Functional Living Skills: A Non-Immersive Virtual Reality Training for Individuals with Major Neurocognitive Disorders

Effectiveness of Virtual Reality Technology Interventions in Improving the Social Skills of Children and Adolescents With Autism: Systematic Review

BACKGROUND

Virtual reality (VR) technology has shown significant potential in improving the social skills of children and adolescents with autism spectrum disorder (ASD).

OBJECTIVE

This study aimed to systematically review the evidence supporting the effectiveness of VR technology in improving the social skills of children and adolescents with ASD.

METHODS

The search for eligible studies encompassed 4 databases: PubMed, Web of Science, IEEE, and Scopus. Two (XY and JW) researchers independently assessed the extracted studies according to predefined criteria for inclusion and exclusion. These researchers also independently extracted information regarding gathered data on the sources, samples, measurement methods, primary results, and data related to the main results of the studies that met the inclusion criteria. The quality of the studies was further evaluated using the Physiotherapy Evidence Database scale.

RESULTS

This review analyzed 14 studies on using VR technology interventions to improve social skills in children and adolescents with ASD. Our findings indicate that VR interventions have a positive effect on improving social skills in children and adolescents with ASD. Compared with individuals with low-functioning autism (LFA), those with high-functioning autism (HFA) benefited more from the intervention. The duration and frequency of the intervention may also influence its effectiveness. In addition, immersive VR is more suitable for training complex skills in individuals with HFA. At the same time, nonimmersive VR stands out in terms of lower cost and flexibility, making it more appropriate for basic skill interventions for people with LFA. Finally, while VR technology positively enhances social skills, some studies have reported potential adverse side effects. According to the quality assessment using the Physiotherapy Evidence Database scale, of the 14 studies, 6 (43%) were classified as high quality, 4 (29%) as moderate quality, and 4 (29%) as low quality.

CONCLUSIONS

This systematic review found that VR technology interventions positively impact social skills in children and adolescents with ASD, with particularly significant effects on the enhancement of complex social skills in individuals with HFA. For children and adolescents with LFA, progress was mainly observed in basic skills. Immersive VR interventions are more suitable for the development of complex skills. At the same time, nonimmersive VR, due to its lower cost and greater flexibility, also holds potential for application in specific contexts. However, the use of VR technology may lead to side effects such as dizziness, eye fatigue, and sensory overload, particularly in immersive settings. These potential issues should be carefully addressed in intervention designs to ensure user comfort and safety. Future research should focus on optimizing individualized interventions and further exploring the long-term effects of VR interventions.

TRIAL REGISTRATION

International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY202420079U1; https://inplasy.com/inplasy-2024-2-0079/.

Effects of Virtual Reality-Based Activities of Daily Living Rehabilitation Training in Older Adults With Cognitive Frailty and Activities of Daily Living Impairments: A Randomized Controlled Trial

OBJECTIVES

Cognitive frailty, which is notably prevalent in nursing homes, correlates with a range of adverse health outcomes; however, interventions targeting this population are scarce, particularly those addressing activities of daily living (ADLs). The objective of this study was to evaluate the effects of virtual reality-based ADL rehabilitation training on older adults with cognitive frailty and ADL impairments.

DESIGN

A 2-arm randomized controlled trial.

SETTING AND PARTICIPANTS

Older adults with cognitive frailty and mild ADL impairments in a nursing home.

METHODS

Sixty-six eligible participants were equally randomized into intervention and control groups. The intervention involved 45-minute sessions conducted twice weekly for 12 weeks. Outcomes evaluated included ADL performance, cognition, frailty, depression, and quality of life. Assessments were performed at baseline, 6 weeks (T1), and 12 weeks (T2).

RESULTS

There was no statistically significant difference between the 2 groups at baseline. The mean age of the participants was 80.20 ± 9.14 years, and most were women (54.55%). Compared with the control group, the intervention group showed significant improvements in ADLs (T1: β = 6.33, T2: β = 12.79), basic ADLs (T1: β = 4.09, T2: β = 6.97), instrumental ADLs (T1: β = 2.24, T2: β = 4.12), cognition (T1: β = 3.67, T2: β = 4.42), frailty (T1: β = -0.76, T2: β = -1.27), and mental component summary of quality of life (T1: β = 8.49, T2: β = 16.44) at T1 and T2. By T2, significant improvements were observed in depression (T2: β = -2.06) and physical component summary of quality of life (T2: β = 8.52).

