Revisiting Obstetric Brachial Plexus Injuries Through a Central Nervous System Lens: Toward Integrated Diagnostic and Therapeutic Frameworks.

Technology-Enabled Crisis Care for Youth: Bridging the Gap.

ABSTRACT Spirituality frequently emerges within professional practice settings that are not explicitly spiritual, particularly when individuals navigate uncertainty, suffering, or identity transitions. In secular counseling contexts, the introduction of client-defined spirituality may raise ethical, relational, and professional identity considerations related to competence, boundaries, and practitioner role. Contemporary scholarship conceptualizes spirituality as a dynamic process of meaning-making expressed within and beyond formal religious traditions. From this perspective, spirituality can be ethically engaged without positioning the counselor as a spiritual authority. This article presents a critically reflexive, practice-based analysis of a counseling relationship in which spirituality emerged within a secular therapeutic framework. Drawing on a condensed case illustration, the analysis examines how client-defined spirituality functioned as a resource for meaning-making and decision-making. Reality therapy’s WDEP framework (Wants, Doing, Evaluation, Planning) is examined as a structurally neutral process, that guides reflection without prescribing beliefs or values while remaining responsive to client-introduced spiritual content. Findings highlight reflexive humility, consultation, and boundary clarity as ethical practices. Spirituality remains client-defined, while co-construction refers to a process in which the counselor facilitates exploration and meaning-making without assuming interpretative authority. Ethical practice requires counselor reflexivity; in this case, it contributed to professional transformation, though personal change is not guaranteed.

Assessment and Treatment of Posttraumatic Stress Disorder via Digital Mental Health Technology.

IntroductionVirtual reality is a tool used in the rehabilitation of neurodegenerative diseases and vestibular disorders, enabling immersion in a playful and illusory world.ObjectiveTo determine the effects of vestibular rehabilitation with virtual reality in adults with vestibular disorders.Data SynthesisAppropriate word combinations were selected and tailored specifically to seven electronic databases. Studies that investigated vestibular rehabilitation with virtual reality in individuals > 18-years-old and diagnosed with vestibular dysfunction were included. The risk of bias and the certainty of the evidence was assessed. A random-effects meta-analysis was performed, with a total of 18 articles included. There was an improvement in the level of confidence in balance scores between baseline and postintervention of 11.22 (95% CI = 8.55–13.88; I2 = 18%). An improvement in the disabling effects caused by dizziness was also observed, with a difference between means in relation to the two periods of −22.76 (95% CI = -28.70 to -16.82; I2 = 88%). The certainty of evidence assessment was very low.ConclusionVirtual reality therapy in vestibular disorders has shown efficient results, being a useful, low-cost, and motivating tool in the treatment of these disorders.

Embodied therapies such as movement therapy have shown promise in enhancing emotional regulation, cognitive engagement, and physical rehabilitation. However, scalable and personalized delivery of such interventions remains a critical challenge. This work presents SIVAM (Synergy-based Intuitive Virtual and Augmented Mental Health platform), a multimodal system that integrates immersive virtual environments, markerless motion capture, physiological sensing, and humanoid robotic mirroring to support affect-aware interventions for mental health. SIVAM combines RGB camera-based skeletal tracking with EEG, EMG, ECG, GSR, and skin temperature sensing using a wearable dry electrode headset to create a closed-loop therapeutic framework. Movement synergies–low-dimensional coordinated patterns across body joints and muscles–are extracted from motion data and aligned with physiological signals to infer affective and motor states in real time, serving as potential biomarkers of stress. The system further introduces a plane-wise movement model that enables natural 3D avatar navigation using a single RGB camera, enhancing embodiment and interaction with virtual environments. A pilot study (N = 5) with five participants of varying dance experience demonstrated reliable motion tracking, real-time synchronization of physiological and movement data, and robust avatar and robot mirroring across diverse movements. These results highlight the feasibility of combining multimodal sensing, virtual avatars, and socially assistive robots to enable scalable, home-based movement therapy.

