a robotic arm equipped with a stereo camera in the local environment. This system enables remote users to actively and flexibly observe the local environment by moving their heads to manipulate the robotic arm. Additionally, to solve the problem of the limited field of view of the stereo camera and limited movement range of the robotic arm, we propose a 3D reconstruction method combined with a stereo video field-of-view enhancement technique to guide remote users to move within the movement range of the robotic arm and provide them with a larger range of local environment perception. Finally, a mixed-reality telecollaboration prototype was built, and two user studies were conducted to evaluate the overall system. User study A evaluated the interaction efficiency, system usability, workload, copresence, and user satisfaction of our system from the remote user's perspective, and the results showed that our system can effectively improve the interaction efficiency while achieving a better user experience than two traditional view-sharing techniques based on 360 video and based on the local user's first-person view. User study B evaluated our MR telecollaboration system prototype from both the remote-user side and the local-user side as a whole, providing directions and suggestions for the subsequent design and improvement of our mixed-reality telecollaboration system.

A comparative assessment of subjective experience in simulator and on-road driving under normal and time pressure driving conditions

This study conducts a comparative assessment of subjective experience of real-world and simulated world driving for investigating factors leading to simulator sickness. Thirty professional car drivers drove a fixed-base driving simulator in real and simulated worlds under No Time Pressure (NTP) and Time Pressure (TP) driving conditions. Drivers rated their perceptions based on real-world driving and simulator driving experiences after each driving session with respect to three factors: simulator sickness, mental workload, and sense of presence. The structural equation model results revealed that drivers experienced high mental workload due to TP driving conditions (factor loading = 0.90) and repeated exposure to simulated world (factor loading = 0.20) which induced simulator sickness (factor loading = 0.41) and resulted in low sense of presence (factor loading = -0.18). Thus, it can be concluded that lack of experience with virtual reality induced high simulator sickness, increased mental workload, and low sense of presence.

Game on: immersive virtual laboratory simulation improves student learning outcomes & motivation

The use of gamified learning interventions is expanding in postsecondary education as a means to improve students' motivation and learning outcomes. Virtual laboratory simulations have been used in science education to supplement students' learning, as well as to increase engagement with course material. Due to COVID-19, many instructors sought to replace or supplement hands-on 'wet-lab' work in an online environment. In this paper, we explored how the use of head-mounted display technology in two laboratory simulations impacts learner motivation and learning outcomes. We used a mixed-methods approach to analyze the experience of 39 undergraduate participants, examining test scores pre- and postsimulation, qualitative feedback, and quantitative experience ratings. The head-mounted display technology was described as easy to use, with eye strain identified as a common occurrence. Participants had increased test scores following the laboratory simulations, with no significant difference between simulation groups. Very positive self-reported measures of motivation and learner engagement were documented. Ninety-one percent of participants agreed that virtual reality laboratory simulation would be a good supplement to regular teaching modalities. Overall, our results suggest that immersive virtual reality laboratory simulations experienced through head-mounted display technology can be used to enhance learning outcomes and increase learner motivation.

The use of transcutaneous Vagal Nerve Stimulation as an effective countermeasure for Simulator Adaptation Syndrome

This research focused on investigating the effectiveness of Transcutaneous Vagal Nerve Stimulation (tVNS) as compared to Galvanic Cutaneous Stimulation (GCS) at mitigating Simulator Adaptation Syndrome (SAS). Fifty drivers (mean age = 23.04 ± 17.71 years old, twenty-two men) participated in a driving simulation experiment. The total scores of the Simulator Sickness Questionnaire, head movements (body balance index), and driving performance variables were measured under five stimulation conditions: i) baseline (no stimulation delivered), ii) sham GCS, iii) sham tVNS, iv) active GCS, and v) active tNVS. The results showed that tVNS alleviated SAS and improved driving performance variables more effectively than GCS. We conclude that GCS and tVNS have similar neurological mechanisms to reduce SAS, providing possible explanations for the greater effectiveness of tVNS. We encourage the use of tVNS to decrease SAS.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Immersive Virtual Reality during Robot-Assisted Gait Training: Validation of a New Device in Stroke Rehabilitation

Background and objective: Duration of rehabilitation and active participation are crucial for gait rehabilitation in the early stage after stroke onset. Virtual reality (VR) is an innovative tool providing engaging and playful environments that could promote intrinsic motivation and higher active participation for non-ambulatory stroke patients when combined with robot-assisted gait training (RAGT). We have developed a new, fully immersive VR application for RAGT, which can be used with a head-mounted display and wearable sensors providing real-time gait motion in the virtual environment. The aim of this study was to validate the use of this new device and assess the onset of cybersickness in healthy participants before testing the device in stroke patients. Materials and Methods: Thirty-seven healthy participants were included and performed two sessions of RAGT using a fully immersive VR device. They physically walked with the Gait Trainer for 20 min in a virtual forest environment. The occurrence of cybersickness, sense of presence, and usability of the device were assessed with three questionnaires: the Simulator Sickness Questionnaire (SSQ), the Presence Questionnaire (PQ), and the System Usability Scale (SUS). Results: All of the participants completed both sessions. Most of the participants (78.4%) had no significant adverse effects (SSQ < 5). The sense of presence in the virtual environment was particularly high (106.42 ± 9.46). Participants reported good usability of the device (86.08 ± 7.54). Conclusions: This study demonstrated the usability of our fully immersive VR device for gait rehabilitation and did not lead to cybersickness. Future studies should evaluate the same parameters and the effectiveness of this device with non-ambulatory stroke patients.

