Sensing behavior change in chronic pain: a scoping review of sensor technology for use in daily life.

ABSTRACT: Technology offers possibilities for quantification of behaviors and physiological changes of relevance to chronic pain, using wearable sensors and devices suitable for data collection in daily life contexts. We conducted a scoping review of wearable and passive sensor technologies that sample data of psychological interest in chronic pain, including in social situations. Sixty articles met our criteria from the 2783 citations retrieved from searching. Three-quarters of recruited people were with chronic pain, mostly musculoskeletal, and the remainder with acute or episodic pain; those with chronic pain had a mean age of 43 (few studies sampled adolescents or children) and 60% were women. Thirty-seven studies were performed in laboratory or clinical settings and the remainder in daily life settings. Most used only 1 type of technology, with 76 sensor types overall. The commonest was accelerometry (mainly used in daily life contexts), followed by motion capture (mainly in laboratory settings), with a smaller number collecting autonomic activity, vocal signals, or brain activity. Subjective self-report provided "ground truth" for pain, mood, and other variables, but often at a different timescale from the automatically collected data, and many studies reported weak relationships between technological data and relevant psychological constructs, for instance, between fear of movement and muscle activity. There was relatively little discussion of practical issues: frequency of sampling, missing data for human or technological reasons, and the users' experience, particularly when users did not receive data in any form. We conclude the review with some suggestions for content and process of future studies in this field.

Guarding and flow in the movements of people with chronic pain: A qualitative study of physiotherapists' observations.

BACKGROUND: Among the adaptations of movement consistently associated with disability in chronic pain, guarding is common. Based on previous work, we sought to understand better the constituents of guarding; we also used the concept of flow to explore the description of un/naturalness that emerged from physiotherapists' descriptions of movement in chronic pain. The aim was to inform the design of technical systems to support people with chronic pain in everyday activities. METHODS: Sixteen physiotherapists, experts in chronic pain, were interviewed while repeatedly watching short video clips of people with chronic low back pain doing simple movements; physiotherapists described the movements, particularly in relation to guarding and flow. The transcribed interviews were analysed thematically to elaborate these constructs. RESULTS: Moderate agreement emerged on the extent of guarding in the videos, with good agreement that guarding conveyed caution about movement, distinct from biomechanical variables of stiffness or slow speed. Physiotherapists' comments on flow showed slightly better agreement, and described the overall movement in terms of restriction (where there was no flow or only some flow), of tempo of the entire movement, and as naturalness (distinguished from normality of movement). CONCLUSIONS: These qualities of movement may be useful in designing technical systems to support self-management of chronic pain. SIGNIFICANCE: Drawing on the descriptions of movements of people with chronic low back pain provided by expert physiotherapists to standard stimuli, two key concepts were elaborated. Guarding was distinguished from stiffness (a physical limitation) or slowness as motivated by fear or worry about movement. Flow served to describe harmonious and continuous movement, even when adapted around restrictions of pain. Movement behaviours associated with pain are better understood in terms of their particular function than aggregated without reference to function.

Effect of the level of task abstraction on the transfer of knowledge from virtual environments in cognitive and motor tasks.

Introduction: Virtual environments are increasingly being used for training. It is not fully understood what elements of virtual environments have the most impact and how the virtual training is integrated by the brain on the sought-after skill transference to the real environment. In virtual training, we analyzed how the task level of abstraction modulates the brain activity and the subsequent ability to execute it in the real environment and how this learning generalizes to other tasks. The training of a task under a low level of abstraction should lead to a higher transfer of skills in similar tasks, but the generalization of learning would be compromised, whereas a higher level of abstraction facilitates generalization of learning to different tasks but compromising specific effectiveness. Methods: A total of 25 participants were trained and subsequently evaluated on a cognitive and a motor task following four training regimes, considering real vs. virtual training and low vs. high task abstraction. Performance scores, cognitive load, and electroencephalography signals were recorded. Transfer of knowledge was assessed by comparing performance scores in the virtual vs. real environment. Results: The performance to transfer the trained skills showed higher scores in the same task under low abstraction, but the ability to generalize the trained skills was manifested by higher scores under high level of abstraction in agreement with our hypothesis. Spatiotemporal analysis of the electroencephalography revealed higher initial demands of brain resources which decreased as skills were acquired. Discussion: Our results suggest that task abstraction during virtual training influences how skills are assimilated at the brain level and modulates its manifestation at the behavioral level. We expect this research to provide supporting evidence to improve the design of virtual training tasks.