Colonoscopy frequently causes significant pre-procedural anxiety and intra-procedural pain. This randomized controlled trial evaluated immersive, culturally adapted virtual reality (VR) therapy on anxiety, perceived stress, pain, patient satisfaction, and hemodynamic stability in Palestinian adults undergoing colonoscopy. In a single-blinded RCT, 150 patients were randomized to VR (n = 75) or standard care (n = 75). All received standard pharmacological sedation; the VR group additionally received culturally adapted passive VR distraction. Primary outcomes: State-Trait Anxiety Inventory (STAI) and Perceived Stress Scale-10 (PSS-10). Secondary outcomes: pain (VAS/NRS), satisfaction, and hemodynamic parameters. Intention-to-treat analysis was applied. The VR group showed significantly greater reductions in post-procedural state-anxiety (29.7 vs. 38.0; p < 0.001; Cohen's d = 1.25) and perceived stress (19.1 vs. 23.9; p < 0.001; d = 0.93). VR patients reported lower pain (VAS 6.4 vs. 8.6; p < 0.001; d = 1.39) and higher satisfaction (84.9 vs. 63.2; p < 0.001; d = 1.70). Heart rates were significantly lower at 30 and 45 min intra-operatively (p < 0.001 and p = 0.002). VR-related side effects were minimal (4.0% mild transient dizziness). Immersive, culturally adapted VR is a highly effective, safe adjunct that significantly reduces anxiety, stress, and pain while improving satisfaction and hemodynamic stability during colonoscopy. Healthcare institutions should consider integrating VR into routine endoscopic care. VR is a cost-effective, patient-centered strategy that may reduce sedation needs and enhance colorectal cancer screening adherence. Trial Registration: ClinicalTrials.gov identifier: NCT07145203 (registered 21 August 2025).

Systematic review of virtual reality therapy in the treatment of visual dysfunction in children with ADHD and dyslexia.

In the context of 21st-century education, the increasing problems of student behavior and mental health require an individual empowerment-based counseling approach such as Reality Counseling which emphasizes internal control and conscious choice to overcome academic failure and build students' positive identities. This article aims to explore in depth the Reality Therapy approach developed by William Glasser and its relevance in the context of modern education. As an approach focused on the present and personal responsibility, Reality Counseling offers a practical framework through Choice Theory. The method used in this paper is a narrative literature study synthesizing various primary and secondary sources, including material from the William Glasser Institute. Key findings suggest that human behavior is driven by five basic genetic needs: survival, love and belonging, power, freedom, and fun. Through the concept of Total Behavior and the WDEP (Wants, Direction, Evaluation, Planning) Model, counselors can guide students to evaluate the effectiveness of their own behavior and develop more constructive action plans. Implications for guidance and counseling (BK) practice in schools include strengthening teacher-student relationships, increasing responsibility for learning, and developing a success identity. This article concludes that the systematic implementation of Reality Counseling can create a school environment without failure (Schools Without Failure) that supports the psychological well-being and academic achievement of students

