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While Virtual Reality (VR) has gained significant attention in different domains of health care and promises benefits for managing vision disturbances, no bibliometric analysis focuses on its use in vision therapy. This study aims to analyze and visualize the scientific literature indexed in the Web of Science databases by visualizing bibliometric indicators illustrating publication trends from 2001. The findings provide a better understanding of the state-of-the-art of existing vision therapy research utilizing VR.

Stroke is one of the prevalent diseases which leads to functional disabilities such as hemiparesis or hemiplegia. It is common practice to treat patients with proper rehabilitation as early as possible for better prognosis after the onset of stroke. One of the effective therapeutic techniques for treating stroke patients is mirror therapy, which can potentially facilitate patients' motor function recovery through repetitive practice. "Rehago" is a software as medical device that implements the concept of mirror therapy in combination with gamified exercises into virtual reality (VR) to provide a home-based rehabilitation environment for stroke patients. In this study, 48 stroke patients completed the full course of intervention with Rehago and their functional performance of pre- and post-intervention was investigated. The intervention with Rehago was predefined as 30 minutes training per day, 5 days per week over a course of 6 weeks. The patient's progress was evaluated by their therapists every 14 days, with a baseline assessment before the intervention began. The results showed an average improvement of 5.54 points in the Functional Independence Measurement score, and an improvement of 7.13 points in the assessed quality-of-life score (EQ5D-5L). An improvement of the FIM score and the quality-of-life score in EQ5D-5L was observed, indicating it is beneficial to the patients using Rehago as a home-based rehabilitation tool.

Pediatric oncology interventions involve many challenges, such as multiple hospitalizations, invasive procedures, and adverse physical and psychological treatment side effects. Treatment burden, including administration of general anesthesia, contributes to high levels of psychological distress among pediatric patients and their families. Virtual reality (VR) is a distraction method, which offers an extremely realistic and interactive virtual environment and helps reduce pain and distress by means of a head-mounted display and headphones. VR is based on two crucial dimensions: immersion and presence, which results in the complete suspension of disbelief that the experience is artificial and allows a greater degree of presence and reaction to the stimulations. The VR technology has become a common practice in scientific and clinical research due to its affordability and ease of use. In pediatric settings, the most widely researched clinical application of VR has focused on the effectiveness of VR distraction therapy in the attenuation of acute pain, anxiety, and distress during invasive medical procedures. It has also been hypothesized to be a nonpharmacological form of analgesia that positively influences the body's intricate pain modulation system during painful medical procedures. In this review, we showed the potential benefits of VR technology during radiotherapy and intrathecal procedures on pediatric oncology patients and its involvement in enhancing their quality of life during and after the treatment. Therefore, a collaboration between researchers, clinicians, and programmers is crucial for the inclusion of VR technology in more clinical procedures, which would consequently enhance the patient's quality of life.

Virtual reality (VR) has become an interesting alternative for the treatment of social phobia. This scoping review explored the impact of VR technologies in the treatment of social phobia (25 papers were included). Treatment approaches to social phobia included virtual reality exposure therapy, cognitive behaviour therapy, exposure group therapy, in vivo exposure therapy, and waiting list. VR was identified as the most successful approach, not only in improving social phobia, but also resulting in real life changes such as improvement in occupational success. VR Head Mounted Displays were used in most of studies (76%), followed by VR-based Specific Systems (24%). Although VR techniques indicated positive impact on patients to reduce their anxiety, it is paramount to consider variables such as the way therapists control the environment as well as individuals' characteristics for achieving the best outcome.

During the last decade, we have experienced fast development of virtual reality technology combined with various sensors and applications in different fields. The devices and applications are more easily accessible for the broader public. In this article, we describe a feasibility study of an affordable personalized, immersive VR motor rehabilitation system with full body tracking. While virtual reality rehabilitation is a relatively new field, several applications were already proven more effective than traditional rehabilitation programs. The applied methods utilize VR headset HTC Vive and HTC trackers together witch inverse kinematics algorithms to provide full body tracking. For that, we provide a framework for individual body calibration. The main result of the study is a developed virtual environment with guided rehabilitation scenarios based on personalized body calibration. We have proven that this approach can be used in personalized rehabilitation programs.

