Realidade virtual na reabilitação de doentes com acidente vascular cerebral: uma scoping review / Virtual reality in the rehabilitation of stroke patients: a scoping review

Introdução: O AVC constitui-se como um dos principais desafios de saúde pública a nível mundial acarretando um elevado impacto em diferentes níveis. A intervenção do Enfermeiro Especialista em Enfermagem de Reabilitação assume um papel preponderante nos cuidados ao doente após AVC. A evolução da tecnologia, os avanços da ciência e da terapêutica no tratamento do AVC, tem vindo a evidenciar-se com repercussões na melhoria da qualidade de vida dos doentes. Com esta evolução surge a Realidade Virtual como um recurso terapêutico com a capacidade de gerar ambientes flexíveis e adequados no processo de recuperação. Objetivo: Mapear o efeito da Realidade Virtual na Reabilitação de Doentes com Acidente Vascular Cerebral. Metodologia: Estudo de revisão, scoping review, sustentada na metodologia de Joanna Briggs Institute. Definindo a População (P), Conceito (C) e Contexto (C) em que P: doentes adultos com AVC, independentemente do género, (C) realidade virtual e (C) reabilitação motora, cognitiva e/ou sensorial. Formulada a questão de revisão: "Qual o Efeito da Realidade Virtual na Reabilitação de Doentes com AVC?". Realizada pesquisa nas seguintes bases de dados: PubMed, CINAHL complete, EBSCO, SciELO e RCAAP com espaço temporal de publicação de janeiro de 2012 a dezembro de 2022. Resultados: Foram incluídos trinta e quatro estudos com diferentes metodologias e natureza de estudo. A análise dos estudos revelou que a integração da realidade virtual conduziu a ganhos nos domínios da reabilitação motora, cognitiva e sensorial com influência na qualidade de vida, podendo ser considerada como um método eficaz e um importante coadjuvante dos programas de reabilitação convencional. Conclusões: Evidenciada a utilidade do uso da realidade virtual no processo de reabilitação, nomeadamente nos programas específicos concebidos e implementados pelo Enfermeiro Especialista em Enfermagem de Reabilitação. Podemos então considerar que o efeito da realidade virtual na reabilitação de doentes com AVC parece ser positivo.

Introduction: Stroke is one of the main public health challenges worldwide, causing a high impact at different levels. The intervention of the Specialist Nurse in Rehabilitation Nursing plays a preponderant role in the care of patients after a stroke. The evolution of technology, advances in science and therapy in the treatment of stroke, have been evident with repercussions in improving the life quality of patients. With this evolution Virtual Reality emerges as a therapeutic resource with the ability to generate flexible and appropriate environments in the recovery process. Objective: Map the effect of Virtual Reality in the Rehabilitation of Patients with Stroke. Methodology: Review study, a scoping review, based on the Joanna Briggs Institute methodology. Defining the Population (P), Concept (C) and Context (C) in which (P): adult stroke patients, regardless of gender, (C) virtual reality and (C) motor, cognitive and/or sensory rehabilitation. The review question was formulated: "What is the Effect of Virtual Reality on the Rehabilitation of Stroke Patients?". Research was carried out in the following databases: PubMed, CINAHL complete, EBSCO, SciELO and RCAAP with publication timeframe from January 2012 to December 2022. Results: Thirty-four studies with different methodologies and study nature were included. The analysis of the studies revealed that the integration of virtual reality led to gains in the areas of motor, cognitive and sensory rehabilitation with an influence on quality of life and can be considered as an effective method and an important adjunct to conventional rehabilitation programs. Conclusions: The usefulness of using virtual reality in the rehabilitation process was highlighted, particularly in specific programs designed and implemented by Specialist Nurse in Rehabilitation Nursing. We can thus consider that the effect of virtual reality on the rehabilitation of stroke patients appears to be positive.

The Effect of Immersive Virtual Reality Application on Anxiety, Pain, and Parental Satisfaction in the Perioperative Process of Children: A Randomized Controlled Trial.

