Journal of Clinical Medicine

Research

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22 pages, 2722 KiB

Open AccessArticle

Could an Immersive Virtual Reality Training Improve Navigation Skills in Children with Cerebral Palsy? A Pilot Controlled Study

by Roberta Nossa, Chiara Gagliardi, Daniele Panzeri, Eleonora Diella, Cristina Maghini, Chiara Genova, Anna Carla Turconi and Emilia Biffi

J. Clin. Med. 2022, 11(20), 6146; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11206146 - 18 Oct 2022

Cited by 2 | Viewed by 1772

Abstract

Children with cerebral palsy (CP) suffer deficits in their motor, sensory, and cognitive abilities, as well as in their visuospatial competences. In the last years, several authors have tried to correlate the visuospatial abilities with the navigational ones. Given their importance in everyday [...] Read more.

Children with cerebral palsy (CP) suffer deficits in their motor, sensory, and cognitive abilities, as well as in their visuospatial competences. In the last years, several authors have tried to correlate the visuospatial abilities with the navigational ones. Given their importance in everyday functions, navigation skills have been deeply studied using increasingly cutting-edge techniques such as virtual reality (VR). However, to our knowledge, there are no studies focused on training using immersive VR (IVR) in children with movement disorders. For this reason, we proposed an IVR training to 35 young participants with CP and conceived to improve their navigation skills in a “simil-real” environment while playing on a dynamic platform. A subgroup performed a part of the training which was specifically dedicated to the use of the allocentric strategy (i.e., looking for landmarks) to navigate the virtual environment. We then compared the children’s navigation and spatial skills pre- and post-intervention. All the children improved their visual–spatial abilities; particularly, if the IVR activities specifically trained their ability to look for landmarks and use them to navigate. The results of this work highlight the potential of an IVR training program to increase the navigation abilities of patients with CPs. Full article

(This article belongs to the Special Issue Virtual Reality Therapy: Emerging Topics and Future Challenges)

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15 pages, 3109 KiB

Open AccessArticle

Development of an ICT-Based Exergame Program for Children with Developmental Disabilities

by Hyunjin Kwon, Hyokju Maeng and Jinwook Chung

J. Clin. Med. 2022, 11(19), 5890; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11195890 - 5 Oct 2022

Cited by 1 | Viewed by 1749

Abstract

The purpose of this study was to develop an information and communications technology (ICT)-based exergame for children with developmental disabilities (DD) and to examine its impacts on physical fitness and fundamental motor skills (FMS). The ICT-based exergame consisted of visual and auditory demonstrations [...] Read more.

The purpose of this study was to develop an information and communications technology (ICT)-based exergame for children with developmental disabilities (DD) and to examine its impacts on physical fitness and fundamental motor skills (FMS). The ICT-based exergame consisted of visual and auditory demonstrations of diverse locomotor movement and object manipulation activities by the virtual characters. A total of 52 children with DD participated in the present study. The participants were divided into twenty-seven children in the experimental group and 25 children with DD in the control group. The experimental group participants engaged in the exergame program for 12 weeks. All participants’ muscle strength (i.e., standing long jump) and four fundamental motor skills, such as the horizontal jump, hop, overhand throw, and dribble, were assessed during the pre- and post-test process. There were significant impacts on physical fitness and FMS (p < 0.001) between the groups. Specifically, the results of three FMS (hop, overhand throw, and dribble) and standing long jump significantly improved in children with DD except for the horizontal jump skill. The results of this study is evidence that the ICT-based exergame program for children with DD may be utilized to improve physical fitness and FMS in children with DD. Full article

(This article belongs to the Special Issue Virtual Reality Therapy: Emerging Topics and Future Challenges)

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17 pages, 1182 KiB

Open AccessArticle

COVID Feel Good: Evaluation of a Self-Help Protocol to Overcome the Psychological Burden of the COVID-19 Pandemic in a German Sample

by Marie Lisa Meyer, Arne Kaesler, Stefanie Wolffgramm, Nicolina Laura Perić, Gentian Bunjaku, Lilith Dickmann, Silvia Serino, Daniele Di Lernia, Cosimo Tuena, Luca Bernardelli, Elisa Pedroli, Brenda K. Wiederhold, Giuseppe Riva and Youssef Shiban

J. Clin. Med. 2022, 11(8), 2080; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11082080 - 7 Apr 2022

Cited by 8 | Viewed by 2551

Abstract

The COVID-19 pandemic has severe consequences for physical as well as mental well-being. In times of restricted social contact, online self-help programs offer a low-threshold first aid to cope with the psychological burden. This current study evaluates the online self-help protocol “COVID Feel [...] Read more.

