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The aim of this study was to determine the immersive virtual reality‐based sensorimotor rehabilitation (IVR‐SRB) effect on mental health (global mental health, depression, anxiety and well‐being) in older adults. Methods: This study was experimental, with a sample of 111 older adults (control‐experimental), considering an application of IVR‐SRB in four different virtual settings with exteroceptive synchronization, proprioceptive and vestibular stimuli, for 6 weeks. Outcome variables: symptoms associated with depression and anxiety; positive mental health (psychological well‐being). A descriptive and inferential approach was used to analyze the data, and the ANCOVA test was used to compare the post‐intervention groups, controlled by the baseline; In case of baseline moderation, a linear regression model was applied to identify the level of moderation and a region of significance analysis. Results: An IVR‐SRB positive net effect was found in the reduction of symptoms of global mental health (p < 0.0001) and depression (p < 0.0001), without baseline moderation. The anxiety scores showed moderation at the beginning (p < 0.0001; b = −0.53), identifying that the greater the presence of anxiety symptoms, the greater the effect of IVR‐SRB in reducing these symptoms; its effect is present from scores of 2.9 (Goldberg‐12). There were no changes in well‐being. Conclusion: IVR‐SRB is recognized as a great intervention tool among elderly population, showing its multidimensional approach capacity, properly responding to the reduction of symptoms associated with mental disorders. Key Points: New technologies can change the reality of mental health in older adults.The sensation of presence in an interactive virtual environment, modifies the perception of reality and generates changes in the calibration of a new reality in virtual worlds.Our findings show that depressive symptoms scores decrease in older adults who underwent immersive virtual reality sensorimotor rehabilitation.The moderation effect showed that the higher the anxiety symptoms score, the greater the effect of immersive virtual reality therapy. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Occupational Therapy / Cadernos Brasileiros de Terapia Ocupacional is the property of Cadernos de Terapia Ocupacional da UFSCar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Brazilian Journal of Occupational Therapy / Cadernos Brasileiros de Terapia Ocupacional is the property of Cadernos de Terapia Ocupacional da UFSCar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Fisioterapia e Pesquisa is the property of Universidade de Sao Paulo, Faculdade de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim and Background: Burnout in couples is a gradual and rarely sudden process in which intimacy and love are gradually faded and general fatigue becomes evident. Therefore, the aim of this study was to investigate the effectiveness of reality therapy training on marital burnout in couple with marital conflicts. Methods and Materials: This experimental study was conducted with a pretest-posttest design with control group and follow up 45 days. The statistical population of this study included all the couple with marital conflicts refer to counseling centers in Karaj city in year 2019-2020 and 14 couple with marital conflicts were considered as the sample size in one experimental groups (7 couple) and control (7 couple). The experimental groups underwent reality therapy training (12 sessions - 90 minutes), but the control group received no training and remained in the waiting list. To collect data marital conflicts questionnaire (MCQ) of Barati and Sanaee (1994) and marital burnout questionnaire (MBQ) of Pines (2003). Data analysis was performed using SPSS-24 software in two sections: descriptive (mean and standard deviation) and inferential (analysis of variance with repeated measures and Bonferroni). Findings: Results indicated that reality therapy training, significantly decreased marital burnout in couples, and the results have had enough consistency in the follow-up period, as well (P

Abstract Background Cerebral Palsy (CP) is characterised by variable difficulties in muscular action, resulting in inability of the individual to perform functional movement. An option to provide functionality to the individual with CP is the use of computer innovation. The aim of this paper was to verify if there was any performance improvement in a task performed in a virtual environment and if there was transfer to the task performed in the real environment and vice versa in this population. Methods A computer program was developed comprising a motor task, but with two possibilities of user interaction: a) concrete interface (with physical contact): in which the individual touches the computer screen to finish the task and b) abstract interface (no physical contact): in which the individual performs a hand movement in front of the Kinect device. Participants were split into two groups. The experimental group consisted of 28 individuals with CP within the ages of 6 and 15 years old. The control group included 28 typically developing individuals mirroring the age and sex of the experimental group. Results Individuals from both groups were able to improve task performance and retain acquired information. The CP group presented worse performance than the control group in all phases of the study. Further findings showed that the CP group presented better performance in the abstract interface than in the concrete interface, whereas, in the control group, the opposite occurred: their best performance was in the concrete. Conclusions Motor tasks performed by individuals with CP through an interface with a more virtual environment feature (abstract interface: Kinect) provided better performance when compared to an interface with a more real characteristic (concrete interface: Touchscreen). Trial registration ClinicalTrials.gov Identifier - NCT03352440 ; Date of registration - November 17, 2017.

To enable virtual reality exposure therapy (VRET) that treats anxiety disorders by gradually exposing the patient to fear using virtual reality (VR), it is important to monitor the patient's fear levels during the exposure. Despite the evidence of a fear circuit in the brain as reflected by functional near-infrared spectroscopy (fNIRS), the measurement of fear response in highly immersive VR using fNIRS is limited, especially in combination with a head-mounted display (HMD). In particular, it is unclear to what extent fNIRS can differentiate users with and without anxiety disorders and detect fear response in a highly ecological setting using an HMD. In this study, we investigated fNIRS signals captured from participants with and without a fear of height response. To examine the extent to which fNIRS signals of both groups differ, we conducted an experiment during which participants with moderate fear of heights and participants without it were exposed to VR scenarios involving heights and no heights. The between-group statistical analysis shows that the fNIRS data of the control group and the experimental group are significantly different only in the channel located close to right frontotemporal lobe, where the grand average oxygenated hemoglobin Δ[HbO] contrast signal of the experimental group exceeds that of the control group. The within-group statistical analysis shows significant differences between the grand average Δ[HbO] contrast values during fear responses and those during no-fear responses, where the Δ[HbO] contrast values of the fear responses were significantly higher than those of the no-fear responses in the channels located towards the frontal part of the prefrontal cortex. Also, the channel located close to frontocentral lobe was found to show significant difference for the grand average deoxygenated hemoglobin contrast signals. Support vector machine-based classifier could detect fear responses at an accuracy up to 70% and 74% in subject-dependent and subject-independent classifications, respectively. The results demonstrate that cortical hemodynamic responses of a control group and an experimental group are different to a considerable extent, exhibiting the feasibility and ecological validity of the combination of VR-HMD and fNIRS to elicit and detect fear responses. This research thus paves a way toward the a brain-computer interface to effectively manipulate and control VRET.