High-impact chronic pain (HICP) involves substantial interference in functioning, affects 8.5% of the population, and leads to higher health care costs relative to low-impact chronic pain (LICP). Behavioral interventions such as virtual reality (VR) offer scalable and accessible treatment, but testing is needed to ensure durable effectiveness in HICP. We conducted a secondary analysis of the largest real-world dataset for a therapeutic skill-based VR vs a sham VR control to test treatment efficacy in HICP vs LICP. Relative to LICP, we found significantly larger (and clinically meaningful; ie, ≥2 points) pain interference and pain intensity reductions for HICP at end of treatment and 1 year posttreatment. End-of-treatment reduction in pain interference reclassified 70% (114/163) of participants with HICP as LICP, and this improvement held at 1 year posttreatment (104/155, 67%). This study examined the effectiveness of a 56-session skill-based VR therapy in HICP at 2 years posttreatment and compared the effects with those on LICP. We conducted a secondary analysis of the skill-based VR sample (536/1067, 50.2%) at 2 years posttreatment from a randomized controlled trial involving an in-home chronic low back pain sample that was recruited and tested online and was diverse (female: 411/536, 77%; non-White individuals: 166/536, 31%; high school or lower educational level: 102/536, 19%; mean age 50.8 years) and had clinically severe pain at baseline (intensity=6.6; interference=6.2; 42% with severe or complete disability). Focusing on the skill-based VR participants (536/1067, 50.2%) and using a validated approach, we classified participants at baseline as either HICP (baseline Brief Pain Inventory pain interference score>7) or LICP (baseline Brief Pain Inventory pain interference score<7). Clinical effectiveness was examined using a general linear model at 2 years posttreatment relative to baseline with the primary outcomes of pain interference and pain intensity. Participants with HICP (192/536, 35.8%) reported superior reductions in pain interference, pain intensity, sleep disturbance, and physical disability (P<.001 in all cases) at 2 years posttreatment compared to participants with LICP (344/536, 64.2%). Participants with HICP had clinically meaningful (≥2-point) reductions in pain interference (mean 3.1, 95% CI 2.66-3.54; effect size=1.12) and pain intensity (mean 2.6, 95% CI 2.18-3.02; effect size=1.01) at 2 years posttreatment. Importantly, reduced pain interference scores at 2 years posttreatment reclassified 71.1% (106/149) of the participants with HICP as LICP. No serious adverse events or side effects were reported. Patients with HICP experience severe pain that drives high health care use. The skill-based VR therapy demonstrated durable reductions in pain and related outcomes 2 years posttreatment, with the largest benefits observed in the HICP subgroup. These results suggest that a skill-based, VR-delivered therapy produces durable effects in patients with HICP, a population that is frequently overmedicalized and undertreated with behavioral interventions. These findings suggest that home-based VR-delivered therapy offers a scalable treatment option for this underserved population.

ABSTRACT This study, based on media richness theory and social cognitive theory, explores the materials, processes, and perceived effects of virtual reality (VR) therapy in the treatment of depression and anxiety in China. Through semi-structured in-depth interviews with 30 patients, results indicate that participants perceived VR therapy as enhancing their sense of immersion through real-time interaction, multisensory signals, and the integration of Chinese cultural elements. By examining patients’ experiences from the perspectives of modeling, self-efficacy, and outcome expectancies, most patients reported perceiving emotional relief. However, a few patients also reported limitations, including simplistic VR scenes, insufficient interactivity, and a decline in perceived effectiveness over time. This study suggests that future VR therapies should focus on cultural adaptation by designing treatment scenarios that resonate more deeply with local cultural characteristics, and on integrating VR therapy with other forms of treatment to support longer-term engagement through regular follow-ups and ongoing support. In addition, exploring multi-user interaction modes that allow patients to communicate with other patients or healthcare professionals in virtual environments is recommended.

Mental health conditions represent a global public health challenge, with persistent treatment gaps across healthcare systems despite available, effective interventions. Virtual reality therapy (VRT) offers a promising avenue for improving mental health service delivery; however, understanding practitioner acceptability is essential for successful implementation. This cross-sectional study examined the acceptability of VRT among mental health practitioners in Greece. Forty professionals (psychologists, psychiatrists, nurses, and social workers) working across hospital, community, and long-term care settings completed a structured questionnaire assessing familiarity with virtual reality and VRT, and the acceptability of VRT for anxiety disorders, bipolar disorder, schizophrenia, and its clinical integration. Overall, VRT was perceived as acceptable; acceptability was highest for anxiety disorders, followed by bipolar disorder and schizophrenia. Acceptability of VRT's clinical integration was low, with participants expressing concerns regarding service readiness, practitioner training, and long-term outcomes. Although practitioner familiarity with VRT was limited, they were open to VRT use, particularly as an adjunct. To our knowledge, this is the first study to examine VRT acceptability among mental health practitioners in Greece. The findings indicate that acceptability is shaped more by training, infrastructure, and culturally sensitive implementation than by resistance to technological innovation.

