Virtual Reality Games Research Articles

Assessing virtual reality acceptance in long-term care facilities: a quantitative study with older adults

Purpose Our study aimed to investigate the factors associated with the acceptance of virtual reality (VR) games among older adults living in LTC, with a particular emphasis on identifying social and individual factors that have been overlooked in existing technology acceptance models. Materials and methods We conducted VR gaming sessions, followed by a composite questionnaire to explore the factors associated with the acceptance of VR games among residents of LTC with a focus on technology acceptance models (TAM) and social factors derived from Selective Optimization with Compensation (SOC) theory and Socioemotional Selectivity Theory (SST). Results We studied 20 older adults aged 65 and older. Participants were moderately sedentary, with the majority of them having prior gaming experience. Participants with prior gaming experience had higher mean scores in most SOC theory and SST subscales, except for elective selection. Participants perceived the technology as useful and easy to use, with no heightened gaming-related anxiety. Significant correlations were found between perceived ease of use and selection strategies, and between attitudes towards gaming and elective selection strategies. No significant score differences were observed between male and female participants. Conclusions The positive correlation between VR acceptance and using SOC strategies suggests a positive response to straightforward experiences. Our study highlights VR exergaming’s potential benefits for encouraging LTC residents’ engagement in valued activities and pursuing goals. Moreover, social theories of aging can inform technology acceptance and guide the design and marketing of VR exergames to better suit older adults’ needs and preferences in LTC. IMPLICATIONS FOR REHABILITATION The findings of this study have important implications for rehabilitation programs aimed at enhancing physical activity (PA) and engagement among older adults living in long-term care (LTC) facilities. The use of virtual reality (VR) games can be an important tool to promote PA and improve the overall well-being of LTC residents. Based on the results, the following implications can be drawn: Integrating VR exergaming in rehabilitation: The positive perception of VR technology’s usefulness and ease of use among older adults in LTC suggests that VR exergaming can be effectively integrated into rehabilitation programs. Healthcare professionals and rehabilitation specialists in LTC facilities can consider incorporating VR-based exercise routines and gaming sessions to motivate and engage residents in physical activities. By doing so, they can create enjoyable and interactive rehabilitation experiences that may lead to improved adherence to exercise regimens. Addressing social factors for VR acceptance: Our study highlights the significance of social factors derived from theories of aging, such as Selective Optimization with Compensation (SOC) and Socioemotional Selectivity Theory (SST), in influencing VR acceptance among LTC residents. Rehabilitation programs should take into account these social aspects and create a supportive and encouraging environment for older adults to engage with VR exergames. Encouraging social interactions and providing opportunities for residents to share their experiences with VR gaming may enhance acceptance and overall engagement. Tailoring VR exergames for older adults: The correlation between VR acceptance and the use of SOC strategies indicates that customized experiences may be well-received by LTC residents. Game developers and rehabilitation specialists should consider designing VR exergames that align with the specific preferences and needs of older adults. This could involve providing choices and options for users to optimize their gaming experiences based on their individual abilities and interests. Recognizing gaming experience: Our study highlights that prior gaming experience positively influenced participants’ attitudes towards VR gaming. Rehabilitation professionals should acknowledge and leverage this prior experience when introducing VR exergaming to older adults in LTC. By incorporating elements familiar to older adults or providing guidance for those new to gaming, rehabilitation programs can foster a more seamless and enjoyable transition to VR exergames. Promoting goal pursuit and valued activities: Our study suggests that VR exergaming has the potential to encourage LTC residents’ engagement in valued activities and goal pursuit. Rehabilitation programs can utilize VR exergaming as a means to help residents achieve specific rehabilitation goals and engage in activities that are meaningful to them. This approach can contribute to a sense of purpose and satisfaction in the rehabilitation process. Overall, the integration of VR exergaming in rehabilitation for older adults in LTC facilities has promising implications for improving physical activity levels, enhancing engagement, and addressing the holistic well-being of residents. By considering the social factors influencing VR acceptance and tailoring experiences to individual preferences, rehabilitation professionals can optimize the potential benefits of VR technology in LTC settings.