Serious games could be used to improve cognitive functions in the elderly. We evaluated the adoption of a new tablet application dedicated to cognitive stimulation in the elderly. The Stim'Art application offers various serious games to work different cognitive functions (memory, attention, concentration, etc.). The usage of fifteen older adults was followed for six months. The type of the game, the number of launches for each game, the time spent on each game, the difficulty level, the success rate and perceived well-being of users have been studied and compared at the end of the first and the sixth months. The participants have played half an hour per day on average. The average time of playing per day in the sixth month was significantly higher than the average time of playing during the first month (p value7 * 10(-4)). The same result was found for the average number of game launches per day (p value7 * 10(-4)). However, older people seem not to launch more difficult levels in the last month. The success rate at sixth months was significantly higher than the success rate at the end of the first month (p value6.4 * 1010(-4)). Generally, seniors have had an improvement in their wellbeing score judged by themselves. Our study showed that the mobile application receives a good admission from users. The results are promising and can pave the way for improving cognitive function in the elderly patients. The use of tablets and the constitution of serious games in close cooperation with health professionals and elderly patients (the end user), are likely to provide satisfactory results to improve healthcare provided for elderly patients suffering from cognitive disorders.

The widespread use and ubiquity of mobile computing technologies such as smartphones, tablets, laptops and portable gaming consoles has led to an increase in musculoskeletal disorders due to overuse, bad posture, repetitive movements, fixed postures and physical de-conditioning caused by low muscular demands while using (and over-using) these devices. In this paper we present the development of a hand motion-based virtual reality-based exergame for occupational health purposes that allows the user to perform simple exercises using a cost-effective non-invasive motion capture device to help overcome and prevent some of the muskoloskeletal problems associated with the over-use of keyboards and mobile devices.

Due to advances in treatment and people's living longer, chronic diseases are becoming more common among our population. This is a leading contributor to the increasing burden on our current healthcare system. To reduce this burden and sufficiently meet the needs of this growing segment of the population, healthcare organizations must encourage the elderly to take a more active role in caring for their own health and well-being. Technology may offer a solution to this shortcoming. "Positive Technology" focuses on the use of technology for improving the quality of our personal experience, and it suggests specific strategies for modifying/improving each of the different dimensions involved - Emotional Quality (affect regulation); Engagement/Actualization (presence and flow); Connectdness (collective intentions and networked flow) - and for generating motivation and engagement in the process. "Transformative Technology" are technologically-mediated experiences that support positive, enduring transformation of the self-world. The transformative content is delivered through a set of experiential affordances, which are stimuli designed to elicit emotional and cognitive involvement in the designed experience: (i) emotional affordances; (ii) epistemic affordances. The paper discusses discuss the possible role of positive and transormative technologies for healthy living and active ageing by presenting different practical applications of this approach recently developed by our team.

Researchers have shown that immersive Virtual Reality (VR) can serve as an unusually powerful pain control technique. However, research assessing the reported symptoms and negative effects of VR systems indicate that it is important to ascertain if these symptoms arise from the use of particular VR display devices, particularly for users who are deemed "at risk," such as chronic pain patients Moreover, these patients have specific and often complex needs and requirements, and because basic issues such as 'comfort' may trigger anxiety or panic attacks, it is important to examine basic questions of the feasibility of using VR displays. Therefore, this repeated-measured experiment was conducted with two VR displays: the Oculus Rift's head-mounted display (HMD) and Firsthand Technologies' immersive desktop display, DeepStream3D. The characteristics of these immersive desktop displays differ: one is worn, enabling patients to move their heads, while the other is peered into, allowing less head movement. To assess the severity of physical discomforts, 20 chronic pain patients tried both displays while watching a VR pain management demo in clinical settings. Results indicated that participants experienced higher levels of Simulator Sickness using the Oculus Rift HMD. However, results also indicated other preferences of the two VR displays among patients, including physical comfort levels and a sense of immersion. Few studies have been conducted that compare usability of specific VR devices specifically with chronic pain patients using a therapeutic virtual environment in pain clinics. Thus, the results may help clinicians and researchers to choose the most appropriate VR displays for chronic pain patients and guide VR designers to enhance the usability of VR displays for long-term pain management interventions.

