Virtual Reality Training Sessions Research Articles

Application of Virtual Reality (VR) in Facility Management Competency-based Training (CBT) in the Era of Industrie 5.0

This case study investigates the implementation of Virtual Reality (VR) technology in facilities management Competency-Based Training (CBT) within one of Singapore’s leading facilities and township management companies. Traditionally, workplace training in facility management has relied heavily on lecture-based methods, often resulting in insufficient preparation and a high turnover rate among newly onboarded staff. To address this challenge, this study explores the conversion of training materials into VR-based courseware, enabling immersive and interactive learning experiences. Two groups of newly onboarded staff underwent either traditional lecture-based or VR training sessions. Results indicate that those trained using VR exhibited a better comprehension of the material and higher levels of motivation compared to their counterparts in the traditional lecture-based group. However, it was noted that VR training carries the risk of cybersickness, with some participants reporting symptoms such as dizziness. To mitigate this issue, insights from existing literature on cybersickness are incorporated to enhance future VR training materials. This paper studies the application of VR in Facilities Management Competency-based training within the discourse of Industrie 5.0, the latest evolution of industrial technology that emphasizes human-machine collaboration and smart technologies such as VR. By leveraging VR technology for training purposes, this initiative aligns with the principles of Industrie 5.0, fostering innovation and efficiency in facility management practices. Overall, this research underscores the potential of VR in revolutionizing training methodologies within the practices of facilities management while addressing associated challenges to ensure optimal learning outcomes.

An interdisciplinary framework to optimize the anticipation skills of high-level athletes using virtual reality.

The ambition of our contribution is to show how an interdisciplinary framework can pave the way for the deployment of innovative virtual reality training sessions to improve anticipation skills in top-level athletes. This improvement is so challenging that some authors say it is like "training for the impossible". This framework, currently being implemented as part of a project to prepare athletes for the 2024 Olympic Games in Paris, based on the ecological-dynamics approach to expertise, is innovative in its interdisciplinary nature, but also and above all because it overcomes the limitations of more traditional training methods in the field designed to optimize anticipation skills in top-level athletes. The ambition is to tackle successive challenges ranging from the design of virtual partners and opponents to the deployment of training programs in virtual reality, while ensuring the acceptability and acceptance of such innovative virtual reality training protocols and measuring associated workloads.

Training the public health emergency response workforce: a mixed-methods approach to evaluating the virtual reality modality

ObjectivesTo produce and evaluate a novel virtual reality (VR) training for public health emergency responders.DesignFollowing a VR training designed to test key public health emergency responder competencies, a prospective cohort...

Improving real-world skills in people with intellectual disabilities: an immersive virtual reality intervention

Virtual reality (VR) is a promising tool for training life skills in people with intellectual disabilities. However, there is a lack of evidence surrounding the implementation, suitability, and effectiveness of VR training in this population. The present study investigated the effectiveness of VR training for people with intellectual disabilities by assessing (1) their ability to complete basic tasks in VR, (2) real-world transfer and skill generalisation, and (3) the individual characteristics of participants able to benefit from VR training. Thirty-two participants with an intellectual disability of varying severity completed a waste management training intervention in VR that involved sorting 18 items into three bins. Real-world performance was measured at pre-test, post-test, and delayed time points. The number of VR training sessions varied as training ceased when participants met the learning target (≈ 90% correct). A survival analysis assessed training success probability as a function of the number of training sessions with participants split by their level of adaptive functioning (as measured on the Adaptive Behaviour Assessment System Third Edition). The learning target was met by 19 participants (59.4%) within ten sessions (Mdn = 8.5, IQR 4–10). Real-world performance significantly improved from pre- to post-test and pre- to delayed test. There was no significant difference from post- to delayed test. Further, there was a significant positive relationship between adaptive functioning and change in the real-world assessment from the pre-test to the post- and delayed tests. VR facilitated the learning of most participants, which led to demonstrations of real-world transfer and skill generalisation. The present study identified a relationship between adaptive functioning and success in VR training. The survival curve may assist in planning future studies and training programs.

Safety and Potential Usability of Immersive Virtual Reality for Brain Rehabilitation: A Pilot Study.