PURPOSE: To determine the effects of virtual reality (VR) interventions on pre- and postoperative anxiety, pain, and parental satisfaction in children. DESIGN: A randomized controlled trial. METHODS: Children undergoing surgery for the first time and their families were randomly assigned to the control or VR group. The control group received conventional education regarding the perioperative process. The VR group watched a VR video illustrating the operating theater and explaining the perioperative process. The primary outcome of interest was preoperative anxiety, evaluated using the Children's State Anxiety Scale. Secondary outcomes of interest included postoperative pain ratings using the Wong-Baker Faces Pain Rating Scale and parental satisfaction scores using the PedsQL Health Care Satisfaction Scale. RESULTS: The analysis included 70 children and their families (control = 35, VR = 35). Demographic characteristics were similar between the groups. Children in the VR group had significantly lower preoperative anxiety scores (p < .001) and postoperative anxiety scores (p = .010) compared to the control group. Parental satisfaction scores were significantly higher in the VR group (p < .001). The VR group had lower postoperative pain scores, but this difference was not statistically significant (p > .05). CONCLUSIONS: Preoperative education using VR tours may reduce preoperative anxiety and increase parental satisfaction. However, the lack of baseline measurements limits our ability to definitively attribute these effects to the VR intervention. Despite this, VR is a promising nonpharmacological strategy for managing children's anxiety and increasing parental satisfaction. CLINICAL IMPLICATIONS: Virtual reality interventions offer an effective nonpharmacological strategy for perioperatively managing children's anxiety and increasing parental satisfaction.

The Effect of Video Streaming With Virtual Reality Glasses on on Pain Anxiety and Satisfaction Applied in Peripheral Intravenous Catheter Process.

BACKGROUND: Peripheral intravenous catheter (PIC) implementation is among the most frequent and highly invasive nursing initiatives. PIC leads to anxiety with procedural pain, causing individuals to reject these procedures or negatively affecting the process's success. AIM: The study was conducted to determine the effect of virtual reality glasses (VRG) on pain, anxiety, and patient satisfaction during the peripheral intravenous catheter (PIC) process in adults. DESIGN: An experimental study. SETTINGS: An emergency department of a university hospital. METHODS: Individuals who were admitted to the emergency unit of the university hospital were recruited between the data collection dates. Data from individuals' "Patient Information Form," "Visual Pain Scale," "Visual Anxiety Scale," and "Visual Satisfaction Scale" were collected. "VR-Box 3D Glasses" was used as virtual reality glasses. RESULTS: In our study, when the pain point averages with VAS were compared during the PIC process, the pain score average of the patients in the control group was 5.78 ± 1.23 visual anxiety scale 5.89 ± 1.23 and patient satisfaction scale 3.86 ± 2.48, The visual pain score average of patients in the VRG group is 4.12 ± 2.16, visual anxiety scale 3.14 ± 1.76 and visual patient satisfaction scale 7.64 ± 3.26. In short, it has been detected that the pain, anxiety, and patient satisfaction score averages of patients in the VRG group are statistically significant compared to the pain score averages of patients in the control group (p < .005). Our study unearthed a statistically significant relationship at an average level of negative direction between PIC post-treatment pain, anxiety, and patient satisfaction (r = - 0.476). CONCLUSION: Utilization of VRG has been detected to reduce pain and anxiety felt during the PIC process in adult patients and increase process satisfaction. VRG, a non-pharmacological, non-invasive, inexpensive, and feasible nursing initiative, may be recommended for use in pain and anxiety control in patients undergoing PIC treatment.

Scientometric Analysis of the World Scientific Production on Augmented and Virtual Reality in Dental Education.

