Welcome to the Learning Hub!
Two Questions For You
Hi, I'm Todd! Welcome to the Learning Hub

Todd Maddox, PhD

Learning Scientist | Researcher

Hi, I'm Todd Maddox. I've spent over two decades researching and teaching the brain science behind how humans learn. This page is meant to be a resource for you — to expand your knowledge of what's possible with VR, what's working and why, and what we still hope to discover.

Clinical Focus Areas
Overview
Definitions of VR / AR / MR

"Virtual Reality (VR) refers to a intuitive interaction between exploiting human sensory, motor and cognitive affective responses, that are relevant “presence” are often associated with VR, but are prerequisites in the delivery of engaging virtual worlds. a range of devices, from so-called “immersive” scale computer technologies, and from whole traditional gaming controllers to physiological interfaces (such as eye links). Although predominantly associated with 3D computer symbolic, photographic/video and multisensory when judged appropriate to the task being undertaken (touch and force), proprioceptive (body to a suite of technologies that strive to support real interaction between humans and simulated/computer-generated environments loiting human sensory, motor and cognitive capabilities, in addition to human emotion and are relevant to the task being undertaken.

The terms “immersion” or “presence” are often associated with VR, but are future ideal states and prerequisites in the delivery of engaging virtual worlds. Interaction within VR may be achieved using called “immersive” wearable displays to conventional , and from whole-/part-body motion capture or tracking to physiological interfaces (such as eye-tracking and brain Although predominantly associated with 3D computer-generated graphi and multisensory data can be integrated with virtual environments to the task being undertaken. This includes the use of auditory, haptic and force), proprioceptive (body position and movement) and olfactory stimulation.

Augmented Reality (AR)..."

Find the full paper here.

--

This paper was written by Professor Bob Stone in July 2019 to provide his definitions of "VR", "AR", and "MR" after 30+ years working with these technologies. Professor Stone directs the University of Birmingham’s Human Interface Technologies Team.

Is Clinical Virtual Reality Ready for Primetime?

Objective: Since the mid-1990s, a significant scientific literature has evolved regarding the outcomes from the use of what we now refer to as clinical virtual reality (VR). This use of VR simulation technology has produced encouraging results when applied to address cognitive, psychological, motor, and functional impairments across a wide range of clinical health conditions. This article addresses the question, "Is clinical VR ready for primetime?"

Conclusions: Although there is still much research needed to advance the science in this area, we strongly believe that clinical VR applications will become indispensable tools in the toolbox of psychological researchers and practitioners and will only grow in relevance and popularity in the future.

Find the full report here.

--

Rizzo AS. Keynote Speaker is Clinical Virtual Reality Ready for Primetime? 2018 IEEE Conference on Virtual Reality and 3D User Interfaces (VR). 2018. doi:10.1109/vr.2018.8446505

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.

Find the full paper here.

--

Garrett, Bernie, et al. “Virtual Reality Clinical Research: Promises and Challenges.” JMIR Serious Games, vol. 6, no. 4, 2018, doi:10.2196/10839.

Clinical Results Using Virtual Reality

Abstract: Virtual Reality (VR) technology offers new opportunities for the development of innovative clinical research, assessment, and intervention tools. VR-based testing, training, teaching, and treatment approaches that would be difficult, if not impossible to deliver using traditional methods are now being developed that take advantage of the assets that are available with VR technology. As research evidence continues to indicate clinical efficacy, VR applications are being increasingly regarded as providing innovative options for targeting the cognitive, psychological, motor, and functional impairments that result from various clinical health conditions. VR allows for the precise presentation and control of stimuli within dynamic multisensory 3-D computer generated simulations as well as providing advanced methods for capturing and quantifying behavioral responses. These characteristics support the rationale for the use of VR applications in clinical assessment, intervention, and training. This article begins with a brief review of the history and rationale for the use of VR with clinical populations. We then detail one use-case for the clinical application of VR—the exposure therapy treatment of anxiety disorders and post-traumatic stress disorder. While significant work is cited in other areas of Clinical VR (e.g., pain management, cognitive/physical assessment/rehabilitation, eating disorders, social skills/clinical training, etc.), a full overview of such a broad literature is beyond the scope of this article. Thus, we have opted to provide more in-depth analysis of one specific clinical area that clearly illustrates how VR has been successfully applied and is supported by an encouraging and evolving scientific literature.

Find the full article here.

--

Rizzo, Albert, et al. “Clinical Results Using Virtual Reality.” Journal of Technology in Human Services, vol. 37, no. 1, 2019, pp. 51–74., doi:10.1080/15228835.2019.1604292.

The Past, Present, and Future of Virtual and Augmented Reality Research: A Network and Cluster Analysis of the Literature

Abstract: The recent appearance of low cost virtual reality (VR) technologies – like the Oculus Rift, the HTC Vive and the Sony PlayStation VR – and Mixed Reality Interfaces (MRITF) – like the Hololens – is attracting the attention of users and researchers suggesting it may be the next largest stepping stone in technological innovation. However, the history of VR technology is longer than it may seem: the concept of VR was formulated in the 1960s and the first commercial VR tools appeared in the late 1980s. For this reason, during the last 20 years, 100s of researchers explored the processes, effects, and applications of this technology producing 1000s of scientific papers. What is the outcome of this significant research work? This paper wants to provide an answer to this question by exploring, using advanced scientometric techniques, the existing research corpus in the field.

Find the full report here.

--

Inzerillo L. Augmented reality: past, present, future. The Engineering Reality of Virtual Reality 2013. 2013. doi:10.1117/12.2001833

Virtual Reality in Health System: Beyond Entertainment. A Mini-Review on the Efficacy of VR During Cancer Treatment

Abstract: Virtual reality (VR), a computer-generated virtual environment, has been increasingly used in the entertainment world becoming a very new evolving field, but VR technology has also found a variety of applications in the biomedical field. VR can offer to subjects a safe environment within which to carry on different interventions ranging from the rehabilitation of discharged patients directly at home, to the support of hospitalized patients during different procedures and also of oncological inpatient subjects. VR appears as a promising tool for support and monitoring treatments in cancer patients influencing psychological and physiological functions. The aim of this systematic review is to provide an overview of all the studies that used VR intervention on cancer patients and analyze their main findings. Nineteen studies across nearly a thousand articles were identified that explored effects of VR interventions on cancer patients. Although these studies varied greatly in setting and design, this review identified some overarching themes. Results found that VR improved patients' emotional well-being, and diminished cancer-related psychological symptoms. The studies explored various relevant variables including different types of settings (i.e., during chemotherapy, during pain procedures, during hospitalization). Here, we point to the need of a global and multi-disciplinary approach aimed at analyzing the effects of VR taking advantage of the new technology systems like biosensors as well as electroencephalogram monitoring pre, during, and after intervention. Devoting more attention to bio-physiological variables, standardized procedures, extending duration to longitudinal studies and adjusting for motion sickness related to VR treatment need to become standard of this research field.

Find the full study here.

--

Chirico, Andrea, et al. “Virtual Reality in Health System: Beyond Entertainment. A Mini-Review on the Efficacy of VR During Cancer Treatment.” Journal of Cellular Physiology, vol. 231, no. 2, 2015, pp. 275–287., doi:10.1002/jcp.25117.

Application of virtual reality technology in clinical medicine

Abstract: The present review discusses the application of virtual reality (VR) technology in clinical medicine, especially in surgical training, pain management and therapeutic treatment of mental illness. We introduce the common types of VR simulators and their operational principles in aforementioned fields. The clinical effects are also discussed. In almost every study that dealt with VR simulators, researchers have arrived at the same conclusion that both doctors and patients could benefit from this novel technology. Moreover, advantages and disadvantages of the utilization of VR technology in each field were discussed, and the future research directions were proposed.

Find the full paper here.

--

Li L, Yu F, Shi D, et al. Application of virtual reality technology in clinical medicine. Am J Transl Res. 2017;9(9):3867–3880. Published 2017 Sep 15.

Feasibility of an Immersive Virtual Reality Intervention for Hospitalized Patients: An Observational Cohort Study

Background: Virtual reality (VR) offers immersive, realistic, three-dimensional experiences that “transport” users to novel environments. Because VR is effective for acute pain and anxiety, it may have benefits for hospitalized patients; however, there are few reports using VR in this setting.

Objective: The aim was to evaluate the acceptability and feasibility of VR in a diverse cohort of hospitalized patients.

Methods: We assessed the acceptability and feasibility of VR in a cohort of patients admitted to an inpatient hospitalist service over a 4-month period. We excluded patients with motion sickness, stroke, seizure, dementia, nausea, and in isolation. Eligible patients viewed VR experiences (eg, ocean exploration; Cirque du Soleil; tour of Iceland) with Samsung Gear VR goggles. We then conducted semistructured patient interview and performed statistical testing to compare patients willing versus unwilling to use VR.

 

Find the full study here.

--

Mosadeghi, Sasan et al. “Feasibility of an Immersive Virtual Reality Intervention for Hospitalized Patients: An Observational Cohort Study.” JMIR mental healthvol. 3,2 e28. 27 Jun. 2016, doi:10.2196/mental.5801

Virtual reality and the role of the prefrontal cortex in adults and children

In this review, the neural underpinnings of the experience of presence are outlined. Firstly, it is shown that presence is associated with activation of a distributed network, which includes the dorsal and ventral visual stream, the parietal cortex, the premotor cortex, mesial temporal areas, the brainstem and the thalamus. Secondly, the dorsolateral prefrontal cortex (DLPFC) is identified as a key node of the network as it modulates the activity of the network and the associated experience of presence. Thirdly, children lack the strong modulatory influence of the DLPFC on the network due to their unmatured frontal cortex. Fourthly, it is shown that presence-related measures are influenced by manipulating the activation in the DLPFC using transcranial direct current stimulation (tDCS) while participants are exposed to the virtual roller coaster ride. Finally, the findings are discussed in the context of current models explaining the experience of presence, the rubber hand illusion, and out-of-body experiences.

Find the full study here.

--

Jäncke L. Virtual reality and the role of the prefrontal cortex in adults and children. Frontiers in Neuroscience. 2009;3(1). doi:10.3389/neuro.01.006.2009

Meta-Analysis of the Efficacy of Virtual Reality–Based Interventions in Cancer-Related Symptom Management

Background. This meta-analysis summarizes the results from recent studies that examined the use of virtual reality (VR)-based interventions on health-related outcomes in patients with cancer, and quantitatively evaluates the efficacy of VR-based interventions. Findings of this meta-analysis can provide direction for future symptom management research. 

Methods. The search terms included a combination of "virtual reality" OR "virtual environment" OR "head-mounted display" with "oncology" OR "cancer." Three databases (Medline, PubMed, and CAJ Full-text Database), one search engine (Google Scholar), and the website of ResearchGate, covering the period from December 2013 to May 15, 2019, and including articles published in both English and Chinese, were searched. Data synthesis used the RevMan 5.3 to generate pooled estimates of effect size. 

Results. A total of 6 empirical studies met the eligibility criteria. VR-based interventions had statistically significant effects on reducing symptoms of anxiety, depression, pain, and cognitive function, whereas statistically significant benefit was observed for fatigue (Z = 2.76, P = .006). 

Conclusion. Most recent studies have primarily examined VR-based interventions for symptom management in the acute stages of cancer care. However, the management of late and long-term side effects is central to cancer survivorship care. There is burgeoning empirical support for further research to evaluate the efficacy of VR-based interventions in cancer rehabilitation.

Find the full paper here.

--

Zeng, Yingchun, et al. “Meta-Analysis of the Efficacy of Virtual Reality–Based Interventions in Cancer-Related Symptom Management.” Integrative Cancer Therapies, vol. 18, 2019, p. 153473541987110., doi:10.1177/1534735419871108.

Attitudes Toward and Familiarity With Virtual Reality Therapy Among Practicing Cognitive Behavior Therapists: A Cross-Sectional Survey Study in the Era of Consumer VR Platforms

Abstract: Virtual reality exposure therapy (VRET) is an efficacious treatment for fear and anxiety and has the potential to solve both logistic issues for therapists and be used for scalable self-help interventions. However, VRET has yet to see large-scale implementation in clinical settings or as a consumer product, and past research suggests that while therapists may acknowledge the many advantages of VRET, they view the technology as technically inaccessible and expensive. We reasoned that after the 2016 release of several consumer virtual reality (VR) platforms and associated public acquaintance with VR, therapists' concerns about VRET may have evolved. The present study surveyed attitudes toward and familiarity with VR and VRET among practicing cognitive behavior therapists (n = 185) attending a conference. Results showed that therapists had an overall positive attitude toward VRET (pros rated higher than cons) and viewed VR as applicable to conditions other than anxiety. Unlike in earlier research, high financial costs and technical difficulties were no longer top-rated negative aspects. Average negative attitude was a larger negative predictor of self-rated likelihood of future use than positive attitude was a positive predictor and partially mediated the positive association between VRET knowledge and likelihood of future use, suggesting that promotional efforts should focus on addressing concerns. We conclude that therapist's attitudes toward VRET appear to have evolved in recent years, and no longer appear to constitute a major barrier to implementing the next generation of VR technology in regular clinical practice.

Find the full study here.

--

Lindner, Philip, et al. “Attitudes Toward and Familiarity With Virtual Reality Therapy Among Practicing Cognitive Behavior Therapists: A Cross-Sectional Survey Study in the Era of Consumer VR Platforms.” Frontiers in Psychology, vol. 10, 2019, doi:10.3389/fpsyg.2019.00176.

The Effects of Immersion and Real-World Distractions on Virtual Social Interactions

Abstract: This study explores the independent and joint effects of immersion and real-world distractions (a ringing cell phone) on cognitive (i.e., recognition and recall), affective valence, and interpersonal outcomes (i.e., interpersonal liking and communication satisfaction) as well as general feelings of presence (social presence and telepresence) during a virtual experience. Participants interacted with a virtual agent in an immersive virtual environment or nonimmersive virtual environment under three different levels of real-world distractions (i.e., no distraction, passively being exposed to the sound of a ringing cell phone, and actively responding to ringing cell phone). Increased immersion had a positive effect on telepresence, but a negative effect on recognition and recall; immersion did not have a significant effect on social presence. Real-world distractions had a negative effect on recognition, recall, and social presence, but did not affect telepresence or affective valence. Participants who were actively distracted performed more poorly on the recall measure and reported lower levels of social presence than their passively distracted counterparts. These findings suggest that (a) increased immersion will not uniformly improve social virtual reality experiences and (b) more research is needed on whether and how real-world events should be integrated into virtual environments.

Find the full report here.

--

Oh C, Herrera F, Bailenson J. The Effects of Immersion and Real-World Distractions on Virtual Social Interactions. Cyberpsychology, Behavior, and Social Networking. 2019;22(6):365-372. doi:10.1089/cyber.2018.0404

Report: Using Extended Reality in Healthcare

The healthcare industry is ripe for embracing immersive learning technologies in training professionals and informing patients.

After a 25-year career as a learning scientist and the last 3 years “immersed” in the private sector, Todd's opinion is that immersive technologies have the potential to improve the quality and quantity of training, to reduce training costs and to enhance patient satisfaction through better care from healthcare professionals and a deeper understanding for patients.

 

This report was originally published in Tech Trends.

--

Maddox T, Bonasio A, Barber T. Report: Using Extended Reality in Healthcare. Tech Trends. https://techtrends.tech/tech-trends/report-using-extended-reality-in-healthcare/. Published September 7, 2018. Accessed April 5, 2019.

Anxiety Reduction
Clinical VR tools to advance the prevention, assessment, and treatment of PTSD

The article presents the use of Virtual Reality (VR) as a clinical tool to address the assessment, prevention, and treatment of PTSD, based on the VR projects that were evolved at the University of Southern California Institute for Creative Technologies since 2004.

You can find the full article here.

--

Rizzo A‘S, Shilling R. Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD. European Journal of Psychotraumatology. 2017;8(sup5):1414560. doi:10.1080/20008198.2017.1414560

Implementations of Virtual Reality for Anxiety-Related Disorders: Systematic Review

Background: Although traditional forms of therapy for anxiety-related disorders (eg, cognitive behavioral therapy, CBT) have been effective, there have been long-standing issues with these therapies that largely center around the costs and risks associated with the components comprising the therapeutic process. To treat certain types of specific phobias, sessions may need to be held in public, therefore risking patient confidentiality and the occurrence of uncontrollable circumstances (eg, weather and bystander behavior) or additional expenses such as travel to reach a destination. To address these issues, past studies have implemented virtual reality (VR) technologies for virtual reality exposure therapy (VRET) to provide an immersive, interactive experience that can be conducted privately and inexpensively. The versatility of VR allows various environments and scenarios to be generated while giving therapists control over variables that would otherwise be impossible in a natural setting. Although the outcomes from these studies have been generally positive despite the limitations of legacy VR systems, it is necessary to review these studies to identify how modern VR systems can and should improve to treat disorders in which anxiety is a key symptom, including specific phobias, posttraumatic stress disorder and acute stress disorder, generalized anxiety disorder, and paranoid ideations.

Find the full study here.

--

Oing, Theodore, and Julie Prescott. “Implementations of Virtual Reality for Anxiety-Related Disorders: Systematic Review.” JMIR Serious Games, vol. 6, no. 4, 2018, doi:10.2196/10965.

A Free Virtual Reality Experience to Prepare Pediatric Patients for Magnetic Resonance Imaging: Cross-Sectional Questionnaire Study

Background: A magnetic resonance image (MRI) is a diagnostic test that requires patients to lie still for prolonged periods within a claustrophobic and noisy environment. This can be difficult for children to tolerate, and often general anesthetic (GA) is required at considerable cost and detriment to patient safety. Virtual reality (VR) is a newly emerging technology that can be implemented at low cost within a health care setting. It has been shown to reduce fear associated with a number of high-anxiety situations and medical procedures.

Objective: The goal of the research was to develop a VR resource to prepare pediatric patients for MRI, helping to reduce anxieties in children undergoing the procedure.

Find the full study here.

--

Ashmore J, Di Pietro J, Williams K, Stokes E, Symons A, Smith M, Clegg L, McGrath C "A Free Virtual Reality Experience to Prepare Pediatric Patients for Magnetic Resonance Imaging: Cross-Sectional Questionnaire Study" JMIR Pediatr Parent 2019;2(1):e11684

Home to Hospital Live Streaming With Virtual Reality Goggles: A Qualitative Study Exploring the Experiences of Hospitalized Children

Background: Being separated from home and relatives is a major stressor for children and adolescents when hospitalized. Children long for a manner to be distracted, pleasured, and socially connected during hospitalization. Different technological devices have been applied in health care to answer those needs. Both virtual reality (VR) and videoconferencing have proven their value in hospital wards and pediatrics. VisitU combines these 2 technologies innovatively. VisitU is a recently launched VR product enabling users to be virtually at home during hospitalization.

Objective: This study aims to explore the experiences of hospitalized patients with the VR intervention of VisitU in addition to standard care.

Find the full paper here.

--

Bakker, Aafke, et al. “Home to Hospital Live Streaming With Virtual Reality Goggles: A Qualitative Study Exploring the Experiences of Hospitalized Children.” JMIR Pediatrics and Parenting, vol. 1, no. 2, 2018, doi:10.2196/pediatrics.9576.

Virtual Reality-Enhanced Extinction of Phobias and Post-Traumatic Stress

Abstract: Virtual reality (VR) refers to an advanced technological communication interface in which the user is actively participating in a computer-generated 3-dimensional virtual world that includes computer sensory input devices used to simulate real-world interactive experiences. VR has been used within psychiatric treatment for anxiety disorders, particularly specific phobias and post-traumatic stress disorder, given several advantages that VR provides for use within treatment for these disorders. Exposure therapy for anxiety disorder is grounded in fear-conditioning models, in which extinction learning involves the process through which conditioned fear responses decrease or are inhibited. The present review will provide an overview of extinction training and anxiety disorder treatment, advantages for using VR within extinction training, a review of the literature regarding the effectiveness of VR within exposure therapy for specific phobias and post-traumatic stress disorder, and limitations and future directions of the extant empirical literature.

Find the full study here.

--

Maples-Keller, Jessica L., et al. “Virtual Reality-Enhanced Extinction of Phobias and Post-Traumatic Stress.” Neurotherapeutics, vol. 14, no. 3, 2017, pp. 554–563., doi:10.1007/s13311-017-0534-y.

VR-based cognitive behavioral therapy for patients with generalized social anxiety disorder

Aims: To assess the feasibility and potential effect of virtual reality-based cognitive behavioral therapy (VR-CBT) for patients with severe generalized social anxiety disorder (SAD).

Conclusions: This uncontrolled pilot study demonstrated the feasibility and treatment potential of VR-CBT in a difficult-to-treat group of patients with generalized SAD. Results suggest that VR-CBT may be effective in reducing anxiety as well as depression, and can increase quality of life.

You can find the full pilot study here.

--

Geraets CN, Veling W, Witlox M, Staring AB, Matthijssen SJ, Cath D. Virtual reality-based cognitive behavioural therapy for patients with generalized social anxiety disorder: a pilot study. Behavioural and Cognitive Psychotherapy. 2019:1-6. doi:10.1017/s1352465819000225

Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review

Abstract: This review is designed to systematically examine the available evidence about virtual reality exposure therapy's (VRET) efficacy for phobias, critically describe some of the most important challenges in the field and discuss possible directions. Evidence reveals that virtual reality (VR) is an effective treatment for phobias and useful for studying specific issues, such as pharmacological compounds and behavioral manipulations, that can enhance treatment outcomes. In addition, some variables, such as sense of presence in virtual environments, have a significant influence on outcomes, but further research is needed to better understand their role in therapeutic outcomes. We conclude that VR is a useful tool to improve exposure therapy and it can be a good option to analyze the processes and mechanisms involved in exposure therapy and the ways this strategy can be enhanced. In the coming years, there will be a significant expansion of VR in routine practice in clinical contexts.

Find the full study here.

--

Botella, Cristina, et al. “Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review.” Current Psychiatry Reports, vol. 19, no. 7, 2017, doi:10.1007/s11920-017-0788-4.

User-Centered Virtual Reality for Promoting Relaxation: An Innovative Approach

Abstract: Virtual reality has been used effectively to promote relaxation and reduce stress. It is possible to find two main approaches to achieve such aims across the literature. The first one is focused on generic environments filled with relaxing “narratives” to induce control over one’s own body and physiological response, while the second one engages the user in virtual reality-mediated activities to empower his/her own abilities to regulate emotion. The scope of the present contribution is to extend the discourse on VR use to promote relaxation, by proposing a third approach. This would be based on VR with personalized content, based on user research to identify important life events. As a second step, distinctive features of such events may be rendered with symbols, activities or other virtual environments contents. According to literature, it is possible that such an approach would obtain more sophisticated and long-lasting relaxation in users. The present contribution explores this innovative theoretical proposal and its potential applications within future research and interventions.

Find the full study here.

--

Pizzoli, Silvia Francesca Maria, et al. “User-Centered Virtual Reality for Promoting Relaxation: An Innovative Approach.” Frontiers in Psychology, vol. 10, 2019, doi:10.3389/fpsyg.2019.00479.

Single-session gamified virtual reality exposure therapy for spider phobia vs. traditional exposure therapy: study protocol for a randomized controlled non-inferiority trial

Background: Traditional one-session exposure therapy (OST) in which a patient is gradually exposed to feared stimuli for up to 3 h in a one-session format has been found effective for the treatment of specific phobias. However, many individuals with specific phobia are reluctant to seek help, and access to care is lacking due to logistic challenges of accessing, collecting, storing, and/or maintaining stimuli. Virtual reality (VR) exposure therapy may improve upon existing techniques by facilitating access, decreasing cost, and increasing acceptability and effectiveness. The aim of this study is to compare traditional OST with in vivo spiders and a human therapist with a newly developed single-session gamified VR exposure therapy application with modern VR hardware, virtual spiders, and a virtual therapist.

Discussion: VR exposure therapy has previously been evaluated as a treatment for specific phobias, but there has been a lack of high-quality randomized controlled trials. A new generation of modern, consumer-ready VR devices is being released that are advancing existing technology and have the potential to improve clinical availability and treatment effectiveness. The VR medium is also particularly suitable for taking advantage of recent phobia treatment research emphasizing engagement and new learning, as opposed to physiological habituation. This study compares a market-ready, gamified VR spider phobia exposure application, delivered using consumer VR hardware, with the current gold standard treatment. Implications are discussed.

Find the full study here.

--

Miloff, Alexander, et al. “Single-Session Gamified Virtual Reality Exposure Therapy for Spider Phobia vs. Traditional Exposure Therapy: Study Protocol for a Randomized Controlled Non-Inferiority Trial.” Trials, vol. 17, no. 1, 2016, doi:10.1186/s13063-016-1171-1.

Virtual Reality for Anxiety Reduction Demonstrated by Quantitative EEG: A Pilot Study

Abstract: 

While previous research has established that virtual reality (VR) can be successfully used in the treatment of anxiety disorders, including phobias and PTSD, no research has examined changes in brain patterns associated with the use of VR for generalized anxiety management. In the current study, we compared a brief nature-based mindfulness VR experience to a resting control condition on anxious participants. Self-reported anxiety symptoms and resting-state EEG were recorded across intervals containing quiet rest or the VR intervention. EEG activity was analyzed as a function of global power shifts in Alpha and Beta activity, and with sLORETA current source density estimates of cingulate cortex regions of interest. Results demonstrated that both a quiet rest control condition and the VR meditation significantly reduced subjective reports of anxiety and increased Alpha power. However, the VR intervention uniquely resulted in shifting proportional power from higher Beta frequencies into lower Beta frequencies, and significantly reduced broadband Beta activity in the anterior cingulate cortex. These effects are consistent with a physiological reduction of anxiety. This pilot study provides preliminary evidence supporting the therapeutic potential of VR for anxiety management and stress reduction programs.

Find the full report here.

--

Tarrant J, Viczko J, Cope H. Virtual Reality for Anxiety Reduction Demonstrated by Quantitative EEG: A Pilot Study. Frontiers in Psychology. 2018;9. doi:10.3389/fpsyg.2018.01280

Inducing an Anxiety Response Using a Contaminated Virtual Environment: Validation of a Therapeutic Tool for Obsessive–Compulsive Disorder.

Obsessive–compulsive disorder (OCD) is characterized by the presence of unwanted and repetitive thoughts triggering significant anxiety, as well as the presence of ritual behaviors or mental acts carried out in response to obsessions to reduce the associated distress. In the contamination subtype, individuals are scared of germs and bacteria, are excessively concerned with cleaning, fear contamination and the spread of disease, and may have a very strong aversion to bodily secretions. A few studies on virtual reality (VR) have been conducted with people suffering from OCD, but they all focus on the subtype characterized by checking rituals. The goal of this study is to confirm the potential of a “contaminated” virtual environment in inducing anxiety in 12 adults suffering from contamination-subtype OCD compared to 20 adults without OCD (N = 32) using a within–between protocol. Subjective (questionnaire) and objective (heart rate) measurements were compiled.

Participants were immersed in a control virtual environment (empty and clean room) and a “contaminated” virtual environment (filthy public restroom) designed for the treatment of OCD. Immersions were conducted in a 6-wall CAVE-like system. As hypothesized, the results of repeated-measures ANCOVAs revealed the significant impact of immersion in a filthy public restroom for participants suffering from OCD on both measures. Presence was correlated with anxiety in OCD participants and no difference in presence was observed between groups. Unwanted negative side effects induced by immersions in VR were higher in the OCD group. The clinical implications of the results and directions for further studies are discussed.

Find the full report here.

--

Laforest M, Bouchard S, Crétu A-M, Mesly O. Inducing an Anxiety Response Using a Contaminated Virtual Environment: Validation of a Therapeutic Tool for Obsessive–Compulsive Disorder. Frontiers in ICT. 2016;3. doi:10.3389/fict.2016.00018

Single-Session Gamified Virtual Reality Exposure Therapy for Spider Phobia vs. Traditional Exposure Therapy: Study Protocol for a Randomized Controlled Non-Inferiority Trial

Background: Traditional one-session exposure therapy (OST) in which a patient is gradually exposed to feared stimuli for up to 3 h in a one-session format has been found effective for the treatment of specific phobias. However, many individuals with specific phobia are reluctant to seek help, and access to care is lacking due to logistic challenges of accessing, collecting, storing, and/or maintaining stimuli. Virtual reality (VR) exposure therapy may improve upon existing techniques by facilitating access, decreasing cost, and increasing acceptability and effectiveness. The aim of this study is to compare traditional OST with in vivo spiders and a human therapist with a newly developed single-session gamified VR exposure therapy application with modern VR hardware, virtual spiders, and a virtual therapist.

Methods/Design: Participants with specific phobia to spiders (N = 100) will be recruited from the general public, screened, and randomized to either VR exposure therapy (n = 50) or traditional OST (n = 50). A behavioral approach test using in vivo spiders will serve as the primary outcome measure. Secondary outcome measures will include spider phobia questionnaires and self-reported anxiety, depression, and quality of life. Outcomes will be assessed using a non-inferiority design at baseline and at 1, 12, and 52 weeks after treatment.

