Virtual Reality as a Tool in the Treatment of Claustrophobia - A Review

Within the context of psychology, virtual reality (VR) is presented as a technological tool to address and treat the symptoms of claustrophobia. Claustrophobia is distinguished by a fear of small or enclosed environments, which can be a challenge for conventional treatments. This research work focused on conducting a detailed analysis of the existing literature on using VR as an alternative tool to treat claustrophobia symptoms. The research results indicated that treatment with VR technology may be effective in providing a controlled and safe way to expose patients to situations such as those they fear, allowing them to overcome their fears more effectively. This review article provides a comprehensive analysis of the use of VR to treat laustrophobia. A total of 384 manuscripts from different virtual databases were analyzed, from which 61 major articles were selected. The results showed that VR allows for treating different types of phobias such as Acrophobia, Agoraphobia, rachnophobia, claustrophobia, Fear of flying, Fear of public speaking and Fear of injections, achieving significant patient results. Studies have proven the effectiveness of VR in reducing the symptoms of claustrophobia, and it is anticipated that it will continue to be an important tool in the future

Emotional activation in human beings: procedures for experimental stress induction

The study about the effects of stress on cognition and behavior is an area of special interest and research development for psychology and neurosciences. Stress induction is an essential element for these studies, because it enables the manipulation of this kind of emotional activation as an independent variable to prove its effect over behavior. Nevertheless, this induction must be enough to produce a significant increase in cortisol levels and, at the same time, to achieve the stablished ethical standards for experiments with human beings. This article aims to provide a general review about emotional activation in order to deepen the procedures used in the experimental induce stress in human beings. The conclusion is that the elaboration of more efficient protocols is required, and the use of simulation and other technologic tools could be very useful.O estudo dos efeitos do estresse sobre a cognição e o comportamento é uma área de especial interesse e desenvolvimento investigativo tanto para a psicologia como para as neurociências. A introdução de estresse constitui um elemento fundamental nestes estudos, pois permite a manipulação desta forma de ativação emocional como variável independente, para observar o seu efeito sobre o comportamento; porém, esta indução deve ser suficiente para gerar incrementos significativos nos níveis de cortisol e ao mesmo tempo cumprir os padrões éticos estabelecidos para a experimentação com humanos. O presente artigo tem como propósito aportar uma revisão geral sobre a ativação emocional, para afundar nos procedimentos utilizados na indução experimental de estresse em sujeitos humanos. Conclui-se que é requerido a elaboração de protocolos mais eficientes, e para tal, o uso de simulações e outras ferramentas tecnológicas pode ser de grande utilidade.L’étude des effets du stress sur la cognition et le comportement est un domaine d’intérêt particulier et de développement de la recherche tant pour la psychologie que pour les neurosciences. L’induction du stress constitue un élément fondamental de ces études, car elle permet la manipulation de ce mode d’activation émotionnelle en tant que variable indépendante, afin d’observer son effet sur le comportement; cependant, cette induction devrait être suffisante pour provoquer des augmentations significatives des taux de cortisol tout en respectant les normes éthiques établies pour l’expérimentation humaine. Le but de cet article est d’effectuer une revue générale de l’activation émotionnelle afin d’approfondir les procédures utilisées dans l’induction expérimentale du stress chez l’homme. Cet article conclut que la conception de protocoles plus efficaces est nécessaire; à cette fin, l’utilisation de simulations et d’autres outils technologiques peut être très utile.El estudio de los efectos del estrés sobre la cognición y el comportamiento es un área de especial interés y desarrollo científico, tanto para la Psicología como para las Neurociencias. La inducción de estrés constituye un elemento fundamental en estos estudios, pues permite la manipulación de esta forma de activación emocional, como variable independiente, para observar su efecto sobre la conducta; no obstante, esta inducción debe ser suficiente para generar incrementos significativos en los niveles de cortisol y cumplir los estándares éticos establecidos para la experimentación con humanos. El presente artículo tiene como propósito aportar una revisión general sobre la activación emocional, para profundizar en el conocimiento acerca de los procedimientos utilizados en la inducción experimental de estrés en sujetos humanos. Se concluye que se requiere el diseño de protocolos más eficaces, para lo cual, el uso de las simulaciones y otras herramientas tecnológicas puede ser de gran utilidad

