The present findings show proof of concept for using avatars, particularly more interactive avatars, to expose differences in executive functioning when applying context-specific protocols (here for the military). Implications for rehabilitation Virtual reality provides a means to control context-specific factors for assessment and intervention. Adding human interaction and agency through avatars increases the ecologic nature of the virtual environment. Avatars in the present application of the Virtual Reality avatar interaction platform appear to provide a better ability to reveal differences between trained, military personal with and without mTBI.

Purpose: Motor imagery can improve motor function and reduce pain. This is relevant to individuals with spinal cord injury (SCI) in whom motor dysfunction and neuropathic pain are prevalent. However, therapy efficacy could be dependent on motor imagery ability, and a clear understanding of how motor imagery might be facilitated is currently lacking. Thus, the aim of the present study was to assess the immediate effects of interactive virtual feedback on motor imagery performance after SCI.Methods: Nine individuals with a traumatic SCI participated in the experiment. Motor imagery tasks consisted of forward (i.e. simpler) and backward (i.e. more complex) walking while receiving interactive versus static virtual feedback. Motor imagery performance (vividness, effort and speed), neuropathic pain intensity and feasibility (immersion, distraction, side-effects) were assessed.Results: During interactive feedback trials, motor imagery vividness and speed were significantly higher and effort was significantly lower as compared static feedback trials. No change in neuropathic pain was observed. Adverse effects were minor, and immersion was reported to be good.Conclusions: This exploratory study showed that interactive virtual walking was feasible and facilitated motor imagery performance. The response to motor imagery interventions after SCI might be improved by using interactive virtual feedback.

Context: This review aimed to synthesize the literature on the acceptability, feasibility, and effectiveness of immersive virtual technologies to promote physical exercise in older people. Method: We performed a literature review, based on four databases (PubMed, CINAHL, Embase, and Scopus; last search: 30 January 2023). Eligible studies had to use immersive technology with participants aged 60 years and over. The results regarding acceptability, feasibility, and effectiveness of immersive technology-based interventions in older people were extracted. The standardized mean differences were then computed using a random model effect. Results: In total, 54 relevant studies (1853 participants) were identified through search strategies. Concerning the acceptability, most participants reported a pleasant experience and a desire to use the technology again. The average increase in the pre/post Simulator Sickness Questionnaire score was 0.43 in healthy subjects and 3.23 in subjects with neurological disorders, demonstrating this technology’s feasibility. Regarding the effectiveness, our meta-analysis showed a positive effect of the use of virtual reality technology on balance (SMD = 1.05; 95% CI: 0.75–1.36; p < 0.001) and gait outcomes (SMD = 0.7; 95% CI: 0.14–0.80; p < 0.001). However, these results suffered from inconsistency and the number of trials dealing with these outcomes remains low, calling for further studies. Conclusions: Virtual reality seems to be well accepted by older people and its use with this population is feasible. However, more studies are needed to conclude its effectiveness in promoting exercise in older people.

BackgroundVirtual reality (VR) provides interactive multimodal sensory stimuli and biofeedback, and can be a powerful tool for physical and cognitive rehabilitation. However, existing systems have generally not implemented realistic full-body avatars and/or a scaling of visual movement feedback. We developed a “virtual mirror” that displays a realistic full-body avatar that responds to full-body movements in all movement planes in real-time, and that allows for the scaling of visual feedback on movements in real-time. The primary objective of this proof-of-concept study was to assess the ability of healthy subjects to detect scaled feedback on trunk flexion movements.MethodsThe “virtual mirror” was developed by integrating motion capture, virtual reality and projection systems. A protocol was developed to provide both augmented and reduced feedback on trunk flexion movements while sitting and standing. The task required reliance on both visual and proprioceptive feedback. The ability to detect scaled feedback was assessed in healthy subjects (n = 10) using a two-alternative forced choice paradigm. Additionally, immersion in the VR environment and task adherence (flexion angles, velocity, and fluency) were assessed.ResultsThe ability to detect scaled feedback could be modelled using a sigmoid curve with a high goodness of fit (R2 range 89-98%). The point of subjective equivalence was not significantly different from 0 (i.e. not shifted), indicating an unbiased perception. The just noticeable difference was 0.035 ± 0.007, indicating that subjects were able to discriminate different scaling levels consistently. VR immersion was reported to be good, despite some perceived delays between movements and VR projections. Movement kinematic analysis confirmed task adherence.ConclusionsThe new “virtual mirror” extends existing VR systems for motor and pain rehabilitation by enabling the use of realistic full-body avatars and scaled feedback. Proof-of-concept was demonstrated for the assessment of body perception during active movement in healthy controls. The next step will be to apply this system to assessment of body perception disturbances in patients with chronic pain.

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Physical interactions within virtual environments are often limited to visual information within a restricted workspace. A new system exploiting a cable-driven parallel robot to combine visual and haptic information related to environmental physical constraints (e.g. shelving, object weight) was developed. The aim of this study was to evaluate the impact on user movement patterns of adding haptic feedback in a virtual environment with this robot. Twelve healthy participants executed a manual handling task under three conditions: 1) in a virtual environment with haptic feedback; 2) in a virtual environment without haptic feedback; 3) in a real physical environment. Temporal parameters (movement time, peak velocity, movement smoothness, time to maximum flexion, time to peak wrist velocity) and spatial parameters of movement (maximum trunk flexion, range of motion of the trunk, length of the trajectory, index of curvature and maximum clearance from the shelf) were analysed during the reaching, lowering and lifting phases. Our results suggest that adding haptic feedback improves spatial parameters of movement to better respect the environmental constraints. However, the visual information presented in the virtual environment through the head mounted display appears to have an impact on temporal parameters of movement leading to greater movement time. Taken together, our results suggest that a cable-driven robot can be a promising device to provide a more ecological context during complex tasks in virtual reality.

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