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Virtual reality (VR)-based rehabilitation is a growing technological field, which gradually becomes integrated into existing programs. However, technology has to support human behavior and -needs, including social relatedness, to achieve health-related outcomes. Elderly people have high risk of loneliness, and VR has technological affinity for natural social interaction. Previous studies have relied on competitiveness rather than collaborative elements, but research shows that competitiveness can lead to (feelings of) stress and aggressive behavior in some individuals. This article presents a mixed methods study to gather end-user feedback on a social VR scenario that encourages inter-player collaboration on a virtual tandem bike. Outpatients ($$n=11$$ n = 11 , 64% males, $$60\pm 11$$ 60 ± 11 years) were invited to participate with a co-player (friend or family). Participants biked on average 10.7 (± 3) minutes with a mean speed of 14.8 kmph (± 5.8). The results indicate potential and feasibility for the collaborative social biking application. Participants reported excellent usability-scores (85 ± 5), high intrinsic motivation in all categories: enjoyment (6.5 ± 0.5), effort/importance (6.4 ± 0.3), relatedness (6.3 ± 0.7) and minimal increase in symptoms of nausea, oculomotor and disorientation. Furthermore, participants found the social aspect enjoyable, agreed that collaboration eased tasks and that they lost track of exercise duration. Interpersonal interaction between participants varied, but was mostly positively rated valence, even if the sense of copresence was limited by physical constraints and avatar representation. Most participants expressed that they would use the program again, but future studies should explore how to improve location and appearance of the virtual coactor, as well as implement additional tasks.

Background: As the elderly population continues to grow, so does the demand for new and innovative solutions to tackle age-related chronic diseases and disabilities. Virtual Reality (VR) has been explored as a novel therapeutic tool for numerous health-related applications. Although findings frequently favors VR, methodological shortcomings prevent clinical recommendations. Moreover, the term “VR” is frequently used ambiguously to describe e.g., video games; the distinction remains vague between immersive VR (IVR) systems and non-immersive VR (NVR). With no distinct demarcation, results of outcome measures are often pooled in meta-analyses, without accounting for the immersiveness of the system.Objective: This systematic review focused on virtual reality-based rehabilitation of older adults (+60) in motor rehabilitation programs. The review aims to retrospectively classify previous studies according to the level of immersion, in order to get an overview of the ambiguity-phenomenon, and to utilize meta-analyses and subgroup analyses to evaluate the comparative efficacy of system immersion in VR-based rehabilitation.Methods: Following PRISMA guidelines, we conducted a systematic search for randomized controlled trials, describing virtual rehabilitation or video games interventions for older adults (+60). Main outcomes were pain, motivation, mobility, balance, and adverse events.Results: We identified 15 studies which included 743 patients. Only three studies utilized IVR. The rest used various NVR-equipment ranging from commercial products (e.g., Nintendo Wii), to bespoke systems that combine tracking devices, software, and displays. A random effects meta-analysis of 10 studies analyzed outcome measures of mobility, balance, and pain. Protocols and dosage varied widely, but outcome results were in favor of immersive and non-immersive interventions, however, dropout rates and adverse events were mostly in favor of the control.Conclusions: We initialize a call-for-action, to distinguish between types of VR-technology and propose a taxonomy of virtual rehabilitation systems based on our findings. Most interventions use NVR-systems, which have demonstrably lower cybersickness-symptoms than IVR-systems. Therefore, adverse events may be under-reported in RCT-studies. An increased demand for IVR-systems highlight this challenge. Care should be given, when applying the results of existing NVR tools to new IVR-technologies. Future studies should provide more detail about their interventions, and future reviews should differentiate between NVR and IVR.

Virtual reality (VR) has been shown to function well as an assistive technology to physical therapy for elderly users. Elderly users are a unique user group in this field, due to their characteristics and demands. They are also a user group that can definitely benefit from VR technology, which is unfortunately a perspective that seems elude the VR community. This study explores how augmenting a manuped exercise (chair-based exercise bike), using an interactive screen-based virtual environment (VE), can change the exercise experience for retirement home residents. It is the first study in a series of studies, initiating an investigation into how to use VR to augment conventional exercise experiences, specifically for the retirement home resident audience. In a larger scope, the ambition is longterm to use VR technology to increase motivation with retirement home residents, to uphold a regular exercise routine. The results showed that a majority of subjects reported to support the VE augmentation and preferred the VE based exercise experience to the conventional exercise. This supports VR as an assisting technology for physical therapy, and suggests the potentiality VE augmented exercises, tailored for retirement home residents.

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