Simulator Sickness Questionnaire Scores Research Articles

Immersive reality for robotic surgical training: a pilot study using 3D visors for immersive view of the operating field.

Immersive intracorporeal vision is a key feature of robotic surgery, limited today to only one trainee per operation when the dual console is available. We developed a tool that provides a virtually unlimited number of surgeons with the operator's view, with the possibility to also watch the surgeon's hand movements and the operating table. In this study, we aim to assess trainees' reaction to this innovative training method. Medical students and surgery residents were offered an immersive experience with head-mounted devices, showing a didactic video in a 360° virtual space with 3D intracorporeal robotic vision, the surgeon's hand movements and the surrounding operating room during a robotic rectal resection with total mesorectal excision. Subsequently, participants were asked to fill a questionnaire evaluating the user's reaction to the new training tool including the validated System Usability Scale (SUS) and Simulator Sickness Questionnaire (SSQ), and non-validated questions. 102 participants took part in the training and the assessment questionnaires, 94 (92%) medical students and 8 (8%) surgery residents. Users' feedback was overall positive. In the engagement and intention to use items, almost 90% of the respondents voted for a complete or near complete agreement. The median SUS score was 80 [IQR 70-90]. The median SSQ score was 44.88 [IQR 22.44-82.28]. Exposing trainees to immersive robotic vision of the surgical field had a positive reaction from our audience. Our initial results encourage further implementing this technology in surgical training of medical students and residents to prove its efficacy.

HOW DOES MENTAL DISTRACTION INDUCED BY AN ADDITIONAL TASK AFFECT THE SEVERITY OF SIMULATOR SICKNESS SYMPTOMS IN PILOTS: A SPATIAL DISORIENTATION SIMULATOR STUDY

Introduction: To improve the effectiveness of spatial disorientation (SD) training in a flight simulator, pilots are recommended to perform an additional task that induces a mental distraction. The presented study explored how the inclusion of an additional task that may enhance the effectiveness of SD training changes the severity of simulator sickness symptoms reported after exposure in the Gyro-IPT simulator. