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The use of virtual reality as a training mechanism continues to gain popularity as equipment becomes more readily available. It is important to not only understand the relationship between virtual reality training and motor learning, but to understand the extent to which practice manipulations enhance performance in virtual reality. One common practice manipulation is adopting an external focus of attention, which has been shown to facilitate motor learning in a variety tasks. The purposes of the present study were to investigate the effectiveness of an external focus of attention and the effects of target occlusion times in virtual reality. Fifty-six participants performed a single-leg long jump during baseline, training, and retention and were randomly assigned to either an external or control group. During baseline and retention, all participants performed the task in both a virtual reality (VR) and real world (RW) environments. Training was all done in VR where participants were provided an external focus cue or no cue. Results revealed that individuals jumped significantly further in RW than VR in both baseline and retention (p < .001). During training, the external group jumped significantly further than control (p < .05). These results suggest that the adoption of an external focus improves performance during training. However, we did not see a benefit of an external focus in retention. These findings should be taken into consideration when using virtual reality as a training tool when performance must be transferred to a real world environment., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Obstacle crossing, such as stepping over a curb, becomes more challenging with natural aging and could lead to obstacle-related trips and falls. To reduce fall-risk, obstacle training programs using physical obstacles have been developed, but come with space and human resource constraints. These barriers could be removed by using a virtual obstacle crossing training program, but only if the learned gait characteristics transfer to a real environment. We examined whether virtual environment obstacle crossing behavior is transferred to crossing real environment obstacles. Forty participants (n = 20 younger adults and n = 20 older adults) completed two sessions of virtual environment obstacle crossing, which was preceded and followed by one session of real environment obstacle crossing. Participants learned to cross the virtual obstacle more safely and that change in behavior was transferred to the real environment via increased foot clearance and alterations in foot placement before and after the real environment obstacle. Further, while both age groups showed transfer to the real environment task, they differed on the limb in which their transfer effects applied. This suggests it is plausible to use virtual reality training to enhance gait characteristics in the context of obstacle avoidance, potentially leading to a novel way to reduce fall-risk. [ABSTRACT FROM AUTHOR]

Background: Neurologic rehabilitation aims to restore function, address barriers to activity, and improve quality of life in those with injury to the nervous system. Virtual reality (VR) has emerged as a useful tool to enhance neurorehabilitation interventions and outcomes. However, the manner in which VR-based neurorehabilitation has been manipulated to optimize outcomes using theory-based frameworks has not been documented. Behavior Change Techniques (BCTs) are described as the smallest active ingredient in an intervention aimed to change behavior via theoretically-proposed pathways. The purpose of this review was to investigate the ways VR is being used in neurorehabilitation to improve upright mobility, and systematically code those VR interventions for active BCTs. Methods: Keyword searches were performed using database searches of PubMed, SPORTDiscus, and psycINFO. The search yielded 32 studies for inclusion. Coding for BCTs was conducted using the Behavior Change Techniques Taxonomy v1 (BCTTv1). Results: Behavioral Practice, Graded Tasks, Biofeedback, and Explicit Feedback were the most commonly used BCTs. All studies reported improvements in motor performance outcomes. However, none of the studies investigated the efficacy of each component of their VR intervention making it difficult to point to the most effective components of VR interventions overall. Conclusions: This review suggests that investigation into the specific components of VR interventions, along with purposeful implementation and reporting of BCTs will help improve understanding of the efficacy of VR as a neurorehabilitation tool. Future research could benefit from incorporating BCTs into the design process of VR interventions to produce optimal rehabilitation potential. [ABSTRACT FROM AUTHOR]

Obstacle crossing, such as stepping over a curb, becomes more challenging with natural aging and could lead to obstacle-related trips and falls. To reduce fall-risk, obstacle training programs using physical obstacles have been developed, but come with space and human resource constraints. These barriers could be removed by using a virtual obstacle crossing training program, but only if the learned gait characteristics transfer to a real environment. We examined whether virtual environment obstacle crossing behavior is transferred to crossing real environment obstacles. Forty participants (n = 20 younger adults and n = 20 older adults) completed two sessions of virtual environment obstacle crossing, which was preceded and followed by one session of real environment obstacle crossing. Participants learned to cross the virtual obstacle more safely and that change in behavior was transferred to the real environment via increased foot clearance and alterations in foot placement before and after the real environment obstacle. Further, while both age groups showed transfer to the real environment task, they differed on the limb in which their transfer effects applied. This suggests it is plausible to use virtual reality training to enhance gait characteristics in the context of obstacle avoidance, potentially leading to a novel way to reduce fall-risk. [ABSTRACT FROM AUTHOR]

Gait control challenges commonly coincide with vestibular dysfunction and there is a long history in using balance and gait activities to enhance functional mobility in this population. While much has been learned using traditional rehabilitation exercises, there is a new line of research emerging that is using visual stimuli in a very specific way to enhance gait control. For example, avatars can be created in an individualized manner to incorporate specific gait characteristics. The avatar could then be used as a visual stimulus to which the patient can synchronize their own gait cycle. This line of research builds upon the rich history of sensorimotor control research in which augmented sensory information (visual, haptic, or auditory) is used to probe, and even enhance, human motor control. This review paper focuses on gait control challenges in patients with vestibular dysfunction, provides a brief historical perspective on how various visual displays have been used to probe sensorimotor and gait control, and offers some recommendations for future research. [ABSTRACT FROM AUTHOR]

Objective: Examine the acceptability of an evidence-based, contextually tailored, virtual avatar coaching approach for nutrition education among adult-child dyads with low income. Design: Structured observations and semistructured interviews. Setting: Low-income communities in 2 midsized urban areas. Participants: Fifteen African American adult and child (aged 5−10 years old) dyads recruited from community agencies. Phenomenon of Interest: Structured observation during the use of the virtual avatar coaching program and qualitative feedback on program experience after using the program. Analysis: Transcripts were independently coded by 2 trained coders. Content analysis was conducted to determine trends and patterns in responses, and salient quotes were extracted from the manuscripts. Results: The program generated dialogue between the children and adults around preferences and dietary habits. Adults and children described the program as being helpful, informative, motivational, and fun. Adults and children liked that the avatar acknowledged them at a personal level, provided accountability, and was tailored to them and their environment. Children wanted the ability to customize the avatar, more gamification, and avatar demonstration of healthy behaviors. Children felt the program would improve their health behaviors and were interested in using it again. Conclusions and Implications: This study highlights information that can be used to improve avatarbased programs for nutrition education with children and their adult caregivers who have low income. Future work should assess the impact of user customization experience, program impact on dietary behaviors, and resources required to scale and maintain the program with community agencies. [ABSTRACT FROM AUTHOR]