Realtime Adaptive Virtual Reality for Pain Reduction

Extended-Reality Technologies: An Overview of Emerging Applications in Medical Education and Clinical Care.

Several studies compared the player experience of Virtual Reality (VR) games and non-VR games. However, there is a lack of research on the specific subject of VR and non-VR multiplayer games. Therefore, this work explores how implementing a multiplayer game in VR may influence the player experience compared to the non-VR alternative. We developed a short multiplayer puzzle game that can be played as a VR game or as a non-VR game. The player experience of the different game versions was evaluated by having players answer the Game Experience Questionnaire by IJsselsteijn et al. and the Simulator Sickness Questionnaire by Kennedy et al. after playing each version. The results showed that a majority of the aspects of player experience were rated significantly higher for the VR versions compared to the non-VR alternative. However, it was noted that two different VR versions fared differently compared to the non-VR alternative, and they scored vastly different when calculating a total simulator sickness score. We conclude that implementing similar multiplayer games in VR can improve the player experience, but care is required to achieve the best player experience in VR.

Video games are popular as entertainment tools. Yet, they can also be used as tools for other activities, including relaxation and meditation. Virtual reality (VR) games have enhanced player experiences thanks to immersive applications, such as VR cinema, virtual browsing, and virtual spaces that can be used as an extension of the physical area. Among those applications, VR shows promise for relaxing and therapeutic applications. However, most of these applications position users in a passive interaction with their environment. This project explores if relaxation and mindfulness in VR can be achieved through active player engagement, where users directly control their character and provide input. Two versions of a relaxing video game were made: (1) a PC version where the player flies and explores natural landscapes in-game on a classical PC gaming setup (i.e., a monitor display, keyboard, and gamepad); (2) a VR version, where the game is played via head-mounted display (HMD), specifically the Oculus Quest. I used a brain-computer interface (BCI), specifically the "Emotiv Insight" Electroencephalography (EEG) headband, to record participants' brainwave activities while playing the game. Based on the results of my study, I found a statistically significant difference on both theta and alpha brainwave frequencies (i.e., the brainwaves that express relaxation and engagement) between the PC and VR versions of the game. Furthermore, I collected qualitative impressions of both the PC and VR games, where participants reported their subjective levels of relaxation after each version. The results of the survey show that participants experienced enhanced relaxations states in VR compared to PC. This thesis contributes empirical evidence that VR games can be used to further enhance relaxation states in players and show promise for applications in mindfulness and meditation through active player engagement.--Author's abstract

Physical discomforts, such as sickness, experienced during virtual reality (VR) gaming were analyzed using electroencephalography (EEG). Correlations between the results of a survey on the physical discomforts felt during a head mounted 360° VR gaming and EEGs were analyzed. EEGs were measured using 19 electrodes before, during, and after VR gaming. The brain was categorized into eight regions and EEGs were analyzed for each region. After gaming, a questionnaire was completed, and correlations between the scores of nausea, ocular discomfort, and disorientation and EEGs were examined. Before and during VR, there were substantial changes in the absolute power and relative power bands depending on the region of interest. The analysis of correlations with the physical discomforts classified based on the questionnaire showed that the theta and beta waves from the occipital and temporal lobes exhibited significant correlations. The EEGs before and after VR gaming did not exhibit significant changes. In this study, a qualitative analysis on the physical discomforts occurring during VR was conducted based on EEG. We expect that EEG can be utilized in providing customized VR capable of minimizing physical discomforts by analyzing the EEG measured in real time and providing feedback to VR gaming.

Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Virtual reality (VR) with its engagement, interaction, and real time feedback could be a solution, with immersive VR systems having preliminary evidence in stroke to be more effective in improving UL outcomes in comparison to non-immersive VR. However, immersive VR research is limited within the realm of MS rehabilitation. Therefore, the main aim of the PhD was to explore immersive VR as an approach for UL rehabilitation for people with MS (pwMS). This was achieved in four stages: 1) a systematic review of the current evidence for VR in UL rehabilitation in MS; 2) predevelopment focus groups to determine requirements for the development of bespoke immersive VR games; 3) software development of bespoke VR games to potentially improve UL function for pwMS; and 4) a feasibility study of the games and immersive VR for pwMS’ UL rehabilitation. The systematic review initially yielded ten articles with varying study design, VR intervention and UL outcome measures used. There were some statistically significant improvements after VR interventions in outcomes such as in nine-hole peg test (NHPT), hand grip strength and active range of motion. There were however conflicting results regarding if VR was more effective than conventional approaches. Whilst the review demonstrated there were positive results for VR improving UL function, most of the studies had small sample sizes and were inadequately powered, and the level of immersion on effectiveness in MS remains unknown. The predevelopment focus groups recruited ten pwMS and eight specialist clinicians to explore their views on immersive VR as an approach to UL rehabilitation and determine requirements to develop VR games for this purpose. PwMS commonly reported that their UL problems interfered with activities of daily living and resulted in the loss of meaningful hobbies such as writing. Many pwMS neglected UL exercise and found strategies for adapting to their UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a potential solution, as it was convenient for pwMS to access and could provide a more engaging and disguised approach to exercise. Although, there were shared concerns about cybersickness and disengagement while using VR approaches. Finally, both groups agreed games should be meaningful and adaptable for users but suggested different VR activities, with clinicians suggesting games directly reflecting activities of daily living and pwMS suggesting more abstract activities. Recommendations were made for the development of VR rehabilitation games which could be personalised and customisable for the varying abilities of pwMS. Using theme-based content analysis and requirement analysis, requirements for the software development of immersive VR games were created and developed using Unity game engine. Three games, “Piano”; “Catch-a-falling-star” and “VR Whack-a-mole” which targeted dexterity and strength for pwMS were developed, with different difficulty levels implemented to adapt to varying ability of pwMS. The final stage of this PhD was a randomised, controlled feasibility study to investigate an intervention of immersive VR involving the three co-produced games for pwMS’ UL rehabilitation. Participants were randomised to either an intervention group consisting of 30 minutes of VR co-produced games, twice/week, for eight weeks, or to a control group of usual care. Participants were recruited from the NHS and third sector organisations. Nineteen pwMS were recruited (intervention n=11, control n=8), with a recruitment rate of 3.2 participants/month. Only minor adverse events were reported (n=9), such as fatigue and UL pain. Adherence was good with 87% (±12%) session completed, and two dropouts were reported in the control group. There were positive trends for improving NHPT and hand grip strength, but there was an observed ceiling effect in the Action Research Arm Test. Participants reported high levels of satisfaction and good usability of the co-produced VR games, as measured by the USE questionnaire. Thematic analysis revealed participants enjoyed the distraction and atmospheres that immersive VR provided, and believed the games were fit for purpose with the majority of participants reporting improvements in their UL function. Participants suggested more variety and progression of exercises for future development. Overall, these studies show that immersive VR has the potential to be beneficial for UL rehabilitation and is feasible and safe for pwMS. Therefore, future work should refine VR games for long-term application and explore the clinical and cost effectiveness of this approach.

How much music contributes to player experience (PX) in virtual reality (VR) games remains unclear in the games user research literature. A core factor of PX in VR games that has not been studied before (in relation to audio or otherwise) is time perception. Thus, we provide the first empirical exploration of how music affects time perception in a VR game. In a user study (N=64), we investigated the effects of music on PX and time perception (operationalized as retrospective time estimation). Participants retrospectively perceived time to pass significantly quicker in the VR game when music was present, but reported no difference in PX components, including immersion. This contributes to ongoing discourse on the surprising lack of music effects in VR games. Moreover, our results highlight the need to re-conceptualize our understanding of the relationship between time perception and immersion in games.

Virtual reality (VR) games are currently becoming part of the public-space entertainment (e.g., VR amusement parks). Therefore, VR games should be attractive for players, as well as for bystanders. Current VR systems are still mostly focused on enhancing the experience of the head-mounted display (HMD) users; thus, bystanders without an HMD cannot enjoy the experience together with the HMD users. We propose the "ReverseCAVE": a proof-of-concept prototype for public VR visualization using CAVE-based projection with translucent screens for bystanders toward a shareable VR experience. The screens surround the HMD user and the VR environment is projected onto the screens. This enables the bystanders to see the HMD user and the VR environment simultaneously. We designed and implemented the ReverseCAVE, and evaluated it in terms of the degree of attention, attractiveness, enjoyment, and shareability, assuming that it is used in a public space. Thus, we can make the VR world more accessible and enhance the public VR experience of the bystanders via the ReverseCAVE.

Instead of traditional free movement, node-based movement can be used in virtual reality (VR) games. In node-based movement systems, players navigate by jumping to set locations. Node-based movement is similar to hypertext navigation. We show that the hypertext lostness measure can be used as a game analytic to evaluate navigational efficiency. In a randomized controlled trial with 25 adolescent participants, an immersive desktop game environment and a VR game environment were compared on the transmission of in-game educational content and navigational efficiency. Results show that the hypertext lostness measure is also valuable outside its original hypertext domain: in VR. VR did not improve players' retention of factual knowledge, but did significantly improve players' spatial knowledge and navigational efficiency. We conclude (a) the hypertext lostness measure is also valuable for node-based VR games and (b) VR games add to spatial learning, even when compared with already immersive desktop games.