Although Virtual Reality (VR) applications have been shown to reduce many forms of acute pain, such research of VR applications and their effects on chronic pain is still at its infancy. In this study, we designed a VR game Cryoslide, and examined its analgesic effect on chronic pain patients, its end users, in a clinical setting. In this randomized, controlled crossover clinical study of 20 chronic pain patients, Cryoslide significantly reduced perceived pain compared to the baseline and the control group. The results demonstrate that Cryoslide can be effectively used as an analgesic intervention for chronic pain management to lessen pain intensity during short-term symptom spikes.

Fibromyalgia (FM) is a disorder characterized by chronic physical pain. The perception of this pain has psychological effects on mood, anxiety, and the degree of perceived control. In turn, these factors may increase the experience of pain. This study aims to develop a new virtual environment for the treatment of FM in order to enhance the therapeutic effects of traditional interventions. The first phase included a sample of 19 patients in order to identify common characteristics of the representation of pain and absence of pain, through drawing. The results showed that patients used different colors and different physical states to depict pain (red, motionless) and the absence of pain (blue, in motion). These features were then included in a 3D representation of the human body. ANOVA analysis showed that the degree of anxiety and depression influenced the perceived characteristic of movement.

Post Traumatic Stress Disorder (PTSD) can be a debilitating problem in service members who have served in Iraq or Afghanistan. Virtual Reality Exposure Therapy (VRET) is one of the few interventions demonstrated in randomized controlled trials to be effective for PTSD in this population. There are theoretical reasons to expect that Virtual Reality (VR) adds to the effectiveness of exposure therapy, but there is also added expense and difficulty in using VR. Described is a trial comparing outcomes from VRET and a control exposure therapy (CET) protocol in service members with PTSD.

The AVATAR therapy is a computer-based intervention which aims to reduce the frequency and severity of voices. The approach is based on computer technology which enables each patient to create an avatar of the entity (human or non-human) that they believe is talking to them. The therapist promotes a dialogue between the patient and the avatar in which the avatar progressively comes under the patient's control. Using real-time voice conversion delivery software, the therapist can modify the relationship between the patient and his/her voice. The innovation of this new intervention is discussed in the present paper as well as the advantages of using a computer based system. The subjective view of the technology from a participant's point of view is also presented.

This paper presents a single-subject feasibility study of a motion-based VR game designed to provide benefits similar to constraint-induced movement therapy for children with cerebral palsy, while providing a more enjoyable experience. The game was designed to encourage the child to perform the desired therapeutic movements by allowing him to interact with the game using only his more-affected arm. The study used an AB design: Performance across baseline and intervention phases was assessed to determine whether the intervention resulted in changes to repeated measures. Results of the study showed that compared with baseline measurements done prior to his game experience, the participant's post-intervention performance showed improvement in speed of reach, dissociated movement, and bilateral integration of upper extremities in functional tasks. The child's mother, as well as one of his therapists, reported better performance outside of the study environment as well.

Letting children with severe physical disabilities (like Tetraparesis spastica) to get relevant motional experiences of appropriate quality and quantity is now the greatest challenge for us in the field of neurorehabilitation. These motional experiences may establish many cognitive processes, but may also cause additional secondary cognitive dysfunctions such as disorders in body image, figure invariance, visual perception, auditory differentiation, concentration, analytic and synthetic ways of thinking, visual memory etc. Virtual Reality is a technology that provides a sense of presence in a real environment with the help of 3D pictures and animations formed in a computer environment and enable the person to interact with the objects in that environment. One of our biggest challenges is to find a well suited input device (hardware) to let the children with severe physical disabilities to interact with the computer. Based on our own experiences and a thorough literature review we have come to the conclusion that an effective combination of eye-tracking and EMG devices should work well.

