Clinical Applications of Immersive and Nonimmersive Virtual Reality

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Brain Injury".

Deadline for manuscript submissions: closed (20 July 2023) | Viewed by 22186

Special Issue Editors


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Guest Editor
UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
Interests: brain injury; tDCS; virtual reality; rehabilitation; motor imagery
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Guest Editor
Virtual Reality Lab, University of Rome Unitelma Sapienza, Piazza Sassari, 4, 00161 Rome, Italy
Interests: neurorehabilitation in VR; clinical application in VR; virtual embodiment; ownership and agency; VR training for medical devices; sense of presence; body and brain reactivity in VR

Special Issue Information

Dear Colleagues,

In recent decades, new technologies such as immersive and non-immersive virtual reality have begun to be used as a new tool for scientific research in different fields, including neuroscience, psychology, medicine, neurorehabilitation, and sport rehabilitation, opening novel ways for implementing innovative rehabilitation treatments and clinical applications. The first evidence in this regard shows promising results in many fields, ranging from motor and cognitive exercises for rehabilitation to VR-based application for reducing anxiety and specific phobias. However, despite the many efforts so far, a clear comprehension of the possible applications of immersive and non-immersive VR in clinical and medical fields is still far from being achieved. This Special Issue of the Journal of Clinical Medicine aims to collect works that shed new light into the use of VR technologies for clinical and medical applications in order to provide novel evidence that could be useful for future development and will cover the following important aspects:

  • Novel clinical treatments with immersive and non-immersive VR;
  • Motor and cognitive neurorehabilitation with VR;
  • VR for sport rehabilitation;
  • VR treatments for injury at the central and peripheral nervous system;
  • VR treatments for aging and dementia;
  • Telemedicine with VR technologies;
  • Specific reviews of VR clinical applications;
  • Case studies with VR;
  • Exergames for clinical applications;
  • Literature review of clinical VR-based applications.

Prof. Dr. Augusto Fusco
Dr. Gaetano Tieri
Guest Editors

Manuscript Submission Information

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Keywords

  • immersive and non-immersive virtual reality
  • motor and cognitive neurorehabilitation
  • clinical application with VR
  • brain injury
  • sport
  • VR training for medical applications
  • telemedicine
  • body related disorder
  • aging and dementia
  • exergames

Published Papers (9 papers)

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Editorial

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4 pages, 203 KiB  
Editorial
Challenges and Perspectives for Clinical Applications of Immersive and Non-Immersive Virtual Reality
by Augusto Fusco and Gaetano Tieri
J. Clin. Med. 2022, 11(15), 4540; https://doi.org/10.3390/jcm11154540 - 4 Aug 2022
Cited by 17 | Viewed by 2902
Abstract
The development of rehabilitative technologies able to increase the intensity and the amount of time for daily treatment as well as the patients’ motivation and interest is a high-priority area of scientific research [...] Full article
(This article belongs to the Special Issue Clinical Applications of Immersive and Nonimmersive Virtual Reality)

