Virtual Reality for Research in Social Neuroscience

Comparing the effectiveness of virtual reality vs 2D display-based cue reactivity paradigms to induce nicotine-craving: a behavioral and psychophysiological study

Craving is a key symptom of nicotine addiction, driving the urge to seek cigarettes. It is often strongly influenced by social and environmental cues associated with the typical use of the substance. In both clinical and laboratory setting, craving can be experimentally triggered using cue reactivity paradigms, where nicotine-related cues are presented to evoke, and then assess, the desire to smoke. In the last few years, virtual reality (VR) has begun to attract a lot of interest in recreating realistic simulations to investigate craving through cue-reactivity exposure. However, a direct comparison between VR and non-immersive devices (e.g. 2D images presented using monitor) regarding their effectiveness in triggering cravings is still missing. In this study, we investigated differences in craving responses by comparing immersive and non-immersive nicotine-related cue-reactivity paradigms. A group of smokers (N = 23, F = 15, Mage = 23.2y.o.) and non-smokers (N = 22, F = 13, Mage = 23.7y.o.) participated in two sessions of cue reactivity exposure, featuring neutral and smoking-related scenarios presented through VR (immersive) and 2D display images (non-immersive). Each session included recording of physiological activity (skin conductance level), self-reported cigarette craving, and an assessment of the overall quality of the experience. Results showed that smokers experienced increase in cigarette cravings after exposure to nicotine-related cues compared to neutral scenarios. Moreover, self-report craving was higher after the VR cue reactivity compared to the 2D modality. A positive relationship between scores in the nicotine dependence questionnaire and self-report craving during VR cue-reactivity session was found, but not for the non-immersive session. Regarding physiological responses, smokers exhibited significantly higher skin conductance levels compared to non-smokers during the VR cue reactivity session. In contrast, no significant differences between the two groups were observed during the 2D display exposures. Participants evaluated the VR paradigm as more realistic tool to recreate credible simulations of real-life situations, and a positive correlation between self-reported craving and vividness of experience was found in the smokers' cohort. The present study provides further elements supporting the use of VR in the cue-reactivity paradigm for craving assessment, compared to non-immersive devices. Future studies will aim to confirm the effectiveness of VR as a better tool in assessing craving during clinical treatment.

Development, Validation, and Usability of a Virtual Game for Consciousness and Relaxation of the Pelvic Floor Muscles

BACKGROUND

Applicability of the virtual games has been increasingly added to rehabilitation treatments, including women's health interventions.

OBJECTIVE

To develop a virtual interface designed to increase consciousness and relax the pelvic floor muscles, validate its content and appearance, and check the level of usability and satisfaction.

METHODS

Physiotherapy specialists with experience in pelvic floor rehabilitation and database research were consulted to define the content. Thus, 13 physiotherapists specialized in the area participated in the content and appearance validation of the virtual game with a minimum agreement level of 80%. An evaluation of the usability level was conducted through MATCH (Checklist for Evaluation of the Usability of Applications for Touchscreen Phones) and the satisfaction level through a visual analog scale.

RESULTS

The game is presented in two-dimensional (2D) configuration and is based on parachuting. The main activity required is muscle relaxation to open the parachute and descend to the target. The goal is to reach the target by traveling as long as possible with the parachute open. A physical exercise protocol from the American College of Sports Medicine was used to define the contraction/relaxation time. A total of 4 of the 15 items which represented the content and appearance for validation needed a second round to reach the desired level of agreement. The game showed a high level of usability M: 63.04 (±5.28) and the level of satisfaction of the virtual game showed an average of 9.7 (±0.55).

CONCLUSION

The virtual game developed for the pelvic floor muscle relaxation training showed content validity and adequate appearance and a high level of usability and satisfaction.

International perspective on social cognition in schizophrenia: current stage and the next steps

In the last decades, research from cognitive science, clinical psychology, psychiatry, and social neuroscience has provided mounting evidence that several social cognitive abilities are impaired in people with schizophrenia and contribute to functional difficulties and poor clinical outcomes. Social dysfunction is a hallmark of the illness, and yet, social cognition is seldom assessed in clinical practice or targeted for treatment. In this article, 17 international experts, from three different continents and six countries with expertise in social cognition and social neuroscience in schizophrenia, convened several meetings to provide clinicians with a summary of the most recent international research on social cognition evaluation and treatment in schizophrenia, and to lay out primary recommendations and procedures that can be integrated into their practice. Given that many extant measures used to assess social cognition have been developed in North America or Western Europe, this article is also a call for researchers and clinicians to validate instruments internationally and we provide preliminary guidance for the adaptation and use of social cognitive measures in clinical and research evaluations internationally. This effort will assist promoting scientific rigor, enhanced clinical practice, and will help propel international scientific research and collaboration and patient care.

Effect of content framing in smoking prevention campaigns on recognition and attitudes: a virtual reality study

Objectives

Anti-tobacco campaigns often suffer from a lack of systematic evaluation and may not always have the intended impact on the target population. Our research adopted immersive virtual reality (iVR) to systematically evaluate preventive anti-tobacco messages in a controlled setting while mimicking a naturalistic and ecological environment. We investigated the effect of content framing of Anti-tobacco posters on attitudes and cravings toward tobacco, and poster recognition.

Methods

Participants were undergraduate students (n = 121), mostly female (76%). They were immersed in a virtual environment incidentally exposing them to either negatively, positively, or neutrally framed preventive posters based on their experimental condition. Their gaze was eye-tracked during the entire procedure.

Results

Results indicate that incidental exposure to preventive anti-tobacco posters while directly looking at negatively framed posters was associated with lower positive attitudes toward tobacco. Incidental exposure to posters did not impact their explicit recognition, except when exposed to negatively framed posters. No significant effect was found on craving.

Conclusions

We advise health campaign designers to consistently use negatively framed preventive messages and recommend the use of iVR to evaluate campaigns before launching them.

Amplifying Cognitive Functions in Amateur Esports Athletes: The Impact of Short-Term Virtual Reality Training on Reaction Time, Motor Time, and Eye-Hand Coordination

OBJECTIVES

Electronic sports (esports) have grown into a major competitive field in today's digital landscape, attracting the interest of established companies and evolving into a fast-growing industry. Cognitive function, including reaction time, motor time, and eye-hand coordination, plays a crucial role in e-athlete performance. This study aims to examine the impact of VR training on these cognitive functions in amateur e-athletes.

METHODS

The study involved 66 amateur e-athletes (45 men and 21 women, aged 19-41, with a mean age of 23.96 ± 3.90 years) who reported active, non-professional involvement in esports. Participants were randomly assigned to an experimental group (E) (n = 32) and a control group (C) (n = 34), with initial comparisons confirming no significant differences in daily gaming habits, esports experience, or age between groups. The E group completed 15-minute daily training sessions using the VR game Beat Saber over eight consecutive days.

RESULTS

The results demonstrated that VR training significantly improved eye-hand coordination in the experimental group, although there were no notable effects on reaction time or motor time.

CONCLUSIONS

These findings suggest that VR training may be an effective method to enhance certain cognitive functions, specifically eye-hand coordination, among amateur e-athletes. This could offer a valuable approach for performance improvement in this rapidly growing field.

Innovative technology-based interventions in Parkinson's disease: A systematic review and meta-analysis

OBJECTIVE

Novel technology-based interventions have the potential to improve motor symptoms and gait in Parkinson's disease (PD). Promising treatments include virtual-reality (VR) training, robotic assistance, and biofeedback. Their effectiveness remains unclear, and thus, we conducted a Bayesian network meta-analysis.

METHODS

We searched the Medline, Embase, Cochrane CENTRAL, and Clinicaltrials.gov databases until 2 April 2024 and only included randomized controlled trials. Outcomes included changes in UPDRS-III/MDS-UPDRS-III score, stride length, 10-meter walk test (10MWT), timed up-and-go (TUG) test, balance scale scores and quality-of-life (QoL) scores. Results were reported as mean differences (MD) or standardized mean differences (SMD), with 95% credible intervals (95% CrI).