Purpose: Virtual reality-based therapy (VRBT) may be an effective physical therapy complement employed in the rehabilitation of patients with anterior cruciate ligament (ACL) injury. This study aims to assess the effectiveness of VRBT in improving pain, knee function, strength, proprioception, flexion range of motion (ROM), and dynamic balance after ACL injury., Methods: We conducted this systematic review with meta-analysis following PRISMA criteria. Since inception to June 2024, we searched in PubMed Medline, WOS, SCOPUS, CINAHL and PEDro without publication date and language restrictions. Randomised controlled trials (RCTs), comprising only patients with ACL injury, that assess the effectiveness of VRBT compared to classical interventions on the outcomes of interest were included. PEDro scale was employed to analyze the methodological quality of the RCTs included. Cohen's standardised mean difference (SMD) and its 95% confidence interval (95% CI) was used to calculate the pooled effect in meta-analyses., Results: Nine RCTs, providing data from 330 participants (26.96 ± 3.11 years, 85% males) were included. The RCTs included showed good methodological quality (PEDro scale = 6.88 points), being, performance and detection biases, the most common biases reported. Meta-analyses showed that VRBT was more effective than classical interventions in reducing pain (SMD = -1.15; 95% CI -1.85 to -0.45; p = 0.001; I 2  = 0%), and increasing knee function (SMD = 1.71; 95% CI 0.93 to 2.5; p < 0.001; I 2  = 0%), strength (SMD = 0.82; 95% CI 0.4-1.23; p < 0.001; I 2  = 0%) and flexion ROM (SMD = 0.7; 95% CI 0.37-1.01; p < 0.001; I 2  = 0%). Additionally, VRBT improved postero-medial (SMD = 0.46; 95% CI 0.01-0.9; p = 0.045; I 2  = 15.1%) and postero-lateral CoP excursion (SMD = 0.75; 95% CI 0.3-1.21; p = 0.001; I 2  = 0%), being effective in improving dynamic balance., Conclusion: VRBT is an effective physical therapy complement to be included in the ACL's rehabilitation programmes due to reduces pain and increases knee function, strength, ROM and dynamic balance after ACL injury., Level of Evidence: Level II evidence., (© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background and Objectives: Anxiety related school avoidance can affect up to 5% of a country's students each year. VRET (Virtual Reality Exposure Therapy) is a novel therapy proven to be as effective as conventional approaches for treating many anxiety disorders. The aim of this research is to co-design and evaluate a VRET intervention for students experiencing school related anxiety., Method: Eighteen adolescents participated in design thinking workshops where they developed a script and storyboard for the VRET. Using an iterative approach, a VRET prototype was developed based on this work. Eighteen teenagers were subsequently recruited to engage with the VRET for one session each and provide feedback on their experience via a structured questionnaire (supervised by a study coordinator) particularly focusing on the ability of the VR experience to reduce school related anxiety., Results: Exposure therapy needs to produce an anxiety response to be effective. The VRET was effective in producing an anxiety response in 89% of participants. Results demonstrated that 93% of participants found the simulations immersive, 94% found the scenarios believable, and 83% could relate to 'Dala', the avatar in the videos. 100% of participants believed that VRET would help with school anxiety., Conclusion: This proof-of-concept study demonstrates favourable face validity indicating promise for this mode of intervention for delivering targeted support to anxious students. VRET could be used as a scalable, cost effective early intervention to reduce the severity of anxiety associated with school avoidance.

Virtual reality (VR) and augmented reality (AR) applications benefit both health care providers and patients in cardiovascular teaching by supplementing traditional techniques.VR/AR has already been utilized to treat patients in rehabilitation programmers and in intensive care patients who are immobilized. In the catheterization laboratory, there are a slew of other possibilities. The ultimate goal of AR and VR display development is to provide reality-like, crystal-clear visuals that can imitate, integrate into, or rebuild the surrounding environment while avoiding discomfort. Virtual reality has become a novel approach to improving the efficacy of medical treatment intervention as a result of improvements in computer technology. Cardiopulmonary rehabilitation has long been considered a necessary treatment for people who have survived heart attacks or strokes. The goal of this review is to outline the existing and future role of virtual reality and augmented reality in many sectors of cardiology, as well as their problems and perspectives. [ABSTRACT FROM AUTHOR]

While most upper limb training interventions in neurological rehabilitation are based on established principles of motor learning and neural plasticity, recovery potential may be improved if the focus includes remediating an individual's specific motor impairment within the framework of a motor control theory. This paper reviews current theories of motor control and motor learning and describes how they can be incorporated into training programs to enhance sensorimotor recovery in patients with neurological lesions. An emphasis is placed on dynamical systems theory and the use of new technologies such as virtual, augmented and mixed reality applications for rehabilitation to facilitate learning. Kinematic abundance allows the healthy nervous system to produce different combinations of joint rotations to perform a desired task. The structure of practice to improve the movement repertoire in rehabilitation should take into account the kinematic abundance of the system. Learning can be enhanced by varied practice with feedback about key movement elements. Virtual reality environments provide opportunities to manipulate the structure and schedule of practice and feedback. [ABSTRACT FROM AUTHOR]

Objective: Visual-vestibular mismatch patients experience persistent postural and perceptual dizziness. Previous studies have shown the benefit of vestibular rehabilitation for visual desensitisation using gaze stabilisation exercises and optokinetic stimulation. This study assessed the benefit of customised vestibular rehabilitation with visual desensitisation and virtual reality based therapy rehabilitation in the management of patients with persistent postural-perceptual dizziness. Methods: This retrospective study included 100 patients with Situational Characteristic Questionnaire scores of more than 0.9. All patients received virtual reality based therapy along with usual vestibular rehabilitation using gaze stabilisation exercises with a plain background followed by graded visual stimulation and optokinetic digital video disc stimulation. Patients' symptoms were assessed before and after vestibular rehabilitation using the Situational Characteristic Questionnaire, Generalised Anxiety Disorder Assessment-7, Nijmegen Questionnaire and Dizziness Handicap Inventory. Results: There were statistically significant improvements in Situational Characteristic Questionnaire scores, Nijmegen Questionnaire scores and Dizziness Handicap Inventory total score. However, there was a statistically insignificant difference in Generalised Anxiety Disorder Assessment-7 scores. There was a significant positive correlation between post-rehabilitation Situational Characteristic Questionnaire scores and other questionnaire results. Conclusion: Incorporating virtual reality based therapy with customised vestibular rehabilitation exercises results in significant improvement in persistent postural-perceptual dizziness related symptoms. [ABSTRACT FROM AUTHOR]

The aim of the study was to explore the opinions of the volunteers about the plyometric training protocol associated with resistance (PTRE) and virtual (VT) exercises for injury prevention. This approach was chosen considering that patients' perceptions in general could be neglected. Data collection took place with two Focus Groups (FGs) and to this end, an invitation was made to seven participants from both groups who had already completed the training. A meeting was held, with an average duration of 60 minutes for each intervention group, and a trained moderator conducted it; the sessions were recorded on audio and later transcribed for analysis. The participants reported the increase of physical conditioning, endurance and muscle strength in both training sessions. It was concluded that in PTRE, the issue of improved balance and stability of lower limbs was highlighted, while in VT the improvement of concentration and disposition for the daily routine. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess whether two weeks of therapy (traditional and VR) may improve balance in children and adolescents with neurological problems of different origins and whether the deterioration in gait dynamic balance showed by patient's ground reaction forces (GRF) determinates therapy effectiveness. 29 participants aged 9–17 attended traditional therapy supplemented by tailor-made games. Therapy comprised exercises improving balance, range of motion, posture control, proprioception, muscle strength. Biodex Balance System was used for main assessment before and after therapy in tests: Postural Stability, modified Clinical Test of Sensory Integration and Balance, and Limits of Stability. Participants underwent gait analysis before the therapy to determine GRF. An increased maximal lateral component or decreased maximal anterior component in the push-off phase taking place in both legs were regarded as deterioration. This enabled the division into two groups with and without such a deterioration. Results were compared between the groups before and within groups before and after therapy. The precision of forward-backwards body sway improved most significantly in the group with decreased GRF and reached the level of the second group, who worsened antero-posterior repeatability during stance on an unstable surface with eyes open. Two weeks of combined traditional and VR therapy tailored to patients' functional weakness positively influenced the balance of neurologically impaired children. The group with decreased gait dynamic balance improved the tasks, which were intensively trained in the games. The second group remained more spontaneous in the trained direction. [ABSTRACT FROM AUTHOR]