Purpose The present study explored participants’ experiences with and perceptions of using fully immersive head-mounted virtual reality (VR) gaming as rehabilitation after stroke. Methods Four men and three women (median age 64 years) with chronic stroke and varying motor impairment (mild to severe) were interviewed after 10 weeks of VR training on the commercial HTC Vive system, focusing on the upper extremities. Inductive qualitative thematic analysis was performed. Results The analysis revealed three main themes: playing the game, benefits and effects, and personalizing the game. Playing the game encompasses both the feeling of being immersed in the game and descriptions of the gaming being motivating and fun. Benefits and effects describe the participants’ expectations of potential benefits, the importance of getting feed-back, and the impact in daily life. Personalizing the game includes finding the right game and level, and the participants’ need for support to achieve full use of the training. Conclusions Participants with chronic stroke described the fully immersive VR gaming intervention as a fun and motivating way to improve their functioning in everyday life. Qualitative studies are needed to explore how people with stroke perceive VR gaming when it is implemented in real clinical environments. Clinical implications VR gaming was perceived as a positive and motivating rehabilitation after stroke. Getting feedback and perceiving benefits are essential parts of VR rehabilitation. Commercial fully immersive VR-games might be an option for stroke rehabilitation when the game can be personalized and support is available.

With the development of virtual reality (VR) technology, various VR devices are flooding the market. VR head-mounted displays (HMDs) sales are overgrowing as the primary medium for experiencing VR games. Therefore, exploring user concerns about HMDs is significant, enabling developers to design better VR devices and VR games. In this work, we conduct an empirical study of 7,413 VR games and 176,428 player reviews collected from three platforms (i.e., Oculus, Steam, and Viveport). First, we investigate the evolutionary trends of HMDs based on VR games. Subsequently, we extract nine topics (e.g., cybersickness, performance, and privacy) related to HMDs from game reviews that users are concerned about, analyze the emotional trends, and explore the voices of players. We find that users complain less about the cybersickness and immersion of HMDs and more about other topics (e.g., performance, tracking, and compatibility). In addition, more users have expressed concerns about privacy in recent years.

Virtual reality systems are complex and made of various parts. Since a person is an integral component of such systems, virtual reality technologies also have a cognitive aspect. As such, these technologies engage with the perceptual, attentional, and decision-making processes of users. Consequently, they can be considered cognitive tools. Thus, it is imperative to understand what people think of such environments. To take a step towards this understanding, textual reviews of virtual reality games made for entertainment were investigated using text mining methods. Thus, 1,635,919 textual reviews were scraped from the Steam digital video game distribution platform in the spring of 2023. The reviews were grouped by whether they were positive or negative. According to the results, the following conclusions can be made regarding virtual reality games: 1) Negative reviews are significantly longer than positive ones. 2) Negative reviews are written significantly earlier than positive ones, although no correlation was found between the review type and the playtime before writing the review. 3) The most frequent words and word correlations are different between review types since negative reviews are more focused on game mechanics and bugs. Due to the results, insights can be provided to virtual reality game developers to help them refine their games. Index Terms—computer games; game review; player experi ence; Steam; textual analysis Abstract—Virtual reality systems are complex and made of various parts. Since a person is an integral component of such systems, virtual reality technologies also have a cognitive aspect. As such, these technologies engage with the perceptual, attentional, and decision-making processes of users. Consequently, they can be considered cognitive tools. Thus, it is imperative to understand what people think of such environments. To take a step towards this understanding, textual reviews of virtual reality games made for entertainment were investigated using text mining methods. Thus, 1,635,919 textual reviews were scraped from the Steam digital video game distribution platform in the spring of 2023. The reviews were grouped by whether they were positive or negative. According to the results, the following conclusions can be made regarding virtual reality games: 1) Negative reviews are significantly longer than positive ones. 2) Negative reviews are written significantly earlier than positive ones, although no correlation was found between the review type and the playtime before writing the review. 3) The most frequent words and word correlations are different between review types since negative reviews are more focused on game mechanics and bugs. Due to the results, insights can be provided to virtual reality game developers to help them refine their games.