RESULTS

Fifty-one randomized controlled trials with 2095 patients were included. For UPDRS (motor outcome), all interventions had similar efficacies. VR intervention was the most effective in improving TUG compared with control (MD: -4.36, 95% CrI: -8.57, -0.35), outperforming robotic, exercise, and proprioceptive interventions. Proprioceptive intervention significantly improved stride length compared to control intervention (MD: 0.11 m, 95% CrI: 0.03, 0.19), outperforming VR, robotic and exercise interventions. Virtual reality improved balance scale scores significantly compared to exercise intervention (SMD: 0.75, 95% CrI: 0.12, 1.39) and control intervention (SMD: 1.42, 95% CrI: 0.06, 2.77). Virtual reality intervention significantly improved QoL scores compared to control intervention (SMD: -0.95, 95% CrI: -1.43, -0.52), outperforming Internet-based interventions.

INTERPRETATION

VR-based and proprioceptive interventions were the most promising interventions, consistently ranking as the top treatment choices for most outcomes. Their use in clinical practice could be helpful in managing motor symptoms and QoL in PD.

Virtual Reality Tennis Training: Performance Gains Derived from User Characteristics

There is growing interest in virtual reality (VR) training among competitive athletes and casual sports players alike as a tool to supplement real-life play within a highly controlled, intellectually stimulating environment. We examined data from a commercially available, recently released VR software for tennis for changes in and correlates of performance. Two most frequently used tasks were evaluated-Baseline Center and Quick Volley, which include Efficiency (both), Concentration (both), and Reaction Time (Quick Volley only) subtasks. In all, 1,124 (Baseline Center) and 745 (Quick Volley) users met inclusion criteria (completed more than four trials; active sometime between November 2022 and July 2023). We found that most users were male adults and were about evenly split between advanced/pro users and intermediate/beginner users. Two or three trajectories emerged across the subtasks. Performance gains were most pronounced on movement efficiency, especially early on. Adult users generally exhibited more improvement than junior users. Additionally, women and right-handed users improved more on Baseline Center subtasks, and advanced/pro users did better than intermediate/beginner users on Quick Volley subtasks. We discuss that, despite strong performance gains within VR environment, VR training may still reflect in better real-world performance, may increase confidence and accuracy of relevant movement, lower risk of injury, and present a welcome diversion from a potential monotony of performing sport-related tasks in purely real-world settings. Future research should explore the extent to which VR training transfers to real-world performance.

Exploring Adaptive Virtual Reality Systems Used in Interventions for Children With Autism Spectrum Disorder: Systematic Review

BACKGROUND

Adaptive systems serve to personalize interventions or training based on the user's needs and performance. The adaptation techniques rely on an underlying engine responsible for processing incoming data and generating tailored responses. Adaptive virtual reality (VR) systems have proven to be efficient in data monitoring and manipulation, as well as in their ability to transfer learning outcomes to the real world. In recent years, there has been significant interest in applying these systems to improve deficits associated with autism spectrum disorder (ASD). This is driven by the heterogeneity of symptoms among the population affected, highlighting the need for early customized interventions that target each individual's specific symptom configuration.

OBJECTIVE

Recognizing these technology-driven therapeutic tools as efficient solutions, this systematic review aims to explore the application of adaptive VR systems in interventions for young individuals with ASD.

METHODS

An extensive search was conducted across 3 different databases-PubMed Central, Scopus, and Web of Science-to identify relevant studies from approximately the past decade. Each author independently screened the included studies to assess the risk of bias. Studies satisfying the following inclusion criteria were selected: (1) the experimental tasks were delivered via a VR system, (2) system adaptation was automated, (3) the VR system was designed for intervention or training of ASD symptoms, (4) participants' ages ranged from 6 to 19 years, (5) the sample included at least 1 group with ASD, and (6) the adaptation strategy was thoroughly explained. Relevant information extracted from the studies included the sample size and mean age, the study's objectives, the skill trained, the implemented device, the adaptive strategy used, the engine techniques, and the signal used to adapt the systems.

RESULTS

Overall, a total of 10 articles were included, involving 129 participants, 76% of whom had ASD. The studies included level switching (7/10, 70%), adaptive feedback strategies (9/10, 90%), and weighing the choice between a machine learning (ML) adaptive engine (3/10, 30%) and a non-ML adaptive engine (8/10, 80%). Adaptation signals ranged from explicit behavioral indicators (6/10, 60%), such as task performance, to implicit biosignals, such as motor movements, eye gaze, speech, and peripheral physiological responses (7/10, 70%).

CONCLUSIONS

The findings reveal promising trends in the field, suggesting that automated VR systems leveraging real-time progression level switching and verbal feedback driven by non-ML techniques using explicit or, better yet, implicit signal processing have the potential to enhance interventions for young individuals with ASD. The limitations discussed mainly stem from the fact that no technological or automated tools were used to handle data, potentially introducing bias due to human error.

Examining the Mechanisms of Virtual Reality Tourism's Impact on the Mental Well-Being of Long-Term Care Facility Residents: Perspectives on Presence and Flow

This study investigates the mechanisms of virtual reality (VR) tourism's impact on the well-being of residents in long-term care facilities (LTCFs). It aims to understand how presence and flow during VR experiences can enhance well-being. This experimental study used a quantitative approach with structured questionnaires to investigate VR experiences among LTCF residents in Taiwan. After obtaining ethical approval, 145 eligible participants from four LTCFs completed a full five-week VR tourism experience. Data collection took place from June to November 2022. This study employed Partial Least Squares Structural Equation Modeling (PLS-SEM) with Smart PLS software to analyze the causal relationships between latent variables. The results confirm that the more vivid the virtual reality image (β = 0.240, p < 0.05), the more immersive the experience (β = 0.267, p < 0.05), the greater the ability to control the experience (β = 0.465, p < 0.001), and the greater the ability to stimulate curiosity during the experience (β = 0.290, p < 0.05), the greater the sense of presence. Increased presence leads to user engagement and a state of flow (β = 0.556, p < 0.001), which is essential for personal hedonia (β = 0.453, p < 0.001) and eudaimonia (β = 0.220, p < 0.001). This study elucidates the mechanisms through which VR tourism experiences enhance well-being among LTCF residents, emphasizing the critical roles of presence and flow in promoting both hedonic and eudaimonic dimensions of well-being.

When virtual reality becomes psychoneuroendocrine reality: A stress(or) review

This review article was awarded the Dirk Hellhammer award from ISPNE in 2023. It explores the dynamic relationship between stressors and stress from a historical view as well as a vision towards the future of stress research via virtual reality (VR). We introduce the concept of a "syncytium," a permeable boundary that blurs the distinction between stress and stressor, in order to understand why the field of stress biology continues to inadequately measure stress alone as a proxy for the force of external stressors. Using Virtual Reality (VR) as an illustrative example to explicate the black box of stressors, we examine the distinction between 'immersion' and 'presence' as analogous terms for stressor and stress, respectively. We argue that the conventional psychological approaches to stress measurement and appraisal theory unfortunately fall short in quantifying the force of the stressor, leading to reverse causality fallacies. Further, the concept of affordances is introduced as an ecological or holistic tool to measure and design a stressor's force, bridging the gap between the external environment and an individual's physiological response to stress. Affordances also serve to ameliorate shortcomings in stress appraisal by integrating ecological interdependencies. By combining VR and psychobiological measures, this paper aims to unravel the complexity of the stressor-stress syncytium, highlighting the necessity of assessing both the internal and external facets to gain a holistic understanding of stress physiology and shift away from reverse causality reasoning. We find that the utility of VR extends beyond presence to include affordance-based measures of immersion, which can effectively model stressor force. Future research should prioritize the development of tools that can measure both immersion and presence, thereby providing a more comprehensive understanding of how external stressors interact with individual psychological states.