Virtual Reality (VR) is used in a variety of fields with the goal to increase ecological validity compared to traditional monitor-based setups. Here we report additional evidence for the adequacy of this research strategy. In a memory confusion paradigm spanning over stimuli presentation in reality, VR and on a computer monitor, participants were more prone to confusing reality with VR than with a traditional monitor-based setup, indicating a relative proximity of experiences in VR and reality. We speculate that the human source memory's difficulty in distinguishing VR from reality may provide a basis for the good generalizability of treatment effects in VR to daily life. At the same time, the effect may demonstrate a potential danger of a mindless use of VR technology.

Objective: To systematically evaluate the effects of virtual reality exposure therapy（VRET） in the treatment of post-traumatic stress disorder（PTSD）.Methods:Databases including Pubmed, Cochrane Library, Embase, SpringerLink, ClinicalKey, ScienceDirect were searched by computer for a limited period of time from the establishment of the database to August 2020,paper inclusion criteria were confined to randomized controlled trail of VRET and traditional treatment or in waitlist patients with PTSD. Results: A total of 301 patients with PTSD were included in this study. The pooled studies showed that VRET effectively alleviated PTSD total symptoms compared with those in waitlist（SMD=-0.51,95% CI:-0.89-0.14,P <0.01）,but there was no significant difference in which compared with the traditional treatment group(SMD=-0.24,95% CI:-0.66-0.18,P> 0.05].The long-term efficacy of the VRET group after 3 months or 6 months was not statistically significant compared with the traditional treatment group（P>0.05）.Conclusion:It suggests that virtual reality exposure therapy has a positive effect on relieving the symptom severity of post-traumatic stress disorder. [ABSTRACT FROM AUTHOR]

Copyright of Psychotherapeut is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Increased life expectancy leads to an increase in the number of older adults and in the prevalence of aging-associated diseases and disabilities. Active aging strategies—particularly those based on physical exercise therapy— have great positive impact on older people's health. Virtual reality (VR) represents an innovative approach to involve and motivate patients during therapy sessions. Exergaming programs based on VR technologies and commercially available gaming platforms are amenable to therapeutic use in older adults, according to various systematic reviews and meta-analyses. The use of immersive virtual reality (IVR) in the field of rehabilitation or physical skills training in seniors is understudied.In the present systematic review, we analyze the therapeutic use and application of IVR in older adults through physical activity. We describe the populations studied, the conditions of IVR application (device, session, physical, and virtual environments), its potential benefits, and its limitations. We found that most studies are feasibility pilot experiences, where the use and acceptability of the immersive platform were evaluated. Cumulative data suggest that the use of IVR with therapeutic intent in senior populations is in early stages of clinical development and shows promise as a complementary tool in the fields of health, rehabilitation, and active aging. [ABSTRACT FROM AUTHOR]

To analyse the virtual reality applications in the subjects' neuro-psychomotor functions rehabilitation with motor and/or neuropsychiatric impairment. The search was carried out in nine databases (Scopus, PubMed, Web of Science, ScienceDirect, Cochrane Library, CINAHL, PsycINFO, LILACS, and SciELO), from December 2017 to March 2019. An additional manual search was performed, taking into consideration references of the included papers, through the same eligibility criteria. The methodological quality of the included papers was evaluated using the Physiotherapy Evidence Database (PEDro). One hundred and twenty-two papers were selected by the initial screening, but only 33 studies participated in the final inclusion in the study (11 clinical trials and 14 experimental studies). The data extracted were: the proposed objective, the sample population, the neurological condition treated, the VR modality used in the procedures and the study intervention period. Virtual reality supports the rehabilitation process of neuro-psychomotor functions, allowing potential gains in the patients' recovery. Therefore, its development facilitates its availability and access in the future. It has minimal adverse effects during the virtual therapies performance, such as the presence of vertigo related to cybersickness conditions, suggesting virtual reality as a safe rehabilitation tool, compared to other therapies. Virtual reality use is useful and effective in helping the rehabilitation process of motor, cognitive and psychosocial functions. It plays a role as an adjunctive and complementary therapy in the neuro-psychomotor rehabilitation process to obtain a clinically significant result. [ABSTRACT FROM AUTHOR]

Research has documented the efficacy of clinical applications that leverage Virtual Reality (VR) for assessment and treatment purposes across a wide range of domains, including pain, phobias, and posttraumatic stress disorder (PTSD). As the field of Clinical VR matures, it is important to review its origins and examine how these initial explorations have progressed, what gaps remain, and what opportunities the community can pursue. We do this by reflecting on our personal scientific journey against the backdrop of the field in general. In particular, this paper discusses how a clinical research program that was initially designed to deliver trauma-focused VR exposure therapy (VRET) for combat-related PTSD has been evolved to expand its impact and address a wider range of trauma sources. Such trauma sources include sexual trauma and the needs of first responders and healthcare professionals serving on the frontlines of the COVID-19 pandemic. We provide an overview of the field and its general trends, discuss the genesis of our research agenda and its current status, and summarize upcoming opportunities, together with common challenges and lessons learned. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) causes a progressive decline of motor and cognitive functions, often affecting postural control. Training through virtual reality has been shown to be effective in improving this condition. This study aims to analyse the effects of the Kinect Adventures! games in postural control of people with PD. Ten individuals diagnosed with idiopathic PD, in stages I to III of the Hoehn & Yahr scale, aged between 48 and 73 years, were selected. Fourteen training sessions of one hour each, twice a week, were performed. Individuals were evaluated pre, post-intervention and 30 days after the last session of intervention by a force platform that measured the oscillation area (COP) and velocity (VOS) of the centre of pressure in ten different sensory conditions and the Limits of Stability (LOS). LOS showed a statistically significant increase immediately after the training the 14 sessions, as were observed and there were no significant changes in COP and VOS immediately after the intervention or 30 days after the end of training. The results of this study indicate that the training with Kinect Adventures! Games improve the postural control of people with PD, by increasing the LOS. [ABSTRACT FROM AUTHOR]

