Is it possible to use highly realistic virtual reality in the elderly? A feasibility study with image-based rendering

User Experience of a Semi-Immersive Musical Serious Game to Stimulate Cognitive Functions in Hospitalized Older Patients: Questionnaire Study

Background

Reminiscence therapy through music is a psychosocial intervention with benefits for older patients with neurocognitive disorders. Therapies using virtual or augmented reality are efficient in ecologically assessing, and eventually training, episodic memory in older populations. We designed a semi-immersive musical game called "A Life in Songs," which invites patients to immerse themselves in a past era through visuals and songs from that time period. The game aspires to become a playful, easy-to-use, and complete tool for the assessment, rehabilitation, and prevention of neurocognitive decline associated with aging.

Objective

This study aimed to assess the user experience (UX) associated with the newly designed serious game.

Methods

After one or several sessions of the game guided by the therapist, patients of the geriatric wards were asked to answer questions selected from 2 widely known UX scales (AttrakDiff and meCUE [modular evaluation of the components of user experience]) with the therapist's help. The internal consistency of the UX dimensions was assessed through Cronbach α to verify the validity of the dimensions. The level of engagement of the patient throughout the experimental session was also assessed following an internally developed scale, which included 5 levels (interactive, constructive, active, passive, and disengaged behaviors). UX mean scores were computed and presented graphically. Verbal feedbacks were reported to support the quantitative results.

Results

Overall, 60 inpatients with a mean age of 84.2 (SD 5.5) years, the majority of whom were women (41/60, 68%), were included. Their score on the Mini-Mental State Examination (MMSE) ranged between 12 and 29. A majority of patients (27/56, 48%) had no major neurocognitive disorder (MNCD), 22/56 (39%) had mild MNCD, and 7/56 (13%) had moderate MNCD. The results revealed very positive UX with mean values beyond the neutral values for every UX dimension of both scales. The overall mean (SD) judgment was rated 3.92 (SD 0.87) (on a scale of -5 to 5). Internal consistency was acceptable to good for the emotional dimensions of the meCUE. Questionable to unacceptable consistency was found for the other UX dimensions. Participants were mostly active (23/60, 38%) and constructive (21/60, 35%).

Conclusions

These findings demonstrated a very good appreciation of the game by geriatric inpatients. Participants' and health care professionals' verbal comments strongly aligned with the quantitative results. The poor internal consistency in the UX dimensions reflected the high heterogeneity among the included patients. Further studies are needed to evaluate the potential benefits of clinical factors such as neurocognitive functions, mood, depression, or quality of life.

Virtual reality tolerability, sense of presence and usability in Huntington disease: a pilot study

INTRODUCTION

Several studies demonstrated the utility of immersive virtual reality (VR) as a complementary approach to conventional therapy for improving motor, psychological and cognitive impairment in some pathological conditions. Our pilot study aims to evaluate for the first time: 1) sense of presence, tolerability and usability of VR immersive experience in patients with early stages of Huntington disease (eHDp) compared to healthy controls (HC); 2) correlation between the use of technology/cybersickness and the variables of presence/usability; 3) correlation between clinical characteristics (genetic, motor, functional and cognitive) and VR's variables.

METHOD

We recruited 10 eHDp and 10 age, gender and education matched HC. Participants completed questionnaires about sense of presence, usability, tolerability and technology use profile. Subjects were exposed to different VR scenarios from a first-person perspective through a standalone VR headset.

RESULTS

Our results showed no significant statistical difference between eHDp and HC for the sense of presence (p=0.910), usability (p=0.744) and tolerability (p=0.730) during the VR experience. Familiarity with the use of technology was also comparable between groups (p=0.676). Regarding correlations in eHDp group, our results showed no correlations between use of technology/tolerability and the sense of presence/usability. Moreover, clinical characteristics of eHDp (genetic, motor, functional and cognitive scores) did not influence the sense of presence, tolerability and usability.

CONCLUSION

Our research presents preliminary evidence for the applicability of VR in eHDp. These results open up the possibility to explore future applications of this methodology in rehabilitation (i.e., cognitive training, physiotherapy), diagnosis and psychological support in Huntington disease patients.

Carers and professionals' views on using virtual reality in dementia care: A qualitative study

BACKGROUND AND OBJECTIVES

Virtual reality (VR) interventions provide immersive, interactive computer-simulated virtual environments. There is interest in their use for people with dementia as they may provide stimulating experiences and improve dementia symptoms and quality of life. However, as more insight is needed about carers' and clinical professionals' perspectives to understand how VR may be implemented successfully, we elicited their views on the benefits of, and challenges to, using VR in dementia care.

METHODS

We conducted five qualitative focus groups involving 25 healthcare professionals and informal carers with experience of dementia care. Participants received a demonstration of a VR headset and content and were then questioned following a topic guide asking for views on benefits of, and challenges to, using VR for dementia care.

FINDINGS

The main findings addressed the benefits of, and concerns about, the impact and implications of VR on wellbeing, ethics, implementation, caregivers and services. Overall, participants had a positive attitude toward VR and made several suggestions for its future use to enable enjoyable and immersive experiences. Examples included suggestions to personalise VR content to accommodate heterogenous profiles and stages of dementia, co-developing protocols to address health risks and side effects and further investigating shared experiences of VR with caregivers.

CONCLUSION

Healthcare professionals and informal carers thought that VR had potential to enhance a holistic and personalised approach to dementia care. They suggested changes which could guide future implementation of VR interventions for dementia patients and their caregivers.

The Effects of Virtual Reality-Based Reminiscence Therapies for Older Adults With Cognitive Impairment: Systematic Review

BACKGROUND

Reminiscence therapy (RT) is a commonly used nonpharmaceutical treatment for cognitive impairment. Artifacts or conversations are used in RT to recall individuals' memories and past experiences. Virtual reality (VR) has increasingly been used as an assistive technology during RT. However, the effects of VR-based RT (VR-RT) methods remain unclear, and insights into the related benefits and challenges are urgently needed.

OBJECTIVE

The study aims to systematically review the effects of VR-RTs for older adults with cognitive impairment.

METHODS

Seven databases (MEDLINE, Academic Search Premier, CINAHL, Web of Science, PubMed, the Cochrane Central Register of Controlled Trials, and ScienceDirect) were searched to identify relevant articles published from inception to August 10, 2023. Peer-reviewed publications that assessed the effect of VR-RTs (ie, using virtual clues to evoke participants' memories or past experiences) on cognitive-related outcomes were included. Two independent researchers conducted the literature search, review, and data extraction processes. A narrative synthesis approach was used to analyze the extracted data.

RESULTS

Of the 537 identified articles, 22 were ultimately included in the data analysis. The results revealed that VR-RTs could maintain cognitive status (4/4, 100%) and reduce anxiety (2/2, 100%) in older adults with cognitive impairment. Nevertheless, one study found a cognitive improvement after VR-RTs, whereas cognitive degradation was observed at a 3- to 6-month follow-up measure. Around 88% (7/8) of the included studies indicated that VR-RTs improved memory; however, the evidence regarding the beneficial effects of VR-RTs was limited in improving quality of life (1/4, 25%) and reducing apathy (0/2, 0%) and depression (1/3, 33%). The results indicated that VR-RTs are safe, engaging, acceptable, and satisfying for older adults with cognitive impairment. In VR scenarios, personalized stimulus materials related to the users' youth experiences were more effective for treating cognitive impairment than other stimulus materials.

CONCLUSIONS

The results of this systematic review demonstrate the potential benefits of VR-RT for older adults with cognitive impairment, especially in improving emotion and memory and maintaining cognitive status. VR-RT is also safe and enjoyable for older adults. However, due to the trial heterogeneity of included studies, we can only provide qualitative results instead of performing meta-analysis to quantify the effect size of VR-RTs. Thus, more randomized controlled trials are required to examine the designs and effects of VR-RTs for groups of older adults with specific needs.

Virtual reality-based reminiscence therapy for older adults to improve psychological well-being and cognition: A systematic review

BACKGROUND

Virtual reality-reminiscence therapy (VR-RT) has increasingly been applied to older adults to improve psychological well-being and cognition.

