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Not perfect but good enough: a primer for creating spherical video-based virtual reality for autistic users

Authors:

Abstract

Purpose Previous research provides promising insights to the role of spherical video-based virtual reality (SVVR) applied with and for autistic users. Work already conducted in this area suggests that SVVR delivered via a range of head-mounted displays (HMDs) are useable, acceptable, can enable skill acquisition, can be relevant for delivering training, can help to reduce discomfort and promote skills generalization. However, to date very little research articulates methods or approaches to the design and development of SVVR. Here, the authors share the experiences of working in this space and designing SVVR content with and for autistic groups. Design/methodology/approach The authors draw upon two case studies/projects that were previous worked on with the intention to extrapolate key parts of the production process of SVVR development. The authors also outline key theoretical contexts as related to SVVR development in this field. Findings The goal of this primer on SVVR is to provide researchers and practitioners with an overview of using this technology. The authors provide a set of recommendations that should inform others in creating their own content and developing SVVR for/with/by autistic people. Originality/value This work combines and outlines theoretical, conceptual and practical considerations for practitioners and stakeholders seeking to build and deploy SVVR content; aspects not reported in previous research.
Not perfect but good enough: a primer for
creating spherical video-based virtual
reality for autistic users
Nigel Newbutt, Noah Glaser and Heath Palmer
Abstract
Purpose Previous research provides promising insights to the role of spherical video-based virtual reality
(SVVR) applied with and for autistic users. Work already conducted in this area suggests that SVVR delivered via
a range of head-mounted displays (HMDs) are useable, acceptable, can enable skill acquisition, can be relevant
for delivering training, can help to reduce discomfort and promote skills generalization. However, to date very
little research articulates methods or approaches to the design and development of SVVR. Here, the authors
share the experiences of working in this space and designing SVVR content with and for autistic groups.
Design/methodology/approach The authors draw upon two case studies/projects that were previous
worked on with the intention to extrapolate key parts of the production process of SVVR development. The
authors also outline key theoretical contexts as related to SVVR development in this field.
Findings The goal of this primer on SVVR is to provide researchers and practitioners with an overview of using
this technology. The authors provide a set of recommendations that should inform others in creating their own
content and developing SVVR for/with/by autistic people.
Originality/value This work combines and outlines theoretical, conceptual and practical considerations for
practitioners and stakeholders seeking to build and deploy SVVR content; aspects not reported in previous
research.
Keywords Autism, Virtual reality, Spherical video-based virtual reality, 360-degree video-based VR, Immersive
technology, SVVR
Paper type Technical paper
1. Introduction
Autistic people can face increased challenges living in a predominantly neurotypical society
(Woods, 2017), which can impact their quality of life (Hedley et al., 2017). Estimates suggest that
between 1 in 54 in the USA (Baio et al., 2018) and approximately 2% of people worldwide have
autism (Roman-Urrestarazu et al., 2021). Several societal-wide obstacles and accessibility issues
can exist that complicate community integration for autistic groups (Woods, 2017). Responding to
this, researchers have sought to create effective and appropriate supports that can help autistic
people develop skills needed to thrive in a range of situations (Rao et al., 2008). In particular,
technology supports have received some attention, as they are believed to have useful affordances
and unique characteristics that can align to the needs and strengths of autistic people (Grynszpan
et al., 2014).
1.1 Autism and VR
One technology that maintains promise and is used with autistic groups is virtual reality (VR) and
head-mounted displays (HMDs). Research has located this specific technology as being
Nigel Newbutt is based at the
Institute of Advanced
Learning Technologies,
University of Florida,
Gainesville, Florida, USA.
Noah Glaser is based at the
Department of STEM
Education and Professional
Studies, Old Dominion
University, Norfolk, Virginia,
USA.
Heath Palmer is based at the
University of Cincinnati,
Cincinnati, Ohio, USA.
Received 19 January 2022
Revised 1 February 2022
Accepted 2 February 2022
Both the first and second authors
report equal contribution as co-
first author.
DOI 10.1108/JET-01-2022-0008 VOL. ▪▪▪ NO. ▪▪▪ , pp. 1-9, ªEmerald Publishing Limited, ISSN 2398-6263
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well-aligned to autistic people as it can provide realistic and supportive environments, free of real-
life consequences and other obstacles (e.g. overstimulation; Bradley and Newbutt, 2018).
The effectiveness of using this technology with autistic people has been discussed for over
three decades in the literature (Karami et al., 2021;Mesa-Gresa et al., 2018;Parsons, 2016).