Find the full paper here.

--

Miloff, Alexander, et al. “Single-Session Gamified Virtual Reality Exposure Therapy for Spider Phobia vs. Traditional Exposure Therapy: Study Protocol for a Randomized Controlled Non-Inferiority Trial.” Trials, vol. 17, no. 1, 2016, doi:10.1186/s13063-016-1171-1.

Can VR reduce fear of spiders?

Findings: Compared to a control group of standard psychoeducation, VR exposure therapy significantly reduced arachnophobia in a randomized trial.

You can find the full study here.

--

Minns S, Levihn-Coon A, Carl E, et al. Immersive 3D exposure-based treatment for spider fear: A randomized controlled trial. Journal of Anxiety Disorders. 2018;58:1-7. doi:10.1016/j.janxdis.2018.05.006

Controlling Social Stress in Virtual Reality Environments

Abstract: Virtual reality exposure therapy has been proposed as a viable alternative in the treatment of anxiety disorders, including social anxiety disorder. Therapists could benefit from extensive control of anxiety eliciting stimuli during virtual exposure. Two stimuli controls are studied in this study: the social dialogue situation, and the dialogue feedback responses (negative or positive) between a human and a virtual character. In the first study, 16 participants were exposed in three virtual reality scenarios: a neutral virtual world, blind date scenario, and job interview scenario. Results showed a significant difference between the three virtual scenarios in the level of self-reported anxiety and heart rate.

In the second study, 24 participants were exposed to a job interview scenario in a virtual environment where the ratio between negative and positive dialogue feedback responses of a virtual character was systematically varied on-the-fly. Results yielded that within a dialogue the more positive dialogue feedback resulted in less self-reported anxiety, lower heart rate, and longer answers, while more negative dialogue feedback of the virtual character resulted in the opposite. The correlations between on the one hand the dialogue stressor ratio and on the other hand the means of SUD score, heart rate and audio length in the eight dialogue conditions showed a strong relationship: r(6) = 0.91, p = 0.002; r(6) = 0.76, p = 0.028 and r(6) = −0.94, p = 0.001 respectively. Furthermore, more anticipatory anxiety reported before exposure was found to coincide with more self-reported anxiety, and shorter answers during the virtual exposure. These results demonstrate that social dialogues in a virtual environment can be effectively manipulated for therapeutic purposes.

Find the full study here.

--

Hartanto D, Kampmann IL, Morina N, Emmelkamp PGM, Neerincx MA, Brinkman W-P. Controlling Social Stress in Virtual Reality Environments. PLoS ONE. 2014;9(3). doi:10.1371/journal.pone.0092804

Patient Satisfaction
Effect of an Immersive Preoperative VR Experience on Patient Reported Outcomes

Objective: To investigate the effect of exposure to a virtual reality (VR) environment preoperatively on patient-reported outcomes for surgical operations.

Background: There is a scarcity of well-developed quality improvement initiatives targeting patient satisfaction.

Methods: We performed a randomized controlled trial of patients undergoing cranial and spinal operations in a tertiary referral center. Patients underwent a 1:1 randomization to an immersive preoperative VR experience or standard preoperative experience stratified on type of operation. The primary outcome measures were the Evaluation du Vecu de l'Anesthesie Generale (EVAN-G) score and the Amsterdam Preoperative Anxiety and Information (APAIS) score, as markers of the patient's experience during the surgical encounter

Conclusions: In a randomized controlled trial, the research team demonstrated that patients exposed to preoperative VR had increased satisfaction during the surgical encounter. Harnessing the power of this technology, hospitals can create an immersive environment that minimizes stress, and enhances the perioperative experience.

You can find the full report here.

--

Bekelis K, Calnan D, Simmons N, Mackenzie TA, Kakoulides G. Effect of an Immersive Preoperative Virtual Reality Experience on Patient Reported Outcomes. Annals of Surgery. 2017;265(6):1068-1073.

Using mobile VR to enhance medical comprehension and satisfaction in patients and their families

 Abstract: Patients are typically debriefed by their healthcare provider after any medical procedure or surgery to discuss their findings and any next steps involving medication or treatment instructions. However, without any medical or scientific background knowledge, it can feel overwhelming and esoteric for a patient to listen to a physician describe a complex operation. Instead, providing patients with engaging visuals and a virtual reality (VR) simulation of their individual clinical findings could lead to more effective transfer of medical knowledge and comprehension of treatment information. A newly developed VR technology is described, called HealthVoyager, which is designed to help facilitate this knowledge transfer between physicians and patients. The platform represents a customizable, VR software system utilizing a smartphone or tablet computer to portray personalized surgical or procedural findings as well as representations of normal anatomy. The use of such technology for eliciting medical understanding and patient satisfaction can have many practical and clinical applications for a variety of disease states and patient populations.

Find the full report here.

--

Palanica A, Docktor MJ, Lee A, Fossat Y. Using mobile virtual reality to enhance medical comprehension and satisfaction in patients and their families. Perspectives on Medical Education. 2019. doi:10.1007/s40037-019-0504-7

Brain Science of Satisfaction and Why VR Provides an Ideal Solution

Familiarity and experience can reduce stress, anxiety, and discomfort while enhancing preparedness and satisfaction for patients and their loved ones. 

Virtual reality achieves these goals; the psychological and brain research are clear on that point.

Read the full article here.

This article was originally published by the Association for Talent Development.

--

Maddox T, Fitzpatrick T. The Brain Science of Patient Satisfaction and Why VR Provides an Ideal Solution. Main. https://www.td.org/insights/the-brain-science-of-patient-satisfaction-and-why-vr-provides-an-ideal-solution. Published December 19, 2018. Accessed April 5, 2019.

Patient Education
Virtual Reality Simulation in Peritoneal Dialysis Training

Background/Aim: Peritonitis rates in peritoneal dialysis (PD) vary considerably not only across countries but also between centers in the same country. Patient education has been shown to significantly reduce infection rates but up till now training lacks standardization with patients being trained using different methods and media (e.g., illustrations, videos). As a result, patients may be insufficiently experienced in performing PD, which might be one of the causes for high peritonitis rates. To address these issues, we developed a PD training program based on virtual reality (VR).

Conclusion: Previous studies on the effectiveness of learning showed that VR training applications are superior to traditional methods, such as text- or video-based training. However, no study has been undertaken in the context of dialysis. We believe that the implementation of VR training programs in clinical practice will be beneficial in improving the patient's proficiency, and thereby the quality and safety of PD.

Find the full report here.

--

Zgoura P, Hettich D, Natzel J, Özcan F, Kantzow B. Virtual Reality Simulation in Peritoneal Dialysis Training: The Beginning of a New Era. Blood Purification. 2018;47(1-3):265-269. doi:10.1159/000494595

The Role of Personalized Virtual Reality in Education for Patients Post Stroke

Background/Aim: Education is essential to promote prevention of recurrent stroke and maximize rehabilitation; however, current techniques are limited and many patients remain dissatisfied. Virtual reality (VR) may provide an alternative way of conveying complex information through a more universal language. To develop and conduct preliminary assessments on the use of a guided and personalized 3D visualization education session via VR, for stroke survivors and primary caregivers.

Conclusions: Preliminary results suggest this approach provides a safe and promising educational tool to promote understanding of individualized stroke experiences.

Find the full report here.

--

Thompson-Butel AG, Shiner CT, Mcghee J, et al. The Role of Personalized Virtual Reality in Education for Patients Post Stroke—A Qualitative Case Series. Journal of Stroke and Cerebrovascular Diseases. 2019;28(2):450-457. doi:10.1016/j.jstrokecerebrovasdis.2018.10.018

Radiation therapy patient education using VERT: combination of technology with human care

Abstract: The Virtual Environment for Radiotherapy Training (VERT) system is a recently available tool for radiation therapy education. The majority of research regarding VERT-based education is focused on students, with a growing area of research being VERT's role in patient education. Because large differences in educational requirements exist between students and patients, focused resources and subsequent evaluations are necessary to provide solid justification for the unique benefits and challenges posed by VERT in a patient education context. This commentary article examines VERT's role in patient education, with a focus on salient visual features, VERT's ability to address some of the spatial challenges associated with RT patient education and how to combine technology with human care.

Find the full report here.

--

Jimenez YA, Lewis SJ. Radiation therapy patient education using VERT: combination of technology with human care. Journal of Medical Radiation Sciences. 2018;65(2):158-162. doi:10.1002/jmrs.282

Patient education using VR increases knowledge and positive experience for breast cancer patients undergoing radiation therapy

Purpose: Improved access to technology in the radiation therapy (RT) workforce education has resulted in opportunities for innovative patient education methods. This study investigated the impact of a newly developed education tool using the Virtual Environment for Radiotherapy Training (VERT) system on patients' RT knowledge and anxiety.

Conclusions: This study reports the high value of VERT breast cancer-targeted education programs in improving RT knowledge and perhaps decreasing patient anxiety. Continued efforts are required to improve patients' accessibility to VERT in Australia, and to better understand the effect of VERT's unique educational features on patients' emotional and physical needs throughout their RT.

Find the full report here.

--

Jimenez YA, Cumming S, Wang W, Stuart K, Thwaites DI, Lewis SJ. Patient education using virtual reality increases knowledge and positive experience for breast cancer patients undergoing radiation therapy. Supportive Care in Cancer. 2018;26(8):2879-2888. doi:10.1007/s00520-018-4114-4

Professional Training
Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial

Objective: This study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students.

Conclusions: The introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students.

You can find the full study here.

--

Padilha JM, Machado PP, Ribeiro A, Ramos J, Costa P. Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial (Preprint). 2018. doi:10.2196/preprints.11529

Digital Education for the Management of Chronic Wounds in Healthcare Professionals

Objective: Our main objective is to assess the effectiveness of digital education as a stand-alone approach or as part of a blended-learning approach in improving pre- and postregistration health care professionals' knowledge, attitudes, practical skills, and behavior in the management of chronic wounds, as well as their satisfaction with the intervention. Secondary objectives are to evaluate patient-related outcomes, cost-effectiveness of the interventions, and any unfavorable or undesirable outcomes that may arise.

Conclusions: This systematic review will provide an in-depth analysis of digital education strategies to train health care providers in the management of chronic wounds. We consider this topic particularly relevant given the current challenges facing health care systems worldwide, including shortages of skilled personnel and a steep increase in the population of older adults as a result of a prolonged life expectancy.

Find the full report here.

--

Martinengo L, Yeo NJY, Tang ZQ, Markandran KD, Kyaw BM, Car LT. Digital Education for the Management of Chronic Wounds in Health Care Professionals: Protocol for a Systematic Review by the Digital Health Education Collaboration. JMIR Research Protocols. 2019;8(3). doi:10.2196/12488

Virtual Reality for Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

Background: Virtual reality (VR) is a technology that allows the user to explore and manipulate computer-generated real or artificial three-dimensional multimedia sensory environments in real time to gain practical knowledge that can be used in clinical practice.

Objective: The aim of this systematic review was to evaluate the effectiveness of VR for educating health professionals and improving their knowledge, cognitive skills, attitudes, and satisfaction.

Methods: We performed a systematic review of the effectiveness of VR in pre- and postregistration health professions education following the gold standard Cochrane methodology. We searched 7 databases from the year 1990 to August 2017. No language restrictions were applied. We included randomized controlled trials and cluster-randomized trials. We independently selected studies, extracted data, and assessed risk of bias, and then, we compared the information in pairs. We contacted authors of the studies for additional information if necessary. All pooled analyses were based on random-effects models. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to rate the quality of the body of evidence.

Find the full study here.

--

Kyaw, Bhone Myint, et al. “Virtual Reality for Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration.” Journal of Medical Internet Research, vol. 21, no. 1, 2019, doi:10.2196/12959.

Resident Perspectives on Communication Training That Utilizes Immersive Virtual Reality

Background: Communication skills can be difficult to teach and assess in busy outpatient settings. These skills are important for effective counseling such as in cases of influenza vaccine hesitancy. It is critical to consider novel educational methods to supplement current strategies aimed at teaching relational skills.

Methods: An immersive virtual reality (VR) curriculum on addressing influenza vaccine hesitancy was developed using Kern's six-step approach to curriculum design. The curriculum was meant to teach best-practice communication skills in cases of influenza vaccine hesitancy. Eligible participants included postgraduate level (PL) 2 and PL-3 pediatric residents (n = 24). Immediately following the curriculum, a survey was administered to assess residents' attitudes toward the VR curriculum and perceptions regarding the effectiveness of VR in comparison to other educational modalities. A survey was administered 1 month following the VR curriculum to assess trainee-perceived impact of the curriculum on clinical practice.

Find the full study here.

--

Real, Francisj, et al. “Resident Perspectives on Communication Training That Utilizes Immersive Virtual Reality.” Education for Health, vol. 30, no. 3, 2017, p. 228., doi:10.4103/efh.efh_9_17.

The Past, Present, and Future of Virtual Reality in Pharmacy Education

Objective. To characterize how virtual reality (VR) has been and is being used in pharmacy education, and evaluate the projected utility of VR technology in pharmacy education in the future. 

Findings. Virtual reality technology has been used in pharmacy education for many years to provide engaging learning experiences. Although these learning experiences were not available in the three-dimensional digital environments provided by current VR, they demonstrated improvements in learning. Recent technological advancements have substantially increased the potential usefulness of VR for pharmacy education by providing immersive educational activities that mimic real world experiences to reinforce didactic and laboratory concepts. Virtual reality training that uses head-mounted displays is just beginning in pharmacy education, but more educational VR programs are becoming available. Further research will be necessary to fully understand the potential impact of VR on pharmacy education. 

Summary. Virtual reality technology can provide an immersive and interactive learning environment, overcoming many of the early challenges faced by instructors who used virtual activities for pharmacy education. With further technological and software development, VR has the potential to become an integral part of pharmacy education.

Find the full paper here.

--

Coyne, L, et al. “The Past, Present, and Future of Virtual Reality in Pharmacy Education.” American Journal of Pharmaceutical Education, Apr. 2019, doi:10.5688/ajpe7456.

The Applications of Virtual Reality Technology in Medical Groups Teaching

Introduction: Virtual reality is a new method for training different medical groups. Based on this technology, professionals and students of various medical sciences can determine their level of competence for medical treatment before any performance on the patient. Therefore, the aim of this study was to identify the applications of virtual reality technology for training the medical groups.

Methods: This is a scoping review study conducted in 2016. Articles were retrieved through the search of related keywords in databases such as Pub Med, Scopus, Web of Sciences, Springer, and Google scholar. Then, after applying the entry criteria, 21 papers were selected from a total of 1343. Data extraction was done by a data collection form. The collected data were summarized and reported using content analysis technique according to the study purpose.

Find the full paper here.

