Virtual Worlds, Volume 4, Issue 2 (June 2025) – 9 articles

Neonatal endotracheal intubation (ETI) is a complex medical procedure that demands extensive training before practicing on real patients. Clinical studies indicate that the conventional training approach, typically conducted in idealized conditions with task trainers, has a low skill transferability rate compared to performance in the dynamic environments common in intensive care units (ICUs). According to cognitive load theory, novices encounter difficulties in multitasking scenarios, exhibiting performance declines due to competition among tasks for cognitive resources; experts, having achieved automaticity, have more cognitive resources to handle additional tasks present in high-stress environments and therefore exhibit less performance degradation. Current ETI skill assessment methods do not capture these differences in expertise. To bridge this gap, we develop an innovative dual-task mixed-reality (MR) simulator to evaluate the influence of cognitive distractors on ETI and substantiate effective performance measurement metrics. Results affirm that experts demonstrate superior proficiency in handling extraneous cognitive loads compared to novices. This has important implications for understanding how to measure novice performance in ETI settings. Taken together, the dual-task ETI training simulator and the associated automated skill evaluation metric system hold promise for enhancing training in neonatal ETI practice and ultimately leading to improved patient care outcomes. Full article

Natural and human-made disasters can severely impact communities and can result in high numbers of human injuries and deaths. Animals, both companion and livestock, are often injured as a result of these disasters and require veterinary care. Veterinarians are not only involved in providing care for these animals but also play important roles in planning and preparedness functions that occur before a disaster strikes. There are several examples of the use of multi-user virtual environments (MUVE) to provide human health care workers with valuable training centered on disaster response and disaster medicine. This communication provides a thorough review of a clinical rotation, as part of a professional veterinary curriculum, that uses a combination of classroom and experiential learning via an MUVE, Second Life^®. This rotation has provided more than 1800 senior veterinary students at a veterinary school in the United States with experiential learning opportunities focused on veterinary disaster preparedness, planning, and response training. The authors have prepared this communication to provide other institutions and educators with information on the practical implementation of Second Life^® in teaching and to offer recommendations based on our institutional experience. Full article

This paper presents an augmented reality (AR) mobile application developed for Android devices, which brings five bust sculptures of historical personalities of the city of Komotini, Greece, to ‘life’ using the Unity engine. These busts narrate their achievements in two languages, Greek and English, to educate visitors on historical and cultural heritage and provide a comprehensive glimpse into the area’s past using 3D models, textures, and animations tailored to the educational content. Based on the users’ location, the application provides an interactive educational experience, allowing the users to explore the history and characteristics of the busts in an innovative way. The users may interact with the busts using markerless AR, discover information and historical facts about them, and stimulate their understanding of the busts’ significance in the context of local history and culture. Interactive elements, such as videos and 3D animations, are incorporated to enrich the learning experience. A location-based knowledge quiz game was also developed for this purpose. The application was evaluated by statistical analysis to measure the effect of using the application on the involvement of users in the educational process and to study the users’ satisfaction and experience. This approach revealed that the proposed AR app is effective in providing educational content, promotes active user participation, and provides a high level of user satisfaction. Full article

Effective teleoperation visualization is crucial but challenging for tasks like remote inspection. This study proposes a VR-based teleoperation framework featuring a ‘Virtual Co-Existence Space’ and systematically investigates visualization modalities within it. We compared four interfaces (2D camera feed, 3D point cloud, combined 2D3D, and Augmented Virtuality-AV) for controlling an industrial robot. Twenty-four participants performed inspection tasks while performance (time, collisions, accuracy, photos) and cognitive load (NASA-TLX, pupillometry) were measured. Results revealed distinct trade-offs: 3D imposed the highest cognitive load but enabled precise navigation (low collisions). 2D3D offered the lowest load and highest user comfort but slightly reduced distance accuracy. AV suffered significantly higher collision rates and participant feedback usability issues. 2D showed low physiological load but high subjective effort. No significant differences were found for completion time, distance accuracy, or photo quality. In conclusion, no visualization modality proved universally superior within the proposed framework. The optimal choice is balancing task priorities like navigation safety versus user workload. Hybrid 2D3D shows promise for minimizing load, while AV requires substantial usability refinement for safe deployment. Full article

Introduction: In line with previous research conducted during chemotherapy to explore whether virtual reality (VR) can support patients’ emotional regulation, this study examines the relevance of adding olfactory reinforcement to VR sessions during breast cancer treatment. Methods: An experimental protocol assessed the impact of VR sensoriality in 50 patients over three chemotherapy sessions. Each patient experienced a 10-min immersion in a natural environment under three randomized conditions: Contemplative VR, Participatory VR, Participatory VR with olfactory reinforcement. The sense of presence measured immersion, while anxiety, depression, and emotional state were evaluated using a within-subject design to compare the effects of each VR modality. Results: A reduction in anxiety and depression was observed in patients regardless of the type of VR immersion experienced. The interactive and multimodal nature of VR may support patients in their emotional regulation. Conclusions: This study provides preliminary evidence for the usefulness of olfactory enhancement in VR during chemotherapy sessions in breast cancer patients. The multimodal potential of VR contributes to the reduction of anxiety and depression by inducing a positive emotional experience in a soothing natural environment. The reported results highlight the value of sensorimotor VR, which also stimulates the sense of smell, in improving supportive care. Full article