Exploring multisensory integration of non-naturalistic sounds on body perception in young females with eating disorders symptomatology: a study protocol.

BACKGROUND: Bodily illusions can be used to investigate the experience of being in a body by manipulating the underlying processes of multisensory integration. Research suggests that people with eating disorders (EDs) may have impairments in visual, interoceptive, proprioceptive, and tactile bodily perception. Furthermore, people with EDs also show abnormalities in integrating multisensory visuo-tactile and visual-auditory signals related to the body, which may contribute to the development of body image disturbances. Visuo-auditory integration abnormalities have been observed also in people with subthreshold ED symptomatology. However, it remains unclear whether these impairments are specific to bodily signals or if they extend to any auditory signals. METHODS: We will recruit 50 participants (aged 18-24; females assigned at birth) with ED symptomatology (subthreshold group) and 50 control participants. The Eating Disorder Examination Questionnaire will be administered to screen for ED symptomatology and divide the sample into two groups accordingly (control and subthreshold group using a clinical cut-off score of 2.8). The strength of both illusions will be measured implicitly with estimations of body part position and size, and explicitly with self-report questionnaires. As a secondary aim, regression analysis will be run to test the predictive role of susceptibility for both illusions on interoceptive body awareness (measured by the Multidimensional Assessment of Interoceptive Awareness Scale) and sensory-processing sensitivity (measured by the Highly Sensitive Person Scale). DISCUSSION: Our study may contribute to our understanding of the mechanisms underlying body image disturbances. The results may pave the way for novel clinical interventions targeting early symptoms prior to the development of the disorder in young females.

This study aims to investigate whether individuals with subthreshold eating disorder (ED) symptoms show differences in the integration of proprioceptive and auditory cues in relation to body representation, as compared to healthy controls. This will be examined by focusing on two different body parts (finger and waist) with different levels of emotional significance for individuals with EDs. Participants will be screened for ED symptoms and divided into groups accordingly. The strength of the illusions will be measured using estimations of body part position and size, as well as self-report questionnaires. Regression analysis will be used to assess the predictive role of susceptibility to the body illusions on interoceptive body awareness and sensory-processing sensitivity. The results of this study may have implications for understanding the underlying mechanisms of body image disturbances in EDs, and inform the development of clinical interventions for individuals with subthreshold EDs.

Body weight distortions in an auditory-driven body illusion in subclinical and clinical eating disorders.

Previous studies suggest a stronger influence of visual signals on body image in individuals with eating disorders (EDs) than healthy controls; however, the influence of other exteroceptive sensory signals remains unclear. Here we used an illusion relying on auditory (exteroceptive) signals to manipulate body size/weight perceptions and investigated whether the mechanisms integrating sensory signals into body image are altered in subclinical and clinical EDs. Participants' footstep sounds were altered to seem produced by lighter or heavier bodies. Across two experiments, we tested healthy women assigned to three groups based on self-reported Symptomatology of EDs (SED), and women with Anorexia Nervosa (AN), and used self-report, body-visualization, and behavioural (gait) measures. As with visual bodily illusions, we predicted stronger influence of auditory signals, leading to an enhanced body-weight illusion, in people with High-SED and AN. Unexpectedly, High-SED and AN participants displayed a gait typical of heavier bodies and a widest/heaviest visualized body in the 'light' footsteps condition. In contrast, Low-SED participants showed these patterns in the 'heavy' footsteps condition. Self-reports did not show group differences. The results of this pilot study suggest disturbances in the sensory integration mechanisms, rather than purely visually-driven body distortions, in subclinical/clinical EDs, opening opportunities for the development of novel diagnostic/therapeutic tools.

Investigating psychological variables for technologies promoting physical activity.