Using game technologies and digital media for improving physical and mental health and for the therapeutic benefit and well-being of a wide range of people is an area of study that is rapidly expanding. Much research in this emerging field is centered at the intersection of serious games, alternative realities, and play therapy. In this paper the authors describe their transdisciplinary work at this intersection: i) an integrative system of psychotherapy technologies called MyPsySpace currently being prototyped in Second Life with the aim of offering new and virtual translations of traditional expressive therapies (virtual sandplay, virtual drama therapy, digital expressive therapy, and virtual safe spaces) and ii) a mature body of research entitled SoundScapes that is exploring the use of interactive video games and abstract creative expression (making music, digital painting, and robotic device control) as a supplement to traditional physical rehabilitation intervention. Aside from introducing our work to a broader audience, our goal is to encourage peers to investigate ideas that reach across disciplines-to both risk and reap the benefits of combining technologies, theories, and methods stemming from multiple disciplines.

The stressful experiences that have been characteristic of the combat environments in Iraq and Afghanistan have produced significant numbers of returning service members at risk for developing posttraumatic stress disorder and other psychosocial/behavioral health conditions. This paper describes a set of projects that are expanding the content for inclusion in a newly updated "Virtual Iraq/Afghanistan" Virtual Reality system for the delivery of exposure therapy (VRET) for PTSD with Service Members and Veterans. In addition to the complete rebuilding of this VRET system using the latest version of the Unity Game Engine, the system's content and functionality has been expanded to now support the use of VRET with combat medics/corpsmen and persons who have experienced military sexual trauma (MST). The focus of this paper is to present the rationale and general overview of the progress on these projects that will provide new relevant and customizable options for conducting VRET with a wider range of trauma experiences.

Cue exposure therapy has been reported to be an effective intervention for reducing binge eating behavior in patients with eating disorders and obesity. However, in vivo food exposure conducted in the therapist's office presents logistical problems and lacks ecological validity. This study proposes the use of virtual reality technology as an alternative to in vivo exposure, and assesses the ability of different virtual environments to elicit anxiety and craving for food in a non-clinical sample. The results show that exposure to virtual environments provokes changes in reported craving for food. High-calorie food cues are the ones that elicit the highest increases in craving.

Although the symptoms of Post-Traumatic Stress Disorder (PTSD) in the general and military population seem very similar, combat-related PTSD (cr-PTSD) is typically thought to be more severe due to the repeated and prolonged exposure of traumatic events. Therapeutic adherence is reported a problem in military populations compromising treatment efficacy. Therefore, a new potential supplementary treatment is specially designed for patients with cr-PTSD. This intervention is called Military Motion Memory Desensitization and Reprocessing (3MDR). The treatment incorporates key elements of successful treatments as Virtual Reality Exposure (VRE) and Eye Movement Desensitization Reprocessing (EMDR) and adds motion to the condition. We aimed at designing a treatment procedure that preserved dual task processing principle, yet introduced new engagement by performing the desensitization during motion by to walking on a treadmill. Moreover, we aimed at exposure to real high-affect pictures of deployment setting. Subjects walk a repetitive cycle while walking and viewing high affect pictures of deployment scenes. Dual task processing was maintained by an oscillating ball. Aspects of presence are adhered to, to maximize possible positive outcome.Two veterans with chronic PTSD, received four weekly sessions of 3MDR therapy. The indicator of effectiveness was difference in CAPS (Clinical Administrated PTSD Scale)-score. The treatment was designed on the Computer Assisted Rehabilitation Environment (CAREN) facility.The 3MDR treatment did further decrease PTSD symptoms. Patients were highly satisfied about the treatment and had no attention to drop out.The results of the two cases suggest that the 3MDR treatment is a successful, more additional treatment that goes further into the patients affect where other treatment may stagnate. The presence was highly appreciated. Further research with more patients needs to be performed to obtain more reliable results.