The COVID-19 pandemic has severe consequences for physical as well as mental well-being. In times of restricted social contact, online self-help programs offer a low-threshold first aid to cope with the psychological burden. This current study evaluates the online self-help protocol “COVID Feel Good” in a German sample. The multicentric study was designed as a single cohort with a waiting list control condition. The convenience sample consisted of 38 German individuals who experienced at least two months of restrictions during the COVID-19 pandemic. The 7-day self-help protocol included the VR video “Secret Garden” as well as a social or cognitive exercise each day. General distress, depression, anxiety, stress, and hopelessness were assessed as primary outcomes. Social connectedness and fear of coronavirus were measured as secondary outcomes. Results showed a significant decrease in all primary outcomes except for hopelessness. Furthermore, the results indicated a significant improvement in social connectedness. Treatment effects on general distress, depression, stress, and anxiety persisted for two weeks after participation. The present study indicates that VR-based self-help protocols can mitigate the psychological burden associated with the pandemic, supporting recent findings. Full article

(This article belongs to the Special Issue Virtual Reality Therapy: Emerging Topics and Future Challenges)

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18 pages, 3554 KiB

Open AccessArticle

A Psychometric Tool for Evaluating Executive Functions in Parkinson’s Disease

by Francesca Borgnis, Francesca Baglio, Elisa Pedroli, Federica Rossetto, Mario Meloni, Giuseppe Riva and Pietro Cipresso

J. Clin. Med. 2022, 11(5), 1153; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11051153 - 22 Feb 2022

Cited by 5 | Viewed by 1947

Abstract

Recently, there has been an increasing interest in using 360° virtual-reality video for an ecologically valid assessment of executive functioning in the neurologic population. In this framework, we have developed the EXecutive-functions Innovative Tool (EXIT 360°), an original 360°-based instrument for a multicomponent, [...] Read more.

Recently, there has been an increasing interest in using 360° virtual-reality video for an ecologically valid assessment of executive functioning in the neurologic population. In this framework, we have developed the EXecutive-functions Innovative Tool (EXIT 360°), an original 360°-based instrument for a multicomponent, ecologically valid evaluation of executive functioning in Parkinson’s Disease (PD). This work aimed to test the usability and user experience of EXIT 360° in patients with PD (PwPD). Twenty-seven PwPD and twenty-seven healthy controls underwent an evaluation that involved: (1) usability assessment by the System Usability Scale and (2) evaluation of user experience using the ICT—Sense of Presence and User Experience Questionnaire. Results showed a satisfactory level of usability for patients (mean = 76.94 ± 9.18) and controls (mean = 80 ± 11.22), with good scores for usability and learnability. Regarding user experience, patients provided a positive overall impression of the tool, evaluating it as attractive, enjoyable, activating, and funny. Moreover, EXIT 360° showed good pragmatic (e.g., efficient, fast, clear) and hedonic quality (e.g., exciting, interesting, and creative). Finally, PwPD considered EXIT 360° as an original tool with high ecological validity (mean = 4.29 ± 0.61), spatial presence (mean = 3.11 ± 0.83) and engagement (mean = 3.43 ± 0.54) without relevant adverse effects. Technological expertise had no impact on performance. Overall, EXIT 360° appeared to be a usable, easy-to-learn, engaging, and innovative instrument for PD. Further studies will be conducted to deepen its efficacy in distinguishing between healthy subjects and patients with executive dysfunctions. Full article

(This article belongs to the Special Issue Virtual Reality Therapy: Emerging Topics and Future Challenges)