Acceptance of physical activity virtual reality games by residents of long-term care facilities: a scoping review

Purpose This scoping review aims to identify evidence on older adults’ acceptance of PA VR games in LTC facilities, describe research designs used, define key acceptance concepts, and identify knowledge gaps for future research. Materials and methods Following Arksey and O’Malley’s framework, data from published and unpublished articles (Jan 2000–May 2023) were collected. Twelve databases and additional sources were searched for studies on LTC residents (≥65 years), PA video games (including VR and console games), acceptance, and attitudes. Data extraction included article details, design, population, intervention, outcomes, and limitations. Results Five studies met inclusion criteria from 1628 initial titles. They assessed acceptance of PA VR games among older adults in LTC facilities, showing varying levels of acceptance. Most studies used analytical designs, including RCTs. Key concepts of VR acceptance were poorly defined, with only one study using a validated TAM questionnaire. Knowledge gaps highlight the need for further research to understand PA VR acceptance among older adults in LTC facilities. Conclusion Validated acceptance questionnaires are needed in study of VR acceptance by older adults. Use of qualitative and quantitative methods can enhance understanding of technology acceptance, alongside exploration of individual, environmental, and age-related factors. Detailed reporting of VR interventions is recommended to comprehend acceptance factors.

Development and Studies of VR-Assisted Hand Therapy Using a Customized Biomechatronic 3D Printed Orthosis

This article presents the process of development, testing, and use of wrist–hand orthosis in the hand therapy of a teen patient with congenital paresis disease. A regular 3D-printed anatomically adjusted orthosis is modified with a set of sensors, to work as motion and interaction controller in virtual reality (VR). As the patient with this condition cannot operate VR controllers due to wrist and hand defects, the corrective orthosis was converted to a VR controller, by introducing custom-made electronics and commercially available motion trackers, linking them to the orthosis. A VR game scenario, with typical input from the VR controllers replaced by input from the custom-made controllers is then designed. The VR game scenario is prepared with involvement of physiotherapists, to incorporate the most important exercises for patients with the same condition. The scenario is tested with a group of human patients and assessed by an expert physiotherapist, for determining its efficiency, as well as to determine a set of necessary improvements for future development of the orthosis.

Research into the world of Cloud-Virtual Reality

Virtual Reality technology has not been able to penetrate the mainstream consumer market due to restrictions on hardware and content. With the advancement of cloud computing technologies, Virtual Reality hardware and technology applications may now be supported strongly. The metaverse, cloud VR gaming, and cloud VR stimulator are just a few of the real-world applications that are now employing cloud computing in Virtual Reality. We can lower the cost of Virtual Reality technology which would begin a new era of many users to apply cloud-based technologies. With the aid of technology, it will be possible to operate from anywhere without having to transport a lot of equipment. The performance, usability, and compatibility of Virtual Reality software and hardware can be improved by cloud computing on the level of hardware and content. The VR dataset is made available for public collaboration through the Internet using a VR-Cloud server. The digital asset that represents the layout of our pedestrian bridge comprises images of all the streets, buildings, trees, and other urban amenities. In the virtual environment of the metropolitan area, where they run and stroll according to predetermined behaviour scenarios, the cars and people are created and entered. By employing cloud communication software to analyse simulations of vehicles and pedestrian crowds and to debate design ideas, users share the VR reality by connecting to the VR Cloud servers from remote devices. This research demonstrates how VR-cloud may be combined with Neuralink and NFT in the virtual world for future enhancement. This paper is a research note on cloud computing and its application using the Virtual Reality (VR) platform for the modern world with futuristic innovations. Keywords: Cloud Computing, Metaverse, Neuralink, Virtual Reality, VR-Cloud.)

IVAL: Immersive Virtual Anatomy Laboratory for enhancing medical education based on virtual reality and serious games, design, implementation, and evaluation

Learning anatomy is a complex subject that requires a thorough understanding of 3D structures, posing challenges with traditional teaching methods. Anatomy education often involves the use of cadavers, which can be expensive, time-consuming, and ethically complex. As a result, medical educators need effective ways to engage students and promote learning. Immersive virtual reality (IVR) and serious games (SGs) provide innovative and immersive learning experiences that enhance students’ understanding and retention of anatomical concepts and improve the effectiveness of anatomy education. This work aims to develop and evaluate the effectiveness of IVAL,11Immersive Virtual Anatomy Laboratory. an Immersive Virtual Anatomy Laboratory, for immersive and engaging learning experiences. A study involving dozens of University students assessed the efficacy of this innovative tool, resulting in high levels of satisfaction, success, and learning outcomes. IVAL was found to be an effective tool in promoting learning and retention of anatomical concepts, with participants highly rating the tool regarding engagement and learning enhancement. This study demonstrates that immersion in a 3D representation of the skeletal system through VR is essential for a deep knowledge of anatomical learning. These results have important implications for medical educators because IVR technologies can enhance student learning and improve the effectiveness of medical education.

Gamelan Land: A Multiplayer Virtual Reality Game based on a Social Presence Approach

A Multiplayer Virtual Reality Game (MVRG) was developed in order to support experiences in learning and playing orchestral music through a virtual world called the Gamelan Land (GL) game. The GL game was aimed as a virtual place to support interaction between musicians and Gamelan enthusiasts who are spread all over the world. It supports them carrying out Gamelan community activities in the real world into a virtual world through immersive virtual experiences. The story developed in the GL game reflects the real life of the Gamelan community. Oculus Quest 2 which is a Head Mounted Displays (HMD) device that can deliver highly immersive 3D environments was selected as the platform to run the Gamelan music MVRG provided in the GL game. The performance of the Gamelan music MVRG shows promising results. Improvement of audio and visual latency in playing music in orchestra is still a problem to be solved. The problem can be caused by differences in internet network speed and device specifications. So far, low poly 3D models can be an alternative solution. Moreover, although it still requires testing involving more users and longer time, the social presence approach in the GL game can be implemented well and has promising prospects for further development.

Beyond and from below: Rehearsing reparative futures in the VR roleplays of Cao Fei and Ana María Millán

The rise of virtual reality games, films and social experiences in recent years has been accompanied by the promise of simulating utopian futures. The visions they conjure include limitless options for opening, exploring, and expanding new worlds. However, these tropes reproduce settler-colonial attitudes to space, time, and civilizational progress. They project the militarized and consumerist roles of neoliberal western societies into the future, while hiding their negative effects across past and present environments. In this article, I ask whether virtual worlds can be used to connect users with reparative futures. Looking at artworks by Colombian artist Ana María Millán and Chinese artist Cao Fei, I discuss how they intervene into existing virtual landscapes and aesthetics to question their modes of co-creation. I argue that they combine recontextualization, roleplay and rehearsal as forms of reparative practice. They resist narratives of exceptional authorship and agency in favor of pluralized approaches to the future. Rather than supporting the gamified erasure of existing worlds, these works hold space for loss, memory, and survival. By redistributing responsibility for harm from below and imaginations beyond the horizon of dominant visibility, these practices approach reparative futures.

Co-Design of a Virtual Reality Multiplayer Adventure Game for Adolescents With Autism Spectrum Disorder: Mixed Methods Study.

Virtual reality (VR) adventure games can offer ideal technological solutions for training social skills in adolescents with autism spectrum disorder (ASD), leveraging their support for multisensory and multiplayer interactions over distance, which may lower barriers to training access and increase user motivation. However, the design of VR-based game environments for social skills training is still understudied and deserves the deployment of an inclusive design approach to ensure its acceptability by target users. We aimed to present the inclusive design process that we had followed to develop the Zentastic VR adventure game to foster social skills training in adolescents with ASD and to investigate its feasibility as a training environment for adolescents. The VR game supports multiplayer training sessions involving small groups of adolescents and their therapists, who act as facilitators. Adolescents with ASD and their therapists were involved in the design and in an explorative acceptability study of an initial prototype of the gaming environment, as well as in a later feasibility multisession evaluation of the VR game final release. The feasibility study demonstrated good acceptability of the VR game by adolescents and an enhancement of their social skills from baseline to posttraining. The findings provide preliminary evidence of the benefits that VR-based games can bring to the training of adolescents with ASD and, potentially, other neurodevelopmental disorders.