--

Samadbeik M, Yaaghobi D, Bastani P, Abhari S, Rezaee R, Garavand A. The Applications of Virtual Reality Technology in Medical Groups Teaching. J Adv Med Educ Prof. 2018;6(3):123–129.

Getting VR Right Then and Now … The Indispensable Role of Human Factors and Human Centered Design

Invited Essay

"From that point on, I vowed that we would never undertake another VR (or AR or MxR) project unless we could demand that a proper human-centred design process was put in place from Day One, and that we had the involvement and engagement of key stakeholders and end users throughout the entire project lifecycle. ‘Humans First, Technology Second’ became our ‘battle cry’. Of course, from time to time we would indulge in that ‘fun’ part of research often referred to as developing a ‘technology demonstrator’. Who in the VR community does not? But for mainstream, large-scale projects, a sound HF approach was always mandated. Sometimes, customers would refuse such a ‘luxury’, claiming it would unnecessary time and cost to a project. Often they went away; often the alternative they eventually sponsored failed."― Excerpted from a section of Professor Bob Stone's essay titled "Humans First, Technology Second".

Read the full essay here.

--

Stone, R 2016, 'Getting VR Right Then and Now … The Indispensable Role of Human Factors and Human Centred Design' Presence, vol. 25, no. 2, pp. 151-160. https://doi.org/10.1162/PRES_a_00253

The (human) science of medical virtual learning environments

Abstract: The uptake of virtual simulation technologies in both military and civilian surgical contexts has been both slow and patchy. The failure of the virtual reality community in the 1990s and early 2000s to deliver affordable and accessible training systems stems not only from an obsessive quest to develop the ‘ultimate’ in so-called ‘immersive’ hardware solutions, from head-mounted displays to large-scale projection theatres, but also from a comprehensive lack of attention to the needs of the end users. While many still perceive the science of simulation to be defined by technological advances, such as computing power, specialized graphics hardware, advanced interactive controllers, displays and so on, the true science underpinning simulation—the science that helps to guarantee the transfer of skills from the simulated to the real—is that of human factors, a well-established discipline that focuses on the abilities and limitations of the end user when designing interactive systems, as opposed to the more commercially explicit components of technology. Based on three surgical simulation case studies, the importance of a human factors approach to the design of appropriate simulation content and interactive hardware for medical simulation is illustrated. The studies demonstrate that it is unnecessary to pursue real-world fidelity in all instances in order to achieve psychological fidelity—the degree to which the simulated tasks reproduce and foster knowledge, skills and behaviours that can be reliably transferred to real-world training applications.

Find the full report here.

--

Stone RJ. The (human) science of medical virtual learning environments. Philosophical Transactions of the Royal Society B: Biological Sciences. 2011;366(1562):276-285. doi:10.1098/rstb.2010.0209

Virtual Reality for Health Professions Education: Systematic Review

Objectives: The aim of this systematic review was to evaluate the effectiveness of VR for educating health professionals and improving their knowledge, cognitive skills, attitudes, and satisfaction.

Conclusions: We found evidence suggesting that VR improves post-intervention knowledge and skills outcomes of health professionals when compared with traditional education or other types of digital education such as online or offline digital education. The findings on other outcomes are limited. Future research should evaluate the effectiveness of immersive and interactive forms of VR and evaluate other outcomes such as attitude, satisfaction, cost-effectiveness, and clinical practice or behavior change.

Find the full report here.

--

Dunleavy G, Nikolaou CK, Nifakos S, Atun R, Law GCY, Car LT. Mobile Digital Education for Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. Journal of Medical Internet Research. 2019;21(2). doi:10.2196/12937

Report: Building Healthcare Expertise With Virtual Reality

Q. Can immersive technologies help professionals in the healthcare sector build crucial expertise and save lives?

A. Yes, it certainly can — and it already is!

 

This report was originally published in Tech Trends.

--

Maddox T, Bonasio A. Report: Building Healthcare Expertise With VR. Tech Trends. https://techtrends.tech/virtual-reality/report-building-healthcare-expertise-with-vr/. Published January 4, 2019. Accessed April 4, 2019.

How xR Technologies Will Accelerate Healthcare Training

Immersive learning technologies are growing, and one sector embracing them is healthcare training. Immersive learning tools uniquely engage learning systems in the brain that are highly effective for many forms of training, especially training related to healthcare. These technologies have the potential to improve the quality and quantity of training, reduce training costs, and enhance patient satisfaction through better care from healthcare professionals and a deeper understanding for patients.

Read the full article here.

--

This article was originally published by the Association for Talent Development.

--

Maddox T. How xR Technologies Will Accelerate Healthcare Training. Main. https://www.td.org/insights/how-xr-technologies-will-accelerate-healthcare-training. Published September 19, 2018. Accessed April 5, 2019.

A Discussion of Virtual Reality As a New Tool for Training Healthcare Professionals

Background: Virtual reality technology describes the use of headsets displaying a particular environment to simulate a user’s physical existence in a virtual or imaginary setting. Headsets are sometimes combined with other sensory inputs, such as haptic feedback, smells, and changing temperatures. Avatars (virtual characters with whom the user interacts) can be programmed to express emotions, for example, by blushing or crying. These high-fidelity avatars provide the user a greater sense of reality and facilitate meaningful interaction.

The field of virtual reality first came to light decades ago; however, recent advances in technology have made it the exciting and emerging field it is today. Its applications are vast, ranging from military training to gaming. In medicine, the technology has been trialed for uses such as cognitive rehabilitation post-stroke (), improving reaction times in children with cerebral palsy () and in aiding the diagnosis of psychiatric conditions ().

This paper sets out the viewpoint that virtual reality technology could be a new focus of direction in the development of training tools for medical education. We concentrate on its use in improving the communication skills of clinicians and medical students. 

Find the full report here.

--

Fertleman C, Aubugeau-Williams P, Sher C, et al. A Discussion of Virtual Reality As a New Tool for Training Healthcare Professionals. Frontiers in Public Health. 2018;6. doi:10.3389/fpubh.2018.00044

Emotion & Mood
The ENGAGE study: managing depression and obesity in a precision medicine model

Abstract: Precision medicine models for personalizing achieving sustained behavior changeare largely outside of current clinical practice. Yet, changing self-regulatory behaviors is fundamental to the self-management of complex lifestyle-related chronic conditions such as depression and obesity - two top contributors to the global burden of disease and disability. To optimize treatments and address these burdens, behavior change and self-regulation must be better understood in relation to their neurobiological underpinnings. Here, we present the conceptual framework and protocol for a novel study, “Engaging self-regulation targets to understand the mechanisms of behavior change and improve mood and weight outcomes (ENGAGE)”. The ENGAGE study integrates neuroscience with behavioral science to better understand the self-regulation related mechanisms of behavior change for improving mood and weight outcomes among adults with comorbid depression and obesity. We collect assays of three self-regulation targets (emotion, cognition, and self-reflection) in multiple settings: neuroimaging and behavioral lab-based measures, virtual reality, and passive smartphone sampling. By connecting human neuroscience and behavioral science in this manner within the ENGAGE study, we develop a prototype for elucidating the underlying self-regulation mechanisms of behavior change outcomes and their application in optimizing intervention strategies for multiple chronic diseases.

You can access the ENGAGE here.

--

Williams LM, Pines A, Goldstein-Piekarski AN, et al. The ENGAGE study: Integrating neuroimaging, virtual reality and smartphone sensing to understand self-regulation for managing depression and obesity in a precision medicine model. Behaviour Research and Therapy. 2018;101:58-70. doi:10.1016/j.brat.2017.09.012

Virtual reality in the assessment, understanding, and treatment of mental health disorders

Abstract: Mental health problems are inseparable from the environment. With virtual reality (VR), computer-generated interactive environments, individuals can repeatedly experience their problematic situations and be taught, via evidence-based psychological treatments, how to overcome difficulties. VR is moving out of specialist laboratories. Our central aim was to describe the potential of VR in mental health, including a consideration of the first 20 years of applications. A systematic review of empirical studies was conducted. In all, 285 studies were identified, with 86 concerning assessment, 45 theory development, and 154 treatment. The main disorders researched were anxiety (n = 192), schizophrenia (n = 44), substance-related disorders (n = 22) and eating disorders (n = 18). There are pioneering early studies, but the methodological quality of studies was generally low. The gaps in meaningful applications to mental health are extensive. The most established finding is that VR exposure-based treatments can reduce anxiety disorders, but there are numerous research and treatment avenues of promise. VR was found to be a much-misused term, often applied to non-interactive and non-immersive technologies. We conclude that VR has the potential to transform the assessment, understanding and treatment of mental health problems. The treatment possibilities will only be realized if - with the user experience at the heart of design - the best immersive VR technology is combined with targeted translational interventions. The capability of VR to simulate reality could greatly increase access to psychological therapies, while treatment outcomes could be enhanced by the technology's ability to create new realities. VR may merit the level of attention given to neuroimaging.

Find the full study here.

--

Freeman, D., et al. “Virtual Reality in the Assessment, Understanding, and Treatment of Mental Health Disorders.” Psychological Medicine, vol. 47, no. 14, 2017, pp. 2393–2400., doi:10.1017/s003329171700040x.

Trauma and Self-Narrative in Virtual Reality: Toward Recreating a Healthier Mind

This study discusses the concept of virtual selves created in the virtual spaces [e.g. social network services or virtual reality (VR)]. It analyzes the activities in the different virtual spaces and claims that experience gained there can be transferred to real life. In respect to that, the effects of the VR treatment on the self as well as the concept of creating a life story are analyzed as interconnected. The research question which arises from these considerations is how to look at psychological trauma in order to explain the effectiveness of the usage of VR for treatment of traumatic disorders.

The proposal in the study is to see trauma as a shift in the normal storyline of the narrative people create. With this concept in mind, it might be possible to support the claim that reliving traumatic events, regaining control over one’s life narrative, and creating new stories in the VR aids the treatment process in the search for meaning and resolution in life events. Considering the findings of researchers who argue in the field of self-narrative and traumatic treatment, as well as researchers on virtual selves, virtual spaces and VR, this study discusses the virtual as a possible medium to experience narratives and utilize those narratives as better explanatory stories to facilitate the therapeutic process of recovery and self-recreation.

This study supports the idea that VR can be used to visualize patients’ narratives and help them perceive themselves as active authors of their life’s story by retelling traumatic episodes with additional explanation. This experience in the VR is utilized to form healthier narratives and coping techniques for robust therapeutic results that are transferred to real life.

Find the full study here.

--

Georgieva I. Trauma and Self-Narrative in Virtual Reality: Toward Recreating a Healthier Mind. Frontiers in ICT. 2017;4. doi:10.3389/fict.2017.00027

Meditation experts try Virtual Reality Mindfulness: A pilot study evaluation of the feasibility and acceptability of Virtual Reality to facilitate mindfulness practice in people attending a Mindfulness conference

Abstract: Regular mindfulness practice benefits people both mentally and physically, but many populations who could benefit do not practice mindfulness. Virtual Reality (VR) is a new technology that helps capture participants’ attention and gives users the illusion of “being there” in the 3D computer generated environment, facilitating sense of presence. By limiting distractions from the real world, increasing sense of presence and giving people an interesting place to go to practice mindfulness, Virtual Reality may facilitate mindfulness practice. Traditional Dialectical Behavioral Therapy (DBT®) mindfulness skills training was specifically designed for clinical treatment of people who have trouble focusing attention, however severe patients often show difficulties or lack of motivation to practice mindfulness during the training. The present pilot study explored whether a sample of mindfulness experts would find useful and recommend a new VR Dialectical Behavioral Therapy (DBT®) mindfulness skills training technique and whether they would show any benefit. Forty four participants attending a mindfulness conference put on an Oculus Rift DK2 Virtual Reality helmet and floated down a calm 3D computer generated virtual river while listening to digitized DBT® mindfulness skills training instructions. On subjective questionnaires completed by the participants before and after the VR DBT® mindfulness skills training session, participants reported increases/improvements in state of mindfulness, and reductions in negative emotional states. After VR, participants reported significantly less sadness, anger, and anxiety, and reported being significantly more relaxed. Participants reported a moderate to strong illusion of going inside the 3D computer generated world (i.e., moderate to high “presence” in VR) and showed high acceptance of VR as a technique to practice mindfulness. These results show encouraging preliminary evidence of the feasibility and acceptability of using VR to practice mindfulness based on clinical expert feedback. VR is a technology with potential to increase computerized dissemination of DBT® skills training modules. Future research is warranted.

Find the full study here.

--

Navarro-Haro, María V., et al. “Meditation Experts Try Virtual Reality Mindfulness: A Pilot Study Evaluation of the Feasibility and Acceptability of Virtual Reality to Facilitate Mindfulness Practice in People Attending a Mindfulness Conference.” Plos One, vol. 12, no. 11, 2017, doi:10.1371/journal.pone.0187777.

A Public Database of Immersive VR Videos with Corresponding Ratings of Arousal, Valence, and Correlations between Head Movements and Self Report Measures

Virtual reality (VR) has been proposed as a methodological tool to study the basic science of psychology and other fields. One key advantage of VR is that sharing of virtual content can lead to more robust replication and representative sampling. A database of standardized content will help fulfill this vision. There are two objectives to this study. First, we seek to establish and allow public access to a database of immersive VR video clips that can act as a potential resource for studies on emotion induction using virtual reality. Second, given the large sample size of participants needed to get reliable valence and arousal ratings for our video, we were able to explore the possible links between the head movements of the observer and the emotions he or she feels while viewing immersive VR. To accomplish our goals, we sourced for and tested 73 immersive VR clips which participants rated on valence and arousal dimensions using self-assessment manikins. We also tracked participants' rotational head movements as they watched the clips, allowing us to correlate head movements and affect. Based on past research, we predicted relationships between the standard deviation of head yaw and valence and arousal ratings. Results showed that the stimuli varied reasonably well along the dimensions of valence and arousal, with a slight underrepresentation of clips that are of negative valence and highly arousing. The standard deviation of yaw positively correlated with valence, while a significant positive relationship was found between head pitch and arousal. The immersive VR clips tested are available online as supplemental material.

You can find the full study here.

--

Li BJ, Bailenson JN, Pines A, Greenleaf WJ, Williams LM. A Public Database of Immersive VR Videos with Corresponding Ratings of Arousal, Valence, and Correlations between Head Movements and Self Report Measures. Frontiers in Psychology. 2017;8. doi:10.3389/fpsyg.2017.02116

Actionable Empathy
Building long-term empathy: a large-scale comparison of traditional and virtual reality perspective taking

Abstract: Virtual Reality (VR) has been increasingly referred to as the “ultimate empathy machine” since it allows users to experience any situation from any point of view. However, empirical evidence supporting the claim that VR is a more effective method of eliciting empathy than traditional perspective-taking is limited. Two experiments were conducted in order to compare the short and long-term effects of a traditional perspective-taking task and a VR perspective-taking task (Study 1), and to explore the role of technological immersion when it comes to different types of mediated perspective-taking tasks (Study 2).