OBJECTIVE

This review aims to identify (1) the design characteristics of conducting a VR-RT and (2) the effects of VR-RT on the user experience, cognitive outcomes and psychological well-being.

DESIGN

Systematic review.

METHODS

Eligible studies were sourced across nine electronic databases, trial registries, grey literature and hand-searching of the reference list. A narrative synthesis was conducted. Twenty-two studies were included, and most were appraised as high quality. Most of the VR-RTs were highly immersive and personalised, with participants having the autonomy of control. VR-RT has the potential to improve anxiety and depression, and cognitive outcomes for older adults. Overall, VR-RT was reported to be an enjoyable experience for older adults.

CONCLUSIONS

VR-RT is a promising innovation that can improve older adults' psychological well-being and cognition without significant side effects, including cybersickness and with the potential for scalability across various settings. More randomised controlled studies are needed to evaluate the effectiveness of VR-RT and its features and treatment dosage. These studies could also examine the effectiveness of VR-RT as an intervention to promote independence in activities of daily living and physical rehabilitation.

RELEVANCE TO CLINICAL PRACTICE

VR-RT is a promising intervention for older adults in community settings to enhance psychological well-being and cognition. VR's versatility enables personalised experiences within dynamic virtual environments, possibly enhancing engagement and therapeutic outcomes.

NO PATIENT OR PUBLIC CONTRIBUTION

This systematic review did not directly involve patient or public contribution to the manuscript.

Evaluation of an exercise program incorporating an international cycling competition: a multimodal intervention model for physical, psychological, and social wellbeing in residential aged care

BACKGROUND

The transition into residential aged care is frequently associated with a reduction in physical activity, social engagement, and emotional wellbeing. Our aim was to evaluate the impact of a 26-day international cycling competition (Road Worlds Competition for Seniors), incorporating elements of exercise, audiovisual cycling footage, social engagement, and gamification, on the physical, psychological, and social well-being of aged care residents. We aimed to use findings to inform the development of a multi-modal intervention model to maximise wellbeing for older adults.

METHODS

Residents (N = 32) participated in a mixed-methods single-group intervention pilot study that compared pre-and post-competition measures for the following wellbeing domains; physical, psychological, and social. In addition, interviews were conducted with residents (n = 27) and staff (n = 6) to explore their experiences.

RESULTS

Measures identified significant improvements across multiple wellbeing domains, including functional fitness, depression, self-efficacy, and social network sizes. Findings from the interview data indicated that the multimodal components involved in the program delivery were valued by staff and residents who enjoyed the gamification, audiovisual cycling footage, social engagement, opportunities for reminiscence, and camaraderie between peers, staff, and volunteers.

CONCLUSIONS

Findings highlight a constellation of benefits across physical, psychological, and social domains of wellbeing and inform a model for innovative multidimensional programs in residential aged care. The benefits for residents with varying physical and cognitive abilities support the use of creative strategies that maximise inclusion and engagement for residents.

Evaluating the Impact of Virtual Reality on the Behavioral and Psychological Symptoms of Dementia and Quality of Life of Inpatients With Dementia in Acute Care: Randomized Controlled Trial (VRCT)

BACKGROUND

Virtual reality (VR) is increasingly considered a valuable therapeutic tool for people with dementia. However, rigorous studies are still needed to evaluate its impact on behavioral and psychological symptoms of dementia (BPSDs) and quality of life (QoL) across care settings.

OBJECTIVE

The primary aim of this study was to evaluate the impact of VR therapy on managing BPSDs, falls, length of stay, and QoL in inpatients with dementia admitted to an acute care hospital. The secondary aim was to evaluate the intervention's feasibility in terms of acceptability, safety, and patient experience.

METHODS

A prospective, open-label, mixed methods, randomized controlled clinical trial was conducted between April 2019 and March 2020. A total of 69 participants (aged ≥65 years with a diagnosis of dementia and who did not meet the exclusion criteria) were randomly assigned to either the control (n=35, 51%) or VR (n=34, 49%) arm. Participants in the experimental (VR) arm were visited by a researcher and watched 360° VR films on a head-mounted display for up to 20 minutes every 1 to 3 days, whereas individuals in the control arm received standard of care. Instances of daily BPSDs and falls were collected from nurses' daily notes. QoL was measured through semistructured interviews and the Quality of Life in Late-Stage Dementia scale. Structured observations and semistructured interviews were used to measure treatment feasibility. The primary outcomes were analyzed at a 95% significance level based on the intention-to-treat method.

RESULTS

VR therapy had a statistically significant effect on reducing aggressiveness (ie, physical aggression and loud vociferation; P=.01). Substantial impact of VR therapy was not found for other BPSDs (eg, apathy), falls, length of stay, or QoL as measured using the Quality of Life in Late-Stage Dementia scale. The average VR therapy session lasted 6.8 (SD 6.6; range 0-20) minutes, and the intervention was overall an acceptable and enjoyable experience for participants. No adverse events occurred as a result of VR therapy.

CONCLUSIONS

Immersive VR therapy appears to have an effect on aggressive behaviors in patients with dementia in acute care. Although the randomized controlled trial was stopped before reaching the intended sample size owing to COVID-19 restrictions, trends in the results are promising. We suggest conducting future trials with larger samples and, in some cases, more sensitive data collection instruments.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03941119; https://clinicaltrials.gov/study/NCT03941119.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/22406.

Use of Virtual Reality to Improve Spatial Orientation in Alzheimer's Disease and Mild Cognitive Impairment: A Systematic Review

BACKGROUND

Alzheimer's disease is a chronic, neurodegenerative condition that leads to a significant cognitive decline. One of the symptoms that greatly reduces the quality of daily functioning is the deterioration of spatial orientation abilities. A non-pharmacological treatment option for Alzheimer's disease, which is also employed to improve the cognitive functioning of individuals with mild cognitive impairment, is virtual reality training.

OBJECTIVE

To the best of the authors' knowledge, there is no existing systematic review on the use of virtual reality training to enhance spatial orientation in individuals with Alzheimer's disease or mild cognitive impairment. The review was therefore conducted to fill this gap. The findings of this review may support the efficacy of virtual reality in enhancing spatial orientation.

METHODS

Five databases were searched. The primary inclusion criteria were study participants aged over 60 years with a diagnosis of Alzheimer's disease or mild cognitive impairment and the use of virtual reality for improving spatial orientation. Six studies meeting these criteria were ultimately included in the review.

RESULTS

All included studies demonstrated an improvement in the spatial orientation of individuals with Alzheimer's disease or mild cognitive impairment following virtual reality training. This indicates the effectiveness of virtual reality technology in cognitive rehabilitation.

CONCLUSION

As virtual reality cognitive training has proven effective, its use should be more widely adopted. Further research on the application of virtual reality for enhancing spatial orientation in individuals with dementia is recommended.

Alterations of Audiovisual Integration in Alzheimer's Disease

Audiovisual integration is a vital information process involved in cognition and is closely correlated with aging and Alzheimer's disease (AD). In this review, we evaluated the altered audiovisual integrative behavioral symptoms in AD. We further analyzed the relationships between AD pathologies and audiovisual integration alterations bidirectionally and suggested the possible mechanisms of audiovisual integration alterations underlying AD, including the imbalance between energy demand and supply, activity-dependent degeneration, disrupted brain networks, and cognitive resource overloading. Then, based on the clinical characteristics including electrophysiological and imaging data related to audiovisual integration, we emphasized the value of audiovisual integration alterations as potential biomarkers for the early diagnosis and progression of AD. We also highlighted that treatments targeted audiovisual integration contributed to widespread pathological improvements in AD animal models and cognitive improvements in AD patients. Moreover, investigation into audiovisual integration alterations in AD also provided new insights and comprehension about sensory information processes.