Background: Many technological interventions designed to promote physical activity (PA) have limited efficacy and appear to lack important factors that could increase engagement. This may be due to a discrepancy between research conducted in this space, and software designers' and developers' use of this research to inform new digital applications. Objectives: This study aimed to identify (1) what are the variables that act as barriers and facilitators to PA and (2) which PA variables are currently considered in the design of technologies promoting PA including psychological, physical, and personal/contextual ones which are critical in promoting PA. We emphasize psychological variables in this work because of their sparse and often simplistic integration in digital applications for PA. Methods: We conducted two systematized reviews on PA variables, using PsycInfo and Association for Computing Machinery Digital Libraries for objectives 1 and 2. Results: We identified 38 PA variables (mostly psychological ones) including barriers/facilitators in the literature. 17 of those variables were considered when developing digital applications for PA. Only few studies evaluate PA levels in relation to these variables. The same barriers are reported for all weight groups, though some barriers are stronger in people with obesity. Conclusions: We identify PA variables and illustrate the lack of consideration of these in the design of PA technologies. Digital applications to promote PA may have limited efficacy if they do not address variables acting as facilitators or barriers to participation in PA, and that are important to people representing a range of body weight characteristics.

Effects of pitch and musical sounds on body-representations when moving with sound.

The effects of music on bodily movement and feelings, such as when people are dancing or engaged in physical activity, are well-documented-people may move in response to the sound cues, feel powerful, less tired. How sounds and bodily movements relate to create such effects? Here we deconstruct the problem and investigate how different auditory features affect people's body-representation and feelings even when paired with the same movement. In three experiments, participants executed a simple arm raise synchronised with changing pitch in simple tones (Experiment 1), rich musical sounds (Experiment 2) and within different frequency ranges (Experiment 3), while we recorded indirect and direct measures on their movement, body-representations and feelings. Changes in pitch influenced people's general emotional state as well as the various bodily dimensions investigated-movement, proprioceptive awareness and feelings about one's body and movement. Adding harmonic content amplified the differences between ascending and descending sounds, while shifting the absolute frequency range had a general effect on movement amplitude, bodily feelings and emotional state. These results provide new insights in the role of auditory and musical features in dance and exercise, and have implications for the design of sound-based applications supporting movement expression, physical activity, or rehabilitation.

Action Sounds Informing Own Body Perception Influence Gender Identity and Social Cognition.

Sensory information can temporarily affect mental body representations. For example, in Virtual Reality (VR), visually swapping into a body with another sex can temporarily alter perceived gender identity. Outside of VR, real-time auditory changes to walkers' footstep sounds can affect perceived body weight and masculinity/femininity. Here, we investigate whether altered footstep sounds also impact gender identity and relation to gender groups. In two experiments, cisgender participants (26 females, 26 males) walked with headphones which played altered versions of their own footstep sounds that sounded more typically male or female. Baseline and post-intervention measures quantified gender identity [Implicit Association Test (IAT)], relation to gender groups [Inclusion of the Other-in-the-Self (IOS)], and perceived masculinity/femininity. Results show that females felt more feminine and closer to the group of women (IOS) directly after walking with feminine sounding footsteps. Similarly, males felt more feminine after walking with feminine sounding footsteps and associated themselves relatively stronger with "female" (IAT). The findings suggest that gender identity is temporarily malleable through auditory-induced own body illusions. Furthermore, they provide evidence for a connection between body perception and an abstract representation of the Self, supporting the theory that bodily illusions affect social cognition through changes in the self-concept.

Bridging the gap between emotion and joint action.

Our daily human life is filled with a myriad of joint action moments, be it children playing, adults working together (i.e., team sports), or strangers navigating through a crowd. Joint action brings individuals (and embodiment of their emotions) together, in space and in time. Yet little is known about how individual emotions propagate through embodied presence in a group, and how joint action changes individual emotion. In fact, the multi-agent component is largely missing from neuroscience-based approaches to emotion, and reversely joint action research has not found a way yet to include emotion as one of the key parameters to model socio-motor interaction. In this review, we first identify the gap and then stockpile evidence showing strong entanglement between emotion and acting together from various branches of sciences. We propose an integrative approach to bridge the gap, highlight five research avenues to do so in behavioral neuroscience and digital sciences, and address some of the key challenges in the area faced by modern societies.

Head movement differs for positive and negative emotions in video recordings of sitting individuals.