therapy based on non-immersive virtual reality (VRT) comprises a technique of interaction between the user and the interface system that allows the creation of an environment in which functional and motivational activities can be performed, while training with restricted blood flow (RBF) is an intervention modality that has been used in individuals who do not have good tolerance to high intensities of exercise. Among the various training modalities for the elderly population, both therapies have easy applicability and low financial cost. However, there are no studies on the combination of such interventions in relation to the autonomic outcome in elderly women. To evaluate the behavior of cardiac autonomic modulation after VRT with or without RBF in elderly women. This is a cross-over clinical trial composed of 17 elderly women with a mean age of 66.82±4.11 years who underwent three conditions: VRT-RBF, VRT only and control. The VRT was performed using a Nintendo Wii® videogame with the games Hulla Hoop, Free Run and Free Step with a total duration of 21 minutes approximately. For VRT-RBF, occlusion occurred in the proximal thigh and was set at 40% of the absolute occlusion pressure. The control group received an educational session of the same duration as the other conditions. For all groups, initially at rest (20 minutes), during the conditions, and in the recovery period (60 minutes analyzed every 10 minutes), RR intervals were collected for analysis of linear indices of heart rate variability (HRV) in the time domain (RR interval, SDNN, and rMSSD). Descriptive statistics were used and analysis of variance for repeated measures with two factors and significance level of p<0.05 was used for comparisons. There was no effect between conditions and interaction conditions vs. moments for all analyzed indices (p>0.05). There was an effect of moment for the RR intervals in the VRT-RBF condition in which the values showed a significant reduction from the baseline moment (95%CI 666-765) until 30 minutes [10′ (95%CI 599-725; p<0.05), 20′ (95%CI 618-719; p<0.05) and 30′ (95%CI 637-741; p<0.05)] of the recovery period. VRT with or without RBF did not promote autonomic imbalance in the recovery period. VRT-RBF can be an exercise alternative for the elderly population, due to its low financial cost and easy applicability that can promote the reduction of the deleterious effects of aging and sedentarism, providing an activity through playful games and favoring motivation and adherence in rehabilitation programs. [ABSTRACT FROM AUTHOR]

Abstract Background Public Speaking Anxiety (PSA) is a common anxiety with onset in adolescence and early adulthood. With the advent of consumer virtual reality (VR) technology, VR-delivered exposure therapy is now a scalable and practical treatment option and has previously been shown to be efficacious with adults. In this non-randomized feasibility and pilot trial, we explore the effect of one-session (90 min) VR-delivered exposure therapy for adolescents (aged 13–16) with PSA. Methods A total of 27 adolescents were recruited from Norwegian high schools and completed self-report measures of PSA twice prior to treatment, 1 week after treatment, and at 1 and 3 month follow-up. Heart rate was recorded during the treatment session. A low-cost head-mounted VR display with a custom-built VR stimuli material depicting a cultural and age appropriate classroom and audience were used when a series of speech (exposure exercises) were performed. Results Linear mixed effects model revealed a significant decrease in PSA symptoms (Cohen’s d = 1.53) pre-post treatment, and improvements were maintained at follow-ups. Physiological data revealed a small increase in heart rate during exposure tasks. Based on feedback from the adolescents, the feasibility of the intervention was increased during the trial. Conclusions The results show that low-cost, consumer VR hardware can be used to deliver efficacious treatment for PSA in adolescents, in a feasible one-session format.

ABSTRACT Immersive virtual reality (VR) is a technology that provides a more realistic environmental design and object tracking than ordinary VR. The aim of this study was to investigate the effectiveness of immersive VR on upper extremity function in patients with ischemic stroke. Sixty-five patients with ischemic stroke were included in this randomized, controlled, double-blind study. Patients were randomly divided into VR (n = 33) and control (n = 32) groups. The VR group received 60 minutes of the upper extremity immersive VR rehabilitation program and the control group received 45 minutes of conventional therapy and 15 minutes of a sham VR program. Rehabilitation consisted of 18 sessions of therapy, three days per week, for six weeks. The outcome measures were the Action Research Arm Test (ARAT), Functional Independence Measure (FIM), Fugl-Meyer Upper Extremity Scale (FMUE) and Performance Assessment of Self-Care Skills (PASS). In both the VR and control groups all parameters except the PASS improved over time. However independent t-test results showed that all of the FMUE, ARAT, FIM and PASS scores were significantly higher in the VR group compared with the control (p < 0.05). The minimal clinically important difference (MCID) scores of the FMUE and ARAT were higher than the cut-off MCID scores described in the literature in the VR group, whereas the FIM scores were below the cut-off MCID scores. All scores in the control group were below the cut-off scores. Immersive VR rehabilitation appeared to be effective in improving upper extremity function and self-care skills, but it did not improve functional independence.

ABSTRACT Objective: To describe the intervention protocols to using commercial video games as virtual reality (VR) in rehabilitation of patients with stroke. Methods: Integrative review using the descriptors “rehabilitation”, “virtual reality exposure therapy” and “videogames” in the LILACS and PUBMED databases. Articles published from 2011 to 2018 were selected. Results: We found 1,396 articles, 1,383 were excluded and 13 were selected. Most of the articles were randomized clinical trials published in 2014 or later. The sample size varied from 5–47 adults, or adults and elders, with chronic stroke. The Nintendo Wii® was the most used video game system. The intervention happened two or three times a week, each session lasting from 30 to 60 minutes, over 2–12 weeks. Balance, upper limb motor functions, quality of life and daily living activities were the most common evaluated outcomes. The Fugl-Meyer Assessment, Berg Balance Scale, Timed Up and Go test, Barthel Scale and SF-36 were the most common outcome measurement tools. Conclusions: The studies indicated improvement in dynamic balance, upper limb motor function and quality of life after rehabilitation using VR. The VR was more effective than conventional treatments for the outcome of dynamic balance. Two studies did not find any changes in static balance and daily living activities. Physical aspects and quality of life were the outcomes most evaluated by the researchers; as were the population with chronic strokes and protocols of long duration and low intensity. Few studies targeted immediate VR effects, performance in daily living activities and social participation.

Aim and Background: The purpose of this study was to investigate the effectiveness of Virtual Reality Exposure Therapy (VRET) on reducing the symptoms of social avoidance and distress in people with Social Anxiety Disorder (SAD) . Materials and Methods: This was semi-experimental study was a pre-test-post-test design with control group. The statistical population of the study consisted of all students of Semnan University in the academic year of 2017-2018. Among them, 20 Students were selected by purposeful sampling and randomly assigned 10 subjects to the experimental group and 10 subjects to the control group. Students were screened for social anxiety disorder and diagnosis of other disorders from Structured Clinical Interview for DSM-4 (SCID-4) and Social Phobia Inventory (SPIN). The experimental group received individual VRET for 12 sessions, 30 minutes each week. Social Avoidance and Distress Scale (SADS) was administered among the selected sample as pretest. VRET was performed in experimental group, and again, the questionnaires were administered among the participants as posttest. Findings: The results showed that VRET is effective in reducing social avoidance and distress symptoms in in people with SAD. Conclusion: The results showed the effectiveness of this therapeutic model on reducing the symptoms of social anxiety. This method can be used as a new therapeutic approach for the treatment of SAD and other same disorders.

