TY - JOUR AU - Liszio, Stefan AU - Bäuerlein, Franziska AU - Hildebrand, Jens AU - van Nahl, Carolin AU - Masuch, Maic AU - Basu, Oliver PY - 2025/3/31 TI - Cooperative Virtual Reality Gaming for Anxiety and Pain Reduction in Pediatric Patients and Their Caregivers During Painful Medical Procedures: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e63098 VL - 14 KW - virtual reality KW - extended reality KW - mixed reality KW - serious game KW - video game KW - pain KW - anxiety KW - stress KW - child KW - caregiver KW - patient experience KW - well-being KW - medical procedures KW - punctures KW - distraction KW - intervention N2 - Background: The hospital experience is often marked by fear and pain, particularly for children undergoing medical procedures. Sedation is commonly used to alleviate patient anxiety, but it poses additional health risks. Caregivers, usually the parents, also experience emotional distress during the child?s hospital stay, which can further exacerbate the child?s anxiety and pain. While various interventions exist to ease patient distress, few consider the emotional well-being of caregivers. Objective: This study aims to explore the effectiveness of a cooperative virtual reality (VR) game as a novel nonpharmacological solution to reduce anxiety and pain for both pediatric patients and their caregivers during medical procedures. Specifically, we aim to investigate whether the VR game ?Sweet Dive VR? (SDVR), designed for children aged between 6 and 12 years to play with 1 caregiver, can alleviate anxiety and pain during different types of needle punctures and Kirschner-wire removal. Methods: A prospective multicenter randomized clinical trial will be conducted. Eligible participants will be identified by scanning the hospital information system, and group allocation will follow stratified randomization. During the medical procedure, patients in the VR condition will play SDVR with a caregiver present, while patients in the control group will listen to a recording of gently crashing waves. Data collection will be carried out through self-reports of patients and caregivers using visual analog scales and questionnaires at 2 measurement time points: before and after the intervention. In addition, observation by the interviewers will occur during the intervention to capture emotional and pain reactions as well as interaction quality between patients and caregivers and smoothness of the procedure flow using a structured observation protocol. The measured variables will encompass patient affect and pain, caregiver affect, player experience, patient experience, and the flow of the procedure. Results: As of November 2024, we enrolled 39 patients and caregivers, 28 of whom completed the study. Data collection is still ongoing. Conclusions: Cooperative VR gaming, as exemplified by SDVR, emerges as a promising intervention to address anxiety and pain in pediatric patients while involving caregivers to support the emotional well-being of both parties. Our approach strives to foster positive shared experiences and to maintain trust between children and caregivers during emotionally challenging medical situations. Trial Registration: German Clinical Trial Register (DRKS) DRKS00033544; https://drks.de/search/en/trial/DRKS00033544 International Registered Report Identifier (IRRID): DERR1-10.2196/63098 UR - https://www.researchprotocols.org/2025/1/e63098 UR - http://dx.doi.org/10.2196/63098 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63098 ER - TY - JOUR AU - Yang, Xipeng AU - Wu, Jinlong AU - Ma, Yudan AU - Yu, Jingxuan AU - Cao, Hong AU - Zeng, Aihua AU - Fu, Rui AU - Tang, Yucheng AU - Ren, Zhanbing PY - 2025/2/5 TI - Effectiveness of Virtual Reality Technology Interventions in Improving the Social Skills of Children and Adolescents With Autism: Systematic Review JO - J Med Internet Res SP - e60845 VL - 27 KW - VR technology KW - autism spectrum disorder KW - children KW - adolescents KW - social skills KW - virtual reality KW - VR N2 - Background: Virtual reality (VR) technology has shown significant potential in improving the social skills of children and adolescents with autism spectrum disorder (ASD). Objective: This study aimed to systematically review the evidence supporting the effectiveness of VR technology in improving the social skills of children and adolescents with ASD. Methods: The search for eligible studies encompassed 4 databases: PubMed, Web of Science, IEEE, and Scopus. Two (XY and JW) researchers independently assessed the extracted studies according to predefined criteria for inclusion and exclusion. These researchers also independently extracted information regarding gathered data on the sources, samples, measurement methods, primary results, and data related to the main results of the studies that met the inclusion criteria. The quality of the studies was further evaluated using the Physiotherapy Evidence Database scale. Results: This review analyzed 14 studies on using VR technology interventions to improve social skills in children and adolescents with ASD. Our findings indicate that VR interventions have a positive effect on improving social skills in children and adolescents with ASD. Compared with individuals with low-functioning autism (LFA), those with high-functioning autism (HFA) benefited more from the intervention. The duration and frequency of the intervention may also influence its effectiveness. In addition, immersive VR is more suitable for training complex skills in individuals with HFA. At the same time, nonimmersive VR stands out in terms of lower cost and flexibility, making it more appropriate for basic skill interventions for people with LFA. Finally, while VR technology positively enhances social skills, some studies have reported potential adverse side effects. According to the quality assessment using the Physiotherapy Evidence Database scale, of the 14 studies, 6 (43%) were classified as high quality, 4 (29%) as moderate quality, and 4 (29%) as low quality. Conclusions: This systematic review found that VR technology interventions positively impact social skills in children and adolescents with ASD, with particularly significant effects on the enhancement of complex social skills in individuals with HFA. For children and adolescents with LFA, progress was mainly observed in basic skills. Immersive VR interventions are more suitable for the development of complex skills. At the same time, nonimmersive VR, due to its lower cost and greater flexibility, also holds potential for application in specific contexts. However, the use of VR technology may lead to side effects such as dizziness, eye fatigue, and sensory overload, particularly in immersive settings. These potential issues should be carefully addressed in intervention designs to ensure user comfort and safety. Future research should focus on optimizing individualized interventions and further exploring the long-term effects of VR interventions. Trial Registration: International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY202420079U1; https://inplasy.com/inplasy-2024-2-0079/ UR - https://www.jmir.org/2025/1/e60845 UR - http://dx.doi.org/10.2196/60845 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60845 ER - TY - JOUR AU - Chen, Yanya AU - Guan, Lina AU - Wu, Weixin AU - Ye, Liang AU - He, Yan AU - Zheng, Xiaofen AU - Li, Sicun AU - Guan, Bingsheng AU - Ming, Wai-kit PY - 2024/12/30 TI - Factors That Influence Young Adults? Preferences for Virtual Reality Exergames in a Weight Control Setting: Qualitative Study JO - J Med Internet Res SP - e58422 VL - 26 KW - virtual reality KW - games KW - weight control KW - preferences KW - young adults KW - qualitative research N2 - Background: Obesity could compromise people?s health and elevate the risk of numerous severe chronic conditions and premature mortality. Young adults are at high risk of adopting unhealthy lifestyles related to overweight and obesity, as they are at a phase marked by several significant life milestones that have been linked to weight gain. They gain weight rapidly and excess adiposity mostly accrues, compared with middle-aged and older adults when weight stabilizes or even decreases. Virtual reality exergames have the potential to increase physical activity in people?s daily lives. However, the factors that influence young adults? preference for using virtual reality exergames for weight control remain unclear. Objective: The objective of this study is to identify, characterize, and explain the factors influencing young adults' preference for weight control using virtual reality exergames. Methods: This qualitative study used semistructured interviews. In total, 4 focus group interviews were conducted with 23 young adults aged between 18 and 25 years. The qualitative data were analyzed using the Colaizzi phenomenological methodology. Results: In total, 3 major factors were found to influence young adults? preference for virtual reality exergames in weight control settings: individual factors, social or environmental factors, and expectations of virtual reality exergames. Individual factors included experience with previous weight control methods, previous experience with virtual reality, psychological status, attitudes toward personal BMI, preference for exercise type, and acceptance of virtual reality exergames. Social or environmental factors included social definitions of beauty, weather or public health events, and knowledge of virtual reality provided. Expectations of virtual reality exergames included cost of the device, the fun of virtual reality exergames, supervision, modality of virtual reality exergames, feedback after exercise, convenience to use, and weight loss effect. Conclusions: Young adults take various factors into account when deciding whether to use virtual reality exergames for weight control. These factors can inform the development and further refinement of devices, guides, and policies related to virtual reality exergames for controlling weight. UR - https://www.jmir.org/2024/1/e58422 UR - http://dx.doi.org/10.2196/58422 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58422 ER - TY - JOUR AU - Giguere, Sabrina AU - Beaudoin, Mélissa AU - Dellazizzo, Laura AU - Phraxayavong, Kingsada AU - Potvin, Stéphane AU - Dumais, Alexandre PY - 2024/11/27 TI - Avatar Intervention in Virtual Reality for Cannabis Use Disorder in Individuals With Severe Mental Disorders: Results From a 1-Year, Single-Arm Clinical Trial JO - JMIR Ment Health SP - e58499 VL - 11 KW - cannabis use disorder KW - cannabis use KW - virtual reality therapy KW - virtual reality KW - addiction intervention KW - relational therapy KW - avatar KW - digital mental health N2 - Background: The dual diagnosis of cannabis use disorder (CUD) and severe mental disorder (SMD) results in clinically complex individuals. Cannabis use is known to have negative consequences on psychiatric symptoms, medication compliance, and disease prognosis. Moreover, the effectiveness of currently available psychotherapeutic treatments is limited in this population. In this context, our research team developed avatar intervention, an approach using virtual reality as a therapeutic tool to treat CUD in individuals with SMD. Objective: This pilot clinical trial aimed to evaluate, until the 1-year follow-up, the efficacy of avatar intervention for CUD among 32 participants with a dual diagnosis of SMD and CUD. Methods: Over the course of the 8 intervention sessions, participants were given the opportunity to enter a dialogue in