Technological competence is a precondition for effective implementation of virtual reality head mounted displays in human neuroscience:A technological review and meta-analysis

International audienceImmersive virtual reality (VR) emerges as a promising research and clinical tool. However, several studies suggest that VR induced adverse symptoms and effects (VRISE) may undermine the health and safety standards, and the reliability of the scientific results. In the current literature review, the technical reasons for the adverse symptomatology are investigated to provide suggestions and technological knowledge for the implementation of VR head-mounted display (HMD) systems in cognitive neuroscience. The technological systematic literature indicated features pertinent to display, sound, motion tracking, navigation, ergonomic interactions, user experience, and computer hardware that should be considered by the researchers. Subsequently, a meta-analysis of 44 neuroscientific or neuropsychological studies involving VR HMD systems was performed. The meta-analysis of the VR studies demonstrated that new generation HMDs induced significantly less VRISE and marginally fewer dropouts. Importantly, the commercial versions of the new generation HMDs with ergonomic interactions had zero incidents of adverse symptomatology and dropouts. HMDs equivalent to or greater than the commercial versions of contemporary HMDs accompanied with ergonomic interactions are suitable for implementation in cognitive neuroscience. In conclusion, researchers' technological competency, along with meticulous methods and reports pertinent to software, hardware, and VRISE, are paramount to ensure the health and safety standards and the reliability of neuroscientific results

Evaluation techniques used to evaluate extended reality (XR) head mounted displays (HMDs) used in healthcare: A literature review

Extended Reality (XR) Head Mounted Displays (HMDs) are used across various healthcare pathways for staff/student education and training, and for improving patient experiences. As XR HMDs become affordable, accessible and their acceptance increases, it is critical to document the techniques used for evaluating the technology, processes of user engagement and immersion, and outcomes. At present there is limited research on evaluation techniques used to evaluate XR HMDs. This manuscript presents findings from 104 clinical studies that use XR HMDs. The aim of this review is to give the user an insight into the current healthcare XR HMD landscape by presenting the different HMDs used, variety of XR interventions and their applications across medical pathways and intended research outcomes of the XR applications. The manuscript further guides the reader toward a detailed documentation of evaluation techniques used to investigate antecedents and consequences of using XR and delivers a critical discussion and suggestions for improvement of XR evaluation practices. This paper will be of excellent use to clinicians, academics, funding bodies and hospital decision makers who would like suggestions for evaluating the efficacy and effectiveness of XR HMDs. The authors hope to encourage discussions on the importance of improving XR evaluation practices

Immersive virtual reality methods in cognitive neuroscience and neuropsychology: the Virtual Reality Everyday Assessment Lab (VR-EAL).an immersive neuropsychological test battery of everyday cognitive functions