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16 pages, 1981 KiB

Open AccessArticle

Changes in Brain Activation through Cognitive-Behavioral Therapy with Exposure to Virtual Reality: A Neuroimaging Study of Specific Phobia

by Yolanda Álvarez-Pérez, Francisco Rivero, Manuel Herrero, Conrado Viña, Ascensión Fumero, Moisés Betancort and Wenceslao Peñate

J. Clin. Med. 2021, 10(16), 3505; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10163505 - 9 Aug 2021

Cited by 13 | Viewed by 4799

Abstract

Background: Cognitive-behavioral therapy (CBT) with exposure is the treatment of choice for specific phobia. Virtual reality exposure therapy (VRET) has shown benefits for the treatment and prevention of the return of fear in specific phobias by addressing the therapeutic limitations of exposure to [...] Read more.

Background: Cognitive-behavioral therapy (CBT) with exposure is the treatment of choice for specific phobia. Virtual reality exposure therapy (VRET) has shown benefits for the treatment and prevention of the return of fear in specific phobias by addressing the therapeutic limitations of exposure to real images. Method: Thirty-one participants with specific phobias to small animals were included: 14 were treated with CBT + VRET (intervention group), and 17 were treated with CBT + exposure to real images (active control group). Participants’ scores in anxiety and phobia levels were measured at baseline, post-treatment, and 3-month follow-up, and brain activation was measured through functional magnetic resonance imaging (fMRI) baseline and post-treatment. Results: Both groups showed a significant decrease in anxiety and phobia scores after the therapy and were maintained until follow-up. There were no significant differences between both groups. Overall, fMRI tests showed a significant decrease in brain activity after treatment in some structures (e.g., prefrontal and frontal cortex) and other structures (e.g., precuneus) showed an increasing activity after therapy. However, structures such as the amygdala remained active in both groups. Conclusions: The efficacy of CBT + VRET was observed in the significant decrease in anxiety responses. However, the results of brain activity observed suggest that there was still a fear response in the brain, despite the significant decrease in subjective anxiety levels. Full article

(This article belongs to the Special Issue Virtual Reality Therapy: Emerging Topics and Future Challenges)

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Review

Jump to: Research

12 pages, 1678 KiB

Open AccessReview

Various Types of Virtual Reality-Based Therapy for Eating Disorders: A Systematic Review

by Julia Ciążyńska and Janusz Maciaszek

J. Clin. Med. 2022, 11(17), 4956; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11174956 - 24 Aug 2022

Cited by 5 | Viewed by 2726

Abstract

(1) Background: Interactive VR (virtual reality) environments (i.e., using three-dimensional graphics presented with a head-mounted display) have recently become a popular professional tool for the treatment of patients with eating disorders (EDs). However, there are no published review reports that have analyzed the [...] Read more.

(1) Background: Interactive VR (virtual reality) environments (i.e., using three-dimensional graphics presented with a head-mounted display) have recently become a popular professional tool for the treatment of patients with eating disorders (EDs). However, there are no published review reports that have analyzed the original papers between 2015 and 2021, which additionally focused only on HMD (head-mounted display) 3DVR (three-dimensional virtual reality) exposure and included only three therapeutic categories for ED patients. (2) Methods: The EbscoHost and Scopus databases were searched to identify relevant papers on VR research employing VR in the assessment and treatment of eating disorders. (3) Results: In addition to the known therapeutic divisions for ED, there are new forms of therapy based on 360 cameras, eye-tracking, and remote therapy. (4) Conclusions: The potential of VR in combination with different therapies may offer an alternative for future research. More rigorous testing, especially in terms of larger sample sizes, the inclusion of control groups or multisessions, and follow-up measures, is still needed. The current state of research highlights the importance of the nature and content of VR interventions for ED patients. Future research should look to incorporate more home-based and remote forms of VR tools. Full article

(This article belongs to the Special Issue Virtual Reality Therapy: Emerging Topics and Future Challenges)

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18 pages, 1044 KiB

Open AccessReview

State-of-the-Art Review on Immersive Virtual Reality Interventions for Colonoscopy-Induced Anxiety and Pain

by Marcel-Alexandru Găină, Andreea Silvana Szalontay, Gabriela Ștefănescu, Gheorghe Gh Bălan, Cristina Mihaela Ghiciuc, Alexandra Boloș, Alexandra-Maria Găină and Cristinel Ștefănescu

J. Clin. Med. 2022, 11(6), 1670; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11061670 - 17 Mar 2022

Cited by 13 | Viewed by 4724

Abstract

Background: Colonoscopy related fear impairs the current gold standard screening of colorectal cancer. Compared to other minimally invasive procedures for cancer screening, colonoscopy-induced anxiety exceeds the procedure through bowel preparation. Immersive virtual reality’s (iVR) role in alleviating the complex stress–pain relationship encountered during [...] Read more.

