Motor learning of people with visual impairment in a non-immersive virtual reality coincident time task

BackgroundDown syndrome (DS) has unique physical, motor and cognitive characteristics. Despite cognitive and motor difficulties, there is a possibility of intervention based on the knowledge of motor learning. However, it is important to study the motor learning process in individuals with DS during a virtual reality task to justify the use of virtual reality to organize intervention programs. The aim of this study was to analyze the motor learning process in individuals with DS during a virtual reality task.MethodsA total of 40 individuals participated in this study, 20 of whom had DS (24 males and 8 females, mean age of 19 years, ranging between 14 and 30 yrs.) and 20 typically developing individuals (TD) who were matched by age and gender to the individuals with DS. To examine this issue, we used software that uses 3D images and reproduced a coincidence-timing task.ResultsThe results showed that all individuals improved performance in the virtual task, but the individuals with DS that started the task with worse performance showed higher difference from the beginning. Besides that, they were able to retain and transfer the performance with increase of speed of the task.ConclusionIndividuals with DS are able to learn movements from virtual tasks, even though the movement time was higher compared to the TD individuals. The results showed that individuals with DS who started with low performance improved coincidence- timing task with virtual objects, but were less accurate than typically developing individuals.Trial registrationClinicalTrials.gov Identifier: NCT02719600.

Introduction: Limb-girdle muscular dystrophies (LGMDs) are neuromuscular and genetic disorders that progress with weakness and damage of the proximal muscles, developing with loss of functionality. Virtual reality environments are suggested as an effective alternative for performance of daily life activities. However, there is no evidence in the literature on the use of virtual reality in this population. Objective: Assess motor performance through a motor learning protocol in a coincident timing task. Methods: 10 participants with LGMD and 10 healthy individuals were selected and included in the study to perform a non-immersive virtual reality task divided into three phases: acquisition (20 attempts), retention (5 attempts), and transfer (5 attempts, with speed increase). Results: It is observed that the accuracy of movement improves from the beginning to the end of the acquisition (p = 0.01); however, there is a marginal difference between the groups in block A1 (p = 0.089). Regarding the variability of touches, observed by the variable error, both groups improved performance in all phases. Conclusion: Even with lower performance than the control group at the beginning of the practice, individuals with LGMD showed the potential to optimize motor function during the practice of a non-immersive virtual reality activity and were able to match their performance with the control group after a few attempts.

ObjectiveIncreasing evidence shows that traditional neuropsychological tests are insensitive for detecting mild unilateral spatial neglect (USN), lack ecological validity, and are unable to clarify USN in all different spatial domains. Here we present a new, fully immersive virtual reality (VR) task battery with integrated eye tracking for mild visual USN and extinction assessment in the acute state of stroke to overthrow these limitations.MethodsWe included 11 right-sided stroke patients and 10 healthy controls aged 18−75 years. Three VR tasks named the Extinction, the Storage and the Shoot the target tasks were developed to assess USN. Furthermore, neuropsychological assessment examining various parts of cognitive functioning was conducted to measure general abilities. We compared VR and neuropsychological task performance in stroke patients – those with (USN+, n = 5) and without USN (USN−, n = 6) – to healthy controls (n = 10) and tentatively reported the usability of VR system in the acute state of stroke.ResultsPatients had mostly mild neurological and USN symptoms. Nonetheless, we found several differences between the USN+ and healthy control groups in VR task performance. Compared to controls, USN+ patients showed visual extinction and asymmetry in gaze behavior and detection times in distinct spatial locations. Extinction was most evident in the extrapersonal space and delayed detection times on the extreme left and on the left upper parts. Also, USN+ patients needed more time to complete TMT A compared with USN− patients and TMT B compared with controls. VR system usability and acceptance were rated high; no relevant adverse effects occurred.ConclusionNew VR technology with eye tracking enables ecologically valid and objective assessment methods with various exact measures for mild USN and thus could potentially improve future clinical assessments.

Virtual reality is an alternative tool to provide a safe and competitive environment, especially for training and competitions. This study aims to evaluate the effects of modified psychomotor tasks in the virtual reality on the alpha/beta ratio, power output, heart rate, and cadence. The participants are recruited among national development cyclists from National Sport School. The environment of virtual reality was modified from the available virtual reality TACX smart trainer system. The one-way multivariate of variance (MANOVA) identified the effects of the five different levels of psychomotor task (independent variables) in virtual reality on multiple variables of physiological responses. The MANOVA results indicate a statistically significant multivariate main effect for the five levels of task difficulty in road cycling, when jointly considering on the variables of alpha/beta ratio, power output, heart rate, and cadence. The multivariate general linear model for univariate ANOVA results demonstrates a significant difference between subject on alpha/beta ratio and cadence. Significant task pairwise differences were obtained for cadence between Task 1 and both Tasks 2 and 5. The results suggest human's interaction with virtual reality, specifically during the psychomotor task during road cycling. The significant effects on the joint physiological responses ensured that evaluation of the experiment on developed task difficulty in virtual reality was practical, applicable and can be modified when required for training or assessment. The involvement of cognitive functions in response to behavioural mechanism merits further investigation and are deferred for future work.

