Journal of Cybertherapy and Rehabilitation

Volume 1 - Issue 1 - Spring 2008


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Journal of CyberTherapy and Rehabilitation, 2008, 1 (1), 7-22



Giuseppe Riva, Ph.D.


The emerging approach of “embodied cognition” is redefining the nature of cognition: cognition is no longer a set of formal operations on abstract symbols, but rather a situated embodied activity. On one side, the characteristics of our perceptual and motor systems play a foundational role in concept definition and in rational inference. On the other side, practical activity plays a role in giving meaning to the particular experiences of, and the representations generated by, a given individual agent.

Within this framework, virtual reality (VR) can be considered an embodied technology with potential that is wider than the simple reproduction of real worlds. By designing meaningful embodied activities, VR may be used to facilitate cognitive modeling and change. This paper will both discuss this claim and present a possible application of this approach: the therapeutic use of VR for the treatment of body image disturbances.


Journal of CyberTherapy and Rehabilitation, 2008, 1 (1), 23-36


Brenda K. Wiederhold, Ph.D., MBA, BCIA and Mark D. Wiederhold, M.D., Ph.D., FACP


Over the past decade, virtual reality (VR) has made a significant impact on behavioral healthcare, permeating the field with its multiple effective uses. One arena in which VR shines is in providing training and treatment for those exposed to traumatic or especially stressful events. Though traditional treatment methods for Posttraumatic Stress Disorder (PTSD) include medication, psychotherapy, and exposure therapy, none of these treatments has been sufficient to alleviate symptoms in many of those who suffer from the disorder.

However, when imaginal exposure is replaced with VR exposure, many non-responders seem to receive relief. Over 15 studies entailing diverse populations have shown VR exposure therapy to enhance traditional cognitive behavioral treatment regimens for PTSD. Most studies reveal a treatment success rate of 66%-90%. Another area in which VR is contributing to success is in prevention or attenuation of stress-related reactions through Stress Inoculation Training (SIT). SIT is a type of training used to prepare individuals for stressful situations (such as combat or medical emergencies), diminishing the potential for a negative psychological reaction like PTSD. In cognitive-behavioral therapy, SIT is accomplished through gradual, controlled, and repeated

exposure to a stressor. The goal behind this exposure is to desensitize the person to the stressful situation, avoiding a panic or “fight or flight” response to the real thing. This not only allows the individual to accomplish the tasks at hand in a stressful environment, but also may act to prevent long-term psychological reactions to stress such as PTSD. Though a relatively new area, several researchers have begun to use VR to enhance SIT techniques. The results to date appear to be quite promising.


Journal of CyberTherapy and Rehabilitation, 2008, 1 (1), 37-48


Luciano Gamberini, Mariano Alcaniz, Giacinto Barresi, Malena Fabregat, Lisa Prontu, Bruno Seraglia


This paper offers an overview of recent game-based applications for therapy and rehabilitation of elderly people. Information and Communication Technologies represent a viable solution to meet the various physical and psychological needs of a population growing at an incredibly fast rate. In particular, videogames have proven to improve elderly people’s cognitive abilities and take care of psychological problems accompanying illnesses and social isolation. We will present several examples of videogames adopted within training programs for elderly people, and tested through scientific procedures. We will include both old-fashioned games and recent ones. Characterized by a higher naturalness in the input system, the latter rely on already established usage practices with non-digital tools (a pen, a bowling ball, etc) that make the interface more accessible. Finally, we will describe a current European project that aligns with these efforts towards natural interfaces and aims at developing a mixed reality game for cognitive training and sociability of elderly users. 


Journal of CyberTherapy and Rehabilitation, 2008, 1 (1), 49-62


Giovanni Pioggia, Roberta Igliozzi, Maria Luisa Sica, Marcello Ferro, Filippo Muratori, Arti Ahluwalia and Danilo De Rossi


Individuals with Autistic Spectrum Disorders (ASDs) have impairments in processing of social and emotional information. To widen emotive responsiveness, the employment of robotic systems to engage proactive interactive responses in children with ASDs has been recently suggested. Understanding and teaching the processing of socio-emotional abilities is the inspiring principle of this novel approach and could be of tremendous clinical significance. Encouraging studies with robotic dolls, mobile robots and humanoids acting as social mediators have provided important insights and demonstrate the necessity of long term studies. In this study we report on a series of experiments on four subjects affected by ASDs as they interact with a biomimetic android. We assessed both their spontaneous behavior and reactions to therapist presses in correlation with the time course of the physiological and behavioral data, as well as the focusing of attention towards the android’s eye movements and the spontaneous ability to imitate gesture and facial expressions. Overall, subjects demonstrated a decrease in dysfunction in the areas of social communication, implying a marked improvement in these areas after interacting with the android. 