One of the pillars which underpins active aging is found in the performance of physical activity. While adherence to physical activity programs has traditionally been low in older people, immersive virtual reality (IVR) could provide an alternative and complementary training mode. A randomized clinical trial was conducted to explore the feasibility and effects of a 10-week IVR exergame program on physical functions of 24 institutionalized older adults who were allocated to an experimental group (EG n = 13; 85.08 ± 8.48 years) and control group (CG n = 11; 84.82 ± 8.10 years). The IVR intervention was feasible, with no adverse effects being reported (no Simulator Sickness Questionnaire symptoms; low negative experience scores on the Game Experience Questionnaire < 0.34/4), no dropouts, high adherence, and good post-gaming usability (System Usability Scale > 73.96%). The EG showed significant improvements: Tinetti scores for balance (1.84 ± 1.06; p < 0.001), gait (1.00 ± 1.08; p < 0.001), total score (2.84 ± 1.67; p < 0.001), and handgrip (4.96 ± 4.22; p < 0.001) (pre–post assessment). The CG showed significantly worsened compared to the EG: Five times sit-to-stand test, Tinetti scores for balance, gait, and total score, and the Timed Up and Go test total score (post-assessment). The findings show that the IVR intervention is a feasible method to approach a personalized exercise program and an effective way by which to improve physical function in the target population.

Virtual Reality Therapy (VRT) has been shown to be effective in treating anxiety disorders and phobias, but has not yet been widely tested for Substance Use Disorders (SUDs) and it is not known whether health care practitioners working with SUDs would use VRT if it were available. We report the results of an interview study exploring practitioners’ and researchers’ views on the utility of VRT for SUD treatment. Practitioners and researchers with at least two years’ experience delivering or researching and designing SUD treatments were recruited (n = 14). Interviews were thematically analyzed, resulting in themes relating to the safety and realism of VRT, and the opportunity for the additional insight it could offer to during SUD treatment. Participants were positive about employing VRT as an additional treatment for SUD. VRT was thought suitable for treating adults and people with mental health issues or trauma, provided that risks were appropriately managed. Subsequent relapse, trauma and over-confidence in the success of treatment were identified as risks. The opportunity VRT offered to include other actors in therapy (via avatar use), and observe reactions, were benefits that could not currently be achieved with other forms of therapy. Overall, VRT was thought to offer the potential for safe, realistic, personalized and insightful exposure to diverse triggering scenarios, and to be acceptable for integration into a wide range of SUD treatments.

Background: Recently, there is an increased number of studies that use 360° virtual reality (VR) video for medical and rehabilitative purposes. However, the 360° VR video experience for older adults has not yet been investigated. This study aimed to examine the validity of an 360° VR video-based immersive cycling training system (360° VRCTS) for older adults and to provide preliminary evidence of efficacy.Methods: We developed a new virtual reality training system using an immersive environment 360° VRCTS. Five healthy older adults (2 males and 3 females) participated in this study. The system was tested in a single training session (biking for 20 min while viewing a 360° VR video scene through a large curved screen) to identify its strengths and weakness. The usability and acceptability of our system were measured using the system usability scale (SUS) and the simulator sickness questionnaire (SSQ).Results: All participants successfully completed the session without any discomfort. The average score for the SUS was 94.60 (range, 90-100), indicating high usability of the technology. The average score for the SSQ was 2.24 (standard deviation = 2.05), indicating that the system is well tolerated and has few side effects.Conclusions: The 360° VRCTS may be a useful indoor training system for older adults due to its easy manipulation, high usability, and limited cybersickness.Trial Registration Number: Clinical Research Information Services (CRiS), KCT0003555 , Registered February 25, 2019, https://cris.nih.go.kr/cris/index/index.do . [ABSTRACT FROM AUTHOR]

Virtual Reality Therapy (VRT) has been shown to be effective in treating anxiety disorders and phobias, but has not yet been widely tested for Substance Use Disorders (SUDs) and it is not known whether health care practitioners working with SUDs would use VRT if it were available. We report the results of an interview study exploring practitioners' and researchers' views on the utility of VRT for SUD treatment. Practitioners and researchers with at least two years' experience delivering or researching and designing SUD treatments were recruited (n = 14). Interviews were thematically analyzed, resulting in themes relating to the safety and realism of VRT, and the opportunity for the additional insight it could offer to during SUD treatment. Participants were positive about employing VRT as an additional treatment for SUD. VRT was thought suitable for treating adults and people with mental health issues or trauma, provided that risks were appropriately managed. Subsequent relapse, trauma and over-confidence in the success of treatment were identified as risks. The opportunity VRT offered to include other actors in therapy (via avatar use), and observe reactions, were benefits that could not currently be achieved with other forms of therapy. Overall, VRT was thought to offer the potential for safe, realistic, personalized and insightful exposure to diverse triggering scenarios, and to be acceptable for integration into a wide range of SUD treatments. [ABSTRACT FROM AUTHOR]

Background: Telerehabilitation represents a new cutting-edge method in the treatment of patients suffering from motor and cognitive disorders caused by stroke. Even if there exist dedicated devices able to track patients' movements to evaluate the performed rehabilitation exercises, they require specific settings necessary for a correct and simple use at the patient's home. If we consider the recent pandemic situation and the lockdown condition, which made difficult the access to these products, post stroke patients may be not able to perform home rehabilitation. Objectives: the goal of this work is the design of a specific method to develop a telerehabilitation platform for post-stroke patients using consumer technologies without involving ad-hoc devices. Method: Open-source tools have been investigated for speeding up the development starting with the medical knowledge. Results: a group of four healthcare technologies engineering students with no specific skills about computer science has developed a platform in four months using the design method. Conclusion: the presented method allowed the development of a clinical knowledgebased web platform for post-stroke patients totally based on consumer technology. [ABSTRACT FROM AUTHOR]

Background: The new human coronavirus that leads to COVID-19 (coronavirus disease 2019) has spread rapidly around the world and has a high degree of lethality. In more severe cases, patients remain hospitalized for several days under treatment of the health team. Thus, it is important to develop and use technologies with the aim to strengthen conventional therapy by encouraging movement, physical activity, and improving cardiorespiratory fitness for patients. In this sense, therapies for exposure to virtual reality (VR) are promising and have been shown to be an adequate and equivalent alternative to conventional exercise programs.Aim: This is a study protocol with the aim of comparing the conventional physical therapy intervention with the use of a non-immersive VR software during COVID-19 hospitalization.Methods: Fifty patients hospitalized with confirmed diagnosis of COVID-19 will be divided in two groups under physiotherapy treatment using conventional or VR intervention: Group A: participants with COVID-19 will start the first day of the protocol with VR tasks in the morning and then in the second period, in the afternoon, will perform the conventional exercises (n = 25) and Group B: participants with COVID-19 will start the first day with conventional exercises in the morning and in the second period, in the afternoon, will perform activity with VR (n = 25). All participants will be evaluated with different motor and physiologic scales before and after the treatment to measure improvements.Conclusion: Considering the importance of benefits from physical activity during hospitalization, VR software shows promise as a potential mechanism for improving physical activity. The results of this study may provide new insights into hospital rehabilitation.Trial Registration:ClinicalTrials.gov, identifier: NCT04537858. Registered on 01 September 2020.

Introducing computer games to the rehabilitation market led to development of numerous Virtual Reality (VR) training applications. Although VR has provided tremendous benefit to the patients and caregivers, it has inherent limitations, some of which might be solved by replacing it with Augmented Reality (AR). The task of pick-and-place, which is part of many activities of daily living (ADL's), is one of the major affected functions stroke patients mainly expect to recover. We developed an exercise consisting of moving an object between various points, following a flash light that indicates the next target. The results show superior performance of subjects in spatial AR versus non-immersive VR setting. This could be due to the extraneous hand-eye coordination which exists in VR whereas it is eliminated in spatial AR.