virtual reality with an avatar representing a person with a significant role in their consumption, who was animated in real time by a therapist. The primary outcomes were the quantity of cannabis consumed and the frequency of use. Secondary outcomes included severity of problematic cannabis use, motivation for change, protective strategies for cannabis use, consequences of cannabis use, psychiatric symptoms, and quality of life. Changes in reported outcomes during the assessment periods before the intervention; postintervention; and 3, 6, and 12 months after the end of the intervention were assessed using a linear mixed-effects model. Results: Significant reductions were observed in the quantity of cannabis consumed, and these were maintained until the 12-month follow-up visit (d=0.804; P<.001; confirmed by urine quantification). Frequency of cannabis use showed a small significant reduction at the 3-month follow-up (d=0.384; P=.03). Moreover, improvements were observed in the severity of CUD, cannabis-related negative consequences, the motivation to change cannabis use, and the strategies used to mitigate harms related to cannabis use. Finally, moderate benefits were observed for quality of life and psychiatric symptoms. Conclusions: Overall, this unique intervention shows promising results that seem to be maintained up to 12 months after the end of the intervention. With the aim of overcoming the methodological limitations of a pilot study, a single-blind randomized controlled trial is currently underway to compare the avatar intervention for CUD with a conventional addiction intervention. Trial Registration: ClinicalTrials.gov NCT05726617; https://clinicaltrials.gov/study/NCT05726617 UR - https://mental.jmir.org/2024/1/e58499 UR - http://dx.doi.org/10.2196/58499 ID - info:doi/10.2196/58499 ER - TY - JOUR AU - Peterson, M. Colleen AU - Visclosky, Timothy AU - Flannagan, A. Carol AU - Mahajan, Prashant AU - Gabanyicz, Andrew AU - Bouchard, Jean-Jacques AU - Cervantes, Vincent AU - Gribbin, William AU - Hashikawa, Nobuhide Andrew PY - 2024/11/26 TI - Evaluating a Virtual Reality Game to Enhance Teen Distracted Driving Education: Mixed Methods Pilot Study JO - JMIR Form Res SP - e60674 VL - 8 KW - safety KW - virtual reality KW - VR KW - distracted driving KW - intervention KW - inattention KW - smartphone KW - novice drivers KW - risky driving KW - mobile phone KW - awareness KW - game KW - driving education KW - gamification KW - adolescent N2 - Background: Inexperienced adolescent drivers are particularly susceptible to engaging in distracted driving behaviors (DDBs) such as texting while driving (TWD). Traditional driver education approaches have shown limited success in reducing motor vehicle crashes among young drivers. Objective: We tested an innovative approach to help address the critical issue of DDB among teenagers. We investigated the effectiveness of using a novel virtual reality (VR) game ?Distracted Navigator? to educate novice teenage drivers about DDB. Methods: The game consisted of maneuvering a spaceship around asteroids while engaging in simulated DDB (eg, inputting numbers into a keypad). A physician-facilitated discussion, based on the theory of planned behavior, linked gameplay to real-life driving. Teenagers were recruited for the in-person study and randomly assigned at the block level to intervention (VR gameplay or discussion) and control groups (discussion only), approximating a 2:1 ratio. Unblinded, bivariate statistical analyses (all 2-tailed t tests or chi-square tests) and regression analyses measured programming impact on TWD-related beliefs and intentions. Content analysis of focus group interviews identified thematic feedback on the programming. Results: Of the 24 participants, 15 (63%) were male; their ages ranged from 14 to 17 (mean 15.8, SD 0.92) years, and all owned cell phones. Compared to the control group (n=7, 29%), the intervention group (n=17, 71%) was more likely to report that the programming had positively changed how they felt about texting and driving (?218=?8.3; P=.02). However, specific TWD attitudes and intentions were not different by treatment status. Irrespective of treatment, pre- and postintervention scores indicated reduced confidence in safely TWD (ie, perceived behavioral control; ?=?.78; t46=?2.66; P=.01). Thematic analysis revealed the following: (1) the VR gameplay adeptly portrayed real-world consequences of texting and driving, (2) participants highly valued the interactive nature of the VR game and discussion, (3) both the VR game and facilitated discussion were deemed as integral and complementary components, and (4) feedback for improving the VR game and discussion. Conclusions: Our findings show that the novel use of immersive VR experiences with interactive discussions can raise awareness of DDB consequences and is a promising method to enhance driving safety education. The widespread accessibility of VR technology allows for scalable integration into driver training programs, warranting a larger, prospective, randomized study. UR - https://formative.jmir.org/2024/1/e60674 UR - http://dx.doi.org/10.2196/60674 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60674 ER - TY - JOUR AU - Konaç, Asli AU - Bini, Maristella AU - Fusco, Naomi AU - Bourdin-Kreitz, Pierre PY - 2024/11/22 TI - Enhancing Executive Function Skills in Children With Attention-Deficit/Hyperactivity Disorder via Immersive Virtual Reality Interventions: Scoping Review JO - JMIR XR Spatial Comput SP - e57225 VL - 1 KW - immersive virtual reality KW - ADHD KW - neurofeedback KW - executive functions KW - systematic review KW - adolescent KW - attention-deficit/hyperactivity disorder KW - behavioral therapy KW - digital health tools KW - neurodiversity KW - virtual reality KW - digital mental health N2 - Background: This scoping review investigated immersive virtual reality (IVR) interventions for improving executive function skills of children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Objective: This study aimed to identify and closely inspect the characteristics of these interventions and provide a summary of key findings to guide researchers in their future investigations. Methods: A search across Web of Science, Scopus, PubMed, and APA PsycInfo databases was carried out with restrictions of publication date (2000?2023) and language (English). The inclusion criteria were (1) research articles, excluding protocols, book chapters, reviews, and meta-analyses; (2) usage of IVR, excluding computer-based VR or augmented reality technologies; (3) aim of targeting executive function skills; (4) sample of children and adolescents diagnosed with ADHD (with or without learning disorder comorbidity); and (5) intervention studies (quasi-experimental clinical trials and randomized controlled trials, excluding assessments). Finally, the characteristics of the studies were summarized and inspected. Results: The search yielded 2484 potential records. After a rigorous screening process, 6 articles (5 randomized controlled trials and 1 pilot study) were included. A certain heterogeneity in duration, designs of IVR interventions, and outcome measures were observed. All studies reported overall improvements in the attentional performances of children; however, only a few reported improvements in executive functions. In addition, a tendency toward integration of neurofeedback systems with IVR technologies was observed. Conclusions: Because of the specific objectives and related inclusion and exclusion criteria of this review, only a few interventions could be included and analyzed. Even though there seem to be promising applications of IVR for children and adolescents with ADHD, heterogeneity in intervention characteristics accompanied by observed overall high or serious risk of bias prevented the authors from making generalized conclusions. UR - https://xr.jmir.org/2024/1/e57225 UR - http://dx.doi.org/10.2196/57225 ID - info:doi/10.2196/57225 ER - TY - JOUR AU - Wong, Po Ka AU - Zhang, Bohan AU - Lai, Yi Cynthia Yuen AU - Xie, Jie Yao AU - Li, Yan AU - Li, Chen AU - Qin, Jing PY - 2024/10/28 TI - Empowering Social Growth Through Virtual Reality?Based Intervention for Children With Attention-Deficit/Hyperactivity Disorder: 3-Arm Randomized Controlled Trial JO - JMIR Serious Games SP - e58963 VL - 12 KW - attention deficit and hyperactivity disorder KW - virtual reality KW - social skills KW - social skills training KW - emotional control KW - social growth KW - digital world KW - social learning theory N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) usually begins in childhood and is often accompanied by impairments in social functioning. Virtual reality (VR) has emerged as an adjunctive tool to embed in social skills training to enhance the social skills of children with ADHD, but its effectiveness requires further investigation. Objective: This study aims to enhance the social skills of children with ADHD by examining the feasibility and effectiveness of VR-based training in comparison to traditional social skills training. Methods: A 3-arm randomized controlled trial was conducted with 90 children with ADHD aged 6-12 years. Participants were randomly assigned to 3 weeks of 12-session VR-based social skills training, traditional social skills training, or a waitlist control group of equivalent duration. Outcome measures included assessments by a clinical psychologist who was blinded to group assignments, the Social Skills Improvement System Rating Scale, the Behavior Rating Inventory of Executive Function, and the Simulator Sickness Questionnaire, conducted at baseline and after the intervention. Results: The preliminary results support the feasibility and acceptability of VR training for children with ADHD aged 6-12 years. Analysis showed that the VR and traditional social skills training groups experienced a statistically significant improvement in the clinical psychologist assessment of social skills and parent-rated self-control, initiative, and emotional control after the intervention compared with baseline. The VR group performed significantly better than the traditional social skills group on social skills assessed by clinical psychologists (F2,85=76.77; P<.001) and on parent-rated self-control (F2,85=18.77; P<.001), initiative (F2,85=11.93; P<.001), and emotional control (F2,85=17.27; P<.001). No significant between-group differences were found for parent-rated cooperation and inhibition (all P>.05). Conclusions: The findings provide preliminary evidence supporting the feasibility and superior effectiveness of VR-based social skills training compared to traditional approaches for enhancing social skills and related executive functions in children with ADHD. These results suggest that VR may be a valuable tool to embed within social skills interventions for this population. Further research is warranted to explore the long-term impacts and generalizability of these benefits. Trial Registration: ClinicalTrials.gov NCT05778526; https://clinicaltrials.gov/study/NCT05778526 International Registered Report Identifier (IRRID): RR2-10.2196/48208 UR - https://games.jmir.org/2024/1/e58963 UR - http://dx.doi.org/10.2196/58963 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58963 ER - TY - JOUR AU - Gee, Brioney AU - Teague, Bonnie AU - Laphan, Andrew AU - Clarke, Tim AU - Coote, Georgianna AU - Garner, Jessica AU - Wilson, Jon PY - 2024/10/22 TI - Outcomes of Providing Children Aged 7-12 Years With Access to Evidence-Based Anxiety Treatment Via a Standalone