Virtual Reality Applications in Rehabilitation

The final publication is available at Springer via http://dx.doi.org/10.1007/978-3-319-39510-4_1One of the most valuable applications of virtual reality (VR) is in the domain of rehabilitation. After brain injuries or diseases, many patients suffer from impaired physical and/or cognitive capabilities, such as difficulties in moving arms or remembering names. Over the past two decades, VR has been tested and examined as a technology to assist patients’ recovery and rehabilitation, both physical and cognitive. The increasing prevalence of low-cost VR devices brings new opportunities, allowing VR to be used in practice. Using VR devices such as head-mounted displays (HMDs), special virtual scenes can be designed to assist patients in the process of re-training their brain and reorganizing their functions and abilities. However, such VR interfaces and applications must be comprehensively tested and examined for their effectiveness and potential side effects. This paper presents a review of related literature and discusses the new opportunities and challenges. Most of existing studies examined VR as an assessment method rather than a training/exercise method. Nevertheless, promising cases and positive preliminary results have been shown. Considering the increasing need for self-administered, home-based, and personalized rehabilitation, VR rehabilitation is potentially an important approach. This area requires more studies and research effort

Smartphone-Based Therapeutic Exercises for Men Affected by Premature Ejaculation: A Pilot Study

Introduction: Smartphone-delivered healthcare interventions allow patients to access services on demand when needed, improving motivation and compliance. However, the use of mobile health apps has been scarcely explored in sexual medicine. Aim: To evaluate the effects of integrating psychological treatment for premature ejaculation (PE) with a mobile coaching app that offers therapeutic exercises on the patient's smartphone. Methods: This study comprised 35 heterosexual men with primary psychogenic PE (mean age 34 years, standard deviation = 9.15). All patients entered a cycle of 15 sessions of psychodynamic psychotherapy integrating behavioral therapy, each lasting about 45 minutes. The patients were randomly assigned to 2 groups, each of which performed daily homework exercises (physiotherapy exercises for reinforcing the pelvic floor muscles and cognitive exercises for distancing from sexual failure.) The first group (15 patients) received verbal and printed instructions only (treatment as usual\u2014TAU), whereas the second group (17 patients) experienced the exercises with guidance from the mobile app (app). In both groups, the exercises started after the seventh session. Patients were advised to perform the exercises 3 times a day for 3 months. Main Outcome Measures: The primary outcome measures were the Premature Ejaculation Diagnostic Tool and the Premature Ejaculation Profile. Results: Analysis of the data revealed significant pre-post improvements in Premature Ejaculation Diagnostic Tool and Premature Ejaculation Profile scores for the app group compared with those of the TAU group (P <.01). The frequency of patients with no-PE condition for the app group after treatment was significantly higher than the frequency of patients with no-PE condition for the TAU group (P <.001). Conclusion: Results suggest that a mobile coaching app performs better than TAU in improving both the behavioral skills of ejaculatory delay and sexual self-confidence within a psychological treatment for PE. Future studies should collect follow-up data and explore the potential of mobile coaching apps in combined pharmacotherapy and psychotherapy interventions. Optale G, Burigat S, Chittaro L. et al. Smartphone-Based Therapeutic Exercises for Men Affected by Premature Ejaculation: A Pilot Study. J Sex Med 2020;XX:XXX\u2013XXX

Virtual environments as memory training devices in navigational tasks for older adults.

Cognitive training approaches using virtual environments (VEs) might counter age-related visuospatial memory decline and associated difficulties in wayfinding. However, the effects of the visual design of a VE in route learning are not fully understood. Therefore, we created a custom-designed VE optimized for route learning, with adjusted levels of realism and highlighted landmark locations (MixedVE). Herein we tested participants' route recall performance in identifying direction of turn at the intersection with this MixedVE against two baseline alternatives (AbstractVE, RealisticVE). An older vs. a younger group solved the tasks in two stages (immediate vs. delayed recall by one week). Our results demonstrate that the MixedVE facilitates better recall accuracy than the other two VEs for both age groups. Importantly, this pattern persists a week later. Additionally, our older participants were mostly overconfident in their route recall performance, but the MixedVE moderated this potentially detrimental overconfidence. Before the experiment, participants clearly preferred the RealisticVE, whereas after the experiment, most of the younger, and many of the older participants, preferred the MixedVE. Taken together, our findings provide insights into the importance of tailoring visualization design in route learning with VEs. Furthermore, we demonstrate the great potential of the MixedVE and by extension, of similar VEs as memory training devices for route learning, especially for older participants

The effects of multi-domain versus single-domain cognitive training in non-demented older people: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Whether healthy older people can benefit from cognitive training (CogTr) remains controversial. This study explored the benefits of CogTr in community dwelling, healthy, older adults and compared the effects of single-domain with multi-domain CogTr interventions.</p> <p>Methods</p> <p>A randomized, controlled, 3-month trial of CogTr with double-blind assessments at baseline and immediate, 6-month and 12-month follow-up after training completion was conducted. A total of 270 healthy Chinese older people, 65 to 75 years old, were recruited from the Ganquan-area community in Shanghai. Participants were randomly assigned to three groups: multi-domain CogTr, single-domain CogTr, and a wait-list control group. Twenty-four sessions of CogTr were administrated to the intervention groups over a three-month period. Six months later, three booster training sessions were offered to 60% of the initial training participants. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS, Form A), the Color Word Stroop test (CWST), the Visual Reasoning test and the Trail Making test (TMT) were used to assess cognitive function.</p> <p>Results</p> <p>Multi-domain CogTr produced statistically significant training effects on RBANS, visual reasoning, and immediate and delayed memory, while single-domain CogTr showed training effects on RBANS, visual reasoning, word interference, and visuospatial/constructional score (all <it>P </it>< 0.05). At the 12-month posttest, the multi-domain CogTr showed training effects on RBANS, delayed memory and visual reasoning, while single-domain CogTr only showed effects on word interference. Booster training resulted in effects on RBANS, visual reasoning, time of trail making test, and visuospatial/constructional index score.</p> <p>Conclusions</p> <p>Cognitive training can improve memory, visual reasoning, visuospatial construction, attention and neuropsychological status in community-living older people and can help maintain their functioning over time. Multi-domain CogTr enhanced memory proficiency, while single-domain CogTr augmented visuospatial/constructional and attention abilities. Multi-domain CogTr had more advantages in training effect maintenance.</p> <p>Clinical Trial Registration</p> <p>Chinese Clinical Trial Registry. Registration number: ChiCTR-TRC-09000732.</p

