Virtual Reality in Health Context

P1: Pawel Bun et al (2016)

Participants: 20 Individuals, inclusive of people with and without fear of heights, and people with and without sight impairments.

Gender: 17 male, 3 female

Age range: 23 to 32 years old

Participants are divided into 4 main groups, according to their individual features:

Group 1: With no sight impairment and no fear of heights
Group 2: with both sight impairment and fear of heights
Group 3: with no sight impairment but with fear of heights
Group 4: with sight impairment, but no fear of heights

After preparation and initial pulse measurement, each user was transported to the roof of the building (in VR) and perform the following actions:

1) Enter one of the moving platforms
2) Go one level down
3) Leave the platform and enter a bridge between buildings
4) Go to another platform
5) Enter the platform
6) Go down to the ground level
7) Repeat the sequence in inverted order (get back to the roof using the same route)

The above tasks were done twice:

- first one using nVisor MH60 (expensive VR device)
- second one using Oculus Rift CV1 (low-cost device)

Measurement for fear of height symptom during experiment:

1) Pulse Rate with 2 Pulsometers
2) Manual pulse checking on neck artery for 30 seconds
3) Self-report from participants
4) Observation of participants reaction

Results

1. Group 3 participants took more time to complete the tasks.

2. Group 3 participants' body movement was less stable than other groups, and they also reported typical acrophobia (fear of heights) reactions, such as vertigo and leg tremor.

3. Group 3 has the highest overall pulse rate.

4. Maximal pulse rate was recorded during platform(elevator) ride, in Group 3. (113.2 bpm and 113.8 bpm)

5. For Group 1, 2 and 4, The difference in mean pulse rate value was approximately 8 bpm. While the maximal recorded value was 10bpm higher.

For Group 3, the diffference in mean pulse rate value was 13.2 bpm, and the maximal value was 17.2 bpm.

The difference in measured values were significantly higher in Group 3, when compared to the other groups.

P2: B. Giap et al (2019)

Participants: post cancer patients with self-reported moderate to severe 'chemo brain' symptoms

(number of participants was not specified in this study)

First 2 weeks: Participants was randomized to play VRT system or 2-D Luminosity, at their own home. 15-30 minutes session per day, 5 days a week.

Second 2 weeks: Rest. No game activity.

Last 2 weeks: Play 2-D Luminosity

Each participants were provided with the necessary equipments for both VRT system and 2-D Luminosity.

If participants over-exerted (e.g Heart Rate too high or Oxygen Saturation too low), system will pause and display warning.

Measurement of Dependent Variables

Primary Dependent Variables

1) PIPER fatigue score

To measure participants subjective fatigue level

Secondary Dependent Variables

1) standardized Patient Health Questionnaire (PHQ-9)

To measure participant's depression level

2) Mini Mental Status Exam (MMSE)

To assess Cognitive Dysfunction

3) Subjective Report

To assess pain

4) Observation of pain medication used by participants

To assess pain

Evaluation

First evaluation were scored pre-treatment

Followed by evaluations in 2 week intervals, for a total of 5 evaluations

Result

Mean score for fatigue using PIPER score.

Scale of 0 to 10

Severity:
0 none
1-3 mild
4-6 moderate
7-10 severe

8.6 for placebo

7.9 for 2-D Luminosity game

5.5 for VRT system

Mean score for depression using PHQ-9

Depression severity:
0-4 none
5-9 mild
10-14 moderate
15-19 moderately severe
20-27 severe

10 for placebo

7 for 2-D Luminosity game

3 for VRT system

Cognitive Dysfunction assessment using MMSE.

The lower the score, the more severe the level of dementia.

Improvement on MMSE by 5

P3:

Participants : 20 post stroke individuals

Players interact with the virtual objects in the virtual park through three scenarios (case studies)

1. Reach-Graps-Release fruit game
2. Reach-press-hold buttons game
3. Reach-Press button game

it is further assesed using an engagement questionnaire that was developed to assesed ReHabGame.

