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      Older Adults With Cognitive and/or Physical Impairments Can Benefit From Immersive Virtual Reality Experiences: A Feasibility Study

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          Abstract

          Background: Older adults living in long term care, rehabilitation hospitals, and seniors' residences often experience reduced mobility, sometimes resulting in confinement indoors and isolation, which can introduce or aggravate symptoms of depression, anxiety, loneliness, and apathy. As Virtual Reality (VR) technologies become increasingly accessible and affordable, there is a unique opportunity to enable older adults to escape their restricted physical realities and be transported to both stimulating and calming places which may improve their general well-being. To date no robust evaluations of the use of immersive VR therapy [experienced through a head-mounted-display (HMD)] for older adults within these settings have been reported. VR-therapy may prove to be a safe, inexpensive, non-pharmacological means of managing depressive symptoms and providing engagement and enjoyment to this rapidly growing demographic.

          Objectives: Establish whether it is feasible to use immersive VR technology as therapy for older adults who have reduced sensory, mobility and/or impaired cognition. This includes evaluation of tolerability, comfort, and ease of use of the HMD, and of the potential for immersive VR to provide enjoyment/relaxation and reduce anxiety and depressive symptoms.

          Methods: Sixty-six older adults (mean age 80.5, SD = 10.5) with varying cognitive abilities (normal = 28, mild impairment = 17, moderate impairment = 12, severe impairment = 3, unknown cognitive score = 6), and/or physical impairments, entered a multi-site non-randomized interventional study in Toronto, Canada. Participants experienced 3 to 20 min of 360°-video footage of nature scenes displayed on Samsung GearVR HMD. Data was collected through pre/post-intervention surveys, standardized observations during intervention, and post-intervention semi-structured interviews addressing the VR experience.

          Results: All participants completed the study with no negative side-effects reported (e.g., No dizziness, disorientation, interference with hearing aids); the average time spent in VR was 8 min and 76% of participants viewed the entire experience at least once. Participants tolerated the HMD very well; most had positive feedback, feeling more relaxed and adventurous; 76% wanted to try VR again. Better image quality and increased narrative video content were suggested to improve the experience.

          Conclusion: It is feasible and safe to expose older adults with various levels of cognitive and physical impairments to immersive VR within these settings. Further research should evaluate the potential benefits of VR in different settings (e.g., home/community based) and explore better customization/optimization of the VR content and equipment for the targeted populations.

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          Most cited references27

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          Natural Versus Urban Scenes: Some Psychophysiological Effects

          R. Ulrich (1981)
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            Inducing physiological stress recovery with sounds of nature in a virtual reality forest--results from a pilot study.

            Experimental research on stress recovery in natural environments is limited, as is study of the effect of sounds of nature. After inducing stress by means of a virtual stress test, we explored physiological recovery in two different virtual natural environments (with and without exposure to sounds of nature) and in one control condition. Cardiovascular data and saliva cortisol were collected. Repeated ANOVA measurements indicated parasympathetic activation in the group subjected to sounds of nature in a virtual natural environment, suggesting enhanced stress recovery may occur in such surroundings. The group that recovered in virtual nature without sound and the control group displayed no particular autonomic activation or deactivation. The results demonstrate a potential mechanistic link between nature, the sounds of nature, and stress recovery, and suggest the potential importance of virtual reality as a tool in this research field. Copyright © 2013 Elsevier Inc. All rights reserved.
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              View through a window may influence recovery from surgery.

              R. Ulrich (1984)
              Records on recovery after cholecystectomy of patients in a suburban Pennsylvania hospital between 1972 and 1981 were examined to determine whether assignment to a room with a window view of a natural setting might have restorative influences. Twenty-three surgical patients assigned to rooms with windows looking out on a natural scene had shorter postoperative hospital stays, received fewer negative evaluative comments in nurses' notes, and took fewer potent analgesics than 23 matched patients in similar rooms with windows facing a brick building wall.
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                Author and article information

                Contributors
                Journal
                Front Med (Lausanne)
                Front Med (Lausanne)
                Front. Med.
                Frontiers in Medicine
                Frontiers Media S.A.
                2296-858X
                15 January 2020
                2019
                : 6
                : 329
                Affiliations
                [1] 1Faculty of Health, School of Health Policy and Management, York University , Toronto, ON, Canada
                [2] 2OpenLab, University Health Network , Toronto, ON, Canada
                [3] 3Faculty of Medicine, University of Toronto , Toronto, ON, Canada
                [4] 4Department of Psychology, Ryerson University , Toronto, ON, Canada
                [5] 5KITE, Toronto Rehabilitation Institute, University Health Network , Toronto, ON, Canada
                [6] 6Department of Psychology, University of Toronto , Toronto, ON, Canada
                Author notes

                Edited by: Jon Irazusta, University of the Basque Country, Spain

                Reviewed by: Mario Ulises Pérez-Zepeda, Dalhousie University, Canada; Tomasz Grodzicki, Jagiellonian University Medical College, Poland

                *Correspondence: Lora Appel Lora.Appel@ 123456uhn.ca

                This article was submitted to Geriatric Medicine, a section of the journal Frontiers in Medicine

                Article
                10.3389/fmed.2019.00329
                6974513
                32010701
                2e5990f7-381b-4b1f-a50a-c9d1d779fe7b
                Copyright © 2020 Appel, Appel, Bogler, Wiseman, Cohen, Ein, Abrams and Campos.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 18 June 2019
                : 20 December 2019
                Page count
                Figures: 4, Tables: 5, Equations: 0, References: 45, Pages: 13, Words: 10060
                Categories
                Medicine
                Original Research

                non-pharmacological therapy,dementia,head-mounted-display,interventional study,nature,simulation,long-term care,social isolation

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