The effects of task novelty for age cohort and cognition level on memory for everyday virtual meal preparation tasks

Nonsensical information increases task novelty, which makes it difficult to rely on previous learning and provides insight into the learning of new tasks. This study investigated procedural-based action scripts in everyday memory for meal preparation tasks in virtual reality. The sample (N = 171) consisted of 3 groups determined by age and cognitive function: young adults (YA; n = 61), older adults with normal cognition (OA; n = 82), and older adults with impaired cognition (IC; n = 28). The three groups completed the Virtual Kitchen Protocol, a virtual reality-based measure of learning and memory for cooking both familiar and nonsensical meals. Results showed that YAs had a greater recall for both familiar and nonsensical meals than OAs or ICs. Additionally, novel stimuli (i.e., nonsensical meal tasks) appear to impact older adults more than young adults. Among older adults, impaired cognition was associated with lower performance on both the sensical and nonsensical meals compared to normal cognition. All three groups performed better on familiar tasks than nonsensical tasks. These results were consistent with the notion that familiarity may be of greater use than novelty in the context of procedural-based action scripts.

A multimodal group-based immersive virtual reality intervention for improving cognition and mental health in patients with post-covid-19 condition. A quasi-experimental design study

Introduction

Adults with Post-COVID-19 Condition (PCC) may show cognitive impairments in attention, processing speed, memory, and executive function. Multimodal programs that combine cognitive training, physical activity and emotional tasks, such as mindfulness-based interventions (MBIs), may offer a suitable alternative for improving PCC treatments. Immersive Virtual Reality (IVR) is a promising technology that can enhance traditional cognitive training, physical activity, and MBIs. The use of IVR technology may increase engagement with these interventions and potentially enhance the individual benefits of cognitive training, exercise and MBIs. The current study evaluated the impact of a multimodal IVR intervention, comparing this with a usual care intervention (control group), in order to assess changes in cognition and mental health in adults with PCC. We also aimed to assess user experience factors such as enjoyment, perceived improvement, and fatigue following each multimodal IVR session within the experimental group.

Method

Thirty-one participants with PCC symptoms were assigned to either the experimental group (IVR, n = 15) or the control group (usual care intervention, n = 16) in a quasi-experimental design study. The multimodal IVR intervention consisted of MBI, cognitive training and physical exercise and was delivered in a 60-min group session with 5 participants, twice a week, for 8 weeks (16 sessions in total). Measures of global cognition, attention, processing speed, verbal episodic memory and subjective memory complaints (primary measures), and depressive and anxiety symptoms and fatigue (secondary measures) were assessed at baseline and also after 8 weeks (post-intervention).

Results

Mixed between-group (group) and within-group (pre-post assessments) ANOVAs revealed significant group*time interactions in global cognition, simple attention, processing speed, memory and depressive symptoms, with large effect sizes (p < 0.05; partial η2 > 0.14). There was also a marginally significant group*time interaction for executive function (p = 0.05). Follow-up analyses comparing pre-and post-intervention outcomes for each group separately showed that the experimental group significantly improved in global cognition, processing speed, memory and depressive symptoms, while the control group showed no significant pre-post changes. Friedman tests showed a significant main effect of time (χ2(2) = 6.609, p = 0.04), with a gradual increase in enjoyment from the first, to the mid, and then to the final session. In addition, perceived improvement scores remained high throughout the intervention, and patient-reported fatigue levels did not fluctuate significantly throughout the intervention.

Conclusion

To our knowledge, no previous research has combined cognitive training, physical exercise and MBI using an IVR paradigm in adults with PCC. Despite their inherent limitations, our findings mark a pioneering step toward improving cognition and mental health outcomes in PCC through the innovative use of new technology and multimodal approaches. This first study should be accompanied by more extensive, randomized clinical trials aimed at further exploring and refining these interventions.

Static and Dynamic Hand Gestures: A Review of Techniques of Virtual Reality Manipulation

This review explores the historical and current significance of gestures as a universal form of communication with a focus on hand gestures in virtual reality applications. It highlights the evolution of gesture detection systems from the 1990s, which used computer algorithms to find patterns in static images, to the present day where advances in sensor technology, artificial intelligence, and computing power have enabled real-time gesture recognition. The paper emphasizes the role of hand gestures in virtual reality (VR), a field that creates immersive digital experiences through the Ma blending of 3D modeling, sound effects, and sensing technology. This review presents state-of-the-art hardware and software techniques used in hand gesture detection, primarily for VR applications. It discusses the challenges in hand gesture detection, classifies gestures as static and dynamic, and grades their detection difficulty. This paper also reviews the haptic devices used in VR and their advantages and challenges. It provides an overview of the process used in hand gesture acquisition, from inputs and pre-processing to pose detection, for both static and dynamic gestures.

Virtual reality, face-to-face, and 2D video conferencing differently impact fatigue, creativity, flow, and decision-making in workplace dynamics

Digital communication technologies are rapidly evolving, and understanding their impact on group dynamics and cognitive performance in professional settings becomes central. This study investigates the psychological impact of different interaction settings-two-dimensional Video Conferencing (VC), Face-To-Face (FTF), and Virtual Reality (VR)-on group dynamics, cognitive performance, and aspects of well-being in a professional context. Utilizing a sample of 40 participants from a large Italian electricity transmission company, the study employs a within-subjects design to explore various metrics, including flow, creativity, fatigue and aspects of interaction. The results indicate that FTF interactions are optimal for idea generation and task absorption. VR, although initially more fatiguing for first-time users, fosters a more collaborative and peaceful environment, encouraging participants to engage more openly with each other. VC was found to be the least fatiguing, but also the least engaging in terms of task absorption and idea generation. Additionally, age-related differences were observed, particularly in the perception of motivational and emotional fatigue in the VR setting. The study provides empirical evidence supporting the integration of VR in professional settings for specific types of meetings, while also highlighting the limitations and areas for future research. These findings have implications for organizational well-being, cognitive ergonomics, and the evolving landscape of remote work technologies.

Social Signal Processing in Affective Virtual Reality: Human-Shaped Agents Increase Electrodermal Activity in an Elicited Negative Environment

Prior research on affect elicitation indicates that stimuli with social content (pictures or videos) are more arousing than nonsocial stimuli. In particular, they elicit stronger physiological arousal as measured by electrodermal activity (EDA; i.e., social EDA effect). However, it is unclear how this effect applies to virtual reality (VR), which enables an enhanced sense of presence (SoP) and ecological validity. The study here approached this question from a social-emotional VR framework. A sample of N = 72 participants (55 percent women) experienced a set of six virtual environments (VEs) in the form of emotional parks specifically designed to elicit positive, negative, or neutral affectivity. Half of these VEs included human-shaped agents (social context) and the other half omitted these agents (nonsocial context). The results supported the social EDA effect, which in addition was amplified by the reported SoP. Importantly, the VE featuring a social negative content qualified this observed social EDA effect. The finding is discussed in the light of a negativity bias reported in affect literature, through which negative stimuli typically mobilize attention and bodily activation as a mechanism linked to stress responses. The study's implications extend to the use of VR in both research and practical applications, emphasizing the role of social content in influencing affective and physiological responses.

iVR-fNIRS: studying brain functions in a fully immersive virtual environment

Immersive virtual reality (iVR) employs head-mounted displays or cave-like environments to create a sensory-rich virtual experience that simulates the physical presence of a user in a digital space. The technology holds immense promise in neuroscience research and therapy. In particular, virtual reality (VR) technologies facilitate the development of diverse tasks and scenarios closely mirroring real-life situations to stimulate the brain within a controlled and secure setting. It also offers a cost-effective solution in providing a similar sense of interaction to users when conventional stimulation methods are limited or unfeasible. Although combining iVR with traditional brain imaging techniques may be difficult due to signal interference or instrumental issues, recent work has proposed the use of functional near infrared spectroscopy (fNIRS) in conjunction with iVR for versatile brain stimulation paradigms and flexible examination of brain responses. We present a comprehensive review of current research studies employing an iVR-fNIRS setup, covering device types, stimulation approaches, data analysis methods, and major scientific findings. The literature demonstrates a high potential for iVR-fNIRS to explore various types of cognitive, behavioral, and motor functions in a fully immersive VR (iVR) environment. Such studies should set a foundation for adaptive iVR programs for both training (e.g., in novel environments) and clinical therapeutics (e.g., pain, motor and sensory disorders and other psychiatric conditions).

