Virtual Reality Video Games Research Articles

Congruity of Virtual Reality In-Game Advertising.

With virtual reality (VR) video game users beginning to see beta advertisements within game play, this conceptual article adds a needed digital and interactive marketing research foundation to the new construct of VR in-game advertising (IGA) activation. New consumer VR technology continues to disrupt traditional media as a $7.7 billion USD industry, that is expected to reach $57.55 billion by 2027. As such, marketing researchers must continue to evolve and understand the interdisciplinary VR research evolution as many VR users are likely to view IGA as intrusive. IGA and VR are not new constructs, but IGA within VR is unique as VR consumers have not yet experienced VR IGA intrusion. This article utilizes a sport marketing focus to provide an industry specific set of examples for the reader, however this article can be applied to broader fields including communications and interactive marketing. The main contributions of this article are 2-fold. First the development of a VR In-Game Advertising Congruity Framework is developed through a review of the literature and application to VR IGA in the topical areas of congruity of the IGA, interactivity of the IGA, intrusiveness of the IGA, realism of the experience, telepresence, brand awareness, and attitude toward the IGA. Secondly, a proper VR context definition of telepresence is provided through review of the literature that takes into account the interaction of a VR participant. This article aims to aid marketers in making informed IGA development decisions through strategic choice, via a centralized VR IGA congruity framework, that not only enhances brand awareness, but leaves participants with a favorable attitude toward the IGA to increase sales activation.

Can Immersive Virtual Reality Videogames Help Parkinson's Disease Patients? A Case Study.

Video games have proven useful in physical rehabilitation therapy. Accessibility, however, is limited for some groups such as the elderly or patients with Parkinson’s disease (PD). We explore the potential of fully immersive video games as a rehabilitation tool in PD patients. Four patients with mild-moderate PD (3 males:1 female, 53–71 years) participated in the study. Training consisted in two immersive virtual reality video gaming sessions. Outcomes were evaluated using System Usability Scale (SUS), Simulator Sickness Questionnaire (SSQ), Game Experience Questionnaire-post game (GEQ), an ad hoc satisfaction questionnaire and perceived effort. All participants completed the sessions without adverse effects (100%), without SSQ symptoms reported. Post-gaming SUS was >75% in both sessions (range 75–80%). Post-gaming GEQ scores were 3.3–4.0/4 in both sessions. Immersive virtual reality video gaming is feasible in patients with mild-moderate PD, with positive usability and patient satisfaction, and no adverse effects.

Feasibility of full immersive virtual reality video game on balance and cybersickness of healthy adolescents

Various virtual reality (VR) games with head-mounted displays (HMDs) can provide immersive experiences, but are often accompanied by negative experiences. We investigated the feasibility of immersive virtual reality game on balance and cybersickness in healthy adolescents. This is cross-over design. This study included 11 healthy adolescents. Balance and cybersickness were measured in the following three conditions. First, as a baseline, only balance was measured while no immersive virtual reality game was being played. Second, balance and cybersickness were measured while the participants played an immersive virtual reality game with a fixed background. Third, balance and cybersickness were measured while the participants played an immersive virtual reality game with a moving background. A force plate was used to measure balance, while the Questionnaire (VRSQ) and Simulator Sickness Questionnaire (SSQ) were used to measure cybersickness. Sway velocity and length significantly increased during the game with a moving background compared to baseline and a fixed background game (p < 0.05). VRSQ and SSQ scores significantly increased during the game with a fixed and moving background compared to baseline (p < 0.05) and were significantly higher with use of the moving versus fixed background (p < 0.05). This study demonstrated that playing an immersive virtual reality game with a moving background could negatively affect balance and cybersickness. These results will help to select game contents that can reduce side effects when applying VR HMD to various fields in the future.