Effects of a Modern Virtual Reality 3D Head-Mounted Display Exergame on Simulator Sickness and Immersion Under Specific Conditions in Young Women and Men: Experimental Study

Background

Many young adults do not reach the World Health Organization’s minimum recommendations for the amount of weekly physical activity. The virtual reality 3D head-mounted display (VR 3D HMD) exergame is a technology that is more immersive than a typical exercise session. Our study considers gender differences in the experience of using VR games for increasing physical activity.

Objective

The aim of this study was to examine the differences in the effects of VR 3D HMD gaming in terms of immersion, simulator sickness, heart rate, breathing rate, and energy expenditure during two 30-minute sessions of playing an exergame of increasing intensity on males and females.

Methods

To examine the effects of the VR 3D HMD exergame, we experimented with 45 participants (23 males and 22 females) exercising with VR 3D HMD Oculus Quest 1, hand controllers, and Zephyr BioHarness 3.0. Players exercised according to the Audio Trip exergame. We evaluated the immersion levels and monitored the average heart rate, maximum heart rate, average breathing rate, maximum breathing rate, and energy expenditure in addition to simulator sickness during two 30-minute exergame sessions of increasing intensity.

Results

Audio Trip was well-tolerated, as there were no dropouts due to simulator sickness. Significant differences between genders were observed in the simulator sickness questionnaire for nausea (F2,86=0.80; P=.046), oculomotor disorders (F2,86=2.37; P=.010), disorientation (F2,86=0.92; P=.040), and total of all these symptoms (F2,86=3.33; P=.04). The measurements after the first 30-minute VR 3D HMD exergame session for all the participants showed no significant change compared to the measurements before the first 30-minute exergame session according to the total score. There were no gender differences in the immersion (F1,43=0.02; P=.90), but the measurements after the second 30-minute exergame session showed an increase in the average points for immersion in women and men. The increase in the level of immersion in the female group was higher than that in the male group. A significant difference between genders was observed in the average breathing rate (F2,86=1.44; P=.04), maximum breathing rate (F2,86=1.15; P=.047), and energy expenditure (F2,86=10.51; P=.001) measurements. No gender differences were observed in the average heart rate and maximum heart rate measurements in the two 30-minute sessions.

Conclusions

Our 30-minute VR 3D HMD exergame session does not cause simulator sickness and is a very immersive type of exercise for men and women users. This exergame allows reaching the minimum recommendations for the amount of weekly physical activity for adults. The second exergame session resulted in simulator sickness in both groups, more noticeably in women, as reflected in the responses in the simulator sickness questionnaire. The gender differences observed in the breathing rates and energy expenditure measurements can be helpful when programming VR exergame intensity in future research.

Electrogastrogram-Derived Features for Automated Sickness Detection in Driving Simulator

The rapid development of driving simulators for the evaluation of automated driving experience is constrained by the simulator sickness-related nausea. The electrogastrogram (EGG)-based approach may be promising for immediate, objective, and quantitative nausea assessment. Given the relatively high EGG sensitivity to noises associated with the relatively low amplitude and frequency spans, we introduce an automated procedure comprising statistical analysis and machine learning techniques for EGG-based nausea detection in relation to the noise contamination during automated driving simulation. We calculate the root mean square of EGG amplitude, median and dominant frequencies, magnitude of Power Spectral Density (PSD) at dominant frequency, crest factor of PSD, and spectral variation distribution along with newly introduced parameters: sample and spectral entropy, autocorrelation zero-crossing, and parameters derived from the Poincaré diagram of consecutive EGG samples. Results showed outstanding robustness of sample entropy with moderate robustness of autocorrelation zero-crossing, dominant frequency, and its median. Machine learning reached an accuracy of 88.2% and revealed sample entropy as one of the most relevant and robust parameters, while linear analysis highlighted spectral entropy, spectral variation distribution, and crest factor of PSD. This study clearly indicates the need for customized feature selection in noisy environments, as well as a complementary approach comprising machine learning and statistical analysis for efficient nausea detection.

