The calming effect of a new wearable device during the anticipation of public speech

Haptic coordination: Squeezing a vibrating stress ball decreases anxiety and arousal

We evaluated the effect of haptic coordination on anxiety and arousal. Participants looked at a stressful or calming image and then repeatedly squeezed a vibrating stress ball for 20 s. Using a pre-post paradigm with a control group, we showed that squeezing the vibrating ball reduced anxiety and arousal, as assessed by the State-Trait Anxiety Inventory and electrodermal activity, respectively. The stability of haptic coordination was manipulated by varying the detuning between the spontaneous squeezing frequency and the intrinsic frequency of ball vibration. Coordination stability affected arousal and stress affected stability. The data were discussed in the light of Kahneman's attentional resource-sharing model.

Evaluating Doppel's impact on Anxiety and Focus amongst adults with ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed psychiatric disorder in children. Amongst adults, it is often underdiagnosed and associated with comorbidities including anxiety. This study presents a trial evaluating the efficacy of Doppel, a wrist-worn wearable that provides vibrations linked to one's heart rate to improve symptoms of anxiety and poor focus amongst young adults with ADHD. Young adults (aged 18-25) used either an active or comparator Doppel for 8 weeks, completing measures of anxiety and focus at baseline, 4 weeks, and 8 weeks. Participants in both groups experienced a reduction in anxiety and an increase in focus across the trial duration. No superiority for vibrations linked to one's heart rate was found. Whilst the current study cannot determine a specific mechanism of action, the findings provide some promising initial evidence as to the potential for direct-to-consumer digital health products to be useful in symptom management amongst young adults with ADHD.

Assistive Technology's Potential to Improve Employment of People with Disabilities

PURPOSE

This study investigates how access to assistive technologies affects employment and earnings among people with disabilities.

METHODS

We first document employment and earnings gaps associated with specific impairments and activity limitations using 2017-2021 American Community Survey and 2014 Survey of Income and Program Participation data. We then use accommodations data from the 2012, 2019, and 2021 Current Population Survey (CPS) Disability Supplements to examine employment and earnings growth for people with disabilities related both to any, and to technology-based, accommodations. We also provide short descriptions of three developing assistive technologies that assist people with upper body impairments, visual impairments, and anxiety conditions.

RESULTS

Almost all impairments and activity limitations are linked to lower employment and earnings, with especially low employment among people with mobility impairments and particularly low earnings among those with cognitive impairments. About one-tenth of workers with disabilities received any accommodations, and 3-4% received equipment-based accommodations in the 2012-2021 period; these figures increased slightly over the period. The occupations with the highest disability accommodations rates had greater disability employment growth from 2012 to 2021, but disability pay gaps did not decrease more in these occupations. The three developing assistive technologies we describe illustrate the potential to reduce the estimated employment and earnings deficits.

CONCLUSION

Assistive technology accommodations have potential for improving employment outcomes for people with disabilities.

Does Body Memory Exist? A Review of Models, Approaches and Recent Findings Useful for Neurorehabilitation

Over the past twenty years, scientific research on body representations has grown significantly, with Body Memory (BM) emerging as a prominent area of interest in neurorehabilitation. Compared to other body representations, BM stands out as one of the most obscure due to the multifaceted nature of the concept of "memory" itself, which includes various aspects (such as implicit vs. explicit, conscious vs. unconscious). The concept of body memory originates from the field of phenomenology and has been developed by research groups studying embodied cognition. In this narrative review, we aim to present compelling evidence from recent studies that explore various definitions and explanatory models of BM. Additionally, we will provide a comprehensive overview of the empirical settings used to examine BM. The results can be categorized into two main areas: (i) how the body influences our memories, and (ii) how memories, in their broadest sense, could generate and/or influence metarepresentations-the ability to reflect on or make inferences about one's own cognitive representations or those of others. We present studies that emphasize the significance of BM in experimental settings involving patients with neurological and psychiatric disorders, ultimately analyzing these findings from an ontogenic perspective.

Interoceptive technologies for psychiatric interventions: From diagnosis to clinical applications

Interoception-the perception of internal bodily signals-has emerged as an area of interest due to its implications in emotion and the prevalence of dysfunctional interoceptive processes across psychopathological conditions. Despite the importance of interoception in cognitive neuroscience and psychiatry, its experimental manipulation remains technically challenging. This is due to the invasive nature of existing methods, the limitation of self-report and unimodal measures of interoception, and the absence of standardized approaches across disparate fields. This article integrates diverse research efforts from psychology, physiology, psychiatry, and engineering to address this oversight. Following a general introduction to the neurophysiology of interoception as hierarchical predictive processing, we review the existing paradigms for manipulating interoception (e.g., interoceptive modulation), their underlying mechanisms (e.g., interoceptive conditioning), and clinical applications (e.g., interoceptive exposure). We suggest a classification for interoceptive technologies and discuss their potential for diagnosing and treating mental health disorders. Despite promising results, considerable work is still needed to develop standardized, validated measures of interoceptive function across domains and before these technologies can translate safely and effectively to clinical settings.

