Limitations and solutions of low cost virtual reality mirror therapy for post-stroke patients.

Mirror therapy is applied to reduce phantom pain and as a rehabilitation technique in post-stroke patients. Using Virtual Reality and head-mounted displays this therapy can be performed in virtual scenarios. However, for its efficient use in clinical settings, some hardware limitations need to be solved. A new system to perform mirror therapy in virtual scenarios for post-stroke patients is proposed. The system requires the patient a standalone virtual reality headset with hand-tracking features and for the rehabilitator an external computer or tablet device. The system provides functionalities for the rehabilitator to prepare and follow-up rehabilitation sessions and a virtual scenario for the patient to perform rehabilitation. The system has been tested on a real scenario with the support of three experienced rehabilitators and considering ten post-stroke patients in individual sessions focused on upper limb motor rehabilitation. The development team observed all the sessions and took note of detected errors regarding technological aspects. Solutions to solve detected problems will be proposed and evaluated in terms of feasibility, performance cost, additional system cost, number of solved issues, new limitations, or advantages for the patient. Three types of errors were detected and solved. The first error is related to the position of the hands relative to the head-mounted display. To solve it the exercise area can be limited to avoid objectives that require turning the head too far. The second error is related to the interaction between the hands and the virtual objects. It can be solved making the main hand non-interactive. The last type of error is due to patient limitations and can be mitigated by having a virtual hand play out an example motion to bring the patient's attention back to the exercise. Other solutions have been evaluated positively and can be used in addition or instead of the selected ones. For mirror therapy based on virtual reality to be efficient in post-stroke rehabilitation the current head-mounted display-based solutions need to be complemented with specific strategies that avoid or mitigate the limitations of the technology and the patient. Solutions that help with the most common issues have been proposed.

Effects of virtual reality simulation on medical students' learning and motivation in human parasitology instruction: a quasi-experimental study.

BACKGROUND: Despite the proven effectiveness of simulation-based learning activities, its adoption in medical education remains limited, and the influence of simulation on student motivation, particularly subjective task values, is seldom explored. This study aimed to investigate the impact of a simulation-based learning activity on student learning and subjective task values in a medical morphology-related course of Human Parasitology. METHODS: A quasi-experimental study was conducted with 113 Chinese undergraduate medical students who participated in a Human Parasitology course during April to May 2022. Students were divided into two groups: Simulation Group (n = 55), where students used the simulation, and Lecture Group (n = 58), where students attended an online lecture. Students' learning was measured prior to the intervention, immediately after the intervention, and three weeks later to assess knowledge retention. The subjective task values questionnaire was administered before and after the interventions. Data were analyzed using one-way ANCOVA and MANOVA. RESULTS: Students in the Simulation Group exhibited significantly higher knowledge gain compared to the Lecture Group [F (1,110) = 23.69, p < 0.01]. Additionally, the Simulation Group retained knowledge significantly better than the Lecture Group [F (1,101) = 10.05, p < 0.005]. Furthermore, students in the Simulation Group experienced a significant increase in subjective task values after the intervention [F (3, 52) = 3.57, p < 0.05, ηp2 = 0.17], while students in the Lecture Group reported a significant decrease in subjective task values [F (3, 55) = 2.96, p < 0.05, ηp2 = 0.14]. CONCLUSIONS: Simulation-based learning not only leads to superior learning but also enhances students' subjective task values. These findings offer valuable insights into designing effective simulation-based learning experiences in medical education and have significant practical implications for educators and medical professionals.

Developing a virtual reality (VR) application for practicing the ABCDE approach for systematic clinical observation.