3 concepts that will be evaluated in the questionnaire

Flow , the enjoyment of the game

Presence , the sense of being within the game

Absorption , the total engagement in the present experience

a Motor Assessment Scale (MAS) is the standardised assessment tool for this study

RESULT ?

The majority of participants enjoyed the rehabilitation sessions and the ReHabgame
activities

the participants commented very positively and reported that
the activities covered a good ROM for the upper body

The finding showed that the therapy provides an adequate physical and mental engagement through sufficient visual feedback throughout the sessions.

P4 : Oh ,et al (2019)

Participants: 31 patients in the chronic phase of stroke who had previously undergone inpatient poststroke rehabilitation

Patients were randomly divided into a group by a computer program

Experimental

underwent real instrument training in a VR environment and were supervised by an occupational therapist.

Controlled

seated at a table and were subjected to a standardized treatment program

Measurements were evaluate and analuzed using certain guidelines

Manual Muscle Test (MMT)

hand grip test

Box and Block Test

9-Hole Peg Test (9-HPT)

modified Ashworth scale (MAS)

the Korean-Montreal Cognitive Assessment (K-MoCA)

RESULT?

experimental group exhibited significant improvements in the MMT and MAS for wrist extension

both control and experimental groups showed significant improvements in the MMT for finger extension

The experimental group showed significant improvements in the Box and Block Test

P5:

Participants: 60 older subjects aged 65 & above living in a nursing home.

Using VR Wii Fit

Exercise organized in 1 hour session held on 3 days a week for 6 weeks.

Conventional exercise

RESULTS

Independent test showed that there were no statistically significant difference in the average pre-test PPA values and numbers of falls over previous one year between two groups.

Two-way repeated measures of ANOVA did show significant interactions in the PPA scores and falls incidence.

P6:

A brief study on Virtual Reality and its applications for the COVID-19 pandemic is carried out by
employing keywords as Virtual reality or VR and COVID-19 from the databases of SCOPUS, Google
Scholar, PubMed, Web of science Academia and ResearchGate.

P7:

Participants: 14 stroke survivors with disabilites

Two-part study

Field study of traditional art-making

Weekly site visits that lasted for 2 hrs and 30 mins

Experiential VR interviews using 3D tool as technology probe

One-on-one experiential interviews in person while participant used VR

Each participant had a single session of 35 minutes

Asked participants to describe the experience, perceptions of VR art compared to traditional art

P8:

gameChange

Scenarios

The list of six gameChange scenarios was generated by the Lived Experience Advisory Panel(LEAP), and includes:

•a bus;
•a street;
•a cafe;
•a pub;
•a doctor's waiting room;
•a shop.

Specifically designed to activate fearful cognitions and thus provide opportunities for the patient to test out their fears

VR Therapy

Begins in the coach’s room where the patient meets Nic, their virtual coach

Each session lasts approximately 30 minutes

In each scenario, patients have to carry out key tasks

Usability testing

Usability questionnaire was developed during the project

Patients with lived experience of psychosis completed a session of gameChange VR therapy, providing feedback and completing the usability questionnaire.

Formal usability testing (pre-completion)

5 patients

Second usability testing (post-completion)

6 patients

Success criterion set at beginning of project was for 90% of users to rate gameChange as immersive, easy to use and engaging.

Success criterion was achieved

P9:

Participants:Four experts working in the field of physiotheraphy tested the product

Physical rehabilitation is bounded to the rotator cuff on the right shoulder

The game developed in this work focuses on abduction & adduction

The rehabilitation session can be either supervised or
autonomous

The sight is block when the patient wear the virtual reality, so he is unable to see himself moving his upper trunk joints (ie the shoulder, elbow & hand)

RESULTS

The movement performed by the patient would correspond to those required by a treatment of active kinesiotherapy and performing shoulder abduction of over 90 degrees would achieve an increase of the shoulder joint mobility, which would in any case depend on the patient and the injury severity.