Effect of the VR-guided grasping task on the brain functional network.

Virtual reality (VR) technology has been demonstrated to be effective in rehabilitation training with the assistance of VR games, but its impact on brain functional networks remains unclear. In this study, we used functional near-infrared spectroscopy imaging to examine the brain hemodynamic signals from 18 healthy participants during rest and grasping tasks with and without VR game intervention. We calculated and compared the graph theory-based topological properties of the brain networks using phase locking values (PLV). The results revealed significant differences in the brain network properties when VR games were introduced compared to the resting state. Specifically, for the VR-guided grasping task, the modularity of the brain network was significantly higher than the resting state, and the average clustering coefficient of the motor cortex was significantly lower compared to that of the resting state and the simple grasping task. Correlation analyses showed that a higher clustering coefficient, local efficiency, and modularity were associated with better game performance during VR game participation. This study demonstrates that a VR game task intervention can better modulate the brain functional network compared to simple grasping movements and may be more beneficial for the recovery of grasping abilities in post-stroke patients with hand paralysis.

Improving Social Isolation and Loneliness Among Adolescents With Physical Disabilities Through Group-Based Virtual Reality Gaming: Feasibility Pre-Post Trial Study.

Adolescents with disabilities experience alarmingly higher rates of depression and isolation than peers without disabilities. There is a need to identify interventions that can improve mental health and isolation among this underserved population. Innovations in virtual reality (VR) gaming "standalone" headsets allow greater access to immersive high-quality digital experiences, due to their relatively low cost. This study had three purposes, which were to (1) examine the preliminary effects of a low-cost, home-based VR multiplayer recreation and socialization on depression, socialization, and loneliness; (2) quantify the acceptability of the program as measured by participant adherence, total play time, and exercise time; and (3) identify and describe behavioral mechanisms that affected participant engagement. This was a single-group, pre- to postdesign trial. The intervention was conducted at home. Participants were recruited from a children's hospital. The intervention lasted 4 weeks and included 2×1-hour sessions per week of supervised peer-to-peer gaming. Participants used the Meta Quest 2 headset to meet peers and 2 coaches in a private party held digitally. Aim 1 was evaluated with the Children's Depression Inventory 2 Short Form and the University of California, Los Angeles Loneliness Scale 20 items, which are measures of social isolation and loneliness, respectively. Aim 2 was evaluated through the following metrics: participant adherence, the types of games played, friendship building and playtime, and program satisfaction and enjoyment. In total, 12 people enrolled (mean age 16.6, SD 1.8 years; male: n=9 and female: n=3), and 8 people completed the program. Mean attendance for the 8 participants was 77% (49 sessions of 64 total possible sessions; mean 6, SD 2 sessions). A trend was observed for improved Children's Depression Inventory 2 Short Form scores (mean preintervention score 7.25, SD 4.2; mean postintervention score 5.38, SD 4.1; P=.06; effect size=0.45, 95% CI -0.15 to 3.9), but this was not statistically significant; no difference was observed for University of California, Los Angeles Loneliness Scale 20 items scores. Most participants (7/8, 88%) stated that they became friends with a peer in class; 50% (4/8) reported that they played with other people. Participants reported high levels of enjoyment and satisfaction with how the program was implemented. Qualitative analysis resulted in 4 qualitative themes that explained behavioral mechanisms that determined engagement in the program. The study findings demonstrated that a brief VR group program could be valuable for potentially improving mental health among adolescents with physical disabilities. Participants built friendships with peers and other players on the web, using low-cost consumer equipment that provided easy access and strong scale-up potential. Study findings identified factors that can be addressed to enhance the program within a larger clinical trial. ClinicalTrials.gov NCT05259462; https://clinicaltrials.gov/study/NCT05259462. RR2-10.2196/42651.

Go Across Immersive Technology: A Preliminary Study of the Design and Development of a System for Gait Training Using Virtual Reality.