Individuals tend to approach positive stimuli and avoid negative stimuli. Furthermore, emotions influence whether individuals freeze or move more. These two kinds of motivated behavior refer to the approach/avoidance behavior and behavioral freezing/activation. Previous studies examined (e.g., using forced platforms) whether individuals' behavior depends on stimulus' valence; however, the results were mixed. Thus, we aimed to test whether emotions' effects on spontaneous whole-body behavior of standing individuals also occur in the seated position. We used a computer vision method to measure the head sway in video recordings that offers ease of use, replicability, and unobtrusiveness for the seated research participant. We analyzed behavior recorded in the laboratory during emotion manipulations across five studies totaling 932 participants. We observed that individuals leaned more forward and moved more when watching positive stimuli than when watching negative stimuli. However, individuals did not behave differently when watching positive or negative stimuli than in the neutral condition. Our results indicate that head movements extracted from seated individuals' video recordings can be useful in detecting robust differences in emotional behavior (positive vs. negative emotions).

The application of psychologically informed practice: observations of experienced physiotherapists working with people with chronic pain.

OBJECTIVES: Psychologically informed practice (PIP) is advocated for physiotherapists to help people with chronic pain. There is little research observing how PIP is delivered in clinical practice. This study describes behaviours and techniques used by experienced physiotherapists working with groups of people with chronic pain. SETTING AND PARTICIPANTS: Experienced physiotherapists (n=4) were observed working with groups of people with chronic pain in out-patient pain management, and physiotherapy departments, in a large UK city centre teaching hospital. DESIGN: We observed the clinical behaviours and interpersonal skills of experienced psychologically informed physiotherapists, enriched by their accounts of intentions. The physiotherapists were audio and video recorded delivering group movement sessions. Recordings were reviewed with the physiotherapists for elaboration of intentions, then thematically analysed for comparison with defined CBT competencies. RESULTS: Four themes representing physiotherapist intentions when working with people with chronic pain were identified; building a therapeutic alliance, reducing perceived threat, reconceptualising beliefs and somatic experience, and fostering self-efficacy. The physiotherapists also reflected on challenges including engaging patients in self-management, encouraging activity and reinforcing rather than correcting movement. Considerable overlap existed between the observed behaviours in this study and existing CBT competencies. CONCLUSIONS: This paper complements current recommendations for delivering psychologically informed physiotherapy by providing examples of these skills being used in clinical practice. Further research supporting the development of training for, and mentoring of, physiotherapists, to promote competence and confidence in delivering psychologically informed interventions is recommended.

The relationship between guarding, pain, and emotion.

INTRODUCTION: Pain-related behavior in people with chronic pain is often overlooked in a focus on increasing the amount of activity, yet it may limit activity and maintain pain and disability. Targeting it in treatment requires better understanding of the role of beliefs, emotion, and pain in pain behavior. OBJECTIVES: This study aimed to clarify the interrelationships between guarding, pain, anxiety, and confidence in movement in people with chronic pain in everyday movements. METHODS: Physiotherapists rated extent of guarding on videos of people with chronic pain and healthy controls making specific movements. Bayesian modelling was used to determine how guarding was related to self-reported pain intensity, anxiety, and emotional distress, and observer-rated confidence in movement. RESULTS: The absence of guarding was associated with low levels of pain, anxiety, distress, and higher movement self-efficacy, but guarding behavior occurred at high and low levels of each of those variables. Guarding was not directly dependent on pain but on anxiety; the relationship between pain and guarding was mediated by anxiety, with a high probability. Nor was guarding directly related to the broader distress score, but to self-efficacy for movement, again with a high probability. CONCLUSION: Pain-related guarding is more likely to be effectively addressed by intervention to reduce anxiety rather than pain (such as analgesia); more attention to how people move with chronic pain, rather than only how much they move, is likely to help to extend activity.

Instant Stress: Detection of Perceived Mental Stress Through Smartphone Photoplethysmography and Thermal Imaging.

