The association between social rewards and anxiety: Links from neurophysiological analysis in virtual reality and social interaction game.

Individuals' affective experience can be intricate, influenced by various factors including monetary rewards and social factors during social interaction. However, within this array of factors, divergent evidence has been considered as potential contributors to social anxiety. To gain a better understanding of the specific factors associated with anxiety during social interaction, we combined a social interaction task with neurophysiological recordings obtained through an anxiety-elicitation task conducted in a Virtual Reality (VR) environment. Employing inter-subject representational similarity analysis (ISRSA), we explored the potential linkage between individuals' anxiety neural patterns and their affective experiences during social interaction. Our findings suggest that, after controlling for other factors, the influence of the partner's emotional cues on individuals' affective experiences is specifically linked to their neural pattern of anxiety. This indicates that the emergence of anxiety during social interaction may be particularly associated with the emotional cues provided by the social partner, rather than individuals' own reward or prediction errors during social interaction. These results provide further support for the cognitive theory of social anxiety and extend the application of VR in future cognitive and affective studies.

Neural signatures of motor imagery for a supernumerary thumb in VR: an EEG analysis.

Human movement augmentation is a rising field of research. A promising control strategy for augmented effectors involves utilizing electroencephalography through motor imagery (MI) functions. However, performing MI of a supernumerary effector is challenging, to which MI training is one potential solution. In this study, we investigate the validity of a virtual reality (VR) environment as a medium for eliciting MI neural activations for a supernumerary thumb. Specifically, we assess whether it is possible to induce a distinct neural signature for MI of a supernumerary thumb in VR. Twenty participants underwent a two-fold experiment in which they observed movements of natural and supernumerary thumbs, then engaged in MI of the observed movements. Spectral power and event related desynchronization (ERD) analyses at the group level showed that the MI signature associated with the supernumerary thumb was indeed distinct, significantly different from both the baseline and the MI signature associated with the natural thumb, while single-trial classification showed that it is distinguishable with a 78% and 69% classification accuracy, respectively. Furthermore, spectral power and ERD analyses at the group level showed that the MI signatures associated with directional movement of the supernumerary thumb, flexion and extension, were also significantly different, and single-trial classification demonstrated that these movements could be distinguished with 60% accuracy. Fine-tuning the models further increased the respective classification accuracies, indicating the potential presence of personalized features across subjects.

Exploring ambulance clinicians' clinical reasoning when training mass casualty incidents using virtual reality: a qualitative study.

BACKGROUND: How ambulance clinicians (ACs) handle a mass casualty incident (MCI) is essential for the suffered, but the training and learning for the ACs are sparse and they don't have the possibility to learn without realistic simulation training. In addition, it is unclear what type of dilemmas ACs process in their clinical reasoning during an MCI. With virtual reality (VR) simulation, the ACs clinical reasoning can be explored in a systematic way. Therefore, the objective was to explore ambulance clinicians' clinical reasoning when simulating a mass casualty incident using virtual reality. METHODS: This study was conducted as an explorative interview study design using chart- stimulated recall technique for data collection. A qualitative content analysis was done, using the clinical reasoning cycle as a deductive matrix. A high-fidelity VR simulation with MCI scenarios was used and participants eligible for inclusion were 11 senior ACs. RESULTS/CONCLUSION: All phases of the clinical reasoning cycle were found to be reflected upon by the participants during the interviews, however with a varying richness of analytic reflectivity. Non-analytic reasoning predominated when work tasks followed specific clinical guidelines, but analytical reasoning appeared when the guidelines were unclear or non-existent. Using VR simulation led to training and reflection on action in a safe and systematic way and increased self-awareness amongst the ACs regarding their preparedness for MCIs. This study increases knowledge both regarding ACs clinical reasoning in MCIs, and insights regarding the use of VR for simulation training.

Virtual clinical simulation as a paedagogical strategy in healthcare learning: Evidence and Gap Map protocol.