You can read the full study here.

--

Herrera F, Bailenson J, Weisz E, Ogle E, Zaki J (2018) Building long-term empathy: A largescale comparison of traditional and virtual reality perspective-taking. PLoS ONE 13(10): e0204494. https://doi.org/10.1371/journal.pone.0204494

Do medical students respond empathetically to a virtual patient?

Background: Significant information exchange occurs between a doctor and patient through nonverbal communication such as gestures, body position, and eye gaze. In addition, empathy is an important trust-building element in a physician: patient relationship. Previous work validates the use of virtual patients (VP) to teach and assess content items related to history-taking and basic communication skills. The purpose of this study was to determine whether more complex communication skills, such as nonverbal behaviors and empathy, were similar when students interacted with a VP or standardized patient (SP).

Methods: Medical students (n = 84) at the University of Florida (UF) and the Medical College of Georgia (MCG) underwent a videotaped interview with either a SP or a highly interactive VP with abdominal pain. In the scenario, a life-sized VP was projected on the wall of an exam room in SP teaching and testing centers at both institutions. VP and SP scripted responses to student questions were identical. To prompt an empathetic response (ie, acknowledging the patients' feelings), during the interview the VP or SP stated "I am scared; can you help me?" Clinicians (n = 4) rated student videotapes with respect to nonverbal communication skills and empathetic behaviors using a Likert-type scale with anchored descriptors.

Find the full study here.

--

Deladisma, Adeline M., et al. “Do Medical Students Respond Empathetically to a Virtual Patient?” The American Journal of Surgery, vol. 193, no. 6, 2007, pp. 756–760., doi:10.1016/j.amjsurg.2007.01.021.

Neuroanatomical basis of concern-based altruism in virtual environment

Abstract: Costly altruism entails helping others at a cost to the self and prior work shows that empathic concern (EC) for the well-being of distressed and vulnerable individuals is one of the primary motivators of such behavior. However, extant work has investigated costly altruism with paradigms that did not feature self-relevant and severe costs for the altruist and have solely focused on neurofunctional, and not neuroanatomical, correlates. In the current study, we used a contextually-rich virtual reality environment to study costly altruism and found that individuals who risked their own lives in the virtual world to try to save someone in danger had enlarged right anterior insula and exhibited greater empathic concern than those who did not. These findings add to the growing literature showing the role of caring motivation in promoting altruism and prosociality and its neural correlates in the right anterior insula.

Find the full study here.

--

Patil, Indrajeet, et al. “Neuroanatomical Basis of Concern-Based Altruism in Virtual Environment.” Neuropsychologia, vol. 116, 2018, pp. 34–43., doi:10.1016/j.neuropsychologia.2017.02.015.

Enhancing Empathy: a Role for Virtual Reality?

The capacity for empathy is essential to clinical medicine and is of particular importance to the practice of psychiatry. The physician’s experience of empathy in patient care has been described as “a sequence of emotional engagement, compassion, and an urge to help the patient” produced by a “doctor’s awareness of the patient’s concerns” []. Empathic identification with patients’ suffering is the driving force behind the prevention and mitigation of suffering, pain, and distress [], a professional obligation generated by the fundamental professional virtue of compassion.

Strengthening the capacity for empathy is an important goal of medical education, but longitudinal studies suggest that empathy declines during residency and even during medical school []. Fortunately, decreases in medical students’ empathy, while appreciable and statistically significant in a variety of empirical projects, are not thought to be large; effect sizes appear to be small []. For this reason, the threats to empathy may be reversible and, we suggest, a number of steps may be taken (a) to mitigate the factors that are diminishing empathy and (b) to encourage the enhancement of empathy in residency and medical school.

Greater curricular emphasis on empathy should be considered, as well as more attempts at measuring empathy among resident and medical student populations. In order to gain or protect time for teaching empathy, educators must be able to describe precise teaching methods and evidence of positive outcomes. Such efforts are especially important in light of the growing list of topics required in the graduate and undergraduate medical curriculum.

Find the full paper here.

--

Louie, Alan K., et al. “Enhancing Empathy: a Role for Virtual Reality?” Academic Psychiatry, vol. 42, no. 6, 2018, pp. 747–752., doi:10.1007/s40596-018-0995-2.

Using Virtual Patients to Teach Empathy: A Randomized Controlled Study to Enhance Medical Students' Empathic Communication

Introduction: Physician empathy is a complex phenomenon known to improve illness outcomes; however, few tools are available for deliberate practice of empathy. We used a virtual patient (VP) to teach empathic communication to first-year medical students. We then evaluated students' verbal empathy in a standardized patient (SP) interaction.

Methods: Seventy medical students, randomly assigned to 3 separate study groups, interacted with (1) a control VP portraying depression, (2) a VP with a backstory simulating patient shadowing, or (3) a VP able to give immediate feedback about empathic communication (empathy-feedback VP). Subsequently, the students interviewed an SP portraying a scenario that included opportunities to express empathy. All SP interviews were recorded and transcribed. The study outcomes were (1) the students' verbal response to the empathic opportunities presented by the SP, as coded by reliable assessors using the Empathic Communication Coding System, and (2) the students' responses as coded by the SPs, using a communication checklist.

Find the full study here.

--

Foster, Adriana, et al. “Using Virtual Patients to Teach Empathy.” Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, vol. 11, no. 3, 2016, pp. 181–189., doi:10.1097/sih.0000000000000142.

Empathy toward virtual humans depicting a known or unknown person expressing pain

Abstract: This study is about pain expressed by virtual humans and empathy in users immersed in virtual reality. It focuses on whether people feel more empathy toward the pain of a virtual human when the virtual human is a realistic representation of a known individual, as opposed to an unknown person, and if social presence is related to users' empathy toward a virtual human's pain. The 42 participants were immersed in virtual reality using a large immersive cube with images retro projected on all six faces (CAVE-Like system) where they can interact in real time with virtual characters. The first immersion (baseline/control) was with a virtual animal, followed by immersions involving discussions with a known virtual human (i.e., the avatar of a person they were familiar with) or an unknown virtual human. During the verbal exchanges in virtual reality, the virtual humans expressed acute and very strong pain. The pain reactions were identical in terms of facial expressions, and verbal and nonverbal behaviors. The Conditions by Time interactions in the repeated measures analyses of variance revealed that participants were empathic toward both virtual humans, yet more empathic toward the known virtual human. Multivariate regression analyses revealed that participants' feeling of social presence--impression that the known virtual character is really there, with them--was a significant predictor of empathy.

Find the full study here.

--

Bouchard, Stéphane, et al. “Empathy Toward Virtual Humans Depicting a Known or Unknown Person Expressing Pain.” Cyberpsychology, Behavior, and Social Networking, vol. 16, no. 1, 2013, pp. 61–71., doi:10.1089/cyber.2012.1571.

Understanding Empathy Training with Virtual Patients

Abstract: While the use of virtual characters in medical education is becoming more and more commonplace, an understanding of the role they can play in empathetic communication skills training is still lacking. This paper presents a study aimed at building this understanding by determining if students can respond to a virtual patient's statement of concern with an empathetic response. A user study was conducted at the [blinded] College of Medicine in which early stage medical students interacted with virtual patients in one session and real humans trained to portray real patients (i.e., standardized patients) in a separate session about a week apart. During the interactions, the virtual and ‘real' patients presented the students with empathetic opportunities which were later rated by outside observers. The results of pairwise comparisons indicate that empathetic responses made to virtual patients were rated as significantly more empathetic than responses made to standardized patients. Even though virtual patients may be perceived as artificial, the educational benefit of employing them for training medical students' empathetic communications skills is that virtual patients offer a low pressure interaction which allows students to reflect on their responses.

Find the full paper here.

--

Kleinsmith, Andrea, et al. “Understanding Empathy Training with Virtual Patients.” Computers in Human Behavior, vol. 52, 2015, pp. 151–158., doi:10.1016/j.chb.2015.05.033.

Using virtual reality in medical education to teach empathy

Objective: The project adopted technology that teaches medical and other health professions students to be empathetic with older adults, through virtual reality (VR) software that allows them to simulate being a patient with age-related diseases, and to familiarize medical students with information resources related to the health of older adults.

Methods: The project uses an application that creates immersive VR experiences for training of the workforce for aging services. Users experience age-related conditions such as macular degeneration and high-frequency hearing loss from the patient's perspective. Librarians and faculty partner to integrate the experience into the curriculum, and students go to the library at their convenience to do the VR assignment.

Find the full study here.

--

Dyer, Elizabeth, et al. “Using Virtual Reality in Medical Education to Teach Empathy.” Journal of the Medical Library Association, vol. 106, no. 4, 2018, doi:10.5195/jmla.2018.518.

VR perspective-taking increases cognitive empathy for specific others

Abstract: Previous research shows that virtual reality perspective-taking experiences (VRPT) can increase prosocial behavior toward others. We extend this research by exploring whether this effect of VRPT is driven by increased empathy and whether the effect extends to ostensibly real-stakes behavioral games. 

You can find the full study here.

--

van Loon A, Bailenson J, Zaki J, Bostick J, Willer R (2018) Virtual reality perspective-taking increases cognitive empathy for specific others. PLoS ONE 13(8): e0202442. https://doi.org/ 10.1371/journal.pone.0202442

Learning Empathy Through Virtual Reality: Multiple Strategies for Training Empathy-Related Abilities Using Body Ownership Illusions in Embodied Virtual Reality

Several disciplines have investigated the interconnected empathic abilities behind the proverb “to walk a mile in someone else’s shoes” to determine how the presence, and absence, of empathy-related phenomena affect prosocial behavior and intergroup relations. Empathy enables us to learn from others’ pain and to know when to offer support. Similarly, virtual reality (VR) appears to allow individuals to step into someone else’s shoes, through a perceptual illusion called embodiment, or the body ownership illusion. Considering these perspectives, we propose a theoretical analysis of different mechanisms of empathic practices in order to define a possible framework for the design of empathic training in VR. This is not intended to be an extensive review of all types of practices, but an exploration of empathy and empathy-related phenomena. Empathy-related training practices are analyzed and categorized. We also identify different variables used by pioneer studies in VR to promote empathy-related responses. Finally, we propose strategies for using embodied VR technology to train specific empathy-related abilities.

 

Find the full report here.

--

Bertrand P, Guegan J, Robieux L, Mccall CA, Zenasni F. Learning Empathy Through Virtual Reality: Multiple Strategies for Training Empathy-Related Abilities Using Body Ownership Illusions in Embodied Virtual Reality. Frontiers in Robotics and AI. 2018;5. doi:10.3389/frobt.2018.00026

Combining Virtual Reality and Biofeedback to Foster Empathic Abilities in Humans

Recent technological advances coupled with progress in brain and psychological sciences allow the controlled induction and regulation of human psychophysiological states. These progresses often aim toward the goal of developing human-machine interfaces to improve human factors such as mental health, human relations, well-being, and empathy. In this short article, we present some of such devices with a particular emphasis on technology aiming to foster empathic abilities in humans; that is, our ability to care, understand, and help our fellow human beings. In order to discuss any possible use for such devices in a clinical setting, we start by outlining definitions for the terms used in the article, and present three devices designed with the goal of modulating empathy in humans.

Find the full report here.

--

Schoeller F, Bertrand P, Gerry LJ, Jain A, Horowitz AH, Zenasni F. Combining Virtual Reality and Biofeedback to Foster Empathic Abilities in Humans. Frontiers in Psychology. 2019;9. doi:10.3389/fpsyg.2018.02741

VR vs Traditional Learning
Virtual Memory Palaces: Immersion Aids Recall

Abstract: Virtual reality displays, such as head-mounted displays (HMD), aford us a superior spatial awareness by leveraging our vestibular and proprioceptive senses, as compared to traditional desktop displays. Since classical times, people have used memory palaces as a spatial mnemonic to help remember information by organizing it spatially and associating it with salient features in that environment. In this paper, we explore whether using virtual memory palaces in a head-mounted display with head-tracking (HMD condition) would allow a user to better recall information than when using a traditional desktop display with a mouse-based interaction (desktop condition). We found that virtual memory palaces in HMD condition provide a superior memory recall ability compared to the desktop condition. We believe this is a first step in using virtual environments for creating more memorable experiences that enhance productivity through better recall of large amounts of information organized using the idea of virtual memory palaces.

Find the full report here.

--

Krokos E, Plaisant C, Varshney A. Correction to: Virtual memory palaces: immersion aids recall. Virtual Reality. 2018;23(1):17-17. doi:10.1007/s10055-018-0360-5

A Case Study - The Impact of VR on Academic Performance

Objectives: This experiment aims to show the difference between traditional teaching and VR-based teaching in students’ celestial physics learning. 

Results:In Retention Test, the average score of VR group is 90, while that of the traditional teaching group is 68. The gap between the two average scores is 32.4%, higher than that in the Immediate Test 27.4% (# 4.1.1-1), suggesting that knowledge taught in traditional mode is more inclined to be forgotten, while VR-based teaching could help students get a deeper impression and maintain long-term memory because it creates a quasi-real environment, interacts with students and make students more involved in the teaching.

VR-based teaching enjoys tremendously positive reception among students. Students like it very much and students fairly like it account for 100% of all the students. In the experiment, 65% students have heard about VR, 45% students have 15 experienced VR content, most of which is VR games. This is the first time for these students to experience VR in education. The introduction of the latest VR Technology into education is very fascinating to students, who are looking forward to seeing VR-based teaching integrated in their classes.

Find the full report here

 --

A Case Study - The Impact of VR on Academic Performance. https://cdn.uploadvr.com/wp-content/uploads/2016/11/A-Case-Study-The-Impact-of-VR-on-Academic-Performance_20161125.pdf. Accessed April 4, 2019.

Training Situational Awareness With Virtual Reality

VR provides the ideal training tool for gaining the emotional intelligence and cognitive behavioral understanding needed to develop situational awareness.

Situational awareness involves understanding how information, events and actions around us impact our current situation and how changes might impact the future. While it is important in all settings, it is especially critical in high stakes, rapidly-changing environments such as healthcare, law enforcement, leadership, air traffic control, ship navigation, and nuclear power plant operation (to name but a few) where a bad decision could have serious or dangerous consequences.

This article originally appeared in Tech Trends.

--

Maddox T, Atkinson T, Bonasio A. Training Situational Awareness With Virtual Reality. Tech Trends. https://techtrends.tech/uncategorized/training-situational-awareness-with-virtual-reality/. Published July 23, 2018. Accessed April 5, 2019.