The Application of Fully Immersive Virtual Reality on Reminiscence Interventions for Older Adults: Scoping Review

BACKGROUND

The increasing number of older adults with mental, behavioral, and memory challenges presents significant public health concerns. Reminiscence is one type of nonpharmacological intervention that can effectively evoke memories, stimulate mental activities, and improve psychological well-being in older adults through a series of discussions on previous experiences. Fully immersive virtual reality (FIVR) may be a useful tool for reminiscence interventions because it uses realistic virtual environments connected to a person's significant past stories.

OBJECTIVE

This review aims to examine empirical evidence regarding the application of FIVR in reminiscence interventions, its usability and acceptability, and its effectiveness in assisting the intervention to achieve optimal outcomes.

METHODS

We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach for scoping reviews. The PubMed, PsycINFO, Embase, CINAHL, Web of Science, ACM, and IEEE Xplore electronic databases were used for the search. We included peer-reviewed studies that used FIVR as an assistive tool for reminiscence interventions; were published between January 1, 2000, and August 1, 2022; reported empirical research; involved older adults as participants; and addressed health- and behavior-related outcomes or the feasibility and usability of FIVR. We used Endnote X9 to organize the search results and Microsoft Excel for data extraction and synthesis.

RESULTS

Of the 806 articles collected from the databases and other resources, 11 were identified. Most of the studies involved participants aged between 70 and 90 years. Only 1 study did not involve those with cognitive impairments, whereas 3 specifically targeted people living with dementia. The results indicated that FIVR reminiscence interventions enhanced engagement and reduced fatigue. Although some studies have observed positive effects on anxiety, apathy, depression, cognitive functions, and caregiver burden reduction, these findings were inconsistent across other research. In addition, FIVR showed overall usability and acceptability with manageable side effects among older adults across various health conditions during reminiscence sessions. However, 1 study reported adverse feelings among participants, triggered by unpleasant memories evoked by the virtual reality content.

CONCLUSIONS

The role of FIVR in reminiscence interventions remains nascent, with limited studies evaluating its impacts on older adults. Many of the reviewed studies had notable limitations: small sample sizes, absence of rigorous research design, limited assessment of long-term effects, lack of measures for health and behavior outcomes, and quality of life. Beyond these limitations, this review identified a list of future research directions in 6 categories. On the basis of the review findings, we provide practical recommendations to enhance FIVR reminiscence interventions, covering topics such as virtual reality content, device choice, intervention types, and the role and responsibility of facilitators.

Addressing Cognitive Function and Psychological Well-Being in Chronic Kidney Disease: A Systematic Review on the Use of Technology-Based Interventions

Patients with chronic kidney disease (CKD) are at risk of both a gradual decline in cognitive function and an increase in psychological distress. This includes symptoms of anxiety, depression, and sleep disturbances, all of which are factors that have been associated with increased morbidity and mortality. In response, we are now seeing that interventions based on new digital technologies are increasingly used in order to optimize patients' quality of life. Systematic research of the literature on electronic databases (MEDLINE/PubMed, Scopus, Web of Science, and PsycInfo/ProQuest) covering the period from 2012 to 2022 was conducted in order to methodically review the existing evidence regarding the implementation and effectiveness of technology-based interventions in the management of cognitive and psychological well-being symptoms in patients with CKD. A total of 739 articles were retrieved, 13 of which are included in the present review. All the studies focused on the usability, acceptability, and feasibility of technology-based interventions aimed at psychological symptoms, with no studies targeting cognitive functioning. Technology-based interventions offer feelings of safety, fun, and satisfaction, and they also have the potential to improve CKD patients' health outcomes regarding their psychological well-being. The diverseness of technologies allows an approximation towards the identification of those types of technologies most frequently used, as well as the symptoms targeted. There was considerable heterogeneity in the types of technologies used for interventions in so few studies, making it difficult to draw conclusive findings with regard to their efficiency. In order to adequately assess the technology-based health interventions effect, future lines of research should consider designing non-pharmacological treatments for the improvement of cognitive and psychological symptoms in this type of patient.

VR for Cognition and Memory

This chapter will provide a review of research into human cognition through the lens of VR-based paradigms for studying memory. Emphasis is placed on why VR increases the ecological validity of memory research and the implications of such enhancements.

Appraising Virtual Technologies' Impact on Older Citizens' Mental Health-A Comparative between 360° Video and Virtual Reality

Aging populations across the world are facing a number of challenges in the context of health and healthcare. These challenges are driven by the aging process and the illnesses associated with aging. Healthcare for older people has become a point of concern with most health organizations, and this is particularly the case with palliative care. In this instance, the movement of the patient may be restricted to a room with no or limited access to the outdoors. This research focuses on the active integration of immersive technologies with healthcare. By addressing the problem of providing patients with the experience of being present in an outdoors space, the associated psychological and physiological benefits can be identified. In this mixed methods research paper, the impact of a crossover study to discern technology preferences in relation to immersive technologies among a sample of older people is reported. In addition, the study highlights factors that contribute to a meaningful immersive experience that can improve psychological and physiological wellbeing. The study identifies that there are two significant categorical aspects that contribute to such immersive experiences, technological aspects (including, for example, the weight of headsets, visual impairment, pixelation, and gamification) and emotive aspects (for example, joy, anger, and fear). The study suggests that older people prefer immersive Virtual Reality (VR) environments rather than 360 video experiences. This can be attributed to the greater flexibility in the provision of interactivity in virtual reality systems.

Visual post-occupancy evaluation of a restorative garden using virtual reality photography: Restoration, emotions, and behavior in older and younger people

Natural environments have a restorative effect from mental/attentional fatigue, prevent stress, and help to revitalize psychological and physical resources. These benefits are crucial for promoting active aging, which is particularly relevant given the phenomenon of population aging in recent decades. To be considered restorative, green spaces have to meet specific requirements in ecological and psychological terms that can be assessed through Post-Occupancy Evaluation (POE), a multimethod approach commonly used by environmental psychologists and landscape architects after construction to evaluate the design outcomes from the users’ perspective. Generally, POEs consist of surveys and/or interviews accompanied by more or less structured observations of onsite users’ behavior. Despite this, various practical constraints can prevent physical access to the renovated area (e.g., weather conditions, time/resources limits, health issues, bureaucratic constraints). Exploiting digital tools for such an assessment can be a crucial support in such circumstances. The current study presents the visual POE of a restorative garden for older adults in Milan, Italy. We developed a web application, that includes the exp-EIA© patented method, which allows participants to virtually explore a visual simulation of the environment and provide their feedback. We identified 3 representative viewpoints in the redeveloped garden differing from each other for the functions and the design principles that inspired the transformation. For each point of view, we created 360° Virtual Reality photographs, that can be navigated by looking around, i.e., panning, from the standing point of each view. In connection to each virtual scene, a survey was conducted (N = 321). The focus was the psychological experience related to each viewpoint, assessed with two psychometric scales investigating the constructs of emotions (pleasure and arousal) and restoration (fascination, being away, coherence, scope, and environmental preference); such information is integrated with behavioral aspects, including the main activities prefigured by participants and their visual exploration of the VR photography. The results of the virtual exploration show that the garden is perceived as restorative, with a more intense effect in a spot purposely designed. The emotions experienced in the garden are positive and a mild level of arousal is observed. The behavioral dimension is characterized by predominantly contemplative activities and contact with nature. A cartographic representation of the psychological and behavioral data is developed, to support the maintenance of the garden.

Brain M-App’s Structure and Usability: A New Application for Cognitive Rehabilitation at Home

Cognitive frailty is defined as a clinical condition characterized by both physical frailty and cognitive impairment, without reaching the criteria for dementia. The major goal of rehabilitation intervention is to assist patients in performing ordinary personal duties without the assistance of another person, or at the very least to remove the need for additional support, using adaptive approaches and facilities. In this regard, home-based rehabilitation allows patients to continue an intervention begun in a hospital setting while also ensuring support and assistance when access to healthcare systems is limited, such as during the present pandemic situation. We thus present Brain m-App, a tablet-based application designed for home-based cognitive rehabilitation of frail subjects, addressing spatial memory, attention, and executive functions. This app exploits the potential of 360° videos which are well-suited to home-based rehabilitation. The Brain m-app is made up of 10 days of activities that include a variety of exercises. The activities were chosen based on those patients used to do during their clinical practice in the hospital with the aim to improve their independence and autonomy in daily tasks. The preliminary usability test, which was conducted on five older people, revealed a sufficient level of usability, however, the sample size was modest. Results from the clinical study with 10 patients, revealed that Brain m-App improved especially executive functions and memory performances.