In cognitive neuroscience and neuropsychology, the collection of cognitive and behavioural data is predominantly achieved by implementing paper-and-pencil and computerized (i.e., 2D and 3D applications) assessments. However, these psychometric tools in clinics and/or laboratories display several limitations and discrepancies between the observed performance in the laboratory/clinic and the actual performance of individuals in everyday life. The functional and predictive association between an individual's performance on a set of neuropsychological tests and the individual's performance in various everyday life settings is called ecological validity. Ecological validity is considered an important issue that cannot be resolved by the currently available assessment tools. Virtual reality head-mounted displays (HMD) appear to be effective research tools, which may address the problem of ecological validity in neuropsychological testing. However, their widespread implementation is hindered by virtual reality induced symptoms and effects (VRISE) and the lack of skills in virtual reality software development. In this PhD, a technological systematic literature review of the reasons for adverse symptomatology was conducted and suggestions and technological knowledge for the implementation of virtual reality HMD systems in cognitive neuroscience provided. The review indicated features pertinent to display, sound, motion tracking, navigation, ergonomic interactions, user experience, and computer hardware that should be considered by researchers. Subsequently, a meta-analysis of 44 neuroscientific or neuropsychological studies involving virtual reality HMD systems was performed. The meta-analysis of the virtual reality studies demonstrated that new generation HMDs induce significantly less VRISE and marginally fewer dropouts. Importantly, the commercial versions of the new generation HMDs with ergonomic interactions had zero incidents of adverse symptomatology and dropouts. HMDs equivalent to or greater than the commercial versions of contemporary HMDs accompanied with ergonomic interactions are suitable for implementation in cognitive neuroscience. Another aim of this PhD was to devise a brief tool to appraise and report both the quality of software features and VRISE intensity quantitatively; such a tool does not currently exist. The Virtual Reality Neuroscience Questionnaire (VRNQ; Kourtesis et al., 2019) was developed to assess the quality of virtual reality software in terms of user experience, game mechanics, in-game assistance, and VRISE. Forty participants aged between 28 and 43 years were recruited (18 gamers and 22 non-gamers) for the study. They participated in 3 different virtual reality sessions until they felt weary or discomfort and subsequently filled in the VRNQ. The results demonstrated that VRNQ is a valid tool for assessing virtual reality software as it has good convergent, discriminant, and construct validity. The maximum duration of virtual reality sessions should be between 55 and 70 min when the virtual reality software meets or exceeds the parsimonious cut-offs of the VRNQ, and the users are familiarized with the virtual reality system. Also, gaming experience does not affect how long virtual reality sessions should last. Furthermore, while the quality of virtual reality software substantially modulates the maximum duration of virtual reality sessions, age and education do not. Finally, deeper immersion, better quality of graphics and sound, and more helpful in-game instructions and prompts were found to reduce VRISE intensity. The VRNQ facilitates the brief assessment and reporting of the quality of virtual reality software features and/or the intensity of VRISE, while its minimum and parsimonious cut-offs may appraise the suitability of virtual reality software for implementation in research and clinical settings. However, the development of virtual reality software is predominantly dependent on third parties (e.g., freelancers or companies) with programming and software development skills. A solution that will promote the adoption of immersive virtual reality as a research and clinical tool might be the in-house development of virtual reality research/clinical software by computer science literate cognitive scientists or research software engineers. In Chapter 4, guidelines are offered for the development of virtual reality software in cognitive neuroscience and neuropsychology, by describing and discussing the stages of the development of Virtual Reality Everyday Assessment Lab (VR-EAL), the first neuropsychological battery in immersive virtual reality. Techniques for evaluating cognitive functions within a realistic storyline are discussed. The utility of various assets in Unity, software development kits, and other software are described so that cognitive scientists can overcome challenges pertinent to VRISE and the quality of the virtual reality software. In addition, VR-EAL is evaluated in accordance with the necessary criteria for virtual reality software for research purposes. The virtual reality neuroscience questionnaire (VRNQ) was implemented to appraise the quality of the three versions of VR-EAL in terms of user experience, game mechanics, in-game assistance, and VRISE. Twenty-five participants aged between 20 and 45 years with 12–16 years of full-time education evaluated various versions of VR-EAL. The final version of VR-EAL achieved high scores in every sub-score of the VRNQ and exceeded its parsimonious cut-offs. It also appeared to have better in-game assistance and game mechanics, while its improved graphics substantially increased the quality of the user experience and almost eradicated VRISE. The results substantially support the feasibility of the development of effective virtual reality research and clinical software without the presence of VRISE during a 60-min virtual reality session. In Chapter 5, validation of VR-EAL as an assessment of prospective memory, episodic memory, attention, and executive functions using an ecologically valid approach is examined. Performance on the VR-EAL, an immersive virtual reality neuropsychological battery, is examined against an extensive paper-and-pencil neuropsychological battery. Forty-one participants (21 females) were recruited: 18 gamers and 23 non-gamers who attended both an immersive virtual reality and a paper-and-pencil testing session. Bayesian Pearson correlation analyses were conducted to assess construct and convergent validity of the VR-EAL. Bayesian t-tests were performed to compare virtual reality and paper-and-pencil testing in terms of administration time, similarity to real life tasks (i.e., ecological validity), and pleasantness. VR-EAL scores were significantly correlated with their equivalent scores on the paper-and-pencil tests. The participants’ reports indicated that the VR-EAL tasks were considered significantly more ecologically valid and pleasant than the paper-and-pencil neuropsychological battery. The VR-EAL battery also had a shorter administration time. The VR-EAL appears to be an effective neuropsychological tool for the assessment of everyday cognitive functions, and has enhanced ecological validity, a highly pleasant testing experience, and does not induce cybersickness. In the final part of this thesis, the preparatory attentional and memory (PAM) and the multiprocess theories of prospective memory are examined by attempting to identify the cognitive functions which may predict the individual’s performance on ecologically valid prospective memory tasks in the same group of participants described in Chapter 5. Bayesian t-tests were conducted to explore the differences among different prospective memory tasks (e.g., event-based and time-based) and prospective memory tasks with varying delays between encoding and the recall of the intended action (e.g., short-delay versus long-delay). Bayesian linear regression analyses were performed to examine the predictors of VR-EAL scores. The results revealed that the type of prospective memory task does not play a significant role in everyday prospective memory functioning, but instead the length of delay between encoding and retrieving the prospective memory intention plays a central role. Support for the PAM and MP frameworks was found in non-focal and focal event-based tasks respectively. However, the findings, inferring a dynamic interplay between automatic and intentional monitoring and retrieval processes, agree with the inclusive approach of the multiprocess framework. Also, the role of executive functions appears crucial in everyday PM. Finally, everyday PM is predominantly facilitated by episodic memory, visuospatial attention, auditory attention, and executive functions. In conclusion, this PhD thesis attempted to show how immersive virtual reality research methods may be implemented efficiently without the confounding effect of cybersickness symptomatology in order to enhance the ecological validity of neuropsychological testing and contribute to our understanding of everyday cognitive ability

