Non-immersive Virtual Reality Research Articles

The use of virtual reality for activities of daily living rehabilitation after brain injury: A scoping review.

Individuals with acquired brain injury (ABI) experience high rates of poor functional outcomes such as inability to complete activities of daily living (ADL). Occupational therapy needs to be customised to the individual's function, goals, and environment to facilitate improvement in ADLs after ABI. Virtual reality (VR) is a novel treatment approach that aims to improve skills within an individualised environment. This study aimed to review the current literature for the use of VR platforms that incorporate ADLs to improve functional outcomesafter ABI. This review followed the six-stage framework by Arksey & O'Malley (2005). Electronic databases were searched for peer-reviewed journal articles based on inclusion and exclusion criteria. One thousand and six hundred eighty articles were screened, including 413 full text articles and 13 articles were included for review. Among the 13 articles, six were RCTs and the rest were pre-post intervention studies. Studies largely used non-immersive VR platforms, which incorporated ADLs such as grocery shopping, aiming to improve functional outcomes. Consumer and community were not involved in executing this study. This review suggests mixed results if VR is effective at treating upper limb, cognition, and ADL function after ABI. Using their clinical reasoning, occupational therapists can determine the suitability of VR for ADL rehabilitation for specific patient populations and settings. Plain Language Summary Individuals who sustain an acquired brain injury can have difficulty performing their daily activities such as, making a meal or getting dressed, because of limited function (e.g., physical and cognitive problems). To help improve their ability to complete daily activities, occupational therapy needs to be customised to the individual's function, goals, and environment. Virtual reality is a new rehabilitation approach that allows individuals to improve their function in an individualised environment. In this study, we reviewed the current studies that have used virtual reality platforms that incorporate daily activities to improve functionafter acquired brain injury. We searched databases and screened the titles and abstracts of 1,680 studies. Then, 413 full-text studies were screened, and 13 studies were included. Studies mostly used non-immersive platforms to practise daily activities such as, grocery shopping, aiming to improve function after acquired brain injury. This review suggests mixed results if virtual reality can effectively treat function after acquired brain injury.

A machine learning approach to evaluate the impact of virtual balance/cognitive training on fall risk in older women

A machine learning approach to evaluate the impact of virtual balance/cognitive training on fall risk in older women

Effectiveness of non-immersive virtual reality exercises for balance and gait improvement in older adults: A meta-analysis.

Virtual reality (VR)-based physical exercise is an innovative and effective intervention strategy for healthcare in older adults. This meta-analysis aimed to clarify the effects of VR-based balance exercise programs on various balancing abilities of older adults. In addition, the effect size of each variable was computed by total exercise time, sensor type, avatar presence, and feedback type to determine influencing factors that lead to the success of VR-based rehabilitation programs. The databases searched were PubMed/Medline, CINAHL, NDSL, and Google Scholar. Inclusion criteria were: (1)independent older adults; (2) non-immersive VR exercise; (3) randomized controlled design; (4) both balance and gait data; and (5) written in English and Korean. The studies without information to compute effect sizes were excluded. Standardized mean difference was used to analyze the effect size (d). Twenty-five studies were finally included in this study. The main findings of this meta-analysis were as follows: (1)Non-immersive VR-based balance exercises are moderately and largely effective for improving overall balance function, (2) VR balance exercise was more effective for static balance than for gait, (3) VR exercise is more effective when avatars are presented and KP is provided as feedback. Total exercise time and mode of feedback are influencing factors that affect the effectiveness of VR-based balance exercises.

Understanding of non-immersive virtual reality technology in the context of museums via the lens of stimulus–organism–response (S–O–R) and aesthetics frameworks

ABSTRACT Guided by the Stimulus–Organism–Response (S–O–R) and aesthetics frameworks, this research investigated the impacts of non-immersive virtual reality (VR) aesthetics on visitors’ perceived utilitarian and hedonic values, attitudes toward VR, and visit intention. Three hundred and thirty-five respondents who had completed a virtual guided tour provided by the Hong Kong Railway Museum by using personal devices such as computers and smartphones without having the aid of more advanced technologies were surveyed. The results revealed that design aesthetics, interactivity aesthetics, and presence aesthetics of VR could strongly predict users’ cognitive and emotional reactions regarding their perceptions of utilitarian and hedonistic values, their attitude toward using VR, and their intention to visit the museums, with the exception that interactivity aesthetics was found to have no effects on the perceived utilitarian values. This study contributed by providing a newly formulated and tested theoretical framework that aids understanding of the role of aesthetics in VR technology in the specific context of museums. It also sheds light for museum operators on how VR innovation can evoke positive responses and attract more visitors.

