Immersive Virtual Reality Headset Research Articles

890 Surgical Multidisciplinary Team Meetings Are Enhanced by Collaboration in the Metaverse

Abstract Aim Multidisciplinary team meetings (MDT-Ms) are utilised as a clinical decision-making tool. Currently, these are in-person or remote, using screen-sharing of patient health records including clinical findings, numerical data, and imaging (2D/3D). Immersive Virtual Reality (IVR) is an emerging technology allowing multiple care-providers to remotely interact with patient data in the metaverse. Our aim was to develop an IVR metaverse for MDT-M and test its feasibility and efficacy in the orthopaedic trauma setting. Method Interviews of users attending existing orthopaedic trauma MDT-Ms at a regional major trauma centre identified strengths, weaknesses, opportunities, and threats (SWOT analysis) for a novel platform. Iterative testing allowed feature development and curation of twenty-four simulated cases from previous admissions. User experience in pilot MDT-Ms was measured using the NASA Task Load Index (NASA-TLX) and System Usability Scale (SUS). Results An IVR metaverse platform was developed and four MDT-Ms were successfully conducted with healthcare professionals (n = 13). Participants found ‘data visualisation’ and ‘clinical decision-making’ effective in IVR: median 5 (IQR 4-5); and 5 (IQR 4-5) respectively. Ratings on ‘ease of communication’ in the metaverse were varied with a median of 3 (IQR 2-4.5). Qualitative analysis highlighted the strength of IVR for collaborative interrogation of 3D anatomy and injury patterns. The NASA-TLX domain ‘task performance’ was rated consistently highly. Conclusions Healthcare professionals can conduct MDT-Ms using a novel platform on commercially available IVR headsets. Participants were able to collaboratively interrogate clinical data, facilitating enhanced discussion, decision-making, and perceived task performance. Future iterations will focus on role designation to improve communication in MDT-Ms.

The “Canopy Approach”: Case Series Using Immersive Virtual Reality for Bottom-Up Target-Based Preoperative Planning in Pediatric Neurosurgery

BACKGROUND: Virtual reality (VR) is increasingly used for trajectory planning in neurosurgery. OBJECTIVE: To describe a case series showing the application of immersive VR involving both “top-down” from skull to lesion and “bottom-up” from lesion to skull approaches for trajectory planning in pediatric neurosurgical patients. METHODS: We detail the preoperative and intraoperative application of VR and clinical courses of 5 children (aged 7-14 years) with anatomically challenging intraparenchymal lesions that posed operative risks to nearby vascular anatomy and fiber tracts. Preoperative planning consisted of standard presurgical evaluation with computed tomography and magnetic resonance imaging used to render 3-dimensional models that could be viewed and manipulated using desktop software and immersive VR headsets and hand controllers by the surgeon and family. Patient satisfaction was evaluated by survey. Surgical outcomes were degree of seizure control or extent of resection. RESULTS: Three patients underwent lesion resection and 2 laser ablation. Modifications to 2-dimensional and “top-down” VR trajectory plans were made after “bottom-up” navigation in all cases. All families reported that the VR enhanced their understanding of the procedure. There were no complications, and no patients suffered permanent neurological deficits postoperatively. Gross total resection was achieved in all lesional cases, and patients with epilepsy achieved seizure freedom at 2 years postoperatively. CONCLUSION: Immersive VR allows operative corridors to be virtually traveled and viewed from a “top-down” and “bottom-up” perspective, as if looking up from under a forest canopy of overlying anatomy, for optimal trajectory planning and improvement of family understanding in pediatric neurosurgery.

Finding landmarks - An investigation of viewing behavior during spatial navigation in VR using a graph-theoretical analysis approach.

Vision provides the most important sensory information for spatial navigation. Recent technical advances allow new options to conduct more naturalistic experiments in virtual reality (VR) while additionally gathering data of the viewing behavior with eye tracking investigations. Here, we propose a method that allows one to quantify characteristics of visual behavior by using graph-theoretical measures to abstract eye tracking data recorded in a 3D virtual urban environment. The analysis is based on eye tracking data of 20 participants, who freely explored the virtual city Seahaven for 90 minutes with an immersive VR headset with an inbuild eye tracker. To extract what participants looked at, we defined "gaze" events, from which we created gaze graphs. On these, we applied graph-theoretical measures to reveal the underlying structure of visual attention. Applying graph partitioning, we found that our virtual environment could be treated as one coherent city. To investigate the importance of houses in the city, we applied the node degree centrality measure. Our results revealed that 10 houses had a node degree that exceeded consistently two-sigma distance from the mean node degree of all other houses. The importance of these houses was supported by the hierarchy index, which showed a clear hierarchical structure of the gaze graphs. As these high node degree houses fulfilled several characteristics of landmarks, we named them "gaze-graph-defined landmarks". Applying the rich club coefficient, we found that these gaze-graph-defined landmarks were preferentially connected to each other and that participants spend the majority of their experiment time in areas where at least two of those houses were visible. Our findings do not only provide new experimental evidence for the development of spatial knowledge, but also establish a new methodology to identify and assess the function of landmarks in spatial navigation based on eye tracking data.