Virtual reality video game improves high-fidelity memory in older adults

Therapeutic interventions have not yet been shown to demonstrate restorative effects for declining long-term memory (LTM) that affects many healthy older adults. We developed a virtual reality (VR) spatial wayfinding game (Labyrinth-VR) as a cognitive intervention with the hypothesis that it could improve detailed, high-fidelity LTM capability. Spatial navigation tasks have been used as a means to achieve environmental enrichment via exposure to and learning about novel and complex information. Engagement has been shown to enhance learning and has been linked to the vitality of the LTM system in the brain. In the current study, 48 older adults (mean age 68.7 ± 6.4 years) with average cognitive abilities for their age were randomly assigned to 12 h of computer game play over four weeks in either the Labyrinth-VR or placebo control game arms. Promptly before and after each participant’s treatment regimen, high-fidelity LTM outcome measures were tested to assess mnemonic discrimination and other memory measures. The results showed a post-treatment gain in high-fidelity LTM capability for the Labyrinth-VR arm, relative to placebo, which reached the levels attained by younger adults in another experiment. This novel finding demonstrates generalization of benefits from the VR wayfinding game to important, and untrained, LTM capabilities. These cognitive results are discussed in the light of relevant research for hippocampal-dependent memory functions.

Therapeutic effects of virtual reality video gaming on functional mobility, balance, and gait speed in individuals with tropical spastic paraparesis: A randomized crossover clinical trial

INTRODUCTION: Individuals with human T-cell lymphotropic virus 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) experience sensorimotor alterations, which can affect functional performance. Virtual reality (VR) videogaming is a therapeutic option, though there is scarce evidence for its use in this population. We aimed to investigate the therapeutic effects of a VR video game on functional mobility, balance, and gait speed in individuals with HAM/TSP. METHODS: We conducted a blinded, crossover clinical trial comprising 29 individuals with HAM/TSP and randomized them into two groups: (1) early therapy: rehabilitative protocol started immediately after the initial evaluation and (2) late therapy: rehabilitative protocol started 10 weeks later. We assessed all participants for balance using the Berg Balance Scale (BBS) scores, functional mobility using the Timed Up and Go (TUG) test, and gait speed using video camera and CvMob software. Differences were considered significant if p<0.05. RESULTS: The early therapy group individuals presented with higher BBS scores (p=0.415), less TUG times (p=0.290), and greater gait speed (p=0.296) than the late therapy group individuals. CONCLUSIONS: VR videogaming is a useful option for rehabilitative therapy in individuals with HAM/TSP; it positively affects balance, functional mobility, and gait speed.

Principles for the design of a history and heritage game based on the evaluation of immersive virtual reality video games

The extension of technology in current society has encouraged teachers to introduce products based on VR and IVR in their classrooms, especially video games. In this paper the specific role of video games in cultural heritage and history teaching is analyzed. Moreover, the results of recent research on the application of video games in Secondary Education is discussed. The results advocate taking into account principles such as Civic Education, Historical Relevance, Engagement, Applicability and Multimodality (what has been called the CREAM Model) in the design of a video game. These principles are especially important if the video game aims to introduce archaeological and/or historical contents into the classroom. This model has been implemented in the design of the IVR video game Carthago Nova, which is discussed as an exemplar of how the proposed principles can be engaged. The educational sequence, in which the video game is contextualized, reinforces its educational aims.

Critically appraised paper: Tailored prescription of digitally enabled rehabilitation may improve mobility, but not physical activity, in geriatric and neurological rehabilitation [commentary

Question: Does tailored prescription of digitally enabled rehabilitation using affordable devices improve mobility and physical activity in people with mobility limitations admitted to aged care or neurological rehabilitation? Design: Pragmatic, parallel-group, randomised controlled trial with concealed allocation and blinded outcome assessment. Setting: Three inpatient rehabilitation (aged care, neurological rehabilitation) hospitals in Australia. Participants: Adults with reduced mobility (defined using Short Physical Performance Battery score 12 months, anticipated length of stay at least 10 days from randomisation, and able to maintain standing position (assistance of one person permitted). Key exclusion criteria were cognitive or visual impairment likely to interfere with device use, inability to communicate in English, medical conditions prohibiting exercise and anticipated discharge to nursing home. Randomisation of 300 participants allocated 149 to usual care plus digitally enabled rehabilitation and 151 to usual care only. Interventions: Both groups received usual multidisciplinary rehabilitation care. In addition, the intervention group was prescribed 30 to 60 minutes of digitally enabled rehabilitation (virtual reality video games, activity monitors, tablet and smartphone exercise applications) 5 days a week in hospital and after discharge (using loaned devices) for 6 months. The digitally enabled rehabilitation was individually tailored and progressed by a physiotherapist. Outcome measures: Co-primary outcomes were mobility (performance-based Short Physical Performance Battery) and upright time as a proxy for physical activity (proportion of day upright measured by activPAL, averaged over 7 days) 6 months after randomisation. Secondary outcomes included performance- based and patient-reported measures of mobility and physical activity. Results: A total of 258 participants (129 control,129 intervention) completed the 6-month assessments. At the 6-month follow-up, the change in mobility score on the Short Physical Performance Battery was greater for the intervention group than the control group (MD0.2 points, 95% CI 0.1 to 0.3), but there was no evidence of a between-group difference in upright time (MD -0.2, 95% CI -2.7 to 2.3). Between-group differences favoured the intervention group across most secondary mobility outcomes, but there was no evidence of between-group differences for most other secondary outcomes including steps taken per day. Conclusion: Digitally enabled rehabilitation to promote mobility and physical activity in mobility-limited adults receiving geriatric or neurological inpatient rehabilitation can improve mobility, but does not appear to increase time spent upright.