AFFECT: Altered-Fidelity Framework for Enhancing Cognition and Training

In this paper, we present a new framework for analyzing and designing virtual reality (VR) techniques. This framework is based on two concepts – system fidelity (i.e., the degree with which real-world experiences are reproduced by a system) and memory (i.e., the formation and activation of perceptual, cognitive, and motor networks of neurons). The premise of the framework is to manipulate an aspect of system fidelity in order to assist a stage of memory. We call it the Altered-Fidelity Framework for Enhancing Cognition and Training (AFFECT). AFFECT provides nine categories of approaches to altering system fidelity to positively affect learning or training. These categories are based on the intersections of three aspects of system fidelity (interaction fidelity, scenario fidelity, and display fidelity) and three stages of memory (encoding, implicit retrieval, and explicit retrieval). In addition to discussing the details of our new framework, we show how AFFECT can be used as a tool for analyzing and categorizing VR techniques designed to facilitate learning or training. We also demonstrate how AFFECT can be used as a design space for creating new VR techniques intended for educational and training systems.

Find the full report here.

--

Mcmahan RP, Herrera NS. AFFECT: Altered-Fidelity Framework for Enhancing Cognition and Training. Frontiers in ICT. 2016;3. doi:10.3389/fict.2016.00029

Healthcare Simulation
VR in Healthcare: Medical Simulation and Experiential Interface

Abstract: Annual Review of CyberTherapy and Telemedicine (ARCTT) ISSN: 1554-8716 is published annually by the Interactive Media Institute (IMI), a 501c3 non-profit organisation, dedicated to the collaboration of interdisciplinary researchers from around the world to create, test and develop clinical tools and protocols for the medical and psychological community. IMI realizes that the mind and body work in concert to affect quality of life in individuals and works to develop technology that can be effectively used to improve the standards and reduce the cost of healthcare delivery worldwide.

You can download the full PDF here.

--

Wiederhold, Brenda & Riva, Giuseppe & Wiederhold, Mark. (2015). Annual Review of CyberTherapy and Telemedicine: Virtual Reality in Healthcare: Medical Simulation and Experiential Interface. 

A ‘mixed reality’ simulator concept for future Medical Emergency Response Team training

Abstract: The UK Defence Medical Service's Pre-Hospital Emergency Care (PHEC) capability includes rapid-deployment Medical Emergency Response Teams (MERTs) comprising tri-service trauma consultants, paramedics and specialised nurses, all of whom are qualified to administer emergency care under extreme conditions to improve the survival prospects of combat casualties. The pre-deployment training of MERT personnel is designed to foster individual knowledge, skills and abilities in PHEC and in small team performance and cohesion in ‘mission-specific’ contexts. Until now, the provision of airborne pre-deployment MERT training had been dependent on either the availability of an operational aircraft (eg, the CH-47 Chinook helicopter) or access to one of only two ground-based facsimiles of the Chinook's rear cargo/passenger cabin. Although MERT training has high priority, there will always be competition with other military taskings for access to helicopter assets (and for other platforms in other branches of the Armed Forces). This paper describes the development of an inexpensive, reconfigurable and transportable MERT training concept based on ‘mixed reality’ technologies—in effect the ‘blending’ of real-world objects of training relevance with virtual reality reconstructions of operational contexts.

Find the full study here.

--

Stone RJ, Guest R, Mahoney P, Lamb D, Gibson C. A ‘mixed reality’ simulator concept for future Medical Emergency Response Team training. Journal of the Royal Army Medical Corps. 2017;163(4):280-287. doi:10.1136/jramc-2016-000726

Training Together: How Another Human Trainee’s Presence Affects Behavior during Virtual Human-Based Team Training

Despite research showing that team training can lead to strong improvements in team performance, logistical difficulties can prevent team training programs from being adopted on a large scale. A proposed solution to these difficulties is the use of virtual humans to replace missing teammates. Existing research evaluating the use of virtual humans for team training has been conducted in settings involving a single human trainee. However, in the real world, multiple human trainees would most likely train together. In this paper, we explore how the presence of a second human trainee can alter behavior during a medical team training program. Ninety-two nurses and surgical technicians participated in a medical training exercise, where they worked with a virtual surgeon and virtual anesthesiologist to prepare a simulated patient for surgery. The agency of the nurse and the surgical technician were varied between three conditions: human nurses and surgical technicians working together; human nurses working with a virtual surgical technician; and human surgical technicians working with a virtual nurse. Variations in agency did not produce statistically significant differences in the training outcomes, but several notable differences were observed in other aspects of the team’s behavior. Specifically, when working with a virtual nurse, human surgical technicians were more likely to assist with speaking up about patient safety issues that were outside of their normal responsibilities; human trainees spent less time searching for a missing item when working with a virtual partner, likely because the virtual partner was physically unable to move throughout the room and assist with the searching process; and more breaks in presence were observed when two human teammates were present. These results show that some behaviors may be influenced by the presence of multiple human trainees, though these behaviors may not impinge on core training goals. When developing virtual human-based training programs, designers should consider that the presence of other humans may reduce involvement during training moments perceived to be the responsibility of other trainees and also should consider that a virtual teammate’s limitations may cause human teammates to limit their own behaviors in corresponding ways (e.g., searching less).

Find the full report here.

--

Robb A, Kleinsmith A, Cordar A, et al. Training Together: How Another Human Trainee’s Presence Affects Behavior during Virtual Human-Based Team Training. Frontiers in ICT. 2016;3. doi:10.3389/fict.2016.00017

Pain Management
Economic analysis of implementing virtual reality therapy for pain among hospitalized patients

Abstract: Virtual reality (VR) has emerged as a novel and effective non-pharmacologic therapy for pain, and there is growing interest to use VR in the acute hospital setting. We sought to explore the cost and effectiveness thresholds VR therapy must meet to be cost-saving as an inpatient pain management program. The result is a framework for hospital administrators to evaluate the return on investment of implementing inpatient VR programs of varying effectiveness and cost. Utilizing decision analysis software, we compared adjuvant VR therapy for pain management vs. usual care among hospitalized patients. In the VR strategy, we analyzed potential cost-savings from reductions in opioid utilization and hospital length of stay (LOS), as well as increased reimbursements from higher patient satisfaction as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The average overall hospitalization cost-savings per patient for the VR program vs. usual care was $5.39 (95% confidence interval -$11.00 to $156.17). In a probabilistic sensitivity analysis across 1000 hypothetical hospitals of varying size and staffing, VR remained cost-saving in 89.2% of trials. The VR program was cost-saving so long as it reduced LOS by ≥14.6%; the model was not sensitive to differences in opioid use or HCAHPS. We conclude that inpatient VR therapy may be cost-saving for a hospital system primarily if it reduces LOS. In isolation, cost-savings from reductions in opioid utilization and increased HCAHPS-related reimbursements are not sufficient to overcome the costs of VR.

Find the full study here.

--

Delshad, Sean D., et al. “Economic Analysis of Implementing Virtual Reality Therapy for Pain among Hospitalized Patients.” Npj Digital Medicine, vol. 1, no. 1, 2018, doi:10.1038/s41746-018-0026-4.

Virtual Reality as a Clinical Tool for Pain Management

Purpose of Review: To evaluate the use of virtual reality (VR) therapies as a clinical tool for the management of acute and chronic pain.

Recent Findings: Recent articles support the hypothesis that VR therapies can effectively distract patients who suffer from chronic pain and from acute pain stimulated in trials. Clinical studies yield promising results in the application of VR therapies to a variety of acute and chronic pain conditions, including fibromyalgia, phantom limb pain, and regional specific pain from past injuries and illnesses. Current management techniques for acute and chronic pain, such as opioids and physical therapy, are often incomplete or ineffective. VR trials demonstrate a potential to redefine the approach to treating acute and chronic pain in the clinical setting. Patient immersion in interactive virtual reality provides distraction from painful stimuli and can decrease an individual's perception of the pain. In this review, we discuss the use of VR to provide patient distraction from acute pain induced from electrical, thermal, and pressure conditions. We also discuss the application of VR technologies to treat various chronic pain conditions in both outpatient and inpatient settings.

Find the full review here.

--

Pourmand, Ali, et al. “Virtual Reality as a Clinical Tool for Pain Management.” Current Pain and Headache Reports, vol. 22, no. 8, 2018, doi:10.1007/s11916-018-0708-2.

Future Directions: Advances and Implications of Virtual Environments Designed for Pain Management

Abstract: Pain symptoms have been addressed with a variety of therapeutic measures in the past, but as we look to the future, we begin encountering new options for patient care and individual health and well-being. Recent studies indicate that computer-generated graphic environments--virtual reality (VR)--can offer effective cognitive distractions for individuals suffering from pain arising from a variety of physical and psychological illnesses. Studies also indicate the effectiveness of VR for both chronic and acute pain conditions. Future possibilities for VR to address pain-related concerns include such diverse groups as military personnel, space exploration teams, the general labor force, and our ever increasing elderly population. VR also shows promise to help in such areas as drug abuse, at-home treatments, and athletic injuries.

Find the full study here.

--

Wiederhold, Brenda K., et al. “Future Directions: Advances and Implications of Virtual Environments Designed for Pain Management.” Cyberpsychology, Behavior, and Social Networking, vol. 17, no. 6, 2014, pp. 414–422., doi:10.1089/cyber.2014.0197.

The Effect of Interactive Virtual Reality on Pain Perception: a Systematic Review of Clinical Studies

Purpose: The aim of this systematic review was to evaluate the effect of immersive and non-immersive interactive virtual reality on pain perception in patients with a clinical pain condition.

Methods: The following databases were searched from inception: Medline (Ovid), PsychInfo, CINAHL, Cochrane library and Web of Science. Two reviewers screened reports and extracted the data. A third reviewer acted as an arbiter. Studies were eligible if they were randomized controlled trials, quasi-randomized trials, and uncontrolled trials. Crossover and parallel-group designs were included. Risk of bias was assessed for all included studies.

Results: Thirteen clinical studies were included. The majority of studies investigated a sample of participants with chronic pain. Six were controlled trials and seven uncontrolled studies. Findings from controlled research suggest that interactive virtual reality may reduce pain associated with ankylosing spondylitis and post-mastectomy, but results are inconsistent for patients with neck pain. Findings from uncontrolled studies suggest that interactive virtual reality may reduce neuropathic limb pain, and phantom limb pain, but had no effect on nonspecific chronic back pain.

Find the full study here.

--

Wittkopf, Priscilla G., et al. “The Effect of Interactive Virtual Reality on Pain Perception: a Systematic Review of Clinical Studies.” Disability and Rehabilitation, 2019, pp. 1–12., doi:10.1080/09638288.2019.1610803.

Virtual Reality Analgesia in Labor: The VRAIL Pilot Study

Findings: Compared to a standard control group, VR reduced sensory pain, affective pain, cognitive pain, and anxiety during childbirth.

You can find the full report here.

--

Frey DP, Bauer ME, Bell CL, et al. Virtual Reality Analgesia in Labor. Anesthesia & Analgesia. 2018:1. doi:10.1213/ane.0000000000003649

Virtual Reality as a Distraction Technique for Pain and Anxiety among Patients with Breast Cancer: A Randomized Control Trial

Objective: The goal of this study was to assess the effectiveness of immersive virtual reality (VR) distraction technology in reducing pain and anxiety among female patients with breast cancer.

Method: A randomized control trial design was used with a sample of 80 female patients with breast cancer at a specialized cancer center in Jordan. Participants were randomly assigned into intervention and comparison groups.

Result: The study findings showed that one session of the immersive VR plus morphine made a significant reduction in pain and anxiety self-reported scores, compared with morphine alone, in breast cancer patients.

Significance of results: Immersive VR is an effective distraction intervention for managing pain and anxiety among breast cancer patients. Using immersive VR as an adjuvant intervention is more effective than morphine alone in relieving pain and anxiety; furthermore, VR is a safe intervention more than pharmacological treatment.

Find the full study here.

--

Mohammad, Eslam Bani, and Muayyad Ahmad. “Virtual Reality as a Distraction Technique for Pain and Anxiety among Patients with Breast Cancer: A Randomized Control Trial.” Palliative and Supportive Care, vol. 17, no. 1, 2018, pp. 29–34., doi:10.1017/s1478951518000639.

Effects of Immersive Virtual Reality Intervention on Pain and Anxiety among Pediatric Patients Undergoing Venipuncture: a Study Protocol for a Randomized Controlled Trial

Background: Venipuncture is one of the most painful and distressing procedure experienced by pediatric patients. Evidence suggests that distraction combined with age-appropriate procedural information can effectively decrease procedural pain and anxiety in pediatric patients. Immersive virtual reality (IVR) can simultaneously provide complete distraction and procedural information to patients.

Methods: Guided by the gate control theory and Lazarus and Folkman's theory, this study aims to examine the effects of IVR intervention on reducing the pain, anxiety and stress, the duration of venipuncture, and the satisfaction of healthcare providers for the procedure. A randomized controlled trial with repeated assessments will be conducted. A total of 200 pediatric patients aged 4-12 years will be recruited from a regional public hospital and randomly assigned to either the intervention or control group. The study will use two age-appropriate IVR modules that consist of procedural information. The intervention group will receive IVR intervention, whereas the control group will receive standard care only. The cost-effectiveness of IVR intervention will be compared with that of standard care. Outcome evaluation will be conducted at four time points: 10 min before, during, immediately after, and 30 min after the procedure. Intention to treat and generalized estimating equation model will be used to analyze the data.

Find the full study here.

--

Wong, Cho Lee, et al. “Effects of Immersive Virtual Reality Intervention on Pain and Anxiety among Pediatric Patients Undergoing Venipuncture: a Study Protocol for a Randomized Controlled Trial.” Trials, vol. 20, no. 1, 2019, doi:10.1186/s13063-019-3443-z.

Effectiveness of a Virtual Reality Intervention to Minimize Pediatric Stress and Pain Intensity during Venipuncture

Purpose: Virtual reality (VR) technology is an effective tool in treatment of acute pain. Numerous studies show the effectiveness of this method both in a clinical context and in the laboratory. However, research results on the effectiveness of VR in pediatric venipuncture pain is not conclusive-not all studies report the analgesic effect of VR. In addition to testing effectiveness of VR, we also assess the usability of a novel hands-free interface.

Design and Method: Patients of paediatric nephrology clinic (N = 38; mean age 11 years, range 7-17) participated in a posttest only between group quasi-experimental study. Participants in the treatment group received the venipuncture procedure with VR distraction. They were wearing a head-mounted Oculus DK2 HMD, and playing a game designed by the authors of the study. The game was based on Multiple Object Tracking (MOT) task, where players have to remember and simultaneously track several moving targets. MOT has been used in many studies on attention and working memory. Participants rated their pain and stress intensity on visual analogue scales (VAS) on a scale of 0 to 100 and answered a short questionnaire.

