Search Results (611)

The burden of disability is rising rapidly in Africa, where a severe shortage of rehabilitation professionals and limited infrastructure create a major treatment gap. Immersive virtual reality and serious games have shown promise for upper limb rehabilitation, but current extended reality (XR) solutions lack personalization, cultural adaptability, real-time feedback, and scalability. This perspective paper proposes a conceptual AI-enhanced XR framework tailored to African low- and middle-income countries. We identify how generative AI, large language models, multiagent systems, and explainable AI can address specific rehabilitation barriers. The framework integrates these four pillars into a three-layer architecture covering content creation, interaction, and decision support. We analyze implementation considerations specific to African contexts—infrastructure, capacity building, cultural adaptation, ethics, and financing—and outline a detailed research agenda with near, medium, and longer term priorities. Realizing this vision requires co-design with African communities, investment in local capacity, adaptation to infrastructure constraints, and development of ethical frameworks. AI-enhanced XR has the potential to democratize access to quality rehabilitation across Africa, but this potential must be validated through rigorous, context-sensitive research. Full article

Simulation technologies are widely used in the construction industry to analyze complex operations and evaluate project performance before physical construction begins. However, interpreting simulation outputs remains challenging due to the dynamic nature of construction activities and the difficulty of representing spatial and temporal changes using traditional numerical or textual outputs. To address these limitations, researchers increasingly integrate visualization technologies with construction simulation models to improve understanding, communication, and decision-making. Using the PRISMA methodology, this paper presents a systematic literature review of visualization technology applications in construction simulation during the building phase. A total of 118 relevant publications published between 2000 and 2023 are reviewed and analyzed. The findings reveal a strong relationship between visualization technologies and Building Information Modeling (BIM), Virtual Reality (VR), and game engine technologies. Autodesk Navisworks and Unity are identified as the most frequently used visualization platforms, with game engines showing increasing adoption in recent years due to their support for immersive and interactive environments. The reviewed studies are further categorized into six primary use cases: scheduling and planning, education and training, equipment management, safety management, workspace planning, and simulation validation and verification. The results also demonstrate increasing research interest in real-time visualization, AR/VR integration, and interactive simulation environments. Overall, the findings highlight the growing role of visualization technologies in improving construction project planning, communication, training, safety, and decision-making, while also identifying important future research directions related to interoperability, real-time interaction, and extensible visualization platforms. Full article

Virtual reality (VR) has emerged as a versatile technology for cognitive and professional training, enabling the simulation of complex environments that promote engagement, motivation, and adaptive learning. This study presents the design and development of a VR-based training system composed of three serious games aimed at strengthening executive functions (EFs), cognitive flexibility, inhibitory control, working memory, planning and logical reasoning, within the framework of continuous improvement methodologies in industrial contexts. The system was developed using the Game Development Software Engineering (GDSE) model combined with a Design-Based Research (DBR) approach, following iterative cycles of analysis, design, and heuristic validation by experts in engineering, design, and cognitive psychology. The results show that the final version of the system achieved high usability, cognitive coherence, and visual immersion, with game mechanics accurately reflecting the targeted EFs. Each game integrates progressive difficulty, multimodal feedback, and realistic industrial scenarios to ensure ecological validity and potential transfer to real workplace behaviors. The findings demonstrate the technical and conceptual feasibility of applying immersive environments for executive function training in adults and suggest that VR can support the development of cognitive and behavioral competencies essential for sustaining continuous improvement programs in organizational settings. Full article

Gamification, defined as the application of game elements in non-gaming contexts, has emerged as a promising tool for enhancing student engagement in content-heavy curriculums such as anatomy and physiology. This preliminary study describes the development of a virtual reality (VR) cardiac anatomy escape room and provides initial data on student engagement and confidence with learning objectives. Participants were recruited from Colorado State University following completion of a cadaveric anatomy course. The heart-themed escape room was developed using Unity 6000.1.7f1 and deployed on Meta Quest 3 headsets, featuring seven puzzle stations that generated cardiac structures upon successful completion. Players then assembled a complete heart model within a set time. Results showed high engagement and accomplishment, with students reporting improved understanding of visualizing cardiac structures and enjoyment in testing anatomical knowledge. All participants reported that they felt confident with the content following completion of the escape room. While VR has been successfully incorporated into curricula, VR escape rooms have the potential to serve as an engaging and fun supplementary learning tool for students. These findings suggest that virtual reality implementation can enhance anatomy education through immersive gamified learning environments. Full article