Challenges With the Use of Digital Sham: Systematic Review and Recommendations

BACKGROUND

Digital therapeutics (DTx) are software-based products that prevent, manage, or treat a medical condition and are delivered through a smartphone app, web application, or wearable device. Clinical trials assessing DTx pose challenges, foremost among which is designing appropriate digital shams (or digital placebos), which should ideally mimic DTx (in terms of design, components, and duration of treatment) while omitting the active principle or component.

OBJECTIVE

The objective of our review was to understand how digital shams are being used in clinical research on DTx in neuroscience, which is the most common therapy area for DTx.

METHODS

We conducted a systematic literature review of DTx in neuroscience (including neurodevelopmental, neurodegenerative, and psychiatric disorders) with a focus on controlled clinical trials involving digital shams. Studies were identified from trial registries (ClinicalTrials.gov, the European Union Clinical Trials Register, and Trial Trove) and through structured searches in MEDLINE and Embase (both via the Embase website) and were limited to articles in English published from 2010 onward. These were supplemented by keyword-based searches in PubMed, Google, and Google Scholar and bibliographic searches. Studies assessing DTx in neuroscience (including neurodevelopmental, neurodegenerative, and psychiatric disorders) were included. Details related to the publication, DTx, comparator, patient population, and outcomes were extracted and analyzed.

RESULTS

Our search criteria identified 461 neuroscience studies involving 213 unique DTx. Most DTx were extended reality based (86/213, 40.4%) or mobile device based (56/213, 26.3%); 313 were comparative, of which 68 (21.7%) used shams. The most common therapeutic areas assessed in these studies were stroke (42/213, 19.7%), depression (32/213, 15%), and anxiety (24/213, 11.3%). The most common treatments were cognitive behavioral therapy or behavioral therapy (67/213, 32.4%), physical rehabilitation (60/213, 28.2%), and cognitive training (41/213, 19.2%). We identified the following important issues related to the use of digital shams in neuroscience: shams were not validated before use in studies, they varied widely in design (from being nearly identical to the DTx to using different software programs altogether), and the level of patient engagement or satisfaction with the sham and the impact of the sham on study outcomes were infrequently reported.

CONCLUSIONS

Digital shams are critical for the clinical development of DTx in neuroscience. Given the importance of sham controls in evaluating DTx efficacy, we provide recommendations on the key information that should be reported in a well-designed DTx trial and propose an algorithm to allow the correct interpretation of DTx study results. Sham-controlled studies should be routinely used in DTx trials-in early-phase studies-to help identify DTx active components and-in late-phase studies-to confirm the efficacy of DTx. The use of shams early in development will ensure that the appropriate sham control is used in later confirmatory trials.

Effect of subconscious changes in bodily response on thought shifting in people with accurate interoception

Our thought states shift from one state to another from moment to moment. The relationship between the thought shifting and bodily responses is yet to be directly examined. This exploratory study examined the influence of cardiovascular reactivity and interoception-sensing an internal bodily state-on the shifting of thought states. Participants (N = 100, 70 women) completed two tasks: the heartbeat counting task (HCT) and the vigilance task (VT). We assessed their interoceptive accuracy through their performance on the HCT. The VT was a simple sustained attention task in which participants pressed a key when the target stimulus appeared and were asked to report their thoughts. We presented subliminal vibration stimuli to induce alterations in heart rate (i.e., vibration block). Results showed that participants with higher interoceptive accuracy reported more continuation of self-referential thought (about past episodes and future plans regarding themselves) during the vibration block than did those with lower interoceptive accuracy. These results suggest that individuals with higher interoceptive accuracy are more likely to be influenced by their subliminal bodily response, resulting in divergent attention from the task and intermittent self-referential thought.

Wearables for Stress Management: A Scoping Review

In recent years, wearable devices have been increasingly used to monitor people's health. This has helped healthcare professionals provide timely interventions to support their patients. In this study, we investigated how wearables help people manage stress. We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) standard to address this question. We searched studies in Scopus, IEEE Explore, and Pubmed databases. We included studies reporting user evaluations of wearable-based strategies, reporting their impact on health or usability outcomes. A total of 6259 studies were identified, of which 40 met the inclusion criteria. Based on our findings, we identified that 21 studies report using commercial wearable devices; the most common are smartwatches and smart bands. Thirty-one studies report significant stress reduction using different interventions and interaction modalities. Finally, we identified that the interventions are designed with the following aims: (1) to self-regulate during stress episodes, (2) to support self-regulation therapies for long-term goals, and (3) to provide stress awareness for prevention, consisting of people's ability to recall, recognize and understand their stress.

Using a haptic dynamic clamp to reduce arousal: preference, arousal, and coordination stability are related

We have developed a haptic dynamic clamp dedicated to the regulation of arousal. It takes the form of a vibrating stress ball to be squeezed, called Viball, controlled by Righetti's nonlinear adaptive Hopf oscillator. Participants squeezed an adaptive Viball which adapts its frequency of vibration to the current frequency of human squeezing. The adaptive Viball was compared to three non-adaptive Viballs, parametrized to vibrate at a lower, equal, or higher frequency than the participants' preferred frequency. While squeezing the ball, participants looked at stressful or calming pictures and their electrodermal activity was recorded. Using the preference paradigm, we show that participants preferred to interact with the adaptive Viball rather than with the most slowly vibrating ball that most strongly reduced arousal. The stability of the human-ball coordination was the highest with the adaptive Viball. There was also a positive correlation between the stability of coordination and arousal. The data are discussed in light of the energy-based interpretation of coordination dynamics.