Research

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12 pages, 1513 KiB  
Article
The Immediate Effects of Immersive Virtual Reality on Autonomic Nervous System Function in Patients with Disorders of Consciousness after Severe Acquired Brain Injury: A Pilot Study
by Giuseppe Reale, Augusto Fusco, Rossella Calciano, Noemi Vallario, Gabriele Vagnarelli, Pietro Caliandro, Letizia Castelli, Marco Moci, Gaetano Tieri, Luigi Iasevoli and Luca Padua
J. Clin. Med. 2023, 12(24), 7639; https://doi.org/10.3390/jcm12247639 - 12 Dec 2023
Cited by 1 | Viewed by 1090
Abstract
Disorders of Consciousness (DoCs) after severe acquired brain injury involve substantial impairment of cognition and physical functioning, requiring comprehensive rehabilitation and support. Technological interventions, such as immersive Virtual Reality (VR), have shown promising results in promoting neural activity and enhancing cognitive and motor [...] Read more.
Disorders of Consciousness (DoCs) after severe acquired brain injury involve substantial impairment of cognition and physical functioning, requiring comprehensive rehabilitation and support. Technological interventions, such as immersive Virtual Reality (VR), have shown promising results in promoting neural activity and enhancing cognitive and motor recovery. VR can induce physical sensations that may activate the Autonomic Nervous System (ANS) and induce ANS-regulated responses. This study aimed to investigate the effects of immersive VR on the ANS in patients with DoCs through the analysis of the electrodermal activity (EDA). EDA was measured with a wearable device during a single immersive VR session consisting of static and dynamic videos depicting naturalistic environments. A pilot case–control study was conducted with 12 healthy participants and 12 individuals with DoCs. Results showed higher EDA values in patients than in healthy participants (p = 0.035), suggesting stronger autonomic activation during immersive VR exposure, while healthy subjects, in turn, showed a decrease in EDA values. Our results revealed a significant interaction between conditions and groups (p = 0.003), with patients showing significantly increased EDA values from the baseline compared to dynamic video observation (p = 0.014) and final rest (p = 0.007). These results suggest that immersive VR can elicit sympathetic arousal in patients with DoCs. This study highlights the potential of immersive VR as a tool to strengthen autonomic responses in patients with impaired consciousness. Full article
(This article belongs to the Special Issue Clinical Applications of Immersive and Nonimmersive Virtual Reality)
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11 pages, 748 KiB  
Article
Virtual Art Therapy: Application of Michelangelo Effect to Neurorehabilitation of Patients with Stroke
by Roberto De Giorgi, Antonio Fortini, Federica Aghilarre, Federico Gentili, Giovanni Morone, Gabriella Antonucci, Mario Vetrano, Gaetano Tieri and Marco Iosa
J. Clin. Med. 2023, 12(7), 2590; https://doi.org/10.3390/jcm12072590 - 29 Mar 2023
Cited by 6 | Viewed by 2733
Abstract
In neurorehabilitation, some studies reported the effective use of art therapy for reducing psychological disorders and for enhancing physical functions and cognitive abilities. Neuroaesthetical studies showed that seeing an art masterpiece can spontaneously elicit a widespread brain arousal, also involving motor networks. To [...] Read more.
