{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T23:27:58Z","timestamp":1761175678805,"version":"build-2065373602"},"reference-count":69,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Boston Children\u2019s Hospital Department of Anesthesia, Critical Care and Pain Medicine Ignition and Trailblazer Awards"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Virtual Worlds"],"abstract":"<jats:p>This feasibility study explored the integration of physiological monitoring into a virtual reality (VR) intervention for pediatric pain management. The goal of this study is to identify a feasible strategy for collecting physiologic data in the context of a VR intervention currently being developed for youth with chronic pain. We assess the potential of Cognitive Load (CL)\u2014derived from heart rate and pupillometry\/eye-tracking data\u2014as a marker of arousal and user engagement in a VR simulation to promote school functioning in youth with chronic pain. The HP Reverb G2 Omnicept headset and Polar H10 heart-rate sensor were utilized. The Child Presence Questionnaire (CPQ) assessed participants\u2019 self-reported immersion and engagement. Data collection focused on feasibility and utility of physiologic data in assessing arousal and correlations with self-reported experience. Nine participants engaged in the simulation, with eight yielding complete data. The simulation and headset were well tolerated. CPQ Transportation subscale showed trend-level correlation with mean CL. Due to small sample and feasibility focus, individual-level results were examined. Combining multiple physiologic markers into a construct like CL is intriguing, but data interpretability was limited. Pupillometry and related metrics show promise as feasible markers of engagement and arousal for VR-based intervention but require appropriate expertise to fully interpret. The study found that integration of physiologic monitoring is feasible, but further work is needed to standardize metrics and identify the most useful and user-friendly markers.<\/jats:p>","DOI":"10.3390\/virtualworlds4040047","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T08:41:08Z","timestamp":1761122468000},"page":"47","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrating Physiologic Assessment into Virtual Reality-Based Pediatric Pain Intervention: A Feasibility Study"],"prefix":"10.3390","volume":"4","author":[{"given":"Harsheen","family":"Marwah","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children\u2019s Hospital, Boston, MA 02445, USA"}]},{"given":"Stefania R.","family":"Moldovanu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children\u2019s Hospital, Boston, MA 02445, USA"}]},{"given":"Talis","family":"Reks","sequence":"additional","affiliation":[{"name":"MIT.nano Immersion Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA"}]},{"given":"Brian","family":"Anthony","sequence":"additional","affiliation":[{"name":"MIT.nano Immersion Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA"}]},{"given":"Deirdre E.","family":"Logan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children\u2019s Hospital, Boston, MA 02445, USA"},{"name":"Department of Psychiatry, Harvard Medical School, Boston, MA 02445, USA"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.1097\/j.pain.0000000000003267","article-title":"The Prevalence of Chronic Pain in Children and Adolescents: A Systematic Review Update and Meta-Analysis","volume":"165","author":"Chambers","year":"2024","journal-title":"Pain"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1093\/jpepsy\/jsx063","article-title":"School Self-Concept in Adolescents with Chronic Pain","volume":"42","author":"Logan","year":"2017","journal-title":"J. Pediatr. Psychol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.pedn.2008.07.003","article-title":"Pediatric Chronic Pain and Health-Related Quality of Life","volume":"24","author":"Gold","year":"2009","journal-title":"J. Pediatr. Nurs."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1155\/2012\/420676","article-title":"Anxiety and Functional Disability in a Large Sample of Children and Adolescents with Chronic Pain","volume":"17","author":"Simons","year":"2012","journal-title":"Pain Res. Manag."