Although researchers hypothesize that VR could be a highly effective training, therapeutic and
intervention modality, reviews of the literature suggest only moderate effects and learning benefits
(Karami et al., 2021). These findings have led some to claim that the promise of the technology has
yet to be fully realized (Parsons, 2016) and for others to report that findings have been overly
generalized (Glaser and Schmidt, 2021). However, since the first studies utilizing VR and autistic
groups were conducted (Strickland et al., 1996), VR technology development for autistic groups
has been slow and mainly reserved for research labs at very high costs and specific skill sets.
Several commercially available HMDs have been released onto the market since 2015 (e.g. Oculus
Rift, HTC Vive) which offer visually stimulating graphics, rich display experiences and a higher
degree of immersion. The commercial success of these products has led to a renewed interest in
exploring the use of HMD-based VR for autistic people (Newbutt et al., 2016). The increasingly
portable nature of VR HMD has also provided a new opportunity to place this technology in the
hands of end-users and to deploy therapeutic learning interventions in the community and outside
of academic research spaces. However, designing VR experiences for autistic people can be
technically challenging (Glaser et al., 2021;Schmidt et al., 2019), which can include the need for
highly technical development skills and, in some cases, prohibitive hardware costs (Grynszpan
et al., 2014;Glaser et al., 2021). Due to the challenges associated with creating fully immersive VR
systems, some researchers are beginning to explore the use of spherical video-based virtual reality
(SVVR; Schmidt et al., 2019). These systems are predominantly (or can be) mobile-based and
therefore require the coupling of a smartphone and plastic/cardboard head-mounted display.
Due to the emergence of this relatively new technology, practitioners and researchers often do not
know where to get started with creating SVVR learning systems (Schmidt et al., 2019). Therefore,
the goal of this primer on SVVR is to provide researchers and practitioners with an overview of using
this technology. This primer seeks to provide the following six components:
1. A broad overview and description of SVVR.
2. A brief outline of some theoretical foundations for using SVVR with autistic groups.
3. An overview of preliminary research that has been conducted where SVVR systems have been
designed, evaluated and deployed with autisitc people.
4. A simple do-it-yourself guide. In this section, we outline the hardware and software
requirements as well as a procedural description of production steps.
5. Two case examples from our prior work are presented to further shed light into the design and
production process of creating SVVR systems.
6. Directions for future work and implications are provided to establish routes ahead to maximize
the potential of SVVR and best practices.
1.2 Description of the technology
SVVR systems position the user in the center of a 360-degree environment that combines
perspectives from every direction (Geng et al., 2021). SVVR provides three degrees of freedom
(3DOF) where users can look around and interact with the environment they are viewing (Hwang
et al., 2018). Experiences are typically viewed via dedicated HMDs. Users can pan around the
video wearing a HMD and moving their head. This technology can be used to view 360-degree
videos in an immersive format similar to VR (Schmidt et al., 2019). In contrast to fully immersive 3D
virtual environments, users are unable to directly navigate through or manipulate the virtual world
and must remain centrally positioned (Glaser and Schmidt, 2021). Due to this constraint, SVVR
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systems are objectively less immersive than traditional VR systems where users wear a HMD with
full body and motion tracking (Miller and Bugnariu, 2016;Slater, 2009).
1.3 Theoretical premise for using SVVR with autistic groups
The promise of SVVR applications is in many ways derived from that of video modeling which has a
long history in the field of autism research and is supported by a wealth of research (Bross et al.,
2020;McCoy and Hermansen, 2007). Video modeling itself rests on the notion that learners can
develop a range of skills by watching how others perform and model those skills. Video modeling-
based instruction typically involves a pre-recorded demonstration of a target skill (Bellini and
Akullian, 2007) and is supported by theories such as Banduras social learning theory which posits
that learning can take place through observing and imitating how others behave (Bandura and
Walters, 1977).
2. Research overview
There has been recent interest and attention in VR used with autistic groups. However, due to the
specific and expert knowledge required to design and develop VR, there has been a growing body
of work and interest in less specialist VR systems; such as SVVR. This, however, means that
reports and studies reporting data and even the process of producing are limited. We next draw
together some preliminary findings and case studies located in the literature.
First, Gelsomini et al. (2017) report on an in-development Google Cardboard system called
Wildcard that is being designed to help individuals with neurodevelopmental disorders. In
Wildcard, users are able to interact with various virtual environments that are displayed within a
Google Cardboard. Interaction is mediated through gaze focus and direction. Findings from
preliminary analyses suggest that the usability and acceptance of the technology varied between
users. Some participants expressed discomfort with wearing the HMD.