In neurorehabilitation, some studies reported the effective use of art therapy for reducing psychological disorders and for enhancing physical functions and cognitive abilities. Neuroaesthetical studies showed that seeing an art masterpiece can spontaneously elicit a widespread brain arousal, also involving motor networks. To combine contemplative and performative benefits of art therapy protocols, we have developed an immersive virtual reality system, giving subjects the illusion that they are able to paint a copy of famous artistic paintings. We previously observed that during this virtual task, subjects perceived less fatigue and performed more accurate movements than when they were asked to color the virtual canvas. We named this upshot the Michelangelo effect. The aim of this study was to test the rehabilitative efficacy of our system. Ten patients with stroke in the subacute phase were enrolled and trained for one month with virtual art therapy (VAT) and physiotherapy. Their data were compared with those of ten patients matched for pathology, age and clinical parameters, trained only with conventional therapy for the same amount of time. The VAT group showed a significantly higher improvements in the Barthel Index score, a measure of independency in activities of daily living (66 ± 33% vs. 31 ± 28%, p = 0.021), and in pinching strength (66 ± 39% vs. 18 ± 33%, p = 0.008), with respect to the group treated with conventional rehabilitation. Full article
(This article belongs to the Special Issue Clinical Applications of Immersive and Nonimmersive Virtual Reality)
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12 pages, 287 KiB  
Article
Effectiveness of Early Rehabilitation with Exergaming in Virtual Reality on Gait in Patients after Total Knee Replacement
by Anna Hadamus, Michalina Błażkiewicz, Kamil T. Wydra, Aleksandra J. Kowalska, Małgorzata Łukowicz, Dariusz Białoszewski and Wojciech Marczyński
J. Clin. Med. 2022, 11(17), 4950; https://doi.org/10.3390/jcm11174950 - 23 Aug 2022
Cited by 5 | Viewed by 2448
Abstract
Total knee replacement (TKR) is the treatment of choice for advanced stages of osteoarthritis but it requires good postoperative rehabilitation. This study aimed to assess the effectiveness of exercises using virtual reality to improve gait parameters in patients after TKR. Fifty-nine patients 7–14 [...] Read more.
Total knee replacement (TKR) is the treatment of choice for advanced stages of osteoarthritis but it requires good postoperative rehabilitation. This study aimed to assess the effectiveness of exercises using virtual reality to improve gait parameters in patients after TKR. Fifty-nine patients 7–14 days after TKR surgery were divided into a study group (VRG, n = 38) and a control group (CG, n = 21). Both groups underwent the same 4-week rehabilitation protocol. The VRG group had 12 additional nonimmersive virtual reality game sessions on the Virtual Balance Clinic prototype system at 30 min each, focusing on gait and balance improvement. Spatiotemporal, force and foot plantar pressure parameters were collected on an instrumented treadmill during a 30 s walk. The most significant improvement was in the symmetry indices of forefoot force, maximum forefoot force, loading response time, and preswing time (p < 0.05) in both groups. Gait speed increased by 31.25% and 44% in the VRG and CG groups, respectively (p < 0.005). However, the extra exergaming sessions did not significantly improve rehabilitation outcomes. Therefore, additional VR training does not improve gait better than standard rehabilitation alone, but the improvement of gait, especially its symmetry, is significant within the first six weeks after surgery. Full article
(This article belongs to the Special Issue Clinical Applications of Immersive and Nonimmersive Virtual Reality)