As the core repository of historical memory, the revitalisation and utilisation of cultural heritage (CH) are paramount to cultural transmission. Currently, virtual reality (VR) has become a mainstream method for public engagement with cultural heritage, but existing research mainly focuses on knowledge transfer efficiency while neglecting emotional factors’ key role in heritage identification and dissemination. This study examines the VR-based CH experience for Tianjin Marco Polo Square via multi-stakeholder collaboration, exploring how emotional design affects users’ CH learning and identity formation. Findings show emotionally driven VR games enhance immersion, engagement, resonance and learning outcomes through multisensory immersion, goal-oriented interaction and narrative connections. Theoretically, a three-tier “instinct–behaviour–reflection” emotional design framework integrated with constructivist learning theory is built to tackle emotional deficiency in CH communication. Practically, it verifies that affective VR games upgrade CH transmission from unidirectional dissemination to dynamic inheritance, establishing a new participatory culture paradigm. Full article

Aging is a progressive and heterogeneous biological process influenced by multiple factors that may compromise physical and cognitive capacities and increase the risk of frailty, functional decline, and falls in older adults. Falls represent a major public health concern due to their impact on independence and long-term care demand. Immersive virtual reality (IVR) delivered through active video games (exergames) has emerged as a preventive strategy that integrates sensory, motor, and cognitive stimulation within controlled and engaging environments, particularly where traditional programs face challenges related to adherence and individual adaptation. This study aims to determine the feasibility and implementation of an IVR-based program for falls prevention in older adults at risk of frailty in primary health care (PHC). A quasi-experimental pre–post design will be conducted with an intervention group (IVR/exergames) and a conventional control group, including a total sample of 40 participants (20 per group). The protocol comprises three phases: baseline assessment and IVR familiarization; a 12-week intervention delivered twice weekly; and post-intervention assessment. The primary outcome will be fall risk assessed using the Timed Up and Go (TUG) test. Secondary outcomes include physical performance (Short Physical Performance Battery, SPPB, and handgrip dynamometry) and psychological aspects related to falls (Falls Efficacy Scale International, FES-I, and Activities-specific Balance Confidence Scale, ABC). Feasibility indicators will include recruitment, adherence, retention, and cybersickness. A reduction in TUG time is expected, providing preliminary evidence on the feasibility of integrating IVR-based programs for falls prevention within PHC systems. Full article

Background: Technology such as telerehabilitation, virtual reality, robotics, and wearable systems are reshaping pediatric physiotherapy. While evidence remains fragmented, there is little guidance on how these approaches can be integrated into coherent, family-centered care pathways. Objective: To develop the Digital Pediatric Physiotherapy Framework (DPPF) based on a systematic review of randomized evidence on digital interventions in pediatric physiotherapy. Methods: Several databases were searched for randomized trials published after 1 January 2020, including PubMed, Web of Science Core Collection, and Google Scholar. The included studies assessed the results of physiotherapist-delivered or physiotherapist-supervised digital interventions in children and adolescents aged 18 and younger. Population, intervention, outcome, implementation, and safety data were extracted. Considering the substantial heterogeneity of the findings, they were synthesized narratively. Cochrane RoB 2 was used to assess risk of bias, and GRADE was used to evaluate certainty of evidence. Results: Twenty-nine trials involving 1196 participants were included. Most studies examined virtual reality and gaming-based interventions, with fewer evaluating telerehabilitation/tele-exercise and robotic or wearable technologies. Digital interventions were most often directed at body-function and activity-level outcomes, while participation outcomes were less frequently studied. The strongest evidence supported short-term benefits in balance, gross motor function, upper-limb activity, pain, and selected fitness outcomes, particularly in children with cerebral palsy. Evidence for telerehabilitation and robotic or wearable approaches was more limited but generally promising. Implementation, equity, cost, and long-term outcomes were rarely reported. No eligible trial directly evaluated electronic patient-reported outcome measures, digital triage, or clinical decision support as stand-alone interventions. Conclusions: Digital interventions have the potential to strengthen pediatric physiotherapy, particularly for short-term motor and functional outcomes. The proposed DPPF provides an implementation-informed structure to guide future research, pathway design, and more purposeful integration of digital health into pediatric rehabilitation practice. Full article