Background: The new human coronavirus that leads to COVID-19 (coronavirus disease 2019) has spread rapidly around the world and has a high degree of lethality. In more severe cases, patients remain hospitalized for several days under treatment of the health team. Thus, it is important to develop and use technologies with the aim to strengthen conventional therapy by encouraging movement, physical activity, and improving cardiorespiratory fitness for patients. In this sense, therapies for exposure to virtual reality (VR) are promising and have been shown to be an adequate and equivalent alternative to conventional exercise programs. Aim: This is a study protocol with the aim of comparing the conventional physical therapy intervention with the use of a non-immersive VR software during COVID-19 hospitalization. Methods: Fifty patients hospitalized with confirmed diagnosis of COVID-19 will be divided in two groups under physiotherapy treatment using conventional or VR intervention: Group A: participants with COVID-19 will start the first day of the protocol with VR tasks in the morning and then in the second period, in the afternoon, will perform the conventional exercises (n = 25) and Group B: participants with COVID-19 will start the first day with conventional exercises in the morning and in the second period, in the afternoon, will perform activity with VR (n = 25). All participants will be evaluated with different motor and physiologic scales before and after the treatment to measure improvements. Conclusion: Considering the importance of benefits from physical activity during hospitalization, VR software shows promise as a potential mechanism for improving physical activity. The results of this study may provide new insights into hospital rehabilitation. Trial Registration: ClinicalTrials.gov, identifier: NCT04537858. Registered on 01 September 2020. [ABSTRACT FROM AUTHOR]

Driving phobia is a widespread anxiety disorder in modern society. Driving phobia disorders often cause difficulties in people's professional and social activities. A growing trend for treating driving phobia is to apply virtual reality exposure therapy (VRET). We refined the system's performance based on the previous research publication and have conducted a VRET pre-test research study with treatment and control group subjects to demonstrate the effectiveness of VRET. Some systemic problems were discovered in the first published experiment. For example, the experimental process and the virtual reality (VR) driving scenarios had to be modified to reflect realistic scenarios causing the fear of driving. These issues were identified and improvements made and verified in this research. A total of 130 subjects completed the driving behavior survey. Thirty subjects were randomly drawn from the subjects with high driving fear questionnaire scores and were invited to participate in the treatment experiments. The latest research presents the refined VRET for driving phobia disorders, including the revised system framework, the main modules and integration, and the subjects' biodata collection, management, and analysis. The experiment results provide strong evidence that the refined VRET design helps subjects overcome driving phobias. The subjects' subjective distress and fear of driving are reduced significantly through the implementation of VRET. [ABSTRACT FROM AUTHOR]

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Purpose: To assess the analgesic and anxiolytic effects of virtual reality (VR) augmentation in patients undergoing peripherally inserted central catheter (PICC) placement or fine-needle aspiration thyroid biopsy., Materials and Methods: This is a prospective, single-center randomized controlled trial with 107 patients enrolled. Patients were randomly assigned to receive standard of care (SOC) or SOC+VR during PICC or thyroid biopsy procedures. Pain and anxiety were individually measured using the visual analog scale (VAS) before and after the procedure. Vital signs including heart rate and systolic and diastolic blood pressure were recorded. One-way analysis of variance test and Games-Howell post hoc analysis were used to assess effect size and statistical significance between SOC and SOC+VR measures., Results: The PICC cohort consisted of 59 patients (33 in SOC+VR and 26 in SOC), with a median age of 53.1 years (interquartile range [IQR], 38.3-62.7 years). The thyroid biopsy cohort consisted of 48 patients (26 in SOC+VR and 22 in SOC), with a median age of 60.1 years (IQR, 49.0-67.2 years). One-way analysis of individuals undergoing thyroid biopsies with adjunctive VR revealed an effect size of -1.74 points (SE ± 0.71; P = .018) on VAS pain scale when compared with SOC. Analysis of individuals undergoing PICC placements revealed an effect size of -1.60 points (SE ± 0.81; P = .053) on VAS anxiety when compared with SOC., Conclusions: VR as a nonpharmacologic adjunct reduced some procedure-related pain and anxiety without increasing the procedural duration., (Copyright © 2024 SIR. Published by Elsevier Inc. All rights reserved.)

Background: Social anxiety disorder (SAD) places a profound burden on public health and individual wellbeing. Systemic inflammation may be important to the onset and maintenance of SAD, and anti-inflammatory treatments have shown promise in relieving symptoms of SAD. In the present study, we conducted secondary analyses on data from a randomized clinical trial to determine whether C-reactive protein (CRP) concentrations and social anxiety symptoms decreased over the course of virtual reality exposure therapy, and whether changes in social anxiety symptoms as a function of treatment varied as a function of CRP., Method: Adult participants (N = 78) with a diagnosis of SAD (59 % female) were randomized to receive exposure therapy alone, or exposure therapy supplemented with scopolamine. Social anxiety symptoms, salivary CRP, and subjective units of distress were measured across three exposure therapy sessions, at a post-treatment extinction retest, and at a 1-month follow-up., Results: CRP decreased over the course of treatment, b = -0.03 (SE = 0.01), p =.02 95 %CI [-0.06, -0.004], as did all social anxiety symptom domains and subjective distress. Higher CRP was associated with greater decreases from pre-treatment to 1-month follow-up in fear, b = -0.45 (SE = 0.15), p =.004 95 %CI [-0.74, -0.15], and avoidance, b = -0.62 (SE = 0.19), p =.002 95 %CI [-1.01, -0.23], and in-session subjective distress from pre-treatment to post-treatment, b = -0.42 (SE = 0.21), p =.05 95 %CI [-0.83, -0.001]. However, declines in CRP were not correlated with declines in fear, r = -0.07, p =.61, or avoidance, r = -0.10, p =.49, within-persons., Conclusions: Virtual reality exposure therapy may be associated with an improvement in systemic inflammation in patients with severe SAD. Pre-treatment CRP may also be of value in predicting which patients stand to benefit the most from this treatment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The presence of mental health conditions is pervasive in patients who experienced acute myocardial infarction (AMI), significantly disrupting their recovery. Providing timely and easily accessible psychological interventions using virtual reality-based cognitive-behavioural therapy (VR-CBT) could potentially improve both acute and long-term symptoms affecting their mental health., Aims: We aim to examine the effectiveness of VR-CBT on anxiety symptoms in patients with AMI who were admitted to the intensive care unit (ICU) during the acute stage of their illness., Methods: In this single-blind randomised clinical trial, participants with anxiety symptoms who were admitted to the ICU due to AMI were continuously recruited from December 2022 to February 2023. Patients who were Han Chinese aged 18-75 years were randomly assigned (1:1) via block randomisation to either the VR-CBT group to receive VR-CBT in addition to standard mental health support, or the control group to receive standard mental health support only. VR-CBT consisted of four modules and was delivered at the bedside over a 1-week period. Assessments were done at baseline, immediately after treatment and at 3-month follow-up. The intention-to-treat analysis began in June 2023. The primary outcome measure was the changes in anxiety symptoms as assessed by the Hamilton Anxiety Rating Scale (HAM-A)., Results: Among 148 randomised participants, 70 were assigned to the VR-CBT group and 78 to the control group. The 1-week VR-CBT intervention plus standard mental health support significantly reduced the anxiety symptoms compared with standard mental health support alone in terms of HAM-A scores at both post intervention (Cohen's d=-1.27 (95% confidence interval (CI): -1.64 to -0.90, p<0.001) and 3-month follow-up (Cohen's d=-0.37 (95% CI: -0.72 to -0.01, p=0.024). Of the 70 participants who received VR-CBT, 62 (88.6%) completed the entire intervention. Cybersickness was the main reported adverse event (n=5)., Conclusions: Our results indicate that VR-CBT can significantly reduce post-AMI anxiety at the acute stage of the illness; the improvement was maintained at the 3-month follow-up., Trial Registration Number: The trial was registered at www.chictr.org.cn with the identifier: ChiCTR2200066435., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To analyse the effect of virtual reality (VR) ther-apy combined with conventional physiotherapy on balance, gait and motor functional disturbances, and to determine whether there is an influence on motor recovery in the subacute (< 6 months) or chronic (> 6 months) phases after stroke. Methods: A total of 59 stroke inpatients (mean age 60.3 years (standard deviation (SD) 14.8); 14.0 months (SD 25.7) post-stroke) were stratified into 2 groups: subacute (n = 31) and chronic (n = 28). Clinical scales (Fugl-Meyer lower extremity (FM LE); Functional Independence Measure (FIM); Berg Balance Scale (BBS); Functional Ambulation Category (FAC); modified Ashworth scale (MAS); 10-metre walk test (10MWT); and kinematic parameters during specific motor tasks in sitting and standing position (speed; time; jerk; spatial error; length) were applied before and after treatment. The VR treatment lasted for 15 sessions, 5 days/week, 1 h/day. Results: The subacute group underwent significant change in all variables, except MAS and length. The chronic group underwent significant improvement in clinical scales, except MAS and kinematics. Motor impairment improved in the severe 29 FM LE points. Neither time since stroke onset nor affected hemisphere differed significantly between groups. The correlations were investigated between the clinical scales and the kinematic parameters of the whole sample. Moreover, FM LE, BBS, MAS, and speed showed high correlations (R2> 0.70) with independent variables. Conclusion: VR therapy combined with conventional physiotherapy can contribute to functional improvement in the subacute and chronic phases after stroke.