Heterogeneities of the perceptual-motor style during locomotion at height

In a recent review, we summarized the characteristics of perceptual-motor style in humans. Style can vary from individual to individual, task to task and pathology to pathology, as sensorimotor transformations demonstrate considerable adaptability and plasticity. Although the behavioral evidence for individual styles is substantial, much remains to be done to understand the neural and mechanical substrates of inter-individual differences in sensorimotor performance. In this study, we aimed to investigate the modulation of perceptual-motor style during locomotion at height in 16 persons with no history of fear of heights or acrophobia. We used an inexpensive virtual reality (VR) video game. In this VR game, Richie's Plank, the person progresses on a narrow plank placed between two buildings at the height of the 30th floor. Our first finding was that the static markers (head, trunk and limb configurations relative to the gravitational vertical) and some dynamic markers (jerk, root mean square, sample entropy and two-thirds power law at head, trunk and limb level) we had previously identified to define perceptual motor style during locomotion could account for fear modulation during VR play. Our second surprising result was the heterogeneity of this modulation in the 16 young, healthy individuals exposed to moving at a height. Finally, 56% of participants showed a persistent change in at least one variable of their skeletal configuration and 61% in one variable of their dynamic control during ground locomotion after exposure to height.

Collaborative co-design and evaluation of an immersive virtual reality application prototype for communication rehabilitation (DISCOVR prototype)

PURPOSE

Virtual reality (VR) lends itself to communication rehabilitation by creating safe, replicable, and authentic simulated environments in which users learn and practice communication skills. The aim of this research was to obtain the views of health professionals and technology specialists on the design characteristics and usability of a prototype VR application for communication rehabilitation.

MATERIALS AND METHODS

Nine professionals from different health and technology disciplines participated in an online focus group or individual online interview to evaluate the application and use of the VR prototype. Data sources were analysed using a content thematic analysis.

RESULTS

Four main themes relating to VR design and implementation in rehabilitation were identified: (i) designing rehabilitation-focused virtual worlds; (ii) understanding and using VR hardware; (iii) making room for VR in rehabilitation and training; and (iv) implementing VR will not replace the health professional's role.

DISCUSSION

Health professionals and technology specialists engaged in co-design while evaluating the VR prototype. They identified software features requiring careful consideration to ensure improved usability, client safety, and success in communication rehabilitation outcomes. Continuing inclusive co-design, engaging health professionals, clients with communication disability, and their families will be essential to creating useable VR applications and integrating these successfully into rehabilitation. Implications for rehabilitationHealth and technology professionals, along with clients, are integral to the co-design of new VR technology applications.Design of VR applications needs to consider the client's communication, physical, cognitive, sensory, psychosocial, and emotional needs for greater usability of these programs.Realism and authenticity of interactions, characters, and environments are considered important factors to allow users to be fully immersed in virtual simulations to enhance rehabilitation.

Molecular mechanisms underlying the neuroprotection of environmental enrichment in Parkinson's disease

Parkinson's disease is the most common movement disorder, affecting about 1% of the population over the age of 60 years. Parkinson's disease is characterized clinically by resting tremor, bradykinesia, rigidity and postural instability, as a result of the progressive loss of nigrostriatal dopaminergic neurons. In addition to this neuronal cell loss, Parkinson's disease is characterized by the accumulation of intracellular protein aggregates, Lewy bodies and Lewy neurites, composed primarily of the protein α-synuclein. Although it was first described almost 200 years ago, there are no disease-modifying drugs to treat patients with Parkinson's disease. In addition to conventional therapies, non-pharmacological treatment strategies are under investigation in patients and animal models of neurodegenerative disorders. Among such strategies, environmental enrichment, comprising physical exercise, cognitive stimulus, and social interactions, has been assessed in preclinical models of Parkinson's disease. Environmental enrichment can cause structural and functional changes in the brain and promote neurogenesis and dendritic growth by modifying gene expression, enhancing the expression of neurotrophic factors and modulating neurotransmission. In this review article, we focus on the current knowledge about the molecular mechanisms underlying environmental enrichment neuroprotection in Parkinson's disease, highlighting its influence on the dopaminergic, cholinergic, glutamatergic and GABAergic systems, as well as the involvement of neurotrophic factors. We describe experimental pre-clinical data showing how environmental enrichment can act as a modulator in a neurochemical and behavioral context in different animal models of Parkinson's disease, highlighting the potential of environmental enrichment as an additional strategy in the management and prevention of this complex disease.

Early threat perception is independent of later cognitive and behavioral control. A virtual reality-EEG-ECG study

Research on social threat has shown influences of various factors, such as agent characteristics, proximity, and social interaction on social threat perception. An important, yet understudied aspect of threat exposure concerns the ability to exert control over the threat and its implications for threat perception. In this study, we used a virtual reality (VR) environment showing an approaching avatar that was either angry (threatening body expression) or neutral (neutral body expression) and informed participants to stop avatars from coming closer under five levels of control success (0, 25, 50, 75, or 100%) when they felt uncomfortable. Behavioral results revealed that social threat triggered faster reactions at a greater virtual distance from the participant than the neutral avatar. Event-related potentials (ERPs) revealed that the angry avatar elicited a larger N170/vertex positive potential (VPP) and a smaller N3 than the neutral avatar. The 100% control condition elicited a larger late positive potential (LPP) than the 75% control condition. In addition, we observed enhanced theta power and accelerated heart rate for the angry avatar vs. neutral avatar, suggesting that these measures index threat perception. Our results indicate that perception of social threat takes place in early to middle cortical processing stages, and control ability is associated with cognitive evaluation in middle to late stages.

Co-design of a Virtual Reality Cognitive Remediation Program for Depression (bWell-D) With Patient End Users and Clinicians: Qualitative Interview Study Among Patients and Clinicians

BACKGROUND

Major depressive disorder (MDD) is the leading cause of global disability; however, the existing treatments do not always address cognitive dysfunction-a core feature of MDD. Immersive virtual reality (VR) has emerged as a promising modality to enhance the real-world effectiveness of cognitive remediation.

OBJECTIVE

This study aimed to develop the first prototype VR cognitive remediation program for MDD ("bWell-D"). This study gathered qualitative data from end users early in the design process to enhance its efficacy and feasibility in clinical settings.

METHODS

Semistructured end-user interviews were conducted remotely (n=15 patients and n=12 clinicians), assessing the participants' perceptions and goals for a VR cognitive remediation program. Video samples of bWell-D were also shared to obtain feedback regarding the program. The interviews were transcribed, coded, and analyzed via thematic analysis.

RESULTS

End users showed an optimistic outlook toward VR as a treatment modality, and perceived it as a novel approach with the potential of having multiple applications. The participants expressed a need for an engaging VR treatment that included realistic and multisensorial settings and activities, as well as customizable features. Some skepticism regarding its effectiveness was also reported, especially when the real-world applications of the practiced skills were not made explicit, as well as some concerns regarding equipment accessibility. A home-based or hybrid (ie, home and clinic) treatment modality was preferred.

CONCLUSIONS

Patients and clinicians considered bWell-D interesting, acceptable, and potentially feasible, and provided suggestions to enhance its real-world applicability. The inclusion of end-user feedback is encouraged when developing future VR programs for clinical purposes.

Virtual Reality-Assisted Awake Craniotomy: A Retrospective Study

BACKGROUND

Awake craniotomy (AC) with brain mapping for language and motor functions is often performed for tumors within or adjacent to eloquent brain regions. However, other important functions, such as vision and visuospatial and social cognition, are less frequently mapped, at least partly due to the difficulty of defining tasks suitable for the constrained AC environment.