Analysing Key Steps of the Photogrammetric Pipeline for Museum Artefacts 3D Digitisation

In recent years, massive digitisation of cultural heritage (CH) assets has become a focus of European programmes and initiatives. Among CH settings, attention is reserved to the immense and precious museum collections, whose digital 3D reproduction can support broader non-invasive analyses and stimulate the realisation of more attractive and interactive exhibitions. The reconstruction pipeline typically includes numerous processing steps when passive techniques are selected to deal with object digitisation. This article presents some insights on critical operations, which, based on our experience, can rule the quality of the final models and the reconstruction times for delivering 3D heritage results, while boosting the sustainability of digital cultural contents. The depth of field (DoF) problem is explored in the acquisition phase when surveying medium and small-sized objects. Techniques for deblurring images and masking object backgrounds are examined relative to the pre-processing stage. Some point cloud denoising and mesh simplification procedures are analysed in data post-processing. Hints on physically-based rendering (PBR) materials are also presented as closing operations of the reconstruction pipeline. This paper explores these processes mainly through experiments, providing a practical guide, tricks, and suggestions when tackling museum digitisation projects.

A Pilot Study to Investigate the Role of Virtual Reality in the Preservice Training of Nursing Staff in Isolation Wards

Healthcare providers without working experience in isolation wards experience enormous challenges. Traditional ward orientation is constrained by space, time, and even infection risk in particular periods (eg, the coronavirus disease 2019 pandemic). Virtual reality has been used widely, but rarely in wards. This study aimed to explore the experience of utilizing virtual reality for isolation ward training among nurses. In this study, nurses completed virtual reality training via an online platform and were then trained in isolation wards, after which their perceptions were explored by questionnaire and interviews. A total of 1868 participants completed the training. Most participants thought the preservice training was important and believed the virtual reality experience was consistent with the in-person training. Virtual reality was found not only to be convenient and valuable for training but also to have the benefits of occupational protection. However, whereas 50.48% of participants wanted to learn the ward via virtual reality, 87.21% of participants wanted to learn via in-person training before working in the wards. As a substitute for in-person training, virtual reality is a feasible and practical instrument to provide preservice training in particular periods. However, there is room for improvement due to general discomfort and technological problems.

Virtual reality-based cognitive stimulation using GRYDSEN software as a means to prevent age-related cognitive-mobility disorders – a pilot observational study

The human aging process is associated with systematic deterioration of cognitive and motor performance. Age-related deficits in motor skills and symptoms of cognitive decline, such as memory, attention and executive functioning problems, are major contributors to a loss of functional independence and reduced quality of life of the elderly. The virtual reality system presented can be used as an aid for effective training of those skills. The use of virtual reality training for therapeutic purposes is promising – not only does it provide encouraging medical and psychological effects but it may also be considered as an interesting leisure activity for seniors. The paper presents a pilot study which aims to qualitatively assess the usefulness of a VR technology-based solution for training cognitive and motor functions. The pre-test phase of the study was conducted on 9 subjects aged 62-81 (M = 71.66; SD = 7.00), who were asked to evaluate the performed tasks in terms of novelty and attractiveness. All subjects completed the pilot study. The SUS result was 55.56 (SD = 9.90), which is a marginal result. However, the UEQ result showed that all aspects of the game were reported as satisfactory. The pilot studies show that VR is well tolerated by the elderly. As demonstrated by the results, the system has moderate utility, but may be a promising solution for training cognitive-motor skills.

The Effectiveness of e-Health Solutions for Aging With Cognitive Impairment: A Systematic Review

Background and Objectives

e-Health solutions are an innovative approach to support aging with cognitive impairment. Because technology is developing at a fast pace, the aim of this review was to present an overview of the research regarding the effectiveness of these solutions. Moreover, the availability of these solutions was examined.

Research Design and Methods

Systematic searches were conducted in 7 databases. Full texts of potentially relevant references were assessed by 2 reviewers, and discrepancies were solved through discussion. Data on study characteristics, technology type, application domain, availability, outcomes, and effects were extracted. A categorization exercise and narrative synthesis were conducted.

Results

In total, 72 studies describing 70 e-Health solutions were identified. The majority of solutions comprised cognitive training for older adults, followed by educational and supportive web platforms for caregivers. Outcomes included mainly measures of cognition, psychosocial functioning, caregiving processes, caregiver–care receiver relationship, and activities of daily living. Positive effects of cognitive training technologies were observed on cognitive functioning of older adults, as well as those of supportive web platforms on behavioral and psychological symptoms of dementia and caregiver self-efficacy. The effects of these solutions on depression in both target groups were inconclusive. The methodological quality of the studies was moderate to good. However, some important limitations were observed.

Discussion and Implications

The review identified cognitive training solutions and supportive web platforms as the most effective on a limited number of outcomes. Although other solutions seem promising, further research has to overcome methodological issues. Furthermore, solutions for leisure and reminiscence and outcomes specifically related to independent living deserve more attention.

A Preference-Driven Smart Home Service for the Elderly's Biophilic Experience

Smart home services (SHS) should support the positive experiences of the elderly in homes with a focus on getting closer to nature. The study identified the services preferred by the elderly through a survey on the biophilic experience-based SHS, and to discuss the configuration of the sensors and devices required to provide the service. We reorganized the biophilic experience-based SHS and related sensors and devices, focusing on our previous study, and developed a survey instrument. A preference survey was conducted on 250 adults aged 20 and older, and the SPSS program was used for a factor analysis and independent two-sample T-test. We derived six factors for biophilic experience-based SHS. Compared to other age groups, the elderly preferred services that were mainly attributed to factors such as 'Immersion and interaction with nature' (A), 'Management of well-being and indoor environmental quality (IEQ)' (B), and 'Natural process and systems' (F). We proposed 15 prioritized services, along with their sensor and device configurations, in consideration of service provision regarding the elderly's preferences and universality. This study contributes to new developments in elderly-friendly smart home research by converting bio-friendly ideas into the market in the development of medical services and SHS for the elderly.

Testing the Feasibility of Virtual Reality With Older Adults With Cognitive Impairments and Their Family Members Who Live at a Distance

BACKGROUND AND OBJECTIVES

This study tests the feasibility of using virtual reality (VR) with older adults with mild cognitive impairment (MCI) or mild-to-moderate dementia with a family member who lives at a distance.

RESEARCH DESIGN AND METHODS

21 residents in a senior living community and a family member (who participated in the VR with the older adult from a distance) engaged in a baseline telephone call, followed by 3 weekly VR sessions.

RESULTS

Residents and family members alike found the VR safe, extremely enjoyable, and easy to use. The VR was also acceptable and highly satisfying for residents with MCI and dementia. Human and automated coding revealed that residents were more conversationally and behaviorally engaged with their family member in the VR sessions compared to the baseline telephone call and in the VR sessions that used reminiscence therapy. The results also illustrate the importance of using multiple methods to assess engagement. Residents with dementia reported greater immersion in the VR than residents with MCI. However, the automated coding indicated that residents with MCI were more kinesically engaged while using the VR than residents with dementia.

DISCUSSION AND IMPLICATIONS

Combining networking and livestreaming features in a single VR platform can allow older adults in senior living communities to still travel, relive their past, and engage fully with life with their family members, despite geographical separation and physical and cognitive challenges.

Virtual reality intervention to improve apathy in residential aged care: protocol for a multisite non-randomised controlled trial

INTRODUCTION

Apathy is a prevalent neuropsychiatric symptom for older adults residing in aged care. Left untreated, apathy has been associated with accelerated cognitive decline and increased risk of mortality. Reminiscence therapy is commonly used in aged care and has demonstrated to reduce apathy. Traditional methods of reminiscence use physical objects and more recently technology including tablets and laptop computers have demonstrated potential. Virtual reality (VR) has successfully been used to treat psychological disorders; however, there is little evidence on using VR for behavioural symptoms such as apathy in older adults. Using VR to deliver reminiscence therapy provides an immersive experience, and readily available applications provide access to a large range of content allowing easier delivery of therapy over traditional forms of therapy. This study aims to identify changes in apathy after a reminiscence therapy intervention using head-mounted displays (HMDs).