AIM: The aim of this study was to perform a comprehensive bibliometric analysis of virtual reality (VR) and augmented reality (AR) applications in dental education. MATERIALS AND METHODS: A cross-sectional research was carried out using a bibliometric methodology. This process entailed the assessment of metadata from scientific publications that are catalogued in the Scopus database, covering the period from January 2018 to August 2023. A variety of indicators were utilized to scrutinize scientific production and dissemination within the academic community. These encompassed elements such as the author, the publication itself, the number of citations, institutional and collaborative affiliations, geographical location, journal quartile ranking, h-index, Source Normalized Impact per Paper (SNIP), Field-Weighted Citation Impact (FWCI), SCImago Journal Rank (SJR), and the CiteScore. RESULTS: Several institutions from different countries and their academic output were found. Beihang University stands out with 16 scholarly articles, followed by Stanford University with 16 articles and 170 citations. The Q1 quartile has experienced a steady increase, reaching 87 scientific articles. The top 10 authors in scientific production on augmented and VR in dentistry include Joe Amal Cecil, Avinash Gupta, and Miguel A Pirela-Cruz. In terms of co-authorship by country, the United States, Germany, and China are the most predominant in the clusters represented. However, other clusters also have a significant presence. By analyzing the explored trends and themes of keyword co-occurrence, four main clusters were identified. The yellow cluster contained the largest amount of research with the keyword "virtual reality." In addition, the blue cluster was found to be best related to the green "simulation," purple "virtual reality (VR)," and light blue "human-centered computing" clusters. CONCLUSION: This study evidenced the availability and quality of the data used for the analysis. Future studies could consider the use of VR systems with integrated eye tracking and compare their effect in dentistry during dental procedures. CLINICAL SIGNIFICANCE: The clinical importance of this study lies in its potential to improve dental education. The VR and AR can provide dental students with immersive, hands-on learning experiences, which can enhance their understanding and clinical skills. Furthermore, the translational value of this study extends beyond dental education. The insights gained from this research could be applicable to other fields of medical education where hands-on training is crucial. Thus, the findings of this study have the potential to influence the broader landscape of medical education, ultimately leading to improved healthcare outcomes. How to cite this article: Alvitez-Temoche D, Silva H, Aguila ED, et al. Scientometric Analysis of the World Scientific Production on Augmented and Virtual Reality in Dental Education. J Contemp Dent Pract 2024;25(4):358-364.

Beyond the symptoms: Exploring attachment styles and reality-testing among schizophrenia clients from a nursing perspective.

WHAT IS KNOWN ON THE SUBJECT?: The insecure attachment styles are associated with mental health problems and can influence reality perception, particularly in individuals with schizophrenia. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper provides empirical evidence for the correlation between insecure attachment styles and reality-testing impairment in clients with schizophrenia. Higher reality testing impairment scores were observed in specific demographics: males who were unmarried and aged between 40 and 50 years old, as well as those with a duration of illness of less than 5 years. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings underscore the importance for nurses to understand insecure attachment styles, particularly anxious and avoidant styles, in clients with schizophrenia. Healthcare providers and nurses should understand the psychological dynamics of clients with insecure attachment styles to establish effective therapeutic relationships. A secure, structured and consistent environment is vital to modifying insecure attachment styles and promoting reality orientation. Secure Attachment Style Psycho-Educational Program, Mentalization, Cognitive Interpersonal Therapy, and Cognitive Analytic Therapy can help reduce reality-testing impairment. Imply early intervention through educating mothers on fostering secure bonds can potentially prevent future occurrences of schizophrenia. WHAT ARE THE IMPLICATIONS FOR FUTURE RESEARCH?: Conducting empirical studies to explore the associations between insecure attachment style, social functioning, and poor service engagement is essential. Research is needed to investigate specific techniques for managing insecure attachment styles, particularly the avoidant ones, and reality testing impairments within the therapeutic setting. ABSTRACT: INTRODUCTION: Insecure attachment styles are associated with mental health problems and may influence reality perception. AIM: This study investigated the link between attachment styles and reality-testing impairment in individuals with schizophrenia. METHODS: A cross-sectional survey with 200 participants diagnosed with schizophrenia assessed their attachment styles (Psychosis Attachment Measure) and reality-testing abilities (Bell Reality Testing Inventory). RESULTS: A significant positive correlation emerged between insecure attachment and poorer reality testing (r = .394, p < .001). Avoidant attachment was most prevalent (mean scores: 17.01, SD = 3.71), followed by anxious attachment (16.53, SD = 4.20). Reality-testing impairment manifested across all three domains: uncertainty of perception (7.16, SD = 2.45), reality distortion (3.52, SD = 1.21), and hallucinations/delusions (26.63, SD = 5.83). Interestingly, specific demographics (male, unmarried, 40-50 years old) and those with a duration of illness of less than 5 years had higher mean scores (27.35, SD = 5.61). DISCUSSION: Insecure attachment styles, notably anxious and avoidant, are dominant among clients with schizophrenia, who also struggle with reality distortion, perceptual uncertainty, and hallucinations/delusions in all three domains. IMPLICATION FOR PRACTICE: Healthcare providers and nurses should understand the psychological dynamics of clients with insecure attachment styles to establish effective therapeutic relationships. A secure, structured, and consistent environment is vital to modifying insecure attachment styles and promoting reality orientation. Secure Attachment Style Oriented Psycho-Educational Program, Mentalization, Cognitive Interpersonal Therapy, and Cognitive Analytic Therapy can help reduce reality-testing impairment. Fostering Maternal and Child Health (MCH) centers on empathizing secure bonds between mothers (and mothers-to-be) and their children to promote healthy attachment styles as a preventive measure.