Review

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23 pages, 1231 KiB  
Review
Effects of Virtual Reality in the Rehabilitation of Parkinson’s Disease: A Systematic Review
by Juan Rodríguez-Mansilla, Celia Bedmar-Vargas, Elisa María Garrido-Ardila, Silvia Teresa Torres-Piles, Blanca González-Sánchez, María Trinidad Rodríguez-Domínguez, María Valle Ramírez-Durán and María Jiménez-Palomares
J. Clin. Med. 2023, 12(15), 4896; https://doi.org/10.3390/jcm12154896 - 26 Jul 2023
Cited by 2 | Viewed by 2188
Abstract
Background: Parkinson’s disease is characterised by the loss of balance and the presence of walking difficulties. The inclusion of rehabilitation therapies to complement pharmacological therapy allows for comprehensive management of the disease. In recent years, virtual reality has been gaining importance in the [...] Read more.
Background: Parkinson’s disease is characterised by the loss of balance and the presence of walking difficulties. The inclusion of rehabilitation therapies to complement pharmacological therapy allows for comprehensive management of the disease. In recent years, virtual reality has been gaining importance in the treatment of neurological diseases and their associated symptoms. Therefore, the objective of this systematic review was to analyse the effectiveness of virtual reality on balance and gait in patients with Parkinson’s disease. Methods: This study is a systematic review conducted following PRISMA’s statements. An electronic search of the literature was carried out in the following databases: PubMed, Cochrane, Dialnet, Scopus, Web of Science, PsycINFO and Science Direct PEDro. The inclusion criteria were controlled and non-controlled clinical trials published in the last 12 years in English or Spanish, in which virtual reality was applied to treat balance and gait impairments in patients with Parkinson’s disease. Results: 20 studies were finally included in this review. A total of 480 patients participated in the included studies. All patients were diagnosed with Parkinson’s disease. Most of the investigations used the Nintendo Wii + Balance Board or the Microsoft Kinect TM combined with the Kinect Adventures games as a virtual reality device. Conclusions: According to the results of this literature review, virtual reality-based interventions achieve good adherence to treatment, bring innovation and motivation to rehabilitation, and provide feedback as well as cognitive and sensory stimulation in patients with Parkinson’s disease. Therefore, virtual reality can be considered an alternative for personalised rehabilitation and for home treatment. Full article
(This article belongs to the Special Issue Clinical Applications of Immersive and Nonimmersive Virtual Reality)
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15 pages, 2470 KiB  
Review
Effects of Non-Immersive Virtual Reality and Video Games on Walking Speed in Parkinson Disease: A Systematic Review and Meta-Analysis
by Francisco Navarro-Lozano, Pawel Kiper, Cristina Carmona-Pérez, Sebastian Rutkowski, Elena Pinero-Pinto and Carlos Luque-Moreno
J. Clin. Med. 2022, 11(22), 6610; https://doi.org/10.3390/jcm11226610 - 8 Nov 2022
Cited by 2 | Viewed by 2754
Abstract
People with Parkinson disease suffer from a loss of dopaminergic neurons, which are involved in walking speed. Currently, virtual reality (VR) has emerged as a useful tool for the rehabilitation of people with neurological diseases, optimizing results in balance and gait. This review [...] Read more.
People with Parkinson disease suffer from a loss of dopaminergic neurons, which are involved in walking speed. Currently, virtual reality (VR) has emerged as a useful tool for the rehabilitation of people with neurological diseases, optimizing results in balance and gait. This review aimed to evaluate the effectiveness of VR or video games (through face-to-face sessions and not telerehabilitation) in improving walking speed and other spatio-temporal parameters of gait, balance, and quality of life in patients with Parkinson disease. A bibliographic search was carried out in the MEDLINE, Web of Science, Scopus, and PEDro databases. This systematic review adhered to the PRISMA guideline statement and was registered in PROSPERO (CRD42020180836). From a total of 119 records, 5 studies met the inclusion criteria for qualitative analysis, of which 3 contributed to the meta-analysis; inconclusive findings were found on gait speed, balance, and quality of life after the use of non-immersive VR systems face-to-face. A greater number of studies are necessary, with a greater number of participants, to differentiate between those VR specific systems (specifically designed for rehabilitation) from commercial video games, including immersive systems, and obtain more conclusive evidence. Furthermore, it would be interesting to compare the administration of this treatment in person versus its administration via telerehabilitation, which will help plan treatment programs. Full article
(This article belongs to the Special Issue Clinical Applications of Immersive and Nonimmersive Virtual Reality)
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Other