Evidence Synthesis of Shoulder Pain Among Canadian Firefighters

Injury or degeneration of rotator cuff tendon leads to rotator cuff disease (subacromial impingement syndrome and rotator cuff tears). Shoulder pain – pain in the upper arm close to the deltoid muscle insertion has been reported as the most common symptom for subacromial impingement syndrome and rotator cuff tears. However, the current state of evidence on treatment effectiveness of rotator cuff disease is indeterminate. The shoulder function is essential for many of the physically demanding tasks that firefighters perform on the fire ground. For fire services and firefighters, the preservation of active duty is critical for their continued service to their communities. However, the prevalence of shoulder pain among Canadian firefighters has not been synthesized. Further, high quality randomized clinical trials (RCTs) provide the highest level of evidence and assist in clinical decision making. The International Committee of Medical Journal Editors (ICMJE) recommendation of RCT trial registration in public trials registry has been made to improve the reporting, transparency, rigor and reproducibility in RCTs. However, there is a paucity of evidence on the proportion of RCTs with proper trial registrations in the field of rehabilitation therapy. Therefore, the purposes of this thesis were 1) to assess the effects of arthroscopic versus mini-open rotator cuff repair surgery on function, pain and range of motion at in patients with rotator cuff tears; 2) to quantify the effects of surgical vs conservative interventions on clinical outcomes of pain and function in patients with subacromial impingement syndrome; 3) to assess the prevalence of musculoskeletal disorders (MSDs) among Canadian firefighters, 4) to examine the proportion of RCTs that were reported to have been prospectively, retrospectively registered or not registered in the field of rehabilitation therapy, and 5) to use the synthesized evidence to inform the design of a single center (fire-station), investigator-blinded, randomized, 12-month, parallel-group, superiority trial for the evaluation of the efficacy of a shoulder exercises on clinical outcomes in firefighters with shoulder pain. From the existing literature, we found evidence that both arthroscopic and mini-open techniques to rotator cuff repairs with post-operative rehabilitation exercises were effective in improving clinical outcomes of function, pain and shoulder range of motion in patients with rotator cuff tears. However, the between-group differences in outcomes were too small to be clinically important. The effects of surgery plus physiotherapy (exercises) vs physiotherapy (exercises) alone on pain and function were too small to be clinically important at 3-, 6-months, 1-, 2-, 5- and ≥ 10-years follow up. This further highlighted that rehabilitation exercises be considered as the first treatment approach in patients with shoulder pain. We also identified high point-prevalence estimates (1 in 4 firefighters) of shoulder-, back-, and knee-related MSDs among Canadian firefighters (shoulder pain was 23%). Our review study indicated that fifteen years after the introduction of standards for RCT registration by ICMJE, only one-third of the RCTs in the field of rehabilitation therapy were prospectively registered. Subsequently, the emergence of further evidence (observational studies in firefighters and RCTs in active-duty military personnel) indicating the clinical effectiveness of occupation-specific rehabilitation exercises along with our evidence syntheses provided the rationale for the design and conduct of an RCT to assess the effectiveness of firefighter-specific rehabilitation exercises among Canadian firefighter with shoulder pain