Physiological feedback technology for real-time emotion regulation: a systematic review

Background

Previous studies suggest that physiological feedback can be an effective method for emotion regulation (ER). However, studies on the specific effects of physiological feedback have shown conflicting results due to inconsistencies in study designs. Therefore, we present this systematic review to further validate the effectiveness of physiological feedback for ER, clarify its specific effects, as well as summarize the factors that influence its effectiveness.

Method

This systematic review following PRISMA guidelines covers all studies using physiological feedback in emotions. A literature search was conducted in Web of Science, PubMed, PsychINFO, China National Knowledge Infrastructure, and WANFANG DATA. And a standardized quality assessment was performed.

Results

We identified 27 relevant articles (25 studies), and the majority of these studies showed a significant regulatory effect of physiological feedback on different emotions. The feedback's content, explanation, authenticity, real-time capability, and modality were the key factors that influenced its effects, and this technology will achieve its optimal ER effect when these factors are considered comprehensively.

Conclusions

These findings further confirmed the effectiveness of physiological feedback as an ER method, as well as providing key factors that should be addressed in its application. Meanwhile, due to the limitations of these studies, more well-designed studies are still needed.

Wearable devices for anxiety & depression: A scoping review

Background

The rates of mental health disorders such as anxiety and depression are at an all-time high especially since the onset of COVID-19, and the need for readily available digital health care solutions has never been greater. Wearable devices have increasingly incorporated sensors that were previously reserved for hospital settings. The availability of wearable device features that address anxiety and depression is still in its infancy, but consumers will soon have the potential to self-monitor moods and behaviors using everyday commercially-available devices.

Objective

This study aims to explore the features of wearable devices that can be used for monitoring anxiety and depression.

Methods

Six bibliographic databases, including MEDLINE, EMBASE, PsycINFO, IEEE Xplore, ACM Digital Library, and Google Scholar were used as search engines for this review. Two independent reviewers performed study selection and data extraction, while two other reviewers justified the cross-checking of extracted data. A narrative approach for synthesizing the data was utilized.

Results

From 2408 initial results, 58 studies were assessed and highlighted according to our inclusion criteria. Wrist-worn devices were identified in the bulk of our studies (n = 42 or 71%). For the identification of anxiety and depression, we reported 26 methods for assessing mood, with the State-Trait Anxiety Inventory being the joint most common along with the Diagnostic and Statistical Manual of Mental Disorders (n = 8 or 14%). Finally, n = 26 or 46% of studies highlighted the smartphone as a wearable device host device.

Conclusion

The emergence of affordable, consumer-grade biosensors offers the potential for new approaches to support mental health therapies for illnesses such as anxiety and depression. We believe that purposefully-designed wearable devices that combine the expertise of technologists and clinical experts can play a key role in self-care monitoring and diagnosis.

Exploring the use of AI text-to-image generation to downregulate negative emotions in an expressive writing application

Conventional writing therapies are versatile, accessible and easy to facilitate online, but often require participants to self-disclose traumatic experiences. To make expressive writing therapies safer for online, unsupervised environments, we explored the use of text-to-image generation as a means to downregulate negative emotions during a fictional writing exercise. We developed a writing tool, StoryWriter, that uses Generative Adversarial Network models to generate artwork from users' narratives in real time. These images were intended to positively distract users from their negative emotions throughout the writing task. In this paper, we report the outcomes of two user studies: Study 1 (N = 388), which experimentally examined the efficacy of this application via negative versus neutral emotion induction and image generation versus no image generation control groups; and Study 2 (N = 54), which qualitatively examined open-ended feedback. Our results are heterogeneous: both studies suggested that StoryWriter somewhat contributed to improved emotion outcomes for participants with pre-existing negative emotions, but users' open-ended responses indicated that these outcomes may be adversely modulated by the generated images, which could undermine the therapeutic benefits of the writing task itself.

Effect of vibrostimulatory wearable technology on stereotyped behaviour in a child with autism and intellectual disability

The aim of the work has been to report on the effects of vibrostimulation, administered through wearable technology, on stereotyped behaviour of a child in middle childhood, with autism, intellectual disability and severe behaviour in the 'stereotypic behaviour' subscale of the Restricted and Repetitive Behaviour Revised Scale. He received vibrostimulation (210 Hz, 2.8 µm), with a continuous pattern of vibration: three vibrations of 700 ms, each separated by a rest period of 500 ms and a pause of 8000 ms. Vibration was delivered bilaterally by two devices, repeating the vibration pattern for 3 min. The measures were repeated four times alternately, with the device turned off and on. The outcome measure was frequency of stereotyed behaviour, which was evaluated for 3 min with and without vibrostimulation. The results and observations, over 3 min of stimulation, showed the disappearance of stereotyped movements during vibrostimulation and better precision in intentional hand movements. Subjectively, the child enjoyed vibrostimulation.