BACKGROUND: The Airways, Breathing, Circulation, Disability, Exposure (ABCDE) approach is an international approach for systematic clinical observation. It is an essential clinical skill for medical and healthcare professionals and should be practiced repeatedly. One way to do so is by using virtual reality (VR). The aim was therefore to develop a VR application to be used by inexperienced health students and professionals for self-instructed practice of systematic clinical observation using the ABCDE approach. METHODS: An iterative human-centred approach done in three overlapping phases; deciding on the ABCDE approach, specifying the requirements, and developing the application. RESULTS: A total of 138 persons were involved. Eight clinical observations were included in the ABCDE approach. The requirements included making it possible for inexperienced users to do self-instructed practice, a high level of immersion, and a sense of presence including mirroring the physical activities needed to do the ABCDE approach, allowing for both single and multiplayer, and automatic feedback with encouragement to repeat the training. In addition to many refinements, the testing led to the development of some new solutions. Prominent among them was to get players to understand how to use the VR hand controllers and start to interact with the VR environment and more instructions like showing videos on how to do observations. The solutions in the developed version were categorised into 15 core features like onboarding, instructions, quiz, and feedback. CONCLUSION: A virtual reality application for self-instructed practice of systematic clinical observation using the ABCDE approach can be developed with sufficient testing by inexperienced health students and professionals.

Increasing awareness and empathy among university students through immersive exercises - testing of the virtual reality application: A pilot study.

BACKGROUND: This paper presents an overview of a pilot study focused on testing the effectiveness of immersive virtual reality (VR) exercises, within extended reality experiences, in increasing awareness and empathy among university students towards pregnant women, elderly people, people in wheelchairs, and people with some sort of sight impairment. The extended reality experience was designed to simulate various scenarios that reflect the experiences of people from diverse backgrounds, to promote a better understanding of different perspectives and social issues related to some of the challenges tackled by people whose limitations are many times overlooked. MATERIAL AND METHODS: A design-based research methodology was applied and qualitative and quantitative data were collected in samples of 20 students from 3 countries. RESULTS: Overall, the results suggest that immersive VR applications can be an effective tool in increasing awareness and empathy among higher education students. The use of VR technology can create a sense of presence and immersion that allows students to experience situations that they may not have encountered otherwise. The results attained with the immersive experiences have provided evidence that these solutions can foster a greater understanding of different perspectives and promote empathy towards individuals from diverse backgrounds. CONCLUSIONS: Ongoing research correlated with the Mixed Reality on Universal Design's Secret Service (Mr. UD) project results is already expanding on these findings by testing the effectiveness of VR applications in different contexts and with larger and more diverse samples. Additionally, the research conducted has provided relevant evidence that suggests that VR applications and their inclusion in training programs may help promote behavior change and reduce prejudice and discrimination towards marginalized groups. Med Pr. 2023;74(3):187-97.

Inclusion and adaptation beyond disability: Using virtual reality to foster empathy.

BACKGROUND: Virtual reality (VR) has the potential to be a powerful tool in promoting empathy towards inclusion, particularly for individuals with impairments such as mobility difficulties, vision deficits, or autism but also about pregnancy, which can create temporary difficulties. By immersing users in simulated environments that replicate the experiences of those with different abilities, VR can create a sense of understanding and empathy for those who face challenges in their daily lives. For example, VR experiences can simulate the experience of navigating space as someone with a mobility impairment, providing a new perspective and appreciation for the difficulties that others face. Similarly, VR experiences can simulate the experience of vision impairment, pregnancy, or autism, providing a window into the challenges faced by those with these conditions and fostering empathy and understanding. MATERIAL AND METHODS: During the development of this study, field experts were consulted to ensure the robustness of the methods employed. Then, questionnaires were specifically developed to explore disabilities and challenges related to inclusion and were administered to a large population. Additionally, guided interviews were conducted with individuals who possess specific impairments to gather first-hand insights. RESULTS: The results obtained from the questionnaires and interviews provide a comprehensive overview of the inclusion challenges that necessitate attention and resolution. By drawing on the expertise of both experts and individuals with lived experiences, a holistic landscape of inclusion challenges has been established. CONCLUSIONS: The VR emerges as a powerful tool for promoting inclusion and fostering understanding among individuals. Its capacity to create immersive experiences that facilitate empathy has the potential to reshape society into a more compassionate and empathetic one. By leveraging the unique capabilities of VR, we can bridge the gap between different perspectives, fostering greater understanding, acceptance, and inclusivity. Med Pr. 2023;74(3):171-85.

Enhancing empathy through virtual reality: Developing a universal design training application for students.

