The feasibility of using virtual reality to induce mobility-related anxiety during turning

Raffegeau, Tiphanie E.; Fawver, Bradley; Clark, Mindie; Engel, Benjamin; Young, William R.; Williams, A. Mark; Lohse, Keith R.; Fino, Peter C.

doi:10.1016/j.gaitpost.2020.01.006

Cited by 20 publications

(22 citation statements)

References 31 publications

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“…Generally, it is considered that as long as conflicting graphical spatial cues are avoided, the overall graphical quality has seemly small effects on how observers perceive a space. The current findings align with more recent literature, supporting the use of VR to safely induce mobility-related anxiety and potential habituation to anxiety-inducing VEs [13].…”

Section: Virtual Reality Environmentsupporting

confidence: 90%

“…Manipulating visual environments to increase perceived postural threat increases anxiety levels [7][8][9]. Feelings of anxiety and associated disorders are linked to greater postural instability [10][11][12][13]. Redfern, Furman, and Jacob [14] found increased COP postural sway in persons with generalized anxiety and agoraphobia in response to changes in visual flow.…”

Section: Introductionmentioning

confidence: 99%

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The Walls Are Closing In: Postural Responses to a Virtual Reality Claustrophobic Simulation

Chander

Freeman

Hill

et al. 2022

CTN

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Background: Changes in the visual environment and thereby, the spatial orientation, can induce postural instability leading to falls. Virtual reality (VR) has been used to expose individuals to virtual environments (VE) that increase postural threats. Claustrophobia is an anxiety disorder categorized under situational phobias and can induce such postural threats in a VE. Purpose: The purpose of the study was to investigate if VR-generated claustrophobic simulation has any impact on postural threats that might lead to postural instability. Methods: Thirty healthy men and women (age: 20.7 ± 1.2 years; height: 166.5 ± 7.3 cm; mass: 71.7 ± 16.2 kg) were tested for postural stability while standing on a force platform, upon exposure to five different testing trials, including a normal stance (NoVR), in stationary VE (VR), and three consecutive, randomly initiated, unexpected claustrophobia trials (VR CP1, VR CP2, VR CP3). The claustrophobia trials involved all four walls closing in towards the center of the room. Center of pressure (COP)-derived postural sway variables were analyzed with a one-way repeated measures analysis of variance at an alpha level of 0.05. Results: Significant main effect differences existed in all but one dependent COP-derived postural sway variables, at p < 0.05. Post-hoc pairwise comparisons with a Bonferroni correction revealed that, predominantly, postural sway excursions were significantly lower in claustrophobia trials compared to NoVR and VR, but only accomplished with significantly increased sway velocity. Conclusion: The VR CP trials induced lower postural sway magnitude, but with increased velocity, suggesting a bracing and co-contraction strategy when exposed to virtual claustrophobic postural threats. Additionally, postural sway decreased with subsequent claustrophobia trials, suggesting potential motor learning effects. Findings from the study offer insights to postural control behavior under virtual claustrophobic simulations and can aid in VR exposure therapy for claustrophobia.

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Section: Virtual Reality Environmentsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

The Walls Are Closing In: Postural Responses to a Virtual Reality Claustrophobic Simulation

Chander

Freeman

Hill

et al. 2022

CTN

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“…Although falls are a very real threat, fear and anxiety related to mobility can prime the body to be in an avoidance state and therefore interfere with optimal ambulation, thus increasing risk of fall (Kitzmüller et al, 2019). Fear can also interfere with performing adaptive gait movements (Raffegeau et al, 2020) and would therefore have profound impacts on the efficacy of behaviors in groups at-risk for injury such as older adults or individuals engaging in physical therapy.…”

Section: Discussionmentioning

confidence: 99%

Recalling fearful memories modifies approach and avoidance behavior based on spatial context.

Fawver¹,

Hass²,

Coombes³

et al. 2022

Emotion

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Motor responses are more efficient when there is a match (or congruency) between the motivational properties of an emotional state and the distance altering characteristics of the movement being executed to the emotion-eliciting stimulus. However, the role of spatial context in shaping motivational orientations to approach and avoid, particularly during whole-body movement tasks, remains less understood. We sought to narrow this knowledge gap by investigating whether an emotion (fear) relived from a previous experience affected movement initiation based on whether motor responses were implicitly coded as approach (i.e., incongruent) or avoidance (i.e., congruent) as per the location of the imagined threat stimulus. Participants (N = 29) completed a tone-initiated forward gait initiation task after recalling a previous fearful experience in which the stimulus from their memory was located either in front (incongruent) or behind (congruent) them. Facilitation versus inhibition of motor responses was indexed by reaction time (RT), displacement and velocity of postural movements prior to stepping, and step kinematics. Analyses revealed that participants initiating forward gait after recalling a fearful experience in which the fearful stimulus was congruent to the movement direction expedited RTs, greater displacement and velocity of anticipatory postural responses, and greater step length and velocity. Results provide support for the theoretical position that motivational orientations to approach and avoid are contextualized based on affective congruency, which includes the spatial orientation of real or imagined emotional stimuli.

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“…We avoided the confounding factor of fear by creating a mundane environment and provided instructions to simply avoid stepping on a particular color. Fear and anxiety are known to modify behavior (Raffegeau et al, 2020) and spinal reflexes when exposed to increased heights (Sibley et al, 2007). Fear may be one method to provide an incentive to abide by such a constraint.…”

Section: Discussionmentioning

confidence: 99%

Flexible Recruitment of Balance Mechanisms to Environmental Constraints During Walking

Fettrow

DiBianca

Santos

et al. 2020

Front. virtual real.

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Background: Humans need to actively control their upright posture during walking to avoid loss of balance. We do not have a comprehensive theory for how humans regulate balance during walking, especially in complex environments. The nervous system must process many aspects of the environment to produce an appropriate motor output in order to maintain balance on two legs. We have previously identified three balance mechanisms that young healthy adults use to maintain balance while walking: (1) The ankle roll mechanism, a modulation of ankle inversion/eversion; (2) The foot placement mechanism, a shift of the swing foot placement; and (3) The push-off mechanism, a modulation of the ankle plantarflexion angle during double stance. We know that these mechanisms are interdependent and can be influenced by internal factors such as the phase of the gait cycle and walking cadence. Here we seek to determine whether there are changes in neural control of balance when walking in the presence of environmental constraints. Methods: Subjects walked on a self-paced treadmill while immersed in a virtual environment that provides three different colored pathways. Subjects were instructed not to step in the No-Step Zone, which appeared either on the right or left side of the subject. While walking, subjects received balance perturbations in the form of galvanic vestibular stimulation, providing the sensation of falling sideways, either toward the No-Step zone or toward the Neutral zone on the other side. Results: The results indicate that the use of the balance mechanisms are altered depending on whether the perceived fall is toward the No-Step or the Neutral zone. Participants increased the use of the lateral ankle and foot placement mechanisms for No-Step stimuli resulting in a larger shift of the center of mass (CoM) compared to the Neutral stimuli. Conclusion: This experiment provides further evidence that the balance control system during walking is extremely flexible, recruiting multiple mechanisms at different times in the gait cycle to adapt to environmental constraints.

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The feasibility of using virtual reality to induce mobility-related anxiety during turning

Cited by 20 publications

References 31 publications

The Walls Are Closing In: Postural Responses to a Virtual Reality Claustrophobic Simulation

The Walls Are Closing In: Postural Responses to a Virtual Reality Claustrophobic Simulation

Recalling fearful memories modifies approach and avoidance behavior based on spatial context.

Flexible Recruitment of Balance Mechanisms to Environmental Constraints During Walking

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