Cybersickness (CS) is a term used to refer to symptoms, such as nausea, headache, and dizziness that users experience during or after virtual reality immersion. Initially discovered in flight simulators, commercial virtual reality (VR) head-mounted displays (HMD) of the current generation also seem to cause CS, albeit in a different manner and severity. The goal of this work is to summarize recent literature on CS with modern HMDs, to determine the specificities and profile of immersive VR-caused CS, and to provide an outlook for future research areas. A systematic review was performed on the databases IEEE Xplore, PubMed, ACM, and Scopus from 2013 to 2019 and 49 publications were selected. A summarized text states how different VR HMDs impact CS, how the nature of movement in VR HMDs contributes to CS, and how we can use biosensors to detect CS. The results of the meta-analysis show that although current-generation VR HMDs cause significantly less CS ($$p<0.001$$ p < 0.001 ), some symptoms remain as intense. Further results show that the nature of movement and, in particular, sensory mismatch as well as perceived motion have been the leading cause of CS. We suggest an outlook on future research, including the use of galvanic skin response to evaluate CS in combination with the golden standard (Simulator Sickness Questionnaire, SSQ) as well as an update on the subjective evaluation scores of the SSQ.

ObjectiveThe goal of this contribution is to gather and to critically analyze recent evidence regarding the potential of exergaming for Parkinson’s disease (PD) rehabilitation and to provide an up-to-date analysis of the current state of studies on exergame-based therapy in PD patients.MethodsWe performed our search based on the conclusions of a previous systematic review published in 2014. Inclusion criteria were articles published in the indexed databases Pubmed, Scopus, Sciencedirect, IEEE and Cochrane published since January 1, 2014. Exclusion criteria were papers with a target group other than PD patients exclusively, or contributions not based on exergames. Sixty-four publications out of 525 matches were selected.ResultsThe analysis of the 64 selected publications confirmed the putative improvement in motor skills suggested by the results of the previous review. The reliability and safety of both Microsoft Kinect and Wii Balance Board in the proposed scenarios was further confirmed by several recent studies. Clinical trials present better (n = 5) or similar (n = 3) results than control groups (traditional rehabilitation or regular exercise) in motor (TUG, BBS) and cognitive (attention, alertness, working memory, executive function), thus emphasizing the potential of exergames in PD. Pilot studies (n = 11) stated the safety and feasibility of both Microsoft Kinect and Wii Balance Board, potentially in home scenarios as well. Technical papers (n = 30) stated the reliability of balance and gait data captured by both devices. Related meta-analyses and systematic reviews (n = 15) further support these statements, generally citing the need for adaptation to patient’s skills and new input devices and sensors as identified gaps.ConclusionRecent evidence indicates exergame-based therapy has been widely proven to be feasible, safe, and at least as effective as traditional PD rehabilitation. Further insight into new sensors, best practices and different cognitive stadiums of PD (such as PD with Mild Cognitive Impairment), as well as task specificity, are required. Also, studies linking game parameters and results with traditional assessment methods, such as UPDRS scores, are required. Outcomes for randomized controlled trials (RCTs) should be standardized, and follow-up studies are required, particularly for motor outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12984-019-0492-1) contains supplementary material, which is available to authorized users.

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