Background: Colonoscopy related fear impairs the current gold standard screening of colorectal cancer. Compared to other minimally invasive procedures for cancer screening, colonoscopy-induced anxiety exceeds the procedure through bowel preparation. Immersive virtual reality’s (iVR) role in alleviating the complex stress–pain relationship encountered during medical procedures is directly proportional to the rising affordability of state-of-the-art Head-Mounted-Displays (HMDs). Objective: to assess the effect of iVR on patients’ colonoscopy-induced anxiety and pain. Materials and methods: A systematic search was conducted in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Embase and Scopus databases up to January 2022. Clinical trials evaluating anxiety as an outcome were included without language restriction. Results: Four clinical trials were included: three on the patients’ intraprocedural anxiety and one on patient education. Intraprocedural iVR interventions for colonoscopy-induced anxiety and pain revealed a similar effect as conventional sedation, while a statistically significant reduction was reported for non-sedated patients. iVR patient education improved the quality of bowel preparation and reduced patient anxiety before colonoscopy. Conclusions: The current research highlights the need to use high-end HMDs and appropriate interactive iVR software content for colonoscopy-induced anxiety. Methodological frameworks regarding the eligibility of participants, double-blinding and randomization of iVR studies can facilitate the development of iVR implementation for anxiety and pain management. Full article

(This article belongs to the Special Issue Virtual Reality Therapy: Emerging Topics and Future Challenges)

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13 pages, 2109 KiB

Open AccessReview

Virtual Reality Interventions for Needle-Related Procedural Pain, Fear and Anxiety—A Systematic Review and Meta-Analysis

by Oliver Czech, Adam Wrzeciono, Anna Rutkowska, Agnieszka Guzik, Paweł Kiper and Sebastian Rutkowski

J. Clin. Med. 2021, 10(15), 3248; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10153248 - 23 Jul 2021

Cited by 39 | Viewed by 8230

Abstract

Needle-related procedures are often a source of pain, anxiety and fear in young patients. This systematic review aimed to investigate the effectiveness of virtual reality (VR) on reducing pain, fear and anxiety in pediatric patients undergoing needle-related procedures. Pain, anxiety, fear, changes in [...] Read more.

Needle-related procedures are often a source of pain, anxiety and fear in young patients. This systematic review aimed to investigate the effectiveness of virtual reality (VR) on reducing pain, fear and anxiety in pediatric patients undergoing needle-related procedures. Pain, anxiety, fear, changes in blood pressure and heart rate as well as satisfaction were evaluated as outcomes during needle-related procedures in VR compared with standard care conditions. A meta-analysis was performed, taking into account online databases. Two authors independently conducted literature searches in December 2020. The last search was conducted in March 2021 from a total of 106 records, 7 met our inclusion criteria. One study was excluded from the meta-analysis due to insufficient data. VR was applied as a distractor during venous access. Statistically significant benefits of using VR were shown in children’s pain scores, where VR significantly decreased symptoms (n = 3204 patients, MD = −2.85; 95% CI −3.57, −2.14, for the Wong–Baker Faces Pain Rating Scale and n = 2240 patients, MD = −0.19; 95% CI −0.58, 0.20, for the Faces Pain Scale—Revised). The analysis of fear, anxiety and satisfaction scores revealed no significant differences between the conditions, as the studies were too heterogeneous to be pooled. Distraction using virtual reality may be an effective intervention for reducing pain in children undergoing needle-related medical procedures. However, further research in the implementation of VR as a distractor for children and adolescents is required, due to the limited research into this field. Full article

(This article belongs to the Special Issue Virtual Reality Therapy: Emerging Topics and Future Challenges)

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