The use of augmented reality (AR) and virtual reality (VR) for life support training is increasing. These technologies provide an immersive experience that supports learning in a safe and controlled environment. This review focuses on the use of AR and VR for emergency care training for health care providers, medical students, and nonprofessionals. In particular, we analyzed (1) serious games, nonimmersive games, both single-player and multiplayer; (2) VR tools ranging from semi-immersive to immersive virtual and mixed reality; and (3) AR applications. All the toolkits have been investigated in terms of application goals (training, assessment, or both), simulated procedures, and skills. The main goal of this work is to summarize and organize the findings of studies coming from multiple research areas in order to make them accessible to all the professionals involved in medical simulation. The analysis of the state-of-the-art technologies reveals that tools and studies related to the multiplayer experience, haptic feedback, and evaluation of user’s manual skills in the foregoing health care-related environments are still limited and require further investigation. Also, there is an additional need to conduct studies aimed at assessing whether AR/VR-based systems are superior or, at the minimum, comparable to traditional training methods.

During movement, modulation of beta power occurs over the sensorimotor areas, with a decrease just before its start (event-related desynchronization, ERD) and a rebound after its end (event-related synchronization, ERS). We have recently found that the depth of ERD-to-ERS modulation increases during practice in a reaching task and the following day decreases to baseline levels. Importantly, the magnitude of the beta modulation increase during practice is highly correlated with the retention of motor skill tested the following day. Together with other evidence, this suggests that the increase of practice-related modulation depth may be the expression of sensorimotor cortex’s plasticity. Here, we determine whether the practice-related increase of beta modulation depth is equally present in a group of younger and a group of older subjects during the performance of a 30-minute block of reaching movements. We focused our analyses on two regions of interest (ROIs): the left sensorimotor and the frontal region. Performance indices were significantly different in the two groups, with the movements of older subjects being slower and less accurate. Importantly, both groups presented a similar increase of the practice-related beta modulation depth in both ROIs in the course of the task. Peak latency analysis revealed a progressive delay of the ERS peak that correlated with the total movement time. Altogether, these findings support the notion that the depth of beta modulation in a reaching movement task does not depend on age and confirm previous findings that only ERS peak latency but not ERS magnitude is related to performance indices.

Movement is associated with power changes over sensory-motor areas in different frequency ranges, including beta (15-30 Hz). In fact, beta power starts decreasing before the movement onset (event-related desynchronization, ERD) and rebounds after its end (event-related synchronization, ERS). There is increasing evidence that beta modulation depth (measured as ERD-ERS difference) increases with practice in a planar reaching task, suggesting that this measure may reflect plasticity processes. In the present work, we analyzed beta ERD, ERS and modulation depth in healthy subjects to determine their changes over three regions of interest (ROIs): right and left sensorimotor and frontal areas, during a reaching task with the right arm. We found that ERD, ERS and modulation depth increased with practice with lower values over the right sensory-motor area. Timing of peak ERD and ERS were similar across ROIs, with ERS peak occurring earlier in later sets. Finally, we found that beta ERS of the frontal ROI involved higher beta range (23-29 Hz) than the sensory-motor ROIs (15-18 Hz). Altogether these results suggest that practice in a reaching task is associated with modification of beta power and timing. Additionally, beta ERS may have different functional meaning in the three ROIs, as suggested by the involvement of upper and lower beta bands in the frontal and sensorimotor ROIs, respectively.

Extended reality (XR) applications for education are usually associated with motivation, engagement, knowledge and experiences that are difficult to achieve in the real world. One example of such knowledge in military education is the threat-based approach to protection of civilians in armed conflicts. The Norwegian Defence University College (NDUC) educates officers on the threat-based approach. This approach challenges conventional military practice, introducing new ways of thinking about what military forces can and cannot do to protect civilians from violence. Today, militaries are expected to protect civilians from perpetrators that target them as part of their warfare, expanding their responsibilities under International Humanitarian Law. This expansion of tasks represents “troublesome knowledge” for many military officers and demands a deeper understanding of the rationales and strategies driving perpetrators’ targeting of civilians. To overcome this pedagogical challenge, we developed an XR-supported educational program combining immersive experiences and pedagogical approaches, including combined 360°-videos and embodiment, dialogue with virtual humans and collaborative VR-landscapes to encourage immersive peer-to-peer learning. The results are encouraging, suggesting high levels of acceptance by learners of the threat-based concept, an effect on stimulating critical discussion and a positive reaction to XR-supported learning.

We have previously demonstrated that, in rested subjects, extensive practice in a motor learning task increased both electroencephalographic (EEG) theta power in the areas involved in learning and improved the error rate in a motor test that shared similarities with the task. A nap normalized both EEG and performance changes. We now ascertain whether extensive visual declarative learning produces results similar to motor learning. Thus, during the morning, we recorded high-density EEG in well rested young healthy subjects that learned the order of different visual sequence task (VSEQ) for three one-hour blocks. Afterward, a group of subjects took a nap and another rested quietly. Between each VSEQ block, we recorded spontaneous EEG (sEEG) at rest and assessed performance in a motor test and a visual working memory test that shares similarities with VSEQ. We found that after the third block, VSEQ induced local theta power increases in the sEEG over a right temporo-parietal area that was engaged during the task. This local theta increase was preceded by increases in alpha and beta power over the same area and was paralleled by performance decline in the visual working memory test. Only after the nap, VSEQ learning rate improved and performance in the visual working memory test was restored, together with partial normalization of the local sEEG changes. These results suggest that intensive learning, like motor learning, produces local theta power increases, possibly reflecting local neuronal fatigue. Sleep may be necessary to resolve neuronal fatigue and its effects on learning and performance.