Virtual Reality Head-mounted Display Research Articles

Virtual Reality Therapy for People With Epilepsy and Related Anxiety: Protocol for a 3-Phase Pilot Clinical Trial.

Anxiety is one of the most common psychiatric comorbidities in people with epilepsy and often involves fears specifically related to the condition, such as anxiety related to the fear of having another seizure. These epilepsy- or seizure-related fears have been reported as being more disabling than the seizures themselves and significantly impact quality of life. Although research has suggested that exposure therapy (ET) is helpful in decreasing anxiety in people with epilepsy, no research to our knowledge has been conducted on ET in people with epilepsy using virtual reality (VR). The use of novel technologies such as an immersive VR head-mounted display for ET in this population offers several benefits. Indeed, using VR can increase accessibility for people with epilepsy with transportation barriers (eg, those who live outside urban centers or who have a suspended driver's license owing to their condition), among other advantages. In the present research protocol, we describe the design of an innovative VR-ET program administered in the home that focuses on decreasing anxiety in people with epilepsy, specifically anxiety related to their epilepsy or seizures. Our primary objective is to examine the feasibility of the study protocol and proposed treatment as well as identify suggestions for improvement when designing subsequent larger clinical trials. Our secondary objective is to evaluate whether VR-ET is effective in decreasing anxiety in a pilot study. We hypothesize that levels of anxiety in people with epilepsy will decrease from using VR-ET. This mixed methods study comprises 3 phases. Phase 1 involves engaging with those with lived experience through a web-based questionnaire to validate assumptions about anxiety in people with epilepsy. Phase 2 involves filming videos using a 360° camera for the VR-ET intervention (likely consisting of 3 sets of scenes, each with 3 intensity levels) based on the epilepsy- and seizure-related fears most commonly reported in the phase 1 questionnaire. Finally, phase 3 involves evaluating the at-home VR-ET intervention and study methods using a series of validated scales, as well as semistructured interviews. This pilot study was funded in November 2021. Data collection for phase 1 was completed as of August 7, 2022, and had a final sample of 18 participants. Our findings will add to the limited body of knowledge on anxiety in people with epilepsy and the use of VR in this population. We anticipate that the insights gained from this study will lay the foundation for a novel and accessible VR intervention for this underrecognized and undertreated comorbidity in people with epilepsy. ClinicalTrials.gov NCT05296057; https://clinicaltrials.gov/ct2/show/NCT05296057. DERR1-10.2196/41523.

The effect of modified optic flow gain on quiet stance

Visual feedback provides critical information to support postural stability. Previous work has shown that magnifying visual feedback, such as by presenting individuals with biofeedback during balance tasks, can improve postural control. When studies manipulate the availability of optic flow directly, the conditions are often restricted to include an absence of visual feedback or sway referenced paradigms. Therefore, the aim of this study was to understand how manipulating the gain of optic flow contributes to quiet standing balance control among healthy adults. Optic flow was amplified or reduced relative to head motion using a virtual reality head-mounted display while participants stood quietly on either a firm or foam surface. Overall, when there was an increased reliance placed on the visual system by standing on foam, a tighter control of upright stance was observed as the gain of optic flow increased. Further, this study provided evidence that visual contributions to balance control may extend to higher frequencies of postural sway than previously theorized (greater than 0.1 Hz).

Motion Sickness during Roll Motion: VR HMD View versus Monitor View

The purpose of this study was to investigate the effect of two views on motion sickness caused by low-frequency roll motion in the laboratory. Fifteen healthy male subjects participated in the study and were exposed to 30 min of 0.25 Hz roll oscillation at an angle of rotation (±5°). Subjects sat on a rigid seat with one of two visual scenes each session: (i) viewing 360° videos through virtual reality (VR) head-mounted display (HMD) device and (ii) reading articles on a monitor in a closed cabin. Ratings of motion sickness were obtained at 1 min intervals. The mean illness ratings of subjects for all visual conditions increased over the 30 min exposure to motion. There was significantly less sickness in the HMD condition than in the monitor condition. The findings suggest a beneficial effect of the HMD view on the severity of sickness. However, the HMD view had no effect on the sickness experienced by those vulnerable to sickness caused by exposure to motion or use of VR. It was concluded that the visual activity had a significant influence on motion sickness induced by 0.25 Hz roll oscillation with an angle of rotation (±5°), and the applications of VR could be implemented to further reduce motion sickness.