Objects May Be Farther Than They Appear: Depth Compression Diminishes Over Time with Repeated Calibration in Virtual Reality

Prior research in depth perception and perceptuo-motor calibration have primarily focused on participants completing experiments in single sessions and therefore do not empirically evaluate changes over time. Further, these studies do not typically take into account the amount of experience that the participants have in virtual reality (VR) prior to participation, the role of experience during participation, or calibration that may occur throughout the experiment session. In this contribution, we conducted a novel empirical evaluation of how calibration affects perception-action coordination over time. We recruited novice VR users and they completed eight sessions of a depth perception reaching experiment over the course of 12 weeks. During these experiments, we examined how participants' ability to estimate depth in a virtual environment changed as they gradually gained experience. While previous literature has shown that participants tend to underestimate distances, we found that this underestimation diminished over time as they gained experience in the virtual environment. Our study highlights the need for carrying out VR studies over time and the influence that longitudinal calibration can have on spatial perception in long-term VR experiences.

Virtual Reality-A Supplement to Posturography or a Novel Balance Assessment Tool?

Virtual reality (VR) is a well-established technology in medicine. Head-mounted displays (HMDs) have made VR more accessible in many branches of medical research. However, its application in balance evaluation has been vague, and comprehensive literature on possible applications of VR in posture measurement is scarce. The aim of this review is to conduct a literature search on the application of immersive VR delivered using a head-mounted display in posturographic measurements. A systematic search of two databases, PubMed and Scopus, using the keywords "virtual reality" and "posturography," was performed following PRISMA guidelines for systematic reviews. Initial search results returned 89 non-duplicate records. Two reviewers independently screened the abstracts. Sixteen papers fulfilled the inclusion criteria and none of the exclusion criteria and were selected for complete text retrieval. An additional 16 records were identified from citation searching. Ultimately, 21 studies were included in this review. virtual reality is often used as additional visual stimuli in static and dynamic posturography evaluation. Only one study has attempted to evaluate a VR environment in a head-mounted display as an independent method in the assessment of posture. Further research should be conducted to assess HMD VR as a standalone posturography replacement.

Durations of virtual exposure to built and natural landscapes impact self-reported stress recovery: evidence from three countries

Exposure to natural landscapes can benefit human health. However, several knowledge gaps remain regarding the impacts of duration and cultural differences on the health benefits of nature. If these gaps are filled, designers and planners can better design landscapes for stress recovery. This study examined the effects of durations of virtual exposure to the built and natural environments across three countries using an experimental design. Two-hundred and seventy people from USA, Taiwan, and Thailand were induced with an acute stressor and then randomly assigned to watch 360° videos of urban or natural landscapes for 1, 5, or 15 min. Self-reported stress recovery data were collected before and after the exposure. The results suggested that gender and duration of exposure to virtual natural landscapes impacted stress recovery. Female participants recovered from stress more when exposed to the virtual natural landscapes than urban landscapes. Among those participants who were exposed to virtual natural landscapes, 5 min of exposure resulted in greater stress recovery than shorter or longer durations of exposure. Perceived familiarity did not influence the extent of stress recovery. These findings support previous research on how nature exposure is related to stress recovery and varies by dosage, leading to better understanding toward landscape design. Future studies should explore other measures of stress, different landscape designs, participants’ immersion, and levels of control in simulated nature scenes.

Rationale and methodology for examining the acute effects of aerobic exercise combined with varying degrees of virtual reality immersion on cognition in persons with TBI

Persons with Traumatic Brain Injury (TBI) commonly present with long-term cognitive deficits in executive function, processing speed, attention, and learning and memory. While specific cognitive rehabilitation techniques have shown significant success for deficits in individual domains, aerobic exercise training represents a promising approach for an efficient and general treatment modality that might improve many cognitive domains concurrently. Existing studies in TBI report equivocal results, however, and are hampered by methodological concerns, including small sample sizes, uncontrolled single-group designs, and the use of suboptimal exercise modalities for eliciting cognitive improvements in this population. One particularly promising modality involves the application of environmental enrichment via virtual reality (VR) during aerobic exercise in persons with TBI, but this has yet to be investigated. One approach for systematically developing an optimal aerobic exercise intervention for persons with TBI involves the examination of single bouts of aerobic exercise (i.e., acute aerobic exercise) on cognition. Acute exercise research is a necessary first step for informing the development of high-quality exercise training interventions that are more likely to induce meaningful beneficial effects. To date, such an acute exercise paradigm has yet to be conducted in persons with TBI. To that end, we propose an acute exercise study that will investigate the acute effects of aerobic exercise with incremental degrees of environmental enrichment (VR) relative to a control comparison condition on executive function (divided attention and working memory) and processing speed in 24 people with TBI.