Artificial intelligence innovations in neurosurgical oncology: a narrative review.

PURPOSE: Artificial Intelligence (AI) has become increasingly integrated clinically within neurosurgical oncology. This report reviews the cutting-edge technologies impacting tumor treatment and outcomes. METHODS: A rigorous literature search was performed with the aid of a research librarian to identify key articles referencing AI and related topics (machine learning (ML), computer vision (CV), augmented reality (AR), virtual reality (VR), etc.) for neurosurgical care of brain or spinal tumors. RESULTS: Treatment of central nervous system (CNS) tumors is being improved through advances across AI-such as AL, CV, and AR/VR. AI aided diagnostic and prognostication tools can influence pre-operative patient experience, while automated tumor segmentation and total resection predictions aid surgical planning. Novel intra-operative tools can rapidly provide histopathologic tumor classification to streamline treatment strategies. Post-operative video analysis, paired with rich surgical simulations, can enhance training feedback and regimens. CONCLUSION: While limited generalizability, bias, and patient data security are current concerns, the advent of federated learning, along with growing data consortiums, provides an avenue for increasingly safe, powerful, and effective AI platforms in the future.

Virtual reality-based therapy for chronic low back and neck pain: a systematic review with meta-analysis.

Purpose: To compile all the scientific evidence available to date to evaluate the effect of virtual reality based therapy (VRBT) on reducing pain intensity, kinesiophobia, and associated disability, and on increasing the hr-QoL in patients with chronic neck pain (CNP) or chronic low back pain (CLBP). Methods: Studies published in PubMed Medline, SCOPUS, Web of Science, CINAHL Complete, and Physiotherapy Evidence Database (PEDro) up to June 2023 were searched. All searches followed the PICOS Framework. Two authors independently screened the studies found in the searches. Any differences of opinion regarding the selection of studies were settled by a third author. Results: Twenty-five RCTs, published between 2013 and 2022, providing data from 1261 patients (20 RCTs) with CLBP and 261 patients (five RCTs) with CNP, were included. In reducing pain intensity for patients with CLBP, meta-analyses showed that VRBT is effective in reducing pain just to the end of the intervention, and this effect could be maintained 1 and 6 months after the therapy. Conclusion: VRBT was found to be better than therapeutic exercise (TE), sham, and no intervention (NI), showing a major effect when VRBT was used as a complementary therapy to conventional physiotherapy (CPT). Further, VRBT showed an immediate effect and immersive VRBT was the most adequate VRBT modality in reducing pain in CNP patients. No differences were found between non-immersive VRBT and immersive VRBT in reducing pain, kinesiophobia, disability, and hr-QoL in patients with CLBP.

Observers predict actions from facial emotional expressions during real-time social interactions.

In face-to-face social interactions, emotional expressions provide insights into the mental state of an interactive partner. This information can be crucial to infer action intentions and react towards another person's actions. Here we investigate how facial emotional expressions impact subjective experience and physiological and behavioral responses to social actions during real-time interactions. Thirty-two participants interacted with virtual agents while fully immersed in Virtual Reality. Agents displayed an angry or happy facial expression before they directed an appetitive (fist bump) or aversive (punch) social action towards the participant. Participants responded to these actions, either by reciprocating the fist bump or by defending the punch. For all interactions, subjective experience was measured using ratings. In addition, physiological responses (electrodermal activity, electrocardiogram) and participants' response times were recorded. Aversive actions were judged to be more arousing and less pleasant relative to appetitive actions. In addition, angry expressions increased heart rate relative to happy expressions. Crucially, interaction effects between facial emotional expression and action were observed. Angry expressions reduced pleasantness stronger for appetitive compared to aversive actions. Furthermore, skin conductance responses to aversive actions were increased for happy compared to angry expressions and reaction times were faster to aversive compared to appetitive actions when agents showed an angry expression. These results indicate that observers used facial emotional expression to generate expectations for particular actions. Consequently, the present study demonstrates that observers integrate information from facial emotional expressions with actions during social interactions.