Design and Test of Spatial Cognitive Training and Evaluation System Based on Virtual Reality Head-Mounted Display With EEG Recording.

The field of spatial cognitive training and evaluation has rapidly evolved. However, the low learning motivation and engagement of the subjects hinder the widespread use of spatial cognitive training. This study designed a home-based spatial cognitive training and evaluation system (SCTES), which aimed to train subjects on spatial cognitive tasks for 20 days, and compared the brain activities before and after the training. This study also evaluated the feasibility of using a portable all-in-one prototype for cognitive training that combined a virtual reality (VR) head-mounted display with high-quality electroencephalogram (EEG) recording. During the course of training, the length of the navigation path and the distance between the starting position and the platform position revealed significant behavioral differences. In the testing sessions, the subjects showed significant behavioral differences in the time it took to complete the test task before and after training. After only four days of training, the subjects demonstrated significant differences in the Granger causality analysis (GCA) characteristics of brain regions in the δ , θ , α1 , β2 , and γ frequency bands of the EEG, as well as significant differences in the GCA of the EEG in the β1 , β2 , and γ frequency bands between the two test sessions. The proposed SCTES used a compact and all-in-one form factor to train and evaluate spatial cognition and collect EEG signals and behavioral data simultaneously. The recorded EEG data can be used to quantitatively assess the efficacy of spatial training in patients with spatial cognitive impairments.

Spatiotemporal image quality of virtual reality head mounted displays

Virtual reality (VR) head mounted displays (HMDs) require both high spatial resolution and fast temporal response. However, methods to quantify the VR image quality in the spatiotemporal domain when motion exists are not yet standardized. In this study, we characterize the spatiotemporal capabilities of three VR devices: the HTC VIVE, VIVE Pro, and VIVE Pro 2 during smooth pursuit. A spatiotemporal model for VR HMDs is presented using measured spatial and temporal characteristics. Among the three evaluated headsets, the VIVE Pro 2 improves the display temporal performance using a fast 120 Hz refresh rate and pulsed emission with a small duty cycle of 5%. In combination with a high pixel resolution beyond 2 k times 2 k per eye, the VIVE Pro 2 achieves an improved spatiotemporal performance compared to the VIVE and VIVE Pro in the high spatial frequency range above 8 cycles per degree during smooth pursuit. The result demonstrates that reducing the display emission duty cycle to less than 20% is beneficial to mitigate motion blur in VR HMDs. Frame rate reduction (e.g., to below 60 Hz) of the input signal compared to the display refresh rate of 120 Hz yields replicated shadow images that can affect the image quality under motion. This work supports the regulatory science research efforts in development of testing methods to characterize the spatiotemporal performance of VR devices for medical use.

Biomechanical fidelity of athletic training using virtual reality head-mounted display: the case of preplanned and unplanned sidestepping

ABSTRACT Virtual reality has recently been recognised as an effective tool for investigating visual-perceptual tasks. To develop a sport-specific virtual environment with realistic locomotion, it is crucial to examine the effect of using virtual reality devices on athletes performing intense and complex movements. Twelve collegiate football players were instructed to perform pre-planned and unplanned sidestepping in both environments with the same dimension and experimental setup in the virtual environment as in the real one. Analysis of the performance and knee biomechanical parameters showed that movements performed in the two environments were generally comparable. Consistent changes in approach velocity and knee angle/moment under unplanned conditions (compared with preplanned conditions) were also found in the virtual environment as in the real one, except for the significantly larger peak flexion angle (p < .05) observed in the virtual environment. Interestingly, half of the participants changed from producing abduction to adduction moment at the weight acceptance phase in the preplanned condition (p < .05). These findings suggested that while it is generally feasible to use virtual reality head-mounted displays for designated experiments and training, the effect of wearing virtual reality devices could be somewhat subject-specific.

Stray light analysis and suppression method of a pancake virtual reality head-mounted display.

Pancake virtual reality head-mounted displays (VR-HMDs) have attracted the attention of researchers in both academia and industry because of the compact size and light weight. However, owing to the use of optical path folding, there exist various stray lights in the optical system, which seriously degrades user experience. In this study, we analyze the causes and effects of multiple types of stray light systematically and design a VR-HMD with low stray light, large exit pupil diameter (EPD), compact form and light weight. Subsequently, several effective stray light suppression solutions are proposed and implemented. Finally, a prototype of a compact pancake VR-HMD system is successfully demonstrated. The prototype has stray light of less than 2.3%, a diagonal field of view (FOV) of 96° and an EPD of 10 mm at an 11 mm eye relief (ERF).