This research includes the study of the existing head-mounted display (HMD)enabled interface program and suggests improved interface scheme of HMD-enabled virtual reality (VR) games. The traditional keyboard and mouse based input schemes need to be replaced by user-friendly interface scheme such as the HMD. The higher the immersion degree of game users is expected, the less user intervention is desired to capture a user input and to give an output to users. For this reason, a user-centric VR environment has been built, where users’ motions such as turning head and raising hands are recognized as meaningful input to the system with the wellknown contact type, Hydra, and non-contact type, Kinect system. Especially, three multiple Kinects are arranged to improve the motion recognition rate. The proposed HMD interface not only aims to increase the degree of mutual interaction between game players and VR games, but also enhances usability of the HMD. Diverse users’ gestures are recognized in combination with newly suggested interfaces. The improved interfaces have been integrated with both representative testbed games which belong to action and sports genres. Action game has been developed and interfaced with non-wearable (non-contact) interface, whereas sports game has been integrated with both contact and non-contact interfaces. After then, the effectiveness and usability of the interface have been assessed according to the empirical evaluation scheme with modified system usability scale (SUS) statements. The SUS test result shows that the proposed interface enhanced the system usability as well as the system interactivity in terms of user satisfaction.

Autonomous robots that are interfaced with virtual or augmented reality gaming are increasingly being developed to provide repetitive intensive practice to promote increased compliance and facilitate better outcomes in neurorehabilitation therapies. These therapist robots, equipped with a set of sensors and actuators for monitorizing the environment, allows health professionals to supervise the recovery of patients with serious disability. In this paper, a new system for supervising neuro-rehabilitation therapies using autonomous robots is presented. The therapy explained in this work is based on a set of virtual reality games developed by using robotics technologies, such as RGB-D camera and depth image processing. Three different virtual reality games have been developed in the application to gain better outcomes during the therapy, each one focuses on a typical exercise: ‘Touch the apple’, ‘Follow the path’ and ‘Imitate the dance’. Both, the virtual reality games and the main robotics technologies for their development, are explained in this paper.

Virtual reality (VR) games offer potential as a fun and immersive way to get enough physical activity to gain significant health benefits. Currently, there is no established way to describe the type and level of physical activity a person can expect to gain when playing a VR game. Nor is there a way of reporting to a person about the exercise they actually did. To address this, we have designed a visual overview that depicts the nature of exercise an individual actually did. To assess the visualisation, we selected four VR games with very different exercise profiles. We used them in a qualitative study with 7 people, so that we could demonstrate how our visualisation could represent the individual differences in the nature and level of physical activity for each game. Our contribution is the design of the first visualisation to represent the nature of exercise gained in VR games, as a personalised, compact summary of the exertion an individual had in a game.

Little is known about the experience and the social and contextual factors influencing the acceptance of virtual reality (VR) physical activity games among long-term care (LTC) residents. Our study aims to address this research gap by investigating the unique experience of older adults with VR games. The findings will provide valuable insights into the factors influencing VR acceptance among LTC residents and help design inclusive VR technology that meets their needs and improves physical activity (PA) and well-being. We aimed to: (1) investigate how participants experience VR exergames and the meaning they associate with their participation; and (2) examine the factors that influence the participant's experience in VR exergames and explore how these factors affect the overall experience. We used a qualitative approach that follows the principles of the Interpretive Description methodology. Selective Optimization and Compensation (SOC) theory, Socioemotional Selectivity theory (SST) and technology acceptance models underpinned the theoretical foundations of this study. We conducted semi-structured interviews with participants. 19 Participants of a LTC were interviewed: five residents and ten tenants, aged 65 to 93 years (8 female and 7 male) and four staff members. Interviews ranged from 15 to 30 minutes and were transcribed verbatim and were analyzed using thematic analysis. We identified four themes based on older adults' responses that reflected their unique VR gaming experience, including (1) enjoyment, excitement, and the novel environment; (2) PA and motivation to exercise; (3) social connection and support; and (4) individual preferences and challenges. Three themes were developed based on the staff members' data to capture their perspective on the factors that influence the acceptance of VR among LTC resident including (1) relevance and personalization of the games; (2) training and guidance; and (3) organizational and individual barriers. VR gaming experiences are enjoyable exciting, and novel for LTC residents and tenants and can provide physical, cognitive, social, and motivational benefits for them. Proper guidance and personalized programs can increase understanding and familiarity with VR, leading to a higher level of acceptance and engagement. Our findings emphasize the significance of social connection and support in promoting acceptance and enjoyment of VR gaming among older adults. Incorporating social theories of aging helps to gain a better understanding of how aging-related changes influence technology acceptance among older adults. This approach can inform the development of technology that better meets their needs and preferences.