CONCLUSIONS AND IMPLICATIONS

For older adults with cognitive frailty and mild ADL impairments residing in a nursing home, the virtual reality-based ADL rehabilitation program was safe and effective. Following the 12-week intervention, significant improvements were observed in ADL performance, cognition, frailty, depression, and quality of life.

Effects of a dual intervention (motor and virtual reality-based cognitive) on cognition in patients with mild cognitive impairment: a single-blind, randomized controlled trial

BACKGROUND

The increase in cases of mild cognitive impairment (MCI) underlines the urgency of finding effective methods to slow its progression. Given the limited effectiveness of current pharmacological options to prevent or treat the early stages of this deterioration, non-pharmacological alternatives are especially relevant.

OBJECTIVE

To assess the effectiveness of a cognitive-motor intervention based on immersive virtual reality (VR) that simulates an activity of daily living (ADL) on cognitive functions and its impact on depression and the ability to perform such activities in patients with MCI.

METHODS

Thirty-four older adults (men, women) with MCI were randomized to the experimental group (n = 17; 75.41 ± 5.76) or control (n = 17; 77.35 ± 6.75) group. Both groups received motor training, through aerobic, balance and resistance activities in group. Subsequently, the experimental group received cognitive training based on VR, while the control group received traditional cognitive training. Cognitive functions, depression, and the ability to perform activities of daily living (ADLs) were assessed using the Spanish versions of the Montreal Cognitive Assessment (MoCA-S), the Short Geriatric Depression Scale (SGDS-S), and the of Instrumental Activities of Daily Living (IADL-S) before and after 6-week intervention (a total of twelve 40-minutes sessions).

RESULTS

Between groups comparison did not reveal significant differences in either cognitive function or geriatric depression. The intragroup effect of cognitive function and geriatric depression was significant in both groups (p < 0.001), with large effect sizes. There was no statistically significant improvement in any of the groups when evaluating their performance in ADLs (control, p = 0.28; experimental, p = 0.46) as expected. The completion rate in the experimental group was higher (82.35%) compared to the control group (70.59%). Likewise, participants in the experimental group reached a higher level of difficulty in the application and needed less time to complete the task at each level.

CONCLUSIONS

The application of a dual intervention, through motor training prior to a cognitive task based on Immersive VR was shown to be a beneficial non-pharmacological strategy to improve cognitive functions and reduce depression in patients with MCI. Similarly, the control group benefited from such dual intervention with statistically significant improvements.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06313931; https://clinicaltrials.gov/study/NCT06313931 .

Impact of AI-Powered Solutions in Rehabilitation Process: Recent Improvements and Future Trends

Rehabilitation is an important and necessary part of local and global healthcare services along with treatment and palliative care, prevention of disease, and promotion of good health. The rehabilitation process helps older and young adults even children to become as independent as possible in activities of daily life and enables participation in useful living activities, recreation, work, and education. The technology of Artificial Intelligence (AI) has evolved significantly in recent years. Many activities related to rehabilitation have been getting benefits from using AI techniques. The objective of this review study is to explore the advantages of AI for rehabilitation and how AI is impacting the rehabilitation process. This study aims at the most critical aspects of the rehabilitation process that could potentially take advantage of AI techniques including personalized rehabilitation apps, rehabilitation through assistance, rehabilitation for neurological disorders, rehabilitation for developmental disorders, virtual reality rehabilitation, rehabilitation of neurodegenerative diseases and Telerehabilitation of Cardiovascular. We presented a survey on the newest empirical studies available in the literature including the AI-based technology helpful in the Rehabilitation process. The novelty feature included but was not limited to an overview of the technological solutions useful in rehabilitation. Seven different categories were identified. Illustrative examples of practical applications were detailed. Implications of the findings for both research and practice were critically discussed. Most of the AI applications in these rehabilitation types are in their infancy and continue to grow while exploring new opportunities. Therefore, we investigate the role of AI technology in rehabilitation processes. In addition, we do statistical analysis of the selected studies to highlight the significance of this review work. In the end, we also present a discussion on some challenges, and future research directions.

User Experience in Virtual Reality (VR) Applications for Elderly People with Cognitive Impairment and Dementia: A Scoping Review

BACKGROUND

In recent years, Virtual Reality (VR) has emerged as a promising tool to improve the well-being and functional capabilities of older adults. Although VR applications have shown positive results, their impact on user experience and therapeutic outcomes still needs to be evaluated.