Digital Intervention Using Immersive Gaming Technology: Real-World Evaluation JO - JMIR Ment Health SP - e52866 VL - 11 KW - anxiety KW - children KW - young people KW - exposure therapy KW - graded exposures KW - cognitive behavioural therapy KW - digital intervention KW - mobile app KW - gaming KW - real-world evaluation KW - gaming technology KW - real-world implementation N2 - Background: Anxiety disorders are among the most common mental health conditions in childhood, but most children with anxiety disorders do not access evidence-based interventions. The delivery of therapeutic interventions via digital technologies has been proposed to significantly increase timely access to evidence-based treatment. Lumi Nova (BfB Labs Limited) is a digital therapeutic intervention designed to deliver evidence-based anxiety treatment for those aged 7?12 years through a mobile app incorporating immersive gaming technology. Objective: We aimed to evaluate the real-world impact of providing access to Lumi Nova through UK National Health Service?funded mental health services. Methods: We analyzed precollected anonymized data routinely captured through the implementation of Lumi Nova from children aged 7?12 years, who lived in the United Kingdom and had the opportunity to use the intervention for at least 1 week over an 18-month period. Engagement indices included whether the game key was activated, number of unique sessions, time spent engaging, and number of ?challenges? completed. Clinical outcomes were assessed using the Goal-Based Outcomes measure and Child Outcome Rating Scale. Demographic data were analyzed to assess the health equality implications of Lumi Nova. Results: Of 1029 eligible families invited to use Lumi Nova, 644 (62.5%) activated their game key, of whom 374 (58.1%) completed at least one in-game graded exposure challenge. The median number of unique sessions was 6 (IQR 3?12) and the median time spent engaging with the intervention was 42 (IQR 15?79) minutes. For the subset of young people with paired outcomes, there were statistically significant small to medium improvements in goal-based outcome scores (n=224; t223=5.78, P<.001; d=0.37, 95% CI 0.25?0.52) and Child Outcome Rating Scale scores (n=123; t122=5.10, P<.001; d=0.46, 95% CI 0.27?0.65) between the first and last data points. Two in 5 young people?s scores reflected a change that would be considered reliable. Analysis of demographic characteristics tentatively suggested that children from ethnic minority backgrounds and those living in the most deprived neighbourhoods may be less likely to access Lumi Nova, but children from socioeconomically deprived areas were more likely to successfully complete a challenge once they accessed the intervention (P=.02). However, the level of missing data and small number of children in some demographic groups limited meaningful statistical comparisons. Conclusions: This study provides initial evidence that Lumi Nova may be associated with improved outcomes for those aged 7?12 years seeking anxiety treatment in real-world settings. However, the lack of a control comparator group and information about concurrent treatments accessed by the young people, in addition to substantial attrition, limited the analysis that could be conducted and confidence in the conclusions drawn. UR - https://mental.jmir.org/2024/1/e52866 UR - http://dx.doi.org/10.2196/52866 ID - info:doi/10.2196/52866 ER - TY - JOUR AU - Houzangbe, Samory AU - Lemay, Martin AU - Levac, E. Danielle PY - 2024/9/23 TI - Toward Physiological Detection of a ?Just-Right? Challenge Level for Motor Learning in Immersive Virtual Reality: Protocol for a Cross-Sectional Study JO - JMIR Res Protoc SP - e55730 VL - 13 KW - virtual reality KW - pediatric rehabilitation KW - physiological data KW - engagement KW - just-right challenge N2 - Background: Motor learning, a primary goal of pediatric rehabilitation, is facilitated when tasks are presented at a ?just-right? challenge level?at the edge of the child?s current abilities, yet attainable enough to motivate the child in persistent efforts for success. Immersive virtual reality (VR) may be ideally suited for ?just-right? task challenges because it enables precise adjustments of task parameters in motivating environments. Rehabilitation-specific VR tasks often use dynamic difficulty algorithms based on task performance to personalize task difficulty. However, these approaches do not consider relevant cognitive processes that could also impact ?just-right? challenges, such as attention and engagement. Objective physiological measurement of these cognitive processes using wearable sensors could support their integration within ?just-right? challenge detection and prediction algorithms. As a first step, it is important to explore relationships between objectively and subjectively measured psychophysiological states at progressively challenging task difficulty levels. Objective: This study aims to (1) evaluate the performance of wearable sensors in a novel movement-based motor learning immersive VR task; (2) evaluate changes in physiological data at 3 task difficulty levels; and (3) explore the relationship between physiological data, task performance, and self-reported cognitive processes at each task difficulty level. Methods: This study uses the within-participant experimental design. Typically developing children and youth aged 8-16 years will be recruited to take part in a single 90-minute data collection session. Physiological sensors include electrodermal activity, heart rate, electroencephalography, and eye-tracking. After collecting physiological data at rest, participants will play a seated unimanual immersive VR task involving bouncing a virtual ball on a virtual racket. They will first play for 3 minutes at a predefined medium level of difficulty to determine their baseline ability level and then at a personalized choice of 3 progressive difficulty levels of 3 minutes each. Following each 3-minute session, participants will complete a short Likert-scale questionnaire evaluating engagement, attention, cognitive workload, physical effort, self-efficacy, and motivation. Data loss and data quality will be calculated for each sensor. Repeated-measures ANOVAs will evaluate changes in physiological response at each difficulty level. Correlation analyses will determine individual relationships between task performance, physiological data, and self-reported data at each difficulty level. Results: Research ethics board approval has been obtained, and data collection is underway. Data collection was conducted on December 12, 2023, and April 12, 2024, with a total of 15 typically developing children. Data analysis has been completed, and results are expected to be published in the fall of 2024. Conclusions: Wearable sensors may provide insights into the physiological effects of immersive VR task interaction at progressive difficulty levels in children and youth. Understanding the relationship between physiological and self-reported cognitive processes is a first step in better identifying and predicting ?just-right? task challenges during immersive VR motor learning interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/55730 UR - https://www.researchprotocols.org/2024/1/e55730 UR - http://dx.doi.org/10.2196/55730 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55730 ER - TY - JOUR AU - Maddalon, Luna AU - Minissi, Eleonora Maria AU - Parsons, Thomas AU - Hervas, Amaia AU - Alcaniz, Mariano PY - 2024/9/18 TI - Exploring Adaptive Virtual Reality Systems Used in Interventions for Children With Autism Spectrum Disorder: Systematic Review JO - J Med Internet Res SP - e57093 VL - 26 KW - adaptive system KW - virtual reality KW - autism spectrum disorder KW - intervention KW - training KW - children KW - machine learning KW - biosignal N2 - Background: Adaptive systems serve to personalize interventions or training based on the user?s needs and performance. The adaptation techniques rely on an underlying engine responsible for processing incoming data and generating tailored responses. Adaptive virtual reality (VR) systems have proven to be efficient in data monitoring and manipulation, as well as in their ability to transfer learning outcomes to the real world. In recent years, there has been significant interest in applying these systems to improve deficits associated with autism spectrum disorder (ASD). This is driven by the heterogeneity of symptoms among the population affected, highlighting the need for early customized interventions that target each individual?s specific symptom configuration. Objective: Recognizing these technology-driven therapeutic tools as efficient solutions, this systematic review aims to explore the application of adaptive VR systems in interventions for young individuals with ASD. Methods: An extensive search was conducted across 3 different databases?PubMed Central, Scopus, and Web of Science?to identify relevant studies from approximately the past decade. Each author independently screened the included studies to assess the risk of bias. Studies satisfying the following inclusion criteria were selected: (1) the experimental tasks were delivered via a VR system, (2) system adaptation was automated, (3) the VR system was designed for intervention or training of ASD symptoms, (4) participants? ages ranged from 6 to 19 years, (5) the sample included at least 1 group with ASD, and (6) the adaptation strategy was thoroughly explained. Relevant information extracted from the studies included the sample size and mean age, the study?s objectives, the skill trained, the implemented device, the adaptive strategy used, the engine techniques, and the signal used to adapt the systems. Results: Overall, a total of 10 articles were included, involving 129 participants, 76% of whom had ASD. The studies included level switching (7/10, 70%), adaptive feedback strategies (9/10, 90%), and weighing the choice between a machine learning (ML) adaptive engine (3/10, 30%) and a non-ML adaptive engine (8/10, 80%). Adaptation signals ranged from explicit behavioral indicators (6/10, 60%), such as task performance, to implicit biosignals, such as motor movements, eye gaze, speech, and peripheral physiological responses (7/10, 70%). Conclusions: The findings reveal promising trends in the field, suggesting that automated VR systems leveraging real-time progression level switching and verbal feedback driven by non-ML techniques using explicit or, better yet, implicit signal processing have the potential to enhance interventions for young individuals with ASD. The limitations discussed mainly stem from the fact that no technological or automated tools were used to handle data, potentially introducing bias due to human error. UR - https://www.jmir.org/2024/1/e57093 UR - http://dx.doi.org/10.2196/57093 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57093 ER - TY - JOUR AU - Orgil, Zandantsetseg AU - Karthic, Anitra AU - Bell, F. Nora AU - Heisterberg, M. Lisa AU - Williams, E. Sara AU - Ding, Lili AU - Kashikar-Zuck, Susmita AU - King, D. Christopher AU - Olbrecht, A. Vanessa PY - 2024/9/16 TI - Use of Biofeedback-Based Virtual Reality in Pediatric Perioperative and Postoperative Settings: Observational Study JO - JMIR Perioper Med SP - e48959 VL - 7 KW - virtual reality KW - biofeedback KW - biofeedback-based virtual reality KW - acute pain KW - postoperative pain KW - pediatrics KW - postoperative KW - pain KW - anxiety KW - children KW - adolescents KW - perioperative management KW - acceptability KW - feasibility KW - pain reduction N2 - Background: Biofeedback-based virtual reality (VR-BF) is a novel, nonpharmacologic method for teaching patients how to control their breathing, which in turn increases heart rate variability (HRV) and may reduce pain. Unlike traditional forms of biofeedback, VR-BF is delivered through a gamified virtual reality environment, increasing the accessibility of biofeedback. This is the first study to systematically integrate VR-BF use in the pediatric perioperative setting, with the ultimate goal of evaluating the efficacy of VR-BF to reduce pain, anxiety, and opioid consumption once feasibility and acceptability have been established. Objectives: The primary objective was to develop a clinical trial protocol for VR-BF use in the pediatric perioperative setting, including preoperative education and training, and postoperative application of VR-BF in children undergoing surgery. A secondary objective was to evaluate the patient and parent experience with VR-BF. Methods: A total of 23 patients (12-18 years of age) scheduled for surgery at Nationwide Children?s Hospital were recruited using purposive sampling. Following training, participants independently completed a daily, 10-minute VR-BF session for 7 days before surgery and during their inpatient stay. Participants could use VR-BF up to 2 weeks after hospital discharge. Patient- and session-level data of VR-BF usage and achievement of target HRV parameters were measured to identify the optimal frequency and duration of sessions before and after surgery for this population. Standardized questionnaires and semistructured interviews were conducted to obtain qualitative information about patients? experiences with VR-BF. Results: Patient-level data indicated that the highest odds of achieving 1 session under target HRV parameters was after 4 sessions (odds ratio [OR] 5.1 for 4 vs 3 sessions, 95% CI 1.3-20.6; OR 16.6 for 3 vs 2 sessions, 95% CI 1.2-217.0). Session-level data showed that a session duration of 9 to 10 minutes provided the greatest odds of achieving 1 session under target HRV parameters (OR 1.3 for 9 vs 8 min, 95% CI 1.1-1.7; OR 1.4 for 8 vs 7 min, 95% CI 1.1-1.8; OR 1 for 10 vs 9 min, 95% CI 0.9-1.2). Qualitative data revealed patient satisfaction with the VR-BF technology, particularly in managing perioperative stress (17/20, 85%). Few patients reported VR-BF as beneficial for pain (8/20, 40%). Conclusions: Children and adolescents undergoing surgery successfully learned behavioral strategies with VR-BF with 10-minute sessions once daily for 5 days. To integrate VR-BF as a therapeutic intervention in a subsequent clinical trial, patients will be instructed to complete three 10-minute sessions a day for 7 days after surgery. Trial Registration: ClinicalTrials NCT04943874; https://clinicaltrials.gov/ct2/show/NCT04943874 UR - https://periop.jmir.org/2024/1/e48959 UR - http://dx.doi.org/10.2196/48959 UR - http://www.ncbi.nlm.nih.gov/pubmed/38742940 ID - info:doi/10.2196/48959 ER - TY - JOUR AU - Gehringer, E. James AU - Woodruff Jameson, Anne AU - Boyer, Hailey AU - Konieczny, Jennifer AU - Thomas, Ryan AU - Pierce III, James AU - Cunha, B. Andrea AU - Willett, Sandra PY - 2024/9/6 TI - Feasibility of At-Home Hand Arm Bimanual Intensive Training in Virtual Reality: Case Study JO - JMIR Form Res SP - e57588 VL - 8 KW - cerebral palsy KW - HABIT KW - home intervention KW - virtual reality KW - rehabilitation KW - VR KW - case study KW - hand KW - hands KW - arm KW - arms KW - intensive training KW - feasibility KW - game KW - games KW - gaming KW - hand arm bimanual intensive training KW - motor KW - movement KW - home setting KW - home-based KW - child KW - children KW - male KW - males KW - men KW - quasi-experimental KW - parent KW - parents KW - intervention KW - interventions UR - https://formative.jmir.org/2024/1/e57588 UR - http://dx.doi.org/10.2196/57588 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57588 ER - TY - JOUR AU - Li, K. Brian S. AU - Fereday, Brendan AU - Wang, Ellen AU - Rodriguez, Samuel AU - Forssell, Karin AU - Bollaert, N. André AU - Menendez, Maria AU - Caruso, J. Thomas PY - 2024/7/30 TI - Enhancement of Immersive Technology Use in Pediatric Health Care With Accessible, Context-Specific Training: Descriptive Feasibility Study JO - JMIR XR Spatial Comput SP - e56447 VL - 1 KW - immersive technology KW - implementation KW - adult learning KW - education KW - pediatric KW - accessibility KW - training KW - therapeutic KW - pediatric care KW - utilization KW - virtual reality KW - VR KW - monitoring KW - license KW - development KW - software KW - monitoring software N2 - Background: Immersive technology provides adjuncts for pediatric care. However, accessibility and inadequate training limit implementation of this technology. Standardized instruction with no-cost software licensing may improve health care professionals? facility with immersive technologies. Objective: This descriptive feasibility study aimed to examine the applications of immersive technologies in pediatric health care, including virtual reality (VR) and projectors. Methods: We developed immersive technology instructional guides for pediatric health care. The training guides were created for multiple software content and hardware types across several clinical scenarios. Content was available in print and digital versions. The primary outcome was technology use across sites with no-cost software agreements. The secondary outcome was the specific application types used at a single site, stratified by sessions and minutes. Data were analyzed using descriptive statistics. Results: Data were collected from 19 licensed sites from January through June 2022. Among the 19 sites, 32% (n=6) used 10 or more VR units. Among the 6 sites that had projectors, half used 5 or more units. The mean minutes of use per month of all sites combined was 2199 (IQR 51-1058). Three sites had more than 10,000 minutes of total use during the 6-month review period. Secondary results indicated that active VR (977 total sessions) and passive projector streaming (1261 total sessions) were the most popular application types by session, while active projector (66,849 total minutes) and passive projector streaming (32,711 total minutes) were the most popular types when stratified by minutes of use. The active VR application with the most minutes of use was an application often used in physical therapy. Conclusions: Context-specific technological instruction coupled to no-cost licenses may increase access to immersive technology in pediatric health care settings. UR - https://xr.jmir.org/2024/1/e56447 UR - http://dx.doi.org/10.2196/56447 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56447 ER - TY - JOUR AU - Gold, I. Jeffrey AU - Akbar, M. Krystal AU - Avila, Sandra AU - Ngo, H. Nhat AU - Klein, J. Margaret PY - 2024/7/1 TI - Exploring Relations Between Unique Patient Characteristics and Virtual Reality Immersion Level on Anxiety and Pain in Patients Undergoing Venipuncture: Secondary Analysis of a Randomized Control Trial JO - J Med Internet Res SP - e53196 VL - 26 KW - pediatrics KW - virtual reality KW - VR KW - immersion KW - anxiety KW - pain management KW - routine medical procedures KW - venipuncture KW - secondary data analysis KW - mediation KW - moderation KW - pain KW - acute pain KW - pediatric pain KW - anxiety sensitivity N2 - Background: Virtual reality (VR) is a well-researched digital intervention that has been used for managing acute pain and anxiety in pediatric patients undergoing various medical procedures. This study focuses on investigating the role of unique patient characteristics and VR immersion level on the effectiveness of VR for managing pediatric pain and anxiety during venipuncture. Objective: The purpose of this study is to determine how specific patient characteristics and level of immersion during a VR intervention impact anxiety and pain levels for pediatric patients undergoing venipuncture procedures. Methods: This study is a secondary data analysis of 2 combined, previously published randomized control trials on 252 pediatric patients aged 10-21 years observed at Children?s Hospital Los Angeles from April 12, 2017, to July 24, 2019. One randomized clinical trial was conducted in 3 clinical environments examining peripheral intravenous catheter placement (radiology and an infusion center) and blood draw (phlebotomy). Conditional process analysis was used to conduct moderation and mediation analyses to assess the impact of immersion level during the VR intervention. Results: Significant moderation was found between the level of immersion and anxiety sensitivity when predicting postprocedural anxiety (P=.01). Patients exhibiting the highest anxiety sensitivity within the standard of care yielded a 1.9 (95% CI 0.9-2.8; P<.001)-point elevation in postprocedural anxiety relative to individuals with high immersion levels. No other significant factors were found to mediate or moderate the effect of immersion on either postprocedural anxiety or pain. Conclusions: VR is most effective for patients with higher anxiety sensitivity who report feeling highly immersed. Age, location of the procedure, and gender of the patient were not found to significantly impact VR?s success in managing levels of postprocedural pain or anxiety, suggesting that immersive VR may be a beneficial intervention for a broad pediatric population. Trial Registration: ClinicalTrials.gov NCT04268901; https://clinicaltrials.gov/study/NCT04268901 UR - https://www.jmir.org/2024/1/e53196 UR - http://dx.doi.org/10.2196/53196 UR - http://www.ncbi.nlm.nih.gov/pubmed/38949862 ID - info:doi/10.2196/53196 ER - TY - JOUR AU - Hrynyschyn, Robert AU - Guldager, Dalgaard Julie AU - Schulze, Daniel AU - Lyk, Bianca Patricia AU - Majgaard, Gunver AU - Stock, Christiane PY - 2024/5/6 TI - Factors Associated With Risky Drinking Decisions in a Virtual Reality Alcohol Prevention Simulation: Structural Equation Model JO - JMIR XR Spatial Comput SP - e56188 VL - 1 KW - alcohol KW - prevention KW - virtual reality KW - risk behavior KW - structural equation model N2 - Background: Risky alcohol consumption among adolescents is a significant public health concern in most Western countries. Various motives and factors (eg, sensation seeking, gender, reduced self-efficacy) known in the literature are associated with risky drinking decisions in real life. Efforts to tackle risky drinking decisions in real life through skills training to deal with social pressures have been successful. However, interventions of this nature require significant resources. Technological solutions, such as virtual reality (VR), offer advantages, as they enable immersive experiences that replicate real-life scenarios. However, a question persists pertaining to the fidelity of real-world behaviors within virtual environments. Objective: This study is exploratory and aims to ascertain if the established drinking motives and factors for risky drinking decisions are transferrable to the virtual environment in the simulation game VR FestLab and to uncover determinants linked to risky drinking decisions within the simulation. Methods: The study analyzed data from the intervention arm of a cluster-randomized study of 161 Danish students aged 14-18 years who tested the virtual alcohol prevention simulation VR FestLab. At baseline and before playing VR FestLab, independent variables such as age, gender, alcohol consumption, use of other drugs, sensation seeking, drinking refusal