2026-03-30
M. Everri, A. C. Queiroz, M. Heitmayer, A. Campbell, F. Balestra, D. Hanley, L. Fruggeri, J. Jacobson, M. Messena, T. Merrick, V. O’Brien, D. S. Rait, A. Roberts, S. Thaker
Role plays and live supervision have been core methods in family therapy education, offering trainees experiential opportunities to practice therapeutic techniques, engage in reflexivity, and develop systemic awareness. However, these traditional methods face limitations in scalability, standardization, and emotional safety. Immersive Virtual Reality (IVR) —a technology capable of eliciting realistic affective and cognitive responses through a sense of presence—presents new possibilities for addressing these challenges. Drawing upon research in simulation-based learning, this article explores how IVR can enhance the acquisition of core family therapy competencies (technical skills, relational, epistemological, and context sensitivity). The paper synthesizes existing family therapy education models and methods and IVR-based training research. It highlights the unique pedagogical affordances of IVR, i.e., embodied perspective-taking, emotional safety, standardization, and repeatability, and links these to family therapy training goals. An IVR prototype developed by the authors simulates a first family therapy session, providing a proof of concept for integrating virtual simulations into therapist education. Preliminary feedback from professionals indicates that IVR can foster engagement and self-reflexivity, though challenges remain regarding content realism, cost, and trainers’ digital skills. The article concludes by identifying future directions for research and practice, emphasizing the need for interdisciplinary collaboration, empirical validation, and ethical frameworks to guide the responsible implementation of IVR in family therapy education.
DOI: 10.3389/frvir.2026.17436412026-03-26
Raviraj Nataraj, Mingxiao Liu, Yu Shi, Sophie Dewil, Noam Y. Harel
BackgroundAugmented sensory feedback (ASF) in virtual reality (VR) can enhance motor performance, yet it is not standardly employed with rehabilitation protocols and its effects on physiological and perceptual states remain underexplored.AimThis study examined how different ASF modalities—visual, haptic, and combined visual + haptic—modulate motor performance, psychophysiological responses, and user perceptions during an upper-limb VR training task.MethodsTwenty neurotypical adults controlled a virtual robotic arm via semi-isometric muscle contractions, while receiving one of four ASF training conditions: no feedback (NF), visual feedback (VF), haptic feedback (HF), or combined (multimodal) visual + haptic feedback (VHF). Improved performance (minimizing motion pathlengths and task completion time), changes in physiological signals (EEG band power, EMG amplitude, electrodermal activity, heart rate), and perceptual ratings (agency, motivation, utility) were assessed before and after each training condition.ResultsVF produced greater efficiency in motor output with improved performance (primary metrics of study) in conjunction with reduced EMG, along with increased electrodermal activity suggestive of higher arousal. VHF elicited significant post-training increases in EEG alpha and beta power. Motivation and utility ratings were significantly higher for VF and VHF compared to HF and NF, while agency ratings remained stable. Across all conditions, improved performance correlated with increased alpha power, reduced EMG and heart rate, and higher motivation and utility.ConclusionThese findings indicate that ASF modality differentially shapes motor, physiological, and perceptual responses. Future work should establish whether these responses generalize to clinical groups, such as those with neuromotor impairment. Ultimately, adaptive VR systems leveraging psychophysiological responses to optimize feedback in real time—balancing exertion, cognitive load, and engagement during rehabilitative training—may be key to accelerating gains in motor function.
DOI: 10.3389/frvir.2026.17724112026-03-26
J. K. Sangeeth Chandran, Marisa Llorens Salvador, Cathy Ennis
IntroductionVirtual reality (VR) systems have evolved significantly over the past decade, enabling immersive experiences with enhanced realism and interactivity. This has motivated an interest in socially oriented applications. As user proxies, Virtual Humans (VHs) play essential roles in such applications. However, despite technological advancements, achieving realistic, expressive, and socially responsive VHs continues to present design and implementation challenges. In this scoping review, we present the state-of-the-art of VR VHs, examining the impact of VHs on the user experience.MethodologyWe reviewed 59 papers retrieved from five databases across three core themes: the implementation and impact of VH facial expressions, the impact of VH fidelity on the user experience, and the influence of VHs on human emotion and social engagement in VR. In addition, we categorized the methodologies of the reviewed studies, detailing the nature of participant interactions and the measurements taken to derive the results.ResultsThe synthesis of the examined studies indicates that both the social context (e.g., collaborative work vs. solo tasks) and the virtual environment (realistic office vs. fantastical world) significantly influence VH design decisions, such as the appropriate level of realism and emotional expressiveness.DiscussionOur review highlights the relation between social engagement, fidelity and expressiveness. We offer a set of guidelines for researchers and developers aimed at optimizing VH design to enhance user experience in VR.