INTRODUCTION: Virtual clinical simulation involves creating and applying scenarios using technology like computers or virtual reality. This method provides a secure experiential learning environment, encouraging active student participation and stimulating clinical, critical and reflective thinking. This article outlines the development of the Evidence and Gap Map, which aims to identify, quantify and visually and interactively classify existing systematic reviews on the effectiveness of virtual clinical simulations in health professional training. METHODS AND ANALYSIS: The Evidence and Gap Map will adhere to the Campbell Collaboration Guidelines. Bibliographic searches in six databases will follow inclusion criteria determined by the Population, Intervention, Comparison, Outcome and Study design strategy. After the initial calibration, two reviewers will independently apply the inclusion and exclusion criteria to the title and abstract of each identified study, with subsequent full reading of the selected articles. The methodological quality of the included systematic reviews will be assessed with the AMSTAR 2 tool. The map will be developed using the EPPI-Mapper software. ETHICS AND DISSEMINATION: There is no requirement for ethical approval for this systematic review. On completion, it will be published in a peer-reviewed academic journal and presented at a conference. This review protocol was registered on the Open Science Framework platform (OSF Associated Project Registration: osf.io/r6wdc and received the following DOI: 10.17605/OSF.IO/R6WDC).

Virtual reality training for radiation safety in cardiac catheterization laboratories - an integrated study.

The advent of fluoroscopically guided cardiology procedures has greatly improved patient outcomes but has also increased occupational radiation exposure for healthcare professionals, leading to adverse health effects such as radiation-induced cataracts, alopecia, and cancer. This emphasizes the need for effective radiation safety training. Traditional training methods, often based on passive learning, fail to simulate the dynamic catheterization laboratory environment adequately. Virtual Reality (VR) offers a promising alternative by providing immersive, interactive experiences that mimic real-world scenarios without the risks of actual radiation exposure. Our study aims to assess the effectiveness of VR-based radiation safety training compared to traditional methods. We conducted a prospective cohort study involving 48 healthcare professionals in a catheterization lab setting. Participants underwent a 1-hour self-directed VR training session using Virtual Medical Coaching's RadSafe VR software, which simulates real-world clinical scenarios. Pre- and post-intervention radiation dose levels were measured using personal dosimeters at the eye, chest, and pelvis. Knowledge and skills were assessed through tests, and feedback was gathered through surveys and interviews. Statistical analysis revealed significant reductions in radiation exposure across all professional groups after VR training. For cardiologists, the eye dose dropped by 21.88% (from 2.88 mSv to 2.25 mSv), the chest dose decreased by 21.65% (from 4.11 mSv to 3.22 mSv), and the pelvis dose went down by 21.84% (from 2.06 mSv to 1.61 mSv). Perioperative nurses experienced similar reductions, with eye doses decreasing by 14.74% (from 1.56 mSv to 1.33 mSv), chest doses by 26.92% (from 2.6 mSv to 1.9 mSv), and pelvis doses by 26.92% (from 1.3 mSv to 0.95 mSv). Radiographers saw their eye doses reduced by 18.95% (from 0.95 mSv to 0.77 mSv), chest doses by 42.11% (from 1.9 mSv to 1.1 mSv), and pelvis doses by 27.63% (from 0.76 mSv to 0.55 mSv).Participants reported enhanced engagement, improved understanding of radiation safety, and a preference for VR over traditional methods. A cost analysis also demonstrated the economic advantages of VR training, with significant savings in staff time and rental costs compared to traditional methods. Our findings suggest that VR is a highly effective and cost-efficient training tool for radiation safety in healthcare, offering significant benefits over traditional training approaches.

Visuomotor prediction during action planning in the human frontoparietal cortex and cerebellum.

The concept of forward models in the brain, classically applied to describing on-line motor control, can in principle be extended to action planning, i.e. assuming forward sensory predictions are issued during the mere preparation of movements. To test this idea, we combined a delayed movement task with a virtual reality based manipulation of visuomotor congruence during functional magnetic resonance imaging. Participants executed simple hand movements after a delay. During the delay, two aspects of the upcoming movement could be cued: the movement type and the visuomotor mapping (i.e. congruence of executed hand movements and visual movement feedback by a glove-controlled virtual hand). Frontoparietal areas showed increased delay period activity when preparing pre-specified movements (cued > uncued). The cerebellum showed increased activity during the preparation for incongruent > congruent visuomotor mappings. The left anterior intraparietal sulcus showed an interaction effect, responding most strongly when a pre-specified (cued) movement was prepared under expected visuomotor incongruence. These results suggest that motor planning entails a forward prediction of visual body movement feedback, which can be adjusted in anticipation of nonstandard visuomotor mappings, and which is likely computed by the cerebellum and integrated with state estimates for (planned) control in the anterior intraparietal sulcus.

