title: Effectiveness of Immersive Virtual Reality in Surgical Training-A Randomized Control Trial. Using Virtual Reality and Videogames for Traumatic Brain Injury Rehabilitation: A Structured Literature Review. Reducing Specific Phobia/Fear in Young People with Autism Spectrum Disorders (ASDs) through a Virtual Reality Environment Intervention The Effect of Balance Training on Postural Control in Patients with Parkinson's Disease Using a Virtual Rehabilitation System. Effect of an Immersive Preoperative Virtual Reality Experience on Patient Reported Outcomes: A Randomized Controlled Trial Integrating Virtual Reality With Activity Management for the Treatment of Fibromyalgia: Acceptability and Preliminary Efficacy
abstract: PURPOSE Surgical training methods are evolving with the technological advancements , including the application of virtual reality ( VR ) and augmented reality . However , 28 to 40 % of novice residents are not confident in performing a major surgical procedure . VR surgery , an immersive VR ( iVR ) experience , was developed using Oculus Rift and Leap Motion devices ( Leap Motion , Inc , San Francisco , CA ) to address this challenge . Our iVR is a multisensory , holistic surgical training application that demonstrates a maxillofacial surgical technique , the Le Fort I osteotomy . The main objective of the present study was to evaluate the effect of using VR surgery on the self-confidence and knowledge of surgical residents . MATERIAL S AND METHODS A multisite , single-blind , parallel , r and omized controlled trial ( RCT ) was performed . The participants were novice surgical residents with limited experience in performing the Le Fort I osteotomy . The primary outcome measures were the self- assessment scores of trainee confidence using a Likert scale and an objective assessment of the cognitive skills .  Ninety-five residents from 7 dental schools were included in the RCT . The participants were r and omly divided into a study group of 51 residents and a control group of 44 . Participants in the study group used the VR surgery application on an Oculus Rift with Leap Motion device . The control group participants used similar content in a st and ard PowerPoint presentation on a laptop . Repeated measures multivariate analysis of variance was applied to the data to assess the overall effect of the intervention on the confidence of the residents . RESULTS The study group participants showed significantly greater perceived self-confidence levels compared with those in the control group ( P = .034 ; α = 0.05 ) . Novices in the first year of their training showed the greatest improvement in their confidence compared with those in their second and third year . CONCLUSIONS iVR experiences improve the knowledge and self-confidence of the surgical residents OBJECTIVE This article review s the available literature about the use of novel methods of rehabilitation using virtual reality interventions for people living with posttraumatic brain injuries . MATERIAL S AND METHODS The MEDLINE , EMBASE , SCOPUS , and Cochrane Library data bases were search ed using the terms " virtual reality " OR " video games " AND " traumatic brain injury . " Included studies investigated therapeutic use of virtual reality in adults with a brain trauma result ing from acquired closed head injury , reported outcomes that included measures of motor or cognitive functionality , and were published in a peer- review ed journal written in English . RESULTS Eighteen articles fulfilled inclusion criteria . Eight were case studies , five studies had a quasi-experimental design with a pre-post comparison , and five were pilot r and omized control trials or comparative studies . The virtual reality systems used were commercial or custom design ed for the study and ranged from expensive , fully immersive systems to cheap online games or videogames . In before-after comparisons , improvements in balance were seen in four case studies and two small r and omized control trials . Between-group comparisons in these r and omized control trials showed no difference between virtual reality and traditional therapy . Post-training improvements were also seen for upper extremity functions ( five small studies ) and for various cognitive function measures ( four case studies and one pilot r and omized control trial ) . Attitudes of participants toward virtual reality interventions was more positive than for traditional therapy ( three studies ) . CONCLUSIONS The evidence that the use of virtual reality in rehabilitation of traumatic brain injury improves motor and cognitive functionality is currently very limited . However , this approach has the potential to provide alternative , possibly more affordable and available rehabilitation therapy for traumatic brain injury in setting s where access to therapy is limited by geographical or financial constraints Anxiety is common in children with autism spectrum disorders ( ASD ) , with specific fears and phobias one of the most frequent subtypes . Specific fears and phobias can have a serious impact on young people with ASD and their families . In this study we developed and evaluated a unique treatment combining cognitive behaviour therapy ( CBT ) with graduated exposure in a virtual reality environment ( VRE ) .  Nine verbally fluent boys with an ASD diagnosis and no reported learning disability , aged 7 to 13 years old , were recruited . Each had anxiety around a specific situation ( e.g. crowded buses ) or stimulus ( e.g. pigeons ) . An individualised scene was recreated in our ‘ wrap-around ’ VRE . In the VRE participants were coached by a psychologist in cognitive and behavioural techniques ( e.g. relaxation and breathing exercises ) while the exposure to the phobia/fear stimulus was gradually increased as the child felt ready . Each child received four 20–30 minute sessions . After participating in the study , eight of the nine children were able to tackle their phobia situation . Four of the participants completely overcame their phobia . Treatment effects were maintained at 12 months . These results provide evidence that CBT with VRE can be a highly effective treatment for specific phobia/fear for some young people with ASD . Trial Registration Controlled-Trials.com IS RCT N58483069 OBJECTIVES Parkinson 's disease ( PD ) is a progressive neurodegenerative disorder characterized by motor clinical alterations among others . Postural problems have serious consequences for patients , not only limiting their daily life but also increasing some risks , like the risk of fall . Inadequate postural control and postural instability is a major problem in PD patients . A Virtual Motor Rehabilitation System ( VMR ) has been tested in patients with PD in the intervention period . Our purpose was to analyze the evolution of the spatial postural control during the intervention period , to see if there are any changes caused precisely by this intervention . METHODS Ten people with PD carried out 15 virtual rehabilitation sessions .  