DOI: 10.3389/frvir.2026.17380002026-03-23
Azriel Kaplan, Liran Kalderon, Shelly Levy-Tzedek, Yoav Gimmon
BackgroundThe successful implementation of vestibular rehabilitation is frequently hindered by low patient adherence due to provoked symptoms and repetitive exercises. Virtual reality is increasingly deployed as a digital health solution to overcome these barriers through gamification, yet the specific active ingredient driving its clinical efficacy remains unclear.ObjectiveThis review evaluates whether the therapeutic advantage of virtual reality in vestibular rehabilitation is driven by specific technological features or by the confounding effect of longer practice durations relative to traditional methods.MethodsWe conducted a narrative review of studies published between 2010 and 2025 using PubMed, Scopus, and Google Scholar. The analysis focused on trials comparing virtual reality tools to conventional rehabilitation.ResultsAlthough intervention protocols varied substantially, studies demonstrating better outcomes (e.g., Vestibulo-Ocular Reflex gain, Dizziness Handicap Inventory, Berg Balance Test) with virtual reality consistently involved greater practice exposure in the virtual reality group. Our analysis suggests that when training duration was matched between intervention arms, virtual reality demonstrated no clinical advantage over conventional rehabilitation with one recent trial reporting better outcomes for conventional rehabilitation.ConclusionVirtual reality appears to enhance engagement in vestibular rehabilitation; however, current evidence suggests that the observed benefits could be attributed to increased practice dosage rather than unique technological effects. Future studies should standardize protocols to determine the independent contribution of virtual reality to clinical outcomes.
DOI: 10.3389/frvir.2026.17630182026-03-18
Vigneshkumar Chellappa, Jeffrey C. F. Ho, Yan Luximon
IntroductionVirtual reality (VR) offers immersive opportunities to enhance safety education, yet the mechanisms through which VR fosters empathy and safety motivation are underexplored. This study examines how perspective (first-person vs. third-person) and narrative context (with vs. without a victim’s background story) influence empathy, safety motivation, and attitudes in a VR simulation of a fatal construction accident.MethodsA 2 × 2 between-subjects experiment was conducted with 160 participants who experienced a VR accident scenario under one of four conditions: first- or third-person perspective, with or without the victim’s background story. Participants completed validated and adapted measures of perceived closeness (IOS), state empathy (SES), embodiment, social presence, safety motivation, and attitudes toward construction safety. Direct, indirect, and serial mediation effects were analyzed using t-tests, ANOVA, and Hayes’ PROCESS macro.ResultsThe results showed that a victim’s background story increased perceived closeness and marginally increased empathy, with an indirect effect on safety motivation. While perspective alone did not directly influence empathy, the first-person perspective enhanced participants’ sense of embodiment, which in turn increased motivation and fostered social presence, resulting in more positive attitudes toward safety.DiscussionThe findings underscore the significance of emotionally resonant narratives and embodiment in VR training for cultivating empathy and a commitment to safety. The study’s results provide insights to inform the design of VR-based safety training programs in the construction industry, highlighting the potential benefits of narrative-driven, immersive experiences in fostering empathy and improving safety education outcomes.
DOI: 10.3389/frvir.2026.17288972026-03-13
Pau Mora, Eugenio Ivorra, Elena Parra-Vargas, Pau Soldevila-Matías, Mariano L. Alcañiz
IntroductionVirtual Reality (VR) has emerged as a pivotal tool for mental health interventions, paving the way for innovative approaches to emotional regulation. While the customization of therapeutic “safe places” is believed to enhance outcomes, existing applications often depend on inflexible, pre-configured content. This paper introduces Refugio, a groundbreaking VR application designed to bridge this gap through an integrated, real-time personalization pipeline powered by a self-hosted Large Language Model (LLM) and an efficient voice-to-3D generative pipeline.MethodsWe conducted a feasibility and usability study with 30 non-clinical participants to evaluate the feasibility and user acceptance of this natural language-driven approach, while preliminarily exploring its potential to support emotional outcomes and immersion while minimizing cognitive workload. We assessed usability (using the System Usability Scale - SUS), cognitive load (NASA-TLX), immersion (RJPQ), and emotional state before and after (Self-Assessment Manikin - SAM).ResultsThe study provided compelling preliminary evidence of the system’s feasibility and high user acceptance. Refugio achieved an “Excellent” mean SUS score of 86.33, alongside low reported mental demand and frustration. Participants showed strong engagement, creating 147 objects, and reported positive emotional shifts, with the majority experiencing increased valence (21 out of 30) and decreased arousal (19 out of 30).DiscussionThis study demonstrates that Refugio’s architecture is a viable and well-received method for implementing deep generative personalization. Our findings suggest that this natural language driven approach adeptly balances creative freedom with high usability and low cognitive load, thereby establishing a robust foundation for future clinical validation.