The Effectiveness of Immersive Virtual Reality as A Complementary Approach and a New Direction in Cancer Related Fatigue Management.

Background: Recent advancements in the field of medical technology have illuminated that the implementation of virtual reality interventions can be highly effective in managing cancer-related fatigue. Moreover, this innovative intervention has demonstrated a substantial improvement in patients' overall well-being and daily functioning. Thus, it represents a promising alternative to traditional pharmacological treatments by effectively addressing symptoms and enhancing quality of life. Therefore, the integration of this approach signifies a significant advancement in patient care. Nevertheless, despite the ongoing efforts to diversify non-pharmacological treatments, pharmacological interventions are still the predominant method for managing cancer-related fatigue. Aim: This systematic review aimed to evaluate the effectiveness of immersive virtual reality in cancer-related fatigue management, and to explore the main side effects of immersive virtual reality. Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Several online databases were used to find eligible studies in peer-reviewed journals relevant to the study keywords. Specifically, the included studies were systematic reviews and clinical trials that used immersive virtual reality-based intervention among adult patients with cancer and suffering from cancer-related fatigue. As well as were published in the English language from 2014 to 2024. As well as, three researchers independently contributed to study selections, data extraction, and study evaluations from different aspects: including quality assessment, risk of bias, and study synthesis. Results: After an extensive and comprehensive search, a total of ten published studies were included in this review study; 6 articles were quantitative clinical trial studies, and the other 4 were systematic review and meta-analysis studies. The quality of 6 included clinical trials was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for quantitative studies, the overall result showed that 33.3% of studies rated with moderate quality, no study was rated with low quality, and (66.7%) studies rated as high-quality studies. As well, the quality assessment of all review studies showed that all included systematic reviews and meta-analyses with a low risk of bias and high to moderate power of evidence. The result of this extensive and comprehensive review showed that immersive virtual reality has a significant effect in reducing cancer-related fatigue, however, still, there is a significant variation in the employment of immersive Virtual Reality protocols for cancer symptom management worldwide. Conclusion: Immersive virtual reality is an effective non-pharmacological intervention in reducing and controlling cancer-related fatigue among patients with various types of cancer, as well as being an affordable, cost-effective approach. Nevertheless, there remains a notable gap in the existing literature concerning virtual reality protocols, associated side effects, and the underlying mechanisms by which immersive virtual reality alleviates fatigue. Therefore, further research studies are warranted to address these gaps and advance our understanding in these areas.

Effects of Virtual Reality Motor-Cognitive Training for Older People With Cognitive Frailty: Multicentered Randomized Controlled Trial.

BACKGROUND: Cognitive frailty refers to a clinical syndrome in which physical frailty and mild cognitive impairment coexist. Motor-cognitive training and virtual reality (VR) have been used to launch various therapeutic modalities to promote health in older people. The literature advocates that motor-cognitive training and VR are effective in promoting the cognitive and physical function of older people. However, the effects on older people with cognitive frailty are unclear. OBJECTIVE: This study examined the effects of VR motor-cognitive training (VRMCT) on global cognitive function, physical frailty, walking speed, visual short-term memory, inhibition of cognitive interference, and executive function in older people with cognitive frailty. METHODS: This study used a multicentered, assessor-blinded, 2-parallel-group randomized controlled trial design. Participants were recruited face-to-face in 8 older adult community centers. Eligible participants were aged ≥60 years, were community dwelling, lived with cognitive frailty, had no dementia, and were not mobility restricted. In the intervention group, participants received VRMCT led by interventionists with 16 one-hour training sessions delivered twice per week for 8 weeks. In the control group, participants received the usual care provided by the older adult community centers that the investigators did not interfere with. The primary outcome was global cognitive function. The secondary outcomes included physical frailty, walking speed, verbal short-term memory, inhibition of cognitive interference, and executive function. Data were collected at baseline (T0) and the week after the intervention (T1). Generalized estimating equations were used to examine the group, time, and interaction (time × group) effects on the outcomes. RESULTS: In total, 293 eligible participants enrolled in the study. The mean age of the participants was 74.5 (SD 6.8) years. Most participants were female (229/293, 78.2%), had completed primary education (152/293, 52.1%), were married (167/293, 57.2%), lived with friends (127/293, 43.3%), and had no VR experience (232/293, 79.5%). In the intervention group, 81.6% (119/146) of participants attended >80% (13/16, 81%) of the total number of sessions. A negligible number of participants experienced VR sickness symptoms (1/146, 0.7% to 5/146, 3%). VRMCT was effective in promoting global cognitive function (interaction effect: P=.03), marginally promoting executive function (interaction effect: P=.07), and reducing frailty (interaction effect: P=.03). The effects were not statistically significant on other outcomes. CONCLUSIONS: VRMCT is effective in promoting cognitive functions and reducing physical frailty and is well tolerated and accepted by older people with cognitive frailty, as evidenced by its high attendance rate and negligible VR sickness symptoms. Further studies should examine the efficacy of the intervention components (eg, VR vs non-VR or dual task vs single task) on health outcomes, the effect of using technology on intervention adherence, and the long-term effects of the intervention on older people with cognitive frailty at the level of daily living. TRIAL REGISTRATION: ClinicalTrials.gov NCT04730817; https://clinicaltrials.gov/study/NCT04730817.