Vagus activation by Cold Face Test reduces acute psychosocial stress responses

Chronic stress is linked to dysregulations of the two major stress pathways-the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis, which could for example result from maladaptive responses to repeated acute stress. Improving recovery from acute stress could therefore help to prevent this dysregulation. One possibility of physiologically interfering with an acute stress reaction might be provided by applying a cold stimulus to the face (Cold Face Test, CFT) which activates the parasympathetic nervous system (PNS), leading to immediate heart rate decreases. Therefore, we investigated the use of the CFT protocol as an intervention to reduce acute stress responses. Twenty-eight healthy participants were exposed to acute psychosocial stress via the Montreal Imaging Stress Task (MIST) in a randomized between-subjects design while heart rate (HR), heart rate variability (HRV), and salivary cortisol were assessed. While both groups were equally stressed during the procedure, participants with CFT intervention showed better recovery, indicated by significant ([Formula: see text]) differences in HR(V). We additionally found a significantly ([Formula: see text]) lower cortisol response to the MIST and less overall cortisol secretion in the CFT condition. Both findings indicate that the CFT can successfully stimulate the PNS and inhibit the HPA axis. To the best of our knowledge, our experiment is the first to successfully use the CFT as a simple and easy-to-apply method to modify biological responses to acute stress.

A calming hug: Design and validation of a tactile aid to ease anxiety

Anxiety disorders affect approximately one third of people during their lifetimes and are the ninth leading cause of global disability. Current treatments focus on therapy and pharmacological interventions. However, therapy is costly and pharmacological interventions often have undesirable side-effects. Healthy people also regularly suffer periods of anxiety. Therefore, a non-pharmacological, intuitive, home intervention would be complementary to other treatments and beneficial for non-clinical groups. Existing at-home anxiety aids, such as guided meditations, typically employ visual and/or audio stimuli to guide the user into a calmer state. However, the tactile sense has the potential to be a more natural modality to target in an anxiety-calming device. The tactile domain is relatively under-explored, but we suggest that there are manifold physiological and affective qualities of touch that lend it to the task. In this study we demonstrate that haptic technology can offer an enjoyable, effective and widely accessible alternative for easing state anxiety. We describe a novel huggable haptic interface that pneumatically simulates slow breathing. We discuss the development of this interface through a focus group evaluating five prototypes with embedded behaviours (‘breathing’, ‘purring’, ‘heartbeat’ and ‘illumination’). Ratings indicated that the ‘breathing’ prototype was most pleasant to interact with and participants described this prototype as ‘calming’ and ‘soothing’, reminding them of a person breathing. This prototype was developed into an ergonomic huggable cushion containing a pneumatic chamber powered by an external pump allowing the cushion to ‘breathe’. A mixed-design experiment (n = 129) inducing anxiety through a group mathematics test found that the device was effective at reducing pre-test anxiety compared to a control (no intervention) condition and that this reduction in anxiety was indistinguishable from that of a guided meditation. Our findings highlight the efficacy of this interface, demonstrating that haptic technologies can be effective at easing anxiety. We suggest that the field should be explored in more depth to capture the nuances of different modalities in relation to specific situations and trait characteristics.

Time to Intervene: A Continuous-Time Approach to Network Analysis and Centrality

Network analysis of ESM data has become popular in clinical psychology. In this approach, discrete-time (DT) vector auto-regressive (VAR) models define the network structure with centrality measures used to identify intervention targets. However, VAR models suffer from time-interval dependency. Continuous-time (CT) models have been suggested as an alternative but require a conceptual shift, implying that DT-VAR parameters reflect total rather than direct effects. In this paper, we propose and illustrate a CT network approach using CT-VAR models. We define a new network representation and develop centrality measures which inform intervention targeting. This methodology is illustrated with an ESM dataset.

An Iterative and Collaborative End-to-End Methodology Applied to Digital Mental Health

Artificial intelligence (AI) algorithms together with advances in data storage have recently made it possible to better characterize, predict, prevent, and treat a range of psychiatric illnesses. Amid the rapidly growing number of biological devices and the exponential accumulation of data in the mental health sector, the upcoming years are facing a need to homogenize research and development processes in academia as well as in the private sector and to centralize data into federalizing platforms. This has become even more important in light of the current global pandemic. Here, we propose an end-to-end methodology that optimizes and homogenizes digital research processes. Each step of the process is elaborated from project conception to knowledge extraction, with a focus on data analysis. The methodology is based on iterative processes, thus allowing an adaptation to the rate at which digital technologies evolve. The methodology also advocates for interdisciplinary (from mathematics to psychology) and intersectoral (from academia to the industry) collaborations to merge the gap between fundamental and applied research. We also pinpoint the ethical challenges and technical and human biases (from data recorded to the end user) associated with digital mental health. In conclusion, our work provides guidelines for upcoming digital mental health studies, which will accompany the translation of fundamental mental health research to digital technologies.