Find the full study here.

--

Piskorz, Joanna, and Marcin Czub. “Effectiveness of a Virtual Reality Intervention to Minimize Pediatric Stress and Pain Intensity during Venipuncture.” Journal for Specialists in Pediatric Nursing, vol. 23, no. 1, 2017, doi:10.1111/jspn.12201.

A feasibility study to determine the benefits of upper extremity virtual rehabilitation therapy for coping with chronic pain post-cancer surgery

Background: Persistent pain in shoulder and arm following post-surgical breast cancer treatment can lead to cognitive and physical deficits. Depression is also common in breast cancer survivors. Virtual reality therapy with integrative cognitive and physical rehabilitation has not been clinically trialed for this population. The novel BrightArm Duo technology improved cognition and upper extremity (UE) function for other diagnoses and has great potential to benefit individuals coping with post-surgical breast cancer pain.

Objectives: The aim of this study was to explore the feasibility of BrightArm Duo therapy for coping with post-surgical chronic pain and associated disability in breast cancer survivors with depression.

Find the full study here.

--

House, Gregory et al. “A feasibility study to determine the benefits of upper extremity virtual rehabilitation therapy for coping with chronic pain post-cancer surgery.” British journal of pain vol. 10,4 (2016): 186-197. doi:10.1177/2049463716664370

Virtual Reality for Spinal Cord Injury-Associated Neuropathic Pain: Systematic Review

Background: Treatment of spinal cord injury (SCI)-associated neuropathic pain is challenging, with limited efficacy and no definitive options, and SCI patients often show resistance to pharmacologic treatment. Virtual reality (VR) therapy is a non-invasive, non-pharmacologic alternative with minimal adverse effects.

Objective: To investigate the effect of VR therapy on SCI-associated neuropathic pain in a systematic review

Find the full study here.

--

Chi, B., et al. “Virtual Reality for Spinal Cord Injury-Associated Neuropathic Pain: Systematic Review.” Annals of Physical and Rehabilitation Medicine, vol. 62, no. 1, 2019, pp. 49–57., doi:10.1016/j.rehab.2018.09.006.

Virtual Reality Analgesia During Venipuncture in Pediatric Patients With Onco-Hematological Diseases

Background: Venipuncture is described by children as one of the most painful and frightening medical procedures.

Objective: To evaluate the effectiveness of Virtual Reality (VR) as a distraction technique to help control pain in children and adolescents undergoing venipuncture.

Methods: Using a within-subjects design, fifteen patients (mean age 10.92, SD = 2.64) suffering from oncological or hematological diseases received one venipuncture with “No VR” and one venipuncture with “Yes VR” on two separate days (treatment order randomized). “Time spent thinking about pain”, “Pain Unpleasantness”, “Worst pain” the quality of VR experience, fun during the venipuncture and nausea were measured.

Results: During VR, patients reported significant reductions in “Time spent thinking about pain,” “Pain unpleasantness,” and “Worst pain”. Patients also reported significantly more fun during VR, and reported a “Strong sense of going inside the computer-generated world” during VR. No side effects were reported.

Conclusion: VR can be considered an effective distraction technique for children and adolescents’ pain management during venipuncture. Moreover, VR may elicit positive emotions, more than traditional distraction techniques. This could help patients cope with venipuncture in a non-stressful manner. Additional research and development is needed.

Find the full study here.

--

Atzori B, Hoffman HG, Vagnoli L, et al. Virtual Reality Analgesia During Venipuncture in Pediatric Patients With Onco-Hematological Diseases. Frontiers in Psychology. 2018;9. doi:10.3389/fpsyg.2018.02508

Assessing the feasibility of implementing low-cost virtual reality therapy during routine burn care

Abstract: Burn care often involves procedures that result in significant pain experiences for patients which, in turn, can lead to poorer physical and psychological health outcomes. Distraction and virtual reality (VR) are an effective adjunct to pharmacological interventions in reducing pain. Much of the research that has demonstrated efficacy for VR in burn care has involved expensive and extensive technology. Thus, identifying cost-effective, feasible, acceptable, and effective approaches to apply distraction within routine burn care is important. The objective of this mixed-methods study was to evaluate key stakeholder (i.e., patients, providers) perceptions of feasibility, acceptability, and effectiveness for the use of low-cost VR technology during routine burn care with adult patients. Ten adult patients used VR during burn care dressing changes in an outpatient clinic setting, after which they completed a satisfaction survey and individual qualitative interview. Providers also completed a satisfaction/perception survey after each participant's care. Quantitative and qualitative results from both patient and provider perspectives consistently supported the feasibility and utility of applying low-cost VR technology in this outpatient burn clinic setting. Special considerations (e.g., aspects to consider when choosing an apparatus or application) stemming from stakeholder feedback are discussed.

Find the full report here.

--

Ford CG, Manegold EM, Randall CL, Aballay AM, Duncan CL. Assessing the feasibility of implementing low-cost virtual reality therapy during routine burn care. Burns. 2018;44(4):886-895. doi:10.1016/j.burns.2017.11.020

Virtual Reality Interventions for Acute and Chronic Pain Management

Abstract: Virtual Reality (VR) is now consumer ready and nearing ubiquity. In terms of clinical applications, several studies suggest that VR can be effective as a complementary adjunct or alternative non-pharmacologic analgesic in a range of pain-inducing procedures and in management of chronic pain. The increasing affordability and quality of portable VR headsets and the ongoing utility of pain therapy signals an exciting future for the use of VR for analgesia. However, further research is needed to establish its long-term benefits if VR is to be adopted into mainstream protocols for analgesia management. This research requires a range of study designs with collection of patient self-report and clinical data together to develop bespoke interventions for different cohorts.

Find the full study here.

--

Ahmadpour, Naseem, et al. “Virtual Reality Interventions for Acute and Chronic Pain Management.” The International Journal of Biochemistry & Cell Biology, vol. 114, 2019, p. 105568., doi:10.1016/j.biocel.2019.105568.

Adjunctive VR for procedural pain management of burn patients during dressing change or physical therapy

Abstract: Dressing change and physical therapy are extremely painful procedures for burn patients. Adjunctive virtual reality therapy reportedly reduces pain when added to analgesics, but a summary analysis of the data has yet to be performed. We conducted this systematic review and meta-analysis of randomized controlled trials to verify the pain-reducing efficacy of virtual reality among burn patients undergoing dressing change or physical therapy. We searched MEDLINE (via PubMed), EMBASE (via OVID), and the Cochrane Central Register of Controlled Trials (via OVID) for relevant trials based on predetermined eligibility criteria from database establishment to February 2018. Two reviewers screened citations and extracted data independently. The quality of the included studies was evaluated according to the Cochrane Handbook, whereas statistical heterogeneity was assessed using chi-square tests and I2 statistics. Review Manager 5.3 was used for statistical analysis. Thirteen randomized controlled trials with 362 patients who underwent 627 burn dressing change or physical therapy sessions were included. The additional use of virtual reality significantly reduced pain intensity, time spent thinking about pain, and unpleasantness, and was more fun compared with that of using analgesics alone. Virtual reality is an effective pain reduction measurement added to analgesics for burn patients undergoing dressing change or physical therapy. However, multicenter, parallel group design randomized controlled trials are still required.

Find the full report here.

--

Luo H, Cao C, Zhong J, Chen J, Cen Y. Adjunctive virtual reality for procedural pain management of burn patients during dressing change or physical therapy: A systematic review and meta-analysis of randomized controlled trials. Wound Repair and Regeneration. 2018;27(1):90-101. doi:10.1111/wrr.1

Virtual Reality for Management of Pain in Hospitalized Patients

Objective: The objective of the study was to measure the impact of a onetime 3D VR intervention versus a two-dimensional (2D) distraction video for pain in hospitalized patients.

Conclusions: Use of VR in hospitalized patients significantly reduces pain versus a control distraction condition. These results indicate that VR is an effective and safe adjunctive therapy for pain management in the acute inpatient setting; future randomized trials should confirm benefit with different visualizations and exposure periods.

Find the full report here.

--

Tashjian VC, Mosadeghi S, Reid MW, Howard A, Lopez M, Spiegel B. Virtual Reality Reduces Abdominal Pain in Hospitalized Patients: Results of a Controlled Trial. Gastroenterology. 2017;152(5). doi:10.1016/s0016-5085(17)30727-8

Aging
A Discussion of the Use of Virtual Reality in Dementia

Dementia is a multifaceted disorder that impairs cognitive functions such as memory, language, and executive functions necessary to plan, organize, and prioritize tasks required for goal-directed behaviours. Ninety percent of persons with dementia present with dementia of the Alzheimer’s type, vascular dementia, diffuse Lewy body dementia, or frontotemporal dementia [1]. All of these conditions affect the neurological functioning of the brain with different pathologies resulting in different clinical presentations [1]. In most, if not all cases, individuals with dementia experience difficulties interacting with their physical and social environments. The current chapter supports the use of virtual reality to explore the nature of these interactions.

Find the full text here.

--

Garcia, Linda, et al. “A Discussion of the Use of Virtual Reality in Dementia.” Virtual Reality in Psychological, Medical and Pedagogical Applications, 2012, doi:10.5772/46412.

Neuropsychological Assessment of Older Adults With Virtual Reality: Association of Age, Schooling, and General Cognitive Status

The development of neuropsychological assessment methods using virtual reality (VR) is a valid and promising option for the detection of cognitive impairment in the older people, focusing on activities composed of tasks of multiple demands. This study verified the association of age, schooling, and general cognitive status on the performance of neurologically healthy older adults in ECO-VR, a VR task of multiple demands for neuropsychological assessment. A total of 111 older adults answered a sociodemographic questionnaire, the Mini Mental State Examination, the Vocabulary subtest of the Wechsler Intelligence Scale for Adults (third edition), and the ECO-VR. Correlation analyses, multiple linear regression, and comparisons between groups (effects by age and schooling groups) were used to evaluate the results. The ECO-VR total score was significantly associated with age, years of education, MMSE, and Vocabulary subtest. The linear regression models identified that age was the main predictor for total score and rule breaking of ECO-VR. According to the univariate analysis, it was identified the main effect of age group and schooling group in the total ECO-VR score, but there was no interaction effect. The results are discussed in order to understand the role of sociodemographic characteristics in the performance of older adults in a VR task of multiple demands. It was also verified the possibility use of VR for neuropsychological assessment of older adults.

Find the full study here.

--

Oliveira, Camila R., et al. “Neuropsychological Assessment of Older Adults With Virtual Reality: Association of Age, Schooling, and General Cognitive Status.” Frontiers in Psychology, vol. 9, 2018, doi:10.3389/fpsyg.2018.01085.

Virtual Reality Using Games for Improving Physical Functioning in Older Adults: a Systematic Review

Abstract: The use of virtual reality through exergames or active video game, i.e. a new form of interactive gaming, as a complementary tool in rehabilitation has been a frequent focus in research and clinical practice in the last few years. However, evidence of their effectiveness is scarce in the older population. This review aim to provide a summary of the effects of exergames in improving physical functioning in older adults. A search for randomized controlled trials was performed in the databases EMBASE, MEDLINE, PsyInfo, Cochrane data base, PEDro and ISI Web of Knowledge. Results from the included studies were analyzed through a critical review and methodological quality by the PEDro scale. Thirteen studies were included in the review. The most common apparatus for exergames intervention was the Nintendo Wii gaming console (8 studies), followed by computers games, Dance video game with pad (two studies each) and only one study with the Balance Rehabilitation Unit. The Timed Up and Go was the most frequently used instrument to assess physical functioning (7 studies). According to the PEDro scale, most of the studies presented methodological problems, with a high proportion of scores below 5 points (8 studies). The exergames protocols and their duration varied widely, and the benefits for physical function in older people remain inconclusive. However, a consensus between studies is the positive motivational aspect that the use of exergames provides. Further studies are needed in order to achieve better methodological quality, external validity and provide stronger scientific evidence.

Find the full study here.

--

Molina, Karina, et al. “Virtual Reality Using Games for Improving Physical Functioning in Older Adults: a Systematic Review.” Journal of NeuroEngineering and Rehabilitation, vol. 11, no. 1, 2014, p. 156., doi:10.1186/1743-0003-11-156.

Effectiveness of a VR-Based Tai Chi Exercise on Cognitive and Physical Function in Older Adults with Cognitive Impairment

Findings: Compared to a standard control group, a six-month VR Thai Chi program improved multiple assessments of physical function and cognitive performance.

 

Study link can be found here.

--

Hsieh C-C, Lin P-S, Hsu W-C, et al. The Effectiveness of a Virtual Reality-Based Tai Chi Exercise on Cognitive and Physical Function in Older Adults with Cognitive Impairment. Dementia and Geriatric Cognitive Disorders. 2018;46(5-6):358-370.

The feasibility and positive effects of a customized video game rehabilitation program for freezing of gait and falls in Parkinson's disease patients

Background: Freezing of gait and falls represent a major burden in patients with advanced forms of Parkinson's disease (PD). These axial motor signs are not fully alleviated by drug treatment or deep-brain stimulation. Recently, virtual reality has emerged as a rehabilitation option for these patients. In this pilot study, we aim to determine the feasibility and acceptability of rehabilitation with a customized video game to treat gait and balance disorders in PD patients, and assess its effects on these disabling motor signs.

Conclusions: This study suggests that rehabilitation with a customized video game to treat gait and balance disorders is feasible, well accepted, and effective in Parkinson's patients. These data serve as preliminary evidence for further larger and controlled studies to propose this customized video game rehabilitation program at home.

Find the full report here.

--

Nuic D, Vinti M, Karachi C, Foulon P, Hamme AV, Welter M-L. The feasibility and positive effects of a customised videogame rehabilitation programme for freezing of gait and falls in Parkinson’s disease patients: a pilot study. Journal of NeuroEngineering and Rehabilitation. 2018;15(1). doi:10.1186/s12984-018-0375-x

The Application Of Virtual Reality In Geriatric Mental Health: The State Of The Evidence

Conclusions: Currently, existing evidence offers clear support for the use of VR as a screening tool for cognitive impairment in older adults, and as a training tool to improve cognitive skills. VR-based tasks demonstrated validity comparable to some traditional paper-based assessments of cognition. Furthermore, there are indications that VR can play a role in delaying the onset of Alzheimer's Disease (AD), mild cognitive impairment (MCI), and other forms of dementia. More work is needed to refine VR screening capabilities for more specific diagnoses, but the potential for innovation in VR environments and tasks makes VR a promising medium to achieve this specificity. 