Truancy among high school students continues to be a serious concern that has negative effects on both academic outcomes and social development. This study seeks to analyze the application of reality therapy as an intervention to minimize truancy behavior. The research utilizes a literature review approach by evaluating six relevant scholarly articles published over the past decade. The findings suggest that truancy is caused by a combination of internal factors, such as lack of learning motivation and feelings of boredom, and external factors, including family environment and peer influence. Conventional approaches that rely heavily on punishment and external control are considered less effective in creating lasting behavioral improvements. On the other hand, reality therapy emphasizes personal responsibility, present actions, and self-assessment, allowing students to better understand their behavior and make more positive decisions. The results demonstrate that this approach enhances students’ self-awareness, responsibility, and decision-making abilities. Therefore, reality therapy can be regarded as an effective alternative counseling method to address truancy behavior in schools and to support long-term behavioral change.

This study examines the application of virtual reality (VR) therapies in dementia care through a systematic literature review and a qualitative analysis of caregiver responses from six aged care facilities in Australia. A PRISMA-guided review identified key technological trends, with VR emerging as a promising intervention alongside monitoring systems and robotics. The NASSS framework was applied to evaluate factors influencing technology implementation, highlighting challenges in long-term adoption, organizational readiness, and value propositions such as efficacy and scalability. To further understand VR’s real-world impact, nine semi-structured caregiver interviews were analysed using the Gioia method. Findings revealed seven aggregate dimensions, with VR strongly supporting social connection, emotional engagement, behavioural management, and memory recall. Caregivers emphasized that personalized and culturally meaningful content, such as nature scenes, seasonal activities, and reminiscence-based experiences, enhanced therapy outcomes and resident participation. Despite benefits, barriers including physical discomfort, fear of unfamiliarity, and lack of training were noted, particularly for residents with advanced dementia. Early exposure, shorter sessions, and tailored content were key drivers of adoption. This study underscores that successful VR integration requires user-centred design, ongoing adaptation, and alignment with care routines, highlighting the critical role of frontline staff in translating technological potential into meaningful dementia care outcomes.

Effectiveness of Virtual Reality on Hand Function for Patients with Hemiplegia After Stroke: A Meta-Analysis of Randomized Controlled Trials.