OBJECTIVE

This scoping review aims to analyze existing studies on VR use in older adults with neurodegenerative disorders, focusing on the factors that influence usability, satisfaction, and immersion, as well as the effects on emotional and cognitive well-being.

MATERIALS AND METHODS

Empirical studies in English were included on VR applications applied to older adults with cognitive impairment without study design restrictions. The search was conducted in IEEE Xplore, PubMed, Scopus, and Web of Science, identifying a total of 650 initial results. After screening, 14 studies met the inclusion criteria.

RESULTS

Immersive VR tends to generate a greater sense of presence, which contributes to improving emotional well-being and reducing neuropsychiatric symptoms, such as apathy and depression. However, its impact on cognitive functions, including memory and executive skills, varied depending on the level of immersion and participant characteristics. Despite these positive findings, significant heterogeneity was evident in study designs, measurement instruments, and user experience indicators.

CONCLUSION

Virtual environments have great potential as a therapeutic tool for older adults, but their success depends on the personalization of applications and the adaptation of technology to the specific needs of this population. Future research should focus on developing standardized protocols, incorporating adaptive technologies such as artificial intelligence, and evaluating the longterm effects of VR to maximize its benefits and minimize its risks. This review was registered in Open Science Framework (OSF).

REGISTRATION NUMBER

10.17605/OSF.IO/PNU36.

Virtual Reality for the Rehabilitation of Acquired Cognitive Disorders: A Narrative Review

This review article explores the use of Virtual Reality (VR) technology in cognitive rehabilitation for individuals with neurological conditions, such as stroke, traumatic brain injury, and neurodegenerative diseases. The introduction highlights the challenges posed by cognitive impairments and the limitations of traditional rehabilitation methods. VR is presented as a transformative tool that immerses individuals in interactive environments, offering promising opportunities for enhancing cognitive functions and improving quality of life. This article covers the foundational principles of VR, its applications across different clinical conditions and cognitive domains, and evaluates empirical evidence supporting its efficacy. It also discusses the advantages, limitations, challenges, and ethical considerations in the use of VR for cognitive rehabilitation. This review concludes by exploring future developments, including advancements in VR technology, the integration of Augmented Reality (AR) and artificial intelligence (AI), and the importance of standardized assessment tools for the objective evaluation of rehabilitation outcomes.

Virtual reality applications based on instrumental activities of daily living (iADLs) for cognitive intervention in older adults: a systematic review

BACKGROUND

In recent years, the use of virtual reality (VR) as a complementary intervention in treating cognitive impairment has significantly increased. VR applications based on instrumental activities of daily living (iADL-VR) could offer a promising approach with greater ecological validity for intervention in groups with cognitive impairments. However, the effectiveness of this approach is still debated.

OBJECTIVE

This systematic review aims to synthesize the effects of iADL-VR interventions to rehabilitate, train, or stimulate cognitive functions in healthy adults and people with mild cognitive impairment (MCI) and different types of dementia.

METHODS

A systematic search was performed in the Scopus, PubMed, IEEE Xplore, Web of Science, and APA PsycNet databases until September 2022 and repeated in April 2023. The selected studies met the search terms, were peer-reviewed, included an iADL-VR intervention, and were written in English. Descriptive, qualitative studies, reviews, cognitive assessment, non-intervention studies, those unrelated to VR or iADL, those focused on motor aspects, and non-degenerative disorders were excluded. The PEDro scale was used to assess the methodological quality of the controlled studies. To present and synthesize the results, we organized the extracted data into three tables, including PEDro scores, participant characteristics, and study characteristics.

RESULTS

Nineteen studies that met the inclusion and exclusion criteria were included. The total sample reached 590 participants, mostly women (72.67%). Approximately 30% were diagnosed with Alzheimer's disease or dementia, and 20% had mild cognitive impairment. Variables such as authors and year of publication, study design, type of intervention and VR applied, duration of the intervention, main findings, and conclusions were extracted. Regarding demographic characteristics, the sample size, age, sex, years of education, neurological diagnosis, dropouts, and the city and country where the intervention took place were recorded. Almost all studies showed improvements in some or all the outcomes after the intervention, generally greater in the iADL-VR group than in the control group.