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1093\/jpepsy\/jsx046","article-title":"Loneliness in Children and Adolescents with Chronic Physical Conditions: A Meta-Analysis","volume":"42","author":"Maes","year":"2017","journal-title":"J. Pediatr. Psychol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1097\/j.pain.0000000000001732","article-title":"Long-Term Impact of Adolescent Chronic Pain on Young Adult Educational, Vocational, and Social Outcomes","volume":"161","author":"Murray","year":"2020","journal-title":"Pain"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1007\/s11916-009-0019-8","article-title":"The Use of Virtual Reality for Pain Control: A Review","volume":"13","author":"Mahrer","year":"2009","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/j.cpr.2010.07.001","article-title":"The Effectiveness of Virtual Reality Distraction for Pain Reduction: A Systematic Review","volume":"30","author":"Malloy","year":"2010","journal-title":"Clin. Psychol. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1089\/cpb.2007.9993","article-title":"The Neurobiology of Virtual Reality Pain Attenuation","volume":"10","author":"Gold","year":"2007","journal-title":"Cyberpsychol. Behav."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1093\/pm\/pnx109","article-title":"Innovative Technology Using Virtual Reality in the Treatment of Pain: Does It Reduce Pain via Distraction, or Is There More to It?","volume":"19","author":"Gupta","year":"2018","journal-title":"Pain Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1093\/jpepsy\/jsq063","article-title":"Videogame Distraction Using Virtual Reality Technology for Children Experiencing Cold Pressor Pain: The Role of Cognitive Processing","volume":"36","author":"Law","year":"2011","journal-title":"J. Pediatr. Psychol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1177\/1545968311433209","article-title":"Targeting Cortical Representations in the Treatment of Chronic Pain: A Review","volume":"26","author":"Moseley","year":"2012","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ma, M., Jain, L.C., and Anderson, P. (2014). Virtual Reality Graded Exposure Therapy as Treatment for Pain-Related Fear and Disability in Chronic Pain. Virtual, Augmented Reality and Serious Games for Healthcare 1, Springer.","DOI":"10.1007\/978-3-642-54816-1"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1097\/j.pain.0000000000001900","article-title":"Virtual Reality: Physiological and Behavioral Mechanisms to Increase Individual Pain Tolerance Limits","volume":"161","author":"Colloca","year":"2020","journal-title":"Pain"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.2147\/JPR.S200498","article-title":"Virtual Reality as an Analgesic for Acute and Chronic Pain in Adults: A Systematic Review and Meta-Analysis","volume":"12","author":"Mallari","year":"2019","journal-title":"J. Pain Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e58086","DOI":"10.2196\/58086","article-title":"Extended Reality Interventions for Health and Procedural Anxiety: Panoramic Meta-Analysis Based on Overviews of Reviews","volume":"27","author":"Arthur","year":"2025","journal-title":"J. Med. Internet Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e58947","DOI":"10.2196\/58947","article-title":"Developing a Core Outcome Set for Pediatric and Adult Acute and Chronic Pain Extended Reality Trials: Delphi Consensus-Building Process","volume":"27","author":"Hess","year":"2025","journal-title":"J. Med. Internet Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e25916","DOI":"10.2196\/25916","article-title":"Leveraging Virtual Reality and Augmented Reality to Combat Chronic Pain in Youth: Position Paper from the Interdisciplinary Network on Virtual and Augmented Technologies for Pain Management","volume":"23","author":"Logan","year":"2021","journal-title":"J. Med. Internet Res."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Halbig, A., and Latoschik, M.E. (2021). A Systematic Review of Physiological Measurements, Factors, Methods, and Applications in Virtual Reality. Front. Virtual Real., 2.","DOI":"10.3389\/frvir.2021.694567"},{"key":"ref_20","first-page":"21","article-title":"HP Omnicept Cognitive Load Database (HPO-CLD)\u2013Developing a Multimodal Inference Engine for Detecting Real-Time Mental Workload in VR","volume":"20","author":"Siegel","year":"2021","journal-title":"HP Labs"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Blum, J., Rockstroh, C., and G\u00f6ritz, A.S. (2019). Heart Rate Variability Biofeedback Based on Slow-Paced Breathing with Immersive Virtual Reality Nature Scenery. Front. Psychol., 10.","DOI":"10.3389\/fpsyg.2019.02172"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Deniaud, C., Honnet, V., Jeanne, B., and Mestre, D. (2015, January 28\u201330). An Investigation into Physiological Responses in Driving Simulators: An Objective Measurement of Presence. Proceedings of the 2015 Science and Information Conference (SAI), London, UK.","DOI":"10.1109\/SAI.2015.7237225"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1136\/archdischild-2014-306286","article-title":"Pupillometry: A Non-Invasive Technique for Pain Assessment in Paediatric Patients","volume":"99","author":"Connelly","year":"2014","journal-title":"Arch. Dis. Child."