Developing a Virtual Reality Video Game to Simulate Rip Currents.

Beachgoers in the United States face many different hazards, but rip currents are annually the deadliest for ocean swimmers. Despite the risk presented by rip currents, it is apparent that the public has a limited understanding of their danger and the proper mitigating actions to take when caught in one. A virtual reality (VR) video game placing participants in a simulated rip current was developed to help ameliorate this issue. The VR game was used to survey beachgoers on the Atlantic Coast of Long Island, New York during July and August 2019. The actions participants took when confronted with the rip current were recorded, along with whether they escaped it or drowned. An interview with each player was also conducted after they partook in the game to determine the realism of the rip current simulation and its effectiveness in demonstrating proper actions to take when impacted by one. Analysis of those results indicates that VR has potential to communicate rip current risk and ways to minimize it in a unique and engaging manner. However, further work is needed to improve ease of use of the VR simulation and better understand how factors such as demographics influence perceived rip current risk and behavioral response.

Heart Rate Variability Mainly Relates to Cognitive Executive Functions and Improves Through Exergame Training in Older Adults: A Secondary Analysis of a 6-Month Randomized Controlled Trial.

Heart rate variability (HRV) mirrors autonomic nervous system activities and might serve as a parameter to monitor health status in older adults. However, it is currently unknown which functional health measures, including cognitive, physical, and gait performance parameters, are most strongly related to HRV indices. This knowledge would enable implementing HRV assessments into health monitoring routines and training planning for older adults. Simultaneous cognitive–motor and exergame training may be effective to improve HRV indices but has not been investigated yet. Eighty-nine healthy older adults (≥70 years of age) were randomized into three groups: (1) virtual reality video game dancing, i.e., exergaming (DANCE); (2) treadmill walking with simultaneous verbal memory training (MEMORY); or (3) treadmill walking only (PHYS). Strength and balance exercises complemented each program. Over 6 months, two weekly 1-h training sessions were performed. HRV indices (standard deviation of N–N intervals, SDNN; root mean square of successive R–R interval differences, RMSSD; and absolute power of high-frequency band (0.15–0.4 Hz), HF power) and various measures of cognitive, physical, and gait performance were assessed at baseline and after 3 months and 6 months. Multiple linear regression analyses with planned comparisons were calculated. At baseline, 8–12% of HRV variance was significantly explained by cognitive executive functions and leg strength (inversely related). Verbal long-term memory, aerobic and functional fitness, and gait performance did not contribute to the model (SDNN: R2 = 0.082, p = 0.016; RMSSD: R2 = 0.121, p = 0.013; HF power: R2 = 0.119, p = 0.015). After 6 months, DANCE improved HRV indices, while MEMORY and PHYS did not (time × intervention interactions: first-contrast DANCE/MEMORY vs. PHYS: SDNN p = 0.014 one-tailed, ΔR2 = 0.020 and RMSSD p = 0.052 one-tailed (trend), ΔR2 = 0.007; second-contrast DANCE vs. MEMORY: SDNN p = 0.002 one-tailed, ΔR2 = 0.035, RMSSD p = 0.017 one-tailed, ΔR2 = 0.012, and HF power p = 0.011 one-tailed, ΔR2 = 0.013). We conclude that mainly cognitive executive functions are associated with HRV indices and that exergame training improves global and parasympathetic autonomic nervous system activities in older adults. Periodic assessments of HRV in older citizens could be particularly beneficial to monitor cognitive health and provide indications for preventative exercise measures.

Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial – description of device use and physiotherapy support in the post-hospital phase

Purpose To describe device use and physiotherapy support in the post-hospital phase of the AMOUNT rehabilitation trial. Methods We performed an evaluation of the support required for device use by participants randomised to the intervention group who received digitally-enabled rehabilitation in the post-hospital phase (n = 144). Intervention, additional to standard rehabilitation, utilised eight digital devices (virtual reality videogames, activity monitors and handheld computer devices) to improve mobility and increase physical activity. Participants were taught to use devices during inpatient rehabilitation and were then discharged home to use the devices for the remainder of the 6-month trial. Physiotherapist-participant contact occurred every 1–2 weeks using a health coaching approach, including technology support when required. Intervention datasheets were audited, and descriptive statistics used to report device use and support required. Results Participants (mean (SD) age 70 (18) years; 49% neurological health conditions) used an average of 2 (SD 1) devices (98% used an activity monitor). Eight percent of physiotherapy contact included technology support with 30% provided remotely. Support addressed 845 issues categorised under initial set-up and instruction (27%), education and training (31%), maintenance (23%) and trouble-shooting (19%). Conclusion Digital devices can be used for home-based rehabilitation, but ongoing technology support is essential. Clinical Trials Registry: ACTRN12614000936628 IMPLICATIONS FOR REHABILITATION Digital device use at home to support long-term management of health conditions is likely to become increasingly important as the need for rehabilitation increases and rehabilitation resources become more limited. Technology support for set-up and ongoing device use is a critical enabler of home-based digital interventions. Health professionals delivering home-based digital interventions require sufficient training and equipment and may need to vary the mode (e.g., home visit vs. telephone or video conference) depending on the technology support required.

Virtual Reality Games and the Role of Body Involvement in Enhancing Positive Emotions and Decreasing Anxiety: Within-Subjects Pilot Study.

BackgroundIn the last few years, the introduction of immersive technologies, especially virtual reality, into the gaming market has dramatically altered the traditional concept of video games. Given the unique features of virtual reality in terms of interaction and its ability to completely immerse the individual into the game, this technology should increase the propensity for video games to effectively elicit positive emotions and decrease negative emotions and anxiety in the players. However, to date, few studies have investigated the ability of virtual reality games to induce positive emotions, and the possible effect of this new type of video game in diminishing negative emotions and anxiety has not yet been tested. Furthermore, given the critical role of body movement in individuals’ well-being and in emotional responses to video games, it seems critical to investigate how body involvement can be exploited to modulate the psychological benefits of virtual reality games in terms of enhancing players’ positive emotions and decreasing negative emotions and anxiety.ObjectiveThis within-subjects study aimed to explore the ability of commercial virtual reality games to induce positive emotions and diminish negative emotions and state anxiety of the players, investigating the effects of the level of body involvement requested by the game (ie, high vs low).MethodsA total of 36 young adults played a low body-involvement (ie, Fruit Ninja VR) and a high body-involvement (ie, Audioshield) video game in virtual reality. The Visual Analogue Scale (VAS) and the State-Trait Anxiety Inventory, Form-Y1 (STAI-Y1) were used to assess positive and negative emotions and state anxiety.ResultsResults of the generalized linear model (GLM) for repeated-measures multivariate analysis of variance (MANOVA) revealed a statistically significant increase in the intensity of happiness (P<.001) and surprise (P=.003) and, in parallel, a significant decrease in fear (P=.01) and sadness (P<.001) reported by the users. Regarding the ability to improve anxiety in the players, the results showed a significant decrease in perceived state anxiety after game play, assessed with both the STAI-Y1 (P=.003) and the VAS-anxiety (P=.002). Finally, the results of the GLM MANOVA showed a greater efficacy of the high body-involvement game (ie, Audioshield) compared to the low body-involvement game (ie, Fruit Ninja VR), both for eliciting positive emotions (happiness, P<.001; and surprise, P=.01) and in reducing negative emotions (fear, P=.05; and sadness, P=.05) and state anxiety, as measured by the STAI-Y1 (P=.05).ConclusionsThe two main principal findings of this study are as follows: (1) virtual reality video games appear to be effective tools to elicit positive emotions and to decrease negative emotions and state anxiety in individuals and (2) the level of body involvement of the virtual video game has an important effect in determining the ability of the game to improve positive emotions and decrease negative emotions and state anxiety of the players.