METHODS AND ANALYSIS

Participants will be allocated to one of three groups; reminiscence therapy using VR; an active control using a laptop computer or physical items and a passive control. A total of 45 participants will be recruited from residential aged care (15 in each group). The three groups will be compared at baseline and follow-up. The primary outcome is apathy, and secondary outcomes include cognition and depression. Side effects from using HMDs will also be examined in the VR group. Primary and secondary outcomes at baseline and follow-up will be analysed using linear mixed modelling.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the University of South Australia Human Research Ethics Committee. The results from this study will be disseminated through manuscript publications and national/international conferences.

TRIAL REGISTRATION NUMBER

ACTRN12619001510134.

Virtual reality to promote wellbeing in persons with dementia: A scoping review

Virtual Reality (VR) technologies have increasingly been considered potentially valuable tools in dementia-related research and could serve as non-pharmacological therapy to improve quality of life (QoL) and wellbeing for persons with dementia (PwD). In this scoping review, we summarize peer-reviewed articles published up to Jan-21, 2021, on the use of VR to promote wellbeing in PwD. Eighteen manuscripts (reporting on 19 studies) met the inclusion criteria, with a majority published in the past 2 years. Two reviewers independently coded the articles regarding A) intended clinical outcomes and effectiveness of the interventions, B) study sample (characteristics of the participants), C) intervention administration (by whom, what setting), D) experimental methods (design/instruments), and E) technical properties of the VR-systems (hardware/devices and software/content). Emotional outcomes were by far the most common objectives of the interventions, reported in seventeen (89.5%) of the included articles. Outcomes addressing social engagement and personhood in PwD have not been thoroughly explored using VR. Based on the positive impact of VR, future opportunities lie in identifying special features and customization of the hardware/software to afford the most benefit to different sub-groups of the target population. Overall, this review found that VR represents a promising tool for promoting wellbeing in PwD, with positive or neutral impact reported on emotional, social, and functional aspects of wellbeing.

Promoting Reminiscences with Virtual Reality Headsets: A Pilot Study with People with Dementia

This study aimed to explore the feasibility and effects of promoting reminiscences, using virtual reality (VR) headsets for viewing 360° videos with personal relevance, with people with dementia. A study with a mixed methods design was conducted with nine older adults diagnosed with dementia. Interventions consisted of four sessions, in which the participants’ engagement, psychological and behavioral symptoms, and simulation sickness symptoms were evaluated. Neuropsychiatric symptomatology and quality of life were measured pre- and post-intervention. Caregivers were interviewed regarding the effect of the approach. In most cases, participants appeared to enjoy the sessions, actively explored the 360° environment, and shared memories associated with the depicted locations, often spontaneously. There were no cases of significant increases in simulator sickness and psychological and behavioral symptoms during sessions, with only some instances of minor eyestrain, fullness of head, anxiety, irritability, and agitation being detected. Although there were no significant changes in the measured outcomes after intervention, the caregivers assessed the experience as potentially beneficial for most participants. In this study, promoting reminiscences with VR headsets was found to be a safe and engaging experience for people with dementia. However, future studies are required to better understand the added value of immersion, using VR, in reminiscence therapy.

Photo-Realistic Interactive Virtual Environments for Neurorehabilitation in Mild Cognitive Impairment (NeuroVRehab.PT): A Participatory Design and Proof-of-Concept Study

Mild cognitive impairment (MCI) is characterized by cognitive, psychological, and functional impairments. Digital interventions typically focus on cognitive deficits, neglecting the difficulties that patients experience in instrumental activities of daily living (IADL). The global conjecture created by COVID-19 has highlighted the seminal importance of digital interventions for the provision of healthcare services. Here, we investigated the feasibility and rehabilitation potential of a new design approach for creating highly realistic interactive virtual environments for MCI patients’ neurorehabilitation. Through a participatory design protocol, a neurorehabilitation digital platform was developed using images captured from a Portuguese supermarket (NeuroVRehab.PT). NeuroVRehab.PT’s main features (e.g., medium-sized supermarket, the use of shopping lists) were established according to a shopping behavior questionnaire filled in by 110 older adults. Seven health professionals used the platform and assessed its rehabilitation potential, clinical applicability, and user experience. Interviews were conducted using the think-aloud method and semi-structured scripts, and four main themes were derived from an inductive semantic thematic analysis. Our findings support NeuroVRehab.PT as an ecologically valid instrument with clinical applicability in MCI neurorehabilitation. Our design approach, together with a comprehensive analysis of the patients’ past experiences with IADL, is a promising technique to develop effective digital interventions to promote real-world functioning.

Cognitive Training Using Fully Immersive, Enriched Environment Virtual Reality for Patients With Mild Cognitive Impairment and Mild Dementia: Feasibility and Usability Study

BACKGROUND

Cognitive training using virtual reality (VR) may result in motivational and playful training for patients with mild cognitive impairment and mild dementia. Fully immersive VR sets patients free from external interference and thus encourages patients with cognitive impairment to maintain selective attention. The enriched environment, which refers to a rich and stimulating environment, has a positive effect on cognitive function and mood.

OBJECTIVE

The aim of this study was to investigate the feasibility and usability of cognitive training using fully immersive VR programs in enriched environments with physiatrists, occupational therapists (OTs), and patients with mild cognitive impairment and mild dementia.

METHODS

The VR interface system consisted of a commercialized head-mounted display and a custom-made hand motion tracking module. We developed the virtual harvest and cook programs in enriched environments representing rural scenery. Physiatrists, OTs, and patients with mild cognitive impairment and mild dementia received 30 minutes of VR training to evaluate the feasibility and usability of the test for cognitive training. At the end of the test, the usability and feasibility were assessed by a self-report questionnaire based on a 7-point Likert-type scale. Response time and finger tapping were measured in patients before and after the test.

RESULTS

Participants included 10 physiatrists, 6 OTs, and 11 patients with mild cognitive impairment and mild dementia. The mean scores for overall satisfaction with the program were 5.75 (SD 1.00) for rehabilitation specialists and 5.64 (SD 1.43) for patients. The response time of the dominant hand in patients decreased after the single session of cognitive training using VR, but this was not statistically significant (P=.25). There was no significant change in finger tapping in either the right or left hand (P=.48 and P=.42, respectively). None of the participants reported headaches, dizziness, or any other motion sickness after the test.

CONCLUSIONS

A fully immersive VR cognitive training program may be feasible and usable in patients with mild cognitive impairment and mild dementia based on the positive satisfaction and willingness to use the program reported by physiatrists, OTs, and patients. Although not statistically significant, decreased response time without a change in finger tapping rate may reflect a temporary increase in attention after the test. Additional clinical trials are needed to investigate the effect on cognitive function, mood, and physical outcomes.

Effects of a virtual group cycling experience on people living with dementia: A mixed method pilot study

Social isolation and sedentary behaviour are common in residential aged care facilities (also known as nursing homes or long-term care). Use of new technologies such as virtual and augmented reality are currently under investigation for their potential to provide exciting and engaging activities for older people in residential aged care facilities. However, there is limited evidence on whether these technologies can promote physical activity in a small group setting for people with cognitive impairment. Using mixed methods, we examined the use of a virtual cycling experience in a sample of 10 participants with cognitive impairment living in residential aged care facilities. In a randomised crossover design, participants engaged in a 25-minute, self-paced, facilitated seated virtual cycling experience and a time-matched seated physical activity session in groups of five. All participants completed a brief pre- and post-intervention mood questionnaire. Video analysis was used for both conditions to compare levels of environmental stimulation, apathy and engagement using both the Person–Environment Apathy Rating Scale and the Engagement of a Person with Dementia Scale. A thematic analysis of semi-structured interviews following the virtual cycling experience was also performed. No differences were observed between conditions for all outcomes except for environmental stimulation, where there was a lower response in the intervention than the control condition ( p = 0.032). This was primarily driven by lower scores for the virtual cycling experience than control in physical accessibility ( p = 0.012). Participants reported the virtual cycling experience to be immersive and challenging and reminisced about cycling earlier in life. The activity manager observed that the virtual cycling experience was an overall positive experience and emphasised benefits of safety screening and preparation prior to the activities. The findings of this study support the use of the virtual cycling experience as an immersive and engaging alternative to usual activities, which might encourage higher levels of physical activity in residential aged care facilities.

Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study

Background

Apathy is a common symptom in neurological disorders, including dementia, and is associated with a faster rate of cognitive decline, reduced quality of life, and high caregiver burden. There is a lack of effective pharmacological treatments for apathy, and nonpharmacological interventions are a preferred first-line approach to treatment. Virtual reality (VR) using head-mounted displays (HMDs) is being successfully used in exposure- and distraction-based therapies; however, there is limited research on using HMDs for symptoms of neurological disorders.

Objective

This feasibility study aimed to assess whether VR using HMDs could be used to deliver tailored reminiscence therapy and examine the willingness to participate, response rates to measures, time taken to create tailored content, and technical problems. In addition, this study aimed to explore the immediate effects between verbal fluency and apathy after exposure to VR.

Methods

A mixed methods study was conducted in a sample of older adults residing in aged care, and 17 participants were recruited. Apathy was measured using the Apathy Evaluation Scale (AES), and verbal fluency was used as a proxy measure of improvements in apathy and debriefing interviews to assess feedback from participants. Side effects that can occur from using HMDs were also measured.

Results

We recruited participants from a high socioeconomic status setting with a high education level, and the participation rate was 85% (17/20); most responses to measures were positive. Access to a wide range of freely available content and the absence of technical difficulties made the delivery of a VR reminiscence intervention highly feasible. Participants had improved semantic scores (t₁₄=−3.27; P=.006) but not phonemic fluency scores (t₁₄=0.55; P=.59) immediately after the intervention. Those with higher levels of apathy demonstrated the greatest cognitive improvements after a VR reminiscence experience, which was indicated by a strong positive relationship between the AES and semantic verbal fluency change scores postminus pre-VR (r=0.719; 95% CI 0.327 to 0.900; P=.003). All participants enjoyed the experience despite 35% (6/17) of participants experiencing temporary side effects.

Conclusions

This study provides initial evidence that it is feasible to use VR with HMDs for therapy to treat symptoms of apathy in older adults in residential aged care. However, there is a need to closely monitor the side effects of HMD use in older adults. Further research is needed using an active control group to compare the use of VR with traditional forms of reminiscence therapy.

Technologically-enhanced psychological interventions for older adults: a scoping review

BACKGROUND

The world population is getting older. As life expectancy increases, traditional health care systems are facing different challenges in terms of cost reduction and high-quality service delivery capability. New ways to improve older adults' quality of life have been explored, taking advantage of new technological solutions. Our focus is on the integration of technology in clinical treatments to facilitate or deliver psychological interventions meant to improve well-being in older adults. Our aims were to describe the main technology-based interventions supporting seniors' quality of life or psychological well-being and to provide greater clarity to what is described in the current literature as their effects on seniors' cognitive and psychological outcomes and healthcare policies.

METHODS

We reviewed the scientific literature looking for studies that investigated how technology can be implemented into clinical psychology treatments for older adults. Our search was conducted using the following databases: PubMed, PsycINFO, Scopus, ISI Web of Science, and CINAHL. The search provided 350 articles, mostly (≈90%) dated after 2002. Abstract analysis narrowed the selection to 150 papers, according to their relevance and actuality as judged by a restricted group of independent researchers.

RESULTS

Through a thematic analysis, we found that virtual reality (VR), robots, telemedicine, software, video games, and smartphone applications could potentially support older adults' psychological treatment with a positive impact on healthcare systems.

CONCLUSION

Findings from the literature are encouraging, although most of these results are only preliminary.

Feasibility and Tolerability of a Culture-Based Virtual Reality (VR) Training Program in Patients with Mild Cognitive Impairment: A Randomized Controlled Pilot Study

The present study examined whether a culture-based virtual reality (VR) training program is feasible and tolerable for patients with amnestic mild cognitive impairment (aMCI), and whether it could improve cognitive function in these patients. Twenty-one outpatients with aMCI were randomized to either the VR-based training group or the control group in a 1:1 ratio. The VR-based training group participated in training for 30 min/day, two days/week, for three months (24 times). The VR-based program was designed based on Korean traditional culture and used attention, processing speed, executive function and memory conditions to stimulate cognitive function. The adherence to the culture-based VR training program was 91.55% ± 6.41% in the VR group. The only adverse events observed in the VR group were dizziness (4.2%) and fatigue (8.3%). Analysis revealed that the VR-based training group exhibited no significant differences following the three-month VR program in Korean Mini-Mental State Examination (K-MMSE) scores, working memory functions such as performance on the digit span test, or in Stroop test performance and word fluency. We conclude that although the 12-week culture-based VR training program did not improve cognitive function, our findings revealed that the culture-based VR training program was feasible and tolerable for participants with aMCI.

Factors Associated With Virtual Reality Sickness in Head-Mounted Displays: A Systematic Review and Meta-Analysis

The use of head-mounted displays (HMD) for virtual reality (VR) application-based purposes including therapy, rehabilitation, and training is increasing. Despite advancements in VR technologies, many users still experience sickness symptoms. VR sickness may be influenced by technological differences within HMDs such as resolution and refresh rate, however, VR content also plays a significant role. The primary objective of this systematic review and meta-analysis was to examine the literature on HMDs that report Simulator Sickness Questionnaire (SSQ) scores to determine the impact of content. User factors associated with VR sickness were also examined. A systematic search was conducted according to PRISMA guidelines. Fifty-five articles met inclusion criteria, representing 3,016 participants (mean age range 19.5–80; 41% female). Findings show gaming content recorded the highest total SSQ mean 34.26 (95%CI 29.57–38.95). VR sickness profiles were also influenced by visual stimulation, locomotion and exposure times. Older samples (mean age ≥35 years) scored significantly lower total SSQ means than younger samples, however, these findings are based on a small evidence base as a limited number of studies included older users. No sex differences were found. Across all types of content, the pooled total SSQ mean was relatively high 28.00 (95%CI 24.66–31.35) compared with recommended SSQ cut-off scores. These findings are of relevance for informing future research and the application of VR in different contexts.

Efficacy of a Web App for Cognitive Training (MeMo) Regarding Cognitive and Behavioral Performance in People With Neurocognitive Disorders: Randomized Controlled Trial

BACKGROUND

Cognitive and behavioral symptoms are the clinical hallmarks of neurocognitive disorders. Cognitive training may be offered to reduce the risks of cognitive decline and dementia and to reduce behavioral symptoms, such as apathy. Information and communication technology approaches, including serious games, can be useful in improving the playful aspect of computerized cognitive training and providing motivating solutions in elderly patients.

OBJECTIVE

The objective of this study was to assess the effectiveness of employing the MeMo (Memory Motivation) Web app with regard to cognitive and behavioral symptoms in patients with neurocognitive disorders.

METHODS

MeMo is a Web app that can be used on any Web browser (computer or tablet). The training activities proposed in MeMo are divided into the following two parts: memory and mental flexibility/attention. The study included 46 individuals (mean age 79.4 years) with a diagnosis of neurocognitive disorders at the Institut Claude Pompidou Memory Center in Nice. This randomized controlled study compared the evolution of cognition and behavior between patients not using MeMo (control group) and patients using MeMo (MeMo group) for 12 weeks (four sessions per week). Patients underwent memory and attention tests, as well as an apathy assessment at baseline, week 12 (end of the training period), and week 24 (12 weeks after the end of the training sessions). In addition, to assess the impact of high and low game uses, the MeMo group was divided into patients who used MeMo according to the instructions (about once every 2 days; active MeMo group) and those who used it less (nonactive MeMo group).