skills, knowledge of blood alcohol concentration, and refusal communication skills were recorded. The dependent variable, virtual risk decisions, was measured immediately after the gameplay. Confirmatory factor analysis and structural equation modeling were used to examine the latent variables in relation to virtual risk decisions. Moderation analyses for age and gender in relation to the latent characteristics and the primary outcome were also conducted. Results: The data indicate that 73.9% (119/161) of the participants engaged in binge drinking at least once in their lifetime. The confirmatory factor analysis demonstrated a good fit of the items for their respective constructs; therefore, they were adopted without modification in the structural equation model. The data suggest that individuals with prior alcohol experience are 4 times more likely to engage in virtual risk decisions within the simulated environment (odds ratio 4.31, 95% CI 1.70-10.84; P=.01). Knowledge and awareness of blood alcohol concentration were associated with a lower chance to engage in virtual risk decisions (odds ratio 0.32, 95% CI 0.11-0.93; P=.04). However, no significant associations were found between virtual risk decisions and other latent variables. Gender and age did not moderate the associations. Conclusions: The immersive and lifelike properties of VR partially reflected risk-related decisions. However, it remains unclear which factors favor the mapping of real-world behaviors in virtual simulations. Therefore, future research should address the mechanisms underlying behavioral dynamics in virtual simulations and explore the translation of virtual behaviors into real behaviors to gain a comprehensive understanding of the potential of virtual simulations for alcohol prevention. UR - https://xr.jmir.org/2024/1/e56188 UR - http://dx.doi.org/10.2196/56188 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56188 ER - TY - JOUR AU - Björling, A. Elin AU - Sonney, Jennifer AU - Zade, Himanshu AU - Rodriguez, Sofia AU - Pullmann, D. Michael AU - Moon, Hyun Soo PY - 2024/4/22 TI - Using Virtual Reality to Reduce Stress in Adolescents: Mixed Methods Usability Study JO - JMIR XR Spatial Comput SP - e49171 VL - 1 KW - virtual reality KW - adolescents KW - perceived stress KW - participatory design KW - depression N2 - Background: Adolescent mental health is a national mental health emergency amid surging rates of anxiety and depression. Given the scarcity and lack of scalable mental health services, the use of self-administered, evidence-based technologies to support adolescent mental health is both timely and imperative. Objective: The goal of this study was 2-fold: (1) to determine the feasibility, usability, and engagement of a participatory designed, nature-based virtual reality (VR) environment and (2) to determine the preliminary outcomes of our self-administered VR environment on depression, mindfulness, perceived stress, and momentary stress and mood. Methods: We conducted a within-person, 3-week, in-home study with a community-based sample of 44 adolescents. Participants completed surveys of perceived stress, depression, cognitive fusion, and mindfulness at intake, postintervention, and a 3-week follow-up. Participants were invited to use a nature-based, VR environment that included 6 evidence-based activities 3 to 5 times per week. They completed momentary stress and mood surveys 5 times each day and before and after each VR session. Postintervention, participants completed surveys on system and intervention usability and their experiences with using the VR system. Quantitative data were analyzed using descriptive statistics and mixed effects modeling to explore the effect of the VR environment on stress. Qualitative data were analyzed using collaborative thematic analysis. Results: Participants? use of the VR environment ranged from 1 session to 24 sessions (mean 6.27 sessions) at home over a 3-week period. The 44 participants completed all study protocols, indicating our protocol was feasible and the VR environment was engaging for most. Both the use of the VR system and novel VR intervention received strong usability ratings (mean 74.87 on the System Usability Scale). Most teens indicated that they found the tool to be easily administered, relaxing, and helpful with stress. For some, it offered space to process difficult emotions. The themes calm, regulating, and forget about everything resulted from open-ended exit interview data. Although the Relaxation Environment for Stress in Teens (RESeT) did not significantly affect repeated survey measurements of depression, mindfulness, nor cognitive fusion, it did positively affect momentary mood (pre-intervention: 10.8, post-intervention: 12.0, P=.001) and decrease momentary stress (pre-intervention: 37.9, post-intervention: 20.6, P=.001). We found a significant reduction in within-day momentary stress that strengthened with increased VR use over time during the study period (P=.03). Conclusions: These preliminary data inform our own VR environment design but also provide evidence of the potential for self-administered VR as a promising tool to support adolescent mental health. Self-administered VR for mental health may be an effective intervention for reducing adolescent stress. However, understanding barriers (including disengagement) to using VR, as well as further encouraging participatory design with teens, may be imperative to the success of future mental health interventions. UR - https://xr.jmir.org/2024/1/e49171 UR - http://dx.doi.org/10.2196/49171 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49171 ER - TY - JOUR AU - Toma, Marian-Vladut AU - Turcu, Elena Cristina AU - Turcu, Octavian Corneliu AU - Vlad, Sorin AU - Tiliute, Eugen Doru AU - Pascu, Paul PY - 2024/2/19 TI - Extended Reality?Based Mobile App Solutions for the Therapy of Children With Autism Spectrum Disorders: Systematic Literature Review JO - JMIR Serious Games SP - e49906 VL - 12 KW - autism KW - autistic KW - autism spectrum disorder KW - ASD KW - virtual reality KW - augmented reality KW - extended reality KW - mixed reality KW - mobile app KW - children KW - preschool KW - mobile phone N2 - Background: The increasing prevalence of autism spectrum disorder (ASD) has driven research interest on the therapy of individuals with autism, especially children, as early diagnosis and appropriate treatment can lead to improvement in the condition. With the widespread availability of virtual reality, augmented reality (AR), and mixed reality technologies to the public and the increasing popularity of mobile devices, the interest in the use of applications and technologies to provide support for the therapy of children with autism is growing. Objective: This study aims to describe the literature on the potential of virtual reality, AR, and mixed reality technologies in the context of therapy for children with ASD. We propose to investigate and analyze the temporal distribution of relevant papers, identify the target audience for studies related to extended reality apps in ASD therapy, examine the technologies used in the development of these apps, assess the skills targeted for improvement in primary studies, explore the purposes of the proposed solutions, and summarize the results obtained from their application. Methods: For the systematic literature review, 6 research questions were defined in the first phase, after which 5 international databases (Web of Science, Scopus, ScienceDirect, IEEE Xplore Digital Library, and ACM Digital Library) were searched using specific search strings. Results were centralized, filtered, and processed applying eligibility criteria and using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The results were refined using a technical and IT-oriented approach. The quality criteria assessed whether the research addressed ASDs, focused on children?s therapy, involved targeted technologies, deployed solutions on mobile devices, and produced results relevant to our study. Results: In the first step, 179 publications were identified in Zotero reference manager software (Corporation for Digital Scholarship). After excluding articles that did not meet the eligibility or quality assessment criteria, 28 publications were finalized. The analysis revealed an increase in publications related to apps for children with autism starting in 2015 and peaking in 2019. Most studies (22/28, 79%) focused on mobile AR solutions for Android devices, which were developed using the Unity 3D platform and the Vuforia engine. Although 68% (19/28) of these apps were tested with children, 32% (9/28) were tested exclusively by developers. More than half (15/28, 54%) of the studies used interviews as an evaluation method, yielding mostly favorable although preliminary results, indicating the need for more extensive testing. Conclusions: The findings reported in the studies highlight the fact that these technologies are appropriate for the therapy of children with ASD. Several studies showed a distinct trend toward the use of AR technology as an educational tool for people with ASD. This trend entails multidisciplinary cooperation and an integrated research approach, with an emphasis on comprehensive empirical evaluations and technology ethics. UR - https://games.jmir.org/2024/1/e49906 UR - http://dx.doi.org/10.2196/49906 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373032 ID - info:doi/10.2196/49906 ER - TY - JOUR AU - Kilcioglu, Seyma AU - Schiltz, Benoît AU - Araneda, Rodrigo AU - Bleyenheuft, Yannick PY - 2023/9/12 TI - Short- to Long-Term Effects of Virtual Reality on Motor Skill Learning in Children With Cerebral Palsy: Systematic Review and Meta-Analysis JO - JMIR Serious Games SP - e42067 VL - 11 KW - cerebral palsy KW - virtual reality KW - motor skill learning KW - long-term effect KW - daily life activities KW - motor functions N2 - Background: Many studies have started integrating virtual reality (VR) into neurorehabilitation for children with cerebral palsy (CP). The results of the effects of VR on motor skill learning, including the short- to long-term results of relevant studies, must be pooled in a generic framework. Objective: This systematic review and meta-analysis aimed to investigate the short- to long-term effects of therapies including VR on motor skill learning in children with CP. Methods: Two examiners followed the inclusion and exclusion criteria of the ?Participant, Intervention, Control, and Outcome? framework. Randomized controlled trials (RCTs) and non-RCTs were considered if they compared VR-included interventions with control groups on motor functions and daily life activities in children with CP. PubMed, ScienceDirect, Embase, and IEEE Xplore databases were searched. The modified Downs and Black assessment was used to assess the methodological quality of the included studies. Meta-analyses and subgroup analyses for RCTs were conducted whenever possible. Results: A total of 7 RCTs, 2 non-RCTs, and 258 children with CP were included. The priority focus of 78% (7/9) of the studies was upper limb functions. There was a significant short-term effect of adding VR to conventional therapies on upper limb functions when compared with conventional therapies (P=.04; standardized mean difference [SMD]=0.39, 95% CI 0.01-0.76). The overall medium- to long-term effects showed a trend toward favoring the VR group, although the difference was not statistically significant (P=.06; SMD=0.37, 95% CI ?0.02 to 0.77). For balance (P=.06; SMD=1.04, 95% CI ?0.04 to 2.12), gross motor functions (P=.30; SMD=2.85, 95% CI ?2.57 to 8.28), and daily life activities outcomes (P=.21; SMD=0.29, 95% CI ?0.16 to 0.74), the overall effect in the short term also showed a trend toward favoring the VR group, but these results were not statistically significant. Conclusions: VR seems to have additional benefits for motor skill learning in children with CP. Studies with follow-up outcomes of VR training focusing on balance and gross motor functions in patients with CP were quite limited. Future research on balance and gross motor function outcomes should target particularly long-term results of therapies including VR on motor skill learning. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021227734; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227734 UR - https://games.jmir.org/2023/1/e42067 UR - http://dx.doi.org/10.2196/42067 UR - http://www.ncbi.nlm.nih.gov/pubmed/37698895 ID - info:doi/10.2196/42067 ER - TY - JOUR AU - Sullivan, Lindsay AU - McKenzie, B. Lara AU - Roberts, Kristin AU - Recker, Robyn AU - Schwebel, C. David AU - Pommering, Thomas AU - Yang, Jingzhen PY - 2023/5/26 TI - A Virtual Reality App Intervention to Improve Concussion Recognition and Reporting in Athletes Aged 9 to 12 Years: Development and Pilot Testing JO - JMIR Form Res SP - e43015 VL - 7 KW - concussion KW - education KW - sports KW - athlete KW - athletic KW - virtual reality KW - youth KW - child KW - pediatric KW - head injury KW - symptom reporting KW - symptom recognition KW - patient education KW - brain injury KW - user experience KW - user centered design N2 - Background: Existing concussion education programs for preteen athletes typically do not result in sustained improvements in concussion symptom recognition or reporting behaviors. Virtual reality (VR) technology offers an innovative tool that may improve concussion symptom recognition and reporting behaviors among preteen athletes. Objective: We aimed to describe the design and development of a VR concussion education app, Make Play Safe (MPS), and present findings on the usability and preliminary efficacy of MPS in improving concussion recognition and reporting intentions among soccer athletes aged 9-12 years. Methods: A collaborative user-centered design process was implemented to develop and evaluate MPS, a semi-immersive VR concussion education app designed to address two behavioral outcomes in preteen athletes aged 9-12 years: (1) recognizing concussion and (2) reporting concussion. The development of MPS occurred in three phases: (1) design and development, (2) usability testing, and (3) preliminary efficacy testing. During phase 1, consultations were completed with 6 experts. Additionally, 5 interviews with children who had a history of concussion were conducted to collect feedback about the proof of concept of MPS. During phase 2, a participatory workshop with 11 preteen athletes and a small group discussion with 6 parents and 2 coaches were conducted to explore the usefulness and acceptability of MPS from the perspective of end users. Finally, phase 3 included preliminary efficacy testing with 33 soccer athletes aged 9-12 years to examine changes in concussion-related knowledge, attitudes, and reporting intentions from pre- to postintervention. The data generated from each phase of this study informed the development of the final version of the proof of concept of the VR concussion education app, MPS. Results: Experts positively rated the features of MPS and noted that the design and content were innovative and age-appropriate. Preteens with a history of concussion indicated the scenarios and symptoms portrayed in the app represented well what they experienced while concussed. Further, they stated that the app would be an engaging way for children to learn about concussions. The 11 healthy children in the workshop perceived the app positively, noting that the scenarios were informative and engaging. Results from preliminary efficacy testing revealed increases in many athletes? knowledge and reporting intentions from pre- to postintervention. Others demonstrated no significant changes or a decrease in knowledge, attitudes, or reporting intentions from pre- to postintervention. Group-level changes in concussion knowledge and intention to report concussions were statistically significant (P<.05), while changes in attitudes toward reporting concussions were not (P=.08). Conclusions: Results suggest VR technology may be an effective and efficient tool to equip preteen athletes with the requisite knowledge and skills to recognize and report future concussions. Further research is recommended to examine the use of VR as an effective strategy to improve concussion-reporting behaviors in preteen athletes. UR - https://formative.jmir.org/2023/1/e43015 UR - http://dx.doi.org/10.2196/43015 UR - http://www.ncbi.nlm.nih.gov/pubmed/37234027 ID - info:doi/10.2196/43015 ER - TY - JOUR AU - Liu, Cong AU - Wang, Xing AU - Chen, Rao AU - Zhang, Jie PY - 2022/11/9 TI - The Effects of Virtual Reality Training on Balance, Gross Motor Function, and Daily Living Ability in Children With Cerebral Palsy: Systematic Review and Meta-analysis JO - JMIR Serious Games SP - e38972 VL - 10 IS - 4 KW - virtual reality KW - cerebral palsy KW - balance KW - gross motor activities KW - activities of daily living KW - meta KW - motor KW - children KW - pediatrics N2 - Background: The increasing number of children with cerebral palsy (CP) has a serious impact on individuals, families, and society. As a new technology, virtual reality (VR) has been used in the rehabilitation of children with CP. Objective: This study aimed to systematically evaluate the effect of VR training on balance, gross motor function, and daily living ability in children with CP. Methods: PubMed, Embase, The Cochrane Library, Web of Science, and China National Knowledge Infrastructure databases were searched by computer, with the search period being from the establishment of each database to December 25, 2021, to collect randomized controlled trials (RCTs) on the effects of VR training on balance, gross motor function, and daily living ability in children with CP. The Cochrane risk of bias assessment tool was used to conduct quality assessment on the included literature, and RevMan software (version 5.3) was used to analyze data. Results: A total of 16 articles were included, involving 513 children with CP. VR training can improve the balance function (Pediatric Balance Scale: mean difference 2.06, 95% CI 1.15-2.97; P<.001; Berg Balance Scale: mean difference 3.66, 95% CI 0.29-7.02; P=.03) and gross motor function (standardized mean difference [SMD] 0.60, 95% CI 0.34-0.87; P<.001) of children with CP. However, there is still certain disagreement on the impact on daily living ability (SMD 0.37, 95% CI ?0.04 to 0.78; P=.08); after removing the source literature with heterogeneity, VR training can improve the daily living ability of children with CP (SMD 0.55, 95% CI 0.30-0.81; P<.001). Conclusions: VR training can significantly improve the balance function and gross motor function of children with CP, but the effect on the daily living ability of children with CP remains controversial. UR - https://games.jmir.org/2022/4/e38972 UR - http://dx.doi.org/10.2196/38972 UR - http://www.ncbi.nlm.nih.gov/pubmed/36350683 ID - info:doi/10.2196/38972 ER - TY - JOUR AU - Ezenwa, Nkolika Beatrice AU - Umoren, Rachel AU - Fajolu, Bamikeolu Iretiola AU - Hippe, S. Daniel AU - Bucher, Sherri AU - Purkayastha, Saptarshi AU - Okwako, Felicitas AU - Esamai, Fabian AU - Feltner, B. John AU - Olawuyi, Olubukola AU - Mmboga, Annet AU - Nafula, Concepta Mary AU - Paton, Chris AU - Ezeaka, Chinyere Veronica PY - 2022/9/12 TI - Using Mobile Virtual Reality Simulation to Prepare for In-Person Helping Babies Breathe Training: Secondary Analysis of a Randomized Controlled Trial (the eHBB/mHBS Trial) JO - JMIR Med Educ SP - e37297 VL - 8 IS - 3 KW - virtual reality KW - mobile learning KW - Helping Babies Breathe KW - neonatal resuscitation KW - mobile Helping Babies Survive powered by District Health Information Software 2 KW - neonatal mortality KW - digital education KW - health care education KW - health care worker KW - medical education KW - digital intervention N2 - Background: Neonatal mortality accounts for approximately 46% of global under-5 child mortality. The widespread access to mobile devices in low- and middle-income countries has enabled innovations, such as mobile virtual reality (VR), to be leveraged in simulation education for health care workers. Objective: This study explores the feasibility and educational efficacy of using mobile VR for the precourse preparation of health care professionals in neonatal resuscitation training. Methods: Health care professionals in obstetrics and newborn care units at 20 secondary and tertiary health care facilities in Lagos, Nigeria, and Busia, Western Kenya, who had not received training in Helping Babies Breathe (HBB) within the past 1 year were randomized to access the electronic HBB VR simulation and digitized HBB Provider?s Guide (VR group) or the digitized HBB Provider?s Guide only (control group). A sample size of 91 participants per group was calculated based on the main study protocol that was previously published. Participants were directed to use the electronic HBB VR simulation and digitized HBB Provider?s Guide or the digitized HBB Provider?s Guide alone for a minimum of 20 minutes. HBB knowledge and skills assessments were then conducted, which were immediately followed by a standard, in-person HBB training course that was led by study staff and used standard HBB evaluation tools and the Neonatalie Live manikin (Laerdal Medical). Results: A total of 179 nurses and midwives participated (VR group: n=91; control group: n=88). The overall performance scores on the knowledge check (P=.29), bag and mask ventilation skills check (P=.34), and Objective Structured Clinical Examination A checklist (P=.43) were similar between groups, with low overall pass rates (6/178, 3.4% of participants). During the Objective Structured Clinical Examination A test, participants in the VR group performed better on the critical step of positioning the head and clearing the airway (VR group: 77/90, 86%; control group: 57/88, 65%; P=.002). The median percentage of ventilations that were performed via head tilt, as recorded by the Neonatalie Live manikin, was also numerically higher in the VR group (75%, IQR 9%-98%) than in the control group (62%, IQR 13%-97%), though not statistically significantly different (P=.35). Participants in the control group performed better on the identifying a helper and reviewing the emergency plan step (VR group: 7/90, 8%; control group: 16/88, 18%; P=.045) and the washing hands step (VR group: 20/90, 22%; control group: 32/88, 36%; P=.048). Conclusions: The use of digital interventions, such as mobile VR simulations, may be a viable approach to precourse preparation in neonatal resuscitation training for health care professionals in low- and middle-income countries. UR - https://mededu.jmir.org/2022/3/e37297 UR - http://dx.doi.org/10.2196/37297 UR - http://www.ncbi.nlm.nih.gov/pubmed/36094807 ID - info:doi/10.2196/37297 ER - TY - JOUR AU - Aminabadi, Asl Naser AU - Golsanamlou, Ozra AU - Halimi, Zohreh AU - Jamali, Zahra PY - 2022/4/18 TI - Assessing the Different Levels of Virtual Reality That Influence Anxiety, Behavior, and Oral Health Status in Preschool Children: Randomized Controlled Clinical Trial JO - JMIR Perioper Med