Objective: This study was conducted to demonstrate the safety and usability of an immersive virtual reality (VR) game as a rehabilitative training by assessing adverse events (AEs), adherence, and satisfaction in patients with brain injury who had free optional opportunities. Materials and Methods: The results were analyzed retrospectively. Seventy-eight patients with brain injury, undergoing rehabilitation treatment for motor impairment, were recruited. Among them, 51 were available for postintervention survey. The immersive type of VR training was programmed to facilitate use of the paralyzed upper extremity through a fishing simulation game. The Oculus Rift was used as head-mounted display device. Patients were observed for any AEs as defined in the Common Terminology Criteria for AEs during and after each VR training session. A postintervention telephone survey was done to investigate adherence-related factors and safety. Results: The results were analyzed after dividing the patients into nonadherence (patients participated <3 times) and high-adherence (≥3 times) groups. No serious AEs were reported during and after the VR training, and several patients reported other AEs, predominantly dizziness, with one case requiring cessation of VR training. Overall, the satisfaction rate was 54%. Compared with the nonadherence group, the high-adherence group expressed higher satisfaction with VR training, regarded it as effective for recovery from upper limb paralysis, accepted VR as comprehensible, and considered the level of difficulty to be appropriate (P < 0.05). Conclusion: Immersive VR training appeared to be safe for patients with brain injury.

Development and evaluation of a virtual reality training for emergency treatment of shortness of breath based on frameworks for serious games.

Virtual reality (VR) can offer an innovative approach to providing training in emergency situations, especially in times of COVID-19. There is no risk of infection, and the procedure is scalable and resource-efficient. Nevertheless, the challenges and problems that can arise in the development of VR training are often unclear or underestimated. As an example, we present the evaluation of the feasibility of development of a VR training session for the treatment of dyspnoea. This is based on frameworks for serious games, and provides lessons learned. We evaluate the VR training session with respect to usability, satisfaction, as well as perceived effectiveness and workload of participants. The VR training was developed using the established framework (Steps 1-4) for serious games of Verschueren et al. and Nicholson's RECIPE elements for meaningful gamification. Primary validation (Step 4) was performed at the University of Bern, Switzerland, in a pilot study without control group, with a convenience sample of medical students (n=16) and established measurement tools. The theoretical frameworks permitted guided development of the VR training session. Validation gave a median System Usability Scale of 80 (IQR 77.5-85); for the User Satisfaction Evaluation Questionnaire, the median score was 27 (IQR 26-28). After the VR training, there was a significant gain in the participants' confidence in treating a dyspnoeic patient (median pre-training 2 (IQR 2-3) vs. post-training 3 (IQR 3-3), p=0.016).Lessons learned include the need for involving medical experts, medical educators and technical experts at an equivalent level during the entire development process. Peer-teaching guidance for VR training was feasible. The proposed frameworks can be valuable tools to guide the development and validation of scientifically founded VR training. The new VR training session is easy and satisfying to use and is effective - and is almost without motion sickness.

Feasibility and effect of an immersive virtual reality-based platform for cognitive training in real-life scenarios in patients with mood - or psychotic disorders: A randomized, controlled proof-of-concept study

ObjectivesCognitive impairment is common across mood disorders (MD) and psychosis-spectrum disorders (PSD) but there is a lack of real-life pro-cognitive training programmes. Fully immersive virtual reality (VR) has the potential to ensure motivating, engaging cognition training directly relevant to patients’ daily lives. This randomized, controlled proof-of-concept study investigated the feasibility and cognitive benefits of short-term VR-assisted training. MethodsForty patients with MD or PSD were randomized to one week of VR-assisted training (n ​= ​20) or treatment as usual (TAU; n ​= ​20). They were assessed at baseline and after one week with a VR cognition test, neuropsychological tests, and questionnaires regarding user experience. Patients in the training group underwent two VR training sessions in a kitchen environment that involved solving tasks related to planning and cooking a meal using various cognitive strategies. They also completed two home assignments during which they applied the acquired strategies. ResultsThe completion rate was 100%. Patients reported high enjoyment and moderate-to-high presence in the VR environment and minimal motion sickness. VR training improved the global VR-based cognitive composite score with a large effect size compared with TAU (F(1, 38) ​= ​11,29, p ​= ​.002, η2 ​= ​0.23). Posthoc assessments of VR subtests showed that this improvement was driven primarily by a large effect on psychomotor speed (F(1, 38) ​= ​22.78, p ​< ​.001, η2 ​= ​0.39), but no effects were observed on other VR subtests or on traditional neuropsychological tests. ConclusionVR-assisted cognition training showed high feasibility and improved aspects of cognition after only one week. We therefore plan a larger trial to investigate the cognitive benefits of four-weeks VR-assisted cognition training.