Proficiency Levels and Validity Evidence for Scoring Metrics for a Virtual Reality and Inanimate Robotic Surgery Simulation Curriculum

Virtual reality (VR) has seen increased use for training and instruction. Designers can enable VR users to gain insights into their own performance by visualizing telemetry data from their actions in VR. Our ability to detect patterns and trends visually suggests the use of data visualization as a tool for users to identify strategies for improved performance. Typical tasks in VR training scenarios are manipulation of 3D objects (e.g., for learning how to maintain a jet engine) and navigation (e.g., to learn the geography of a building or landscape before traveling on-site). In this paper, we present the results of the RUI VR (84 subjects) and Luddy VR studies (68 subjects), where participants were divided into experiment and control cohorts. All subjects performed a series of tasks: 44 cube-matching tasks in RUI VR, and 48 navigation tasks through a virtual building in Luddy VR (all divided into two sets). All Luddy VR subjects used VR gear. RUI VR subjects were divided across three setups: 2D Desktop (with laptop and mouse), VR Tabletop (in VR, sitting at a table), and VR Standup (in VR, standing). In an intervention called “Reflective phase,” the experiment cohorts were presented with data visualizations, designed with the Data Visualization Literacy Framework (DVL-FW), of the data they generated during the first set of tasks before continuing to the second part of the study. For Luddy VR, we found that experiment users had significantly faster completion times in their second trial (p= 0.014) while scoring higher in a mid-questionnaire about the virtual building (p= 0.009). For RUI VR, we found no significant differences for completion time and accuracy between the two cohorts in the VR setups. however, 2D Desktop subjects in the experiment cohort had significantly higher rotation accuracy as well as satisfaction (protation= 0.031,psatisfaction= 0.040). We conclude with suggestions for adjustments to the Reflective phase to boost user performance before generalizing our findings to performance improvement in VR with data visualizations.

Screening surgical residents’ laparoscopic skills using virtual reality tasks: Who needs more time in the sim lab?

Background: Transcranial direct current stimulation (tDCS) and therapy-based virtual reality (VR) have been investigated separately. They have shown promise as efficient and engaging new tools in the neurological rehabilitation of individuals with cerebral palsy (CP). However, the recent literature encourages investigation of the combination of therapy tools in order to potentiate clinic effects and its mechanisms.Methods: A triple-blinded randomised sham-controlled crossover trial will be performed. Thirty-six individuals with gross motor function of levels I to IV (aged 4–14 years old) will be recruited. Individuals will be randomly assigned to Group A (active first) or S (sham first): Group A will start with ten sessions of active tDSC combined with VR tasks. After a 1-month washout, this group will be reallocated to another ten sessions with sham tDCS combined with VR tasks. In contrast, Group S will carry out the opposite protocol, starting with sham tDCS. For the active tDCS the protocol will use low frequency tDCS [intensity of 1 milliampere (mA)] over the primary cortex (M1) area on the dominant side of the brain. Clinical evaluations (reaction times and coincident timing through VR, functional scales: Abilhand-Kids, ACTIVLIM-CP, Paediatric Evaluation of Disability Inventory-PEDI- and heart rate variability-HRV) will be performed at baseline, during, and after active and sham tDCS.Conclusion: tDCS has produced positive results in treating individuals with CP; thus, its combination with new technologies shows promise as a potential mechanism for improving neurological functioning. The results of this study may provide new insights into motor rehabilitation, thereby contributing to the better use of combined tDCS and VR in people with CP.Trial Registration:ClinicalTrials.gov, NCT04044677. Registered on 05 August 2019.

