## 4 Immersive Virtual Reality: Hardware and Software Perspectives
### Overview of Immersive Virtual Reality Software
On the other hand, applications such as: _Cred: Rise to Glory, The Avengers: Powers Unite_, and _The Climb_, have been used in research to facilitate the embodiment of superhero-like avatars with the goal of improving body image dimensions such as perceptions of strength and vulnerability [25]. Studies indicate that using commercially available software can yield positive results in treating musculoskeletal conditions. For example, a study by [PERSON] et al., (2022) [93] demonstrated that, for patients with chronic neck pain, VR interventions using _Ocean Rift_ and _Gala 360_ software were more effective than traditional motor control exercises in reducing joint position sense error, functional limitations, and increasing pain pressure thresholds. In another study, [PERSON] et al., (2021) [124] found that _EaseVRx_ led to high user satisfaction and produced clinically meaningful reductions in average pain intensity and pain-related interference with activities, mood, and stress for patients with chronic low back pain when compared to a sham VR intervention. Similarly, [PERSON] et al., (2022) [95] explored the effects of VR meditation using the _Guided Meditation VR_ app by _Cubic Ninjas_ \begin{table}
\begin{tabular}{p{142.3 pt} p{142.3 pt}} \hline \hline \multicolumn{2}{c}{**Additional Equipment**} \\ \hline
**Type of Equipment** & **Purpose and Functionality** \\ \hline Handheld controllers & Facilitates interaction within the virtual environment. \\ \hline Devices for haptic feedback & Enhances tactile sensations during VR use. \\ \hline Devices for tracking & Supports eye, face, hand, or lower limb tracking, as well as locomotion and full-body tracking. \\ Devices for tracking & Enables tracking through outside-in systems (base stations), inside-out systems (built-in cameras), or motion-tracking cameras that do not require wearable sensors. \\ \hline All-in one solutions & Combines body tracking with haptic feedback, motion capture, and biometric monitoring. \\ \hline Hygiene Solutions & For example: facial interface with a silicone facial pad or a UV-C disinfection cabinet for headsets. \\ \hline VR walkers & Optimized for use in limited physical spaces. \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Overview of additional VR equipment and their functions. on knee osteoarthritis, showing significant moderate to large analgesic effects on knee pain intensity both during and post-VR, with some pain relief lasting into the following day. To achieve specific research objectives, some studies design their own software programs. For example, in the study by [PERSON] et al., (2015) [106], the researchers developed a custom software for kinematic training tailored for patients with chronic neck pain. In another study, [PERSON] et al., (2022) [127] created an application called _ViRST VR_, designed for patients with chronic lower back pain, where participants perform interactive tasks on a virtual farm--such as rowing, turning on light bulbs, or sorting vegetables--to promote movement and engagement. Since there is currently a limited availability of VR software on the market that addresses the specific needs of patients with diverse musculoskeletal disorders, some authors emphasize that caution is needed when adapting commercially available applications (particularly those originally developed for the entertainment industry) for use in patient care settings. [PERSON] et al., (2023) [77] argue that highly vivid and realistic virtual environments, which transmit substantial sensory information through visuals, sounds and touch can overwhelm the senses, particularly if designed as fast-paced, high-stimulation video games. Additionally, [PERSON] et al., (2023) [77] note that many video games are structured with levels that require completing tasks to advance. For chronic pain patients, prolonged immersion in VR environments designed as never-ending level-based games may counteract therapeutic goals, potentially overstimulating the brain rather than promoting the desired calming effects [77].