Features of wearable devices used for Anxiety & Depression: A scoping review (Preprint).. [DOI: 10.2196/preprints.33287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

BACKGROUND

The rates of mental health disorders such as anxiety and depression are at an all time high and the need for readily available digital health care solutions has never been greater. Wearable devices (WD) have seen a steady rise in the usage of sensors previously reserved for hospital settings. The availibity of features that make use of WDs for anxiety and depression is in its infancy, but we are seeing the potential for consumers to self monitor moods and behaviours with everyday commercially available devices and the ability to self-regulate their health needs.

OBJECTIVE

This study aims to explore features of wearable devices (WDs) used for anxiety and depression

METHODS

We have searched the following six bibliographic databases while conducting this review: MEDLINE, EMBASE, PsycINFO, IEEE Xplore, ACM Digital Library, and Google Scholar. Two reviewers independently performed study selection and data extraction; two other individual reviewers justified cross-checking of extracted data. We utilized a narrative approach for synthesizing the data.

RESULTS

From an initial 2,408 studies we assess and report the features in 58 studies that were highlighted according to our inclusion criteria. Wrist worn devices were identified in the bulk of our studies (n=42 or 71%). Depression was assessed in most of the studies (n=27 or 47%), whereas anxiety was assessed in n=15 or 25% of studies. More than a quarter (n=16 or 27%) of the included studies assessed both mental disorders. Finally n=26 or 46% of studies highlighted the wearable device host device as a smartphone.

CONCLUSIONS

The emergence of affordable, consumer-grade biosensors offers the potential for new approaches to support mental health therapies such as anxiety and depression. We see WDs having real potential in aiding with self-care and with purposefully designed WDs that combine the expertise of technologists and clinical experts WDs could play a key role in self-care monitoring and diagnosis.

The effect of haptic stimulation simulating heartbeats on the regulation of physiological responses and prosocial behavior under stress: The influence of interoceptive accuracy

Research has discovered the modulatory effect of peripheral stimulation simulating altered bodily signals on emotion. Whether such an effect varies depending on one's interoceptive accuracy (IAc) remains unclear. Therefore, we provided haptic stimulation simulating participants' slowed-down heartbeats or no stimulation while they engaged in socially stressful tasks to examine whether participants reacted differently depending on their IAc. Results showed that haptic stimulation exhibited the opposite effect on participants with different levels of IAc for both heart rate and heart rate variability (HRV). When receiving the stimulation, participants with higher IAc showed less increased heart rate and more elevated HF than participants with lower IAc. In contrast, in the absence of stimulation, an opposite pattern of response depending on participants' IAc was observed. The modulatory effect of stimuli and IAc on prosocial behavior was not significant. Individual differences in IAc were shown to affect how one perceives/responds to altered bodily signals.

Simple Wearable Device to Reduce Stress When Delivering a Speech without Pre-training

Objectives

There are many occasions in modern life when people must deliver presentations in front of audiences. Most people feel nervous before and while giving a speech. If there were a simple way to ease their stress, speakers would be able to perform better and their quality of life would improve. Consequently, this study aimed to alleviate the stress of speakers giving speeches by regulating breathing using a simple device.

Methods

To achieve this goal, a popular device, the Apple Watch, was chosen. Twenty-eight participants were divided into two groups: the Breathe app group and the non-Breathe app group. The Breathe app group regulated their breathing using the Breathe app installed on an Apple Watch before speech preparation. The non-Breathe app group listened to an explanation of the experiment so that they could not undertake their own stress-easing strategies. Participants prepared speeches about themselves and delivered them in front of the researcher.

Results

The Breathe app exercise eased stress during the exercise itself and the preparation phase of the speech task based on participants’ cardiac activity. However, stress was not alleviated during speech delivery.

Conclusions

Based on the experimental setting and results of this study, together with the findings of previous studies, introducing pre-training sessions and performing stress-easing tasks before and/or during a speech, such as sending vibrations to participants’ wearable devices, might be an effective way to reduce stress when delivering speeches immediately after the breath-regulating task.

Heart rate variability predicts decline in sensorimotor rhythm control

Objective.Voluntary control of sensorimotor rhythms (SMRs, 8-12 Hz) can be used for brain-computer interface (BCI)-based operation of an assistive hand exoskeleton, e.g. in finger paralysis after stroke. To gain SMR control, stroke survivors are usually instructed to engage in motor imagery (MI) or to attempt moving the paralyzed fingers resulting in task- or event-related desynchronization (ERD) of SMR (SMR-ERD). However, as these tasks are cognitively demanding, especially for stroke survivors suffering from cognitive impairments, BCI control performance can deteriorate considerably over time. Therefore, it would be important to identify biomarkers that predict decline in BCI control performance within an ongoing session in order to optimize the man-machine interaction scheme.Approach.Here we determine the link between BCI control performance over time and heart rate variability (HRV). Specifically, we investigated whether HRV can be used as a biomarker to predict decline of SMR-ERD control across 17 healthy participants using Granger causality. SMR-ERD was visually displayed on a screen. Participants were instructed to engage in MI-based SMR-ERD control over two consecutive runs of 8.5 min each. During the 2nd run, task difficulty was gradually increased.Main results.While control performance (p= .18) and HRV (p= .16) remained unchanged across participants during the 1st run, during the 2nd run, both measures declined over time at high correlation (performance: -0.61%/10 s,p= 0; HRV: -0.007 ms/10 s,p< .001). We found that HRV exhibited predictive characteristics with regard to within-session BCI control performance on an individual participant level (p< .001).Significance.These results suggest that HRV can predict decline in BCI performance paving the way for adaptive BCI control paradigms, e.g. to individualize and optimize assistive BCI systems in stroke.