Adaptive QP algorithm for depth range prediction and encoding output in virtual reality video encoding process.

In order to reduce the encoding complexity and stream size, improve the encoding performance and further improve the compression performance, the depth prediction partition encoding is studied in this paper. In terms of pattern selection strategy, optimization analysis is carried out based on fast strategic decision-making methods to ensure the comprehensiveness of data processing. In the design of adaptive strategies, different adaptive quantization parameter adjustment strategies are adopted for the equatorial and polar regions by considering the different levels of user attention in 360 degree virtual reality videos. The purpose is to achieve the optimal balance between distortion and stream size, thereby managing the output stream size while maintaining video quality. The results showed that this strategy achieved a maximum reduction of 2.92% in bit rate and an average reduction of 1.76%. The average coding time could be saved by 39.28%, and the average reconstruction quality was 0.043, with almost no quality loss detected by the audience. At the same time, the model demonstrated excellent performance in sequences of 4K, 6K, and 8K. The proposed deep partitioning adaptive strategy has significant improvements in video encoding quality and efficiency, which can improve encoding efficiency while ensuring video quality.

Perceived travel distance depends on the speed and direction of self-motion.

Although estimating travel distance is essential to our ability to move through the world, our distance estimates can be inaccurate. These odometric errors occur because people tend to perceive that they have moved further than they had. Many of the studies investigating the perception of travel distance have primarily used forward translational movements, and postulate that perceived travel distance results from integration over distance and is independent of travel speed. Speed effects would imply integration over time as well as space. To examine travel distance perception with different directions and speeds, we used virtual reality (VR) to elicit visually induced self-motion. Participants (n = 15) were physically stationary while being visually "moved" through a virtual corridor, either judging distances by stopping at a previously seen target (Move-To-Target Task) or adjusting a target to the previous movement made (Adjust-Target Task). We measured participants' perceived travel distance over a range of speeds (1-5 m/s) and distances in four directions (up, down, forward, backward). We show that the simulated speed and direction of motion differentially affect the gain (perceived travel distance / actual travel distance). For the Adjust-Target task, forwards motion was associated with smaller gains than either backward, up, or down motion. For the Move-To-Target task, backward motion was associated with smaller gains than either forward, up or down motion. For both tasks, motion at the slower speed was associated with higher gains than the faster speeds. These results show that transforming visual motion into travel distance differs depending on the speed and direction of optic flow being perceived. We also found that a common model used to study the perception of travel distance was a better fit for the forward direction compared to the others. This implies that the model should be modified for these different non-forward motion directions.

Application of virtual reality in nursing communication education: A systematic review.

BACKGROUND: Communication skills are very important for nursing students. As a developing teaching technology, virtual reality is used in nursing communication education. However, the teaching effect and the effective teaching elements are not clear. OBJECTIVE: This systematic review was designed to summarize the characteristics of interventions and teaching design of nursing communication education based on virtual reality and to extract the common positive features to provide a reference for further nursing communication education. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched eight databases in December 2021, and an updated search was performed in June 2023. The Mixed Methods Appraisal Tool was used for study appraisal. RESULTS: A total of thirteen studies were included in the systematic review. Although differences were observed in the designs, evaluations and communication results of these studies, we extracted some elements that can be used to promote positive communication results, such as a combination of an intervention design based on theory with communication strategies, positive feedback and reporting. CONCLUSIONS: Virtual reality-based education shows mixed teaching effect in improving nursing students' communication cognition and skills. Further studies are necessary to verify the practical influence of intervention design combined with teaching methods on improving nursing students' communication and clinical communication coping ability.