None of the experts suffered from dizziness, nausea or other sickness while wearing the virtual reality glasses

They all think that the animations are fluid
(The game is running at a minimum rate of 30 frames per second).

They have pointed out that an average assisted kinesiotherapy for a patient with shoulder injury takes
about 20 minutes, and engaging in the soccer game could allow them to complete the exercises on their own

They agree on the fact that at least the first session must be supervised by a physiotherapist to check that
the patient is performing the right movements, and the supervised session mode has proven successful for that
purpose.

One expert stated that the system should have a feature to limit the exercises time, to prevent patients from
performing the movements during too much time, thus reducing the effectiveness of the treatment.

experts showed interest and expectation in the developed proof of concept, and they agreed on the fact that virtual reality and motion tracking are promising technologies to be applied to physical rehabilitation

P5:

Participants: 60 older subjects aged 65 & above living in a nursing home.

Using VR Wii Fit

Exercise organized in 1 hour session held on 3 days a week for 6 weeks.

Conventional exercise

RESULTS

Independent test showed that there were no statistically significant difference in the average pre-test PPA values and numbers of falls over previous one year between two groups.

Two-way repeated measures of ANOVA did show significant interactions in the PPA scores and falls incidence.

P1: Pawel Bun et al (2016)

Small sample size + Low statistical power

The results on this study might not be generalizable to all people with acrophobia (fear of heights).

Low ecological validity

This is because, the experiment is conducted in a highly controlled environment. This means that the findings in the study might be ungeneralizable to real-life situations.

Decrease in Immersion level for some participants

Participants with sight impairments were not allowed to wear glasses or contact lenses. This makes the their sight blurry through-out the experiment, heavily decreasing their immersion level.

P2: B. Giap et al (2019)

Number of paritcipants not specified.

P3:

sample of participants

not fully representative of the diverse population of stroke patients

ethics approval process

time-consuming therefore the study was limit to the volunteers of communities.

P4 : Oh ,et al (2019)

Small sample size

did not evaluate the long-term effects of the intervention, only the effects at 1 month after training.opic

baseline parameters were not set closely between the experimental and control group due to the small sample size of this trial.

P5: N/A

P6:

Some of them are in starting phase. In the future, it will be more challenging and competitive
for VR in terms of effectiveness, precision, economic facts, etc.

P7:

Lack of control

Unable to apply fine pressure with fingers and hands with controller

Inability to achieve a desired shape

Virtual brush strokes created with a controller and trigger yielded less sense of control

Tiring

Mid-air gestures may require more strength hence losing precision with fatigue

Lack of social interaction with other participants

Constrained timing

Participants did not have time to develop knowledge and facility with the materials

Result was not as expected

Printed screenshot was relatively meaningless and disconnected from the embodied experience of art-making

VR headset made several participants nervous

P8:

N/A

P9:

N/A

P10: N/A

P1: Pawel Bun et al (2016)

Hardware

nVisor MH 60

Represents expensive VR device

Oculus Rift V1

Represents low-cost VR device

Beurer PM200+ meter

Measure Pulse Rate (bpm: beats per minute)

OMRON M2 HEM-7121-E

Measure Pulse Rate (bpm: beats per minute) and blood pressure (measurements of blood pressure not stated in the study). Additional pulse rate measurement, to confirm validity.

Windows Compatible Joystick

To be used with VR devices, for movement in VR environment.

Software

3D Studio Max

Create VR application

EON Studio

3D engine for nVisor MH 60

Unreal Engine

3D engine for Oculus Rift V1

P2: B. Giap et al (2019)

Hardware

VR Headset (Model not specified)

To be used in VRT System

Body Motion Sensor (BMS)

To be used along with 'Portable peddler' to simulate cycling motion in VRT System.