Cognitive load in immersive media settings: the role of spatial presence and cybersickness

Faced with the ongoing diversification and commercial success of highly immersive media technologies (e.g., VR headsets), both content producers and scientific scholars have become highly invested in understanding the psychological consequences of experiencing media in these new and lifelike ways. While many studies underscore positive effects of high media immersivity—such as increased enjoyment or persuasive success—others warn about the intense cognitive load that technologies such as VR might put on their users. In a laboratory experiment with N = 121 participants, we compare the cognitive load experienced while watching a 360° video on a laptop screen or via an immersive VR head-mounted display. Furthermore, we scrutinize two prominent explanations for the additional cognitive load in immersive media settings, i.e., the role of spatial presence and cybersickness. As expected, the VR condition results in higher cognitive load, spatial presence, and cybersickness than the 2D condition. However, by means of a parallel mediation model, we observe that only cybersickness emerges as a meaningful mediator of participants’ strained cognitive capacity; spatial presence, on the other hand, remains statistically irrelevant in this regard. We discuss our findings considering implications for media producers and future research.

Usability and Acceptance of Exergames Using Different Types of Training among Older Hypertensive Patients in a Simulated Mixed Reality

Virtual and augmented reality (VR/AR) exergames are promising tools for increasing training motivation. However, the use of exergames with mixed reality (MR) headsets remains under-researched. Older adults with hypertension could also benefit from the increased training adherence associated with MR. Endurance and strength endurance exercises are recommended for this group to lower blood pressure. The aim of the preliminary study (n = 22) was to compare the usability and acceptance of two exergames, which represent two different training types—strength endurance training (SET) and endurance training (ET). The developed exergame prototypes were applied in “simulated MR” using a VR head-mounted display. We examined the following outcomes: usability (TUI), intention to use (TUI), subjective task load (NASA-TLX), frustration (NASA-TLX), and presence (PQ). The results showed that frustration was significantly greater in the ET than in the SET (p = 0.038). Presence was significantly higher in the SET (p = 0.002). No significant differences in usability and acceptance were found in the exergames. The results indicate that usability and acceptance are not related to the type of training when utilizing MR exergames. Whether the results are transferable with a real MR headset must be determined in further research.

Digital wonders

How, if at all, does awe foster information seeking? This question was examined through a two-pronged approach. First, in a laboratory setting, participants (n = 34) were exposed to a variety of awe elicitors through a virtual reality (VR) head-mounted display. Participants’ quantitative and qualitative responses were gathered immediately after exposure in the laboratory as well as 24 hours later through questionnaires. Second, a stratified sample of participants who voluntarily conducted information seeking (n = 8) completed phenomenologically-informed interviews. Findings indicate that although awe is primarily experiential, information seeking may arise from surprising learners with unknown and unexplained phenomena. Additionally, feelings of perceptual envelopment and accessing the inaccessible characterized participants’ VR-based awe experiences. Emergent findings also reveal that creating awe-inspiring VR content may require reduced didactic information to generate feelings of presence. These findings point to ways that VR may increase learners’ intrinsic motivations for informal and formal research.

Exploring Immersive Learning Experiences: A Survey

Immersive technologies have been shown to significantly improve learning as they can simplify and simulate complicated concepts in various fields. However, there is a lack of studies that analyze the recent evidence-based immersive learning experiences applied in a classroom setting or offered to the public. This study presents a systematic review of 42 papers to understand, compare, and reflect on recent attempts to integrate immersive technologies in education using seven dimensions: application field, the technology used, educational role, interaction techniques, evaluation methods, and challenges. The results show that most studies covered STEM (science, technology, engineering, math) topics and mostly used head-mounted display (HMD) virtual reality in addition to marker-based augmented reality, while mixed reality was only represented in two studies. Further, the studies mostly used a form of active learning, and highlighted touch and hardware-based interactions enabling viewpoint and select tasks. Moreover, the studies utilized experiments, questionnaires, and evaluation studies for evaluating the immersive experiences. The evaluations show improved performance and engagement, but also point to various usability issues. Finally, we discuss implications and future research directions, and compare our findings with related review studies.