Enhancing surgical occlusion setting in orthognathic surgery planning using mixed reality technology: a comparative study.

OBJECTIVES: Orthognathic surgery necessitates precise occlusal alignment during surgical planning, traditionally achieved through manual alignment of physical dental models as the recognized gold standard. This study aims to evaluate the efficacy of mixed reality technology in enhancing surgical occlusion setting compared to traditional physical alignment and an established virtual method, addressing the research question: Can mixed reality technology improve the accuracy and efficiency of occlusion setting in orthognathic surgery planning? MATERIALS & METHODS: This experimental study compared the surgical occlusion settings of 30 orthognathic cases using three methods: a new virtual method with mixed reality technology, the traditional gold standard of physical alignment, and an established virtual occlusion method using the IPS Case Designer (KLS Martin SE & Co. KG, Tuttlingen, Germany). RESULTS: Results indicated that surgical occlusions set with mixed reality technology were comparable to the conventional method in terms of maxillary movement and occlusal relationship. Differences observed were within the inter-observer variability of the gold standard. Both virtual methods tended to position the maxilla more anteriorly, resulting in fewer occlusal contacts. However, virtual occlusion demonstrated clinical applicability, achieving an average of 11 occlusal contacts with a bilaterally symmetrical distribution along the dental arch. CONCLUSIONS: The mixed reality environment provides an intuitive and flexible experience for setting surgical occlusion, eliminating the need for costly 3D-printed physical models or the automatic calculations required by other virtual occlusion methods, thereby offering maximum freedom. CLINICAL RELEVANCE: As a novel form of virtual occlusion, it presents a comprehensive tool that contributes to a timely and cost-effective full digital workflow of orthognathic surgery planning.

Color and brightness at work: Shedding some light on mind wandering.

INTRODUCTION: Occupational hazards are partly caused by the physical factors of the work environment, among which are ambient color and brightness, which can interfere with cognitive performance. Especially in modern work environments, performance relies heavily on cognitive functions such as attention, and an important factor in disrupting sustained attention is mind wandering (MW). This study aimed to investigate the effects of white and blue colors with two brightness levels on sustained attention and brain electrophysiology. METHODS: A total of 20 participants were exposed to 4 different conditions (white and blue as color and 300 and 800 lx as the brightness level) in separate blocks in a virtual reality environment in which a continuous performance test (CPT) was performed. RESULTS: The high brightness blue condition induced significant changes in sustained attention. MW network analysis showed a significant decrease in delta frequency band in the blue color condition with high brightness and beta decrease in the blue color condition with low brightness, whereas the activity of MW network increased when exposed to the white color condition. CONCLUSION: High-brightness blue light resulted in better sustained attention and decreased activity of MW-related neural regions. It is thus recommended that these results be taken into consideration in the interior design of educational settings and cars among other environments that require a high level and maintenance of cognitive functions, especially sustained attention.

Implementation of a Virtual Reality Intervention in Outpatient Physiotherapy for Chronic Pain: Protocol for a Pilot Implementation Study.

BACKGROUND: Chronic pain is a global health issue that causes physical, psychological, and social disabilities for patients, as well as high costs for societies. Virtual reality (VR) is a new treatment that provides an opportunity to narrow the gap between clinical practice and recommended care in the use of patient education and behavioral interventions in the outpatient physiotherapy setting. However, there is currently no implementation strategy to integrate VR treatments into this setting. OBJECTIVE: This protocol outlines a pilot implementation study that aims to (1) identify barriers and facilitators for implementing a VR intervention in outpatient physiotherapy care for people with chronic pain and (2) develop and pilot test an implementation strategy in 5 practices in Germany. METHODS: The study consists of 4 phases. The first phase involves adapting the treatment protocol of the VR intervention to the local context of outpatient physiotherapy practices in Germany. The second phase includes the collection of barriers and facilitators through semistructured interviews from physiotherapists and the development of a theory-driven implementation strategy based on the Theoretical Domains framework and the Behavior Change Wheel. This strategy will be applied in the third phase, which will also include a 6-month span of using VR interventions in practices, along with a process evaluation. The fourth phase consists of semistructured interviews to evaluate the developed implementation strategy. RESULTS: The recruitment process and phase 1, including the adaptation of the treatment protocol, have already been completed. We recruited 5 physiotherapy practices in Lower Saxony, Germany, where the VR intervention will be implemented. The collection of barriers and facilitators through semistructured interviews is scheduled to begin in February 2024. CONCLUSIONS: This pilot implementation study aims to develop a theory-driven implementation strategy for integrating a VR intervention into outpatient physiotherapy care for people with chronic pain. The identified barriers and facilitators, along with the implementation strategy, will serve as a starting point for future randomized controlled implementation studies in different settings to refine the implementation process and integrate VR interventions into the outpatient care of people with chronic pain. TRIAL REGISTRATION: German Clinical Trials Register DRKS00030862; https://tinyurl.com/3zf7uujx. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/58089.