OBJECTIVE

The aim of this retrospective study was to demonstrate, through illustrative cases, how a virtual reality headset (VRH) equipped with eye tracking can open up new possibilities for the mapping of language, the visual field and complex cognitive functions in the operating room.

METHODS

Virtual reality (VR) tasks performed during 69 ACs were evaluated retrospectively. Three types of VR tasks were used: VR-DO80 for language evaluation, VR-Esterman for visual field assessment and VR-TANGO for the evaluation of visuospatial and social functions.

RESULTS

Surgery was performed on the right hemisphere for 29 of the 69 ACs performed (42.0%). One AC (1.5%) was performed with all three VR tasks, 14 ACs (20.3%) were performed with two VR tasks and 54 ACs (78.3%) were performed with one VR task. The median duration of VRH use per patient was 15.5 min. None of the patients had "VR sickness". Only transitory focal seizures of no consequence and unrelated to VRH use were observed during AC. Patients were able to perform all VR tasks. Eye tracking was functional, enabling the medical team to analyze the patients' attention and exploration of the visual field of the VRH directly.

CONCLUSIONS

This preliminary experiment shows that VR approaches can provide neurosurgeons with a way of investigating various functions, including social cognition during AC. Given the rapid advances in VR technology and the unbelievable sense of immersion provided by the most recent devices, there is a need for ongoing reflection and discussions of the ethical and methodological considerations associated with the use of these advanced technologies in AC and brain mapping procedures.

Social rather than physical crowding reduces the required interpersonal distance in virtual environments

Interpersonal distance plays an important role in human social interaction. With the increasing usage of virtual reality in social interaction, people's interpersonal distance in virtual space attracts great attention. It remains unclear whether and to what extent human-required interpersonal distance is altered by crowded virtual scenes. In this study, we manipulated crowd density in virtual environments and used the classical stop-distance paradigm to measure required interpersonal distances at different crowd densities. We found that people's required interpersonal distance decreased with increased social crowdedness but not with physical crowdedness. Moreover, the decrease of two types of interpersonal distance was associated with the globally averaged crowd density rather than local crowd density. The reduction is not due to the imitation of other virtual humans in the crowd. Moreover, we developed a model to describe the quantitative relationships between the crowdedness of the environment and the required interpersonal distance. Our finding provides insights into designing user-friendly virtual humans in metaverse virtual worlds.

Smiles and Angry Faces vs. Nods and Head Shakes: Facial Expressions at the Service of Autonomous Vehicles

When deciding whether to cross the street or not, pedestrians take into consideration information provided by both vehicle kinematics and the driver of an approaching vehicle. It will not be long, however, before drivers of autonomous vehicles (AVs) will be unable to communicate their intention to pedestrians, as they will be engaged in activities unrelated to driving. External human–machine interfaces (eHMIs) have been developed to fill the communication gap that will result by offering information to pedestrians about the situational awareness and intention of an AV. Several anthropomorphic eHMI concepts have employed facial expressions to communicate vehicle intention. The aim of the present study was to evaluate the efficiency of emotional (smile; angry expression) and conversational (nod; head shake) facial expressions in communicating vehicle intention (yielding; non-yielding). Participants completed a crossing intention task where they were tasked with deciding appropriately whether to cross the street or not. Emotional expressions communicated vehicle intention more efficiently than conversational expressions, as evidenced by the lower latency in the emotional expression condition compared to the conversational expression condition. The implications of our findings for the development of anthropomorphic eHMIs that employ facial expressions to communicate vehicle intention are discussed.

A reliable and robust online validation method for creating a novel 3D Affective Virtual Environment and Event Library (AVEL)

This paper describes the development and validation of 3D Affective Virtual environments and Event Library (AVEL) for affect induction in Virtual Reality (VR) settings with an online survey; a cost-effective method for remote stimuli validation which has not been sufficiently explored. Three virtual office-replica environments were designed to induce negative, neutral and positive valence. Each virtual environment also had several affect inducing events/objects. The environments were validated using an online survey containing videos of the virtual environments and pictures of the events/objects. They survey was conducted with 67 participants. Participants were instructed to rate their perceived levels of valence and arousal for each virtual environment (VE), and separately for each event/object. They also rated their perceived levels of presence for each VE, and they were asked how well they remembered the events/objects presented in each VE. Finally, an alexithymia questionnaire was administered at the end of the survey. User ratings were analysed and successfully validated the expected affect and presence levels of each VE and affect ratings for each event/object. Our results demonstrate the effectiveness of the online validation of VE material in affective and cognitive neuroscience and wider research settings as a good scientific practice for future affect induction VR studies.

Virtual Reality for Awe and Imagination

Empirical research has explored the potential of the emotion of awe to shape creativity, while theoretical work has sought to understand the link between this emotion and transformation in terms of imagining new possible worlds. This branch of study relies on the transformative potential of virtual reality (VR) to examine and invite cognitive and emotional components of transformative experiences (TEs) within the interdisciplinary model of Transformative Experience Design (TED) and the Appraisal-Tendency Framework (ATF). TED suggests using the epistemic and emotional affordances of interactive technologies, such as VR, to invite TEs. The ATF can provide insight into the nature of these affordances and their relationship. This line of research draws on empirical evidence of the awe-creativity link to broaden the discourse and consider the potential impact of this emotion on core beliefs about the world. The combination of VR with these theoretical and design-oriented approaches may enable a new generation of potentially transformative experiences that remind people that they can aspire to more and inspire them to work toward imagining and creating a new possible world.

Effect of balance training using virtual reality-based serious games in individuals with total knee replacement: A randomized controlled trial

BACKGROUND

Virtual reality (VR) and serious games (SGs) are widespread in rehabilitation for many orthopedic and neurological diseases. However, few studies have addressed the effects of rehabilitation with VR-based SGs on clinical, gait, and postural outcomes in individuals with total knee replacement (TKR).

OBJECTIVE

The primary objective was the efficacy of balance training using non-immersive VR-based SGs compared to conventional therapy in TKR patients on the Time Up and Go test. Secondary objectives included the efficacy on clinical, gait, and postural outcomes.

METHODS

We randomly allocated 56 individuals with unilateral TKR to the experimental group (EG) or control group (CG) for 15 sessions (45 min; 5 times per week) of non-immersive VR-based SGs or conventional balance training, respectively. The primary outcome was functional mobility measured by the Timed Up and Go test; secondary outcomes were walking speed, pain intensity, lower-limb muscular strength, independence in activities of daily living as well as gait and postural parameters.

RESULTS

We found significant within-group differences in all clinical outcomes and in a subset of gait (p<0.0001) and postural (p ≤ 0.05) parameters. Analysis of the stance time of the affected limb revealed significant between-group differences (p = 0.022): post-hoc analysis revealed within-group differences in the EG (p = 0.002) but not CG (p = 0.834). We found no significant between-group differences in other outcomes.

CONCLUSIONS

Balance training with non-immersive VR-based SGs can improve clinical, gait, and postural outcomes in TKR patients. It was not superior to the CG findings but could be considered an alternative to the conventional approach and can be added to a regular rehabilitation program in TKR patients. The EG had a more physiological duration of the gait stance phase at the end of the treatment than the CG.

CLINICALTRIALS

GOV: NCT03454256.