Developing and analyzing eco-driving strategies for on-road emission reduction in urban transport systems - A VR-enabled digital-twin approach

A vast number of pollutants are generated from on-road commuting vehicles, and there is an increasing need to explore vehicle emission monitoring and mitigation strategies. Traditionally, vehicle emissions can be monitored and measured directly from on-vehicle devices such as a sensor at the tailpipe, or based on expensive data collection tools such as roadside units; while another mainstream research estimates vehicle emissions by relying on the connection to the vehicle motions, which can approximately calculate vehicle emissions under certain traffic conditions. This paper proposes a virtual reality (VR) enabled digital twin platform for on-road emission monitoring, and it develops and evaluates eco-driving strategies within a specific area. The proposed approach, integrating a VR-based digital environment, a micro-simulation model for background traffic, and a Motor Vehicle Emission Simulator for emission estimation, offers an alternative to collect and examine vehicle emissions such as NOx under various traffic conditions. A case study on a central business area in Melbourne is conducted and eco-driving strategies are tested in two scenarios. The first scenario concerns the impact of hybrid electric vehicles and connected autonomous vehicles, which points to the long-term benefit of having controllable and cleaner modes of transportation as a strategy. Results showed that manipulating the penetration rate of emission-friendly engines or motions could reduce vehicle emissions effectively. The second scenario concerns the real-time eco-routing based on emission-optimum, which points to the short-term benefit of emission control strategies. Human-in-the-loop experiments were conducted to test drivers' responses toward routing options. Results showed that over 90% of participants would follow the eco-routing recommendations completely. The presented study offers an alternative to data-generating, analyzing, and managing approaches for on-road emissions in urban transportation systems.

A pilot study investigating human behaviour towards DAVE (Dog Assisted Virtual Environment) and interpretation of non-reactive and aggressive behaviours during a virtual reality exploration task

Dog aggression is a public health concern because dog bites often lead to physical and psychological trauma in humans. It is also a welfare concern for dogs. To prevent aggressive behaviours, it is important to understand human behaviour towards dogs and our ability to interpret signs of dog aggression. This poses ethical challenges for humans and dogs. The aim of this study was to introduce, describe and pilot test a virtual reality dog model (DAVE (Dog Assisted Virtual Environment)). The Labrador model has two different modes displaying aggressive and non-reactive non-aggressive behaviours. The aggressive behaviours displayed are based on the current understanding of canine ethology and expert feedback. The objective of the study was to test the recognition of dog behaviour and associated human approach and avoidance behaviour. Sixteen university students were recruited via an online survey to participate in a practical study, and randomly allocated to two experimental conditions, an aggressive followed by a non-reactive virtual reality model (group AN) or vice versa (group NA). Participants were instructed to ‘explore the area’ in each condition, followed by a survey. A Wilcoxon and Mann Whitney U test was used to compare the closest distance to the dog within and between groups respectively. Participants moved overall significantly closer to the non-reactive dog compared to the aggressive dog (p≤0.001; r = 0.8). Descriptions of the aggressive dog given by participants often used motivational or emotional terms. There was little evidence of simulator sickness and presence scores were high indicating sufficient immersion in the virtual environment. Participants appeared to perceive the dog as realistic and behaved and interacted with the dog model in a manner that might be expected during an interaction with a live dog. This study also highlights the promising results for the potential future use of virtual reality in behavioural research (i.e., human-dog interactions), education (i.e. safety around dogs) and psychological treatment (e.g. dog phobia treatment).

Mild simulator sickness can alter heart rate variability, mental workload, and learning outcomes in a 360° virtual reality application for medical education: a post hoc analysis of a randomized controlled trial

Virtual reality (VR) applications could be beneficial for education, training, and treatment. However, VR may induce symptoms of simulator sickness (SS) such as difficulty focusing, difficulty concentrating, or dizziness that could impair autonomic nervous system function, affect mental workload, and worsen interventional outcomes. In the original randomized controlled trial, which explored the effectiveness of using a 360° VR video versus a two-dimensional VR video to learn history taking and physical examination skills, only the former group participants had SS. Therefore, 28 undergraduate medical students who participated in a 360° VR learning module were included in this post hoc study using a repeated measures design. Data of the Simulator Sickness Questionnaire (SSQ), heart rate variability (HRV) analysis, Task Load Index, and Mini-Clinical Evaluation Exercise were retrospectively reviewed and statistically analyzed. Ten (36%) participants had mild SS (total score > 0 and ≤ 20), and 18 (64%) had no SS symptom. Total SSQ score was positively related to the very low frequency (VLF) band power, physical demand subscale, and frustration subscale, and inversely related to physical examination score. Using multilevel modeling, the VLF power mediated the relationship between total SSQ score and physical examination score. Furthermore, frustration subscale moderated the mediating effects of the VLF power. Our results highlight the importance of documenting SS to evaluate a 360° VR training program. Furthermore, the combination of HRV analysis with mental workload measurement and outcome assessments provided the important clinical value in evaluating the effects of SS in VR applications in medical education.