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/j.neubiorev.2005.12.001","article-title":"Eye Movement Trajectories and What They Tell Us","volume":"30","author":"Meeter","year":"2006","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sweller, J., Ayres, P., and Kalyuga, S. (2011). Cognitive Load Theory, Springer Nature.","DOI":"10.1007\/978-1-4419-8126-4"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Mayer, R.E. (2014). The Cambridge Handbook of Multimedia Learning, Cambridge University Press. [2nd ed.].","DOI":"10.1017\/CBO9781139547369"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s10648-010-9128-5","article-title":"Element Interactivity and Intrinsic, Extraneous, and Germane Cognitive Load","volume":"22","author":"Sweller","year":"2010","journal-title":"Educ. Psychol. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1037\/edu0000473","article-title":"Immersive Virtual Reality Increases Liking but Not Learning with a Science Simulation and Generative Learning Strategies Promote Learning in Immersive Virtual Reality","volume":"113","author":"Makransky","year":"2021","journal-title":"J. Educ. Psychol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1007\/s10648-020-09586-2","article-title":"The Cognitive Affective Model of Immersive Learning (CAMIL): A Theoretical Research-Based Model of Learning in Immersive Virtual Reality","volume":"33","author":"Makransky","year":"2021","journal-title":"Educ. Psychol. Rev."},{"key":"ref_30","unstructured":"Sezgin, T.M., and Robinson, P. (2007). Affective Video Data Collection Using an Automobile Simulator, Springer."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/S1077-3142(03)00081-X","article-title":"Facial Expression Recognition from Video Sequences: Temporal and Static Modeling","volume":"91","author":"Cohen","year":"2003","journal-title":"Comput. Vision. Image Underst."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/1529100619832930","article-title":"Emotional Expressions Reconsidered: Challenges to Inferring Emotion from Human Facial Movements","volume":"20","author":"Barrett","year":"2019","journal-title":"Psychol. Sci. Public Interest"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/978-3-319-28109-4_26","article-title":"Predicting Cognitive Load Levels from Speech Data","volume":"Volume 48","author":"Su","year":"2016","journal-title":"Smart Innovation, Systems and Technologies"},{"key":"ref_34","unstructured":"Boril, H., Sadjadi, S.O., and Hansen, J.H.L. (2011, January 4\u20137). UTDrive: Emotion and Cognitive Load Classification for in-Vehicle Scenarios. Proceedings of the 5th Biennial Workshop on DSP for In-Vehicle Systems, Kiel, Germany."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1093\/cercor\/bhl052","article-title":"Interactions of Pain Intensity and Cognitive Load: The Brain Stays on Task","volume":"17","author":"Seminowicz","year":"2007","journal-title":"Cereb. Cortex"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Bong, C.L., Fraser, K., and Oriot, D. (2016). Cognitive Load and Stress in Simulation. Comprehensive Healthcare Simulation: Pediatrics, Springer.","DOI":"10.1007\/978-3-319-24187-6_1"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Logan, D.E., Khanna, K., Randall, E., O\u2019Donnell, S., Reks, T., and McLennan, L. (2023). Centering Patient and Clinician Voices in Developing Tools to Address Pain Related School Impairment: A Phase I Study of a Virtual Reality School Simulation for Children and Adolescents with Chronic Pain. Children, 10.","DOI":"10.3390\/children10101644"},{"key":"ref_38","first-page":"391","article-title":"What Is \u2018Being There\u2019? An Ontology of the Immersive Experience","volume":"48","author":"Chen","year":"2024","journal-title":"Ann. Int. Commun. Assoc."