Toward Physiological Detection of a "Just-Right" Challenge Level for Motor Learning in Immersive Virtual Reality: Protocol for a Cross-Sectional Study.

BACKGROUND: Motor learning, a primary goal of pediatric rehabilitation, is facilitated when tasks are presented at a "just-right" challenge level-at the edge of the child's current abilities, yet attainable enough to motivate the child in persistent efforts for success. Immersive virtual reality (VR) may be ideally suited for "just-right" task challenges because it enables precise adjustments of task parameters in motivating environments. Rehabilitation-specific VR tasks often use dynamic difficulty algorithms based on task performance to personalize task difficulty. However, these approaches do not consider relevant cognitive processes that could also impact "just-right" challenges, such as attention and engagement. Objective physiological measurement of these cognitive processes using wearable sensors could support their integration within "just-right" challenge detection and prediction algorithms. As a first step, it is important to explore relationships between objectively and subjectively measured psychophysiological states at progressively challenging task difficulty levels. OBJECTIVE: This study aims to (1) evaluate the performance of wearable sensors in a novel movement-based motor learning immersive VR task; (2) evaluate changes in physiological data at 3 task difficulty levels; and (3) explore the relationship between physiological data, task performance, and self-reported cognitive processes at each task difficulty level. METHODS: This study uses the within-participant experimental design. Typically developing children and youth aged 8-16 years will be recruited to take part in a single 90-minute data collection session. Physiological sensors include electrodermal activity, heart rate, electroencephalography, and eye-tracking. After collecting physiological data at rest, participants will play a seated unimanual immersive VR task involving bouncing a virtual ball on a virtual racket. They will first play for 3 minutes at a predefined medium level of difficulty to determine their baseline ability level and then at a personalized choice of 3 progressive difficulty levels of 3 minutes each. Following each 3-minute session, participants will complete a short Likert-scale questionnaire evaluating engagement, attention, cognitive workload, physical effort, self-efficacy, and motivation. Data loss and data quality will be calculated for each sensor. Repeated-measures ANOVAs will evaluate changes in physiological response at each difficulty level. Correlation analyses will determine individual relationships between task performance, physiological data, and self-reported data at each difficulty level. RESULTS: Research ethics board approval has been obtained, and data collection is underway. Data collection was conducted on December 12, 2023, and April 12, 2024, with a total of 15 typically developing children. Data analysis has been completed, and results are expected to be published in the fall of 2024. CONCLUSIONS: Wearable sensors may provide insights into the physiological effects of immersive VR task interaction at progressive difficulty levels in children and youth. Understanding the relationship between physiological and self-reported cognitive processes is a first step in better identifying and predicting "just-right" task challenges during immersive VR motor learning interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55730.

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.

Player Experience Evaluation in Game-Based Systems for Older Adults.

Significant efforts are currently being made to improve the quality of life of the older adult population. These efforts focus on aspects such as health, social interaction, and mental health. One of the approaches that has shown positive results in several studies is the application of game-based systems. These systems are not only used for entertainment, but also as tools for learning and promoting positive feelings. They are a means to overcome loneliness and isolation, as well as to improve health and provide support in daily life. However, it is important to note that, while these experiences are gradually being introduced to the older adult population, they are often designed with a younger audience in mind who are assumed to be more technologically proficient. This supposition can make older adults initially feel intimidated when interacting with this type of technology, which limits their ability to fully utilize and enjoy these technological solutions. Therefore, the purpose of this article is to apply a game experience and fun evaluation process oriented toward the older adult population based on the playability theory of human-computer interaction in virtual reality game experiences. This is expected to offer highly rewarding and pleasurable experiences, which will improve engagement with the older population and promote active and healthy aging.