The promise of the metaverse in mental health: the new era of MEDverse

Since Mark Zuckerberg's announcement about the development of new three-dimensional virtual worlds for social communication, a great debate has been raised about the promise of such a technology. The metaverse, a term formed by combining meta and universe, could open a new era in mental health, mainly in psychological disorders, where the creation of a full-body illusion via digital avatar could promote healthcare and personal well-being. Patients affected by body dysmorphism symptoms (i.e., eating disorders), social deficits (i.e. autism) could greatly benefit from this kind of technology. However, it is not clear which advantage the metaverse would have in treating psychological disorders with respect to the well-known and effective virtual reality (VR) exposure therapy. Indeed, in the last twenty years, a plethora of studies have demonstrated the effectiveness of VR technology in reducing symptoms of pain, anxiety, stress, as well as, in improving cognitive and social skills. We hypothesize that the metaverse will offer more opportunities, such as a more complex, virtual realm where sensory inputs, and recurrent feedback, mediated by a "federation" of multiple technologies - e.g., artificial intelligence, tangible interfaces, Internet of Things and blockchain, can be reinterpreted for facilitating a new kind of communication overcoming self-body representation. However, nowadays a clear starting point does not exist. For this reason, it is worth defining a theoretical framework for applying this new kind of technology in a social neuroscience context for developing accurate solutions to mental health in the future.

Reality in a sphere: A direct comparison of social attention in the laboratory and the real world

Humans often show reduced social attention in real situations, a finding rarely replicated in controlled laboratory studies. Virtual reality is supposed to allow for ecologically valid and at the same time highly controlled experiments. This study aimed to provide initial insights into the reliability and validity of using spherical videos viewed via a head-mounted display (HMD) to assess social attention. We chose five public places in the city of Würzburg and measured eye movements of 44 participants for 30 s at each location twice: Once in a real environment with mobile eye-tracking glasses and once in a virtual environment playing a spherical video of the location in an HMD with an integrated eye tracker. As hypothesized, participants demonstrated reduced social attention with less exploration of passengers in the real environment as compared to the virtual one. This is in line with earlier studies showing social avoidance in interactive situations. Furthermore, we only observed consistent gaze proportions on passengers across locations in virtual environments. These findings highlight that the potential for social interactions and an adherence to social norms are essential modulators of viewing behavior in social situations and cannot be easily simulated in laboratory contexts. However, spherical videos might be helpful for supplementing the range of methods in social cognition research and other fields. Data and analysis scripts are available at https://osf.io/hktdu/ .

Ghost on the Windshield: Employing a Virtual Human Character to Communicate Pedestrian Acknowledgement and Vehicle Intention

Pedestrians base their street-crossing decisions on vehicle-centric as well as driver-centric cues. In the future, however, drivers of autonomous vehicles will be preoccupied with non-driving related activities and will thus be unable to provide pedestrians with relevant communicative cues. External human–machine interfaces (eHMIs) hold promise for filling the expected communication gap by providing information about a vehicle’s situational awareness and intention. In this paper, we present an eHMI concept that employs a virtual human character (VHC) to communicate pedestrian acknowledgement and vehicle intention (non-yielding; cruising; yielding). Pedestrian acknowledgement is communicated via gaze direction while vehicle intention is communicated via facial expression. The effectiveness of the proposed anthropomorphic eHMI concept was evaluated in the context of a monitor-based laboratory experiment where the participants performed a crossing intention task (self-paced, two-alternative forced choice) and their accuracy in making appropriate street-crossing decisions was measured. In each trial, they were first presented with a 3D animated sequence of a VHC (male; female) that either looked directly at them or clearly to their right while producing either an emotional (smile; angry expression; surprised expression), a conversational (nod; head shake), or a neutral (neutral expression; cheek puff) facial expression. Then, the participants were asked to imagine they were pedestrians intending to cross a one-way street at a random uncontrolled location when they saw an autonomous vehicle equipped with the eHMI approaching from the right and indicate via mouse click whether they would cross the street in front of the oncoming vehicle or not. An implementation of the proposed concept where non-yielding intention is communicated via the VHC producing either an angry expression, a surprised expression, or a head shake; cruising intention is communicated via the VHC puffing its cheeks; and yielding intention is communicated via the VHC nodding, was shown to be highly effective in ensuring the safety of a single pedestrian or even two co-located pedestrians without compromising traffic flow in either case. The implications for the development of intuitive, culture-transcending eHMIs that can support multiple pedestrians in parallel are discussed.

Evaluating attention deficit hyperactivity disorder symptoms in children and adolescents through tracked head movements in a virtual reality classroom: The effect of social cues with different sensory modalities

Background

Attention deficit hyperactivity disorder (ADHD) is clinically diagnosed; however, quantitative analysis to statistically analyze the symptom severity of children with ADHD via the measurement of head movement is still in progress. Studies focusing on the cues that may influence the attention of children with ADHD in classroom settings, where children spend a considerable amount of time, are relatively scarce. Virtual reality allows real-life simulation of classroom environments and thus provides an opportunity to test a range of theories in a naturalistic and controlled manner. The objective of this study was to investigate the correlation between participants’ head movements and their reports of inattention and hyperactivity, and to investigate how their head movements are affected by different social cues of different sensory modalities.

Methods

Thirty-seven children and adolescents with (n = 20) and without (n = 17) ADHD were recruited for this study. All participants were assessed for diagnoses, clinical symptoms, and self-reported symptoms. A virtual reality-continuous performance test (VR-CPT) was conducted under four conditions: (1) control, (2) no-cue, (3) visual cue, and (4) visual/audio cue. A quantitativecomparison of the participants’ head movements was conducted in three dimensions (pitch [head nods], yaw [head turns], and roll [lateral head inclinations]) using a head-mounted display (HMD) in a VR classroom environment. Task-irrelevant head movements were analyzed separately, considering the dimension of movement needed to perform the VR-CPT.

Results

The magnitude of head movement, especially task-irrelevant head movement, significantly correlated with the current standard of clinical assessment in the ADHD group. Regarding the four conditions, head movement showed changes according to the complexity of social cues in both the ADHD and healthy control (HC) groups.

Conclusion

Children and adolescents with ADHD showed decreasing task-irrelevant movements in the presence of social stimuli toward the intended orientation. As a proof-of-concept study, this study preliminarily identifies the potential of VR as a tool to understand and investigate the classroom behavior of children with ADHD in a controlled, systematic manner.

Virtual-Reality Performance-Based Assessment of Cognitive Functions in Adult Patients With Acquired Brain Injury: A Scoping Review

Individuals with acquired brain injury (ABI) commonly present with impairments in cognitive abilities. As these competencies seem to be predictive of patients' abilities to reintegrate into the everyday settings, it is crucial to assess them properly. However, previous research has indicated that patients may perform relatively well on standard tests of cognitive functioning, but may nonetheless encounter significant difficulties in organizing and executing everyday tasks. In order to overcome this issue, virtual reality (VR) methods have been introduced in clinical practice with the aim of creating assessments that simulate real-world activities and thus, provide a clearer picture of patients' functioning in everyday settings. This review offers an overview of VR assessment tools described in the scientific literature between 2010 and 2019. Overall, 38 relevant records describing 31 different tools were found. Among these tools, 16 assessed executive functions and prospective memory, while the other 15 assessed visuo-spatial abilities. Although promising results have been reported, our analysis indicated that about half of the tools deliver tasks that differ from everyday activities, thus limiting the generalizability of patients' performance to the real-world. Moreover, a variety of methodological shortfalls related to study Internal and External Validity have been highlighted, which hamper the possibility of drawing definite recommendations on tool choice. These limitations suggest the importance of putting considerable efforts into the improvement or development of VR tools for patients with ABI for both research and clinical purposes, considering the great potential of this form of assessment.

Virtual reality interventions for victims of crime: A systematic review

In the forensic field, most studies employing virtual reality (VR) interventions have focused on offenders. The validity and safety of VR applications for victims of crime are still unclear. Following PRISMA guidelines, a systematic review on VR interventions for crime victims was performed to assess the efficacy, acceptability by patients, and cost-effectiveness of these interventions compared to in-person care. We identified 34 potentially eligible studies from 188 records obtained from database searches (Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus); four additional articles were identified via alternative sources. In total, nine articles were included for the qualitative synthesis. Patient satisfaction with VR interventions was found to be equivalent to face-to-face interventions. Both VR exposure and control groups found relief from posttraumatic symptoms, with differences either statistically insignificant or in favor of VR. Despite the increased costs linked to the technology required, VR appears to be a promising alternative to in vivo exposure, but further research is needed. Limitations of the review include the varied experimental protocols, which did not allow us to conduct a quantitative analysis and comparison of findings across different studies, and the generally poor quality of the studies included. Further research, preferably in larger groups, is needed to shed more light on the effectiveness of VR interventions for traumatized victims of crime.