Dear Editor, We read with great interest the study by Groenveld et al (2025) on the early health economic evaluation of virtual reality (VR) therapy for postoperative pain management[1]. The integration of digital therapeutics with economic modeling is both timely and innovative, highlighting the potential of VR to transform pain management while optimizing healthcare resource utilization. Notably, the authors’ use of external validation, a feature often omitted in similar early-stage economic studies, enhances the credibility of their findings and demonstrates a commitment to methodological rigor. The TITAN Guidelines 2025 (Transparent and Interpretable Reporting of Artificial Intelligence in Medicine) now offer a structured roadmap for developing, validating, and transparently reporting AI-based diagnostics, ensuring reproducibility and fostering trust in clinical practice[2]. The study offers an important first step. However, there are several considerations warrant further reflection. First, generalizability of evidence The economic model relies heavily on early-phase trials with relatively small sample sizes. While the preliminary results are promising, the variability in patient populations, surgical procedures, and pain management protocols may limit generalizability. Expanding future analyses to multicenter or international datasets would strengthen the applicability of these findings across diverse clinical contexts. Second, beyond direct costs The current evaluation focuses primarily on direct intervention costs and immediate postoperative outcomes. Indirect costs such as long-term healthcare utilization, rehabilitation requirements, and broader societal impacts like productivity loss remain underexplored[3]. Incorporating these factors in subsequent analyses could substantially alter the perceived cost-effectiveness and provide a more comprehensive understanding of VR therapy’s value. Third, model assumptions and uncertainty Key assumptions regarding the durability of VR-induced analgesic effects, patient adherence, and potential variability across patient subgroups introduce inherent uncertainty[4]. More extensive probabilistic sensitivity analyses, as well as scenario modeling to capture real-world variability, would enhance the robustness of the economic conclusions. Fourth, holistic patient-centered outcomes While pain reduction is an essential endpoint, VR interventions may confer additional benefits, including reduced anxiety, increased patient engagement, and improved overall quality of life[5]. Integrating these patient-centered outcomes into economic modeling would better reflect the comprehensive therapeutic and economic potential of VR therapy. Finally, implementation and scalability considerations Despite the clear promise of VR therapy, real-world adoption depends on addressing logistical, infrastructural, and training barriers[6]. These factors can substantially influence both the feasibility and cost-effectiveness of VR integration into routine clinical pathways. Systematic evaluation of these challenges will be critical for translating early economic insights into practical clinical application. Conclusion Groenveld et al provide a pioneering contribution to the evaluation of digital therapeutics in postoperative care. By addressing the considerations outlined above, future work can translate this early-stage promise into robust, scalable, and generalizable evidence, ultimately informing clinical and policy decision-making. This study not only underscores the potential of VR as a cost-effective, patient-centered intervention but also sets a high methodological standard for early-stage economic analyses in digital health.

Virtual reality (VR) technology is increasingly being used in supportive care for cancer patients, aiming to improve their discomfort symptoms and enhance their health status and quality of life. Understanding patients' feedback and insights is crucial for improving the application of virtual reality among cancer patients. While numerous qualitative studies have examined the experiences and perspectives of cancer patients during their treatment with virtual reality, a comprehensive synthesis of these insights is missing. This review of qualitative evidence aimed to explore the experiences and perceptions of patients receiving VR therapy in cancer, providing guidance for the treatment and rehabilitation of cancer patients with VR technology. A computerised search of the Cochrane Library, PubMed, Embase, CINAHL, Web of Science Core Collection, CNKI, Wanfang, Vip and SinoMed was conducted to identify relevant qualitative studies. The enrolled participants were adult patients with cancer who were 18years of age or older. The search covered the period from establishing each database until May 2025. The Joanna Briggs Institute criteria for qualitative research were utilised to evaluate the quality of the studies. The data included in the literature were analyzed and integrated by "thematic synthesis" to formalize the identification and development of themes. A total of 12 studies were included, encompassing data from cancer patientswith an age range of 20 to 83years. Findings were integrated into 12 sub-themes and 4 themes: (1) experiences of cancer patients receiving VR therapy. (2) perceived benefits of VR therapy for cancer patients. (3) barriers to VR therapy for cancer patients. (4) needs and expectations of cancer patients receiving VR therapy. Each encompassed sub-themes. While most patients develop a strong interest in VR therapy and are willing to try it, some cancer patients express doubts and resistance due to poor human-computer interaction experiences, discomfort such as nausea or dizziness, or economic factors. Participants reported that VR therapy may serve as an effective approach to alleviate patients' physical pain, relieve psychological stress, and promote the recovery process. Additionally, cancer patients receiving VR therapy face various barriers and have put forward some needs and preferences to better apply VR therapy. Future studies should be conducted according to patients' feedback and suggestions on how to further optimize and improve VR therapy. PROSPERO CRD420251053989.