Virtual reality (VR) allows visuotactile interaction in a virtual environment. VR has several potential applications such as surgical training, phobia treatments, and gait rehabilitation. However, further interface development is required. Therefore, the objective of this study was to develop a noninvasive wearable device control to a VR gait training program. It consists of custom-made insoles with vibratory actuators, and plantar pressure sensor-based wireless interface with a VR game. System usability testing involved a habituation period and three gaming sessions. Significant gait improvement was associated with game scores (P < 0.05). This VR gait training system allowed real-time virtual immersive interaction with anticipatory stimulus and feedback during gait.

Quality of service adaptive modulation and coding scheme for IEEE 802.11ac

&lt;p&gt;&lt;span lang="EN-US"&gt;Nowadays, the rising demand for digital communication technologies has contributed to the increase in the volume of traffic. This continuous trend of internet traffic has led to the deterioration of the quality of service (QoS) with reduced throughput and increased latency. This also is due to the proliferation of new broadband applications which require low latency and high throughput such as virtual reality and real-time gaming. Therefore, considering the aforementioned challenge in QoS of wireless networks, a link adaptation method is suggested in this study, in order to enhance the performance of the QoS in IEEE 802.11ac amendment wireless local-area network (WLAN). The proposed technique adaptively changes the transmission data rate by increasing or decreasing the modulation and coding scheme (MCS) level according to the traffic conditions. With the use of an OMNeT++ computer-aided design (CAD)-based simulation model, the effectiveness of the suggested approach is examined. Simulated findings were compared with the link adaptation approach of the default condition. The results of the simulation demonstrate that the proposed technique significantly increases throughput (36.48%) and decreases latency in comparison to the default situation. These findings demonstrate the technique's potential to improve WLAN QoS efficiency, notably in regard to throughput and latency.&lt;/span&gt;&lt;/p&gt;

Age in Place, Move in VR: Investigating the Feasibility and Usability of a Custom‐made Virtual Reality Exergame to Promote the Well‐being of Community‐Dwelling Older Adults

AbstractBackgroundInteractive virtual reality (VR) games combined with exercise (exergames) are a plausible strategy to encourage physical activity (PA) among older adults. However, there is little systematic evaluation of the feasibility, usability, and potential benefits of deploying at‐home VR exergames among this population.MethodFifteen community‐dwelling older adults (M = 67.33 ± 5.3, age range 60‐77) (Table1) were recruited to play 18 sessions (each 15‐20 min) of a custom‐made VR exergame at home over six weeks. Recruitment, retention, and adherence rates were calculated to determine feasibility. The usability of the exergame was assessed through i) a game user experience questionnaire, ii) a self‐reported physical/emotional discomfort questionnaire, and iii) a perceived enjoyment scale. The exploratory outcome measures included changes in i) PA, ii) exercise self‐efficacy, iii) affect, iv) various cognitive and perceptual tasks and were assessed i) before and after acute data, and ii) before and after the intervention.ResultThirteen participants completed the study (13% attrition rate) without missing any exergaming session (100% adherence rate). The completion rate of cognitive assessments, perceptual tasks, and self‐reported questionnaires was = 97%. Low levels of cybersickness were reported (M = 0.9 ±1.0 out of 10). The average perceived enjoyment and perceived rate of exertion were 3.2. ±1.1 (out of 5) and 2.4±1.9 (out of 10), respectively. Most of the participants (92.3%) found the exergame’s instructions easy to follow and had an overall positive experience (84.6%). Whereas the exergame was perceived as useful for increasing PA levels (61.6%), mood enhancement was reported among less than half of participants (46.2%) and only 38% indicated that they would choose VR exergaming for at‐home PA. The likelihood of playing VR exergames in the future was also low (38.5%). The exploratory outcome measures are presented in Table 2.ConclusionOur study provides insights into the feasibility and usability of a custom‐made VR exergaming intervention to promote PA in community‐dwelling older adults which may potentially benefit their well‐being. Our findings inform the future adoption of VR at home. Our results can also be used to inform large‐scale trials and support the design and deployment of other remote exergames and assessments.