Analyzing muscle thickness changes in lateral abdominal muscles while exercising using virtual reality.

[Purpose] Virtual reality (VR) rehabilitation has become popular in the medical field. VR-guided exercises (VR-ge) have demonstrated positive effects on gait and trunk control. Trunk muscle activation, particularly that of the transversus abdominis (TrA), is responsible for these improvements. However, the difference in muscle activation between VR and real space remains unclear. Therefore, this study aimed to clarify the differences in trunk muscle activation during exercise therapy performed in VR and real space. [Participants and Methods] A total of 22 healthy male volunteers were divided into two equal groups: VR-ge and Control exercise (C-e) groups. Both groups performed reaching exercises in a seated position. Ultrasound imaging was used to measure the thicknesses of the right external oblique, internal oblique, and TrA muscles, both at rest and during the reaching exercises performed in six different directions. [Results] No significant differences were observed in TrA muscle thickness changes between the groups before the intervention. However, after the intervention, the VR-ge group showed significantly greater TrA muscle thickness changes during reaching compared to that of the C-e group. [Conclusion] VR-ge increased TrA activation during reaching compared to exercising in real space.

Sex-related differences in young binge drinkers on the neurophysiological response to stress in virtual reality.

Background: Stress is one of the main environmental factors involved in the onset of different psychopathologies. In youth, stressful life events can trigger inappropriate and health-damaging behaviors, such as binge drinking. This behavior, in turn, can lead to long-lasting changes in the neurophysiological response to stress and the development of psychological disorders late in life, e.g., alcohol use disorder. Our aim was to analyze the pattern of neurophysiological responses triggered with the exposition to a stressful virtual environment in young binge drinkers. Methods: AUDIT-3 (third question from the full AUDIT) was used to detect binge drinking (BD) in our young sample (age 18-25 years). According to the score, participants were divided into control (CO) and BD group. Next, a standardized virtual reality (VR) scenario (Richie's Plank) was used for triggering the stress response while measuring the following neurophysiological variables: brain electrical activity by electroencephalogram (EEG) and cortisol levels through saliva samples both measurements registered before and after the stressful situation. Besides, heart rate (HR) with a pulsometer and electrodermal response (EDA) through electrodes placed on fingers were analyzed before, during and after the VR task. Results: Regarding the behavior assessed during the VR task, BD group spent significantly less amount of time walking forward the table and a tendency toward more time walking backwards. There was no statistically significant difference between the BD and the CO group regarding time looking down, but when we controlled the variable sex, the BD women group displayed higher amount of time looking down than the rest of the groups. Neurophysiological measurements revealed that there was not any statistically significant difference between groups in any of the EEG registered measures, EDA response and cortisol levels. Sex-related differences were found in HR response to VR scenario, in which BD women displayed the highest peak of response to the stressor. Also, the change in heartbeat was higher in BD women than men. Conclusion: Unveiling the neurophysiological alterations associated with BD can help us to prevent and detect early onset of alcohol use disorder. Also, from our data we conclude that participants' sex can modulate some stress responses, especially when unhealthy behaviors such as BD are present. Nevertheless, the moment of registration of the neurophysiological variables respect to the stressor seems to be a crucial variable.

Optimizing placebo and minimizing nocebo effects through communication: e-learning and virtual reality training development.