We tested a groundbreaking system based on Virtual Motor Rehabilitation in two periods of time ( baseline evaluation and final evaluation ) . In the training sessions , the participants performed a customizable treatment using a low-cost system , the Active Balance Rehabilitation system ( ABAR ) . We stored the pressure performed by the participants every five hundredths of a second , and we analyzed the patients ' pressure when they maintained their body on the left , on the right , and in the center in sitting position . Our system was able to measure postural control in every patient in each of the virtual rehabilitation sessions . RESULTS There are no significant differences in the performance of postural control in any of the positions evaluated throughout the sessions . Moreover , the results show a trend to an improvement in all positions . This improvement is especially remarkable in the left/right positions , which are the most important positions in order to avoid problems such as the risk of fall . With regard to the suitability of the ABAR system , we have found outst and ing results in enjoyment , success , clarity , and helpfulness . CONCLUSIONS Although PD is a progressive neurodegenerative disorder , the results demonstrate that patients with PD maintain or even improve their postural control in all positions . We think that the main factor influencing these results is that patients use more of their available cognitive processing to improve their postural control . The ABAR system allows us to make this assumption because the system requires the continuous attention of patients , promoting cognitive processing Objective : To investigate the effect of exposure to a virtual reality ( VR ) environment preoperatively on  patient-reported outcomes  for surgical operations . Background : There is a scarcity of well-developed quality improvement initiatives targeting patient satisfaction . Methods : We performed a r and omized controlled trial of patients undergoing cranial and spinal operations in a tertiary referral center . Patients underwent a 1:1 r and omization to an immersive preoperative VR experience or st and ard preoperative experience  stratified on type of operation . The primary outcome measures were the Evaluation du Vecu de l’Anesthesie Generale ( EVAN-G ) score and the Amsterdam Preoperative Anxiety and Information ( APAIS ) score , as markers of the patient 's experience during the surgical encounter . Results : During the study period , a total of 127 patients ( mean age 55.3 years , 41.9 % females ) underwent r and omization . The average EVAN-G score was 84.3 ( st and ard deviation , SD , 6.4 ) after VR , and 64.3 ( SD , 11.7 ) after st and ard preoperative experience ( difference , 20.0 ; 95 % confidence interval , CI , 16.6–23.3 ) . Exposure to an immersive VR experience also led to higher APAIS score ( difference , 29.9 ; 95 % CI , 24.5–35.2 ) . In addition , VR led to lower preoperative VAS stress score ( difference , −41.7 ; 95 % CI , −33.1 to −50.2 ) , and higher preoperative VAS preparedness ( difference , 32.4 ; 95 % CI , 24.9–39.8 ) , and VAS satisfaction ( difference , 33.2 ; 95 % CI , 25.4–41.0 ) scores . No association was identified with VAS stress score ( difference , −1.6 ; 95 % CI , −13.4 to 10.2 ) . Conclusions : In a r and omized controlled trial , we demonstrated that patients exposed to preoperative VR had increased satisfaction during the surgical encounter . Harnessing the power of this technology , hospitals can create an immersive environment that minimizes stress , and enhances the perioperative experience Objectives : Cognitive-behavioral therapies ( CBT ) for fibromyalgia syndrome ( FMS ) are important interventions in the management of this condition . Empirical evidence reports that although the results are promising , further research is needed to respond more appropriately to these patients . This study focuses on exploring the use of Virtual Reality ( VR ) as an adjunct to the activity management component . The aim of this study is to present the results of a small-sized r and omized controlled trial to test the preliminary efficacy and acceptability of this component . Material s and Methods : The final sample was composed of 61 women diagnosed with FMS according to the American College of Rheumatology . The sample was r and omly allocated to 2 conditions : VR treatment and treatment as usual . Results : Participants in the VR condition achieved significant improvements in the primary outcome : disability measured with the FIQ . The improvement was also significant in secondary outcomes , such as perceived quality of life and some of the coping strategies included in the Chronic Pain Coping Inventory : task persistence and exercise . There were no differences in other secondary outcome measures like pain intensity and interference and depression . Participants reported high satisfaction with the VR component . Discussion : The effects were related to the psychological aspects targeted in the treatment . The component was well accepted by FMS patients referred from a public hospital . These findings show that the VR component could be useful in the CBT treatment of FMS and encourage us to continue exploring the use of integrating VR with CBT interventions for the treatment of FMS
target: The studies examined suggest moderate evidence about the effectiveness of  VR-based treatments in ASD .
  VR can add many advantages to the treatment of ASD symptomatology , but it is necessary to develop consistent validations in future studies to state that VR can effectively complement the traditional treatments
background: Autism Spectrum Disorder ( ASD ) is a neurodevelopmental disease that is specially characterized by impairments in social communication and social skills .
  ASD has a high prevalence in children , affecting 1 in 160 subjects .
  Virtual reality ( VR ) has emerged as an effective tool for intervention in the health field .
  Different recent papers have review ed the VR-based treatments in ASD , but they have an important limitation because they only use clinical data bases and do not include important technical indexes such as the Web of Science index or the Scimago Journal & Country Rank .
  To our knowledge , this is the first contribution that has carried out an evidence -based systematic review including both clinical and technical data bases about the effectiveness of VR-based intervention in ASD .