Influence of age and industry experience on learning experiences and outcomes in virtual reality mines rescue training

This study examined the effects of age and industry expertise on trainees’ state of mind before, learning experiences during, and outcomes following virtual reality (VR) mines rescue training. The trainees were 284 mine rescue brigadesmen attending group VR training sessions run by Coal Services NSW. They were aged between 24 and 64 years and had up to 40 years of mines rescue experience. Questionnaire data and learning outcome measures showed that these miners were able to effectively engage with, and learn from, this VR training regardless of their age or mining experience. While the older trainees initially reported higher levels of stress and had less gaming experience, their experiences during VR training were very similar (although reports that the VR technology sometimes did not meet the task requirements did increase with age). Crucially, the perceived learning outcomes of this VR training were unaffected by age or field experience.

Unguided virtual-reality training can enhance the oral presentation skills of high-school students

Public speaking is fundamental in our daily life, and it happens to be challenging for many people. Like all aspects of language, these skills should be encouraged early on in educational settings. However, the high number of students per class and the extensive curriculum both limit the possibilities of the training and, moreover, entail that students give short in-class presentations under great time pressure. Virtual Reality (VR) environments can help speakers and teachers meet these challenges and foster oral skills. This experimental study employs a between-subjects pre- and post-training design with four Catalan high-school student groups, a VR group (N = 30) and a Non-VR group (N = 20). Both groups gave a 2-min speech in front of a live audience before (pre-training) and after (post-training) 3 training sessions (one session per week) in which they practiced public speaking either in front of a VR audience or alone in a classroom (Non-VR). Students assessed their anxiety measures right before performing every speech and filled out a satisfaction questionnaire at the end. Pre- and post-training speeches were assessed by 15 raters, who analyzed the persuasiveness of the message and the charisma of the presenter. Speeches were also analyzed for prosodic features and gesture rate. First, results showed that self-assessed anxiety got significantly reduced at post-training for both conditions. Second, acoustic analyses of both groups' speeches show that the VR group has, unlike the Non-VR group, developed a more clear and resonant voice quality in the post-training speeches, in terms of higher cepstral-peak prominence (CPP) (although no significant differences in f0- related parameters as a function of training were obtained), as well as significantly less erosion effects than the Non-VR group. However, these differences across groups did not trigger a direct improvement on the participants' gesture rate, persuasiveness and charisma at post-training. Furthermore, students perceived the training in the VR environment to be more useful and beneficial for their future oral presentations than the Non-VR group. All in all, short unguided VR training sessions can help students feel less anxious, promote a more clear and resonant voice style, and can prevent them from experiencing an erosion effect while practicing speeches in front of a real audience.

The Design, Development, and Testing of a Virtual Reality Device for Upper Limb Training in People With Multiple Sclerosis: Single-Center Feasibility Study.

BackgroundMultiple sclerosis (MS) is a common nontraumatic, neurological, disabling disease that often presents with upper limb dysfunction. Exercise training has resulted in improvement for patients; however, there can be a lack of compliance due to access because of location and lack of MS experts. Virtual reality (VR) is a promising technology that can offer exercise therapy/rehabilitation at a distance. This type of remote training can be motivational and effective for patients with MS and can improve range of motion and muscle strength for those with upper limb dysfunction.ObjectiveThe aim of this study is to evaluate the safety and feasibility of the XRHealth software and the Oculus Rift Station for patients with MS with upper limb motor dysfunction.MethodsA single-center, prospective, feasibility study was conducted with patients with MS who had upper limb motor dysfunction. Patients participated in a single 45-minute digital environment session with VR and completed a questionnaire about the quality of the training and fatigability. The clinician also completed a questionnaire to evaluate the suitability and safety of the training.ResultsOverall, 30 patients were enrolled between the ages of 20 and 81 years. Patients reported that the training sessions within the digital environment were helpful, challenging, fun, and simple to understand, and that they would be willing to repeat the sessions again. The physical therapist that oversaw the patients reported that the training was suitable for 87% (n=26) of the patients. Anticipated adverse events were fatigue, temporary dizziness, and temporary nausea. The operator complications included that the cable of the head-mounted display interrupted the training (n=2, 7%) and fatigue that caused cessation of the VR training session (n=2, 7%). No serious adverse events were reported.ConclusionsThese preliminary results demonstrated that the use of the XRHealth software and Oculus Rift Station platform is feasible, safe, and engaging for patients, and has the potential to improve the functionality of the upper limbs in patients with MS. This study provides support for future studies of implementing a series of training sessions with virtual reality in a home-based environment.