Towards Mindless Stress Regulation in Advanced Driver Assistance Systems: A Systematic Review

Background: Stress can frequently occur in the driving context. Its cognitive effects can be deleterious and lead to uncomfortable or risky situations. While stress detection in this context is well developed, regulation using dedicated advanced driver-assistance systems (ADAS) is still emergent. Objectives: This systematic review focuses on stress regulation strategies that can be qualified as "subtle" or "mindless": the technology employed to perform regulation does not interfere with an ongoing task. The review goal is 2-fold: establishing the state of the art on such technological implementation in the driving context and identifying complementary technologies relying on subtle regulation that could be applied in driving. Methods: A systematic review was conducted using search operators previously identified through a concept analysis. The patents and scientific studies selected provide an overview of actual and potential mindless technology implementations. These are then analyzed from a scientific perspective. A classification of results was performed according to the different stages of emotion regulation proposed by the Gross model. Results: A total of 47 publications were retrieved, including 21 patents and 26 studies. Six of the studies investigated mindless stress regulation in the driving context. Patents implemented strategies mostly linked to attentional deployment, while studies tended to investigate response modulation strategies. Conclusions: This review allowed us to identify several ADAS relying on mindless computing technologies to reduce stress and better understand the underlying mechanisms allowing stress reduction. Further studies are necessary to better grasp the effect of mindless technologies on driving safety. However, we have established the feasibility of their implementation as ADAS and proposed directions for future research in this field.

Noninvasive Continuous Monitoring of Vital Signs With Wearables: Fit for Medical Use?

BACKGROUND

Wearables (= wearable computer) enable continuous and noninvasive monitoring of a range of vital signs. Mobile and cost-effective devices, combined with powerful data analysis tools, open new dimensions in assessing body functions ("digital biomarkers").

METHODS

To answer the question whether wearables are ready for use in the medical context, a PubMed literature search and analysis for their clinical-scientific use using publications from the years 2008 to 2018 was performed.

RESULTS

A total of 79 out of 314 search hits were publications on clinical trials with wearables, of which 16 were randomized controlled trials. Motion sensors were most frequently used to measure defined movements, movement disorders, or general physical activity. Approximately 20% of the studies used sensors to detect cardiovascular parameters. As for the sensor location, the wrist was chosen in most studies (22.8%).

CONCLUSION

Wearables can be used in a precisely defined medical context, when taking into account complex influencing factors.

The potential for haptic touch technology to supplement human empathetic touch during radiotherapy

Radiotherapy for cancer is an effective treatment but requires precise delivery. Patients are required to remain still in the same position during procedure which may be uncomfortable. This combined with high anxiety experienced by patients, and feelings of isolation, have indicated a need for comfort interventions. Care conveyed through empathetic touch promotes comfort, individual attention and presence and provides both psychological and physical comfort at the same time. Evidence in nursing and care literature showed that empathetic touch interventions have a significant role in promoting comfort, facilitating communication between care recipients and caregivers. However, the application of empathetic touch interventions may be challenging to administer due to the safety concern in the radiotherapy environment. The emergence of haptic technologies that enable the communication of touch remotely may have a potential to fill this gap. We take inspiration from both clinical empathetic touch in radiotherapy practice, as well as affective haptic technologies to envision the opportunities for haptic technologies as a complimentary comfort intervention to supplement human empathetic touch during radiotherapy.

Biosensing and Actuation-Platforms Coupling Body Input-Output Modalities for Affective Technologies

Research in the use of ubiquitous technologies, tracking systems and wearables within mental health domains is on the rise. In recent years, affective technologies have gained traction and garnered the interest of interdisciplinary fields as the research on such technologies matured. However, while the role of movement and bodily experience to affective experience is well-established, how to best address movement and engagement beyond measuring cues and signals in technology-driven interactions has been unclear. In a joint industry-academia effort, we aim to remodel how affective technologies can help address body and emotional self-awareness. We present an overview of biosignals that have become standard in low-cost physiological monitoring and show how these can be matched with methods and engagements used by interaction designers skilled in designing for bodily engagement and aesthetic experiences. Taking both strands of work together offers unprecedented design opportunities that inspire further research. Through first-person soma design, an approach that draws upon the designer's felt experience and puts the sentient body at the forefront, we outline a comprehensive work for the creation of novel interactions in the form of couplings that combine biosensing and body feedback modalities of relevance to affective health. These couplings lie within the creation of design toolkits that have the potential to render rich embodied interactions to the designer/user. As a result we introduce the concept of "orchestration". By orchestration, we refer to the design of the overall interaction: coupling sensors to actuation of relevance to the affective experience; initiating and closing the interaction; habituating; helping improve on the users' body awareness and engagement with emotional experiences; soothing, calming, or energising, depending on the affective health condition and the intentions of the designer. Through the creation of a range of prototypes and couplings we elicited requirements on broader orchestration mechanisms. First-person soma design lets researchers look afresh at biosignals that, when experienced through the body, are called to reshape affective technologies with novel ways to interpret biodata, feel it, understand it and reflect upon our bodies.