A Discussion on Accessibility, Inclusivity, Cultural Design Considerations, and Health &amp; Safety Advisories for Virtual Reality Head Mounted Displays

With the exponential growth in availability of Virtual Reality (VR) head-mounted displays (HMDs), this study aims to discuss Health &amp; Safety advisory information provided by VR products and observe the extent to which each platform considers accessibility and inclusive and culturally informed design. To this end, five commercially available PC-based VR HMDs, and their corresponding setup applications were assessed in this study - the Oculus Quest 2, Oculus Rift S, Samsung Odyssey, HTC Vive Pro, and Varjo XR-3. Three proto personas were created to evaluate these platforms from various perspectives. VR HMDs are moving in the right direction to consider diverse populations in animation design, but there is room for improvement regarding individuals with visual, auditory, or mobility restrictions. Advancements in multimodal sensory cues and inclusive design considerations may increase adoption of VR technologies as well as compliance with Health &amp; Safety advisory information

A Discussion on Accessibility, Inclusivity, Cultural Design Considerations, and Health &amp; Safety Advisories for Virtual Reality Head Mounted Displays

With the exponential growth in availability of Virtual Reality (VR) head-mounted displays (HMDs), this study aims to discuss Health &amp; Safety advisory information provided by VR products and observe the extent to which each platform considers accessibility and inclusive and culturally informed design. To this end, five commercially available PC-based VR HMDs, and their corresponding setup applications were assessed in this study - the Oculus Quest 2, Oculus Rift S, Samsung Odyssey, HTC Vive Pro, and Varjo XR-3. Three proto personas were created to evaluate these platforms from various perspectives. VR HMDs are moving in the right direction to consider diverse populations in animation design, but there is room for improvement regarding individuals with visual, auditory, or mobility restrictions. Advancements in multimodal sensory cues and inclusive design considerations may increase adoption of VR technologies as well as compliance with Health &amp; Safety advisory information

Linking cognitive functioning and postural balance control through virtual reality environmental manipulations.

BackgroundDementia is becoming a relevant problem worldwide. A simple screening at an early stage will be important to detect the risk of developing dementia. Vestibular dysfunction is likely to be associated with cognitive impairment. Since head-mounted display (HMD) virtual reality (VR) technology has the potential to activate the vestibular function, assessing postural sway with visual stimulation using HMD VR technology could be potentially useful for dementia screening.ObjectiveThe purpose of this study is to evaluate the effect of HMD-based VR visual stimuli on posture in older adults and the relationship between the stimulated body sway behaviors and cognitive performance.MethodUsing a cross-sectional study design, we investigated the effect of an optokinetic design-based room with stripes (OKR) VR environment oscillating forwards and backwards at 23/60Hz. Center of pressure (COP) displacement was measured in older adults aged 65 years and over in the OKR VR environment. The frequency response of COP was compared to the cognitive performance of the Montreal Cognitive Assessment (MoCA).Results20 healthy older adults (70.4 ± 4.9 years; 27.2 ± 1.6 MoCA score) and 3 people with mild cognitive impairment (74.7 ± 4.0 years; 20.3 ± 2.1 MoCA score) were assessed. The results reveal that the oscillating OKR VR environment induced different postural sway in the anterior-posterior direction in the real world. Correlation analysis shows that the cognitive test score was associated with the frequency response of stimulated postural sway in the anterior-posterior direction (frequency Band 1 of 0−0.5Hz related to the visual and vestibular systems: rs = 0.45, P = 0.03).ConclusionOutcomes would suggest that a potential link may emerge between cognition and posture when the HMD-based VR visual stimuli are applied. The simple screening of stimulated postural sway could explain cognitive functioning. Further studies are warranted to clarify the vestibular system and spatial cognitive function more specifically in the proposed assessment system.