BACKGROUND: A smartphone is a promising tool for daily cardiovascular measurement and mental stress monitoring. A smartphone camera-based photoplethysmography (PPG) and a low-cost thermal camera can be used to create cheap, convenient, and mobile monitoring systems. However, to ensure reliable monitoring results, a person must remain still for several minutes while a measurement is being taken. This is cumbersome and makes its use in real-life situations impractical. OBJECTIVE: We proposed a system that combines PPG and thermography with the aim of improving cardiovascular signal quality and detecting stress responses quickly. METHODS: Using a smartphone camera with a low-cost thermal camera added on, we built a novel system that continuously and reliably measures 2 different types of cardiovascular events: (1) blood volume pulse and (2) vasoconstriction/dilation-induced temperature changes of the nose tip. 17 participants, involved in stress-inducing mental workload tasks, measured their physiological responses to stressors over a short time period (20 seconds) immediately after each task. Participants reported their perceived stress levels on a 10-cm visual analog scale. For the instant stress inference task, we built novel low-level feature sets representing cardiovascular variability. We then used the automatic feature learning capability of artificial neural networks to improve the mapping between the extracted features and the self-reported ratings. We compared our proposed method with existing hand-engineered features-based machine learning methods. RESULTS: First, we found that the measured PPG signals presented high quality cardiac cyclic information (mean pSQI: 0.755; SD 0.068). We also found that the measured thermal changes of the nose tip presented high-quality breathing cyclic information and filtering helped extract vasoconstriction/dilation-induced patterns with fewer respiratory effects (mean pSQI: from 0.714 to 0.157). Second, we found low correlations between the self-reported stress scores and the existing metrics of the cardiovascular signals (ie, heart rate variability and thermal directionality) from short measurements, suggesting they were not very dependent upon one another. Third, we tested the performance of the instant perceived stress inference method. The proposed method achieved significantly higher accuracies than existing precrafted features-based methods. In addition, the 17-fold leave-one-subject-out cross-validation results showed that combining both modalities produced higher accuracy than using PPG or thermal imaging only (PPG+Thermal: 78.33%; PPG: 68.53%; Thermal: 58.82%). The multimodal results are comparable to the state-of-the-art stress recognition methods that require long-term measurements. Finally, we explored effects of different data labeling strategies on the sensitivity of our inference methods. Our results showed the need for separation of and normalization between individual data. CONCLUSIONS: The results demonstrate the feasibility of using smartphone-based imaging for instant stress detection. Given that this approach does not need long-term measurements requiring attention and reduced mobility, we believe it is more suitable for mobile mental health care solutions in the wild.

Assumptions about the positioning of virtual stimuli affect gaze direction estimates during Augmented Reality based interactions.

We investigated gaze direction determination in dyadic interactions mediated by an Augmented Reality (AR) head-mounted-display. With AR, virtual content is overlaid on top of the real-world scene, offering unique data visualization and interaction opportunities. A drawback of AR however is related to uncertainty regarding the AR user's focus of attention in social-collaborative settings: an AR user looking in our direction might either be paying attention to us or to augmentations positioned somewhere in between. In two psychophysical experiments, we assessed what impact assumptions concerning the positioning of virtual content attended by an AR user have on other people's sensitivity to their gaze direction. In the first experiment we found that gaze discrimination was better when the participant was aware that the AR user was focusing on stimuli positioned on their depth plane as opposed to being positioned halfway between the AR user and the participant. In the second experiment, we found that this modulatory effect was explained by participants' assumptions concerning which plane the AR user was focusing on, irrespective of these being correct. We discuss the significance of AR reduced gaze determination in social-collaborative settings as well as theoretical implications regarding the impact of this technology on social behaviour.

Use of a Low-Cost, Chest-Mounted Accelerometer to Evaluate Transfer Skills of Wheelchair Users During Everyday Activities: Observational Study.

BACKGROUND: Transfers are an important skill for many wheelchair users (WU). However, they have also been related to the risk of falling or developing upper limb injuries. Transfer abilities are usually evaluated in clinical settings or biomechanics laboratories, and these methods of assessment are poorly suited to evaluation in real and unconstrained world settings where transfers take place. OBJECTIVE: The objective of this paper is to test the feasibility of a system based on a wearable low-cost sensor to monitor transfer skills in real-world settings. METHODS: We collected data from 9 WU wearing triaxial accelerometer on their chest while performing transfers to and from car seats and home furniture. We then extracted significant features from accelerometer data based on biomechanical considerations and previous relevant literature and used machine learning algorithms to evaluate the performance of wheelchair transfers and detect their occurrence from a continuous time series of data. RESULTS: Results show a good predictive accuracy of support vector machine classifiers when determining the use of head-hip relationship (75.9%) and smoothness of landing (79.6%) when the starting and ending of the transfer are known. Automatic transfer detection reaches performances that are similar to state of the art in this context (multinomial logistic regression accuracy 87.8%). However, we achieve these results using only a single sensor and collecting data in a more ecological manner. CONCLUSIONS: The use of a single chest-placed accelerometer shows good predictive accuracy for algorithms applied independently to both transfer evaluation and monitoring. This points to the opportunity for designing ubiquitous-technology based personalized skill development interventions for WU. However, monitoring transfers still require the use of external inputs or extra sensors to identify the start and end of the transfer, which is needed to perform an accurate evaluation.