Multimodal emotion classification using machine learning in immersive and non-immersive virtual reality

Affective computing has been widely used to detect and recognize emotional states. The main goal of this study was to detect emotional states using machine learning algorithms automatically. The experimental procedure involved eliciting emotional states using film clips in an immersive and non-immersive virtual reality setup. The participants’ physiological signals were recorded and analyzed to train machine learning models to recognize users’ emotional states. Furthermore, two subjective ratings emotional scales were provided to rate each emotional film clip. Results showed no significant differences between presenting the stimuli in the two degrees of immersion. Regarding emotion classification, it emerged that for both physiological signals and subjective ratings, user-dependent models have a better performance when compared to user-independent models. We obtained an average accuracy of 69.29 ± 11.41% and 71.00 ± 7.95% for the subjective ratings and physiological signals, respectively. On the other hand, using user-independent models, the accuracy we obtained was 54.0 ± 17.2% and 24.9 ± 4.0%, respectively. We interpreted these data as the result of high inter-subject variability among participants, suggesting the need for user-dependent classification models. In future works, we intend to develop new classification algorithms and transfer them to real-time implementation. This will make it possible to adapt to a virtual reality environment in real-time, according to the user’s emotional state.

Stepping into the virtual realm: Examining the utility of non-immersive VR on medical residents' self-efficacy, performance, and satisfaction

Central Venous Catheterization (CVC) is conducted in more than 5 million patients annually in the United States. Currently, CVC theoretical knowledge is typically taught with didactic lectures with minimal assessment of knowledge before simulation training and clinical environment. To assess CVC theoretical knowledge, virtual reality (VR) can develop residents’ surgical skills and can provide feedback on performance. While all types of VR can be used to assess improvements in residents’ knowledge prior to simulation training, few studies have compared the impact of non-immersive VR on improving resident knowledge. The current study was developed to identify the utility of a non-immersive CathSim VR on improvements in resident CVC theoretical knowledge, self-efficacy, and satisfaction when compared to a traditional multiple-choice assessment This was completed through an empirical investigation with 34 medical residents. The results showed that when compared to a traditional multiple-choice assessment, the non-immersive CathSim VR assessment led to improvements in self-efficacy and potentially better learning experience. Meanwhile, results also showed that there were no differences in assessment score, number of attempts, and overall satisfaction. Thus, we can conclude that non-immersive VR has the potential to be more effective than traditional multiple-choice test in improving self-efficacy and is as effective for residents’ assessment score, number of attempts, and overall satisfaction.

Non-immersive virtual reality based treatment for children with unilateral cerebral palsy: Preliminary results.

Unilateral cerebral palsy (UCP) represents about 30-40% of overall cerebral palsy diagnoses. Upper limb impairment has a significant negative impact on activities of daily living (ADL), and recent studies have shown that the use of virtual reality (VR) can increase motivation and promote an improvement in ADL. This preliminary study was aimed at exploring the acceptability and usability of a VR rehabilitation treatment, using the VITAMIN Platform, for children with UCP. A secondary goal of the study was to compare the results of usual standardized clinical scales and questionnaires with kinematic results as well as with the quantitative measures acquired by the VITAMIN platform in each exercise of the rehabilitation sessions. Six children with UCP (aged 7-15) were recruited for a preliminary investigation in using a non-immersive VR system. The treatment was composed of 10 weekly sessions of 45 minutes. Each child played five types of exergames, using the impaired upper limb to hit virtual objects projected on a wide screen. Standardized clinical scales, kinematic analysis, and questionnaires were used to extensively assess upper limb function before and at the end of treatment. Five typically-developing children provided a reference for the instrumented kinematic assessment. At the end of the treatment, Melbourne Assessment 2 (MA2) scores increased for all the participants (mean increase in range of movement (ROM) + 19.1%, accuracy + 4.6%, dexterity + 13.1%, fluency + 10.3%). Shoulder flexion-extension ROM also improved (mean increase + 10.5°), and according to the kinematic analysis, shoulder movements became more similar to reference profiles. These results were confirmed by a general improvement in performing ADL, assessed by the ABILHAND-Kids questionnaire. Finally, a general agreement among the different measures and indexes emerged from the acquired data. The results show that VR treatment with the VITAMIN platform could be engaging and functional for rehabilitation of children with UCP. The good agreement among the qualitative and quantitative measures and indexes confirms the potential of such novel treatment. However, due to the limited sample size and small number of sessions, further and larger investigations are required to evaluate the effectiveness and to generalize the results.