Preliminary Study of Efficacy and Safety of Self-Administered Virtual Exposure Therapy for Social Anxiety Disorder vs. Cognitive-Behavioral Therapy

Social anxiety disorder (SAD) is one of the most frequent mental disorders. Exposure to virtual reality can be a solution complementing standard CBT (cognitive-behavioral therapy) or can be used as an independent therapeutic tool. The study’s objective was to assess the safety and efficacy of using self-administered virtual reality exposure vs. CBT and CBT with virtual exposure. We assessed the efficacy of the applied intervention with the Leibowitz Social Anxiety Scale (LSAS). We compared three groups: CBT (n = 25), CBT + VR (n = 29), and self-administered therapy without aid of a therapist (n = 19). The results indicated that all three groups showed changes on the LSAS. The simple effect analysis showed that there were no differences between experimental conditions at T0 (session 1) and T1 (session 9) and that the only significant difference occurred at T2 (session 14). The pairwise comparisons showed that the participants in the VR condition scored higher on the LSAS score during the measurement at T2 than participants in CBT condition. Our study has several limitations. The presented initial study shows that the methods of CBT for social anxiety used so far are also effective, while the VR tool for self-therapy requires further research.

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.

Simulating the Benefits of Nature Exposure on Cognitive Performance in Virtual Reality: A Window into Possibilities for Education and Cognitive Health

Purpose: This one-group pretest−posttest, designed within a subject study, looks to compare the effects of an outdoor nature walk (ONW) to those of a virtual nature walk (VRW) on memory and cognitive function. Implications are discussed for education as well as for the world of virtual reality. Methods: Sixty-four healthy university students were asked to complete an ONW and a VRW, which was created using 3D video of the same nature trail used for the ONW. The VRW condition involved a five-minute walk on a treadmill, while wearing a virtual reality mask (Oculus, San Francisco, USA) that projected a previously recorded three-dimensional capture of the same nature walk they experienced outdoors. Both experimental conditions lasted approximately 5 min and were counterbalanced between participants. A Digit Span Test (Digit) for working memory and a Trail Test (TMT) for executive function were administered to all study participants, immediately before and after each type of walk. Results: For executive function testing (Trail Making Test), our results demonstrate that both the ONW and VRW condition improved the TMT time, when compared to a baseline (ONW 37.06 ± 1.31 s vs. 31.75 ± 1.07 s, p < 0.01 and VRW 36.19 ± 1.18 s vs. 30.69 ± 1.11 s, p < 0.01). There was no significant difference between the ONW and VRW groups. Similarly, for the Digit memory task, both conditions improved compared to the baseline (ONW 54.30 ± 3.01 vs. 68.4 ± 2.66, p < 0.01 and VRW 58.1 ± 3.10 vs. 67.4 ± 2.72, p < 0.01). There was a difference at the baseline between the ONW and VRW conditions (54.3 ± 3.01 vs. 58.1 ± 3.10, p < 0.01), but this baseline difference in memory performance was no longer significant post exercise, between groups at follow-up (68.4 ± 2.66 vs. 67.4 ± 2.72, p < 0.08). Conclusions: Our results suggest that both a virtual reality protocol and a nature walk can have positive outcomes on memory and executive function in younger adults.

Older adult driving performance assessed under simulated and on-road conditions

Simulated driving offers a convenient test of driving ability for older drivers, although the viability of using simulated driving with this population is mixed. The relative weighting of the relevant perceptual, cognitive, and physical factors may vary between simulated and on-road driving. The current study was designed to assess this possibility. We conducted simulated and on-road driving tests of 61 older adults aged 66-92 years. To ensure that the driving performance was measured similarly between the two driving modalities, we employed the Record of Driving Errors (RODE) driving assessment system during both driving tests. Correlation and random weights analysis (RWA) results indicated only modest evidence of correspondence between the simulated and on-road driving performances. The primary factors operative in both simulated and on-road driving was Useful Field of View and a measure of basic cognition. Unique factors for simulated driving included a measure of physical mobility (Time-Up-and-Go) and spatial reasoning (Line), and for on-road driving included chronological age and sensorimotor processing (Trail-Making Task A). Chronological age was correlated primarily the on-road rather than simulated test, was greatly reduced with the inclusion of additional explanatory factors, and likely reflects driving efficiency rather than driving safety. We conclude that simulated driving in healthy older drivers can be beneficial for research purposes to assess cognitive and perceptual factors that underly driving effectiveness, although it cannot serve as a clear proxy for on-road driving.

VR Sickness Adaptation With Ramped Optic Flow Transfers From Abstract To Realistic Environments

VR sickness is a major concern for many users as VR continues its expansion towards widespread everyday use. VR sickness is thought to arise, at least in part, due to the user's intolerance of conflict between the visually simulated self-motion and actual physical movement. Many mitigation strategies involve consistently modifying the visual stimulus to reduce its impact on the user, but this individualized approach can have drawbacks in terms of complexity of implementation and non-uniformity of user experience. This study presents a novel alternative approach that involves training the user to better tolerate the adverse stimulus by tapping into natural adaptive perceptual mechanisms. In this study, we recruited users with limited VR experience that reported susceptibility to VR sickness. Baseline sickness was measured as participants navigated a rich and naturalistic visual environment. Then, on successive days, participants were exposed to optic flow in a more abstract visual environment, and strength of the optic flow was successively increased by increasing the visual contrast of the scene, because strength of optic flow and the resulting vection are thought to be major causes of VR sickness. Sickness measures decreased on successive days, indicating that adaptation was successful. On the final day, participants were again exposed to the rich and naturalistic visual environment, and the adaptation was maintained, demonstrating that it is possible for adaptation to transfer from more abstract to richer and more naturalistic environments. These results demonstrate that gradual adaptation to increasing optic flow strength in well-controlled, abstract environments allows users to gradually reduce their susceptibility to sickness, thereby increasing VR accessibility for those prone to sickness.