Arachnophobia is a specific phobia characterized by an intense and persistent fear of spiders, often leading to avoidance behaviors that can significantly impact daily life. Virtual Reality Exposure Therapy (VRET) offers a controlled, adaptable, and immersive therapeutic environment, allowing for greater personalization, flexibility, and the real-time modulation of exposure parameters. This pilot study employed a quasi-experimental design without a control group to evaluate the efficacy of a gamified VRET intervention for treating arachnophobia. A sample of 25 participants underwent the intervention, with outcomes assessed through a Behavioral Approach Test (BAT) and self-report measures, including the Fear of Spiders Questionnaire (FSQ) and the Spider Phobia Questionnaire (SPQ-15), administered pre-intervention, post-intervention, and at a two-week follow-up. Findings indicate that gamified VRET led to significant reductions in self-reported fear and avoidance behaviors, suggesting its potential as an effective therapeutic tool for arachnophobia. Although some results were not entirely conclusive, the overall improvements observed support further investigation in larger, controlled trials. Full article

Virtual reality has been used for a variety of training and gaming purposes. Recent studies have demonstrated that their use in higher education enhances student engagement and positively impacts student performance. In this study, we implemented 360-degree video in an introductory biology lab at an American university and assessed student attitudes, engagement, and performance through various assessments, as well as overall course performance. For our methods, we implemented 360-degree videos across two academic semesters compared to two academic semesters in the previous year when the only difference between the courses was the use of 360-degree video. Students were extremely positive about virtual reality (74% of students who were surveyed agreed or strongly agreed that they would like to see more 360-degree video use in the lab), had minimal issues handling the technology (only 15.9% had issues or were distracted by the tech), and indicated that engagement with the topic was better with virtual reality (81.3% agreed or strongly agreed with enhanced self-reported engagement with the topic). Student performance was demonstrated to increase in two of the three formative assessments analyzed and in the single summative assessment analyzed; overall course grades in semesters with virtual reality were higher than in semesters without virtual reality. These results suggest that virtual reality in higher education may not only enhance student engagement and performance but also student attitude about the topic. Full article

(1) Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder that impairs balance and postural control, gait, overall motor function, and mood, and involves the gradual degradation of several physiologic systems. With limited treatments available, physical therapy (PT)-based exercise is the nonpharmacologic measure of choice. There is a growing interest in using virtual reality (VR) gaming when rehabilitating patients with various acute brain injuries and neurological disorders. The purpose of this scoping review was to examine randomized controlled trials comparing VR-based rehabilitation programs versus traditional PT at improving gait and balance. (2) Methods: PubMed, CINAHL, and the Cochrane Central Register of Controlled Trials databases were searched using medical subject headings. Included studies were randomized controlled trials comparing VR intervention versus traditional PT in patients with PD and were published between 2013 and 2025. (3) Results: Eleven studies were reviewed and results in outcome measures (e.g., Berg Balance Scale, Unified Parkinson’s Disease Rating Scale, and the Dynamic Gait Index) were compared between groups. Results of these studies demonstrated that patients receiving VR interventions had similar improvements to those in the traditional PT groups. In several studies, patients receiving VR intervention had superior outcomes. (4) Conclusion: VR is a promising addition to traditional PT and should be considered for patients with PD. Full article

As virtual reality (VR) becomes increasingly integrated into educational settings, understanding preservice teachers’ (PSTs) perceptions and training needs is crucial for effective classroom implementation. Although existing research emphasizes VR’s educational benefits, limited studies have explored how direct, hands-on VR experiences impact PSTs’ intentions to adopt this technology. This mixed-methods study addresses this gap by examining factors influencing PSTs’ willingness to adopt VR and identifying challenges hindering adoption following immersive VR activities using Oculus Quest. Structural equation modeling (SEM) analysis indicated that perceived usefulness and enjoyment directly influenced PSTs’ intentions to adopt VR, whereas self-efficacy indirectly influenced intentions through perceived usefulness. Qualitative findings revealed that PSTs’ initial reluctance to adopt VR, primarily due to low self-efficacy and limited VR knowledge, decreased after hands-on experiences, leading to increased willingness to integrate VR into their teaching practices. However, concerns regarding VR’s appropriateness for young learners, potential health risks such as motion sickness, and classroom management challenges persisted. These results underscore the need for targeted VR training in teacher education programs, focusing on enhancing PSTs’ perceived benefits, enjoyment, and self-efficacy while addressing pedagogical and health-related barriers. Full article