Biometric Sensor for Heart Rate (HR) and Oxygen Saturation (O2Sat)

To check if participants are over-exerted when playing the game in VRT System

Portable peddler

To be used along with Body Motion Sensor (BMS), to simulate cycling motion in VRT system

Software

VRT Software

2-D Game Luminosity

P3:

Hardware

Microsoft Kinect™

The postural balance (increments of displacement of the person’s centre of mass and upper body joints)

Thalmic™ Labs Myo

upper-arm function; hand movements; and advanced hand activities data

Software

The Monte-Carlo Tree Search (MCTS)

Random object (ROG) generator

P4 : Oh ,et al (2019)

Joystim for the VR combined with real instrument training

3-dimensional manipulator

Monitor

Conventional computer

various instruments with 3 degrees of freedom

P5:

Hardware

Nintendo Wii Fit Balance Board

P7:

Software

Google's Tilt Brush

used as the technology probe

an open-ended painting tool

works with two different controllers

Hardware

Oculus Rift controller

designed for a specific left and right hand

HTC Vive controller

designed for use for the left and right hand

P8:

Software

gameChange is an automated psychological therapy

Development was carried out by Oxford VR

a spin-out company from the University of Oxford

Hardware

gameChange can be delivered using commercially available VR equipment

P9:

Hardware

Oculus Rift DK2 (VR Glasses)

Intel RealSense (Motion-Tracking device)

Software

Developed using Unity3D

Soccer game and the patient takes the role of the goalkeeper

P10:

Hardware

Oculus GO VR

Software

Forest of Senerity (Holosphere VR, Birmingham,UK) application

P1: Pawel Bun et al (2016)

(None stated)

P2: B. Giap et al (2019)

(None stated)

P3 : Esfahlani ,et al (2017)

virtual reality (VR) rehabilitation techniques could create an environment that recovers health conditions as well as community integration

VR as a computer-based, interactive, multi-sensory
environment that occurs in real-time.

It provides enhanced feedback about movement
characteristics, and advanced motor task learning and execution

P4 : Oh ,et al (2019)

Virtual reality is a computer hardware and software systems that generate simulations of imagined environments via visual, auditory, and tactile feedback

P6: Singh, et al (2020)

Virtual reality (VR) is defined as developing simulated expertise which is somewhat similar to the real-time situation.

P7: Alex et al., 2021

Virtual reality provides a sense of presence fostered by a head-mounted display that situates the user in an immersive environment.

VR has been lauded as a promising form of rehabilitation because of its ability to provide rich visual experiences and transferable skills, control over dynamic environments and measurements of responses, and the ability to present greater risks than would be possible in real life.

P8: Lambe et al., 2020

VR is described as a three-dimensional computer simulations of environments that can be navigated around and interacted with.

Virtual environments can elicit similar cognitive and emotional responses to their real world counterparts.

P8:Baldominos et al., 2015

The term "Virtual Reality" is referred explicitly to immersive 3D virtual reality such as that attained using 3D glasses

P1: Pawel Bun et al (2016)

The conducted studies has proven that the low-cost, newly developed VR devices can be successfully used for building immersive Virtual Reality applications for exposure therapy
of certain phobias.

As predicted earlier, using large area tracking system allows better immersion.

P2: B. Giap et al (2019)

The combination of VR gameplay and mild exercise in the VRT system can improve Quality of Life by reducing pain and depression while improving fatigue and cognitive function.

Since VRT is non-invasiveness and entertaining, it improves motivation and compliance.

P3:

The therapy provided an adequate physical and mental engagement that offered sufficient visual feedback throughout treatment sessions.

Some positive elements of the ReHabgame that was claimed by the player were the beautiful scenery and appealing feedbacks they received which had a direct relation to the
engagement of a player.

aimed to distract the player’s attention towards the
exciting aspects of the game to avoid fatigue

P4 : Oh ,et al (2019)

real instrument in a VR environment is an innovation transactional intervention options for the comprehensive rehabilitation of patients in the chronic phase of stroke.

it has improved the functional ability of the upper extremites in the chronic phase of stroke.

it is more effective at promoting the recovery of the fine motor function compared to conventional therapy.

P5:

Wii Fit balance training was more effective than conventional balance training in reducing falls risk and incidence among these institutionalized older persons with a history of falls.