Some post-traumatic stress disorder (PTSD) patients do not benefit from imaginal exposure therapy. One possible approach to reach such patients are virtual trauma interventions. Herein, a qualitative scoping review was conducted. Different types of virtual trauma exposure interventions were identified. For each type of virtual trauma exposure interventions it was examined in detail: (1) which in sensu trauma exposure approach serves as therapeutic framework, how it was transferred into virtual reality, and if it was manualized; (2) which hardware and software were used; (3) whether the influence of spatial and social presence on the efficacy of virtual trauma interventions have been measured, and (4) whether the efficacy of virtual trauma interventions for PTSD patients having imagination difficulties was evaluated. These research questions were analyzed qualitatively. Accordingly, an extensive literature search was conducted using the databases Web of Science, PsycINFO, LIVIVO, PTSDpubs, and PubMed for scientific articles published between January 2013 and July 2020. Only studies aimed to reduce PTSD symptoms using virtual trauma interventions were included. The literature search was not limited to a specific study design, treatment/intervention method, or a minimum sample size. Eighteen studies were identified, which reported three different virtual trauma intervention approaches, namely, virtual reality exposure therapy (VRET), multi-modular motion-assisted memory desensitization and reconsolidation (3MDR), and action-centered exposure therapy (ACET). Seven randomized controlled trials (RCTs), two pilot studies, and one case study were focused on VRET; while two RCTs, one pilot study, and three case studies focused on 3MDR, and two case studies on ACET. Regarding the first research question (1), the results show that VRET is based on prolonged exposure, aiming for a virtual re-creation of the patient's traumatic recounting. Several treatment protocols exist for VRET. 3MDR is based on eye movement desensitization and reprocessing, aiming to reduce the patient's avoidance behavior. In 3MDR patients walk toward individualized trauma-related symbolic images in a cave automatic virtual environment (CAVE). One treatment protocol exists for 3MDR. ACET is based on the inhibitory learning theory, aiming for active interactions with a virtual trauma-associated environment to alter the anxiety structure through new secondary inhibitory learning. One treatment protocol exists for ACET. For the second research question (2), the results indicate that all VRET studies used head-mounted displays (HMDs) with a virtual version of the Iraq/Afghanistan or the World Trade Center attacks, while 3MDR studies utilized two different versions of a CAVE with personalized trauma-related images, and the ACET studies used HMDs with virtual street scenarios. For the third research question (3), the results demonstrate that the influence of spatial or social presence on the efficacy of virtual trauma interventions was not examined in any of the included studies. Similarly, for the fourth research question (4), the results show that empirical evidence for the efficacy of virtual trauma interventions on PTSD patients having imagination difficulties was lacking. Therefore, such empirical studies are needed to fill these research gaps.

Background: Transcranial direct current stimulation (tDCS) and therapy-based virtual reality (VR) have been investigated separately. They have shown promise as efficient and engaging new tools in the neurological rehabilitation of individuals with cerebral palsy (CP). However, the recent literature encourages investigation of the combination of therapy tools in order to potentiate clinic effects and its mechanisms.Methods: A triple-blinded randomised sham-controlled crossover trial will be performed. Thirty-six individuals with gross motor function of levels I to IV (aged 4–14 years old) will be recruited. Individuals will be randomly assigned to Group A (active first) or S (sham first): Group A will start with ten sessions of active tDSC combined with VR tasks. After a 1-month washout, this group will be reallocated to another ten sessions with sham tDCS combined with VR tasks. In contrast, Group S will carry out the opposite protocol, starting with sham tDCS. For the active tDCS the protocol will use low frequency tDCS [intensity of 1 milliampere (mA)] over the primary cortex (M1) area on the dominant side of the brain. Clinical evaluations (reaction times and coincident timing through VR, functional scales: Abilhand-Kids, ACTIVLIM-CP, Paediatric Evaluation of Disability Inventory-PEDI- and heart rate variability-HRV) will be performed at baseline, during, and after active and sham tDCS.Conclusion: tDCS has produced positive results in treating individuals with CP; thus, its combination with new technologies shows promise as a potential mechanism for improving neurological functioning. The results of this study may provide new insights into motor rehabilitation, thereby contributing to the better use of combined tDCS and VR in people with CP.Trial Registration:ClinicalTrials.gov, NCT04044677. Registered on 05 August 2019.