RESULTS

When comparing cognitive and behavioral scores among baseline, week 12, and week 24, mixed model analysis for each cognitive and behavioral score indicated no significant interaction between testing time and group. On comparing the active MeMo group (n=9) and nonactive MeMo group (n=13), there were significant differences in two attention tests (Trial Making Test A [P=.045] and correct Digit Symbol Substitution Test items [P=.045]) and in the Apathy Inventory (AI) (P=.02). Mixed analysis (time: baseline, week 12, and week 24 × number of active days) indicated only one significant interaction for the AI score (P=.01), with a significant increase in apathy in the nonactive MeMo group.

CONCLUSIONS

This study indicates that the cognitive and behavioral efficacies of MeMo, a Web-based training app, can be observed only with regular use of the app. Improvements were observed in attention and motivation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04142801; https://clinicaltrials.gov/ct2/show/NCT04142801.

Causal Inference in Generalizable Environments: Systematic Representative Design

Causal inference and generalizability both matter. Historically, systematic designs emphasize causal inference, while representative designs focus on generalizability. Here, we suggest a transformative synthesis - Systematic Representative Design (SRD) - concurrently enhancing both causal inference and "built-in" generalizability by leveraging today's intelligent agent, virtual environments, and other technologies. In SRD, a "default control group" (DCG) can be created in a virtual environment by representatively sampling from real-world situations. Experimental groups can be built with systematic manipulations onto the DCG base. Applying systematic design features (e.g., random assignment to DCG versus experimental groups) in SRD affords valid causal inferences. After explicating the proposed SRD synthesis, we delineate how the approach concurrently advances generalizability and robustness, cause-effect inference and precision science, a computationally-enabled cumulative psychological science supporting both "bigger theory" and concrete implementations grappling with tough questions (e.g., what is context?) and affording rapidly-scalable interventions for real-world problems.

Effects of virtual reality rehabilitation training on gait and balance in patients with Parkinson's disease: A systematic review

OBJECTIVE

In recent years, virtual reality (VR) has been tested as a therapeutic tool in neurorehabilitation research. However, the impact effectiveness of VR technology on for Parkinson's Disease (PD) patients is still remains controversial unclear. In order to provide a more scientific basis for rehabilitation of PD patients' modality, we conducted a systematic review of VR rehabilitation training for PD patients and focused on the improvement of gait and balance.

METHODS

An comprehensive search was conducted using the following databases: PubMed, Web of Science, Cochrane Library, CINHAL, Embase and CNKI (China National Knowledge Infrastructure).Articles published before 30 December 2018 and of a randomized controlled trial design to study the effects of VR for patients with PD were included. The study data were pooled and a meta-analysis was completed. This systematic review was conducted in accordance with the PRISMA guideline statement and was registered in the PROSPERO database (CRD42018110264).

RESULTS

A total of sixteen articles involving 555 participants with PD were included in our analysis. VR rehabilitation training performed better than conventional or traditional rehabilitation training in three aspects: step and stride length (SMD = 0.72, 95%CI = 0.40,1.04, Z = 4.38, P<0.01), balance function (SMD = 0.22, 95%CI = 0.01,0.42, Z = 2.09, P = 0.037), and mobility(MD = -1.95, 95%CI = -2.81,-1.08, Z = 4.41, P<0.01). There was no effect on the dynamic gait index (SMD = -0.15, 95%CI = -0.50,0.19, Z = 0.86, P = 0.387), and gait speed (SMD = 0.19, 95%CI = -0.03,0.40, Z = 1.71, P = 0.088).As for the secondary outcomes, compared with the control group, VR rehabilitation training demonstrated more significant effects on the improvement of quality of life (SMD = -0.47, 95%CI = -0.73,-0.22, Z = 3.64, P<0.01), level of confidence (SMD = -0.73, 95%CI = -1.43,-0.03, Z = 2.05, P = 0.040), and neuropsychiatric symptoms (SMD = -0.96, 95%CI = -1.27,-0.65, Z = 6.07, P<0.01), while it may have similar effects on global motor function (SMD = -0.50, 95%CI = -1.48,0.48, Z = 0.99, P = 0.32), activities of daily living (SMD = 0.25, 95%CI = -0.14,0.64, Z = 1.24, P = 0.216), and cognitive function (SMD = 0.21, 95%CI = -0.28,0.69, Z = 0.84, P = 0.399).During the included interventions, four patients developed mild dizziness and one patient developed severe dizziness and vomiting.

CONCLUSIONS

According to the results of this study, we found that VR rehabilitation training can not only achieve the same effect as conventional rehabilitation training. Moreover, it has better performance on gait and balance in patients with PD. Taken together, when the effect of traditional rehabilitation training on gait and balance of PD patients is not good enough, we believe that VR rehabilitation training can at least be used as an alternative therapy. More rigorous design of large-sample, multicenter randomized controlled trials are needed to provide a stronger evidence-based basis for verifying its potential advantages.

[Virtual reality in upper extremity dysfunction: specific features of usage in acute stroke]

BACKGROUND

Stroke is a leading cause of permanent disability. Being a new technology for neurorehabilitation, virtual reality (VR) allows for intensive trainings with a larger number of repetitions focused on mastering specific skills in patients with upper limb dysfunction. To date, there are insufficient studies evaluating the use of VR in the acute period of a stroke.

AIM

To investigate the effectiveness and safety of adding VR trainings to standard therapy for improving upper limb function and for enhancing activities in daily life in patients with acute stroke.

SUBJECTS AND METHOD

The investigation enrolled 78 patients with acute stroke (the median time from stroke onset, 3.7 days; median age, 63 (43; 79.3) years), who were randomized into 2 groups: a study group (standard therapy + VR) and a control one (standard therapy only). The patients of the study group underwent a VR training cycle lasting 15 minutes twice daily for 10 days. Before and after the training cycle, the British Medical Research Council scale for muscle strength, the upper extremity motor function sections of the Fugl-Meyer assessment (FMA) scale, hand dynamometry, and the nine hole peg test (NHPT) were used to evaluate upper extremity function in the participants; Sections 6 and 7 of the motor function assessment scale (MAS), the modified Rankin scale (MRS), and the total motor function scores of the functional independence measure (FIM) utilizing a 7-point ordinal scale were employed to assess everyday activity limitations.

RESULTS

On completion of rehabilitation measures, the participants in the study and control groups showed a statistically significant improvement in upper extremity function and activities of daily living. According to the ratings of the FMA subscales 'hand' (p=0.034), 'hand (speed)' (p<0,001), and the total score of this scale (p=0.035) and according to those of the FIM scale (p=0.045), the patients of the study group demonstrated a statistically significant improvement compared with those in the control group. Assessments using the MRC scale, FMA subscales 'upper extremity' and 'wrist', NHPT, MAS, the Barthel index (BI), and MRS revealed no differences between the groups. No serious adverse events were recorded in the participants of the study group during the study period.

DISCUSSION

The vast majority of studies evaluating the effect of VR in upper extremity dysfunction are conducted in patients with stroke lasting longer than 3 months. Despite the validity of using VR in the acute period of cerebral lesion, the investigations of this design are not numerous. At the same time, these studies often have limitations, such as a small number of participants (usually less than 10); a small number of training VR sessions; lack of 'blinding'; different types of software and hardware systems that implement VR technology; heterogeneity of participants according to the degree of upper extremity dysfunction; insufficient detailing of the content and scope of conventional therapy; comparison of VR with basic methods of motor rehabilitation, and sometimes the absence of a control group.

CONCLUSION

Thus, the use of VR in addition to standard rehabilitation measures in the acute period of stroke favors improvements in upper extremity function and a reduction in daily limitations and is safe.