Nightlife well-being interventions, although much needed, face several challenges related to the specificity of the context addressed. We argue that a game-facilitated intervention helps with facing these challenges. The characteristics of a game developed to this goal and the results of user tests conducted in situ are presented.

Smoking has increasingly become a burden on America's health and economic status. The fact that four out of every five adult smokers begins tobacco use before the age of eighteen indicates a need for teenage smoking cessation programs. The Virtual Reality Medical Center created an internet-based program that addresses the issue by utilizing cue exposure therapy in home and school environments to teach teens which cues trigger nicotine cravings and how to combat those cravings. The effectiveness of the program was measured through questionnaires administered before and after its use. Results indicated that the participants were engaged in the virtual environment, and that, in every aspect of the program, at least 8% more participants were knowledgeable about the subject than prior to the use of the program. Success of such a program could reduce teen smoking rates, ultimately leading to reduced smoking mortalities, complications, and costs overall.

Patients with psychosis exhibit a wide range of cognitive deficits which are associated with poor functioning and poor outcomes in psychosocial interventions. Recently, virtual reality (VR) has been demonstrated to be a useful tool for treatment and rehabilitation of these patients. We have developed and applied an integrated VR programme to improve social skills in people with schizophrenia: the Soskitrain. The aim of the present study is to evaluate the relationship between patients' cognitive deficits, their sense of presence and their ratings of the programme's acceptability. Twelve clinically stabilized outpatients with a well-established diagnosis of schizophrenia or schizoaffective disorder underwent neuropsychological assessment prior to treatment, while after the intervention they completed a questionnaire about their sense of presence and the acceptability of the VR programme. Post-treatment results revealed a high sense of presence among patients, as well as good verisimilitude and high acceptance of the virtual environments. In addition, there were significant negative correlations between sense of presence and deficits in both delayed verbal learning and processing speed. The paper discusses the implications of cognitive impairment for the experience and acceptance of VR when treating psychotic patients.

Cognitive difficulties are prevalent in people with diagnosis of schizophrenia and are associated with poor long-term functioning. In particular, memory, selective, divided and sustained attention and executive functions are altered by this disease. We used a Virtual Reality environment (developed via the NeuroVr2.0 software) for the rehabilitation of shifting, sustained attention and action planning functions using tasks reminiscent of daily life tasks. Test and retest showed significant differences in the assessed cognitive dimensions.

The consequences of alcohol dependence syndrome are severe, ranging from physical diseases to neuropsychological deficits in several cognitive domains. Alcohol abuse has also been related to brain dysfunction specifically in the prefrontal cortex. We assessed these deficits and the effects of traditional (pen-and-paper) and novel (mobile technology) approaches to cognitive stimulation of alcoholics in a neuropsychological intervention program. Thirty alcoholics in treatment of alcohol dependence syndrome were assessed during four weeks on a three-day/week basis. The results showed an overall increase in frontal lobe function between the first and the final assessment, being more pronounced in alcoholics who were assigned to a treatment group with mobile technologies than to those assigned to a paper-and-pencil treatment and to a control group. These results support the use of ecologically sound and available approaches of neuropsychological stimulation to treat executive dysfunction in patients with alcohol dependence syndrome.

Peak provoked craving (PPC) is an alternative approach to cue-induced craving that focuses on the highest craving level experienced during the exposure to drug-related cues. The main objective of this study was to assess the effect of abstinence on PPC in smokers and to determine whether PPC is altered by continuous abstinence. Results showed reductions on PPC levels only 24 hours after achieving abstinence and craving levels remain significantly lower after 7 days of abstinence.