Intensive Training of Spatial Hearing Promotes Auditory Abilities of Bilateral Cochlear Implant Adults: A Pilot Study.

The aim of this study was to evaluate the feasibility of a virtual reality-based spatial hearing training protocol in bilateral cochlear implant (CI) users and to provide pilot data on the impact of this training on different qualities of hearing. Twelve bilateral CI adults aged between 19 and 69 followed an intensive 10-week rehabilitation program comprised eight virtual reality training sessions (two per week) interspersed with several evaluation sessions (2 weeks before training started, after four and eight training sessions, and 1 month after the end of training). During each 45-minute training session, participants localized a sound source whose position varied in azimuth and/or in elevation. At the start of each trial, CI users received no information about sound location, but after each response, feedback was given to enable error correction. Participants were divided into two groups: a multisensory feedback group (audiovisual spatial cue) and an unisensory group (visual spatial cue) who only received feedback in a wholly intact sensory modality. Training benefits were measured at each evaluation point using three tests: 3D sound localization in virtual reality, the French Matrix test, and the Speech, Spatial and other Qualities of Hearing questionnaire. The training was well accepted and all participants attended the whole rehabilitation program. Four training sessions spread across 2 weeks were insufficient to induce significant performance changes, whereas performance on all three tests improved after eight training sessions. Front-back confusions decreased from 32% to 14.1% ( p = 0.017); speech recognition threshold score from 1.5 dB to -0.7 dB signal-to-noise ratio ( p = 0.029) and eight CI users successfully achieved a negative signal-to-noise ratio. One month after the end of structured training, these performance improvements were still present, and quality of life was significantly improved for both self-reports of sound localization (from 5.3 to 6.7, p = 0.015) and speech understanding (from 5.2 to 5.9, p = 0.048). This pilot study shows the feasibility and potential clinical relevance of this type of intervention involving a sensorial immersive environment and could pave the way for more systematic rehabilitation programs after cochlear implantation.

Improving simulated consumption context with virtual Reality: A focus on participant experience

Context can have a significant impact on liking, emotional response and product choice, and Virtual Reality (VR) is a promising tool to evoke realistic consumption contexts in a controlled testing environment. This study compared an innovative approach – combining a 360° video and a 3D model with object tracking to an Evoked context using pictures and sound recordings to simulate a realistic consumption environment for beer (i.e. bar). This study explored consumer experience of the innovative VR design and measured their engagement with it compared to an Evoked scenario. Additionally, participants’ emotional response and liking between the two contexts and the effect of including a VR training session prior to data collection were also explored. In total, 27 beer consumers participated in this study. The novel VR method that was developed for this study consisted of 360° video footage recorded in a bar with sound, which was projected around a virtual table model with an integrated questionnaire, using a pen and beer bottles attached to tracking devices. The Evoked context consisted of a picture slideshow and sound recording to simulate the exact same bar context. An interview was conducted after the VR training session to explore consumer experience of the VR design. Participant engagement was then measured after participants completed both the VR and Evoked sessions respectively. The results showed that the VR session had clear advantages in terms of participant engagement compared to the Evoked session. Audio, the time spent in VR, and realistically simulated presence of other people were identified as key elements that improved realism and immersion of the VR context, whilst low image quality and technical problems had the opposite effect. The first exposure to VR was shown to have high novelty and further impact on the emotional response to beer, which highlighted the importance of having a training/dummy session to reduce VR novelty and associated effect.

Conducting a VR Clinical Trial in the Era of COVID-19.

The outbreak of severe acute respiratory syndrome coronavirus 2, also known as Coronavirus Disease 2019 (COVID-19) sparked a global public health pandemic that has impacted every aspect of daily life. Medical research was affected, and many clinical trials were halted to minimize COVID-19 transmission risk and spread while the world navigated this novel virus. Here we describe the relaunch of our virtual reality (VR) pilot clinical trial that uses an in-lab brain and body training program to promote brain health in mid-to-late life older adults, in the era of COVID-19. This case series includes five healthy female participants between 51 and 76 years of age, a subset of a larger VR pilot clinical trial that started pre-pandemic. We developed a revised study protocol based on the Center for Disease Control and World Health Organization guidelines to help manage the spread of COVID-19. Since the limited resumption of clinical trials at our institution in August 2020, we successfully completed over 200 in-lab virtual reality training sessions using our revised protocol. During this time, none of the five participants or three study staff reported any COVID-19 symptoms or reported a positive COVID-19 test. More than 40 voluntary COVID-19 tests were completed by our study staff over the last 6 months. All participants rated our safety protocol as very satisfied or extremely satisfied and that they would be very likely or extremely likely to participate in a VR clinical trial during the pandemic. Based on these findings, we suggest that continued VR clinical trial research during the COVID-19 pandemic is achievable and can be safely resumed if specific safety protocols are in place to mitigate the risk of exposure and spread of COVID-19.