A review of virtual reality videogames for job-training applications

Information and Communication Technologies (ICT) are considered as crucial elements in educational processes, as they constitute relevant and necessary tools in the search for higher levels of socioeconomic development. In this context, ICTs have raised the challenge of finding pedagogical models that maximize their impact on teachers and students. The Business Services and Management Center of the SENA Regional Antioquia has a wide range of technical training programs, for a rapid immersion into the labor market, which implies the use of training technologies to ease the understanding of theoretical concepts and the practice of technical procedures. In addition, these programs require the development of skills allowing their students to perform correctly in the workplace. Considering the above, videogames arise as an alternative tool for training operations. This article presents a review of training tools based on virtual reality, focusing mainly on the design of the game elements and their dynamics, which can contribute to magnify user experiences. Moreover, we present some projects showing success stories in the learning process and discussing the impact of the elements and game mechanics.

Effect of virtual reality video games on gross motor function of children with cerebral palsy

Objective To explore the effect of virtual reality video games on gross motor skills of children with cerebral palsy. Methods The 56 patients with cerebral palsy treated in the Fifth Affiliated Hospital of Zhengzhou University from April 2015 to April 2017 were selected as the subjects.The age of the patients was (5.4±1.2) years old (5-7 years old). According to the results of Gross Motor Function Classification System (GMFCS) assessment, all patients belonged to level Ⅰ-Ⅱ.All patients were randomly divided-into 2 groups: video-game group and conventional exercise group for 6 weeks of functional exercise.The evaluation criteria included the average exercise time, the 6-minute walk test (6MWT) and general motion function challenge module (GMFMS-CM) measurement and evaluation. Results The average exercise time of video games in video game group was (44.2 ± 6.1) minutes.The encouragement from the therapists in the intervention process was very important.The technical problems also had a relatively high proportion, and the technical guidance and training should be emphasized at the beginning of the study.The ave-rage score of the Likert scale showed that the practice program was suitable for the patients; GMFMS-CM in video-game group was significantly higher [mean difference was 4.8, the quartile (IQP) was 4.68, Z=-2.025, P=0.035], while conventional exercise group showed an increasing trend which was not significantly different; 6MWT showed a significant increase in the mean level of video-game group (mean difference was 69.1 m, IQR was 40.2 m, Z=-2.108, P=0.045), conventional exercise group was significantly lower than the average level of subjects in video-game group and there was no significant change in the study period. Conclusion For children with cerebral palsy, routine functional rehabilitation exercise plus family-style virtual reality video game practice, on the one hand to improve patient compliance with the treatment, on the other hand can significantly improve their physical movement function, which is conducive for the patients′ quality of life and self-care ability. Key words: Virtual reality; Video game; Cerebral palsy; Motor function

A Virtual Reality–Based Psychological Treatment in Long-Term Hospitalization: A Case Study

The aim of this article is to provide preliminary efficacy of a psychological intervention for children and young patients to help them to improve resilience, coping strategies for pain, anxiety, and general emotional discomfort in long-term hospitalization using a virtual reality videogame and telepsychology. A case study illustration in an adolescent was 15-year-old Spanish boy hospitalized in the pediatric ward and prescribed dialysis is presented to provide some clinical evidence of the treatment’s strategic feasibility and efficacy for this population. Patient was pre, post, and follow-up assessed anxiety, affective, resilience, and avoidance. Space Academy is a virtual reality–based treatment with positive psychology and third-wave therapy components that consist in understanding the basic aspects of their disease, to promote emotional perception and regulation and promote and develop resilience. Results show good acceptability and feasibility, improved state and trait anxiety, resilience, and emotional competence in controlling behavior. The case illustration shows improvements in anxiety resilience and acceptance. The use of information and communication technologies in psychology is an advance in clinical and health care psychology.

Determining Physiological and Psychological Predictors of Time to Task Failure on a Virtual Reality Sørensen Test in Participants With and Without Recurrent Low Back Pain: Exploratory Study.