Second, Wickham (2016) describes a Google Cardboard application that is designed to promote
the skills required to go grocery shopping. All participants in this study were able to complete the
SVVR training, but not without varying levels of prompting. Participants in this study did however
report a largely positive user experience.
In a third example, researchers on the Virtuoso project utilized SVVR technologies to provide
training related to public transportation. In this project, SVVR technologies were deployed as part
of a four-staged instructional strategy (Schmidt and Glaser, 2021). In Virtuoso-SVVR, autistic users
engaged with the application through a light-weight HMD to view videos that modeled the skills
required to board a university shuttle bus. The research team of this project cited the low cost, ease
of development, videographic fidelity, and lesser health and safety concerns (e.g. cybersickness;
Schmidt et al., 2021) as justification for the use of this technology (Schmidt et al., 2019). Findings
from expert reviewers (n54) and autistic usage test participants (n55) suggest that Virtuoso-
SVVR provided high usability, feasibility and relevance for promoting training objectives (Schmidt
and Glaser, 2021).
In a fourth example, Meindl et al. (2019) explored SVVR to examine the potential of the technology
to address phobias through gradual exposure. In this work, researchers developed an SVVR
application with the goal of gradually exposing participants with autism to the process of having
their blood drawn for medical procedures. The participant of this SVVR system expressed
evidence of acceptance and generalization across medical providers and were more willing to have
their blood drawn.
In the last example, Dixon et al. (2019) describe the evaluation of an SVVR pedestrian street-
crossing intervention. Their system delivered 360-degree videos that were created using an
omnidirectional camera. Using an Oculus Rift, participants (n53) watched a series of short clips
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depicting safe and unsafe street-crossing scenarios. Findings suggest that participants of this
study were able to demonstrate safe and appropriate street-crossing behaviors.
Taken together, previous research, outlined above, provides promising insights to the role of
SVVR-based technology applied with and for autistic users. Work already conducted in this area
suggests that SVVR delivered via a range of HMDs are useable, acceptable, can enable skill
acquisition, can be relevant for delivering training, can help to reduce discomfort and promote skills
generalization. Although all of the studies are preliminary, there is optimism that this form of VR can
be successfully applicable across a range of services and outcomes for autistic groups. However,
despite the possible affordances and benefits of using SVVR with autistic groups, there remains a
gap and lack of detail in researchers in this field designing and producing SVVR-based content
(Glaser and Schmidt, 2021). With that in mind, we next outline the key steps in designing content,
and in a way that is accessible for practitioners and users to develop themselves. We offer this as a
way to bridge research to practice in this arena.
3. Do it yourselfa brief guide
This section aims to outline the key stages involved in developing SVVR and applications, and will
cover aspects related to (1) hardware; (2) software and (3) the procedural/production stages. The
intention of this section is to outline the indicative equipment required alongside the software. We
conclude this section by providing an overview of the process from filming through to application/
deployment.
3.1 What you need: computer requirements and hardware with descriptions
3.1.1 Hardware.
1. Mid-range laptop or PC: A computer that is capable of handling basic multimedia production
and processing will be sufficient for the development of an SVVR application. This device will
need to support rendering video at 45.2k resolution and 30þframes per second.
2. Portable HMDs: There are a number of light-weight and portable HMDs that are commercially
available and able to support the streaming of 360-degree multimedia. At the time of writing,
there are two especially viable options. The first is the Google Cardboard coupled with a mobile
phone-type device. The Cardboard is inexpensive (10 dollars) and supports most available
mobile devices with a stereoscopic viewer (i.e. YouTube). The second option is an Oculus
Quest 2 that is a standalone VR headset with an internal operating system that comes with two
touch controllers. The Quest 2 can have the SVVR application preloaded onto the device, or
loaded through a wifi connection.
3. 360-degree camera: A 360-degree or omnidirectional camera is a device that maintains a field
of view that covers approximately the entire sphere or at least a full circle in the horizontal plane.
Popular options include the GoPro and the Gear 360.
4. Tripod: A portable three-legged tripod that is capable of supporting the weight and maintaining
the stability of a 360-degree camera.