Virtual reality in neurorehabilitation: a review of its effects on multiple cognitive domains

INTRODUCTION

Neurological diseases frequently cause adult-onset disability and have increased the demand for rehabilitative interventions. Neurorehabilitation has been progressively relying on computer-assisted programs and, more recently, on virtual reality (VR). Current reviews explore VR-based neurorehabilitation for assessing and treating the most common neurological pathologies. However, none of them explored specifically the impact of VR on multiple cognitive domains.

AREAS COVERED

The present work is a review of 6 years of literature (2015-2020) on VR in neurorehabilitation with the purpose of analyzing its effects on memory, attention, executive functions, language, and visuospatial ability.

EXPERT OPINION

Our review suggests that VR-based neurorehabilitation showed encouraging results for executive functions and visuospatial abilities particularly for both acute and neurodegenerative conditions. Conversely, memory, and attention outcomes are conflicting, and language did not show significant improvements following VR-based rehabilitation. Within five years, it is plausible that VR-based intervention would be provided in standalone and mobile-based platforms that won't need a PC to work, with reduced latency and improved user interaction.

Respiration Entrainment in Virtual Reality by Using a Breathing Avatar

Increasing evidence points to the role of interoception in body perception and in constructing the bodily self. Body ownership illusion (BOI) in virtual reality (VR) is a widely used paradigm to study body perception. However, existing research has focused mainly on exteroceptive sensory modalities, and studies on interoception and BOI remain scarce. The postulated mechanism of BOI is related to the multisensory integration of information and visuo-tactile or visuo-kinesthetic sensory conflict resolution. In this within-subjects experimental study, we introduced systematic visuo-interoceptive (visuo-respiratory) conflicts and tested if participants would resolve them by adjusting their respiration rate (RR). Participants observed a virtual breathing avatar body from the first-person perspective while their own RR was recorded. The VR system was connected to a respiration monitor. The avatar was first breathing for 60 seconds in accordance with the participant's RR; then, it was either slowing down or speeding up, each condition lasting for 180 seconds. The dependent variable was a change in participants' RR, expressed as a linear regression slope coefficient. Forty participants were included in each experimental condition, in a counterbalanced order. There was a change in RR in the predicted direction in both conditions. Participants' RR decreased on average by 0.48 breaths/minute and increased by 0.64 breaths/minute, leading to a change of 1.45 and 1.93 breaths/minute, respectively, over the entire timespan of the experiment. The difference between conditions was statistically significant (V = 192, p < 0.01). Because a change in RR of even 1 breath/minute is considered clinically significant, the results of this study-apart from demonstrating visuo-respiratory conflict resolution-may have an applied significance.

Interoceptive Axes Dissociation in Anorexia Nervosa: A Single Case Study With Follow Up Post-recovery Assessment

Anorexia nervosa (AN) is a disorder characterized by alterations in body perception. Recent literature suggested that AN can also impair the processing of stimuli from inside the body (i.e., interoceptive) however, very few studies performed a complete interoceptive assessment exploring the evolution of the interoceptive dimensions before and after the subject’s recovery. To address this gap in knowledge, this study presented the case of Diana, a 25 years old woman affected by AN. At hospital admission, Diana performed a complete interoceptive assessment for accuracy (IAc), metacognitive awareness (IAw), sensibility (IAs), and interoceptive buffer saturation (IBs) – a new index that behaviourally evaluated the amount of interoceptive processing. Measures were repeated at the end of an outpatients rehabilitative hospital program, after Diana’s recovery. Results were confronted with a control (N = 4) of healthy female subjects. Analyses indicated severe deficits in accuracy, buffer saturation, and sensibility compared to control group. Conversely, metacognitive awareness was pathologically enhanced. After the rehabilitative hospital program, Diana’s clinical condition was largely improved and this reflected back on the interoceptive patterns that appeared restored, with no difference in interoceptive accuracy and metacognition compared to the control group. In conclusion, results indicated a very specific dissociation between interoceptive axes in AN with pervasive deficits in perception and processing that were accompanied by a pathologically enhanced confidence in the wrong perceptions. This case study reported an interesting and unique clinical pattern with a severe dissociation between interoceptive perceptions that nonetheless appeared restored after the subject’s recovery, highlighting the role of interoceptive assessment in the clinical evolution of AN.