Virtual reality among the elderly: a usefulness and acceptance study from Taiwan

BACKGROUND

Virtual reality (VR) has several applications in the medical domain and also generates a secure environment to carry out activities. Evaluation of the effectiveness of VR among older populations revealed positive effects of VR as a tool to reduce risks of falls and also improve the social and emotional well-being of older adults. The decline in physical and mental health, the loss of functional capabilities, and a weakening of social ties represent obstacles towards active aging among older adults and indicate a need for support. Existing research focused on the effects of VR among older populations, and its uses and benefits. Our study investigated the acceptance and use of VR by the elderly.

METHODS

This pilot study was conducted on 30 older adults who voluntarily participated during March to May 2018. Nine VR applications that promote physical activities, motivate users, and provide entertainment were chosen for this study. Participants were asked to use any one of the applications of their choice for 15 min twice a week for 6 weeks. At the end of 6 weeks, participants were asked to fill out a questionnaire based on the Technology Acceptance Model and a literature review, to evaluate their acceptance of VR technology. Cronbach's alpha reliability analysis was used to test the internal consistency of the questionnaire items. Pearson's product moment correlation was used to examine the validity of the questionnaire. A linear regression and mediation analysis were utilized to identify relationships among the variables of the questionnaire.

RESULTS

In total, six male and 24 female participants aged 60~95 years volunteered to participate in the study. Perceived usefulness, perceived ease of use, social norms, and perceived enjoyment were seen to have had significant effects on the intention to use VR. Participants agreed to a large extent regarding the perceived usefulness, perceived enjoyment, and their experience of using VR. Thus, VR was seen to have high acceptance among this elderly population.

CONCLUSIONS

Older people have positive perceptions towards accepting and using VR to support active aging. They perceived VR to be useful, easy to use, and an enjoyable experience, implying positive attitudes toward adopting this new technology.

The potential of virtual reality for spatial navigation research across the adult lifespan

Older adults often experience serious problems in spatial navigation, and alterations in underlying brain structures are among the first indicators for a progression to neurodegenerative diseases. Studies investigating the neural mechanisms of spatial navigation and its changes across the adult lifespan are increasingly using virtual reality (VR) paradigms. VR offers major benefits in terms of ecological validity, experimental control and options to track behavioral responses. However, navigation in the real world differs from navigation in VR in several aspects. In addition, the importance of body-based or visual cues for navigation varies between animal species. Incongruences between sensory and motor input in VR might consequently affect their performance to a different degree. After discussing the specifics of using VR in spatial navigation research across species, we outline several challenges when investigating age-related deficits in spatial navigation with the help of VR. In addition, we discuss ways to reduce their impact, together with the possibilities VR offers for improving navigational abilities in older adults.

Two new virtual reality tasks for the assessment of spatial orientation Preliminary results of tolerability, sense of presence and usability

Spatial orientation is a cognitive domain frequently impaired in Alzheimer's Disease and can be one of its earliest symptoms.

Use of immersive virtual reality to assess episodic memory: A validation study in older adults

Virtual reality (VR) allows for the creation of ecological environments that could be used for cognitive assessment and intervention. This study comprises two parts that describe and assess an immersive VR task, the Virtual Shop, which can be used to measure episodic memory. Part 1 addresses its applicability in healthy older adults by measuring presence, motivation, and cybersickness symptoms. Part 2 addresses its construct validity by investigating correlations between performance in the VR task and on a traditional experimental memory task, and by measuring whether the VR task is sensitive to age-related memory differences. Fifty-seven older and 20 younger adults were assessed in the Virtual Shop, in which they memorised and fetched 12 familiar items. Part 1 showed high levels of presence, higher levels of motivation for the VR than for the traditional task, and negligible cybersickness symptoms. Part 2 indicates that memory performance in the VR task is positively correlated with performance on a traditional memory task for both age groups, and age-related differences were found on the VR and traditional memory tasks. Thus, the use of VR is feasible in older adults and the Virtual Shop is a valid task to assess and train episodic memory in this population.

Functional performance comparison between real and virtual tasks in older adults: A cross-sectional study

INTRODUCTION

Ageing is usually accompanied by deterioration of physical abilities, such as muscular strength, sensory sensitivity, and functional capacity, making chronic diseases, and the well-being of older adults new challenges to global public health.

OBJECTIVE

The purpose of this study was to evaluate whether a task practiced in a virtual environment could promote better performance and enable transfer to the same task in a real environment.

METHOD

The study evaluated 65 older adults of both genders, aged 60 to 82 years (M = 69.6, SD = 6.3). A timing coincident task was applied to measure the perceptual-motor ability to perform a motor response. The participants were divided into 2 groups: started in a real interface and started in a virtual interface.

RESULTS

All subjects improved their performance during the practice, but improvement was not observed for the real interface, as the participants were near maximum performance from the beginning of the task. However, there was no transfer of performance from the virtual to real environment or vice versa.

CONCLUSIONS

The virtual environment was shown to provide improvement of performance with a short-term motor learning protocol in a timing coincident task. This result suggests that the practice of tasks in a virtual environment seems to be a promising tool for the assessment and training of healthy older adults, even though there was no transfer of performance to a real environment.

TRIAL REGISTRATION

ISRCTN02960165. Registered 8 November 2016.

Recommendations for the Use of ICT in Elderly Populations with Affective Disorders

Objective: Affective disorders are frequently encountered among elderly populations, and the use of information and communication technologies (ICT) could provide an added value for their recognition and assessment in addition to current clinical methods. The diversity and lack of consensus in the emerging field of ICTs is however a strong limitation for their global use in daily practice. The aim of the present article is to provide recommendations for the use of ICTs for the assessment and management of affective disorders among elderly populations with or without dementia.

Methods: A Delphi panel was organized to gather recommendations from experts in the domain. A set of initial general questions for the use of ICT in affective disorders was used to guide the discussion of the expert panel and to analyze the Strengths, Weaknesses, Opportunities, and Threats (SWOT) of employing ICT in elderly populations with affective disorders. Based on the results collected from this first round, a web survey was sent to local general practitioners (GPs) and to all interns in psychiatry in France.

Results: The results of the first round revealed that ICT may offer very useful tools for practitioners involved in the diagnosis and management of affective disorders. However, the results of the web survey showed the interest to explain better to current and upcoming practitioners the utility of ICT especially for people living with dementia.

A Feasibility Study with Image-Based Rendered Virtual Reality in Patients with Mild Cognitive Impairment and Dementia

Virtual Reality (VR) has emerged as a promising tool in many domains of therapy and rehabilitation, and has recently attracted the attention of researchers and clinicians working with elderly people with MCI, Alzheimer’s disease and related disorders. Here we present a study testing the feasibility of using highly realistic image-based rendered VR with patients with MCI and dementia. We designed an attentional task to train selective and sustained attention, and we tested a VR and a paper version of this task in a single-session within-subjects design. Results showed that participants with MCI and dementia reported to be highly satisfied and interested in the task, and they reported high feelings of security, low discomfort, anxiety and fatigue. In addition, participants reported a preference for the VR condition compared to the paper condition, even if the task was more difficult. Interestingly, apathetic participants showed a preference for the VR condition stronger than that of non-apathetic participants. These findings suggest that VR-based training can be considered as an interesting tool to improve adherence to cognitive training in elderly people with cognitive impairment.

A succinct overview of virtual reality technology use in Alzheimer's disease

We provide a brief review and appraisal of recent and current virtual reality (VR) technology for Alzheimer’s disease (AD) applications. We categorize them according to their intended purpose (e.g., diagnosis, patient cognitive training, caregivers’ education, etc.), focus feature (e.g., spatial impairment, memory deficit, etc.), methodology employed (e.g., tasks, games, etc.), immersion level, and passive or active interaction. Critical assessment indicates that most of them do not yet take full advantage of virtual environments with high levels of immersion and interaction. Many still rely on conventional 2D graphic displays to create non-immersive or semi-immersive VR scenarios. Important improvements are needed to make VR a better and more versatile assessment and training tool for AD. The use of the latest display technologies available, such as emerging head-mounted displays and 3D smart TV technologies, together with realistic multi-sensorial interaction devices, and neuro-physiological feedback capacity, are some of the most beneficial improvements this mini-review suggests. Additionally, it would be desirable that such VR applications for AD be easily and affordably transferable to in-home and nursing home environments.