Auditing an urban park deck with 3D geovisualization—A comparison of in-situ and VR walk-along interviews

Virtual reality-based urban audit methods are gaining increasing attention; however, most virtual urban audit studies have focused on panoramic views. The 3D city model-based geovisualizations have remained until now rather unexplored in user studies for urban audits and for communicative urban planning. We explored the feasibility of a 3D geovisualization-based urban audit in virtual reality (VR) for assessing the perceived quality of an urban park deck in Helsinki, Finland. For this purpose, we created a photorealistic and geometrically accurate 3D model (Bryga 3D) based on photogrammetric and laser scanning data. Bryga 3D was implemented on a game engine to be viewed with a head-mounted VR display. Bryga 3D’s ability to convey information in a subjective urban audit, that is, subjectively perceived affordances of a park deck, was tested in a walk-along interview study comparing auditing in situ and via the VR method. A comparison of the results with in-situ (n = 13) and VR interviews (n = 21) show that the perception of several tangible elements, such as spatial division, landforms, paths, and chairs when using Bryga VR was similar to when performed in situ. Perception of vegetation was weaker in VR in terms of its detailed quality, which somewhat affected the presented development ideas and assessment of the seasonal context. Also, weaker perception of the surroundings and city context affected the results in VR. However, considering that Bryga 3D presents an example of a highly automated 3D city modeling process conducted with minimal manual work, its results are encouraging for future attempts to advance such realizations for the purposes of communicative urban planning. 3D geovisualization-based virtual audits could be used when urban green space audits are not possible or when they are demanding to implement in situ.

Effect of Visually Induced Motion Sickness from Head-Mounted Display on Cardiac Activity.

Head-mounted display (HMD) virtual reality devices can facilitate positive experiences such as co-presence and deep immersion; however, motion sickness (MS) due to these experiences hinders the development of the VR industry. This paper proposes a method for assessing MS caused by watching VR content on an HMD using cardiac features. Twenty-eight undergraduate volunteers participated in the experiment by watching VR content on a 2D screen and HMD for 12 min each, and their electrocardiogram signals were measured. Cardiac features were statistically analyzed using analysis of covariance (ANCOVA). The proposed model for classifying MS was implemented in various classifiers using significant cardiac features. The results of ANCOVA reveal a significant difference between 2D and VR viewing conditions, and the correlation coefficients between the subjective ratings and cardiac features have significant results in the range of −0.377 to −0.711 (for SDNN, pNN50, and ln HF) and 0.653 to 0.677 (for ln VLF and ln VLF/ln HF ratio). Among the MS classification models, the linear support vector machine achieves the highest average accuracy of 91.1% (10-fold cross validation) and has a significant permutation test outcome. The proposed method can contribute to quantifying MS and establishing viewer-friendly VR by determining its qualities.

Assessing Electroencephalography as a Stress Indicator: A VR High-Altitude Scenario Monitored through EEG and ECG.

Over the last decade, virtual reality (VR) has become an increasingly accessible commodity. Head-mounted display (HMD) immersive technologies allow researchers to simulate experimental scenarios that would be unfeasible or risky in real life. An example is extreme heights exposure simulations, which can be utilized in research on stress system mobilization. Until recently, electroencephalography (EEG)-related research was focused on mental stress prompted by social or mathematical challenges, with only a few studies employing HMD VR techniques to induce stress. In this study, we combine a state-of-the-art EEG wearable device and an electrocardiography (ECG) sensor with a VR headset to provoke stress in a high-altitude scenarios while monitoring EEG and ECG biomarkers in real time. A robust pipeline for signal clearing is implemented to preprocess the noise-infiltrated (due to movement) EEG data. Statistical and correlation analysis is employed to explore the relationship between these biomarkers with stress. The participant pool is divided into two groups based on their heart rate increase, where statistically important EEG biomarker differences emerged between them. Finally, the occipital-region band power changes and occipital asymmetry alterations were found to be associated with height-related stress and brain activation in beta and gamma bands, which correlates with the results of the self-reported Perceived Stress Scale questionnaire.

Exposure to Green, Blue and Historic Environments and Mental Well-Being: A Comparison between Virtual Reality Head-Mounted Display and Flat Screen Exposure.

Improving the mental health of urban residents is a global public health priority. This study builds on existing work that demonstrates the ability of virtual exposure to restorative environments to improve population mental health. It compares the restorative effects of green, blue and historic environments delivered by both flat screen and immersive virtual reality technology, and triangulates data from psychological, physiological and qualitative sources. Results from the subjective measure analyses showed that exposures to all the experimental videos were associated with self-reported reduced anxiety and improved mood, although the historic environment was associated with a smaller reduction of anxiety (p < 0.01). These results were supported by the qualitative accounts. For two of the electroencephalography (EEG) frequency bands, higher levels of activity were observed for historic environments. In relation to the mode of delivery, the subjective measures did not suggest any effect, while for the EEG analyses there was evidence of a significant effect of technology across three out of four frequency bands. In conclusion, this study adds to the evidence that the benefits of restorative environments can be delivered through virtual exposure and suggests that virtual reality may provide greater levels of immersion than flat screen viewing.