BACKGROUND: The effects of many treatments in healthcare are determined by factors other than the treatment itself. Patients' expectations and the relationship with their healthcare provider can significantly affect treatment outcomes and thereby play a major role in eliciting placebo and nocebo effects. We aim to develop and evaluate an innovative communication training, consisting of an e-learning and virtual reality (VR) training, for healthcare providers across all disciplines, to optimize placebo and minimize nocebo effects through healthcare provider-patient communication. The current paper describes the development, mid-term evaluation, optimization, and final evaluation of the communication training, conducted in The Netherlands. METHODS: The development of both the e-learning and the VR training consisted of four phases: 1) content and technical development, 2) mid-term evaluation by healthcare providers and placebo/communication researchers, 3) optimization of the training, and 4) final evaluation by healthcare providers. To ensure the success, applicability, authenticity, and user-friendliness of the communication training, there was ongoing structural collaboration with healthcare providers as future end users, experts in the field of placebo/communication research, and educational experts in all phases. RESULTS: Placebo/communication researchers and healthcare providers evaluated the e-learning positively (overall 7.9 on 0-10 scale) and the content was perceived as useful, accessible, and interesting. The VR training was assessed with an overall 6.9 (0-10 scale) and was evaluated as user-friendly and a safe method for practicing communication skills. Although there were some concerns regarding the authenticity of the VR training (i.e. to what extent the virtual patient reacts like a real patient), placebo and communication researchers, as well as healthcare providers, recognized the significant potential of the VR training for the future. CONCLUSIONS: We have developed an innovative and user-friendly communication training, consisting of an e-learning and VR training (2D and 3D), that can be used to teach healthcare providers how to optimize placebo effects and minimize nocebo effects through healthcare provider-patient communication. Future studies can work on improved authenticity, translate the training into other languages and cultures, expand with additional VR cases, and measure the expected effects on providers communication skills and subsequently patient outcomes.

Emotional eating, internet overuse, and alcohol intake among college students: a pilot study with virtual reality.

Introduction: The term emotional eating (EE) describes the tendency to eat as an automatic response to negative emotions and has been linked to anxiety and depression, common symptoms among the university population. The EE tendencies have also been associated with excessive internet use and an increase in alcohol intake among young university students. Methods: The aim of this study is to examine the relationship between the tendency towards EE and other health-compromising behaviors, such as excessive internet use or high alcohol intake. Additionally, it aims to investigate the association of these risky behaviors with the participants' performance level in a virtual reality (VR) task that assesses their executive functioning, and to assess impulsivity and levels of anxiety and depression. Results: The results associate EE with excessive internet (r = 0.332; p < 0.01). use but not with alcohol consumption. Alcohol consumption was not associated with anxiety, depression, or impulsivity, but it was related to altered executive functions in the VR task: flexibility and working memory explained 24.5% of the variance. By contrast, EE and internet overuse were not related to executive function but were associated with impulsivity, depression, and anxiety. Impulsivity and depressive symptoms accounted for 45% of the variance in EE. Depression, trait anxiety and impulsivity explained 40.6% of the variance in internet overuse. Discussion: The results reveal distinct patterns of psychological and neuropsychological alterations associated with alcohol consumption compared to emotional eating (EE) and excessive internet use. These findings underscore significant differences in the contributing factors between addictions and other substance-free addictive behaviors. For a deeper understanding of the various contributing factors to EE in college students, further research is recommended.

The effectiveness of extended reality on relieving pain after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: Patients with total knee arthroplasty (TKA) often suffer from severe postoperative pain, which seriously hinders postoperative rehabilitation. Extended reality (XR), including virtual reality, augmented reality, and mixed reality, has been increasingly used to relieve pain after TKA. The purpose of this study was to evaluate the effectiveness of XR on relieving pain after TKA. METHODS: The electronic databases including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov were searched for studies from inception to July 20, 2023. The outcomes were pain score, anxiety score, and physiological parameters related to pain. Meta-analysis was performed using the Review Manager 5.4 software. RESULTS: Overall, 11 randomized control trials (RCTs) with 887 patients were included. The pooled results showed XR had lower pain scores (SMD = - 0.31, 95% CI [- 0.46 to - 0.16], P < 0.0001) and anxiety scores (MD = - 3.95, 95% CI [- 7.76 to - 0.13], P = 0.04) than conventional methods. The subgroup analysis revealed XR had lower pain scores within 2 weeks postoperatively (SMD = - 0.49, 95% CI [- 0.76 to - 0.22], P = 0.0004) and XR had lower pain scores when applying XR combined with conventional methods (SMD = - 0.43, 95% CI [- 0.65 to - 0.20], P = 0.0002). CONCLUSION: This systematic review and meta-analysis found applying XR could significantly reduce postoperative pain and anxiety after TKA. When XR was combined with conventional methods, postoperative pain can be effectively relieved, especially within 2 weeks after the operation. XR is an effective non-pharmacological analgesia scheme.

Efficacy of virtual reality exercise in knee osteoarthritis rehabilitation: a systematic review and meta-analysis.