},{"key":"ref_39","unstructured":"(2025, August 27). About the Immersion Lab. Available online: https:\/\/nanousers.mit.edu\/immersion-lab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e22620","DOI":"10.2196\/22620","article-title":"Virtual Reality in Pain Rehabilitation for Youth with Chronic Pain: Pilot Feasibility Study","volume":"7","author":"Griffin","year":"2020","journal-title":"JMIR Rehabil. Assist. Technol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1097\/AJP.0000000000001017","article-title":"A Pilot Randomized Controlled Trial of Virtual Reality Distraction to Reduce Procedural Pain during Subcutaneous Port Access in Children and Adolescents with Cancer","volume":"38","author":"Hundert","year":"2022","journal-title":"Clin. J. Pain"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1089\/cpb.2006.9.207","article-title":"\u201cSkip\u201d Effectiveness of Virtual Reality for Pediatric Pain Distraction during IV Placement","volume":"9","author":"Gold","year":"2006","journal-title":"CyberPsychology Behav."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1097\/j.pain.0000000000002060","article-title":"Virtual Reality Approaches to Pain: Toward a State of the Science","volume":"162","author":"Trost","year":"2021","journal-title":"Pain"},{"key":"ref_44","unstructured":"(2025, October 07). HP Developers Accessing Sensor Data. Available online: https:\/\/developers.hp.com\/omnicept\/docs\/unity\/sensors."},{"key":"ref_45","first-page":"647","article-title":"Immersion Analysis Through Eye-Tracking and Audio in Virtual Reality","volume":"69","author":"Lee","year":"2021","journal-title":"Comput. Mater. Contin."},{"key":"ref_46","unstructured":"King, C., Lo, M., Das, M., and Salvo, D. (2024, January 18\u201320). Assessment of Student Engagement in Virtual Reality Clinical Immersion Environments through Eye Tracking. Proceedings of the 2024 ASEE PSW Conference, Las Vegas, NV, USA."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1093\/jpepsy\/jsae056","article-title":"Navigating Virtual Realities: Identifying Barriers and Facilitators to Implementing VR-Enhanced PT for Youth with Chronic Pain","volume":"50","author":"Jehl","year":"2025","journal-title":"J. Pediatr. Psychol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e40705","DOI":"10.2196\/40705","article-title":"Virtual Reality-Augmented Physiotherapy for Chronic Pain in Youth: Protocol for a Randomized Controlled Trial Enhanced with a Single-Case Experimental Design","volume":"11","author":"Simons","year":"2022","journal-title":"JMIR Res. Protoc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e48959","DOI":"10.2196\/48959","article-title":"Use of Biofeedback-Based Virtual Reality in Pediatric Perioperative and Postoperative Settings: Observational Study","volume":"7","author":"Orgil","year":"2024","journal-title":"JMIR Perioper. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"109331","DOI":"10.1016\/j.dib.2023.109331","article-title":"Dataset Used to Refine a Treatment Protocol of a Biofeedback-Based Virtual Reality Intervention for Pain and Anxiety in Children and Adolescents Undergoing Surgery","volume":"49","author":"Orgil","year":"2023","journal-title":"Data Brief"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e66352","DOI":"10.2196\/66352","article-title":"Virtual Reality Respiratory Biofeedback in an Outpatient Pediatric Pain Rehabilitation Program: Mixed Methods Pilot Study","volume":"12","author":"Recker","year":"2025","journal-title":"JMIR Rehabil. Assist. Technol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Won, A.S., Bailey, J., Bailenson, J., Tataru, C., Yoon, I.A., and Golianu, B. (2017). Immersive Virtual Reality for Pediatric Pain. Children, 4.","DOI":"10.3390\/children4070052"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e53129","DOI":"10.2196\/53129","article-title":"Barriers and Facilitators to the Implementation of Virtual Reality Interventions for People with Chronic Pain: Scoping Review","volume":"1","author":"Elser","year":"2024","journal-title":"JMIR XR Spat. Comput."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.bja.2024.06.005","article-title":"Virtual Reality-Based Analgesia: Towards a Novel Framework for the Biopsychosocial Management of Chronic Pain","volume":"133","author":"Medina","year":"2024","journal-title":"Br. J. Anaesth."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e34402","DOI":"10.2196\/34402","article-title":"Virtual Reality Applications in Chronic Pain Management: Systematic Review and Meta-Analysis","volume":"10","author":"Goudman","year":"2022","journal-title":"JMIR Serious Games"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1186\/s12984-022-01084-6","article-title":"Increased Cognitive Load in Immersive Virtual Reality during Visuomotor Adaptation Is Associated with Decreased Long-Term Retention and Context Transfer","volume":"19","author":"Juliano","year":"2022","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1111\/jcal.12482","article-title":"Cognitive and Affective Processes for Learning Science in Immersive Virtual Reality","volume":"37","author":"Parong","year":"2021","journal-title":"J. Comput. Assist. Learn."