Usefulness of virtual reality-based training to diagnose strabismus

To study the usefulness of virtual reality (VR)-based training for diagnosing strabismus. Fourteen residents in ophthalmology performed at least 30 VR training sessions to diagnose esotropia and exotropia. Examinations of real patients with esotropia or exotropia before and after the VR training were video-recorded and presented to a strabismus expert to assess accuracy and performance scores for measuring the deviation angle and diagnosing strabismus with anonymization. A feedback survey regarding the usefulness and ease of use of the VR application was conducted for participants. The mean age of the 14 ophthalmology residents (10 men and 4 women), was 29.7 years. Before VR training, participants showed a mean accuracy score of 14.50 ± 5.45 and a performance score of 9.64 ± 4.67 for measuring the deviation angle and diagnosing strabismus in real patients with strabismus. After VR training, they showed a significantly improved accuracy score of 22.14 ± 4.37 (p = 0.012) and a performance score of 15.50 ± 1.99 (p = 0.011). According to the survey, most participants agreed on the usefulness of VR applications. This study suggests that VR-based training improved ophthalmology residents’ clinical diagnostic skills for strabismus in a short period.

Virtual Reality Based Cognitive Rehabilitation in Minimally Conscious State: A Case Report with EEG Findings and Systematic Literature Review.

Chronic disorders of consciousness cause a total or partial and fluctuating unawareness of the surrounding environment. Virtual reality (VR) can be useful as a diagnostic and/or a neurorehabilitation tool, and its effects can be monitored by means of both clinical and electroencephalography (EEG) data recording of brain activity. We reported on the case of a 17-year-old patient with a disorder of consciousness (DoC) who was provided with VR training to improve her cognitive-behavioral outcomes, which were assessed using clinical scales (the Coma Recovery Scale-Revised, the Disability Rating Scale, and the Rancho Los Amigos Levels of Cognitive Functioning), as well as EEG recording, during VR training sessions. At the end of the training, significant improvements in both clinical and neurophysiological outcomes were achieved. Then, we carried out a systematic review of the literature to investigate the role of EEG and VR in the management of patients with DoC. A search on PubMed, Web of Science, Scopus, and Google Scholar databases was performed, using the keywords: “disorders of consciousness” and “virtual reality”, or “EEG”. The results of the literature review suggest that neurophysiological data in combination with VR could be useful in evaluating the reactions induced by different paradigms in DoC patients, helping in the differential diagnosis. In conclusion, the EEG plus VR approach used with our patient could be promising to define the most appropriate stimulation protocol, so as to promote a better personalization of the rehabilitation program. However, further clinical trials, as well as meta-analysis of the literature, are needed to be affirmative on the role of VR in patients with DoC.

Investigating the process of mine rescuers' safety training with immersive virtual reality: A structural equation modelling approach

Immersive virtual reality (VR) is a powerful tool for vocational training - especially for safety-critical vocations where real-world training is often too complicated, expensive, or risky. Despite its apparent utility in this context, there is not yet a coherent, systematic framework that captures the key features of user learning experiences in immersive virtual reality environments. With the use of Structural Equation Modelling (SEM), this article presents a comprehensive framework which brings different dimensions (assessment criteria) together. This framework is informed by the analysis of 45 VR training sessions conducted by Mines Rescue Pty Ltd and total of 284 mines rescue brigades partook in this study and received training on specific mines rescue operation. The result of this study shows that actual and perceived learning was enhanced by trainee engagement with the scenario, their perception of the fidelity of the scenario, their sense of co-presence with other trainees, the perceived usability of the system, an overall positive attitude towards the technology, and the involvement of skilled trainers. These results suggest that: 1) there are multiple paths by which immersive VR training can have a positive impact on learning, and 2) immersive VR training will not replace the requirement for skilled trainers, but rather it can serve as an effective vehicle to convey their expertise.