Several approaches to the treatment of bulimia nervosa have proved effective, including cognitive-behavioral therapy; however, not all patients improve. It is therefore necessary to explore the possibilities of increasing the efficacy of such treatments. One way to attempt this is to incorporate new technologies. This review explores the possibility of developing a new, empirically validated procedure for the treatment of bulimia nervosa patients that involves cue exposure via virtual reality.

Anxiety as a symptom or disorder is affected by multiple variables such as antecedent events, interpretation of the events, psychological vulnerability, and individual differences in the reaction towards an event. Nowadays, virtual-reality therapy is used as therapeutic tool for patients suffering from some kind of anxiety disorder. In Mexico, the National Survey on Psychiatric Epidemiology [1] informed that anxiety disorders are the most common disorders followed by affective disorders, which are more prevalent in women than in men. Among the different anxiety disorders, the category of specific phobias (7.1%) was the most common. Based on this demand, a collaborative effort between research groups from the University Jaume I in Spain and the National Autonomous University of Mexico (UNAM), initiated a project which purpose was the technological transfer of systems based on virtual reality for the treatment of Fear of Flying to be implemented and evaluated in the Mexican population. The treatment protocol developed by Botella et al., [2] has been applied to five volunteer participants. In this paper we present data of adapted treatment protocols in Mexican population that support the efficacy of VR of treatment of fear of flying, achieved by the Spanish research group.

Some clinicians have suggested using virtual reality environments to deliver psychological interventions to treat anxiety disorders. However, given a significant body of work on cybersickness symptoms which may arise in virtual environments - especially those involving simulated motion - we tested (a) whether being exposed to a virtual reality environment alone causes anxiety to increase, and (b) whether exposure to simulated motion in a virtual reality environment increases anxiety. Using a repeated measures design, we used Kim's Anxiety Scale questionnaire to compare baseline anxiety, anxiety after virtual environment exposure, and anxiety after simulated motion. While there was no significant effect on anxiety for being in a virtual environment with no simulated motion, the introduction of simulated motion caused anxiety to significantly increase, but not to a severe or extreme level. The implications of this work for virtual reality exposure therapy (VRET) are discussed.

In this work, we propose the use of Transcranial Doppler Monitoring (TCD) as a tool to measure brain activity during the exposure to Virtual Environments (VE) used in clinical therapy sessions. The technique is non-invasive, and can be easily integrated with Virtual Reality (VR) settings. Moreover, it provides a high temporal resolution, which grants the possibility to analyze changes in brain activity during the evolution of a clinical session and to correlate them with specific events that may occur in the VE. We have performed two studies combining TCD with VR. Results of these studies show that it is feasible to use this technique in combination with VR settings designed for virtual therapy. It was observed that immersion and navigation modifications in the VE generated changes in brain activity that can be detected using TCD.

More than 30 years after signing truces, there are still around 20,000 Portuguese war veterans that fill PTSD (Posttraumatic Stress Disorder) diagnose criteria. Despite many of them attending therapy, the outcome is not cheerful. In this way, a research protocol was devised to investigate the opportunity of adopting virtual reality exposure therapy (VRET) to reduce PTSD symptomathology. This protocol consists on a controlled study (VRET vs. traditional psychotherapy vs. waiting list), where in the VRET condition patients will be graded by being exposed to a virtual reality jungle scenario. The activating episodes, that are comprised of three cues (ambush, mortar blasting and waiting for injured rescue), are repeated 3 times each session. The cues' intensity and frequency increase from session to session. Patients are exposed to the VR world through a HMD (Head Mounted Display). This paper reports on the ongoing research where 4 VRET patients that filled CAPS DSM-IV PTSD criteria were assessed at pretreatment and at the middle of treatment (5th session). Results from IES and SCL-90R dimensions showed no statistical significant differences between assessments, with exception to obsession-compulsion dimension of SCL-90R (F(1;3)=21.235; p.05), indicating a decrease in obsessive thoughts. However, through descriptive analysis, it was observed a reduction in all IES and SCL-90R dimensions, except for hostility and psychoticism of SCL-90R.