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1177\/0735633119867422","article-title":"Influence of Students\u2019 Learning Style, Sense of Presence, and Cognitive Load on Learning Outcomes in an Immersive Virtual Reality Learning Environment","volume":"58","author":"Huang","year":"2020","journal-title":"J. Educ. Comput. Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1007\/s00464-019-06887-8","article-title":"Cognitive Load and Performance in Immersive Virtual Reality versus Conventional Virtual Reality Simulation Training of Laparoscopic Surgery: A Randomized Trial","volume":"34","author":"Frederiksen","year":"2020","journal-title":"Surg. Endosc."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1109\/TLT.2023.3326473","article-title":"Measuring Cognitive Load in Virtual Reality Training via Pupillometry","volume":"17","author":"Lee","year":"2024","journal-title":"IEEE Trans. Learn. Technol."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Wei, J., Siegel, E., Sundaramoorthy, P., Gomes, A., Zhang, S., Vankipuram, M., Smathers, K., Ghosh, S., Horii, H., and Bailenson, J. (2025, January 8\u201312). Cognitive Load Inference Using Physiological Markers in Virtual Reality. Proceedings of the 2025 IEEE Conference on Virtual Reality and 3D User Interfaces (VR), Saint Malo, France.","DOI":"10.1109\/VR59515.2025.00098"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"3014","DOI":"10.1109\/TVCG.2025.3549850","article-title":"Predicting and Explaining Cognitive Load, Attention, and Working Memory in Virtual Multitasking","volume":"31","author":"Setu","year":"2025","journal-title":"IEEE Trans. Vis. Comput. Graph."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1177\/10468781241248821","article-title":"Dynamic Cognitive Load Assessment in Virtual Reality","volume":"55","author":"Elkin","year":"2024","journal-title":"Simul. Gaming"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Wang, D., Peng, Y., Haddouk, L., Vayatis, N., and Vidal, P.P. (2025). Assessing Virtual Reality Presence through Physiological Measures: A Comprehensive Review. Front. Virtual Real., 6.","DOI":"10.3389\/frvir.2025.1530770"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.ijhcs.2008.04.004","article-title":"Measuring and Defining the Experience of Immersion in Games","volume":"66","author":"Jennett","year":"2008","journal-title":"Int. J. Hum. Comput. Stud."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1007\/s10639-017-9676-0","article-title":"A Review of the Use of Virtual Reality Head-Mounted Displays in Education and Training","volume":"23","author":"Jensen","year":"2018","journal-title":"Educ. Inf. Technol."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Mara\u00f1es, C., Gutierrez, D., and Serrano, A. (2024). Revisiting the Heider and Simmel Experiment for Social Meaning Attribution in Virtual Reality. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-65532-0"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1007\/s10055-022-00738-z","article-title":"Eye Tracking in Virtual Reality: A Broad Review of Applications and Challenges","volume":"27","author":"Adhanom","year":"2023","journal-title":"Virtual Real."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1080\/01942638.2019.1650867","article-title":"Facilitating the Implementation of Virtual Reality-Based Therapies in Pediatric Rehabilitation","volume":"40","author":"Bigford","year":"2020","journal-title":"Phys. Occup. Ther. Pediatr."}],"container-title":["Virtual Worlds"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2813-2084\/4\/4\/47\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T08:58:29Z","timestamp":1761123509000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2813-2084\/4\/4\/47"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,22]]},"references-count":69,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["virtualworlds4040047"],"URL":"https:\/\/doi.org\/10.3390\/virtualworlds4040047","relation":{},"ISSN":["2813-2084"],"issn-type":[{"type":"electronic","value":"2813-2084"}],"subject":[],"published":{"date-parts":[[2025,10,22]]}}}