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating disorder, characterized by symptoms such as post-exertional malaise (PEM) and cognitive impairments. This study assessed reaction time (RT) metrics in three-dimensional (3D) visual tasks with the aim of objectively quantifying the cognitive impairments in ME/CFS patients compared to controls. Methods: A total of 120 participants (60 ME/CFS patients and 60 controls) were recruited at the Department of Ophthalmology, Universität of Erlangen-Nürnberg. RT was assessed using a virtual reality–oculomotor test system, presenting 3D stimuli at three disparity levels (275″, 550″, and 1100″) within three gaming repetitions (R1, R2, and R3). Mixed-effects models were used to evaluate group differences, with age and gender as covariates. Pairwise contrasts were calculated to assess changes across repetitions. Fatigue self-assessments were recorded by validated questionnaires, (FACIT Fatigue Scale, Chalder Fatigue Scale, Bell Score and Health Assessment Questionnaire), and their correlation with RT metrics was portrayed using a Spearman correlation matrix. Results: Estimated means (EM-means) for RT were significantly prolonged in ME/CFS patients compared to controls at disparity 275″ (1969 ms vs. 1384 ms; p = 0.0001), 550″ (1409 vs. 1071 ms; p = 0.0012) and 1100″ (1126 ms vs. 891 ms; p = 0.00223). Age was a significant covariate (p < 0.001), while gender showed no effect. Both groups demonstrated improvements in RT over repetitions; however, ME/CFS patients showed a significantly lower improvement compared to controls, reaching significance in R3 (p = 0.0042). RT metrics did not correlate with patients’ self-assessment scores. Conclusions: ME/CFS patients showed consistently slower RTs compared to controls, particularly in later, easier gaming repetitions, potentially reflecting the impact of fatigue. Full article

Objective: To investigate the effects of virtual reality (VR) technology on pain and anxiety in hospitalized pediatric patients undergoing Peripheral Venous Catheterization. Methods: This study is a randomized controlled trial (RCT). Between July and December 2024, eligible pediatric inpatients aged 5–14 years from the Chegu Branch of Wuhan Union Hospital were randomly assigned to either the experimental group or the control group. The control group received routine care during peripheral venous catheterization, including health education and psychological comfort. The intervention group, in addition to routine care, used VR headsets to watch age-appropriate game videos, with each VR session lasting 10–15 min. The primary outcome measure was patient-reported pain levels, with anxiety as a key secondary outcome. Secondary outcome measures included catheterization time, heart rate, patient satisfaction with nursing procedures, and usability evaluation of the VR equipment. Results: A total of 80 pediatric patients were enrolled, with 40 in the VR group (mean age 8.05 ± 2.60 years) and 40 in the control group (mean age 8.63 ± 2.50 years). Generalized estimating equation (GEE) analysis showed a significant interaction effect between group and time for pain (Wald χ² = 7.091, p = 0.029), while no significant interaction was found for anxiety (Wald χ² = 0.971, p = 0.615). Before peripheral venous catheterization, there was no significant difference in pain and anxiety scores between the two groups of pediatric patients (p > 0.05). Patients in the VR group reported significantly reduced pain (β = −0.78; 95% CI, −1.40 to −0.15; p = 0.015) during catheterization, and overall anxiety scores were also lower in the VR group (β = −0.43; 95% CI, −0.77 to −0.08; p = 0.016), although the group by time interaction for anxiety was not significant. The intervention group also demonstrated a lower peak heart rate (107.67 ± 16.25 beats/min vs. 115.25 ± 29.53 beats/min; p = 0.047) and a shorter procedure duration [110 (100, 120) seconds vs. 120 (110, 123.5) seconds; p < 0.001]. Operator satisfaction with the nursing procedure was also significantly higher in the intervention group (95.0% vs. 72.5%, p < 0.001). Conclusions: VR significantly reduces pain and anxiety in hospitalized pediatric patients during peripheral venous catheterization. Full article