BackgroundSørensen trunk extension endurance test performance predicts the development of low back pain and is a strong discriminator of those with and without low back pain. Performance may greatly depend on psychological factors, such as kinesiophobia, self-efficacy, and motivation. Virtual reality video games have been used in people with low back pain to encourage physical activity that would otherwise be avoided out of fear of pain or harm. Accordingly, we developed a virtual reality video game to assess the influence of immersive gaming on the Sørensen test performance.ObjectiveThe objective of our study was to determine the physiological and psychological predictors of time to task failure (TTF) on a virtual reality Sørensen test in participants with and without a history of recurrent low back pain.MethodsWe recruited 24 individuals with a history of recurrent low back pain and 24 sex-, age-, and body mass index–matched individuals without a history of low back pain. Participants completed a series of psychological measures, including the Center for Epidemiological Studies-Depression Scale, Pain Resilience Scale, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and a self-efficacy measure. The maximal isometric strength of trunk and hip extensors and TTF on a virtual reality Sørensen test were measured. Electromyography of the erector spinae, gluteus maximus, and biceps femoris was recorded during the strength and endurance trials.ResultsA two-way analysis of variance revealed no significant difference in TTF between groups (P=.99), but there was a trend for longer TTF in females on the virtual reality Sørensen test (P=.06). Linear regression analyses were performed to determine predictors of TTF in each group. In healthy participants, the normalized median power frequency slope of erector spinae (beta=.450, P=.01), biceps femoris (beta=.400, P=.01), and trunk mass (beta=−.32, P=.02) predicted TTF. In participants with recurrent low back pain, trunk mass (beta=−.67, P<.001), Tampa Scale for Kinesiophobia (beta=−.43, P=.01), and self-efficacy (beta=.35, P=.03) predicted TTF.ConclusionsTrunk mass appears to be a consistent predictor of performance. Kinesiophobia appears to negatively influence TTF for those with a history of recurrent low back pain, but does not influence healthy individuals. Self-efficacy is associated with better performance in individuals with a history of recurrent low back pain, whereas a less steep median power frequency slope of the trunk and hip extensors is associated with better performance in individuals without a history of low back pain.

Evidence of a two-way contrast in Mexican Spanish spatial deixis

This study provides evidence for a binary contrast in the deictic system of Mexican Spanish. The analysis is based on experimental data on how native speakers interpret the adverbial demonstratives aquí/acá/ahí/allí/allá in a 3D virtual reality video game. The tests crossed the variables of distance, person, and anaphora. The results revealed that (i) when contrasting degrees of distance and anaphoric reference, ahí primarily has an anaphoric function, while aquí/acá/allí/allá primarily have a deictic function; (ii) acá/aquí designate proximal distances and the domain of the speaker; (iii) ahí designates the domain of the hearer in a person-oriented deixis; and (iv) the meaning of allí and allá cannot be explained by the deictic parameters of distance and person.

Effects of a virtual reality video game exercise program on upper extremity function and daily living activities in stroke patients.

[Purpose] This study examined the effects of training using virtual reality games on stroke patients’ functional recovery. [Paticipants and Methods] Twenty-four hemiplegia patients whose disease duration was longer than six months participated in this study. The participants were divided at random into a control group (n=12), which received traditional rehabilitation therapy, and an experimental group (n=12), which received both traditional rehabilitation therapy and training using virtual reality games. The program lasted for a total of 12 weeks. To examine the participants’ functional recovery, their upper limb function was measured using the Fugl-Meyer Assessment and Manual Function Test before and after they completed the training and their daily living activities were measured using the Stroke Impact Scale before and after they completed the training. [Results] The experimental group participants’ daily living activities improved after training. In addition, the experimental group scored significantly higher on all the tests than the control group, but upper extremity function between the groups was not significantly different. [Conclusion] Stroke patients who completed the additional training using virtual reality games showed significantly greater improvement in their daily living activities than those who only received traditional rehabilitation therapy.

Development of a novel virtual reality gait intervention

IntroductionImproving gait speed and kinematics can be a time consuming and tiresome process. We hypothesize that incorporating virtual reality videogame play into variable improvement goals will improve levels of enjoyment and motivation and lead to improved gait performance. PurposeTo develop a feasible, engaging, VR gait intervention for improving gait variables. MethodsCompleting this investigation involved four steps: 1) identify gait variables that could be manipulated to improve gait speed and kinematics using the Microsoft Kinect and free software, 2) identify free internet videogames that could successfully manipulate the chosen gait variables, 3) experimentally evaluate the ability of the videogames and software to manipulate the gait variables, and 4) evaluate the enjoyment and motivation from a small sample of persons without disability. ResultsThe Kinect sensor was able to detect stride length, cadence, and joint angles. FAAST software was able to identify predetermined gait variable thresholds and use the thresholds to play free online videogames. Videogames that involved continuous pressing of a keyboard key were found to be most appropriate for manipulating the gait variables. Five participants without disability evaluated the effectiveness for modifying the gait variables and enjoyment and motivation during play. Participants were able to modify gait variables to permit successful videogame play. Motivation and enjoyment were high. SummaryA clinically feasible and engaging virtual intervention for improving gait speed and kinematics has been developed and initially tested. It may provide an engaging avenue for achieving thousands of repetitions necessary for neural plastic changes and improved gait.