Male Sexual Disfunction and Multimedia Immersion Therapy (Follow Up)

The aim of the study was to evaluate the efficiency, after 1 year, of combined use of psychodynamic psychotherapy integrating virtual reality (VR) for the treatment of erectile dysfunction (ED) and premature ejaculation (PE) in 160 heterosexual males who had neither any prior sexual therapy nor had made use (either before, during or after therapy) of any specific pharmaceuticals for the treatment of primary sexual dysfunction. All subjects had given their informed consent. After a clinical diagnosis in an andrologic center, 50 presumably psychological ED (average age 43.7 years), 60 mixed ED (53.9 years) and 50 primary PE (39 years) who suffered these problems over 6 months were undergoing a cycle of 12 sessions, over a 25-week period, of psychotherapy, integrating an audio CD and helmet with miniature television screens that projected specially designed CD-ROM program on the ontogenetic development of male sexual identity. The clinical follow up was done after 6 and 12 months after the cycle. After one year, the overall partial (two times out of three) and complete positive response rate for psychological ED was 75%, for mixed ED was 47% and for PE was 54%. We considered drop-out cases as only before the 7th session of the treatment cycle, the drop-outs after session 7 and the patients that did not show up for follow-up are counted as negative results. Two patients reported nausea and one, vertigo during the first 15-min virtual reality experience. Considering the particular way that full-immersion virtual reality involves the subject who experiences it, we hypothesized that this methodological approach could speed up the therapeutic process. The evidence that positive results persist over time allows us to hypothesize that certain changes in cerebral function can be possible and that these changes are correlated to favorable sexual performance in the male

Il Brief Index of Sexual Functioning for Women (BISF-W): validazione su un campione italiano

Lo scopo del presente studio \ue8 di validare il Brief Index of Sexual Functiong for Women sulla popolazione italiana e di valutarne le propriet\ue0 psicometriche. Il campione studiato consisteva di 1305 donne italiane di et\ue0 compresa tra i 18 e i 74 anni. \uc8 stata condotta un\u2019analisi fattoriale esplorativa (EFA) con il metodo delle componenti principali e rotazione OBLIMIN. La consistenza interna \ue8 stata valutata per mezzo dell\u2019alpha di Cronbach per ciascun fattore. Sulla base dello sree-test sono stati considerati 4 fattori che spiegano il 49% della varianza totale: Sessualit\ue0 di coppia (F1); Sessualit\ue0 autoerotica (F2); Insoddisfazione (F3); Sessualit\ue0 anale (F4). Sono risultai debolmente correlati F1 e F2, F1 e F4 ed F2 e F4. L\u2019alpha di Cronbach \ue8 risultata .95 per F1, .85 per F2, .73 per F3 e .80 per F4, attestando un discreto grado di omogeneit\ue0 fra gli item. Questo studio fornisce la validazione del BISF-W come strumento utile per valutare la funzione sessuale delle donne italiane

Male sexual dysfunctions: immersive virtual reality and multimedia therapy.

The study describes a therapeutic approach using psycho-dynamic psychotherapy integrating virtual environment (VE) for resolving impotence or better erectile dysfunction (ED) of presumably psychological or mixed origin and premature ejaculation (PE). The plan for therapy consists of 12 sessions (15 if a sexual partner was involved) over a 25-week period on the ontogenetic development of male sexual identity, and the methods involved the use of a laptop PC, joystick, Virtual Reality (VR) helmet with miniature television screen showing a new specially-designed CD-ROM programs using Virtools with Windows 2000 and an audio CD. This study was composed of 30 patients, 15 (10 suffering from ED and 5 PE) plus 15 control patients (10 ED and 5 PE), that underwent the same therapeutic protocol but used an old VR helmet to interact with the old VE using a PC Pentium 133 16 Mb RAM. We also compared this study with another study we carried out on 160 men affected by sexual disorders, underwent the same therapeutic protocol, but treated using a VE created (in Superscape VRT 5.6) using always Windows 2000 with portable tools. Comparing the groups of patients affected by ED and PE, there emerged a significant positive results value without any important differences among the different VE used. However, we had a % increase of undesirable physical reactions during the more realistic 15-minute VR experience using Virtools development kit. Psychotherapy alone normally requires long periods of treatment in order to resolve sexual dysfunctions. Considering the particular way in which full-immersion VR involves the subject who experiences it (he is totally unobserved and in complete privacy), we hypothesise that this methodological approach might speed up the therapeutic psycho-dynamic process, which eludes cognitive defences and directly stimulates the subconscious, and that better results could be obtained in the treatment of these sexual disorders. This method can be used by any psychotherapist and it can be used alone or associated with pharmacotherapy prescribed by the urologist/andrologist as part of a therapeutic alliance