Comparison of Nonimmersive Virtual Reality and Task-Oriented Circuit Training on Gait, Balance and Cognition Among Elderly Population: A Single-Blind Randomized Control Trial.

Purpose: The purpose of this study was to determine the effects of nonimmersive virtual reality (VR) and task-oriented circuit training on gait, balance, cognitive domains, and quality of life among the elderly population. Methods: This is a single-blind randomized control trial in which 28 elderly individuals between 60 and 75 years were selected. The participants were divided into two groups, task-oriented circuit training and the other receiving nonimmersive VR treatment, with 14 participants in each group. To analyze the effects of both training on balance and gait time up and go test (TUGT), dynamic gait index (DGI), measures were used and for cognitive domains Montreal cognitive assessment (MoCA) scale was used. Short form 12 (SF-12) (along with two domains, Physical Component Summary and Mental Component Summary) was used for the measurement of quality of life. The treatment duration was 8 weeks for both groups. Both the pre-test and post-test readings were analyzed and compared. Results: The mean age of participants was 66.91 ± 3.79 years. Within-group comparison between the pre-test and post-test indicated that significant differences (P < 0.05) existed in all the outcome measures (TUGT, DGI, MoCA, and SF-12) in both groups. However, between-group comparison, significant differences were only found in TUGT and DGI in nonimmersive VR group. Conclusion: This study concluded that both interventions nonimmersive VR and task-oriented circuit training were beneficial for improving balance, gait, quality of life, and cognitive domains like memory, attention spans, executive functions, and so on in elderly population. However nonimmersive virtual reality training is a more effective, feasible, and safe alternative and can be proposed as a form of fall prevention exercise for the older adults. ClinicalTrials.gov Identifier: NCT05021432.

Comparative analysis of spatial ability in immersive and non-immersive virtual reality: the role of sense of presence, simulation sickness and cognitive load

This study investigates the effects of immersion on spatial ability in virtual reality (VR) and the influence of sense of presence, simulation sickness, and cognitive load. Participants performed a spatial ability task using a head-mounted display in an immersive or non-immersive VR condition. Contrary to expectations, immersive VR did not enhance spatial performance compared to non-immersive VR. Interestingly, cognitive load was positively associated with spatial ability in immersive VR but negatively associated with it in non-immersive VR. A higher sense of presence was associated with increased spatial ability for both conditions. Predictably, simulation sickness negatively impacted spatial ability in the more immersive condition. Sense of presence and simulation sickness correlated in the immersive condition but not in the non-immersive condition, indicating the importance of immersion as a covariate. These findings highlight a complex interplay of factors in immersive environments, challenging existing assumptions and providing insights for designing spatial environments in immersive and non-immersive virtual environments.

Improving Behavioral-Based Safety Training in Using Verbal Commands Through a Theory-Driven and Feedback-Based Nonimmersive Virtual Reality Game: Development and Usability Study.