Immersive technology and cause‐related marketing: The role of personalization and value co‐creation

AbstractThis research conducted two studies to investigate the impact of immersive technology adoption on facilitating sustainable consumption behavior according to the perceived value co‐creation model. The first study used an online survey to examine the mediating effect of value co‐creation on the relationship between personalized values and sustainable behavioral intentions in adopting the 360‐degree video. In contrast, the second experimented to investigate the perceived value co‐creation model in adopting the virtual reality game. We collected 501 U.S. participants for watching the video about the presentation of a marine environment in Study 1, while recruited 92 college students in Taiwan to play the game regarding beach cleaning in Study 2. We found that immersive technologies can facilitate personalized values for value co‐creation, leading to increased intention to support, in this case, beach cleaning. The study provides theoretical contributions and managerial implications, providing evidence to show the potential of immersive technologies used in cause‐related marketing associated with sustainable consumption. Prior studies have shown that consumers perceive uncertain toward ethical attributes in sustainable consumption, leading to their low engagement. This research contributes to a solution of the problem by adopting immersive technologies to increase value co‐creation for purchasing cause‐related products.

Exploring VR Games for Enhancing Reading Fluency for Students with Reading Disabilities

Virtual reality (VR) has transformed education by providing an immersive and interactive learning experience. This paper explores the introduction of VR games in education, with a focus on supporting students with dyslexia and hyperlexia. It discusses the importance of understanding reading skills and reading disabilities and highlights the current strategies employed by middle school teachers to address these needs. The potential of VR to enhance reading skills and literacy development is then explored, emphasizing the benefits of personalized and targeted interventions. The paper further delves into the design considerations for effective VR-based educational games and simulations that enhance students' reading skills, including interactivity, immersion, and adaptive challenges. Practical considerations, ethical and equity considerations, as well as future directions and emerging trends in this educational game, are also discussed. By leveraging VR technology, educators are more likely to create inclusive and impactful learning experiences that enhance reading skills and foster a love for reading among students.

The impact of tourist engagement on low–carbon behavior in glacier tourism

Over the last decade, glaciers have gained increasing popularity as tourist destinations while experiencing rapid retreat due to climate change. The accelerated glacial recession worldwide calls for carbon reduction and sustainable glacier conservation and management. To this end, simply prohibiting tourists from visiting may not be as effective, comparing to engaging them through innovative means to promote pro-environmental behavior. This paper examined factors that influence tourists’ low-carbon behavior while on-site and after their visits to glaciers through two studies (Study 1 – on-site visitor survey; Study 2 – a scenario experiment using glacier virtual reality games). Results showed that tourist engagement positively influenced their low-carbon behavior, but was mediated by the sequential influence of place attachment and environmental responsibility. The perceived threat of glacier shrinkage moderated this relationship. Results also provide practical implications for sustainable tourism management at glacier destinations and beyond.

Effects of a Virtual Reality Game on Children's Anxiety During Dental Procedures (VR-TOOTH): Protocol for a Pilot Randomized Controlled Trial.

Dental fear and anxiety (DFA) is a condition that affects approximately one-quarter of children and adolescents. It is a significant cause for pediatric patients to avoid dental care later in adulthood. Lack of patient cooperation due to DFA can create an environment of stress, often obligating dentists to end appointments prematurely and consider alternative pharmacological treatment options. Virtual reality (VR) use during dental care, providing an immersive experience through sensory stimuli, is potentially an additional nonpharmacologic tool to better manage DFA in children with special health care needs (SHCN) undergoing dental procedures. This pilot study aims to assess the feasibility and acceptability of VR immersion as a tool to reduce DFA in pediatric special needs patients undergoing dental procedures. The study also aims to gain insight on parent and health care provider perspectives on the use of VR during dental appointments. This pilot randomized controlled trial study will follow a parallel design including 2 groups: a control group (clinic's standard care using a wall TV) and an experimental group (using a VR game). We will randomize 20 participants to either group. Recruitment will be carried out at the dental clinic of the Centre Hospitalier Universitaire Sainte-Justine, a tertiary-quaternary care center that mostly serves pediatric patients with SHCN. The primary outcome will be patient recruitment rates and completion rates of planned procedures. DFA in children will be assessed using both an observation-based proxy assessment with the Venham Anxiety and Behavior Rating Scale and physiological assessments using parameters such as change in heart rate and levels of salivary alpha-amylase as a stress biomarker before and 10 minutes after the procedure. Sociodemographic characteristics, measures of the levels of parent and health care professional satisfaction, occurrence of side effects, and any deviation from normal procedure length will also be collected. Descriptive statistics, nonparametric tests, and effect sizes will be used for demographic and clinical variables and to present parent and health care professional satisfaction levels as well as procedural time. This study will be conducted from May 2023 to May 2024, with results expected to be available in December 2024. The pilot study will provide insight on the feasibility and acceptability of VR use in clinical dentistry to reduce DFA for pediatric patients with SHCN. This study will guide future research on VR use in pediatric dentistry and can serve as a framework for a larger randomized clinical trial. ClinicalTrials.gov NCT05898100; https://classic.clinicaltrials.gov/ct2/show/NCT05898100. DERR1-10.2196/49956.

