Virtual reality as a tool for balance research: Eyes open body sway is reproduced in photo-realistic, but not in abstract virtual scenes.

Virtual reality (VR) technology is commonly used in balance research due to its ability to simulate real world experiences under controlled experimental conditions. However, several studies reported considerable differences in balance behavior in real world environments as compared to virtual environments presented in a head mounted display. Most of these studies were conducted more than a decade ago, at a time when VR was still struggling with major technical limitations (delays, limited field-of-view, etc.). In the meantime, VR technology has progressed considerably, enhancing its capacity to induce the feeling of presence and behavioural realism. In this study, we addressed two questions: Has VR technology now reached a point where balance is similar in real and virtual environments? And does the integration of visual cues for balance depend on the subjective experience of presence? We used a state-of-the-art head mounted VR system and a custom-made balance platform to compare balance when viewing (1) a real-world environment, (2) a photo-realistic virtual copy of the real-world environment, (3) an abstract virtual environment consisting of only spheres and bars ('low presence' VR condition), and, as reference, (4) a condition with eyes closed. Body sway of ten participants was measured in three different support surface conditions: (A) quiet stance, (B) stance on a sway referenced surface, and (C) surface tilting following a pseudo-random sequence. A 2-level repeated measures ANOVA and PostHoc analyses revealed no significant differences in body sway between viewing the real world environment and the photo-realistic virtual copy. In contrast, body sway was increased in the 'low presence' abstract scene and further increased with eyes closed. Results were consistent across platform conditions. Our results support the hypothesis that state of the art VR reached a point of behavioural realism in which balance in photo-realistic VR is similar to balance in a real environment. Presence was lower in the abstract virtual condition as compared to the photo-realistic condition as measured by the IPQ presence questionnaire. Thus, our results indicate that spatial presence may be a moderating factor, but further research is required to confirm this notion. We conceive that virtual reality is a valid tool for balance research, but that the properties of the virtual environment affects results