Audio-tactile cues from an object's fall change estimates of one's body height.

When we drop an object from our hands, we use internal models of both our body height and object-motion to predict when it will hit the floor. What happens if the sensory feedback finally received from the impact conflicts with this prediction? The present study shows that such conflict results in changes in the internal estimates of our body height: When the object people dropped takes longer than expected to hit the floor, they report feeling taller and behave as if their legs were longer. This provides the first evidence of cross-modal recalibration of body-height representations as a function of changes in the distant environment. Crucially, the recalibration results from a mismatch between the predicted and actual outcome of an action, the ball's release and impact, which are causally-related but separated in space and time. These results suggest that implicit models of object-motion can interact with implicit and explicit models of one's body height.

Author Correction: Embodiment in a Child-Like Talking Virtual Body Influences Object Size Perception, Self-Identification, and Subsequent Real Speaking.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Author Correction: Contingent sounds change the mental representation of one's finger length.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Robust tracking of respiratory rate in high-dynamic range scenes using mobile thermal imaging.

The ability to monitor the respiratory rate, one of the vital signs, is extremely important for the medical treatment, healthcare and fitness sectors. In many situations, mobile methods, which allow users to undertake everyday activities, are required. However, current monitoring systems can be obtrusive, requiring users to wear respiration belts or nasal probes. Alternatively, contactless digital image sensor based remote-photoplethysmography (PPG) can be used. However, remote PPG requires an ambient source of light, and does not work properly in dark places or under varying lighting conditions. Recent advances in thermographic systems have shrunk their size, weight and cost, to the point where it is possible to create smart-phone based respiration rate monitoring devices that are not affected by lighting conditions. However, mobile thermal imaging is challenged in scenes with high thermal dynamic ranges (e.g. due to the different environmental temperature distributions indoors and outdoors). This challenge is further amplified by general problems such as motion artifacts and low spatial resolution, leading to unreliable breathing signals. In this paper, we propose a novel and robust approach for respiration tracking which compensates for the negative effects of variations in the ambient temperature and motion artifacts and can accurately extract breathing rates in highly dynamic thermal scenes. The approach is based on tracking the nostril of the user and using local temperature variations to infer inhalation and exhalation cycles. It has three main contributions. The first is a novel Optimal Quantization technique which adaptively constructs a color mapping of absolute temperature to improve segmentation, classification and tracking. The second is the Thermal Gradient Flow method that computes thermal gradient magnitude maps to enhance the accuracy of the nostril region tracking. Finally, we introduce the Thermal Voxel method to increase the reliability of the captured respiration signals compared to the traditional averaging method. We demonstrate the extreme robustness of our system to track the nostril-region and measure the respiratory rate by evaluating it during controlled respiration exercises in high thermal dynamic scenes (e.g. strong correlation (r = 0.9987) with the ground truth from the respiration-belt sensor). We also demonstrate how our algorithm outperformed standard algorithms in settings with different amounts of environmental thermal changes and human motion. We open the tracked ROI sequences of the datasets collected for these studies (i.e. under both controlled and unconstrained real-world settings) to the community to foster work in this area.

Embodiment in a Child-Like Talking Virtual Body Influences Object Size Perception, Self-Identification, and Subsequent Real Speaking.

People's mental representations of their own body are malleable and continuously updated through sensory cues. Altering one's body-representation can lead to changes in object perception and implicit attitudes. Virtual reality has been used to embody adults in the body of a 4-year-old child or a scaled-down adult body. Child embodiment was found to cause an overestimation of object sizes, approximately double that during adult embodiment, and identification of the self with child-like attributes. Here we tested the contribution of auditory cues related to one's own voice to these visually-driven effects. In a 2 × 2 factorial design, visual and auditory feedback on one's own body were varied across conditions, which included embodiment in a child or scaled-down adult body, and real (undistorted) or child-like voice feedback. The results replicated, in an older population, previous findings regarding size estimations and implicit attitudes. Further, although auditory cues were not found to enhance these effects, we show that the strength of the embodiment illusion depends on the child-like voice feedback being congruent or incongruent with the age of the virtual body. Results also showed the positive emotional impact of the illusion of owning a child's body, opening up possibilities for health applications.