Virtual Reality Distraction Is No Better Than Simple Distraction Techniques for Reducing Pain and Anxiety During Pediatric Orthopaedic Outpatient Procedures: A Randomized Controlled Trial.

In-office procedures can be painful and anxiety-provoking for pediatric patients. Minimizing such pain and anxiety in children improves the patient experience and promotes a rewarding and productive patient-caregiver-provider relationship, which may for some young patients be their first memorable encounter with the healthcare system. Although virtual reality (VR) techniques have proven to be helpful in minimizing pain and anxiety during procedures in pediatric intensive care settings, it remains unclear how VR affects objective and subjective measures of pain and anxiety in children undergoing in-office orthopaedic procedures such as cast removal or percutaneous pin removal after fracture healing. Is a VR gaming simulation more effective than either of two forms of noninteractive visual distraction (VR goggles or tablet computer displaying a noninteractive video) for reducing (1) objective measures of pain and anxiety and (2) subjective measures of pain and anxiety in children undergoing in-office cast removal or percutaneous pin removal? This study was a randomized controlled trial with two parallel, separately analyzed cohorts: children undergoing in-office cast removal or in-office percutaneous pin removal at a single urban tertiary institution. We approached eligible patients who were scheduled to undergo outpatient cast or percutaneous pin removal and who met prespecified inclusion criteria. We enrolled until 105 patients were available for analysis in each of the cast removal and pin removal cohorts. Of note, the study institution was in an urban epicenter of the coronavirus-19 pandemic, and clinical research was paused sporadically, which resulted in a longer-than-expected enrollment period. In the cast removal cohort, all patients were eligible for inclusion and were enrolled and randomized into one of three groups: VR gaming simulation (n = 37), VR goggles with a noninteractive video (n = 36), or a tablet computer with the same noninteractive video (n = 40). Eleven percent (4), 8% (3), and 3% (1) withdrew from each of the three intervention groups, respectively. In the pin removal cohort, all patients were eligible for inclusion and were enrolled and randomized into the same three groups (37, 44, and 41 patients, respectively). In the pin removal group, 14% (5), 18% (8), and 10% (4) withdrew from each of the three intervention groups, respectively. In all, 235 patients were enrolled in the study and 210 patients (mean ± SD age 9 ± 3 years; 48% [100] girls) were included in the final analyses. There were no clinically important differences in age, gender, preprocedure pain, or anxiety among the intervention groups. Primary outcomes included preprocedure-to-maximum heart rate increase (objective measure) and preprocedure and postprocedure pain and anxiety using a VAS (subjective measures). One-way ANOVA and Bonferroni-adjusted pairwise comparisons were used to calculate between-group differences for the primary outcomes. There were no intervention-level groupwise differences between VR goggles with an interactive game, VR goggles with a noninteractive video, or the tablet computer with the same video in preprocedure-to-maximum heart rate increase in the cast removal cohort (18 ± 21 bpm versus 14 ± 11 bpm versus 20 ± 16 bpm, respectively; largest mean difference -6 bpm [95% CI -16 to 3]; p = 0.36) or pin removal cohort (27 ± 20 bpm versus 23 ± 12 bpm versus 24 ± 19 bpm, respectively; largest mean difference 4 bpm [95% CI -7 to 14]; p = 0.99). Similarly, there were no intervention-level groupwise differences in preprocedure to postprocedure VAS pain in the cast removal cohort (1 ± 1 versus 1 ± 2 versus 0 ± 2, respectively; largest mean difference 0 points [95% CI 0 to 1]; p = 0.89) or pin removal cohort (0 ± 3 versus 2 ± 3 versus 0 ± 3 points, respectively; largest mean difference 1 point [95% CI 0 to 3]; p = 0.13). Finally, there were no intervention-level groupwise differences between the same intervention groups in preprocedure to postprocedure VAS anxiety in the cast removal cohort (-2 ± 2 versus -1 ± 2 versus -1 ± 2 points, respectively; largest mean difference -1 point [95% CI -2 to 1]; p = 0.63) or pin removal cohort (-3 ± 3 versus -4 ± 4 versus -3 ± 3 points, respectively; largest mean difference -1 point [95% CI -2 to 1]; p = 0.99). During in-office cast and pin removal in pediatric patients, simple distraction techniques such as tablet video viewing are as effective as higher-fidelity VR headset video and interactive games in minimizing objective measures of procedural pain and subjective measures of pain and anxiety. Because of these findings and because of the associated costs, implementation logistics, and variable tolerance by young patients, widespread use of VR distraction techniques in the pediatric orthopaedic outpatient setting is unnecessary. Level I, therapeutic study.