DOI: 10.3389/frvir.2026.17607652026-03-11
Minxin Cheng, Leanne Chukoskie
Virtual reality (VR) systems with integrated eye tracking offer a powerful way to study and support sensorimotor and cognitive function in neurorehabilitation. Eye movements provide a high-bandwidth window onto information processing, visuomotor integration, cognitive load, and affect, while immersive VR enables more ecologically valid yet controllable tasks spanning visual exploration, movement execution, object interaction, and social exchange. This narrative review synthesizes recent work on eye tracking in VR for neurorehabilitation, focusing on three application domains: assessment, intervention, and supportive design, together with the technical and governance requirements needed to make these systems clinically meaningful and ethically responsible. We highlight how the dominant implementation pattern of integrated headsets streaming preprocessed gaze rays into game engines introduces black-box processing, frame-bound timing, and limited calibration control that pose threats to validity, reproducibility, and cross-site comparability. We review emerging workarounds, including modular architectures that decouple sensing and rendering, explicit latency benchmarking and cross-modal synchronization, adaptive and implicit calibration approaches, and privacy-by-design frameworks from digital phenotyping and metaverse healthcare. Taken together, the evidence suggests that eye-tracked VR is already capable of supporting informative assessments and promising interventions, but that realizing its full potential for neurorehabilitation will require a shift toward architectures that support transparent control over sampling, calibration, timing, and data governance, as well as handling eye tracking data as both a sensitive clinical signal and a protected form of personal data.
DOI: 10.3389/frvir.2026.17572512026-03-06
Alin Moldoveanu, Iulia Cristina Stănică, Andrei Cristian Lambru, Ana Magdalena Anghel, Silviu Stăncioiu, Anca Morar, Victor Asavei, Robert-Gabriel Lupu, Delia Cinteză
IntroductionHuge and increasing global rehabilitation needs, affecting more than 2.4 billion people, require the mainstream adoption of the latest innovative technological solutions, including but not limited to virtual reality (VR), robotics, artificial intelligence (AI), or games. This systematic review focuses on the use and potential of gamified VR in post-stroke neurorehabilitation to effectively address patient engagement and motivation, scalability, costs, and the scarcity of specialists.MethodsOur review, conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, identified 4,856 records narrowed down to 66 key studies from five major databases. These studies were categorized and analyzed based on the technologies used, game mechanics, gamification techniques, adaptation to the user, and evaluation procedure.ResultsOur findings draw significant conclusions for each of these aspects and ultimately highlight the potential of gamified VR to become a mainstream neurorehabilitation technology for post-stroke patients, scalable to societal needs and improving recovery outcomes. Our review concludes with a discussion of the future directions and implications for clinical practice in neurorehabilitation using gamified VR technologies.
DOI: 10.3389/frvir.2026.17374822026-03-06
Dan Bürger, Katalin Altrogge, Florian Heilmann, Stefan Pastel, Kerstin Witte
IntroductionReactions and their inhibition are crucial in many sports. Visual reaction times (RTs) typically increase with eccentricity, and inhibition tasks produce slower RTs than simple reaction tasks. In sports, responses to peripheral stimuli often depend on an additional signal. This randomized within-subject study examined how the position of additional Go/No-Go-signals affects RTs to peripheral stimuli.MethodHealthy adults (n = 30; eligibility: no red-green blindness, no motor restrictions) performed a virtual reality reaction task to stimuli at varying eccentricities in three conditions using a virtual reaction wall. In the no-signal condition, participants reacted to illuminating buttons. In the two Go/No-Go conditions, an additional signal (green = Go, red = No-Go) appeared either centrally (central-signal condition) or peripherally (45° horizontally left and right; peripheral-signal condition). The primary outcome was RT to Go stimuli. Condition order was randomized for each participant using a computer-generated allocation.ResultsThree participants were excluded due to high error rates. Data from the remaining 27 participants showed that RTs increased with eccentricity. Reactions were fastest in the no-signal condition, followed by the central-signal condition, and slowest in the peripheral-signal condition. No evidence for differences in the slope of the eccentricity-related RT increase was observed.ConclusionThis virtual reality setup replicated known real-world findings: RTs increase with eccentricity and are slower in inhibition tasks. The position of a Go/No-Go-signal influences absolute RTs, but no evidence for faciliatory or limiting influence of attentional shifts induced by the additional signals was found.
DOI: 10.3389/frvir.2026.1706034