Simple SummaryAwake craniotomy (AC) with brain mapping by direct electrical stimulation for tumors within or adjacent to eloquent brain regions is a surgical approach for minimizing the risk of postoperative neurologic deficits and preserving the patient’s health-related quality of life. Language and motor functions are frequently mapped, but mapping is less frequent for more complex functions, such as visuospatial and social cognition, despite the importance of these functions for daily life activities. This lack of mapping for these functions results at least in part from a lack of tasks fully compatible with the restrictive environment of an operating room and AC procedures. We show here that the use of a virtual reality headset with eye tracking opens up new possibilities for the mapping of these complex functions.Background: Awake craniotomy (AC) with brain mapping for language and motor functions is often performed for tumors within or adjacent to eloquent brain regions. However, other important functions, such as vision and visuospatial and social cognition, are less frequently mapped, at least partly due to the difficulty of defining tasks suitable for the constrained AC environment. Objective: The aim of this retrospective study was to demonstrate, through illustrative cases, how a virtual reality headset (VRH) equipped with eye tracking can open up new possibilities for the mapping of language, the visual field and complex cognitive functions in the operating room. Methods: Virtual reality (VR) tasks performed during 69 ACs were evaluated retrospectively. Three types of VR tasks were used: VR-DO80 for language evaluation, VR-Esterman for visual field assessment and VR-TANGO for the evaluation of visuospatial and social functions. Results: Surgery was performed on the right hemisphere for 29 of the 69 ACs performed (42.0%). One AC (1.5%) was performed with all three VR tasks, 14 ACs (20.3%) were performed with two VR tasks and 54 ACs (78.3%) were performed with one VR task. The median duration of VRH use per patient was 15.5 min. None of the patients had “VR sickness”. Only transitory focal seizures of no consequence and unrelated to VRH use were observed during AC. Patients were able to perform all VR tasks. Eye tracking was functional, enabling the medical team to analyze the patients’ attention and exploration of the visual field of the VRH directly. Conclusions: This preliminary experiment shows that VR approaches can provide neurosurgeons with a way of investigating various functions, including social cognition during AC. Given the rapid advances in VR technology and the unbelievable sense of immersion provided by the most recent devices, there is a need for ongoing reflection and discussions of the ethical and methodological considerations associated with the use of these advanced technologies in AC and brain mapping procedures.

The identification of specific components in EEG signals is often key when designing EEG-based brain-computer interfaces (BCIs), and a good understanding of the factors that elicit such components can be helpful when it comes to precise, energy-efficient and time-accurate actuation of exoskeletons. CNVs (Contingent Negative Variations), ERDs or ERSs (Event-Related Desynchronizations/Synchronizations) as well as ErrPs (Error-Related Potentials) are particularly important components can be identified during motor tasks and related to specific events in a Coincident Timing (CT) task. This work investigates offline EEG signals acquired during an upper limb CT task and analyzes the task protocol with the purpose of correlating the aforementioned EEG features to movement onset. CNVs and ERD/ERS were successfully identified after averaging multiple trials, and it was further concluded that complementary information about muscle activity (via EMG) as well as video tracking of arm movement play a critical role in the synchronization of EEG components with movement onset. The framework for EEG analysis presented in this paper allows for future development of a BCI on top of this CT task capable of assessing motor learning and actuating an exoskeleton to enable faster motor rehabilitation.

Alzheimer's disease (AD) is a progressive neurodegenerative condition and is currently the fourth leading cause of death in advanced nations. The primary cause of AD is the deterioration of neurons in areas of the brain crucial for memory, typically presenting symptoms like loss of memory and a decline in cognitive abilities. Mild Cognitive Impairment (MCI) represents a transitional phase between normal cognitive health and AD. Recent studies have shown that within five years, 32% of individuals diagnosed with MCI experience a progression to Alzheimer's disease. Hence, the early detection and treatment of MCI are vital in decreasing the likelihood of developing AD. Traditionally, MCI assessment has relied on neuropsychological tests such as the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Nevertheless, these methods have limitations, including inducing participant anxiety and fatigue, cultural biases, and the need for skilled administrators. This has shifted towards more innovative assessment methods, particularly Virtual Reality (VR) technology. VR's engaging and multisensory environment offers the potential for more effective MCI assessment. Various VR tasks, such as the Virtual Supermarket Task (VST) and VR adaptations of the Morris Water Maze and Trail Making Test, have shown promise in delivering insightful performance metrics. However, existing research has primarily focused on VR task performance evaluation, often overlooking the corresponding brain activation patterns these tasks stimulate. Compared with the task performance, the stimulated brain patterns could more directly reflect the cognitive function changes resulting from MCI. Whether these VR tasks can induce distinguishable changes in functional near-infrared spectroscopy (fNIRS) data between MCI and healthy individuals and which fNIRS parameters could be useful for MCI assessment is still unknown. To address this research gap, we investigated human brain activity across MIC and healthy individuals in multi-domain VR tasks. First, we selected a VR drumming task which engages multiple cognitive domains, including motor skills, rhythm, and spatial-temporal orientation. Second, we extracted some potential MCI indicators, such as functional connectivity from fNIRS data to analyse brain activity across MIC and healthy individuals in the VR task. Lastly, we examined the statistically significant parameters and discussed the underlying brain activity patterns and their potential for MCI assessment. Our findings revealed that specific brain activity and functional connectivity parameters indicated significant differences between healthy and MCI groups, suggesting the potential value of these parameters as biomarkers for VR-based MCI assessment. This study introduced the potential fNIRS parameters for MCI assessment and discussed their implications and underlying reasons. In conclusion, our study lays a promising foundation for developing and refining VR-based MCI assessments. We anticipate our findings will lead to more effective VR task designs and promote widespread MCI screening in larger populations, ultimately aiding early detection and intervention in individuals at risk of dementia. Future research should address the identified limitations and explore further enhancements in MCI and related condition assessments.