The construction, chemical, aviation, medical, and health care industries have used serious games for safety training. To our knowledge, serious games have not been developed focusing on behavioral change to improve safety through the use of verbal commands and instilling players with heightened awareness of their spatial proximity to other people in their surroundings. We aimed to develop a theory-driven serious game for improving safety behavior using verbal commands and validate the implementation of the theoretical frameworks used for game development. The game developed, KitchenSpeak, was a first-person character (FPC) game where users respond to in-game prompts to use loud verbal commands when they are approaching another employee's blind spot. In addition to using the SERES framework in guiding the general game design and development, and the Reflection, Engagement, Choice, Information, Play, Exposition (RECIPE) framework to inform the design of the game mechanics, we also applied gestalt laws of perception for graphic design to guide the design of the game's user interface. We conducted 2 evaluative tests (alpha and beta) to collect end user and stakeholder feedback on the implementation of the theoretical frameworks, as well as to collect relevant information for full-scale implementation and a future validation study. The alpha and beta tests had 8 and 40 participants, respectively. The alpha test results revealed that the theoretical frameworks were adequately applied; however, suggestions were also made to modify and improve the game. The beta test results suggested further improvements for the game design and found no differences in the perception of ease of play between participants with and without previous FPC gaming experience (P=.47; Kruskal-Wallis). Results suggested that the game met its design and theoretical requirements, and it would be easily playable by all players regardless of their previous experience in FPC games. A theory-driven and evidence-based FPC game titled KitchenSpeak was developed to teach the use of kitchen-speak terms in commercial kitchens. Evaluative tests were conducted to validate the implementation of the theoretical frameworks. Our main contributions are creating and validating game-based training to improve behavioral-based safety in the workplace and the incorporation of gestalt laws of perception for graphic design in the game's user interface.

Healthcare Interventions for Children Using Nonimmersive Virtual Reality: A Mixed Methods Systematic Review

Nonimmersive virtual reality (NIVR), a computer-generated virtual reality experience wherein users are not fully immersed, has been increasingly used in pediatric healthcare. This study aimed to identify the effects of NIVR-based interventions for children. A mixed methods systematic review of relevant studies published until December 2023 was conducted. We included samples of healthy children and those with chronic conditions or disabilities, findings related to self-management or social skills, and the NIVR interventions applied. A convergent-integrated design was used for the synthesis. This review included 22 studies, of which 15 examined children having autism spectrum disorders. Utilizing NIVR was found to be effective in enhancing social skills. Participating in virtual communities with peers having similar conditions was determined to facilitate social support and identity exploration. Healthcare interventions using NIVR need to be explored further to improve self-management and social skills in children with various conditions.

Hip Arthroscopy Simulator Training With Immersive Virtual Reality Has Similar Effectiveness to Nonimmersive Virtual Reality

PurposeThe purpose of this study was to (1) compare the efficacy of immersive virtual reality (iVR) to non-immersive virtual reality (non-iVR) training in hip arthroscopy on procedural and knowledge-based skills acquisition and (2) evaluate the relative cost of each platform. MethodsFourteen orthopaedic surgery residents were randomized to simulation training utilizing an iVR Hip Arthroscopy Simulator (n=7; PrecisionOS, Vancouver, Canada) or non-iVR simulator (n=7; ArthroS Hip VR; VirtaMed, Zurich, Switzerland). After training, performance was assessed on a cadaver by four expert hip arthroscopists through arthroscopic video review of a diagnostic hip arthroscopy. Performance was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and Arthroscopic Surgery Skill Evaluation Tool (ASSET) scores. A cost analysis was performed using the transfer effectiveness ratio (TER) and a direct cost comparison of iVR to non-iVR. ResultsDemographic characteristics did not differ between treatment arms, by training level, hip arthroscopy experience, or prior simulator use. No significant differences were observed in OSATS and ASSET scores between iVR and non-iVR cohorts (OSATS: iVR 19.6±4.4, non-iVR 21.0±4.1, p=0.55; ASSET: iVR 23.7±4.5, non-iVR 25.8±4.8, p=0.43). The absolute TER was 0.06 and there was a 132-fold cost difference of iVR to non-iVR. ConclusionsHip arthroscopy simulator training with iVR had similar performance results to non-iVR for technical skill and procedural knowledge acquisition after expert arthroscopic video assessment. The iVR platform had similar effectiveness in transfer-of-skill compared to non-iVR with a 132-times cost differential.

