Virtual environment benefits motor dysfunction in Functional Neurological Disorder: Evidence from Virtual and Augmented Reality
- 1University of Fribourg, Department of neurology, Ch. du Musee 5, 1700 Fribourg, Switzerland
Abstract
BackgroundVirtual and Augmented Reality (VR/AR) are increasingly used in medicine and may offer novel interventions for Functional Neurological Disorder (FND) by targeting mechanisms of impaired motor control. However, evidence for the effect of different modalities on movement in FND is limited. Moreover, it is hypothesized that visual feedback of ones affected arm could reinforce FND symptoms through maladaptive self-monitoring. The present study aims to compare motor performance under visual feedback of a virtual avatar versus the real arm.
MethodsFifteen FND patients and eighteen healthy controls completed a dual motor reaching task (touching a virtual fruit such as orange or apple appearing in front of them) with a virtual headset across three modalities: Augmented Reality (AR), where participants saw their real arm; Virtual Reality (VR), with a virtual arm; and Virtual Reality Improved (VRI), with artificially enhanced straightness and larger collision zone with the target. Their movement speed, straightness and number of velocity peaks were calculated for each fruit catch. Additionally, the number of collisions between the eyes and the body was calculated with eye tracking technology.
ResultsFND participants were slower and produced less smooth movements in AR compared to VR (b = 1.09, z = 8.83, P < .001) and VRI (b = 0.85, z = 6.91, P < .001), while the opposite effect was found in healthy controls. Eye tracking showed that FND patients looked more at their affected hand than unaffected hand (b = -1.46, SE = 0.34, z = -4.23, p < .001; OR = 0.23).
ConclusionsVirtual feedback of their limbs avatar appears to support better motor performance, while visual feedback of their real limb appears to exacerbate motor impairments in FND patients, likely reinforcing maladaptive self-monitoring. These findings highlight the therapeutic potential of VR interventions and provide the basis for future studies examining longer protocols, clinical outcome and potential implementation in standard motor rehabilitation.
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BibTeX
@misc{weid2026virtual,
title = {{Virtual environment benefits motor dysfunction in Functional Neurological Disorder: Evidence from Virtual and Augmented Reality}},
author = {L. von der Weid and J. Penalver-Andres and C. Concetti and L. Marchal-Crespo and E. Muller and S. Aybek},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.09.26362633},
url = {https://www.medrxiv.org/content/10.64898/2026.09.09.26362633v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Virtual environment benefits motor dysfunction in Functional Neurological Disorder: Evidence from Virtual and Augmented Reality
AU - L. von der Weid
AU - J. Penalver-Andres
AU - C. Concetti
AU - L. Marchal-Crespo
AU - E. Muller
AU - S. Aybek
PY - 2026
DA - 2026/09/09
PB - medRxiv
DO - 10.64898/2026.09.09.26362633
UR - https://www.medrxiv.org/content/10.64898/2026.09.09.26362633v1
AB - BackgroundVirtual and Augmented Reality (VR/AR) are increasingly used in medicine and may offer novel interventions for Functional Neurological Disorder (FND) by targeting mechanisms of impaired motor control. However, evidence for the effect of different modalities on movement in FND is limited. Moreover, it is hypothesized that visual feedback of ones affected arm could reinforce FND symptoms through maladaptive self-monitoring. The present study aims to compare motor performance under visual feedback of a virtual avatar versus the real arm. MethodsFifteen FND patients and eighteen healthy controls completed a dual motor reaching task (touching a virtual fruit such as orange or apple appearing in front of them) with a virtual headset across three modalities: Augmented Reality (AR), where participants saw their real arm; Virtual Reality (VR), with a virtual arm; and Virtual Reality Improved (VRI), with artificially enhanced straightness and larger collision zone with the target. Their movement speed, straightness and number of velocity peaks were calculated for each fruit catch. Additionally, the number of collisions between the eyes and the body was calculated with eye tracking technology. ResultsFND participants were slower and produced less smooth movements in AR compared to VR (b = 1.09, z = 8.83, P < .001) and VRI (b = 0.85, z = 6.91, P < .001), while the opposite effect was found in healthy controls. Eye tracking showed that FND patients looked more at their affected hand than unaffected hand (b = -1.46, SE = 0.34, z = -4.23, p < .001; OR = 0.23). ConclusionsVirtual feedback of their limbs avatar appears to support better motor performance, while visual feedback of their real limb appears to exacerbate motor impairments in FND patients, likely reinforcing maladaptive self-monitoring. These findings highlight the therapeutic potential of VR interventions and provide the basis for future studies examining longer protocols, clinical outcome and potential implementation in standard motor rehabilitation.
ER -