The lack of empathy towards disability is a significant societal issue that hampers inclusivity and understanding. Many struggle to comprehend the daily challenges and experiences faced by people with disabilities, leading to ignorance, prejudice, and exclusion. However, empathy plays a pivotal role in addressing this problem and serves as the foundation for developing and creating better products, services, and environments. This article explores the potential of developing virtual reality (VR) applications to enhance students' empathy towards individuals with disabilities. By increasing empathy levels, students are expected to gain significant qualifications in universal design (UD). The full application development process covers the most suitable head-mounted display (HMD) set. The implementation methodology using the Unity programming platform, the approach adopted for conducting classes using the developed VR application, and the deployment stage. Testing was successfully conducted on a student population, receiving positive user feedback. Through the integration of VR technology, the authors thoroughly describe how to address the empathy gap and equip students with essential skills for inclusive and accessible design. The findings presented in this study provide valuable guidance for educators and developers interested in harnessing VR's potential to foster empathy and advance universal design practices. With the presented methodology and proposed application, the authors demonstrate the effectiveness of VR applications in elevating students' empathy levels, consequently enhancing their qualifications in universal design. Med Pr. 2023;74(3):199-210.

Investigating social comparison behaviour in an immersive virtual reality classroom based on eye-movement data.

Higher-achieving peers have repeatedly been found to negatively impact students' evaluations of their own academic abilities (i.e., Big-Fish-Little-Pond Effect). Building on social comparison theory, this pattern is assumed to result from students comparing themselves to their classmates; however, based on existing research designs, it remains unclear how exactly students make use of social comparison information in the classroom. To determine the extent to which students (N = 353 sixth graders) actively attend and respond to social comparison information in the form of peers' achievement-related behaviour, we used eye-tracking data from an immersive virtual reality (IVR) classroom. IVR classrooms offer unprecedented opportunities for psychological classroom research as they allow to integrate authentic classroom scenarios with maximum experimental control. In the present study, we experimentally varied virtual classmates' achievement-related behaviour (i.e., their hand-raising in response to the teacher's questions) during instruction, and students' eye and gaze data showed that they actively processed this social comparison information. Students who attended more to social comparison information (as indicated by more frequent and longer gaze durations at peer learners) had less favourable self-evaluations. We discuss implications for the future use of IVR environments to study behaviours in the classroom and beyond.

Safe human-robot collaboration in construction: A conceptual perspective.

INTRODUCTION: Small mobile robots have become increasingly popular in the construction domain over the last few years. They are stable on rough terrains, can walk over small obstacles, climb stairs, and carry various sensors or arms to perform diverse functions and sub-tasks required to complete construction-related tasks. Saving time, improving accessibility to difficult or unsafe spaces, and reducing costs while accomplishing construction tasks are some of the benefits of using small, mobile robots in construction. However, serious concerns about new workplace hazards could arise from having mobile robots on the jobsite. Unfortunately, no study has attempted to evaluate these risks, especially in the construction domain. Therefore, there was a significant need to develop a holistic understanding of the direct and indirect risks of mobile robot applications in construction. METHOD: In this paper, we used inferential and Virtual Reality (VR) visualization techniques to: (1) construct conceptual visualizations of proximal and distant human-robot interaction within the construction context; and (2) identify potential safety challenges of robots, which were categorized into three groups: (a) physical risks, (b) attentional costs, and (c) psychological impacts. These identified safety challenges were then validated and ranked by a group of construction safety and robotic experts who had knowledge and experience using such robots in construction. PRACTICAL APPLICATIONS: The outcomes of the study provided a detailed understanding of how robots might adversely affect workers' safety and health. The study outcomes could also be ultimately used in creating regulatory and administrative guidelines for the safe operations of small mobile robots in construction.

A diagnostic room for lower limb amputee based on virtual reality and an intelligent space.

This article proposes a virtual reality (VR) system for diagnosing and rehabilitating lower limb amputees. A virtual environment and an intelligent space are the basis of the proposed solution. The target audiences are physiotherapists and doctors, and the aim is to provide a VR-based system to allow visualization and analysis of gait parameters and conformity. The multi-camera system from the intelligent space acquires images from patients during gait. This way, it is possible to generate tridimensional information for the VR-based system. Among the provided functionalities, the user can explore the virtual environment and manage several features, such as gait reproduction and parameters displayed, using a head-mounted display and hand controllers. Besides, the system presents an automatic classifier that can assist physiotherapists and doctors in assessing abnormalities from conventional human gait. We evaluate the system through two quantitative experiments. The first one addresses the performance evaluation of the automatic classifier. The second analysis is through a Likert scale questionnaire submitted to a group of physiotherapists. In this case, the specialists evaluate the existing features of the proposed framework. The results from the questionnaire showed that the virtual environment is suitable for helping track patients' rehabilitation. Also, the neural network-based classifier results are promising, averaging higher than 91% for all evaluation metrics. Finally, a comparison with related works in the literature highlights the contributions of the proposed solution to the field.