The effectiveness of virtual reality for rehabilitation of Parkinson disease: an overview of systematic reviews with meta-analyses

BACKGROUND

An increasing number of systematic reviews (SRs) and meta-analyses (MAs) of clinical trials have begun to investigate the effects of virtual reality (VR) in patients with Parkinson disease (PD). The aim of this overview was to systematically summarize the current best evidence for the effectiveness of VR therapy for the rehabilitation of people with PD.

METHODS

We searched SR-MAs based on randomized controlled trials (RCTs) for relevant literature in PubMed, Embase, and Cochrane library databases for systematic reviews from inception to December 5, 2020, and updated to January 26, 2022. The methodological quality of included SR-MAs was evaluated with the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), and the certainty of evidence for outcomes with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). We created an evidence map using a bubble plot format to represent the evidence base in 5 dimensions: effect size of VR therapy versus active intervention (AT), clinical outcome area, number of trials, statistical significance, and certainty of evidence.

RESULTS

From a total of 585 reports, 12 reviews were identified, of which only one was rated moderate quality, three were rated low quality, and eight were rated critically low quality by AMSTAR 2. Compared with AT, VR therapy induced increased benefits on stride/step length, balance, and neuropsychiatric symptoms. Compared with passive intervention (PT), VR therapy had greater effects on gait speed, stride/step length, balance, activities of daily living, and postural control in people with PD. Certainty of evidence varied from very low to moderate.

CONCLUSIONS

We found the methodological quality of the reviews was poor, and certainty of the most evidence within them was low to very low. We were therefore unable to conclude with any confidence that, in people with PD, VR therapy is harmful or beneficial for gait, balance, motor function, quality of life, activities of daily living, cognitive function, neuropsychiatric symptoms, and postural control. In the future, rigorous-designed, high-quality RCTs with larger sample sizes are needed to further verify the effectiveness of VR therapy in the treatment of PD.

Interpersonal Affective Touch in a Virtual World: Feeling the Social Presence of Others to Overcome Loneliness

Humans are by nature social beings tuned to communicate and interact from the very beginning of their lives. The sense of touch represents the most direct and intimate channel of communication and a powerful means of connection between the self and the others. In our digital age, the development and diffusion of internet-based technologies and virtual environments offer new opportunities of communication overcoming physical distance. It however, happens that social interactions are often mediated, and the tactile aspects of communication are overlooked, thus diminishing the feeling of social presence, which may contribute to an increased sense of social disconnection and loneliness. The current manuscript aims to review the extant literature about the socio-affective dimension of touch and current advancements in interactive virtual environments in order to provide a new perspective on multisensory virtual communication. Specifically, we suggest that interpersonal affective touch might critically impact virtual social exchanges, promoting a sense of co-presence and social connection between individuals, possibly overcoming feelings of sensory loneliness. This topic of investigation will be of crucial relevance from a theoretical perspective aiming to understand how we integrate multisensory signals in processing and making sense of interpersonal exchanges, this is important in both typical and atypical populations. Moreover, it will pave the way to promising applications by exploring the possibility to use technical innovations to communicate more interactively in the case of people who suffer from social isolation and disconnection from others.

Subjective distinguishability of seizure and non-seizure Déjà Vu: A case report, brief literature review, and research prospects

Roughly two-thirds of all people report having experienced déjà vu-the odd feeling that a current experience is both novel and a repeat or replay of a previous, unrecalled experience. Reports of an association between déjà vu and seizure aura symptomatology have accumulated for over a century, and frequent déjà vu is also now known to be associated with focal seizures, particularly those of a medial temporal lobe (MTL) origin. A longstanding question is whether seizure-related déjà vu has the same basis and is the same subjective experience as non-seizure déjà vu. Survey research suggests that people who experience both seizure-related and non-seizure déjà vu can often subjectively distinguish between the two. We present a case of a person with a history of focal MTL seizures who reports having experienced both seizure-related and non-seizure common déjà vu, though the non-seizure type was more frequent during this person's youth than it is currently. The patient was studied with a virtual tour paradigm that has previously been shown to elicit déjà vu among non-clinical, young adult participants. The patient reported experiencing déjà vu of the common non-seizure type during the virtual tour paradigm, without associated abnormalities of the intracranial EEG. We situate this work in the context of broader ongoing projects examining the subjective correlates of seizures. The importance for memory research of virtual scenes, spatial tasks, virtual reality (VR), and this paradigm for isolating familiarity in the context of recall failure are discussed.

Effects of Transcranial Direct Current Stimulation on Cognitive and Affective Outcomes Using Virtual Stimuli: A Systematic Review

Transcranial direct current stimulation (tDCS) is a noninvasive form of brain stimulation used to influence neural activity. While early tDCS studies primarily used static stimuli, there is growing interest in dynamic stimulus presentations using virtual environments (VEs). This review attempts to convey the state of the field. This is not a quantitative meta-analysis as there are not yet enough studies following consistent protocols and/or reporting adequate data. In addition to reviewing the state of the literature, this review includes an exploratory analysis of the available data. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, studies were culled from several databases. Results from this review reveal differences between online and offline stimulation. While offline stimulation did not influence affective and cognitive outcomes, online stimulation led to small changes in affect and cognition. Future studies should include randomized controlled trials with larger samples. Furthermore, greater care needs to be applied to full data reporting (e.g., means, standard deviations, and data for their nonsignificant findings) to improve our understanding of the combined effects of virtual stimuli with tDCS.

A Methodological Framework for Assessing Social Presence in Music Interactions in Virtual Reality

Virtual reality (VR) brings radical new possibilities to the empirical study of social music cognition and interaction. In the present article, we consider the role of VR as a research tool, based on its potential to create a sense of "social presence": the illusory feeling of being, and socially interacting, inside a virtual environment. This makes VR promising for bridging ecological validity ("research in the wild") and experimental control ("research in the lab") in empirical music research. A critical assumption however is the actual ability of VR to simulate real-life social interactions, either via human-embodied avatars or computer-controlled agents. The mediation of social musical interactions via VR is particularly challenging due to their embodied, complex, and emotionally delicate nature. In this article, we introduce a methodological framework to operationalize social presence by a combination of factors across interrelated layers, relating to the performance output, embodied co-regulation, and subjective experiences. This framework provides the basis for the proposal of a pragmatic approach to determine the level of social presence in virtual musical interactions, by comparing the outcomes across the multiple layers with the outcomes of corresponding real-life musical interactions. We applied and tested this pragmatic approach via a case-study of piano duet performances of the piece Piano Phase composed by Steve Reich. This case-study indicated that a piano duet performed in VR, in which the real-time interaction between pianists is mediated by embodied avatars, might lead to a strong feeling of social presence, as reflected in the measures of performance output, embodied co-regulation, and subjective experience. In contrast, although a piano duet in VR between an actual pianist and a computer-controlled agent led to a relatively successful performance output, it was inadequate in terms of both embodied co-regulation and subjective experience.

Enhancing Qualities of Consciousness during Online Learning via Multisensory Interactions

Online-learning is a feasible alternative to in-person attendance during COVID-19 pandemic. In this period, information technologies have allowed sharing experiences, but have also highlighted some limitations compared to traditional learning. Learning is strongly supported by some qualities of consciousness such as flow (intended as the optimal state of absorption and engagement activity) and sense of presence (feeling of exerting control, interacting with and getting immersed into real/virtual environments), behavioral, emotional, and cognitive engagement, together with the need for social interaction. During online learning, feelings of disconnection, social isolation, distractions, boredom, and lack of control exert a detrimental effect on the ability to reach the state of flow, the feeling of presence, the feeling of social involvement. Since online environments could prevent the rising of these learning-supporting variables, this article aims at describing the role of flow, presence, engagement, and social interactions during online sessions and at characterizing multisensory stimulations as a driver to cope with these issues. We argue that the use of augmented, mixed, or virtual reality can support the above-mentioned domains, and thus counteract the detrimental effects of physical distance. Such support could be further increased by enhancing multisensory stimulation modalities within augmented and virtual environments.