CONCLUSION

iADL-VR interventions could be beneficial in improving the performance of cognitive functions in older adults and people with MCI and different types of dementia. The ecological component of these tasks makes them very suitable for transferring what has been learned to the real world. However, such transfer needs to be confirmed by further studies with larger and more homogeneous samples and longer follow-up periods. This review had no primary funding source and was registered with PROSPERO under registration ID: 375166.

Editorial: Biomedical Data in Human-Machine Interaction

Analysis of biomedical data can provide useful information regarding human condition and as a result-analysis of these signals has become one of the most popular diagnostic methods [...].

Functional Living Skills in Patients with Major Neurocognitive Disorder Due to Degenerative or Non-Degenerative Conditions: Effectiveness of a Non-Immersive Virtual Reality Training

Virtual reality has gained attention as an effective tool for cognitive, motor, and daily activity rehabilitation in patients with major neurocognitive disorder (M-NCD). The first objective of this study was to check for differences between M-NCD caused by degenerative and non-degenerative conditions (DC and NDC, respectively) in terms of relearning four functional living skills (FLSs), by means of a non-immersive virtual reality training (VRT). The second purpose was to verify whether spontaneous transfer from the virtual environment to the real environment occurred. Four FLS apps were developed in our institute (Information, Suitcase, Medicine, and Supermarket). A nonrandomized interventional study was carried out, comparing experimental and control groups (EG and CG, respectively). The study included three phases: in vivo test at T1; VRT at T2 only for EG; in vivo test at T3. During the in vivo test, the four FLSs were assessed in their natural environments. Both EG-DC and EG-NDC significantly improved in all of the VRT variable scores (the EG-NDC group seemed to show better outcomes than the EG-DC group). Moderate-to-high satisfaction with the VRT was reported. EG-DC and EG-NDC also enhanced their performances in the in vivo test. No statistically significant differences between them were found. CG-DC and CG-NDC improved only in the execution time of Information in the in vivo test. These findings confirm the ecological validity of VRT for FLSs.

Application of virtual reality for peritoneal dialysis exchange learning in patients with end-stage renal disease and cognitive impairment

Cognitive impairment is not uncommon in patients with end-stage renal disease and can make it more difficult for these patients to carry out peritoneal dialysis (PD) on their own. Their attempts to do so may result in adverse consequences such as peritonitis. PD exchange is a complex procedure demanding knowledge and skill which requires close supervision and guidance by a renal nurse specialist. In this study, a non-immersive virtual reality (VR) training program using a Leap motion hand tracking device was developed to facilitate patients' understanding and learning of the PD exchange procedure before attempting real task practice. This study was a two-center single-blinded randomized controlled trial on 23 incident PD patients. Patients in the experimental group received 8 sessions of VR training, while patients in the control were provided with printed educational materials. The results showed that there were significant differences between the two groups in performance of the overall PD exchange sequence, especially on the crucial steps. VR had a patient satisfaction rate of 89%, and all patients preferred to have the VR aid incorporated in PD training. Our findings conclude VR can be a useful aid in the training and reinforcement of PD exchange procedures, with distinct merits of being free from restrictions of time, space, and manpower.

Virtual reality in the diagnostic and therapy for mental disorders: A systematic review

BACKGROUND

Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders.

OBJECTIVE

To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders.

DATA SOURCE

Systematic literature searches via PubMed (last literature update: 9^th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders.

ELIGIBILITY CRITERIA

To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology.

STUDY EVALUATION

For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria.

RESULTS

Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder.

CONCLUSION

While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application.

REVIEW REGISTRATION

PROSPERO register CRD42020188436.

FUNDING

The review was funded by budgets from the University of Bonn. No third party funding was involved.

The More, the Better? Improving VR Firefighting Training System with Realistic Firefighter Tools as Controllers

A virtual reality (VR) controller plays a key role in supporting interactions between users and the virtual environment. This paper investigates the relationship between the user experience and VR control device modality. We developed a VR firefighting training system integrated with four control devices adapted from real firefighting tools. We iteratively improved the controllers and VR system through a pilot study with six participants and conducted a user study with 30 participants to assess two salient human factor constructs—perceived presence and cognitive load—with three device modality conditions (two standard VR controllers, four real tools, and a hybrid of one real tool and one standard VR controller). We found that having more realistic devices that simulate real tools does not necessarily guarantee a higher level of user experience, highlighting a strategic approach to the development and utilization of VR control devices. Our study gives empirical insights on establishing appropriate combinations of VR control device modality in the context of field-based VR simulation and training.