The Influence of a Nutrition Recommendation on Food Choices in a Virtual Fast-Food Restaurant

ObjectivesFood from fast-food restaurants (FFR) is typically high in calories, saturated fat, sugars, and sodium, while being low in whole grains, fruits, and vegetables. Improving choices made when purchasing food at FFR could improve diet and reduce the risk of chronic disease. The RAND Corporation developed performance standards for eating at restaurants that involves limiting calories, saturated fat, trans fat, total sugars, sweetened beverages, sodium and increasing fruit and vegetable intake. This study used a virtual fast-food restaurant to assess the effect of providing participants with a goal of selecting a meal of 700 kcal compared to free-choice on nutrient intake, cost, expected satiety and expected palatability. MethodsFifty-eight students were randomly assigned to the intervention (700 kcal) or control (free-choice) group. Participants wore an immersive virtual reality headset to experience being in a fast-food restaurant. They were asked to rate the palatability and expected satiety of items on the menu before ordering a meal. After they ordered the meal, the participants were asked to rate the palatability and expected satiety of the meal. The time taken to order was also measured. ResultsIn the 700 kcal treatment participants chose a meal that was lower in energy (1300 v 770 kcal; p = 0.001), total fat (55 g v 34 g, p = 0.01), total CHO (151 g v 88 g, p = 0.0006), total sugars (73 g v 22 g, p = 0.02). There was no significant difference for saturated Fat (14.8 g v 8 g, p = 0.08), cholesterol (120 mg v 65 mg, p = 0.1), fiber (7 g v 6 g, p = 0.1), protein (43 g v 27 g, p = 0.06) or sodium (1767 mg v 1125 mg, p = 0.06). The cost of the meal was lower ($9.67 v $6.19; p–0.0003) and there was no difference in the time taken to order (51.7 v 52.9 seconds, p = 0.28), rated palatability of the selected meal (82 mm v 67 mm, p = 0.054). Expected satiety of the restricted meal was lower (100 mm v 79 mm, p = 0.006). ConclusionsThese preliminary results suggest that individuals who select a meal based on a target of 700 kcal have improved nutrient intakes. In addition, there is a reduction in cost of the meal. The participants rated the meals to be of similar palatability but there was a reduction in expected satiety which may lead to compensatory eating. Funding SourcesNone.

Intermittent Visual Occlusions Increase Balance Training Effectiveness.

Improving dynamic balance can prevent falls in humans with neurological and mechanical deficits. Dynamic balance requires the neural integration of multisensory information to constantly assess the state of body mechanics. Prior research found that intermittent visual rotations improved balance training during walking on a narrow beam, but limitations from the immersive virtual reality headset hindered balance training effectiveness overall. We theorized that intermittent visual occlusions with electrically controlled liquid crystal glasses would overcome the previous limitations of the immersive virtual reality headset and provide a means to enhance dynamic balance training efficacy. Forty healthy young individuals walked on a treadmill-mounted balance beam for 30 min (20 subjects with intermittent visual occlusions and 20 subjects with unperturbed vision). Balance performance, in number of step-offs of the beam, improved by 78% for the visual occlusions group on the same day of the training, a near fourfold improvement compared to the 21% improvement for the unperturbed vision group (t(38) = –5.2, p < 0.001). The difference between groups was also apparent 2 weeks later testing for retention (60% improvement for the visual occlusions group, 5% for the unperturbed vision group; t(38) = –4.2, p < 0.001). Intermittent visual occlusions are likely a simple method for enhancing balance training in dynamic motor tasks.