3.1.2 Software.
1. Video editor: A video editor is needed to create a trimmed and modified 360-degree video. The
video editor that is required for this process is dependent upon the complexity of the SVVR
application. Free and open-source solutions such as Handbrake are suitable for trimming and
conducting minor edits. More complex editing may require paid software such as Adobe
Premiere Pro or VEGAS Creative Software.
2. Image editor (optional): If more advanced content is required (i.e. text/visual overlaps), then we
recommend a tool such as PhotoShop Gimp or Corel Draw.
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3. 360-degree video player: Web-based video hosting platforms are sufficient for deploying 360-
degree videos. YouTube, for example, supports 360-degree content and allows for free
streaming on mobile devices and VR headsets. There are also fully dedicated 360-degree
video hosting sites such as Veer.TV.
3.2 What you need: procedural and production steps
Before beginning the development of the SVVR application, you have to determine the nature and
extent of the task that you want to generate SVVR material for. The stages we have engaged that
lead to successful outcomes included:
1. Scope and plan: As part of the pre-production process, you may find it beneficial to hold
conversations where you conceive the targeted task, goal, learning outcome, location and
break it down into its underlying components. Then storyboard or document these to ensure
you align your outcomes to proposed SVVR content.
2. Rehearsal: You might find it beneficial to develop and work through a script with experts or
users to help be sure your content is appropriate and easy to understand. If your SVVR project
does not contain a script or narration, you should still plan the flow and user journey through
your proposed footage. This will save time and money when moving into the next stage
(production).
3.2.1 Production process. During the production of the SVVR materials you will be developing a rig
and capturing the footage for your application. This process may include the following stages:
1. Assemble team: This stage you will need to decide who you need to be in/part of your SVVR
project. Do you require actors/participants, are you filming in public or is it a shoot in a quiet
setting.
2. Film in situ: You will need to set your 360-video camera up on the tripod. If you are recording
video content that is stationary, make sure you are ready to capture/record and set the timer
to start the recording. Be sure the scene is clear or only contains the components required
(remembering this is 360-degree filming). You may need to remove yourself from the
environment for a short while. If you are recording video content that is more active, then you
will need to have somebody hold the tripod that the camera is mounted on. Make sure
that they hold the tripod above shoulder-length to ensure that the 360-degree camera is
not including their body in the frame. Once finished, review the footage and reshoot if
necessary.
3.2.2 Post-production process.
1. Download content: You can download and import your video-based content by connecting
your 360-degree camera to your computer via a USB connection. Simply drag and drop your
files from the device and move them to your computers file system.
2. Trim and edit: You may simply open with an app, like Quicktime or Handbrake and trim the
beginning and/or end. This may be enough to achieve your desired outcome. However, you
might wish to undertake further editing and refining of your content (including overlaying
images or text; for instruction purposes). In this instance, you will need to import your files into a
video editor (i.e. Adobe Premiere) to work on your footage. In addition to including images or
text, you can also include additional audio (narration) or sounds (i.e. noisey cafe). During a
review of the videos, you may notice that the videographer can be seen due to the nature of
capturing 360-degree footage. If the inclusion of this is cumbersome then you can apply an
image overlay at the bottom of the 360-degree video.
3. Export and deploy: You next need to save and/or export your project ensuring it aligns to
the intended platform. While there are many ways of accomplishing this, there are two
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methods that are the easiest. First, if your SVVR materials work well as standalone
videos, then simply uploading the multimedia to a video editor such as Veer.Tv or
YouTube would be sufficient. You can then simply navigate to your uploaded videos and
view the SVVR content on your phone and within a Google Cardboard HMD. There are
also several open-source SVVR library packages that exist. Unity for example has a
wealth of SVVR packages where you can easily generate video lobbies for your materials.
This approach is great if you have multi-step videos that build off of one another. You can
compile your Unity project to work on a range of devices including the Google Cardboard
as a mobile application or as software for higher-end VR HMD such as the Oculus Quests
or Rift.
3.2.3 What does this look like in practice. Having developed and proposed the above SVVR
process, we next share our work in this field having undertaken projects that utilize SVVR and 360-
degree still images, for the specific aim of supporting outcomes for autistic people. The first, in the
USA, explored the role of using SVVR to provide instruction related to the skills required to use
public transportation (Schmidt and Glaser, 2021;Schmidt et al., 2019). The second, in the UK,
developed a simple 360-degree tour of a school as pupils were returning after a prolonged period
away during the coronavirus disease 2019 (COVID-19) pandemic (Newbutt et al., 2020). The key
aim here was to support a stress-free way to support a return to school helping to reduce anxiety.