P7:

VR art-making has some potential as a rehabilitation medium because it enables artists to use the space around their bodies as a canvas through physical gesture.

VR art-making has some promise but needs significant improvements to support social interaction, situated decision-making, reflection, physical engagement with digital materials and meaning-making before it will be appropriate for artists with stroke-related impairments.

P9:

four experts tried and evaluated the game, concluding that its show promising results for the sake of shoulder rehabilitation, pointing out that an expert should supervise at least the first session.

P6

This concept has been broadly employed in the domain of the health sector and effectively
proposed in various diseases.
This approach also provides an extensive edge to defend and confront the present epidemic COVID-19
by enhancing the skill, confidence, performance and overall attitude of healthcare persons

P1: Pawel Bun et al (2016)

Treat various phobias, using various low-cost VR gear

P2: B. Giap et al (2019)

(None stated)

P3:

experiments involving individuals with motor impairment

to incorporate the possibility of implementing social
interactionsthrough online gameplay at patient’s home

That increases the motivation by gathering more patients to cooperatively (or competitively) interact and play the game

P4 : Oh ,et al (2019)

prefer to have a larger scale of participants

to clarify the limitation and to confirm the findings regarding the efficacy of VR combined with real instrument training on the neurorehabilitation of patients with stroke.

P7:

Social interaction

Could be possible to share VR displays to peer's devices

Unfolding materiality

Allow colors to 'age'

VR space

Teleport functionality should be redesigned to be simpler and more intuitive for low-mobility users

Accessibility

Customization function could help enable color selection with a single controller

Meaningful art

Animated graphic that captures the making from the perspective of participant

Comfort

Augmented reality has the additional benefit of a lighter headset similar to glasses

P6:

Further virtual reality application should be targeted over the formation of specifically planned rooms providing with several bigger screen fronts additional to the presently existing small camera screen front in the virutal reality headsets.

P8:

Aim is to recruit 432 patients with psychosis who are anxious going into everday situations

Patients are randomised either to the VR therapy plus usual care or to usual care only

The primary outcome measure is avoidance and anxiety in the real world

Secondary outcomes include activity levels measured by actigraphy and psychiatric symptoms

The clinical trial will be completed in January 2021

A process evaluation is being conducted to identify the facilitators and barriers to delivering gameChange in the UK’s National Health Service

P9:

For future work, full rehabiliation (abduction, adduction, flexion, extension, internal rotation and external rotation) as well as supporting rehavilitation of other muscles and joints (from both the upper and lower trunk)

P10:

N/A

P5:

N/A

P1: Pawel Bun et al (2016)

Confirms the usability of Low-Cost VR device to treat Acrophobia.

Allows acrophobic patients to get wider access to this therapy (VR Exposure Therapy)

P2: B. Giap et al (2019)

The VRT system is very considerate towards the patient. It pauses and display warning signs if patients is over-exerted.

This decreases the risk of having ethical issues, as it protects the patients from harm's way.

The study procedure is conducted in the patients' own home (real life setting), increasing its ecological validity.

The study proves that a combination of VR gameplay and mild exercise in VRT system, improves quality of life (QoL) of cancer patients.

This option might be cheaper in the long run, when compared to expensive medication or psychotherapy sessions, if integrated into their lifestyle gradually.

P3:

Their findings showed that the first process (combined VR and traditional treatment) was more efficient than the other.

movements learned in a VR environment are transferable to real-world similar motor tasks.

P5:

N/A

P6:

Decrease of harm & mistakes and more successful surgeries
Valuable approach for standard and unified education
Improving the teamwork in the medical team
Better learning of anatomical positions

P7:

8 participants enjoyed the experience

Increased upper limb activity

Several participants commented positively on the immersive nature

P8:

Results from the usability testing showed that participants found gameChange easy to use

P9:

An important advantage of virtual realityits that it can be used t0 enhance the development of proprioception
(Proprioception-perception or awareness of the position and movement of the body)