Three-dimensional, virtual reality vestibular rehabilitation for chronic imbalance problem caused by Ménière’s disease: a pilot study

Purposes: The purpose of this study was to evaluate a three-dimensional, virtual reality system for vestibular rehabilitation in patients with intractable Ménière’s disease and chronic vestibular dysfunction.Methods: We included 70 patients (36 for study, 34 as control) with a chronic imbalance problem caused by uncompensated Ménière’s disease. The virtual reality vestibular rehabilitation comprised four training tasks (modified Cawthorne–Cooksey exercises: eye, head, extension, and coordination exercises) performed in six training sessions (in 4 weeks). Measurements of the task scores and balance parameters obtained at the baseline and after final training sessions were compared.Results: A significant improvement was observed in extension and coordination scores. Patients in the early stages of Ménière’s disease had a significantly greater improvement in the center of gravity sway and trajectory excursion in the mediolateral direction than did patients in the late stages of Ménière’s disease. Mild functional disability attributable to Ménière’s disease was a predictor of improvement in the statokinesigram and maximum trajectory excursion in the anteroposterior direction after rehabilitation. The control group showed no significant improvement in almost all parameters.Conclusion: Virtual reality vestibular rehabilitation may be useful in patients with Ménière’s disease, particular those in the early stages or having mild functional disability.Implication for rehabilitationChronic imbalance caused by uncompensated Ménière’s disease is an indication for vestibular rehabilitation.The interactive virtual reality video game, when integrated into vestibular rehabilitation exercise protocol, may assist patients who have mild disability Ménière’s disease and who cannot benefit from treatment with drugs or surgery.The initial data from this study support the applicability of three-dimensional virtual reality technology in vestibular rehabilitation programs. The technology gives professionals a new tool to guide patients for vestibular rehabilitation exercises through three-dimensional virtual reality video game playing.The virtual reality vestibular exercise game can provide patients a step-wise, interactive, dynamic, three-dimensional, and interesting rehabilitation environment.

Development and Reliability Evaluation of the Movement Rating Instrument for Virtual Reality Video Game Play.

BackgroundVirtual reality active video games are increasingly popular physical therapy interventions for children with cerebral palsy. However, physical therapists require educational resources to support decision making about game selection to match individual patient goals. Quantifying the movements elicited during virtual reality active video game play can inform individualized game selection in pediatric rehabilitation.ObjectiveThe objectives of this study were to develop and evaluate the feasibility and reliability of the Movement Rating Instrument for Virtual Reality Game Play (MRI-VRGP).MethodsItem generation occurred through an iterative process of literature review and sample videotape viewing. The MRI-VRGP includes 25 items quantifying upper extremity, lower extremity, and total body movements. A total of 176 videotaped 90-second game play sessions involving 7 typically developing children and 4 children with cerebral palsy were rated by 3 raters trained in MRI-VRGP use. Children played 8 games on 2 virtual reality and active video game systems. Intraclass correlation coefficients (ICCs) determined intra-rater and interrater reliability.ResultsExcellent intrarater reliability was evidenced by ICCs of >0.75 for 17 of the 25 items across the 3 raters. Interrater reliability estimates were less precise. Excellent interrater reliability was achieved for far reach upper extremity movements (ICC=0.92 [for right and ICC=0.90 for left) and for squat (ICC=0.80) and jump items (ICC=0.99), with 9 items achieving ICCs of >0.70, 12 items achieving ICCs of between 0.40 and 0.70, and 4 items achieving poor reliability (close-reach upper extremity-ICC=0.14 for right and ICC=0.07 for left) and single-leg stance (ICC=0.55 for right and ICC=0.27 for left).ConclusionsPoor video quality, differing item interpretations between raters, and difficulty quantifying the high-speed movements involved in game play affected reliability. With item definition clarification and further psychometric property evaluation, the MRI-VRGP could inform the content of educational resources for therapists by ranking games according to frequency and type of elicited body movements.