A comparison of immersive vs. non-immersive virtual reality (VR) exercises for the upper limb: A functional near-infrared spectroscopy (fNIRS) pilot study

A comparison of immersive vs. non-immersive virtual reality (VR) exercises for the upper limb: A functional near-infrared spectroscopy (fNIRS) pilot study

Improving Learners’ Self-Efficacy in Performing Design Reviews with Virtual Reality

Research on the use of innovative technology, such as virtual reality (VR), in Architecture, Engineering, and Construction (AEC) education, has been growing in the past twenty years. However, such research still requires robust investigation, as few studies have adopted educational psychology theories and rigorous methods. Furthermore, most of the research has focused on the cognitive effects of VR and additional research is also needed to investigate the affective effects, such as motivation, engagement, and self-efficacy. This study aims to evaluate the effects of technology decision-making between immersive virtual reality (IVR) and non-immersive virtual reality (nIVR) setups for a learning activity on AEC learners. For this, three hypotheses are formulated and tested on 165 UK students. Based on the results, both the designed IVR and nIVR learning activities had significant positive effects on learners’ self-efficacy and user experience with no significant difference between IVR and nIVR delivery. With this research, the authors contribute to the growing literature on VR implementation in AEC classrooms by showcasing a study founded on educational psychology theory and by using a rigorous research methodology. Furthermore, this study illustrates the effects that IVR and nIVR have on students’ affective learning and opens the possibility of new research in the field.

Dance Exergames for Older Adults: A Systematic Review and Meta-Analysis With Narrative Synthesis.

A systematic review and meta-analysis with narrative synthesis was conducted to evaluate the impact of dance exergaming on older adults' health-related outcomes and its feasibility, usability, and safety. PubMed, Scopus, CINAHL, Web of Science, The Cochrane Library, ProQuest Dissertations and Theses Global, and Google Scholar were searched from inception to December 7, 2023. Interventional studies using immersive or nonimmersive virtual reality platforms conducted on older adults ≥60 years old were eligible. Meta-analysis was conducted using the random effects model by pooling mean differences (MD) or standardized mean differences. Outcomes were narratively synthesized when meta-analysis was not possible. Forty-three articles from 37 studies were included (n = 1139 participants at baseline). Postintervention, dynamic balance measured using Berg Balance Scale (pooled MD = 2.65, 95% CI: 1.73-3.57, p < .0001), Timed-Up-and-Go times (pooled MD = -1.04, 95% CI: -2.06 to -0.03, p = .04), choice stepping reaction time (pooled MD = -92.48, 95% CI: -167.30 to -17.67, p = .02), and movement time (pooled MD = -50.33, 95% CI: -83.34 to -17.33, p = .003) were significantly better in the experimental group compared to the control group. Adherence ranged from 76.5% to 100%, whereas attrition ranged from 9.1% to 31.9%. Most participants completed the intervention with no or minimal adverse effects. Dance exergames are effective, feasible, usable, and safe for older adults. Further research is needed as the findings were limited by small sample sizes. Many studies could not be included in the meta-analysis as outcomes were too varied.

Rehabilitation via HOMe-Based gaming exercise for the Upper limb post Stroke (RHOMBUS): a qualitative analysis of participants’ experience

ObjectiveTo report participants’ experiences of trial processes and use of the Neurofenix platform for home-based rehabilitation following stroke. The platform, consisting of the NeuroBall device and Neurofenix app, is a...

Assessing the Therapeutic Impact of Virtual Reality Interventions on Upper Limb Range of Motion and Functional Mobility in Pediatric Patients with Spastic Hemiplegic Cerebral Palsy: A Faisalabad-based Study

Cerebral palsy is a non-progressive central nervous system injury, most common in children, resulting from the damage to brain. Objectives: To see the effects of non-immersive virtual reality on range of motion, muscle strength, spasticity and functional mobility of upper limb in spastic hemiplegic cerebral palsy children. Methods: This was a quasi-experimental study, in which participants were selected through simple random sampling on the basis of defined selection criteria, there were two groups. Group A received conventional physical therapy exercises and group B was a received functional mobility exercises using non-immersive virtual reality. Data collection tools included Modified Ashworth scale to measure the spasticity, Functional assessment scale for functional status, Goniometer was used to measure the rage of mobility and Manual muscle testing MMT was used to measure the strength. Data was analyzed by SPSS version 26. Results: Mean age of children was 9.818 ± 2.639. From total participants 63.6% were males and 36.4% were females CP child. Paired-t test sowed that, there was a statistically significant difference in means of all outcome measures before and after treatment in group-A as well as in group–B (p-value&lt;0.05). Between-group analysis of A and B showed a statistically significant difference with p-value ≤0.05. Conclusions: Both groups showed improvement in spasticity, functional status, range of motion and muscle strength, but treatment group receiving functional mobility exercises using non-immersive virtual reality was found to be more effective than the control group.