Evaluating cognitive performance using virtual reality gamified exercises

Virtual Reality (VR) environments have been proven useful in memory assessment and have shown to be more sensitive than pen-and-paper in prospective memory assessment. Moreover, these techniques provide the advantage of offering neuropsychological evaluations in a controlled, ecologically valid, and safe manner. In the present study, we used Enhance VR, a cognitive training and assessment tool in virtual reality. User performance was evaluated by means of the in-game scoring system. The primary goal of this study was to compare Enhance VR in-game scoring to already existing validated cognitive assessment tests. As a secondary goal, we tested the tolerance and usability of the system. 41 older adults took part in the study (mean age = 62.8 years). Each participant was evaluated with a predefined set of traditional pen-and-paper cognitive assessment tools and played four VR games. We failed to find a significant positive impact in explaining the variability of the Enhance VR game scores by the traditional pen-and-paper methodologies that addressed the same cognitive ability. This lack of effect may be related to the gamified environment of Enhance VR, where the players are awarded or subtracted points depending on their game performance, thus deviating from the scoring system used in traditional methodologies. Moreover, while the games were inspired by traditional assessment methodologies, presenting them in a VR environment might modify the processing of the information provided to the participant. The hardware and Enhance VR games were extremely well tolerated, intuitive, and within the reach of even those with no experience.

STOP: Joint send buffer and transmission control for user-perceived deadline guarantee via curriculum guided-deep reinforcement learning

Real-time applications with strict user-perceived deadline requirements, such as cloud virtual reality (VR) gaming and high-frequency trading, have experienced substantial growth in recent years. To ensure the user-perceived deadline at the transport layer, i.e., the network transmission delay and the waiting delay in the send buffer, transmission control scheme plays an important role. While several delay-sensitive transmission control schemes have been proposed, none of them consider the impact of waiting delay in the send buffer. To address this issue, we propose STOP, a joint send buffer and congestion window (CWND) control approach for guaranteeing user-perceived deadline via curriculum-guided deep reinforcement learning. To obtain optimal joint control policy, STOP utilizes a reinforcement learning-based algorithm to jointly adjust the CWND and send buffer with respect to the send buffer state, the network condition and the deadline requirement. Furthermore, to enhance the generalization capability of reinforcement learning-based algorithm, STOP incorporates curriculum learning during the training phase with a difficulty measurer and training scheduler. Extensive experiments in NS-3 indicate that the STOP scheme achieves an overwhelmingly higher average arrival ratio, i.e., around 95% vs. around 0.2%, compared with current prevalent transmission control scheme such as BBR, Cubic and Vegas.