A systematic review of the measures that have been used to assess surface characteristics in relation to their impact on walking and falling.

We investigated whether an impediment to progress in understanding the environmental factors that cause falls may be the difficulty in comparing results across studies because walking surfaces are poorly defined and underspecified. We conducted a systematic review of 384 studies from 370 articles that tested how different surfaces influenced human walking and falling. For each study, we report which categories of surfaces were used (indoor, outdoor, treadmill, virtual reality and qualitative), the nature of each surface (stairs, slopes, slippery, compliant, rough or default) and how information about each surface was measured. We found that minimal information was provided for many surfaces, making it impossible to meaningfully compare results for different types of surfaces across studies. We conclude that most published studies of walking and falling provide insufficient data to describe the surfaces that they used and we provide recommendations about how to improve the reporting of walking surfaces.

How to promote the sustainable development of virtual reality technology for training in construction filed: A tripartite evolutionary game analysis.

In recent years, virtual reality training technology (VRTT) has been considered by many scholars as a new training method instead of traditional training (TT) to reduce unsafe behaviors ascribed to construction workers (CWs) and corporate accident rates. However, in this process, a conflict of interest arises among the government, construction enterprises (CEs), and CWs. Therefore, this study introduces a quantitative research method, the three-party evolutionary game and creatively combining them with the product life cycle (PLC) to solve this problem by analyzing the equilibrium and evolutionarily stable strategies of the system. Finally, collaborative players' decision-making behaviors and their sensitivity to critical factors are examined. This paper will illustrate these in each stage through numerical simulations. The results of the study indicate that the government plays a dominant role in the VRTT introduction stage. When the government gives CEs appropriate subsidies, CEs will eventually realize the importance of VRTT for CWs. Then the government will gradually reduce the amount of the subsidies in this process. In addition, we also find that the continually high cost will lead to negative policies by the government, which requires the active cooperation and attitude change from CEs and CWs. Ultimately, the government, CEs and CWs adopt the best strategy in the evolutionary process to facilitate the promotion, application and sustainability of VRTT in the construction industry.

Measurement Accuracy of the HTC VIVE Tracker 3.0 Compared to Vicon System for Generating Valid Positional Feedback in Virtual Reality.

For realistic and reliable full-body visualization in virtual reality, the HTC VIVE Tracker could be an alternative to highly complex and cost- and effort-intensive motion capture systems such as Vicon. Due to its lighter weight and smaller dimensions, the latest generation of trackers is proving to be very promising for capturing human movements. The aim of this study was to investigate the accuracy of the HTC VIVE Tracker 3.0 compared to the gold-standard Vicon for different arrangements of the base stations and various velocities during an athletic movement. Therefore, the position data from three trackers attached to the hip, knee and ankle of one sporty participant were recorded while riding a bicycle ergometer at different pedaling frequencies and different base station arrangements. As parameters for the measurement accuracy, the trajectories of the linear motion of the knee and the circular motion of the ankle were compared between VIVE and Vicon by calculating the spatial distance from the raw data at each point in time. Both the pedaling frequency and the arrangement of the base stations significantly affected the measurement accuracy, with the lowest pedaling frequency of 80 rpm and the rectangular arrangement recommended by the manufacturer showing the smallest spatial differences of 10.4 mm ± 4.5 mm at the knee and 11.3 mm ± 5.1 mm at the ankle. As the pedaling frequency increased gradually (120 rpm and 160 rpm), the measurement accuracy of the trackers per step decreased less at the knee (approximately 5 mm) than at the ankle (approximately 10 mm). In conclusion, the measurement accuracy for various athletic skills was high enough to enable the visualization of body limbs or the entire body using inverse kinematics in VR on the one hand and, on the other hand, to provide initial insights into the quality of certain techniques at lower speeds in sports science research. However, the VIVE trackers are not suitable for exact biomechanical analyses.