Effects of Immersive and Non-Immersive Virtual Reality Training Program on EEG of Stroke Patients

Effects of Immersive and Non-Immersive Virtual Reality Training Program on EEG of Stroke Patients

Enhancing Upper Limb Recovery and Reducing Stress and Anxiety Through Non-Immersive Virtual Reality in Subacute and Chronic Stroke Survivors: An Experimental Study

Introduction: Stroke is the third-leading cause of major long-term disability and the second-leading cause of mortality worldwide. Paralysis, paresis (muscle weakness), spasticity, difficulty walking, difficulty controlling motions, and limb discomfort are frequent limb impairments. Nearly 80% of stroke survivors are affected. Stroke survivors suffer with physical disabilities in addition to a reduced quality of life in terms of their health, a higher degree of worry, and a loss of independence. With a prevalence of 55% to 75%, hand motor deficits are the most prevalent post-stroke.1 The most common impairment is motor dysfunction, which affects 90% of stroke survivors with some kind of upper limb motor disability. Motor dysfunction is a strong indicator of poor functional recovery. The most typical post-stroke symptom is hemiparesis.1 Objectives: The study's objective was to use a virtual reality system to enhance upper limb strength and function in hemiparesis. The study's secondary goal was to lessen tension and anxiety in stroke Survivors. Methods: This research was experimental. A patient was chosen from UEM Hospital in Jaipur, Rajasthan, based on inclusion and exclusion criteria. Upper Extremity Functional Index (UEFI) and Depression Anxiety Stress Scale (DASS-21) were employed as outcome measures to evaluate the patients. Result: The outcome of the post-intervention data revealed that the Upper Extremity Functional Index (UEFI) had significant values of P.311. P .002 was used to determine the importance of the Depression Anxiety Stress Scale (DASS-21). That indicates that following the intervention, all outcome indicators showed a considerable improvement. Conclusion: The post-intervention values of the depression anxiety stress scale (DASS 21) and the upper extremity functional index (UEFI) both indicated a substantial improvement. In order to improve strength and upper limb functions following hemiparesis and to lessen tension and anxiety as a result of the handicap, a low-cost VR system might be employed.

Virtual reality and augmented reality smartphone applications for upskilling care home workers in hand hygiene: a realist multi-site feasibility, usability, acceptability, and efficacy study.

To assess the feasibility and implementation, usability, acceptability and efficacy of virtual reality (VR), and augmented reality (AR) smartphone applications for upskilling care home workers in hand hygiene and to explore underlying learning mechanisms. Care homes in Northwest England were recruited. We took a mixed-methods and pre-test and post-test approach by analyzing uptake and completion rates of AR, immersive VR or non-immersive VR training, validated and bespoke questionnaires, observations, videos, and interviews. Quantitative data were analyzed descriptively. Qualitative data were analyzed using a combined inductive and deductive approach. Forty-eight care staff completed AR training (n = 19), immersive VR training (n = 21), or non-immersive VR training (n = 8). The immersive VR and AR training had good usability with System Usability Scale scores of 84.40 and 77.89 (of 100), respectively. They had high acceptability, with 95% of staff supporting further use. The non-immersive VR training had borderline poor usability, scoring 67.19 and only 63% would support further use. There was minimal improved knowledge, with an average of 6% increase to the knowledge questionnaire. Average hand hygiene technique scores increased from 4.77 (of 11) to 7.23 after the training. Repeated practice, task realism, feedback and reminding, and interactivity were important learning mechanisms triggered by AR/VR. Feasibility and implementation considerations included managerial support, physical space, providing support, screen size, lagging Internet, and fitting the headset. AR and immersive VR apps are feasible, usable, and acceptable for delivering training. Future work should explore whether they are more effective than previous training and ensure equity in training opportunities.