Temporal Development of Sense of Presence and Cybersickness during an Immersive VR Experience

Following the advances in modern head-mounted displays, research exploring the human experience of virtual environments has seen a surge in interest. Researchers have examined how to promote individuals’ sense of presence, i.e., their experience of “being” in the VE, as well as to diminish the negative side effects of cybersickness. Studies investigating the relationship between sense of presence and cybersickness have reported heterogeneous results. Authors that found a positive relation have argued that the phenomena have shared cognitive underpinnings. However, recent literature has reported that positive associations can be explained by the confounding factor of immersion. The current study aims to investigate how cybersickness and sense of presence are associated and develop over time. During the experiment, participants were exposed to a virtual roller coaster and presented orally with questions aimed to quantify their perceived sense of presence and cybersickness. The results of the experiment indicate that cybersickness and sense of presence are both modulated by the time spent in the virtual setting. The utilized short measures for sense of presence and cybersickness were found to be reliable alternatives to multi-item questionnaires.

A Scoping Review of Assistance and Therapy with Head-Mounted Displays for People Who Are Visually Impaired

Given the inherent visual affordances of Head-Mounted Displays (HMDs) used for Virtual and Augmented Reality (VR/AR), they have been actively used over many years as assistive and therapeutic devices for the people who are visually impaired. In this paper, we report on a scoping review of literature describing the use of HMDs in these areas. Our high-level objectives included detailed reviews and quantitative analyses of the literature, and the development of insights related to emerging trends and future research directions.

Our review began with a pool of 1251 papers collected through a variety of mechanisms. Through a structured screening process, we identified 61 English research papers employing HMDs to enhance the visual sense of people with visual impairments for more detailed analyses. Our analyses reveal that there is an increasing amount of HMD-based research on visual assistance and therapy, and there are trends in the approaches associated with the research objectives. For example, AR is most often used for visual assistive purposes, whereas VR is used for therapeutic purposes. We report on eight existing survey papers, and present detailed analyses of the 61 research papers, looking at the mitigation objectives of the researchers (assistive versus therapeutic), the approaches used, the types of HMDs, the targeted visual conditions, and the inclusion of user studies. In addition to our detailed reviews and analyses of the various characteristics, we present observations related to apparent emerging trends and future research directions.

A mixed-methods exploration of virtual reality as a tool to promote green exercise

The salutogenic effects of green exercise are widely recognised, yet many individuals do not engage in this health-related behaviour. Using a convergent mixed methods approach, this study explored the impact of experiencing nature through Virtual Reality (VR) on the decision-making process relating to green exercise. Three experimental trials were conducted (overall n = 136), in which healthy adults were exposed to different VR scenarios reproducing a virtual walk in an existing urban green area. Participants reported medium–high rating of intent to visit the location. Significant pre-to-post increments in future green exercise intention were observed after the VR exposure, though a significance difference was not achieved in comparison with a control condition. Qualitative analysis revealed the impact of the VR experience on behaviour regulation, and highlighted the pivotal role of anticipated emotional benefits. Despite scepticism, the VR experience was effective in arousing curiosity to explore natural environments, which was associated with environmental perceptions as well as nostalgic and socio-cultural perspectives.

A Systematic Survey on Cybersickness in Virtual Environments

Virtual reality (VR) is an emerging technology with a broad range of applications in training, entertainment, and business. To maximize the potentials of virtual reality as a medium, the unwelcome feeling of cybersickness needs to be minimized. Cybersickness is a type of simulation sickness that is experienced in virtual reality. It is a significant challenge for the usability of virtual reality systems. Even with advancements in virtual reality, the usability concerns are barriers for a wide-spread acceptance. Several factors (hardware, software, human) play a part towards a pleasant virtual reality experience. In this paper, we review the potential factors which cause sickness and minimize the usability of virtual reality systems. The reviewed scientific articles are mostly part of documents indexed in digital libraries. We review the best practices from a developer’s perspective and some of the safety measures a user must follow while using the virtual reality systems from existing research. Even after following some of the guidelines and best practices virtual reality environments do not guarantee a pleasant experience for users. Limited research in virtual reality environments towards requirements specification, design, and development for maximum usability and adaptability was the main motive for this work.