We present a bulleted articulation of how both teams instilled the SVVR production process that
was previously described above (see Table 1). The information presented in Table 1 provides
practitioners with two examples of how they can take the broad steps from our do-it-yourself guide
and apply it to a project of their own.
4. Opportunities and challenges moving forward
When working with autistic groups, we suggest working with and capturing the perspectives of
these groups and their stakeholders. These may be in formal settings (with teachers, therapists,
etc.) or in the community (with family, friends, etc.). The aim here is to ensure that SVVR-based
work is fully informed and shaped with the input of autistic people and their communities. In fact,
once users are familiar with the tools and process, autistic groups themselves should be
empowered to create their own content as it meets their needs.
Table 1 Outline of the steps that two SVVR research teams went through
US project UK project
Pre-
production
CConsultation with subject matter experts to outline of the task;
Refined through a ride along process (on the bus)
CInstructional task analysis
CDevelopment and rehearsal of a script
CConsultation with schools and school leadership
CStoryboarding
CMapping school as a 360-degree tour
CDeveloping a process to capture content
Production CStaff and grad students assisted in the video capture
CWent out onto campus and recorded the videos
CDealt with unexpected and logistical issues of capturing the
footage
CStaff and researcher assisted in picture and video
capture
CCaptured content on site at school
CWorked in a systematic way to be sure flow of final
360-degree tour (i.e. the correct order)
Post-
Production
CDownloaded videos from 360-degree camera onto desktop
computer
CStitched the videos together
CExported videos(4k resolution; 30 frames per second) and
imported into 360-video editor
CEdited footage to include iconography related to task design
CPlaced map in centerof footage (blank spot of 360-degree
videos)
CEdited out mistakes and footage that needed to be clipped
CExported in 4k resolution
CUsed open-source 360-degree video project template
CDeployed in Google Cardboard
CDownload photos and video material onto laptop
CSome photo and video editing (mainly brightness and
image quality
CImported/uploaded images (and some video) to
online tool (Lapentor)
CLinked images online in the correct order (to ensure
walk-through was in the right order)
CWorked with school to check final order and quality
CShared URL to publicize with pupils and parents
CAvailable on an app and via a URL to be viewed on a
flat-screen
CDeployed in Google Cardboard
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We propose several opportunities that exist for this form of immersive technologies. We suggest
SVVR warrants further and continued investigation and application as they:
1. Tend to be more affordable compared to commercially available hardware/software;
2. Require far less technical capability; in terms of equipment needed and personnel;
3. Mean expert knowledge is not required;
4. Provide a way to quickly develop and deploy material to autistic groups;
5. Can be easily placed in the hands of autistic people and also designed by them;
6. More accessible to the community.
7. Allow autistic voices to be heard and to shape the research agenda moving forward.
Despite these opportunities and greater access to immersive technologies, there remain some
challenges that we next identify.
1. Content can often be rigid and inflexible; as a result questions remain around generalizations;
2. There is still some level of computer knowledge required to achieve SVVR output successfully;
3. Ensuring that autistic voice is central and driving need for content;
4. Additional skills and knowledge for building in interactivity are required to fully realize the
potential of SVVR.
5. Conclusion
In conclusion, in our work with SVVR-based technology and autistic groups, we have developed
projects that stem from problems/issues identified by autistic groups and/or their stakeholders. In
doing so, both projects have listened to and helped to co-design SVVR with our populations. From
this, we were able to develop swift and applicable SVVR environments that helped support
transitions to support travel and returning to school (after a prolonged period of absence; Newbutt
et al., 2020). Both led to advantages for these groups as they enabled a space to test, replicate and
explore the environments before doing so in real life. We were also led by, and listened to autistic
needs; developing solutions to issues experienced by them. Importantly, using SVVR (as outlined
in this primer) enabled us to respond to these needs in a timely and responsive manner; something
not often achieved in this field.
In this paper, we have provided both an overview of SVVR technologies used with autistic groups, in
addition to outlining a process by which others can follow in the design and development of their own
SVVR materials. We have attempted to breakdown the key production steps and highlighted key parts
of the process that require specific attention. We do so in the hope that professionals working with, and
supporting, autistic populations will be able to create their own SVVR experiences.
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Spectrum Disorders, MIND Institute, The University of California at Davis Medical School, Sacramento, CA.