 Journal of CyberTherapy and Rehabilitation, 2008, 1 (1), 63-74


Mónica S. Cameirão, Sergi Bermúdez i Badia and Paul F.M.J. Verschure


In the last decade there have been major developments in the creation of interactive virtual scenarios for the rehabilitation of motor deficits following stroke. Virtual reality technology is arising as a promising tool to diagnose, monitor and induce functional recovery after lesions to the nervous system. This evidence has grown in the last few years, as effort has been made to develop virtual scenarios that are built on the knowledge of mechanisms of recovery. In this paper we review the state of the art virtual reality techniques for rehabilitation of functionality of the upper extremities following stroke. We refer to some of the main systems that have been developed within different rehabilitative approaches such as learning by imitation, reinforced feedback, haptic feedback, augmented practice and repetition, video capture virtual reality, exoskeletons, mental practice, action observation and execution, and others. The major findings of these studies show that virtual reality technologies will become a more and more essential ingredient in the treatment of stroke and other disorders of the nervous system.


 Journal of CyberTherapy and Rehabilitation, 2008, 1 (1), 75-92


Sophie Côté, Ph.D. and Stéphane Bouchard, Ph.D.


This article is a review of the literature on efficacy and outcome studies using in virtuo exposure treatments to treat specific phobias. Thirty-nine studies were examined for this review: 56% were case studies or small sample studies, 13% were studies using larger samples, but no control or comparison condition, 13% used a comparison group (waiting list, placebo), 8% used a comparative treatment condition (usually in vivo exposure) and 13% used both. The specific phobias that were treated in these studies were acrophobia, aviophobia, claustrophobia, arachnophobia and fear of driving. The majority of these studies demonstrated that in virtuo exposure is effective and constitutes an interesting alternative to in vivo exposure. However, as the area is still taking its first steps, more studies with stronger methodological validity (control and comparative treatment conditions) are needed. 


 Journal of CyberTherapy and Rehabilitation, 2008, 1 (1), 93-100


C. Botella, A. García Palacios, R. Baños, S. Quero & J. Breton-Lopez


Many medical procedures produce acute pain that in most cases is quite disturbing for the individual. Medication is the treatment of choice for acute pain. However, given the involvement of psychological aspects in the experience of pain, psychological techniques are being used as an effective adjunct to alleviate pain related to medical procedures. In the last years a new technology is demonstrating an enormous potential in this field: Virtual Reality (VR) distraction. In this article we review studies that explore the efficacy of immersive VR distraction in reducing pain related to different medical procedures. We include clinical studies and analogue studies with healthy participants. We discuss the results achieved by these studies and recommend future directions of VR pain control research. 


 Journal of CyberTherapy and Rehabilitation, 2008, 1 (1), 101-112


Sun I. Kim, Jeonghun Ku, Kiwan Han, Hyeongrae Lee, Jinsick Park, Jae-Jin Kim, and In Young Kim


Schizophrenia is a brain disorder that is characterized by disturbances in general cognition, such as abnormal expressions of emotion and ways of thinking, mental derangement, regression from reality, strange language or behavior, and delusion or illusion. Family-based interventions, cognitive behavioral therapy, symptom-focused interventions, and social skills training are required for schizophrenic patients to return to normal life. Virtual reality is a medium that can present social and emotional situations via effective human-computer interactions that provide more realistic stimuli than the pictures or movies that are used in existing psychiatric therapy. Using conventional cognitive-behavioral therapy, it is difficult to obtain objective measurements. In addition, it is difficult to provide emotional or social situations. Virtual reality techniques can computerize various parameters so that objective measurements are possible; they can also provide emotional or social situations. Recently, virtual reality techniques have been used in the psychiatric field for effective training and objective assessment, such as in cognitive-behavioral therapy, social skills training, and medication training. In this paper, we describe the potential applications of virtual reality for patients with schizophrenia. More interactive and effective applications for patients with schizophrenia will emerge as virtual reality techniques continue to evolve.