Virtual Reality as a Moderator of Psychedelic-Assisted Psychotherapy

Psychotherapy with the use of psychedelic substances, including psilocybin, lysergic acid diethylamide (LSD), ketamine, and 3,4-methylenedioxymethamphetamine (MDMA), has demonstrated promise in treatment of post-traumatic stress disorder (PTSD), anxiety, addiction, and treatment-resistant depression. Psychedelic-assisted psychotherapy (PP) represents a unique psychopharmacological model that leverages the profound effects of the psychedelic experience. That experience is characterized by strong dependency on two key factors: participant mindset and the therapeutic environment. As such, therapeutic models that utilize psychedelics reflect the need for careful design that promotes an open, flexible, trusting mindset and a supportive setting. To meet this need, the PP model is increasingly supplemented by auxiliary methods, including meditation, relaxation, visualization or spiritual practices. We suggest virtual reality (VR) as a full-spectrum tool able to capitalize on and catalyze the innately therapeutic aspects of the psychedelic experience, such as detachment from familiar reality, alteration of self-experience, augmentation of sensory perception and induction of mystical-type experiences. This is facilitated by VR’s evidenced capacity to: aid relaxation and reduce anxiety; buffer from external stimuli; promote a mindful presence; train the mind to achieve altered states of consciousness (ASC); evoke mystical states; enhance therapeutic alliance and encourage self-efficacy. While these unique VR features appear promising, VR’s potential role in PP remains speculative due to lack of empirical evidence on the combined use of VR and PP. Given the increased commercial interest in this synergy there is an urgent need to evaluate this approach. We suggest specific VR models and their role within PP protocols to inspire future direction in scientific research, and provide a list of potential disadvantages, side effects and limitations that need to be carefully considered. These include sensory overstimulation, cyber-sickness, triggering memories of past traumatic events as well as distracting from the inner experience or strongly influencing its contents. A balanced, evidence-based approach may provide continuity across all phases of treatment, support transition into and out of an ASC, deepen acute ASC experiences including mystical states and enrich the psychotherapeutic process of integration. We conclude that the potential application of VR in modulating psychedelic-assisted psychotherapy demands further exploration and an evidence-based approach to both design and implementation.

Factors Affecting Car Sickness of Passengers Traveled by Vehicles in North Shewa Zone, Oromia, Ethiopia

Introduction

Car sickness is the state of being unhealthy as a result of motions that occur while traveling by vehicles. Passengers traveled by vehicles had experienced car sickness not only as a result of the biological effects but also other associated factors. Therefore, this study aimed to identify sociocultural, individual behavioral factors and situational factors resulting in car sickness of passengers traveling by minibus or bus or both.

Methods

This study was designed in a cross-sectional study and employed a quantitative approach to collect data among 384 passengers. Primary data were collected by a survey method. Both adult male and female passengers without any confirmed disease participated in the study. Car sickness was measured as whether a passenger traveling by vehicle in the past six months had at least one of the signs and symptoms either vomiting, nausea, headache, and (cold) sweating. Quantitative data were analyzed using descriptive statistics, bivariate analysis, and binary logistic regression. The multivariate logistic regression model was employed and used to execute the associated risk factors by declaring all statistical tests significantly at p-value ≤0.05.

Results

The results indicated that being older (aOR = 0.972, 95% CI: 0.947, 0.999) and male passengers (aOR = 0.357, 95% CI: 0.190, 0.673) significantly decreased occurrences of car sickness. However, sleep deprivation (aOR = 8.540, 95% CI: 2.575, 28.328), eating heavy meals before starting traveling (aOR = 4.147, 95% CI: 1.659, 10.366), the aggressiveness of drivers (aOR = 5.467, 95% CI: 2.456, 12.172), and travel with other passengers in overcrowded vehicles (aOR = 9.5212, 95% CI: 5.194, 17.455) were significantly contributed to car sickness.

Conclusions

The findings suggested that younger passengers should take medications that reduce the sensation of car sickness before starting traveling and female passengers should reduce unpaid domestic work before their travels. In order to prevent or reduce the sensation of car sickness, passengers should take enough physical rest, sleep well, and avoid eating heavy meals before a journey. Furthermore, passengers should strongly advise or kindly request aggressive drivers to drive slowly and uniformly. Last, the passengers should avoid traveling with other passengers in overcrowded vehicles as much as possible.

Immersive Virtual Reality-Based Cognitive Intervention for the Improvement of Cognitive Function, Depression, and Perceived Stress in Older Adults With Mild Cognitive Impairment and Mild Dementia: Pilot Pre-Post Study

Background

The incidence of dementia is increasing annually, resulting in varying degrees of adverse effects for individuals, families, and society. With the continuous development of computer information technology, cognitive interventions are constantly evolving. The use of immersive virtual reality (IVR) as a cognitive intervention for older adults with mild cognitive impairment (MCI) and mild dementia (MD) is promising, although only few studies have focused on its use.

Objective

The Chinese virtual supermarket (CVSM) IVR system was developed to provide a comprehensive and individual cognitive intervention program for older patients with MCI and MD. The aim of this study was to explore the feasibility and clinical effectiveness of this 5-week IVR-based cognitive intervention.

