Immersive virtual reality health games: a narrative review of game design.

BACKGROUND: High quality head-mounted display based virtual reality (HMD-VR) has become widely available, spurring greater development of HMD-VR health games. As a behavior change approach, these applications use HMD-VR and game-based formats to support long-term engagement with therapeutic interventions. While the bulk of research to date has primarily focused on the therapeutic efficacy of particular HMD-VR health games, how developers and researchers incorporate best-practices in game design to achieve engaging experiences remains underexplored. This paper presents the findings of a narrative review exploring the trends and future directions of game design for HMD-VR health games. METHODS: We searched the literature on the intersection between HMD-VR, games, and health in databases including MEDLINE, Embase, CINAHL, PsycINFO, and Compendex. We identified articles describing HMD-VR games designed specifically as health applications from 2015 onwards in English. HMD-VR health games were charted and tabulated according to technology, health context, outcomes, and user engagement in game design. FINDINGS: We identified 29 HMD-VR health games from 2015 to 2020, with the majority addressing health contexts related to physical exercise, motor rehabilitation, and pain. These games typically involved obstacle-based challenges and extrinsic reward systems to engage clients in interventions related to physical functioning and pain. Less common were games emphasizing narrative experiences and non-physical exercise interventions. However, discourse regarding game design was diverse and often lacked sufficient detail. Game experience was evaluated using primarily ad-hoc questionnaires. User engagement in the development of HMD-VR health games primarily manifested as user studies. CONCLUSION: HMD-VR health games are promising tools for engaging clients in highly immersive experiences designed to address diverse health contexts. However, more in-depth and structured attention to how HMD-VR health games are designed as game experiences is needed. Future development of HMD-VR health games may also benefit from greater involvement of end-users in participatory approaches.

Virtual Reality-Guided Meditation for Chronic Pain in Patients With Cancer: Exploratory Analysis of Electroencephalograph Activity.

BACKGROUND: Mindfulness-based stress reduction has demonstrated some efficacy for chronic pain management. More recently, virtual reality (VR)-guided meditation has been used to assist mindfulness-based stress reduction. Although studies have also found electroencephalograph (EEG) changes in the brain during mindfulness meditation practices, such changes have not been demonstrated during VR-guided meditation. OBJECTIVE: This exploratory study is designed to explore the potential for recording and analyzing EEG during VR experiences in terms of the power of EEG waveforms, topographic mapping, and coherence. We examine how these measures changed during a VR-guided meditation experience in participants with cancer-related chronic pain. METHODS: A total of 10 adult patients with chronic cancer pain underwent a VR-guided meditation experience while EEG signals were recorded during the session using a BioSemi ActiveTwo system (64 channels, standard 10-20 configuration). The EEG recording session consisted of an 8-minute resting condition (pre), a 30-minute sequence of 3 VR-guided meditation conditions (med), and a final rest condition (post). Power spectral density (PSD) was compared between each condition using a cluster-based permutation test and across conditions using multivariate analysis of variance. A topographic analysis, including coherence exploration, was performed. In addition, an exploratory repeated measures correlation was used to examine possible associations between pain scores and EEG signal power. RESULTS: The predominant pattern was for increased ß and γ bandwidth power in the meditation condition (P<.025), compared with both the baseline and postexperience conditions. Increased power in the δ bandwidth was evident, although not statistically significant. The pre versus post comparison also showed changes in the θ and α bands (P=.02) located around the frontal, central, and parietal cortices. Across conditions, multivariate analysis of variance tests identified 4 clusters with significant (P<.05) PSD differences in the δ, θ, ß, and γ bands located around the frontal, central, and parietal cortices. Topographically, 5 peak channels were identified: AF7, FP2, FC1, CP5, and P5, and verified the changes in power in the different brain regions. Coherence changes were observed primarily between the frontal, parietal, and occipital regions in the θ, α, and γ bands (P<.0025). No significant associations were observed between pain scores and EEG PSD. CONCLUSIONS: This study demonstrates the feasibility of EEG recording in exploring neurophysiological changes in brain activity during VR-guided meditation and its effect on pain reduction. These findings suggest that distinct altered neurophysiological brain signals are detectable during VR-guided meditation. However, these changes were not necessarily associated with pain. These exploratory findings may guide further studies to investigate the highlighted regions and EEG bands with respect to VR-guided meditation. TRIAL REGISTRATION: ClinicalTrials.gov NCT00102401; http://clinicaltrials.gov/ct2/show/NCT00102401.

Henry J. Mankin: A Trailblazer in Skeletal Pathology Research.

: Dr. Henry Mankin has made a profound impact in the fields of skeletal surgery and orthopedics. In a career spanning over 50 years, Dr. Mankin conducted extensive research on and provided treatment for numerous patients with Gaucher disease and spinal tumors such as sacral chordomas. Dr. Mankin's prolific career includes many leadership positions in the field of skeletal surgery, including Chief of Orthopaedics at the Hospital for Joint Diseases and at Massachusetts General Hospital. He has touched the lives of over 19,000 patients with bone and soft tissue tumors and undoubtedly shaped the future of skeletal surgery.

Patients perceptions of virtual reality therapy in the management of chronic cancer pain.

The management of chronic cancer pain remains challenging and complex, with the process often involving a variety of pharmacological and non-pharmacological approaches. Recent studies have shown virtual reality (VR) therapy to be successful in the management of acute pain. However, it remains unclear whether VR-based applications are effective as an adjunctive therapy for cancer patients with chronic pain. Moreover, there exists a gap in the current research landscape that address patient's perceptions of virtual reality therapy. This qualitative study enrolled patients from a larger ongoing randomized controlled clinical trial in two focus groups covering topics including patients experience with and perspectives on using VR for chronic pain control, both generally, and specific to their own circumstances. Five major thematic categories and 23 sub-categories emerged in the analysis process reflecting the participants' narrative. Similar to other research, this study found mixed results in the use of adjunctive VR therapy to manage chronic cancer pain, although a majority of respondents found it to be beneficial. This study confirms that pain management is a highly complex and individualized process. For maximum efficacy, it is recommended that future designs of VR interventions engage pain patients in the design process to ensure maximum efficacy of experiences to with individuals' preferences.

Virtual Reality Clinical Research: Promises and Challenges.

BACKGROUND: Virtual reality (VR) therapy has been explored as a novel therapeutic approach for numerous health applications, in which three-dimensional virtual environments can be explored in real time. Studies have found positive outcomes for patients using VR for clinical conditions such as anxiety disorders, addictions, phobias, posttraumatic stress disorder, eating disorders, stroke rehabilitation, and for pain management. OBJECTIVE: This work aims to highlight key issues in the implementation of clinical research for VR technologies. METHODS: A discussion paper was developed from a narrative review of recent clinical research in the field, and the researchers' own experiences in conducting VR clinical research with chronic pain patients. RESULTS: Some of the key issues in implementing clinical VR research include theoretical immaturity, a lack of technical standards, the problems of separating effects of media versus medium, practical in vivo issues, and costs. CONCLUSIONS: Over the last decade, some significant successes have been claimed for the use of VR. Nevertheless, the implementation of clinical VR research outside of the laboratory presents substantial clinical challenges. It is argued that careful attention to addressing these issues in research design and pilot studies are needed in order to make clinical VR research more rigorous and improve the clinical significance of findings.