The impact of external and internal focus of attention on visual dependence and EEG alpha oscillations during postural control

BackgroundThe ability to maintain upright posture requires successful integration of multiple sensory inputs (visual, vestibular, and somatosensory). When one or more sensory systems become unreliable, the postural control system must “down-weight” (or reduce the influence of) those senses and rely on other senses to maintain postural stability. As individuals age, their ability to successfully reweight sensory inputs diminishes, leading to increased fall risk. The present study investigates whether manipulating attentional focus can improve the ability to prioritize different sensory inputs for postural control.MethodsForty-two healthy adults stood on a balance board while wearing a virtual reality (VR) head-mounted display. The VR environment created a multisensory conflict amongst the different sensory signals as participants were tasked with maintaining postural stability on the balance board. Postural sway and scalp electroencephalography (EEG) were measured to assess visual weighting and cortical activity changes. Participants were randomized into groups that received different instructions on where to focus their attention during the balance task.ResultsFollowing the instructions to direct attention toward the movement of the board (external focus group) was associated with lower visual weighting and better balance performance than when not given any instructions on attentional focus (control group). Following the instructions to direct attention towards movement of the feet (internal focus group) did not lead to any changes in visual weighting or balance performance. Both external and internal focus groups exhibited increased EEG alpha power (8–13 Hz) activity over the occipital cortex as compared to the control group.ConclusionsCurrent results suggest that directing one’s attention externally, away from one’s body, may optimize sensory integration for postural control when visual inputs are incongruent with somatosensory and vestibular inputs. Current findings may be helpful for clinicians and researchers in developing strategies to improve sensorimotor mechanisms for balance.

Virtual Reality as a Therapy Tool for Walking Activities in Pediatric Neurorehabilitation: Usability and User Experience Evaluation.

BackgroundMany essential walking activities in daily life, such as crossing a street, are challenging to practice in conventional therapeutic settings. Virtual environments (VEs) delivered through a virtual reality (VR) head-mounted display (HMD) would allow training such activities in a safe and attractive environment. Furthermore, the game-like character and high degree of immersion in these applications might help maintain or increase children’s motivation and active participation during the rehabilitation process.ObjectiveThis study aimed to investigate the usability, user experience, and acceptability of an immersive VE experienced through a VR HMD to train everyday life walking activities in pediatric neurorehabilitation.MethodsIn a cross-sectional study, 21 youths (median age 12.1 years; range 6.8-17.7 years) with a neuromotor impairment undergoing inpatient or outpatient neurorehabilitation tested a VE experienced through the VR HMD Oculus Quest. The participants, accompanied by their physiotherapists, moved freely around a 4.4 by 10-meter VE, displaying a magical forest and featuring various gamified everyday activities in different game designs. Using their hands, represented in the VE, the participants could interact with the virtual objects placed throughout the VE and trigger visual and auditory feedback. Symptoms of cybersickness were checked, and usability, user experience, and acceptability were evaluated using customized questionnaires with a visual analog scale for youths and a 5-point Likert scale for their therapists.ResultsNone of the participants reported any signs of cybersickness after 20 minutes of VR HMD exposure time. They rated comfort (median 10/10) and movement ability (median 10/10) with the VR HMD as high. The VE was perceived as being really there by the majority (median 8/10), and the participants had a strong feeling of spatial presence in the VE (median 9.5/10). They enjoyed exploring the virtual world (median 10/10) and liked this new therapy approach (median 10/10). Therapists’ acceptance of the VR HMD was high (4/5). There were 5 patients that needed more support than usual, mainly for supervision, when moving around with the VR HMD. Otherwise, therapists felt that the VR HMD hardly affected their patients’ movement behavior (median 4.75/5), whereas it seemed to increase their level of therapy engagement (median 4/5) compared to conventional physiotherapy sessions.ConclusionsThis study demonstrates the usability of an immersive VE delivered through a VR HMD to engage youths in the training of everyday walking activities. The participants’ and therapists’ positive ratings on user experience and acceptance further support the promising application of this technology as a future therapeutic tool in pediatric neurorehabilitation.