Methods

A pretest-posttest study design was conducted with 31 older adults with MCI and MD from August 2020 to January 2021. All participants participated in a 5-week immersive virtual cognitive training program using the CVSM system. Feasibility was assessed as the incidence and severity of cybersickness symptoms and participant satisfaction based on questionnaires conducted after the intervention. Clinical effectiveness was evaluated using neuropsychological assessments, including several commonly used measures of cognitive function, depression, perceived stress, and activities of daily living. Measurements were obtained at baseline and after the intervention period.

Results

A total of 18 patients with MCI (mean age 82.94 [SD 5.44] years; 12 females) and 13 patients with MD (mean age 85.7 [SD 4.67] years, 10 females) participated in this pilot study. Both groups showed significant improvements in all cognitive function measurements (P<.001). The MD group had a significantly greater improvement in general cognitive function compared to the MCI group in Montreal Cognitive Assessment Scale, Symbol Digit Modalities Test, Shape Trail Test, and Auditory Verbal Learning Test. Furthermore, an intervention effect was observed in the improvement of perceived stress (P=.048 for MD group, P=.03 for MCI group ).

Conclusions

The use of the CVSM system may be effective in enhancing the cognitive function of patients with MCI and MD, including general cognitive function, memory, executive function, and attention. IVR technology enriches cognitive intervention approaches and provides acceptable, professional, personalized, and interesting cognitive training for older adults with cognitive impairment.

Trial Registration

ClinicalTrials ChiCTR2100043753; https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2100043753

Cybersickness and Its Severity Arising from Virtual Reality Content: A Comprehensive Study

Virtual reality (VR) experiences often elicit a negative effect, cybersickness, which results in nausea, disorientation, and visual discomfort. To quantitatively analyze the degree of cybersickness depending on various attributes of VR content (i.e., camera movement, field of view, path length, frame reference, and controllability), we generated cybersickness reference (CYRE) content with 52 VR scenes that represent different content attributes. A protocol for cybersickness evaluation was designed to collect subjective opinions from 154 participants as reliably as possible in conjunction with objective data such as rendered VR scenes and biological signals. By investigating the data obtained through the experiment, the statistically significant relationships—the degree that the cybersickness varies with each isolated content factor—are separately identified. We showed that the cybersickness severity was highly correlated with six biological features reflecting brain activities (i.e., relative power spectral densities of Fp1 delta, Fp 1 beta, Fp2 delta, Fp2 gamma, T4 delta, and T4 beta waves) with a coefficient of determination greater than 0.9. Moreover, our experimental results show that individual characteristics (age and susceptibility) are also quantitatively associated with cybersickness level. Notably, the constructed dataset contains a number of labels (i.e., subjective cybersickness scores) that correspond to each VR scene. We used these labels to build cybersickness prediction models and obtain a reliable predictive performance. Hence, the proposed dataset is supposed to be widely applicable in general-purpose scenarios regarding cybersickness quantification.

Postural Control and Psychophysical State Following of Flight Simulator Session in Novice Pilots

Flight simulators can cause side effects usually called simulator sickness. Scientific research proves that postural instability can be an indicator of the occurrence of simulator sickness symptoms. This study aims to assess changes of postural control and psychophysical state in novice pilots following 2-h exposure to simulator conditions. The postural sway was quantified based on variables describing the displacement of the Center of Pressure (COP) generated in a quiet stance with eyes open (EO) and closed (EC). The psychophysical state was assessed using the Simulator Sickness Questionnaire (SSQ). The research was carried out in a group of 24 novice pilots who performed procedural and emergency flight exercises in the simulator at Instrument Meteorological Conditions. Each subject was examined twice: immediately before the simulator session (pre-exposure test), and just after the session (post-exposure test). The differences in postural stability between pre- and post-exposure to simulator conditions were assessed based on the normalized Romberg quotients, calculated for individual variables. The lower median values of all Romberg quotients confirmed the decreasing difference between the measures with eyes open and with eyes closed in the post-exposure tests. After the flight simulator session in both measurements (EO and EC) the values of the length of sway path (SP), the mean amplitude (MA), the sway area (SA) have changed. The visual contribution to postural sway control was reduced. The median values for all SSQ scores (total, nausea, oculomotor, and disorientation scales) were significantly higher in post-exposure tests. The largest increase was noted in the oculomotor SSQ scores (from 7.6 ± 7.6 to 37.9 ± 26.5). Over 50% of pilots participating in this study expressed symptoms typical of simulator sickness connected with visual induction: fatigue, eyestrain, difficulty focusing and difficulty concentrating. The severity of oculomotor and disorientation symptoms were rated as moderate (total SSQ score of more than 25 and <60). This study concludes that changes noted in the postural control and psychophysical state of the studied pilots after exposure to the flight simulator confirm the occurrence of the simulator sickness symptoms. Although, we did not find significant correlation of postural stability with SSQ scores.