Background: Ataxic symptoms are characterized by causing motor, balance and coordination disorders. Virtual reality-based interventions (VRBIs) including video games and exergames can improve ataxic symptoms. The aim of this systematic review with meta-analysis was to assess the effectiveness of VRBI on severity of ataxia, postural balance, mobility and manual dexterity in patients with ataxia. Methods: According to the PRISMA guidelines, we searched PubMed Medline, SCOPUS, WOS, CINAHL, PEDro and other sources for randomized controlled trials (RCTs) that assessed the effectiveness of VRBI, compared to others, on the severity of ataxia, balance, mobility and manual dexterity in patients with ataxia. The pooled effect was calculated using Cohen’s standardized mean difference (SMD) and a 95% confidence interval (95% CI). Results: With data from seven RCTs, providing data from 171 patients with ataxia, our meta-analysis elucidated that VRBI is effective in reducing the severity of ataxia (SMD = −0.43; 95% CI −0.84 to −0.03; p = 0.04) and increasing functional balance (SMD = 0.97; 95% CI 0.16 to 1.78; p = 0.02) and manual dexterity (SMD = −0.63; 95% CI −1.16 to −0.11; p = 0.018). Conclusions: Our findings suggest that VRBI could be a promising and effective therapeutic approach in reducing ataxia disability and increasing balance and manual dexterity in ataxic patients. Full article

Background and Objectives: Stroke is a leading cause of long-term disability in older adults, who often face persistent motor, cognitive, and functional challenges. Conventional stroke rehabilitation programs often involve highly repetitive motor tasks, which may reduce patient motivation and contribute to suboptimal adherence over time. Virtual reality (VR) offers an engaging alternative; however, much of the existing research has focused on specialized rehabilitation-oriented VR systems rather than off-the-shelf commercial platforms. This study evaluated older stroke survivors’ acceptance, tolerability, and lived experiences of a short VR-based rehabilitation session using a commercial game on a commercial wearable VR system. Methods: A single-session convergent mixed-methods design was employed. Thirteen community-dwelling older stroke survivors (mean age 79.2 ± 7.1 years; 9 males, 4 female) completed a 15 min VR session using a commercial wearable VR system. The Technology Acceptance Model (TAM) questionnaire and Simulator Sickness Questionnaire (SSQ) assessed acceptance and tolerability, while semi-structured interviews explored lived experiences. Qualitative data were thematically analyzed. Results: Participants reported high acceptance across all TAM domains (overall M = 4.35 ± 0.79, scale 1–5). Enjoyment/intention to use was rated highest (M = 4.77 ± 0.42), while perceived usefulness was lowest (M = 4.15 ± 0.77). VR was well tolerated: the SSQ total score was 17.38 ± 1.73, with most symptoms rated at the mild level only. Exploratory Spearman correlations revealed a significant positive association between age and SSQ total score (r_h = +0.568, p = 0.043). Thematic analysis identified five themes: (1) usability and accessibility; (2) therapeutic value; (3) engagement and motivation; (4) social and clinical support; and (5) physical and cognitive demands. Conclusions: A commercial wearable VR system was found to be acceptable, safe, and engaging for older stroke survivors. With supervision and therapeutic framing, it may serve as a motivating adjunct to conventional rehabilitation. Full article