Immersive virtual reality training module for active shooter events

Active shooter events are not emergencies that can be reasonably anticipated. However, these events do occur more than we think, and there is a dire need for an effective evacuation plan that can increase the likelihood of saving lives and reducing casualties in the event of an active shooting incident. This has raised a major concern about the lack of tools that would allow robust predictions of realistic human movements and the lack of understanding about the interaction in designated environments. Clearly, it is impractical to carry out live experiments where thousands of people are evacuated from buildings designed for every possible emergency condition. There has been progress in understanding human movement, human motion synthesis, crowd dynamics, indoor environments and their relationships with active shooter events, but challenges remain. This paper presents an immersive virtual reality (VR) experimental setup for conducting evacuation experiments and virtual evacuation drills in response to extreme events that impact the actions of occupants. We have presented two ways for controlling crowd behavior. First, by defining rules for agents or NPCs (Non-Player Characters). Second, by providing controls to the users as avatars or PCs (Player characters) to navigate in the VR environment as autonomous agents with a keyboard/ joystick along with an immersive VR headset in real time.The results will enable scientists and engineers to develop more realistic models of the systems they are designing, and to obtain greater insights into their eventual behavior, without having to build costly prototypes.

Visualization and Interaction Technologies in Serious and Exergames for Cognitive Assessment and Training: A Survey on Available Solutions and Their Validation

Exergames and serious games, based on standard personal computers, mobile devices and gaming consoles or on novel immersive Virtual and Augmented Reality techniques, have become popular in the last few years and are now applied in various research fields, among which cognitive assessment and training of heterogeneous target populations. Moreover, the adoption of Web based solutions together with the integration of Artificial Intelligence and Machine Learning algorithms could bring countless advantages, both for the patients and the clinical personnel, as allowing the early detection of some pathological conditions, improving the efficacy and adherence to rehabilitation processes, through the personalisation of training sessions, and optimizing the allocation of resources by the healthcare system. The current work proposes a systematic survey of existing solutions in the field of cognitive assessment and training. We evaluate the visualization and interaction technologies commonly adopted and the measures taken to fulfil the need of the pathological target populations. Moreover, we analyze how implemented solutions are validated, i.e. the chosen experimental designs, data collection and analysis. Finally, we consider the availability of the applications and raw data to the large community of researchers and medical professionals and the actual application of proposed solutions in the standard clinical practice. Despite the potential of these technologies, research is still at an early stage. Although the recent release of accessible immersive virtual reality headsets and the increasing interest on vision-based techniques for tracking body and hands movements, many studies still rely on non-immersive virtual reality (67.2%), mainly mobile and personal computers, and standard gaming tools for interactions (41.5%). Finally, we highlight that although the interest of research community in this field is increasingly higher, the sharing of dataset (10.6%) and implemented applications (3.8%) should be promoted and the number of healthcare structures which have successfully introduced the new technological approaches in the treatment of their host patients is limited (10.2%).

Observing Actions Through Immersive Virtual Reality Enhances Motor Imagery Training.

Visual information plays an essential role in enhancing neural activity during mental practices. Previous research has shown that using different visual scenarios during mental practices that involve imagining the movement of a specific body part may result in differences in performance. Many of these scenarios utilize the concept of embodiment, or one's observation of another entity to be a part of oneself, to improve practice quality of the imagined body movement. We therefore hypothesized that applying immersive virtual reality headsets, with their ability to provide rich immersion and illusion by presenting egocentrically simulated virtual scenarios, and action observation to motor imagery practice will result in significant improvement. To explore the possible synergy between immersive systems and motor imagery, we analyzed the electroencephalogram signals of our participants as they were presented the same virtual hand movement scenario with two different mediums: an immersive virtual reality headset and a monitor display. Our experimental results provide evidence that the immersive virtual reality headsets induced improved rhythmic patterns with better discriminating spatial features from the brain compared to the monitor display. These findings suggest that the use of immersive virtual reality headsets, with the illusion and embodiment they provide, can effectively improve motor imagery training.

Conducting online virtual environment experiments with uncompensated, unsupervised samples.

Web-based experimentation with uncompensated and unsupervised samples allows for a larger and more diverse sample population, more generalizable results, and faster theory to experiment cycle. Given that participants are unsupervised, it is still unknown whether the data collected in such settings would be of sufficiently high quality to support robust conclusions. Therefore, we investigated the feasibility of conducting such experiments online using virtual environment technologies. We conducted a conceptual replication of two prior experiments that have been conducted in virtual environments. Our results replicate findings previously obtained in conventional laboratory settings. These results hold across different device types of participants (ranging from desktop, through mobile devices to immersive virtual reality headsets), suggesting that experiments can be conducted online with uncompensated samples in virtual environments.