Affordance, usefulness, enjoyment, and aesthetics in sustaining virtual reality engagement.

As virtual reality (VR) continues to develop, it's attracting an increasing number of consumers who are seeking more diverse functions and experiences. This study presents a theoretical model designed to identify predictors of VR users' continuance intentions. Data was collected from VR users who had firsthand experiences with the technology, and partial least squares structural equation modeling was employed to analyze this data. The results showed a significant correlation between functional affordance and perceived usefulness. Cognitive affordance was found to have a significant association with perceived usefulness, but it also influenced perceived enjoyment. Moreover, physical affordance significantly related to both perceived usefulness and enjoyment. Perceived usefulness was found to directly affect both attitude and continuance intention, while empirical results validated the impact of perceived enjoyment on attitude. The element of shape showed a significant correlation with attitude. Finally, attitude was found to have a significant association with continuance intention. The findings from this study will provide valuable insights for VR companies, developers, and consumers.

Effectiveness of virtual reality on activities of daily living in children with cerebral palsy: a systematic review and meta-analysis.

Background: No meta-analysis has been conducted on the effect of specific virtual reality (VR) treatment modes on activities of daily living (ADL) in children with cerebral palsy (CP). Therefore, this study aimed to confirm whether VR therapy is effective in improving ADL in children with CP according to subgroups. Methodology: Literature published in the Cumulated Index to Nursing and Allied Health Literature (CINAHL), Embase, the Physiotherapy Evidence Database (PEDro), and PubMed was reviewed, and Risk of Bias 2.0 (RoB 2) was used to evaluate the quality of the literature. A funnel plot was visually observed to confirm publication bias, supplemented with Egger's regression test. Data analysis was performed using R version 4.2.1. Subgroup analysis was performed according to the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), treatment minutes per week, treatment period, age, and RoB. Results: Eleven of 2,978 studies were included, and the overall effect size was 0.37 (95% confidence interval = 0.17-0.57). Regarding GMFCS, effect sizes of 0.41 and 0.33 was observed for the low- and high-function groups, respectively. For MACS, 0.27 and 0.43 were observed for the low and high-function groups. Regarding treatment minutes per week, the values were 0.22, 0.44, and 0.27 in the 1-100, 101-200, and 201-300 min groups, respectively. In the classification according to age, 0.29 was observed for school-age children and 0.98 for preschool children. Lastly, in the classification according to the RoB, 0.52, -0.01, and 0.23 indicated studies with low risk, some concern, and high risk, respectively. Conclusions: The highest effect was observed when VR was applied within 6 weeks of 101-200 per week. Therefore, it is suggested that if the results of this review are applied to children with cerebral palsy in the community, it will be an effective intervention method. Systematic review registration: PROPEROS (registration number CRD42023409801).

Efectividad de la tecnología robótica y la realidad virtual para la rehabilitación de la función motora en la parálisis cerebral. Revisión sistemática / Effectiveness of robotic technology and virtual reality for the rehabilitation of motor function in cerebral palsy. Systematic review

Introducción: La parálisis cerebral (PC) es una condición de salud secundaria a daños no progresivos que ocurren durante el desarrollo del cerebro en la etapa fetal o infantil. Evaluar la efectividad de la tecnología robótica y la realidad virtual de la función motora en pacientes con PC en comparación con estrategias convencionales de rehabilitación como fisioterapia, terapia ocupacional, intervención de neurodesarrollo y estimulación transcraneal. Se llevó a cabo una revisión de ensayos controlados aleatorizados de los últimos 5 años. Para la evaluación de la calidad metodológica de los estudios incluidos se utilizó la escala PEDro, con evaluación del nivel de evidencia y grado de recomendación según la clasificación de Oxford. Resultados: Diecisiete artículos cumplieron con los criterios de elegibilidad. La tecnología robótica y la realidad virtual demostraron ser efectivas para la mejora de la función motora, las habilidades manuales y las destrezas perceptivo-visuales de los pacientes con PC, en comparación con el uso de estrategias convencionales de rehabilitación.(AU)