Background: This systematic review and meta-analysis aims to investigate the effects of virtual reality (VR) exercise compared to traditional rehabilitation on pain, function, and muscle strength in patients with knee osteoarthritis (KOA). Additionally, the study explores the mechanisms by which VR exercise contributes to the rehabilitation of KOA patients. Methods: We systematically searched PubMed, the Cochrane Library, Embase, Web of Science, Scopus, and PEDro according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search spanned from the library construction to 24 May 2024, focusing on randomized controlled trials Primary outcomes included pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and muscle strength. Meta-analysis was conducted using RevMan (version 5.4) and Stata (version 14.0). The bias risk of included studies was assessed using the Cochrane RoB 2.0 tool, while the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: This meta-analysis and systematic review included nine studies involving 456 KOA patients. The results indicated that VR exercise significantly improved pain scores (SMD, -1.53; 95% CI: -2.50 to -0.55; p = 0.002), WOMAC total score (MD, -14.79; 95% CI: -28.26 to -1.33; p = 0.03), WOMAC pain score (MD, -0.93; 95% CI: -1.52 to -0.34; p = 0.002), knee extensor strength (SMD, 0.51; 95% CI: 0.14 to 0.87; p = 0.006), and knee flexor strength (SMD, 0.65; 95% CI: 0.28 to 1.01; p = 0.0005), but not significantly for WOMAC stiffness (MD, -0.01; 95% CI: -1.21 to 1.19; p = 0.99) and physical function (MD, -0.35; 95% CI: -0.79 to -0.09; p = 0.12). Conclusion: VR exercise significantly alleviates pain, enhances muscle strength and WOMAC total score in KOA patients, but improvements in joint stiffness and physical function are not significant. However, the current number of studies is limited, necessitating further research to expand on the present findings. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024540061, identifier CRD42024540061.

Taking the edge off: a feasibility randomized controlled trial of an online mindfulness-based intervention to reduce suspiciousness/paranoia in high positive schizotypy.

Positive schizotypy can uniquely predict the development of psychosis with suspiciousness/paranoia having emerged as a key risk factor, pointing to significant worth in reducing this aspect in individuals with high positive schizotypy. Reduced paranoia in the general population following brief online mindfulness training has been previously reported. This study investigated the feasibility of a 40-day online mindfulness-based intervention (MBI) (n = 12) in the individuals with high positive schizotypy characterized by high suspiciousness/paranoia and to estimate its effect on paranoia as compared with an active control condition using reflective journaling (n = 12). The outcome measures were self-reported trait and VR-induced state paranoia, completed at baseline, after 10 days and post-intervention. The feasibility criteria included retention, adherence, engagement, and acceptability. There was 100% retention, excellent adherence to content and engagement, with an average MBI session completion rate of 91%. Acceptability, indexed by a self-rated motivation to continue practice post-intervention, was also high. No MBI effect on trait paranoia was observed; however, the MBI group showed a reduction in the VR-induced state paranoia with a medium-to-large effect (d = 0.63). The findings support conducting larger-scale randomized controlled trials to evaluate the effects of online MBIs on reducing suspiciousness/paranoia to mitigate psychosis risk in individuals with high positive schizotypy. Clinical Trial Registration:https://www.isrctn.com/, identifier ISRCTN78697391.

NextLens-The Next Generation of Surgical Navigation: Proof of Concept of an Augmented Reality System for Surgical Navigation.

Objective The aim of this work was the development of an augmented reality system including the functionality of conventional surgical navigation systems. Methods An application software for the Augmented Reality System HoloLens 2 from Microsoft was developed. It detects the position of the patient as well as position of surgical instruments in real time and displays it within the two-dimensional (2D) magnetic resonance imaging or computed tomography (CT) images. The surgical pointer instrument, including a pattern that is recognized by the HoloLens 2 sensors, was created with three-dimensional (3D) printing. The technical concept was demonstrated at a cadaver skull to identify anatomical landmarks. Results With the help of the HoloLens 2 and its sensors, the real-time position of the surgical pointer instrument could be shown. The position of the 3D-printed pointer with colored pattern could be recognized within 2D-CT images when stationary and in motion at a cadaver skull. Feasibility could be demonstrated for the clinical application of transsphenoidal pituitary surgery. Conclusion The HoloLens 2 has a high potential for use as a surgical navigation system. With subsequent studies, a further accuracy evaluation will be performed receiving valid data for comparison with conventional surgical navigation systems. In addition to transsphenoidal pituitary surgery, it could be also applied for other surgical disciplines.