Using Virtual Reality as a Tool in the Rehabilitation of Movement Abnormalities in Schizophrenia

Movement abnormalities are prevalent across all stages of schizophrenia contributing to poor social functioning and reduced quality of life. To date, treatments are scarce, often involving pharmacological agents, but none have been shown to improve movement abnormalities effectively. Virtual reality (VR) is a tool used to simulate virtual environments where behavioral performance can be quantified safely across different tasks while exerting control over stimulus delivery, feedback and measurement in real time. Sensory information is transmitted via a head mounted display allowing users to directly interact with virtual objects and bodies using gestures and body movements in the real world to perform different actions, permitting a sense of immersion in the simulated virtual environment. Although, VR has been widely used for successful motor rehabilitation in a variety of different neurological domains, none have been exploited for motor rehabilitation in schizophrenia. The objectives of this article are to review movement abnormalities specific to schizophrenia, and how VR can be utilized to restore and improve motor functioning in patients with schizophrenia. Constructing VR-mediated motor-cognitive interventions that can help in retaining and transferring the learned outcomes to real life are also discussed.

Paradigm Shift Toward Digital Neuropsychology and High-Dimensional Neuropsychological Assessments: Review

Neuropsychologists in the digital age have increasing access to emerging technologies. The National Institutes of Health (NIH) initiatives for behavioral and social sciences have emphasized these developing scientific and technological potentials (eg, novel sensors) for augmented characterization of neurocognitive, behavioral, affective, and social processes. Perhaps these innovative technologies will lead to a paradigm shift from disintegrated and data-poor behavioral science to cohesive and data-rich science that permits improved translation from bench to bedside. The 4 main advances influencing the scientific priorities of a recent NIH Office of Behavioral and Social Sciences Research strategic plan include the following: integration of neuroscience into behavioral and social sciences, transformational advances in measurement science, digital intervention platforms, and large-scale population cohorts and data integration. This paper reviews these opportunities for novel brain-behavior characterizations. Emphasis is placed on the increasing concern of neuropsychology with these topics and the need for development in these areas to maintain relevance as a scientific discipline and advance scientific developments. Furthermore, the effects of such advancements necessitate discussion and modification of training as well as ethical and legal mandates for neuropsychological research and praxes.

Age-related changes in gaze behaviour during social interaction: An eye-tracking study with an embodied conversational agent

Previous research has highlighted age-related differences in social perception, in particular emotional expression processing. To date, such studies have largely focused on approaches that use static emotional stimuli that the participant has to identify passively without the possibility of any interaction. In this study, we propose an interactive virtual environment to better address age-related variations in social and emotional perception. A group of 22 young (18-30 years) and 20 older (60-80 years) adults were engaged in a face-to-face conversation with an embodied conversational agent. Participants were invited to interact naturally with the agent and to identify his facial expression. Their gaze behaviour was captured by an eye-tracking device throughout the interaction. We also explored whether the Big Five personality traits (particularly extraversion) and anxiety modulated gaze during the social interaction. Findings suggested that age-related differences in gaze behaviour were only apparent when decoding social signals (i.e., listening to a partner's question, identifying facial expressions) and not when communicating social information (i.e., when speaking). Furthermore, higher extraversion levels consistently led to a shorter amount of time gazing towards the eyes, whereas higher anxiety levels led to slight modulations of gaze only when participants were listening to questions. Face-to-face conversation with virtual agents can provide a more naturalistic framework for the assessment of online socio-emotional interaction in older adults, which is not easily observable in classical offline paradigms. This study provides novel and important insights into the specific circumstances in which older adults may experience difficulties in social interactions.

Extended Reality for the Clinical, Affective, and Social Neurosciences

Brain science research often involves the use of low-dimensional tools and stimuli that lack several of the potentially valuable features of everyday activities and interactions. Although this research has provided important information about cognitive, affective, and social processes for both clinical and nonclinical populations, there is growing interest in high-dimensional simulations that extend reality. These high-dimensional simulations involve dynamic stimuli presented serially or concurrently to permit the assessment and training of perceivers' integrative processes over time. Moreover, high-dimensional simulation platforms can contextually restrain interpretations of cues about a target's internal states. Extended reality environments extend assessment and training platforms that balance experimental control with emotionally engaging background narratives aimed at extending the affective experience and social interactions. Herein, we highlight the promise of extended reality platforms for greater ecological validity in the clinical, affective, and social neurosciences.

Introducing virtual reality therapy for inpatients with dementia admitted to an acute care hospital: learnings from a pilot to pave the way to a randomized controlled trial

Background

Behavioural and psychological symptoms of dementia (BPSD) are difficult to manage, particularly in acute care settings. As virtual reality (VR) technology becomes increasingly accessible and affordable, there is growing interest among clinicians to evaluate VR therapy in hospitalized patients, as an alternative to administering antipsychotics/sedatives or using physical restraints associated with negative side effects.

Objectives

Validate and refine the proposed research protocol for a randomized controlled trial (RCT) that evaluates the impact of VR therapy on managing BPSD in acute care hospitals. Special attention was given to ascertain the processes of introducing non-pharmacological interventions in acute care hospitals.

Methods

Ten patients 65 years or older (mean = 87) previously diagnosed with dementia, admitted to an acute care hospital, were recruited over 3-month period into a prospective longitudinal pilot study. The intervention consisted of viewing 20-min of immersive 360° VR using a head-mounted display. Baseline and outcomes data were collected from the hospital electronic medical records, pre/post mood-state questionnaires, Neuropsychiatric Inventory (NPI) score, and standardized qualitative observations. Comprehensive process data and workflow were documented, including timestamps for each study task and detailed notes on personnel requirements and challenges encountered.

Results

Of 516 patients admitted during the study, 67 met the inclusion/exclusion criteria. In total, 234 calls were initiated to substitute decision makers (SDM) of the 67 patients for the consenting process. Nearly half (45.6%) of SDMs declined participation, and 40% could not be reached in time before patients being discharged, resulting in 57 eligible patients not being enrolled. Ten consented participants were enrolled and completed the study. The initial VR session averaged 53.6 min, largely due to the administration of NPI (mean = 19.5 min). Only four participants were able to respond reliably to questions. Seven participants opted for additional VR therapy sessions; of those providing feedback regarding the VR content, they wanted more varied scenery (animals, fields of flowers, holiday themes). Few sessions (4/18) encountered technical difficulties.

Conclusion

The pilot was instrumental in identifying issues and providing recommendations for the RCT. Screening, inclusion criteria, consenting, data collection, and interaction with SDMs and hospital staff were all processes requiring changes and optimizations. Overall, patients with dementia appear to tolerate immersive VR, and with suggested protocol alterations, it is feasible to evaluate this non-pharmacological intervention in acute care hospitals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-020-00708-9.

Virtual Reality in the Assessment, Understanding and Treatment of Mental Health Disorders

Computer scientists usually describe virtual reality (VR) as a set of fancy hardware and software technologies. However, psychology and neuroscience are starting to consider VR as the most advanced form of human-computer interaction allowing individuals to act, communicate and become present in a computer-generated environment. In this view, the feeling of "being there" experienced during a VR experience can become a powerful tool for personal change: it offers a dynamic and social world where individuals can live and share a specific experience. For this reason, the use of VR in mental health shows promise: different researches support its clinical efficacy for conditions including anxiety disorders, stress-related disorders, obesity and eating disorders, pain management, addiction and schizophrenia. However, more research is needed to transform the promises of VR in a real clinical tool for mental health. This Special Issue aims to present the most recent advances in the mental health applications of VR, as well as their implications for future patient care.