The objective of this study was to construct systems for haptic virtual reality (VR) environment and to conduct an experiment to compare muscular activity during ball catching tasks in real and VR environments, where the level of the presence was evaluated. A ball catching task was demonstrated in two environments, where head-mounted display and SPIDAR-HS, the haptic presentation device using tensile force of the wire, were applied for constructing VR environment. As an index of dynamic muscular activity, forearm EMG signals were measured in the time course of a ball catching task. Average peak RMS value for forearm EMG in VR environment was 45.2% smaller than that in real environment. This difference was apparent because the amount of force generated by SPIDAR-HS was relatively lower than that made by the gravity force of the ball. On the other hand, the trends in dynamic muscular activities were similar for both environment, indicating that two tasks were fairly unique regardless the type of environments. It was concluded that the presence of VR was observable by the dynamic muscular changes during VR tasks with further adjustment of force levels required for the task in VR environment.

The aim of the present study was to investigate the effects of realistic and more unrealistic, abstract virtual hand models on neuronal and behavioral responses in virtual reality (VR) using ecologically valid virtual hand movement tasks. 36 participants performed a button press reaction time task, which was a type of a virtual oddball-task, and a virtual object grip task in VR, both performed with their non-dominant hand. Both tasks were performed once with a realistic, human-like hand model and once with an abstract schematic hand model, i.e., a skeletal hand model. Neuronal responses during the VR tasks were assessed using electroencephalography (EEG). The virtual button press task elicited expected event-related potentials (P300) in the EEG comparable to real-world oddball-tasks, showing ecological validity of this VR task. No differences in neuronal or behavioral responses between realistic and skeletal virtual hand models were observed in the button press task. For the virtual object grip task, activation of motor brain areas was stronger when performing the task with a realistic than with a skeletal hand model. Our results show that more complex VR hand movement tasks can elicit neuronal responses comparable to prior real-world tasks. While prior VR studies using relatively simple virtual hand movement tasks found no differences in neuronal responses between realistic and more abstract hand model conditions, we showed that the design of virtual hand models has an effect on motor cortex activation during more complex and ecologically valid virtual tasks, which might have an impact on the design of virtual hand models in future clinical VR applications.

The postural transition from sitting to standing is a moment of dysautonomic occurrence in individuals with Spinal Cord Injury (SCI). Different tools can be used to minimize this event, such as virtual reality. Thus, we aimed to analyze cardiac autonomic modulation in individuals with SCI during postural transition from the sitting to orthostatism position using a cognitive virtual reality (VR) task. Individuals with and without SCI were positioned on the Easy Stand® device, sitting at rest, at 0° considering the angle between the seat and the floor, elevation at 45°, and orthostatism at 90°, for 5 minutes in each position. Heart rate variability (HRV) measures of sympathovagal balance were collected (heart rate receiver: Polar V800). The groups were subdivided into two groups, one that performed VR as an intervention during the postural angle changes and another group that did not perform VR. We evaluated 76 individuals, 40 with a medical diagnosis of SCI and 36 who composed the able-bodied control group without SCI, matched by age and sex. The HRV results showed that the SCI group who performed the task in VR demonstrated no significant difference in parasympathetic activation and global variability between the sitting versus 90° positions. There was better sympathovagal balance in SCI and able-bodied control groups who performed the VR task between the sitting versus 90° positions. The use of a VR task seems to contribute to better sympathovagal balance, with the potential to reduce dysautonomia during postural changes.

Background/Objectives: Fibromyalgia (FM) is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and impaired motor performance. This study aimed to investigate the effects of transcranial direct current stimulation (tDCS) during virtual reality (VR) tasks on the motor performance of women with FM. Methods: Participants were divided into two groups: Group A received active tDCS for 10 days followed by sham tDCS for 10 days, while Group B received the opposite sequence. Both groups performed VR tasks using MoveHero software (v. 2.4) during the tDCS sessions. Motor performance was assessed by the number of hits (movement with correct timing to reach the targets) and absolute (accuracy measure) and variable (precision measure) errors during VR tasks. Participants were 21 women, aged 30–50 years, and diagnosed with FM. Results: Group A, which received active tDCS first, presented significant improvements in motor performance (number of hits and absolute and variable errors). The benefits of active tDCS persisted into the sham phase, suggesting a lasting neuroplastic effect. Conclusions: tDCS during VR tasks significantly improved motor performance in women with FM, particularly in complex, extensive movements. These findings indicate that tDCS enhances neuroplasticity, leading to sustained motor improvements, making it a promising therapeutic tool in FM rehabilitation.