SP - e35415 VL - 5 IS - 1 KW - virtual reality KW - anxiety KW - behavior KW - oral health training N2 - Background: Compared with a traditional behavior management strategy and oral health training, virtual reality (VR) integrated with multisensory feedback possesses potential advantages in dentistry. Objective: This study aimed to assess the impact of different levels of VR on anxiety, behavior, and oral health status. Methods: This study was carried out in the Department of Pediatric Dentistry at the Tabriz University of Medical Sciences from December 2020 to June 2021. We randomly assigned 60 healthy children aged 4 years to 6 years to 4 groups, each consisting of 15 children. The study consisted of 2 consecutive sessions. During the first visit, the plaque index was calculated, and oral health education was carried out in all groups using Immersive VR (group I), Semi-immersive VR (group II), Nonimmersive VR (group III), and tell-show-do (TSD; group IV). In the second session, an amalgam restoration was performed in all groups. Participants? anxiety and behavior were recorded using the face version of the Modified Child Dental Anxiety Scale (MCDAS[f]) and Frankl scale. The plaque index was recorded in 2 follow-up sessions. Results: The greatest prevalence of positive behavior (P=.004) and the lowest anxiety (P<.001) were recorded in group I, followed by group II, group III, and group IV. The plaque index scores showed a reduced trend between the first session and follow-up sessions (P<.001), but the values did not differ significantly between the 4 groups during the 3 sessions (P=.28, P=.54, P=.18). Conclusions: The most positive behavior was observed in the Immersive VR group, followed by the Semi-immersive VR, Nonimmersive VR, and TSD groups. Moreover, oral health education using VR resources can improve oral health status in children. Trial Registration: Iranian Registry of Clinical Trials 20210103049926N1; https://www.irct.ir/trial/53475 UR - https://periop.jmir.org/2022/1/e35415 UR - http://dx.doi.org/10.2196/35415 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436233 ID - info:doi/10.2196/35415 ER - TY - JOUR AU - Schmucker, Michael AU - Haag, Martin PY - 2021/9/20 TI - Automated Size Recognition in Pediatric Emergencies Using Machine Learning and Augmented Reality: Within-Group Comparative Study JO - JMIR Form Res SP - e28345 VL - 5 IS - 9 KW - resuscitation KW - emergency medicine KW - mobile applications KW - mobile phone KW - user-computer interface KW - augmented reality KW - machine learning N2 - Background: Pediatric emergencies involving children are rare events, and the experience of emergency physicians and the results of such emergencies are accordingly poor. Anatomical peculiarities and individual adjustments make treatment during pediatric emergency susceptible to error. Critical mistakes especially occur in the calculation of weight-based drug doses. Accordingly, the need for a ubiquitous assistance service that can, for example, automate dose calculation is high. However, few approaches exist due to the complexity of the problem. Objective: Technically, an assistance service is possible, among other approaches, with an app that uses a depth camera that is integrated in smartphones or head-mounted displays to provide a 3D understanding of the environment. The goal of this study was to automate this technology as much as possible to develop and statistically evaluate an assistance service that does not have significantly worse measurement performance than an emergency ruler (the state of the art). Methods: An assistance service was developed that uses machine learning to recognize patients and then automatically determines their size. Based on the size, the weight is automatically derived, and the dosages are calculated and presented to the physician. To evaluate the app, a small within-group design study was conducted with 17 children, who were each measured with the app installed on a smartphone with a built-in depth camera and a state-of-the-art emergency ruler. Results: According to the statistical results (one-sample t test; P=.42; ?=.05), there is no significant difference between the measurement performance of the app and an emergency ruler under the test conditions (indoor, daylight). The newly developed measurement method is thus not technically inferior to the established one in terms of accuracy. Conclusions: An assistance service with an integrated augmented reality emergency ruler is technically possible, although some groundwork is still needed. The results of this study clear the way for further research, for example, usability testing. UR - https://formative.jmir.org/2021/9/e28345 UR - http://dx.doi.org/10.2196/28345 UR - http://www.ncbi.nlm.nih.gov/pubmed/34542416 ID - info:doi/10.2196/28345 ER - TY - JOUR AU - Canares, Therese AU - Parrish, Carisa AU - Santos, Christine AU - Badawi, Alia AU - Stewart, Alyssa AU - Kleinman, Keith AU - Psoter, Kevin AU - McGuire, Joseph PY - 2021/7/28 TI - Pediatric Coping During Venipuncture With Virtual Reality: Pilot Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e26040 VL - 4 IS - 3 KW - pediatrics KW - psychological distress KW - virtual reality KW - procedural pain KW - anxiety KW - phlebotomy N2 - Background: Virtual reality (VR) has shown promise in reducing children?s pain and anxiety during venipuncture, but studies on VR lack objective observations of pediatric coping. Notably, the process of capturing objective behavioral coping data can be labor- and personnel-intensive. Objective: The primary aims of this pilot trial were to assess the feasibility of conducting a trial of VR in a pediatric emergency department and the feasibility of documenting observed coping behaviors during pediatric procedures. Secondarily, this study examined whether VR affects child and caregiver coping and distress during venipuncture in the pediatric emergency department. Methods: This stratified, randomized, controlled pilot trial compared coping and distress between child life?supported VR engagement and child life specialist support without VR during painful procedures in children aged 7-22 years in the pediatric emergency department. An external control (reference group) received no standardized support. Primary feasibility outcomes included rates of recruitment, rates of withdrawal from VR, and rates of completed Child Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF) observations. Secondary clinical outcomes were applied to venipuncture procedures and included CAMPIS-SF coping and distress (range 0-1.0), pain and anxiety on a visual analog scale (range 0-10), and cybersickness symptoms. Results: Overall recruitment was 93% (66/71), VR withdrawal rate was 27% (4/15), and of the completed procedures, 100% (63/63) CAMPIS-SF observations were completed. A total of 55 patients undergoing venipuncture in the pediatric emergency department were included in the analyses of clinical outcomes: 15 patients (15 caregivers) randomized to VR, 20 patients (15 caregivers) randomized to child life specialist support, and 20 patients (17 caregivers) in the reference group. Patient coping differed across groups with higher coping in the VR group and child life specialist group than in the reference group (P=.046). There were no significant differences in the distress and pain ratings for patients and caregivers between the groups. Caregivers rated the lowest perceived anxiety in the child life specialist group (P=.03). There was no apparent change in cybersickness symptoms before and after VR use (P=.37). Conclusions: Real-time documentation of observed behaviors in patients and caregivers was feasible during medical procedures in which VR was utilized, particularly with the availability of research staff. VR and child life specialists improved coping in children during venipuncture procedures. Given the high participation rate, future studies to evaluate the efficacy of VR are recommended to determine whether an off-the-shelf VR headset can be a low-cost and low-risk tool to improve children?s coping during venipuncture or other related procedures. Trial Registration: ClinicalTrials.gov NCT03686176; https://clinicaltrials.gov/ct2/show/NCT03686176 UR - https://pediatrics.jmir.org/2021/3/e26040 UR - http://dx.doi.org/10.2196/26040 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319249 ID - info:doi/10.2196/26040 ER - TY - JOUR AU - Ridout, Brad AU - Kelson, Joshua AU - Campbell, Andrew AU - Steinbeck, Kate PY - 2021/6/28 TI - Effectiveness of Virtual Reality Interventions for Adolescent Patients in Hospital Settings: Systematic Review JO - J Med Internet Res SP - e24967 VL - 23 IS - 6 KW - virtual reality KW - hospital KW - pain KW - anxiety KW - adolescents N2 - Background: Given the high level of interest and increasing familiarity with virtual reality among adolescents, there is great potential to use virtual reality to address adolescents? unique health care delivery needs while in hospital. While there have been reviews on the use of virtual reality for specific health conditions and procedures, none to date have reviewed the full scope of virtual reality hospital interventions for adolescents who are often combined with children as a homogenous group, despite the fact that adolescents experience virtual environments different from children. Objective: The aim of this review was to systematically identify available evidence regarding the use of virtual reality interventions for adolescent patients in hospital settings to evaluate effectiveness, suitability, and safety and identify opportunities for future research. Methods: PubMed, PsycINFO, Medline, and Scopus databases were searched using keywords and phrases. Retrieved abstracts (n=1525) were double screened, yielding 276 articles for full-text screening. Of these, 8 articles met inclusion criteria. Data were extracted to a standardized coding sheet, and a narrative synthesis was performed due to the heterogeneity of the studies. Results: Four RCTs and 4 single-case reports were identified for inclusion, all of which aimed to reduce pain or anxiety. The scenarios targeted were burn pain, venipuncture, chemotherapy, preoperative anxiety, and palliative care. Three out of 4 RCTs found significant reductions in pain or anxiety outcomes measures when using virtual reality compared to standard care or other distraction techniques; however, only 1 study combined self-reported experiences of pain or anxiety with any physiological measures. Single-case reports relied primarily upon qualitative feedback, with patients reporting reduced pain or anxiety and a preference for virtual reality to no virtual reality. Conclusions: Virtual reality can provide a safe and engaging way to reduce pain and anxiety in adolescents while in hospital, particularly when virtual reality software is highly immersive and specifically designed for therapeutic purposes. As VR becomes more accessible and affordable for use in hospitals, larger and more diverse studies that capitalize on adolescents? interest in and aptitude for virtual reality, and on the full range of capabilities of this emerging technology, are needed to build on these promising results. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020198760; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020198760 UR - https://www.jmir.org/2021/6/e24967 UR - http://dx.doi.org/10.2196/24967 UR - http://www.ncbi.nlm.nih.gov/pubmed/34185015 ID - info:doi/10.2196/24967 ER - TY - JOUR AU - Gold, I. Jeffrey AU - Annick, T. Erin AU - Lane, S. Arianna AU - Ho, Katherine AU - Marty, T. Ryan AU - Espinoza, C. Juan PY - 2021/4/19 TI - ?Doc McStuffins: Doctor for a Day? Virtual Reality (DocVR) for Pediatric Preoperative Anxiety and Satisfaction: Pediatric Medical Technology Feasibility Study JO - J Med Internet Res SP - e25504 VL - 23 IS - 4 KW - virtual reality (VR) KW - pediatric KW - anxiety KW - preoperative KW - satisfaction KW - Doc McStuffins N2 - Background: Preoperative anxiety is a common occurrence among children and is associated with a host of maladaptive postoperative behaviors. Consequently, increased attention has been placed on interventions to reduce preoperative anxiety and its associated outcomes. Child Life preparation prior to surgery includes evidence-based practices such as age-appropriate distraction and therapeutic play. Virtual reality (VR) is a promising addition to the Child Life toolbox to address anxiety prior to surgery. The current study evaluates the implementation and feasibility of a VR experience, ?Doc McStuffins: Doctor for a Day Virtual Reality Experience? (DocVR), developed by Disney Junior in collaboration with Children?s Hospital Los Angeles, to target pediatric preoperative anxiety. Objective: The primary aim of this study was to examine the feasibility and efficacy of DocVR for preoperative anxiety. A secondary aim was to improve patient, caregiver, and health care provider satisfaction with the preoperative experience. Methods: In this study, 51 patients (age 6-14 years) scheduled for surgery in the ambulatory surgery center and the main operating room at Children?s Hospital Los Angeles were approached to participate in Disney?s DocVR experience. The patients played the DocVR experience for an average of 18 minutes (3-55 minutes). Irrespective of surgical procedure, patients and their families were eligible, as long as they had no known marked cognitive or visual impairments that would interfere with completing the survey and engaging in the DocVR experience. Results: Patients who tried the DocVR experience (n=51) responded overwhelmingly positively to both the VR technology and to the game itself. Patients experienced a statistically significant decrease in anxiety following DocVR game play (Z=?3.26, P=.001). On the Facial Affective Scale, the percentage of patients who chose the face with the most positive facial expression to represent their affect increased from 23% (12/51) pre-VR to 49% (25/47) post-VR. Furthermore, 97% (38/39) of patients reported feeling more comfortable at the hospital, and 74% (28/38) reported feeling less scared at the hospital after playing the game. The game was enjoyed by 94% (46/49) of patients, and 88% (30/34) of patients reported feeling both ?Interested? and ?Involved? in the game. Conclusions: DocVR is a feasible and beneficial VR experience to relieve pediatric preoperative anxiety and improve satisfaction in the preoperative area. The VR experience resulted in a decrease in overall anxiety and an increase in overall positive affect during the preoperative time. Patients also responded positively to the game, confirming their interest in the content and affirming the quality of the DocVR experience. The positive response to the game indicates that DocVR has the potential to make the overall preoperative experience less anxiety-producing and more comfortable, which leads to improved patient satisfaction. Naturally, improved patient outcomes lead to improved caregiver and health care provider satisfaction. UR - https://www.jmir.org/2021/4/e25504 UR - http://dx.doi.org/10.2196/25504 UR - http://www.ncbi.nlm.nih.gov/pubmed/33730687 ID - info:doi/10.2196/25504 ER - TY - JOUR AU - Shin, Yu-Bin AU - Kim, Jae-Jin AU - Kim, Hyunji AU - Kim, Soo-Jeong AU - Eom, Hyojung AU - Jung, Hoon Young AU - Kim, Eunjoo PY - 2021/1/18 TI - Managing Game-Related Conflict With Parents of Young Adults With Internet Gaming Disorder: Development and Feasibility Study of a Virtual Reality App JO - JMIR Serious Games SP - e22494 VL - 9 IS - 1 KW - internet gaming disorder KW - family conflict KW - coping behavior KW - virtual reality N2 - Background: Individuals with internet gaming disorder (IGD) report facing family conflicts repeatedly because of their excessive internet gaming. With recent advancements in virtual reality (VR) technology, VR therapy has emerged as a promising method for the management of various psychiatric disorders, including IGD. Given that several risk and protective factors for young people with addiction can be influenced by their interpersonal context, the potential utility of VR-based apps for managing family conflicts needs to be examined with reference to IGD management. However, few studies have evaluated potential treatment modules related to interpersonal conflict management, such as emotion regulation and taking the perspective of others. Objective: This preliminary study aims to examine the potential use of a VR-based app in the management of game-related conflicts with parents of young adults with IGD and matched controls. Methods: In total, 50 young male adults (24 with IGD and 26 controls) were recruited to participate in the study. We developed a virtual room where game-related family conflicts arise. Using this room, participants completed 2 VR tasks that required them to express anger and then implement coping skills (ie, risk/benefit assessment of stopping a game and taking parents? perspective) to deal with negative emotions in interpersonal conflict situations and to decrease one?s gaming behavior. Results: The results showed that immersion in our VR app tended to provoke negative emotions in individuals with IGD. In addition, after a risk/benefit assessment of stopping a game, the response of stopping a game immediately increased significantly in the IGD group, suggesting that patients? gaming behavior could be changed using our VR program. Furthermore, in individuals with IGD, longer gaming hours were associated with a lower level of perceived usefulness of the coping skills training. Conclusions: The findings of this study indicate that our VR app may be useful for implementing more desirable behaviors and managing gaming-related family conflicts in individuals with IGD. Our VR app may offer an alternative for individuals with IGD to learn how a vicious cycle of conflicts is developed and to easily and safely assess their dysfunctional thoughts behind the conflicts (ie, perceived unreasonable risks of stopping a game and thoughts acting as a barrier to taking the perspective of others). UR - http://games.jmir.org/2021/1/e22494/ UR - http://dx.doi.org/10.2196/22494 UR - http://www.ncbi.nlm.nih.gov/pubmed/33459603 ID - info:doi/10.2196/22494 ER - TY - JOUR AU - Ahmadpour, Naseem AU - Weatherall, David Andrew AU - Menezes, Minal AU - Yoo, Soojeong AU - Hong, Hanyang AU - Wong, Gail PY - 2020/7/17 TI - Synthesizing Multiple Stakeholder Perspectives on Using Virtual Reality to Improve the Periprocedural Experience in Children and Adolescents: Survey Study JO - J Med Internet Res SP - e19752 VL - 22 IS - 7 KW - virtual reality KW - periprocedural anxiety KW - children KW - adolescents KW - stakeholder perspective KW - design KW - VR KW - pediatrics KW - patient experience KW - app KW - eHealth N2 - Background: Virtual reality (VR) technology is a powerful tool for augmenting patient experience in pediatric settings. Incorporating the needs and values of stakeholders in the design of VR apps in health care can contribute to better outcomes and meaningful experiences for patients. Objective: We used a multiperspective approach to investigate how VR apps can be designed to improve the periprocedural experiences of children and adolescents, particularly those with severe anxiety. Methods: This study included a focus group (n=4) and a survey (n=56) of clinicians. Semistructured interviews were conducted with children and adolescents in an immunization clinic (n=3) and perioperative setting (n=65) and with parents and carers in an immunization clinic (n=3) and perioperative setting (n=35). Results: Qualitative data were examined to determine the experience and psychological needs and intervention and design strategies that may contribute to better experiences for children in three age groups (4-7, 8-11, and 12-17 years). Quantitative data were used to identify areas of priority for future VR interventions. Conclusions: We propose a set of ten design considerations for the creation of future VR experiences for pediatric patients. Enhancing patient experience may be achieved by combining multiple VR solutions through a holistic approach considering the roles of clinicians and carers and the temporality of the patient?s experience. These situations require personalized solutions to fulfill the needs of pediatric patients before and during the medical procedure. In particular, communication should be placed at the center of preprocedure solutions, while emotional goals can be embedded into a procedure-focused VR app to help patients shift their focus in a meaningful way to build skills to manage their anxiety. UR - http://www.jmir.org/2020/7/e19752/ UR - http://dx.doi.org/10.2196/19752 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706671 ID - info:doi/10.2196/19752 ER - TY - JOUR AU - Ravindran, Vijay AU - Osgood, Monica AU - Sazawal, Vibha AU - Solorzano, Rita AU - Turnacioglu, Sinan PY - 2019/9/30 TI - Virtual Reality Support for Joint Attention Using the Floreo Joint Attention Module: Usability and Feasibility Pilot Study JO - JMIR Pediatr Parent SP - e14429 VL - 2 IS - 2 KW - autism spectrum disorder KW - interpersonal skills KW - virtual reality, instructional N2 - Background: Advances in virtual reality (VR) technology offer new opportunities to design supports for the core behaviors associated with autism spectrum disorder (ASD) that promote progress toward optimal outcomes. Floreo has developed a novel mobile VR platform that pairs a user receiving instruction on target skills with an adult monitor. Objective: The primary objective of this pilot study was to explore the feasibility of using Floreo?s Joint Attention Module in school-aged children with autism in a special education setting. A secondary objective was to explore a novel joint attention measure designed for use with school-aged children and to observe whether there was a suggestion of change in joint attention skills from preintervention to postintervention. Methods: A total of 12 participants (age range: 9 to 16 years) received training with the Joint Attention Module for 14 sessions over 5 weeks. Results: No serious side effects were reported, and no participants dropped out of the study because of undesirable side effects. On the basis of monitor data, 95.4% (126/132) of the time participants tolerated the headset, 95.4% (126/132) of the time participants seemed to enjoy using Floreo?s platform, and 95.5% (128/134) of the time the VR experience was reported as valuable. In addition, scoring of the joint attention measure suggested a positive change in participant skills related to the total number of interactions, use of eye contact, and initiation of interactions. Conclusions: The study results suggest that Floreo?s Joint Attention Module is safe and well tolerated by students with ASD, and preliminary data also suggest that its use is related to improvements in fundamental joint attention skills. UR - http://pediatrics.jmir.org/2019/2/e14429/ UR - http://dx.doi.org/10.2196/14429 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573921 ID - info:doi/10.2196/14429 ER -