The Past, Present, and Future of Virtual and Augmented Reality Research: A Network and Cluster Analysis of the Literature

The recent appearance of low cost virtual reality (VR) technologies - like the Oculus Rift, the HTC Vive and the Sony PlayStation VR - and Mixed Reality Interfaces (MRITF) - like the Hololens - is attracting the attention of users and researchers suggesting it may be the next largest stepping stone in technological innovation. However, the history of VR technology is longer than it may seem: the concept of VR was formulated in the 1960s and the first commercial VR tools appeared in the late 1980s. For this reason, during the last 20 years, 100s of researchers explored the processes, effects, and applications of this technology producing 1000s of scientific papers. What is the outcome of this significant research work? This paper wants to provide an answer to this question by exploring, using advanced scientometric techniques, the existing research corpus in the field. We collected all the existent articles about VR in the Web of Science Core Collection scientific database, and the resultant dataset contained 21,667 records for VR and 9,944 for augmented reality (AR). The bibliographic record contained various fields, such as author, title, abstract, country, and all the references (needed for the citation analysis). The network and cluster analysis of the literature showed a composite panorama characterized by changes and evolutions over the time. Indeed, whether until 5 years ago, the main publication media on VR concerned both conference proceeding and journals, more recently journals constitute the main medium of communication. Similarly, if at first computer science was the leading research field, nowadays clinical areas have increased, as well as the number of countries involved in VR research. The present work discusses the evolution and changes over the time of the use of VR in the main areas of application with an emphasis on the future expected VR's capacities, increases and challenges. We conclude considering the disruptive contribution that VR/AR/MRITF will be able to get in scientific fields, as well in human communication and interaction, as already happened with the advent of mobile phones by increasing the use and the development of scientific applications (e.g., in clinical areas) and by modifying the social communication and interaction among people.

Prostheses as extensions of the body: Progress and challenges

Recent years have seen a surge of interest in the incorporation of artificial limbs. This research promises to provide individuals with sensorimotor disorders such as amputations with prostheses which feel like their own body part. While neuroscience made a leap towards uncovering the basic neurocognitive mechanisms of bodily self-consciousness, the development of incorporated prosthetic limbs still faces substantial challenges in basic neuroscience and in clinical reality. Here we critically examine recent findings on prosthesis incorporation to aid patient rehabilitation in the context of advances in cognitive and applied neuroscience as well as technology. To this end, we integrate results from fundamental and clinical neuropsychological research to outline how several crucial milestones will have to be passed to achieve the self-attribution of prostheses to one's own body. We further discuss the implications of these results for clinical treatment and patients' quality of life.

Learning Empathy Through Virtual Reality: Multiple Strategies for Training Empathy-Related Abilities Using Body Ownership Illusions in Embodied Virtual Reality

Several disciplines have investigated the interconnected empathic abilities behind the proverb "to walk a mile in someone else's shoes" to determine how the presence, and absence, of empathy-related phenomena affect prosocial behavior and intergroup relations. Empathy enables us to learn from others' pain and to know when to offer support. Similarly, virtual reality (VR) appears to allow individuals to step into someone else's shoes, through a perceptual illusion called embodiment, or the body ownership illusion. Considering these perspectives, we propose a theoretical analysis of different mechanisms of empathic practices in order to define a possible framework for the design of empathic training in VR. This is not intended to be an extensive review of all types of practices, but an exploration of empathy and empathy-related phenomena. Empathy-related training practices are analyzed and categorized. We also identify different variables used by pioneer studies in VR to promote empathy-related responses. Finally, we propose strategies for using embodied VR technology to train specific empathy-related abilities.

The neuroscience of body memory: From the self through the space to the others

Our experience of the body is not direct; rather, it is mediated by perceptual information, influenced by internal information, and recalibrated through stored implicit and explicit body representation (body memory). This paper presents an overview of the current investigations related to body memory by bringing together recent studies from neuropsychology, neuroscience, and evolutionary and cognitive psychology. To do so, in the paper, I explore the origin of representations of human body to elucidate their developmental process and, in particular, their relationship with more explicit concepts of self. First, it is suggested that our bodily experience is constructed from early development through the continuous integration of sensory and cultural data from six different representations of the body, i.e., the Sentient Body (Minimal Selfhood), the Spatial Body (Self Location), the Active Body (Agency), the Personal Body (Whole Body Ownership - Me); the Objectified Body (Objectified Self - Mine), and the Social Body (Body Satisfaction - Ideal Me). Then, it is suggested that these six representations can be combined in a coherent supramodal representation, i.e. the "body matrix", through a predictive, multisensory processing activated by central, top-down, attentional processes. From an evolutionary perspective, the main goal of the body matrix is to allow the self to protect and extend its boundaries at both the homeostatic and psychological levels. From one perspective, the self extends its boundaries (peripersonal space) through the enactment and recognition of motor schemas. From another perspective, the body matrix, by defining the boundaries of the body, also defines where the self is present, i.e., in the body that is processed by the body matrix as the most likely to be its one, and in the space surrounding it. In the paper I also introduce and discuss the concept of "embodied medicine": the use of advanced technology for altering the body matrix with the goal of improving our health and well-being.