Abstract Background Amyotrophic Lateral Sclerosis (ALS) is a rapid progressive neurodegenerative disease, characterized by a selective loss of motor neurons, brain stem and spinal cord which leads to deterioration of motor abilities. Devices that promote interaction with tasks on computers can enhance performance and lead to greater independence and utilization of technology. Objective To evaluate performance on a computer task in individuals with ALS using three different commonly used non-immersive devices. Method Thirty individuals with ALS (18 men and 12 women, mean age 59 years, range 44–74 years) with a mean score of 26, (minimum score of 14 and maximum 41) on the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and 30 healthy controls matched for age and gender, participated. All participants were randomly divided into three groups, each using a different device system (motion tracking, finger motion control or touchscreen) to perform three task phases (acquisition, retention and transfer). Results Both the ALS and control group (CG) showed better performance on the computer task when using the touchscreen device, but there was limited transfer of performance onto the task performed on the Finger Motion control or motion tracking. However, we found that using the motion tracking device led to transfer of performance to the touchscreen. Conclusion This study presents novel and important findings when selecting interaction devices for individuals with ALS to access technology by demonstrating immediate performance benefits of using a touchscreen device, such as improvement of motor skills. There were possible transferable skills obtained when using virtual systems which may allow flexibility and enable individuals to maintain performance overtime. Trial registration Registration name: Virtual Task in Amyotrophic Lateral Sclerosis; Registration number: NCT03113630; retrospectively registered on 04/13/2017. Date of enrolment of the first participant to the trial: 02/02/2016.

Abstract Background The aim of this pilot study is to investigate the impact of virtual reality exposure therapy (VRET) on brain metabolism and connectivity. Eighteen patients with acrophobia were assessed by an 18F-FDG PET scan sensitized by virtual exposure before treatment, and nine of them were assessed again after eight sessions of VRET. Statistical Parametric Mapping was used to study the correlations between metabolism and pretherapeutic clinical scores and to compare metabolism before and after VRET (p voxel

Abstract Virtual reality therapy (VRT) has clinical indications in rehabilitation programs for the elderly; however, there is still no consensus on the recovery of body balance. The objective of this review was to summarize the effects of physical therapy interventions with VRT in the rehabilitation of balance in the elderly. The studies were identified via a systematic search in the databases PubMed, SciELO, LILACS and PEDro from 2010 onward. Clinical trials with interventions that involved VRT in the elderly were included in the study and were subjected to methodological quality analysis using the PEDro scale. A random effects meta-analysis of the studies that analyzed balance using the Berg Balance Scale and the Timed Up and Go (TUG) test was performed. Ten articles met the inclusion criteria, which presented variability in relation to the types of interventions used (70%) and the outcomes analyzed (60%). The mean duration of the interventions was 13.90 (± 5.08) weeks, with at least two weekly sessions (± 0.73). There were positive results in relation to improvements in both dynamic and static balance (70% of the studies), mobility (80%), flexibility (30%), gait (20%) and fall prevention (20%). A summary of the meta-analysis showed mean effects on the Berg scale (standardized mean difference [SMD]: -0.848; 95% CI: -1.161; − 0.535) and the TUG test (SMD: 0.894; 95% CI: 0.341; 1.447). Individually, virtual reality is promising in rehabilitation programs for the elderly. The overall measures were sufficient to show beneficial effects of the therapy on balance in the elderly.

Some post-traumatic stress disorder (PTSD) patients do not benefit from imaginal exposure therapy. One possible approach to reach such patients are virtual trauma interventions. Herein, a qualitative scoping review was conducted. Different types of virtual trauma exposure interventions were identified. For each type of virtual trauma exposure interventions it was examined in detail: (1) which in sensu trauma exposure approach serves as therapeutic framework, how it was transferred into virtual reality, and if it was manualized; (2) which hardware and software were used; (3) whether the influence of spatial and social presence on the efficacy of virtual trauma interventions have been measured, and (4) whether the efficacy of virtual trauma interventions for PTSD patients having imagination difficulties was evaluated. These research questions were analyzed qualitatively. Accordingly, an extensive literature search was conducted using the databases Web of Science, PsycINFO, LIVIVO, PTSDpubs, and PubMed for scientific articles published between January 2013 and July 2020. Only studies aimed to reduce PTSD symptoms using virtual trauma interventions were included. The literature search was not limited to a specific study design, treatment/intervention method, or a minimum sample size. Eighteen studies were identified, which reported three different virtual trauma intervention approaches, namely, virtual reality exposure therapy (VRET), multi-modular motion-assisted memory desensitization and reconsolidation (3MDR), and action-centered exposure therapy (ACET). Seven randomized controlled trials (RCTs), two pilot studies, and one case study were focused on VRET; while two RCTs, one pilot study, and three case studies focused on 3MDR, and two case studies on ACET. Regarding the first research question (1), the results show that VRET is based on prolonged exposure, aiming for a virtual re-creation of the patient's traumatic recounting. Several treatment protocols exist for VRET. 3MDR is based on eye movement desensitization and reprocessing, aiming to reduce the patient's avoidance behavior. In 3MDR patients walk toward individualized trauma-related symbolic images in a cave automatic virtual environment (CAVE). One treatment protocol exists for 3MDR. ACET is based on the inhibitory learning theory, aiming for active interactions with a virtual trauma-associated environment to alter the anxiety structure through new secondary inhibitory learning. One treatment protocol exists for ACET. For the second research question (2), the results indicate that all VRET studies used head-mounted displays (HMDs) with a virtual version of the Iraq/Afghanistan or the World Trade Center attacks, while 3MDR studies utilized two different versions of a CAVE with personalized trauma-related images, and the ACET studies used HMDs with virtual street scenarios. For the third research question (3), the results demonstrate that the influence of spatial or social presence on the efficacy of virtual trauma interventions was not examined in any of the included studies. Similarly, for the fourth research question (4), the results show that empirical evidence for the efficacy of virtual trauma interventions on PTSD patients having imagination difficulties was lacking. Therefore, such empirical studies are needed to fill these research gaps. [ABSTRACT FROM AUTHOR]

Background: Transcranial direct current stimulation (tDCS) and therapy-based virtual reality (VR) have been investigated separately. They have shown promise as efficient and engaging new tools in the neurological rehabilitation of individuals with cerebral palsy (CP). However, the recent literature encourages investigation of the combination of therapy tools in order to potentiate clinic effects and its mechanisms. Methods: A triple-blinded randomised sham-controlled crossover trial will be performed. Thirty-six individuals with gross motor function of levels I to IV (aged 4–14 years old) will be recruited. Individuals will be randomly assigned to Group A (active first) or S (sham first): Group A will start with ten sessions of active tDSC combined with VR tasks. After a 1-month washout, this group will be reallocated to another ten sessions with sham tDCS combined with VR tasks. In contrast, Group S will carry out the opposite protocol, starting with sham tDCS. For the active tDCS the protocol will use low frequency tDCS [intensity of 1 milliampere (mA)] over the primary cortex (M1) area on the dominant side of the brain. Clinical evaluations (reaction times and coincident timing through VR, functional scales: Abilhand-Kids, ACTIVLIM-CP, Paediatric Evaluation of Disability Inventory-PEDI- and heart rate variability-HRV) will be performed at baseline, during, and after active and sham tDCS. Conclusion: tDCS has produced positive results in treating individuals with CP; thus, its combination with new technologies shows promise as a potential mechanism for improving neurological functioning. The results of this study may provide new insights into motor rehabilitation, thereby contributing to the better use of combined tDCS and VR in people with CP. Trial Registration: ClinicalTrials.gov, NCT04044677. Registered on 05 August 2019. [ABSTRACT FROM AUTHOR]