There is a growing need for accessible and engaging rehabilitation tools for individuals with neurodevelopmental disorders such as Cerebral palsy (CP), Down syndrome (DS), and Autism spectrum disorder (ASD). Serious games offer a promising approach, yet few are tailor-made to meet the therapeutic demands of these populations. A tailor-made, non-immersive virtual reality (VR) serious games framework featuring a basketball task was developed, with therapist-controlled modules for customization and monitoring. Twenty-eight participants (CP: 14; DS: 7; ASD: 7) completed the game across eight sessions, grouped into three practice phases: an initial session, an early adaptation phase, and a consolidated practice phase. Performance metrics included accuracy, reaction time, and number of victories. All groups improved performance across phases, with accuracy increasing significantly in central (p = 0.005) and total positions (p = 0.007). The number of victories also increased from the initial to the early adaptation phase (p = 0.019) and from the initial to the consolidated practice phase (p = 0.008). Participants with ASD showed significantly higher accuracy than the DS group, while CP and DS participants showed a temporary increase in reaction time during the early adaptation phase, followed by a reduction in the consolidated phase, suggesting task adaptation. These findings support the feasibility and short-term effectiveness of a modular, tailor-made serious games platform for telerehabilitation. Full article

This research presents a new glove-shaped wearable device, designed to deliver torsional cues on the wrist as a tactile guidance tool. The device integrates four tactile modules that apply modulated shallow torque to the anatomical wrist articulation, providing torsional hints for both ulnar–radial deviation and flexion–extension degrees of freedom (DOF). The aim of this research is to evaluate whether this new type of stimulation can convey accurate directional cues on 2-DOF wrist movements, with the main target application as a guidance and support tool in virtual motor rehabilitation. Effectiveness was tested in virtual reality (VR) serious games designed to exercise wrist movements through a virtual navigation task. The glove-shaped haptic device was introduced to guide the user by directional cues provided through the shallow-torques approach. Results showed that the tactile sensations were effective in conveying accurate directional cues, reliably guiding subjects’ wrist movements on 2-DOF. This research highlights the potential of a compact, non-bulky glove-shaped device for providing clear directional cues at the wrist across 2-DOF. The shallow-torque approach, combining the natural interaction of force feedback with hardware simplicity and lightness closer to vibrotactile devices, has the potential of scalability on other body segments, and shows promise for applications in rehabilitation, postural guidance, and virtual interaction. Full article

Background: Virtual, augmented, and mixed reality (or collectively extended reality, XR) serious games, combined with motion-tracking technologies, are increasingly used for motor and cognitive rehabilitation and training. As XR and tracking technologies advance, a systematic mapping of the related research area could offer relevant insights. Objectives: This review aims to map interactive XR serious games, using motion-tracking technologies for physical or cognitive rehabilitation or training, and describe intervention characteristics and evaluation methods. Eligibility Criteria: Eligible studies were English, peer-reviewed journal articles published between 2015 and October 2025, with more than three participants, using custom XR serious games for rehabilitation or training. Studies were excluded if they focused on technical aspects, passive XR, diagnostic evaluation, psychological therapies, minor participants, procedural training, or education. Charting Methods: Data were charted using a structured form capturing XR characteristics, hardware configurations, study characteristics, and evaluation methods. Results: 61 studies were included. Most employed non-immersive or fully immersive VR interventions, targeting physical upper-body rehabilitation, especially post-stroke and Parkinson’s disease. Usability, acceptability and user experience, and training effectiveness were commonly evaluated with positive outcomes. Conclusions: The findings highlight opportunities for research into augmented and mixed reality approaches, particularly for cognitive function, and use of XR-based interventions across broader populations. Full article

Teaching is widely recognized as a highly stressful profession, and recent educational changes have further increased the pressure on teachers to manage demanding classroom situations while adapting to new technologies. To address this challenge, the present study examines the feasibility and user acceptance of XRSkills, a virtual reality serious game designed to strengthen teachers’ coping and problem-solving strategies through realistic school-based scenarios. A feasibility evaluation was conducted with teachers from all school grades and students from multiple European countries, combining a standardized usability measure with open-ended feedback on the game experience. Overall results indicate that XRSkills achieved a good level of usability and was generally perceived as engaging and relevant, particularly for in-service teachers. Participants appreciated the game format and learning approach, while also reporting areas for improvement such as clearer guidance, richer content, and smoother technical performance. These findings support the potential of virtual reality serious games as a practical and scalable training pathway to help teachers rehearse responses to stressors in a safe environment, while also fostering confidence in using immersive technologies for professional development. Full article