Public speaking anxiety decreases within repeated virtual reality training sessions.

Therapy for public speaking phobia using virtual reality exposure (VRE) has focused on distress arousal rather than distress habituation. Understanding habituation will help optimise session duration, making treatment more affordable and accessible. This pilot study utilised within-speech repeated measures to examine distress habituation during three brief public speaking scenarios in a non-clinical sample (n = 19; 18–76 years). VRE elicited significant distress in all three scenarios. Although within-scenario distress habituation was not observed, between-scenario habituation was partially supported. An increase in distress during the second scenario indicated that three consecutive speech performances were critical in achieving habituation. Brief repeated VRE scenarios using an agent audience were effective in eliciting public speaking distress, as well as habituation.

Virtual offender: a pilot project on nurturing social work students’ capacity to work with offenders

ABSTRACTAlthough considerable literature conducted in the context of Western societies has concluded that the use of virtual reality (VR) technology can facilitate students’ learning, the applicability of this learning approach to nurturing social work students in the Chinese context remains uncertain. This pilot study empirically tests the effectiveness of VR technology in enhancing social work students’ perceived creativity and competence in working with offenders. The study uses mixed methods that include qualitative and quantitative procedures in a complementary manner. Survey data that capture the responses of 41 social work students collected in the pre-and post-test periods indicate a positive change in self-perceived confidence in handling offenders following the VR training session. The qualitative data generated from the focus groups echo the survey findings and provide insights into the use of VR technology in social work education. Issues and implications for innovative education in the social work profession are discussed.

Remote Home-Based Virtual Training of Functional Living Skills for Adolescents and Young Adults With Intellectual Disability: Feasibility and Preliminary Results

Background: Virtual Reality (VR) is acquiring increasing credibility as a tool for teaching independent living skills to people with Intellectual Disability (ID). Generalization of skills acquired during VR training into real environment seems to be feasible.Objective: To assess feasibility and verify effectiveness of a remote home-based rehabilitation, focused on functional living skills, for adolescents and young adults with ID, by using virtual apps installed on tablets. In particular, to assess if this tool can be managed independently, if it is enjoyable and simple to be used, and if the acquired skills can be generalized to the real environment of everyday life.Subjects and method: A single group, pre- and post-test research design was used. Sixteen participants with ID were included. A digital system was arranged, with a server managing communication between the database and the apps installed on tablets. In vivo tests were performed before and after the eleven sessions of VR training. Satisfaction questionnaires were also administered.Results: Statistically significant improvements were found between the pre- and post-in vivo tests, as well as between the VR training sessions, in almost all the parameters taken into account, for each app. Final questionnaires showed a good satisfaction level for both the participants and their families.Conclusion: The highly technological system was managed independently by participants with ID, who found it simple to be used, useful and even fun; generalization across settings was obtained. Results obtained require to be confirmed by future controlled studies, with larger samples.

Robotic gait training in multiple sclerosis rehabilitation: Can virtual reality make the difference? Findings from a randomized controlled trial

Gait, coordination, and balance may be severely compromised in patients with multiple sclerosis (MS), with considerable consequences on the patient's daily living activities, psychological status and quality of life. For this reason, MS patients may benefit from robotic-rehabilitation and virtual reality training sessions. Aim of the present study was to assess the efficacy of robot-assisted gait training (RAGT) equipped with virtual reality (VR) system in MS patients with walking disabilities (EDSS 4.0 to 5.5) as compared to RAGT without VR. We enrolled 40 patients (randomized into two groups) undergoing forty RAGT±VR sessions over eight weeks. All the patients were assessed at baseline and at the end of the treatment by using specific scales. Effect sizes were very small and non-significant between the groups for Berg Balance Scale (−0.019, CI95% −2.403 to 2.365) and TUG (−0.064, 95%CI −0.408 to 0.536) favoring RAGT+VR. Effects were moderate-to-large and significant for positive attitude (−0.505, 95%CI −3.615 to 2.604) and problem-solving (−0.905, 95%CI −2.113 to 0.302) sub-items of Coping Orientation to Problem Experienced, thus largely favoring RAGT+VR. Our findings show that RAGT combined with VR is an effective therapeutic option in MS patients with walking disability as compared to RAGT without VR. We may hypothesize that VR may strengthen RAGT thanks to the entrainment of different brain areas involved in motor panning and learning.