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      Usability Issues of Clinical and Research Applications of Virtual Reality in Older People: A Systematic Review


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          Aging is a condition that may be characterized by a decline in physical, sensory, and mental capacities, while increased morbidity and multimorbidity may be associated with disability. A wide range of clinical conditions (e.g., frailty, mild cognitive impairment, metabolic syndrome) and age-related diseases (e.g., Alzheimer's and Parkinson's disease, cancer, sarcopenia, cardiovascular and respiratory diseases) affect older people. Virtual reality (VR) is a novel and promising tool for assessment and rehabilitation in older people. Usability is a crucial factor that must be considered when designing virtual systems for medicine. We conducted a systematic review with Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines concerning the usability of VR clinical systems in aging and provided suggestions to structure usability piloting. Findings show that different populations of older people have been recruited to mainly assess usability of non-immersive VR, with particular attention paid to motor/physical rehabilitation. Mixed approach (qualitative and quantitative tools together) is the preferred methodology; technology acceptance models are the most applied theoretical frameworks, however senior adapted models are the best within this context. Despite minor interaction issues and bugs, virtual systems are rated as usable and feasible. We encourage usability and user experience pilot studies to ameliorate interaction and improve acceptance and use of VR clinical applications in older people with the aid of suggestions (VR-USOP) provided by our analysis.

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          The Continuum of Aging and Age-Related Diseases: Common Mechanisms but Different Rates

          Geroscience, the new interdisciplinary field that aims to understand the relationship between aging and chronic age-related diseases (ARDs) and geriatric syndromes (GSs), is based on epidemiological evidence and experimental data that aging is the major risk factor for such pathologies and assumes that aging and ARDs/GSs share a common set of basic biological mechanisms. A consequence is that the primary target of medicine is to combat aging instead of any single ARD/GSs one by one, as favored by the fragmentation into hundreds of specialties and sub-specialties. If the same molecular and cellular mechanisms underpin both aging and ARDs/GSs, a major question emerges: which is the difference, if any, between aging and ARDs/GSs? The hypothesis that ARDs and GSs such as frailty can be conceptualized as accelerated aging will be discussed by analyzing in particular frailty, sarcopenia, chronic obstructive pulmonary disease, cancer, neurodegenerative diseases such as Alzheimer and Parkinson as well as Down syndrome as an example of progeroid syndrome. According to this integrated view, aging and ARDs/GSs become part of a continuum where precise boundaries do not exist and the two extremes are represented by centenarians, who largely avoided or postponed most ARDs/GSs and are characterized by decelerated aging, and patients who suffered one or more severe ARDs in their 60s, 70s, and 80s and show signs of accelerated aging, respectively. In between these two extremes, there is a continuum of intermediate trajectories representing a sort of gray area. Thus, clinically different, classical ARDs/GSs are, indeed, the result of peculiar combinations of alterations regarding the same, limited set of basic mechanisms shared with the aging process. Whether an individual will follow a trajectory of accelerated or decelerated aging will depend on his/her genetic background interacting lifelong with environmental and lifestyle factors. If ARDs and GSs are manifestations of accelerated aging, it is urgent to identify markers capable of distinguishing between biological and chronological age to identify subjects at higher risk of developing ARDs and GSs. To this aim, we propose the use of DNA methylation, N-glycans profiling, and gut microbiota composition to complement the available disease-specific markers.
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            Virtual reality in neuroscience research and therapy.

            Virtual reality (VR) environments are increasingly being used by neuroscientists to simulate natural events and social interactions. VR creates interactive, multimodal sensory stimuli that offer unique advantages over other approaches to neuroscientific research and applications. VR's compatibility with imaging technologies such as functional MRI allows researchers to present multimodal stimuli with a high degree of ecological validity and control while recording changes in brain activity. Therapists, too, stand to gain from progress in VR technology, which provides a high degree of control over the therapeutic experience. Here we review the latest advances in VR technology and its applications in neuroscience research.
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              Determining what individual susscores mean: Adding an adjective rating scale


                Author and article information

                Front Hum Neurosci
                Front Hum Neurosci
                Front. Hum. Neurosci.
                Frontiers in Human Neuroscience
                Frontiers Media S.A.
                08 April 2020
                : 14
                : 93
                [1] 1Applied Technology for Neuro-Psychology, IRCCS Istituto Auxologico Italiano , Milan, Italy
                [2] 2Department of Psychology, Catholic University of the Sacred Hearth , Milan, Italy
                [3] 3Faculty of Psychology, University of eCampus , Novedrate, Italy
                [4] 4IRCCS Fondazione Don Carlo Gnocchi , Milan, Italy
                [5] 5Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano , Milan, Italy
                [6] 6Scientific Direction, IRCCS INRCA , Ancona, Italy
                Author notes

                Edited by: Valerio Rizzo, University of Palermo, Italy

                Reviewed by: Hasan Ayaz, Drexel University, United States; Diogo Morais, Lusophone University of Humanities and Technologies, Portugal

                *Correspondence: Cosimo Tuena cosimo.tuena@ 123456unicatt.it

                This article was submitted to Cognitive Neuroscience, a section of the journal Frontiers in Human Neuroscience

                Copyright © 2020 Tuena, Pedroli, Trimarchi, Gallucci, Chiappini, Goulene, Gaggioli, Riva, Lattanzio, Giunco and Stramba-Badiale.

                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.

                : 28 October 2019
                : 02 March 2020
                Page count
                Figures: 8, Tables: 2, Equations: 0, References: 100, Pages: 19, Words: 13921
                Funded by: Ministero della Salute 10.13039/501100003196
                Human Neuroscience
                Systematic Review

                aging,assessment,rehabilitation,usability,user-experience,virtual reality
                aging, assessment, rehabilitation, usability, user-experience, virtual reality


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