Immediate and Short-Term Effect of Virtual Reality Training on Pain, Range of Motion, and Kinesiophobia in Patients with Cervical Spondylosis

Context: Neck problems are the second most reported musculoskeletal condition. Neck injuries and pain are the common and frequent causes of absenteeism and disability. These conditions have a negative impact on individuals' activities of daily living. Aim: The aim of this study is to compare the effectiveness of virtual reality training (VRT) along with conventional physiotherapy over conventional treatment alone on pain, range of motion (ROM), and kinesiophobia in the patients with cervical spondylosis. Setting and Design: This was a randomized control trial done at the tertiary care hospital, Pune, India. Materials and Methods: Forty-four participants were randomly allocated using the chit method to the conventional group (n = 22) and conventional plus VRT group (n = 22). VRT was given using an immersive virtual reality headset. The outcomes assessed were pain using the Numeric Rating Scale and cervical ROM (all movements) using universal goniometer and kinesiophobia. Pain and ROM were assessed on the immediate (day 1) and short-term (day 3) basis while kinesiophobia was assessed only on day 3. Statistical Analysis Used: Statistical analysis was performed using the Statistical Package for the Social Sciences software version 16.0. Results: Intragroup analysis revealed a statistically significant difference in the immediate and short-term assessment in both the groups for all the variables (P ≤ 0.05). However, intergroup analysis revealed that VRT is effective in alleviating pain in the immediate (P = 0.02) and short-term (P = 0.00) analysis and improving rotation (left rotation [ P = 0.04]; right rotation [ P = 0.01]) and side flexion (left side flexion [ P = 0.00]; and right side flexion [0.01]) ranges. The results were insignificant for flexion, extension, and kinesiophobia. Conclusion: The present study concluded that both the protocols are effective in reducing pain and improving ROM. VRT was better in reducing pain than conventional treatment on the immediate and short-term basis. However, VRT group was not effective in improving ROM on an immediate basis. Both the treatment methods were equally effective in reducing kinesiophobia.

Effects of Immersive Virtual Reality Headset Viewing on Young Children: Visuomotor Function, Postural Stability, and Motion Sickness

To assess the safety of VR 3D headset (virtual reality 3-dimensional binocular-stereoscopic near-eye display) use in young children. Product safety warnings that accompany VR headsets ban their use in children under age 13 years. Prospective, interventional, before-and-after study. Recordings were obtained in 50 children (29 boys) aged 4-10 years (mean 7.2 ± 1.8 years). Minimum binocular corrected distance visual acuity (CDVA) was 20/50 (logarithm of the minimum angle of resolution [logMAR] 0.4) and stereoacuity 800 seconds of an arc or better. A Sony PlayStation VR headset was worn for 2 sequential play sessions (of 30minutes each) of a first-person 3D flying game (Eagle Flight) requiring head movement to control flight direction (pitch, yaw, and roll axes). Baseline testing preceded VR exposure, and each VR session was followed by post-VR testing of binocular CDVA, refractive error, binocular eye alignment (strabismus), stereoacuity, and postural stability (imbalance). Visually induced motion sickness was probed using the Simulator Sickness Questionnaire modified for pediatric use (Peds SSQ). Visual-vestibulo-ocular reflex (V-VOR) adaptation was also tested pre- vs post-trial in 5 of the children. Safety was gauged as a decline or change from baseline in any visuomotor measure. Forty-six of 50 children (94%) completed both VR play sessions with no significant change from baseline in measures of binocular CDVA (P= .89), refractive error (P= .36), binocular eye alignment (P= .90), or stereoacuity (P= .45). Postural stability degraded an average 9% from baseline after 60minutes of VR exposure (P= .06). Peds SSQ scores increased a mean 4.7%-comparing pretrial to post-trial-for each of 4 symptom categories: eye discomfort (P= .02), head/neck discomfort (P= .03), fatigue (P= .03), and motion sickness (P= .01). None of the children who finished both trial sessions (94%) asked to end the play, and the majority were disappointed when play was halted. V-VOR gain remained unaltered in the 5 children tested. Three children (6% of participants) discontinued the trial during the first 10minutes of the first session of VR play, 2 girls (aged 5 and 6 years) and 1 boy (aged 7 years). The girls reported discomfort consistent with mild motion sickness; the boy said he was bored and the headset was uncomfortable. No child manifested aftereffects ("flashbacks") in the days following the VR exposure. Young children tolerate fully immersive 3D virtual reality game play without noteworthy effects on visuomotor functions. VR play did not induce significant post-VR postural instability or maladaption of the vestibulo-ocular reflex. The prevalence of discomfort and aftereffects may be less than that reported for adults.