Glaser, N.J. and Schmidt, M. (2018), Usage considerations of 3D collaborative virtual learning environments
to promote development and transfer of knowledge and skills for individuals with autism,Technology,
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Corresponding author
Nigel Newbutt can be contacted at: nigel.newbutt@coe.ufl.edu
For instructions on how to order reprints of this article, please visit our website:
www.emeraldgrouppublishing.com/licensing/reprints.htm
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... Spherical video-based virtual reality (SVVR) is a type of VR experience that uses 360-degree video footage to create an immersive environment. In recent years, there has been a growing interest in using SVVR technology as an intervention modality for autistic people (Glaser et al., 2022a(Glaser et al., , 2022b(Glaser et al., , 2022c. However, there is a lack of research synthesizing its evidence and guidelines for optimizing its use for autistic users (Glaser & Schmidt, 2022). ...
... While there is some evidence of effectiveness in these systems, studies that tend to report on the effectiveness of these systems tend to be plagued with a range of methodological flaws (such as using self-report data or reporting highly variable and inconclusive outcomes) (cf., Parsons et al., 2006) and overgeneralizations. In fact, it seems that nearly all research in this area is performed in research institutions (Glaser & Schmidt, 2022); in part because of the innate complexities in designing and deploying VR for autistic users (Schmidt, 2014;Glaser et al., 2022aGlaser et al., , 2022bGlaser et al., , 2022c such as the high cost of development, complex design and development skills requirements, and the lack of portability of traditional VR equipment . Due to the challenges in developing VR systems for this population, researchers have begun to turn their attention to an emerging technology that holds potential for lessening some of the research to practice gaps that exist. ...
... Despite SVVR's limitations, researchers have used SVVR for autistic individuals due to several benefits . First, SVVR is easier to develop compared to other VR technologies (Chien & Hwang, 2022), and requires less specialized devices and software (Glaser et al., 2022a(Glaser et al., , 2022b(Glaser et al., , 2022c. Second, the benefits of SVVR allows designers to easily deploy the content compared to other VR settings (Ye et al., 2021;Wu et al, 2021). ...
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... Recent developments in virtual reality technology have led to major innovations and changes in virtual reality headsets (Özdemir et al., 2019). Basic virtual reality devices, which integrate a smartphone, offer limited mobility, such as allowing users to view a 360degree environment with head movements alone (Newbutt et al. 2022). These devices are categorized as mobile head-mounted displays (HMDs) (Fuhrmann et al., 1998). ...
... Examples of mobile HMDs include "Google Cardboard 3D VR", "VR Shinecon" and "VR Box." Advanced virtual reality devices, in contrast to mobile HMDs, offer significantly greater mobility, allowing users to move within the environment, grasp and throw objects and manipulate the virtual environment. These devices feature built-in operating systems and interfaces and can run applications via platforms such as "Steam" or "Side Quest" or function with highperformance computers or gaming consoles (e.g., Sony PlayStation VR, HTC Vive Cosmos, HP Reverb G2, Oculus Rift, Oculus Quest 2) (Newbutt et al., 2022). highlighted that Oculus provides easier usability and more intuitive controllers compared to HTC Vive. ...
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... To date this remains a limitation, and researchers' understanding of SVVR's learning affordances lag behind the more well-known advantages of IVR (e.g., Glaser & Schmidt, 2018;Schmidt et al., in-press). A need exists to explore technologies such as SVVR that can be more readily designed and deployed (Newbutt et al., 2022). A need also exists to explore possible adverse effects (i.e., cybersickness, eye strain, feeling dizzy) of working with an emerging technology and ethical challenges of working with autistic groups to decide on the most appropriate ways to use this form of technology . ...
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Background Needle phobias are common in children and adults worldwide. One effective intervention for this phobia is exposure therapy where a participant is gradually exposed to increasing levels of the fear‐evoking stimulus while differential reinforcement is applied. This intervention, however, may be difficult to implement with some medical procedures as it may be difficult to obtain unfettered access to medical facilities and equipment for the purposes of exposure. Virtual reality may overcome these obstacles. Methods In this investigation, the present authors developed a low‐cost virtual reality‐based exposure therapy which was used with an adult male with autism spectrum disorder and a history of extreme needle phobia. The effectiveness of this intervention was evaluated using a changing criterions design with generalization probes. Results The intervention quickly increased the participant's compliance in the analogue training setting and the effects were generalized across settings and behaviours, and maintained over time. Conclusions The findings indicate combining virtual reality with exposure therapy may produce an effective intervention for medical phobias. The intervention package may remove barriers associate with traditional exposure therapy and was low‐cost which may increase access to the intervention.