Introduction: Cerebral palsy (CP) is a health condition secondary to non-progressive damage that occurs during brain development in the fetal or infant stage. To evaluate the effectiveness of robotic technology and virtual reality on motor function in patients with CP compared to conventional rehabilitation strategies such as physical therapy, occupational therapy, neurodevelopmental intervention, and transcranial stimulation. A review of randomized controlled trials of the last 5 years was carried out. For the evaluation of the methodological quality of the included studies, the PEDro scale was used, with evaluation of the level of evidence and degree of recommendation according to the Oxford classification. Results: Seventeen articles met the eligibility criteria. Robotic technology and virtual reality proved to be effective in improving motor function, manual skills, and visual–perceptual skills in patients with CP, compared to the use of conventional rehabilitation strategies.(AU)

Public speaking training in front of a supportive audience in Virtual Reality improves performance in real-life.

Public speaking is a challenging task that requires practice. Virtual Reality allows to present realistic public speaking scenarios in this regard, however, the role of the virtual audience during practice remains unknown. In the present study, 73 participants completed a Virtual Reality practice session while audience was manipulated to be supportive or unsupportive or presentations were practiced without audience. Importantly, following the virtual practice, participants held the presentation during a real university course via Zoom. We measured emotional experience, self-efficacy, and the subjective evaluation of performance at baseline, after VR practice, and after the real presentation. Additionally, participants' performance in the real presentation was evaluated by instructors (blinded to condition). Supportive in contrast to unsupportive audiences led to more positive believes about one's own performance, while there were no changes in beliefs in the group without audience. Importantly, practice in front of a supportive compared to unsupportive audience resulted in a more positive evaluation of speaker confidence in real-life public speaking as rated by the instructors. These results demonstrate an impact of virtual social feedback during public speaking on subsequent subjective performance evaluation. This may increase self-confidence resulting in actual improved public speaking performance in real-life.

Development of Orientation and Mobility Training System for Visually Impaired Children Using VR.

Visually impaired children do Orientation and Mobility(O&M) training to acquire the abilities to walk alone with white cane. The abilities to walk alone are to discriminate sound sources, localize sound sources, recognizer sound motion or echoes, and form a mental map. A mental map is a map formed in the brain, and visually impaired people create a map mainly from sound information. Walking without sight is dangerous, so many assistants are needed during O&M training. However, due to the shortage of O&M specialists, the time which visually impaired children do O&M training is becoming shorter. Therefore, we developed an O&M training system on a map created in a Virtual Reality (VR) space to eliminate the danger and alarm which visually impaired children feel during O&M training, and to enable safe and secure O&M training with fewer assistants.

Tolerance of immersive head-mounted virtual reality among older nursing home residents.

Introduction: Virtual Reality (VR) is a tool that is increasingly used in the aging population. Head-Mounted Displays (HMDs) are stereoscopic vision devices used for immersive VR. Cybersickness is sometimes reported after head-mounted display (HMD) VR exposure. Cybersickness severity and anxiety state reflect VR low tolerance. We aimed to evaluate HMD VR tolerance among older nursing home residents through cybersickness and anxiety state. Methods: A total of 36 participants were included in this preliminary study, 33 of whom (mean age: 89.33 ± 5.48) underwent three individual HMD VR sessions with three different contents. Cybersickness occurrence and severity were scored by the Simulator Sickness Questionnaire (SSQ) after each session. Anxiety state was assessed by the State-Trait Anxiety Inventory form Y-A before and after each session. Anxiety trait (using State-Trait Anxiety Inventory form Y-B) was also evaluated before and after the experiment. In total, 92% (33/36) of patients completed all three sessions, of which 61% (20/33) did not report any cybersickness symptoms (SSQ = 0). Six participants reported significant cybersickness (defined by an SSQ score ⩾10) in at least one session. Discussion: Only two participants stopped the study after the first exposure because of cybersickness. Age, cognitive function, anxiety trait, and well-being were not associated with cybersickness. The mean anxiety state decreased significantly from pre- to post-session. This immersive HMD VR experience was well tolerated among nursing home dwellers. Further larger studies in this population aiming to identify CS determinants are needed in order to use HMD VR on a standard basis.