Find the full report here.

--

Mathias L, Rahman A, Skurla M, Vahia I. The Application Of Virtual Reality In Geriatric Mental Health: The State Of The Evidence. The American Journal of Geriatric Psychiatry. 2019;27(3). doi:10.1016/j.jagp.2019.01.085

How Virtual Reality Training Supports Safer Aging

This post is the first installment in a series of blog posts that will cover how virtual reality is being used to change the aging experience for older adults, loved ones and families, and their caregivers in the years ahead.

In fact, virtual reality is already having a tremendous impact on the lives of seniors. This is in large part thanks to outstanding content and applications geared towards combating social isolation by forming connections through travel and therapeutics, for example.

We will continue to focus on the role that training plays in preparing caregivers for what's next. Professional staff and family caregivers alike, the benefits of high-quality training cannot be overstated.

Stay tuned to our blog for more updates as we explore these issues and work towards building a solution to meet the growing demands of our population.

 

 

Using Immersive Technologies with Children and Older Adult Patients

Human development and normal aging have fascinating effects on the prefrontal cortex – the region of the brain associated with working memory and executive attention.

The prefrontal cortex is slow to develop in humans, not reaching full capacity until an individual is in their mid-20s. In addition, prefrontal cortical function declines with normal aging, in many cases starting in middle age. This means that children and older adults are generally going to be less effective learners when content is presented in text or slideshow format, leading to an increase in errors and serious medical consequences in these populations.

This report was originally published in Tech Trends.

--

Maddox T, Bonasio A, Barber T. Using Immersive Technologies with Children and Older Adult Patients. Tech Trends. https://techtrends.tech/tech-trends/immersive-technologies-helping-children-and-older-patients/. Published June 17, 2018. Accessed April 5, 2019.

Acceptance of immersive head-mounted virtual reality in older adults

Abstract: Immersive virtual reality has become increasingly popular to improve the assessment and treatment of health problems. This rising popularity is likely to be facilitated by the availability of affordable headsets that deliver high quality immersive experiences. As many health problems are more prevalent in older adults, who are less technology experienced, it is important to know whether they are willing to use immersive virtual reality. In this study, we assessed the initial attitude towards head-mounted immersive virtual reality in 76 older adults who had never used virtual reality before. Furthermore, we assessed changes in attitude as well as self-reported cybersickness after a first exposure to immersive virtual reality relative to exposure to time-lapse videos. Attitudes towards immersive virtual reality changed from neutral to positive after a first exposure to immersive virtual reality, but not after exposure to time-lapse videos. Moreover, self-reported cybersickness was minimal and had no association with exposure to immersive virtual reality. These results imply that the contribution of VR applications to health in older adults will neither be hindered by negative attitudes nor by cybersickness.

Find the full report here.

--

Huygelier H, Schraepen B, Ee RV, Abeele VV, Gillebert CR. Acceptance of immersive head-mounted virtual reality in older adults. Scientific Reports. 2019;9(1). doi:10.1038/s41598-019-41200-6

Rehabilitation
The use of virtual reality in craving assessment and cue-exposure therapy in substance use disorders

Craving is recognized as an important diagnosis criterion for substance use disorders (SUDs) and a predictive factor of relapse. Various methods to study craving exist; however, suppressing craving to successfully promote abstinence remains an unmet clinical need in SUDs. One reason is that social and environmental contexts recalling drug and alcohol consumption in the everyday life of patients suffering from SUDs often initiate craving and provoke relapse. Current behavioral therapies for SUDs use the cue-exposure approach to suppress salience of social and environmental contexts that may induce craving. They facilitate learning and cognitive reinforcement of new behavior and entrain craving suppression in the presence of cues related to drug and alcohol consumption. Unfortunately, craving often overweighs behavioral training especially in real social and environmental contexts with peer pressure encouraging the use of substance, such as parties and bars. In this perspective, virtual reality (VR) is gaining interest in the development of cue-reactivity paradigms and practices new skills in treatment. VR enhances ecological validity of traditional craving-induction measurement. In this review, we discuss results from (1) studies using VR and alternative virtual agents in the induction of craving and (2) studies combining cue-exposure therapy with VR in the promotion of abstinence from drugs and alcohol use. They used virtual environments, displaying alcohol and drugs to SUD patients. Moreover, some environments included avatars. Hence, some studies have focused on the social interactions that are associated with drug-seeking behaviors and peer pressure. Findings indicate that VR can successfully increase craving. Studies combining cue–exposure therapy with virtual environment, however, reported mitigated success so far.

Find the full study here.

--

Hone-Blanchet A, Wensing T, Fecteau S. The Use of Virtual Reality in Craving Assessment and Cue-Exposure Therapy in Substance Use Disorders. Frontiers in Human Neuroscience. 2014;8. doi:10.3389/fnhum.2014.00844

Application and Outcomes of Therapy Combining Transcranial Direct Current Stimulation and Virtual Reality: a Systematic Review

Purpose: To evaluate the methods and major outcomes of transcranial direct current stimulation (tDCS) combined with virtual reality (VR) therapy in randomized controlled trials.

Method: A systematic review was performed following PRISMA guidelines using PubMed, PubMed Central, Web of Science and CAPES periodic databases, with no time restriction. The studies were screened for the following inclusion criteria: human subjects, combination of VR and tDCS methods, and randomized controlled study design. All potentially relevant articles were independently reviewed by two researchers, who reached a consensus on which articles met the inclusion criteria. The PEDro scale was used to evaluate the studies.

Find the full study here.

--

Massetti, Thais, et al. “Application and Outcomes of Therapy Combining Transcranial Direct Current Stimulation and Virtual Reality: a Systematic Review.” Disability and Rehabilitation: Assistive Technology, vol. 12, no. 6, 2016, pp. 551–559., doi:10.1080/17483107.2016.1230152.

The application of VR technology in rehabilitation

Abstract: Virtual reality (VR) is an emerging technology with a variety of potential benefits for many aspects of rehabilitation assessment, treatment, and research. Through its capacity to allow the creation and control of dynamic 3-dimensional, ecologically valid stimulus environments within which behavioral responding can be recorded and measured, VR offers clinical assessment and rehabilitation options that are not available with traditional methods. Initial applications of VR in other aspects of medicine and psychology have yielded encouraging results, but continued research and understanding of this evolving technology will be crucial for its effective integration into rehabilitation. This article provides a brief introduction to VR technology, examines the specific benefits VR offers consumers and providers of rehabilitation services and discusses potential areas of application and important considerations in applying this technology. Finally, 2 examples of current VR applications are presented

You can find the full study here.

--

Schultheis, Maria & Rizzo, Albert. (2001). The application of virtual reality technology in rehabilitation. Rehabilitation Psychology. 46. 296-311. 10.1037/0090-5550.46.3.296. 

Feasibility of a Walking Virtual Reality System for Rehabilitation: Objective and Subjective Parameters

Background: Even though virtual reality (VR) is increasingly used in rehabilitation, the implementation of walking navigation in VR still poses a technological challenge for current motion tracking systems. Different metaphors simulate locomotion without involving real gait kinematics, which can affect presence, orientation, spatial memory and cognition, and even performance. All these factors can dissuade their use in rehabilitation. We hypothesize that a marker-based head tracking solution would allow walking in VR with high sense of presence and without causing sickness. The objectives of this study were to determine the accuracy, the jitter, and the lag of the tracking system and its elicited sickness and presence in comparison of a CAVE system.

Methods: The accuracy and the jitter around the working area at three different heights and the lag of the head tracking system were analyzed. In addition, 47 healthy subjects completed a search task that involved navigation in the walking VR system and in the CAVE system. Navigation was enabled by natural locomotion in the walking VR system and through a specific device in the CAVE system. An HMD was used as display in the walking VR system. After interacting with each system, subjects rated their sickness in a seven-point scale and their presence in the Slater-Usoh-Steed Questionnaire and a modified version of the Presence Questionnaire.

Find the full study here.

--

Borrego, Adrián, et al. “Feasibility of a Walking Virtual Reality System for Rehabilitation: Objective and Subjective Parameters.” Journal of NeuroEngineering and Rehabilitation, vol. 13, no. 1, 2016, doi:10.1186/s12984-016-0174-1.

Promoting Therapists' Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation

Purpose: Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use.

Method: A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists' confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists' perspectives on MLS use during VR-based therapy provision.

Find the full study here.

--

Levac, Danielle E., et al. “Promoting Therapists’ Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation.” Plos One, vol. 11, no. 12, 2016, doi:10.1371/journal.pone.0168311.

Virtual Reality for Individuals With Substance Use Disorders

Abstract: Substance use disorders (SUDs) remain difficult to treat, with relapse rates averaging 50% despite available treatment. There is a need for new and novel treatment for treating SUDs. The use of virtual reality (VR) shows promising results as a strategy to help patients with SUDs manage cravings, say no to substance use, reduce stress and anxiety, treat pain, learn life skills, exercise, and use as a substitute for substance use. In VR, patients use a head-mounted device to experience computer-generated 360° simulated environments. Studies have shown that VR activates some of the same areas of the brain that substances activate. The science and technology of VR is evolving, resulting in more affordability, but the price is likely still a barrier for most treatment providers and patients. In addition, applications used to treat SUDs were developed for use in research and are not currently available for public use. More rigorous studies are needed to determine the effectiveness of VR as a treatment for SUDs. [Journal of Psychosocial Nursing and Mental Health Services, 57(6), 15-19.].

Find the full study here.

--

Worley, Julie. “Virtual Reality for Individuals With Substance Use Disorders.” Journal of Psychosocial Nursing and Mental Health Services, vol. 57, no. 6, 2019, pp. 15–19., doi:10.3928/02793695-20190430-01.

 

Virtual Reality for Traumatic Brain Injury

Abstract: In this perspective, we discuss the potential of virtual reality (VR) in the assessment and rehabilitation of traumatic brain injury, a silent epidemic of extremely high burden and no pharmacological therapy available. VR, endorsed by the mobile and gaming industries, is now available in more usable and cheaper tools allowing its therapeutic engagement both at the bedside and during the daily life at chronic stages after injury with terrific potential for a longitudinal disease modifying effect.

Find the full study here.

--

Zanier, Elisa R., et al. “Virtual Reality for Traumatic Brain Injury.” Frontiers in Neurology, vol. 9, 2018, doi:10.3389/fneur.2018.00345.

Virtual Restorative Environments: Preliminary Studies in Scene, Sound and Smell

Abstract: Previous restorative environment (RE) research suggests that exposure of individuals to natural settings can reduce stress, improve feelings of well-being, and help individuals to recover from fatigue following intensive mental activities. This paper focuses on possible future opportunities for exploring Virtual Environments (VE) in the pursuit of restorative and rehabilitative therapies. The paper presents early work in developing such a Virtual Restorative Environment (VRE) and includes results from two preliminary studies. The first study compared two VEs (an urban city scene and a rural coastal scene) and showed the effect of ambient sounds on ratings of anxiety and relaxation. The second study explored the opportunity of incorporating odours into a VE using a novel olfactory display system and evaluated methods for measuring their effect on the user. Throughout, the paper discusses human factors and usability issues for VRE technologies and future research opportunities

Find the full paper here.

--

Knight JF, Stone RJ, Qian C. Virtual Restorative Environments. International Journal of Gaming and Computer-Mediated Simulations. 2012;4(3):73-91. doi:10.4018/jgcms.2012070106

VR exercise on a home-based phase III cardiac rehabilitation program

 

Purpose: To analyse the effect of a six-month home-based phase III cardiac rehabilitation (CR) specific exercise program, performed in a virtual reality (Kinect) or conventional (booklet) environment, on executive function, quality of life and depression, anxiety and stress of subjects with coronary artery disease.

Conclusions: The virtual reality format had improved selective attention and conflict resolution ability, revealing the potential of CR, specifically with virtual reality exercise, on executive function. Implications for Rehabilitation In cardiac rehabilitation, especially in phase III, it is important to develop and to present alternative strategies, as virtual reality using the Kinect in a home context. Taking into account the relationship between the improvement of the executive function with physical exercise, it is relevant to access the impact of a cardiac rehabilitation program on the executive function. Enhancing the value of the phase III of cardiac rehabilitation.

Find the full report here.

--

Vieira Á, Melo C, Machado J, Gabriel J. Virtual reality exercise on a home-based phase III cardiac rehabilitation program, effect on executive function, quality of life and depression, anxiety and stress: a randomized controlled trial. Disability and Rehabilitation: Assistive Technology. 2017;13(2):112-123. doi:10.1080/17483107.2017.1297858

Virtual Natural Environments for Restoration and Rehabilitation in Healthcare

Abstract: For over two decades, research and clinical projects have exploited Virtual Reality technologies in the treatment of numerous human conditions, from desensitisation régimes combating phobias to the use of distraction and exposure therapies for burns victims and those suffering from post-traumatic stress disorders. In contrast to previous “high-tech” interface and combat-oriented approaches to using VR in the psychological rehabilitation process, the present chapter advocates the use of virtual restorative environments (VREs)—the recreation of locations and scenes that, by virtue of their natural beauty and peacefulness, can significantly help to reduce the body’s reactivity to stress and restore cognitive or attentional capacities. The chapter also argues that VREs, suitably enhanced with more interactive and dynamic features, could offer significant benefits to patients in physical rehabilitation programmes. This is especially the case for amputees, for example, who, whilst awaiting the fitting of prosthetic limbs, could undertake competitive and motivational “virtual exercises”, thereby avoiding muscle atrophy and related reductions in residual limb capabilities. The report concludes that the exploitation of simulation technologies in psychological therapies is worthy of continued investigation, especially in the pursuit of enhancing patients’ recovery profiles following surgical procedures, from intensive care to the hospital recovery ward. VREs possess a range of important qualities, not least significant of which is real-time interaction and ease-of-editing, supporting the cost-effective generation of engaging and distributable scenarios that can be tailored relatively easily to meet the needs of individual patients.

Find the full report here.

--

Stone R, Small C, Knight J, Qian C, Shingari V. Virtual Natural Environments for Restoration and Rehabilitation in Healthcare. Virtual, Augmented Reality and Serious Games for Healthcare 1 Intelligent Systems Reference Library. 2014:497-521. doi:10.1007/978-3-642-54816-1_24

canva-photo-editor (42)

Tim Fitzpatrick

Co-founder & CEO

Hi there! Thanks for taking the time to read through our research page. The results you see here are just a fraction of the mounting evidence that supports VR's growing role in healthcare. I'd like to thank all those clinicians and researchers who continue to push the envelope in the name of improving patient care. And I especially want to thank YOU for your support — it's why we're here.

Anything we should add to the Learning Hub?

Contact us