9 pages, 879 KiB  
Case Report
Improving Adherence to a Home Rehabilitation Plan for Chronic Neck Pain through Immersive Virtual Reality: A Case Report
by Matteo Cioeta, Sanaz Pournajaf, Michela Goffredo, Giuseppe Giovannico and Marco Franceschini
J. Clin. Med. 2023, 12(5), 1926; https://doi.org/10.3390/jcm12051926 - 28 Feb 2023
Cited by 1 | Viewed by 1993
Abstract
Idiopathic chronic neck pain is a highly disabling musculoskeletal condition. Immersive virtual reality shows a promising efficacy in the treatment of chronic cervical pain through the mechanism of distraction from the pain. This case report describes the management of C.F., a fifty-seven-year-old woman, [...] Read more.
Idiopathic chronic neck pain is a highly disabling musculoskeletal condition. Immersive virtual reality shows a promising efficacy in the treatment of chronic cervical pain through the mechanism of distraction from the pain. This case report describes the management of C.F., a fifty-seven-year-old woman, who suffered from neck pain for fifteen months. She had already undergone a cycle of physiotherapy treatments including education, manual therapy, and exercises, following international guidelines. The patient’s poor compliance did not allow adherence to the exercise’s prescription. Home exercise training through virtual reality was therefore proposed to the patient to improve her adherence to the treatment plan. The personalization of the treatment allowed the patient to resolve in a short time period her problem and return to live with her family peacefully. Full article
(This article belongs to the Special Issue Clinical Applications of Immersive and Nonimmersive Virtual Reality)
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14 pages, 2315 KiB  
Case Report
Clinical Effectiveness of Non-Immersive Virtual Reality Tasks for Post-Stroke Neuro-Rehabilitation of Distal Upper-Extremities: A Case Report
by Debasish Nath, Neha Singh, Megha Saini, Onika Banduni, Nand Kumar, Madakasira Vasantha Padma Srivastava, Shanmugam Senthil Kumaran and Amit Mehndiratta
J. Clin. Med. 2023, 12(1), 92; https://doi.org/10.3390/jcm12010092 - 22 Dec 2022
Cited by 4 | Viewed by 2262
Abstract
A library of non-immersive Virtual Reality (VR) tasks were developed for post-stroke rehabilitation of distal upper extremities. The objective was to evaluate the rehabilitation impact of the developed VR-tasks on a patient with chronic stroke. The study involved a 50-year-old male patient with [...] Read more.
A library of non-immersive Virtual Reality (VR) tasks were developed for post-stroke rehabilitation of distal upper extremities. The objective was to evaluate the rehabilitation impact of the developed VR-tasks on a patient with chronic stroke. The study involved a 50-year-old male patient with chronic (13 month) stroke. Twenty VR therapy sessions of 45 min each were given. Clinical scales, cortical-excitability measures, functional MRI (fMRI), and diffusion tensor imaging (DTI) data were acquired pre-and post-therapy to evaluate the motor recovery. Increase in Fugl-Meyer Assessment (wrist/hand) by 2 units, Barthel Index by 5 units, Brunnstrom Stage by 1 unit, Addenbrooke’s Cognitive Examination by 3 units, Wrist Active Range of Motion by 5° and decrease in Modified Ashworth Scale by 1 unit were observed. Ipsilesional Motor Evoked Potential (MEP) amplitude (obtained using Transcranial Magnetic Stimulation) was increased by 60.9µV with a decrease in Resting Motor Threshold (RMT) by 7%, and contralesional MEP amplitude was increased by 56.2µV with a decrease in RMT by 7%. The fMRI-derived Laterality Index of Sensorimotor Cortex increased in precentral-gyrus (from 0.28 to 0.33) and in postcentral-gyrus (from 0.07 to 0.3). The DTI-derived FA-asymmetry decreased in precentral-gyrus (from 0.029 to 0.024) and in postcentral-gyrus (from 0.027 to 0.017). Relative reduction in task-specific performance metrics, i.e., time taken to complete the task (31.6%), smoothness of trajectory (76.7%), and relative percentage error (80.7%), were observed from day 1 to day 20 of the VR therapy. VR therapy resulted in improvement in clinical outcomes in a patient with chronic stroke. The research also gives insights to further improve the overall system of rehabilitation. Full article
(This article belongs to the Special Issue Clinical Applications of Immersive and Nonimmersive Virtual Reality)
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11 pages, 1881 KiB  
Brief Report
Immersive Virtual Reality as a Novel Physical Therapy Approach for Nonagenarians: Usability and Effects on Balance Outcomes of a Game-Based Exercise Program
by Pablo Campo-Prieto, José Mª Cancela-Carral, Borja Alsina-Rey and Gustavo Rodríguez-Fuentes
J. Clin. Med. 2022, 11(13), 3911; https://doi.org/10.3390/jcm11133911 - 5 Jul 2022
Cited by 11 | Viewed by 2592
Abstract
Physical exercise has been recognized as an important strategy in the promotion of healthy aging. Positive effects on older adults’ motor ability are brought about by engaging their motor skills and promoting sensorimotor learning and cortical plasticity. These processes could be increased with [...] Read more.
Physical exercise has been recognized as an important strategy in the promotion of healthy aging. Positive effects on older adults’ motor ability are brought about by engaging their motor skills and promoting sensorimotor learning and cortical plasticity. These processes could be increased with the use of immersive virtual reality (IVR) technology, since the multisensory stimulation is greater. The aim of this study was to explore the usability and balance effects of an IVR exercise program in community-dwelling nonagenarian people. A sample of 12 women were allocated to an experimental group (EG n = 6; 91.67 ± 1.63 years) and a control group (CG n = 6; 90.83 ± 2.64 years). For 10 weeks, the EG used a commercial IVR exergame three times a week. All the sample completed the program without adverse effects (without Simulator Sickness Questionnaire symptoms). Post-gaming usability was good (System Usability Scale 78.33). The EG improved some balance parameters significantly (Tinetti test: balance (10.97 %; Sig = 0.017), gait (9.23%; Sig = 0.047) and total score (10.20%; Sig = 0.014) and maintained total TUG test times (−0.45%)). There were significant differences between groups (Tinetti test: balance (Sig = 0.004) and total score (Sig = 0.0032)). We successfully demonstrated that IVR training is feasible and is an effective and personalized method to enhance balance and to reduce the risk of falls in community-dwelling nonagenarian women. Full article
(This article belongs to the Special Issue Clinical Applications of Immersive and Nonimmersive Virtual Reality)
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