From real to virtual prism adaptation therapy: a systematic review on benefits and challenges of a new potential rehabilitation approach.

Prism adaptation (PA) is a sensorimotor technique that has been shown to alleviate neglect symptoms. Due to its demonstrated functional effectiveness, PA has recently been implemented in virtual reality environments. However, research on virtual prism adaptation (VPA) is limited and it lacks a standardized methodological approach. It is crucial to investigate whether VPA can be effective in inducing traditional effect of PA and to have potential utility in a rehabilitation context. Clarifying this aspect would allow the use of VPA in a wider range of contexts and neurological disorders, with the additional opportunity to overcome PA traditional limits. The aim of the present study is to revise current literature on VPA in both healthy individuals and patients highlighting also its advantages and limitations. Studies performed between 2013 and 2023 and fulfilling the inclusion criteria were searched on three electronic databases, by combining the terms "Virtual prism adaptation" and "Virtual prism adaptation therapy. Out of 123 articles, only 16 met the inclusion criteria. The current literature review suggests that VPA may serve as a potentially useful tool for inducing visuomotor adaptation, with most studies conducted in healthy individuals. The high variability in the methodologies observed among studies suggests that more standardized approaches are needed to gain a deeper understanding of the mechanisms underlying adaptation and aftereffects when PA is administered in a virtual environment. Future studies should also address practical applications and clinical efficacy of VPA, particularly in patients with spatial neglect.

Successful laparoscopic retroperitoneal tumor resection using mixed reality and guiding marker techniques.

Introduction: Small tumors may be difficult to identify visually and require preoperative effort to locate. Recent advancements in mixed reality technology have improved surgical accuracy in various departments. Here, we present the application of mixed reality-assisted surgery and a guiding marker in the case of small retroperitoneal metastasis of uterine cancer. Case presentation: A 67-year-old female with a history of uterine cancer had a retroperitoneal metastasis in the lateroconal fascia near the right diaphragm, measuring 2 cm and infiltrating the peritoneum. We performed precise surgical planning using the preoperative mixed reality software "Holoeyes" on a head-mounted display called HoloLens2. Novel techniques, including ultrasonography-guided placement of a guiding marker and strategic port-site placement facilitated by HoloLens2, ensured accurate tumor identification and laparoscopic resection with minimal blood loss and no intraoperative complications. Conclusion: The use of mixed reality-assisted surgery and a guiding marker effectively enhanced the precision of retroperitoneal tumor resection.

Embodied Spatial Navigation Training in Mild Cognitive Impairment: A Proof-of-Concept Trial.

Background: Egocentric and allocentric spatial memory impairments affect the navigation abilities of older adults with mild cognitive impairment (MCI). Embodied cognition research hints that specific aids can be implemented into virtual reality (VR) training to enhance spatial memory. Objective: In this study, we preliminarily tested 'ANTaging', an embodied-based immersive VR training for egocentric and allocentric memory, compared to treatment as usual (TAU) spatial training in MCI. Methods: MCI patients were recruited for this controlled trial. A cognitive battery was administered at pre-test, after ten sessions of ANTaging or TAU intervention, and at 3-month follow-up (FU). The primary outcomes were spatial cognition tests (Corsi supra-span, CSS; Manikin test, MT). VR egocentric and allocentric performance was also collected. Results: We found that ANTaging significantly improved MT scores at FU compared to TAU. CSS slightly improved in both groups. Concerning secondary outcomes, auditory-verbal forgetting significantly improved at post-test in the ANTaging but not TAU group and significantly declined at FU in the TAU but not in the ANTaging group. Global cognition significantly improved at FU for TAU and remained stable for ANTaging. Other tests showed no improvement or deterioration. Clinical significance showed that ANTaging is effective for CSS. Virtual egocentric and allocentric memory performance improved across ANTaging sessions. Conclusions: ANTaging holds the potential to be superior for improving spatial cognition in MCI compared to TAU. Embodied cognition research provides insights for designing effective spatial navigation rehabilitation in aging.