Introduction: Teaching is considered one of the most stressful occupations. This issue is more complex for female teachers due to multitude of roles and occupational and family responsibilities, causing them to experience high levels of job stress and work-family conflict. Given that reality therapy is an effective approach in enhancing responsibility and managing challenges, the aim of this study was to investigate the effect of group reality therapy on reducing job stress and improving work-family conflict in female high school teachers. Materials and Methods: This research was conducted as a quasi-experimental study with a pretest-posttest design and control group. The statistical population included all female teachers of secondary school level in district 2 of Yazd City in the academic year 2023-2024. Thirty teachers were selected using convenience sampling and randomly assigned to two experimental and control groups (15 participants each). The experimental group received 8 sessions of 60-minutes reality therapy, while the control group remained on a waiting list and received no training. Both groups were evaluated at pretest and posttest stages using the Job Stress Questionnaire of the United Kingdom Health and Safety Institute (1990) and the Work-Family Conflict Questionnaire of Net Mayer et al. (1996). Data analysis was performed using SPSS version 23 software and multivariate and univariate analysis of covariance. Results: The results showed that reality therapy had a significant effect on reducing job stress and work-family conflict (p&lt;01.0). Conclusion: The findings of this study indicate that group reality therapy can effectively reduce job stress and work-family conflict in female teachers; therefore, it is recommended that this approach be used as an effective intervention to promote the mental health of female teachers.

To map the applications and impacts of virtual reality in the care of critically ill patients in intensive care units. This scoping review followed the Joanna Briggs Institute guidelines and the PRISMA-ScR guidelines, where, according to the criteria during the selection stages, it was carried out by 2 independent evaluators. The search was carried out between February and March 2025, in the MEDLINE, Embase, LILACS, RCAAP, and HAL databases, initially resulting in 2803 articles, 28 of which were included in the final analysis after applying the inclusion criteria and excluding nonoriginal or non-peer-reviewed materials. The results indicated that virtual reality therapy had a high acceptance rate among patients and was considered safe and effective. However, technical difficulties in using the technology were also identified, as well as the need for more extensive and rigorous studies to assess its impact comprehensively. The mapped studies suggest that virtual reality has potential as a complementary tool in intensive care, especially in terms of promoting the well-being of patients and professionals, as well as opening up avenues for therapeutic and educational applications. However, there is a need for research with greater methodological rigor, to ensure the robustness of the results and enable replication in different contexts, as well as adaptations that consider diverse cultural, socioeconomic and regional contexts, such as those in Latin America, to ensure that interventions are effective and accessible in different realities.

Amblyopia affects 1-4% of the population and remains a leading cause of unilateral visual impairment, with adherence and residual deficits limiting outcomes of standard therapies. This systematic review and meta-analysis compared the effectiveness of conventional and emerging amblyopia treatments in children, adolescents, and adults with anisometropic, strabismic, or mixed amblyopia. Following PRISMA guidelines and PROSPERO registration (CRD420251123552), PubMed, Web of Science, and Scopus were searched up to 5 August 2025 for randomized controlled trials. Sixty-six trials (sample sizes 7-404) were included, with thirty-six contributing to the meta-analysis. Primary outcomes were best-corrected visual acuity (logMAR) and stereopsis. Risk of bias was assessed using the Cochrane tool, and certainty of evidence was assessed using GRADE. Atropine penalization and occlusion demonstrated equivalent effects on visual acuity (mean difference 0.04 logMAR; 95% CI -0.04 to 0.12; moderate-certainty evidence). Digital, dichoptic, binocular, and virtual reality therapies showed a statistically significant but small improvement over patching (mean difference 0.02 logMAR; 95% CI 0.00-0.04; low-certainty evidence). Pharmacological adjuvants combined with patching yielded slightly larger gains (mean difference 0.08 logMAR; 95% CI 0.03-0.13; low-to-moderate certainty). No consistent benefit was observed for stereopsis outcomes. Overall, the certainty of evidence ranged from low to moderate, and most pooled effects were below commonly accepted thresholds for clinically meaningful visual acuity improvement (≈0.1 logMAR, one line). Atropine and occlusion remain equivalent first-line treatments, while adjunctive and multimodal approaches may offer limited additional benefit in selected patients when adherence, tolerability, and engagement are prioritized.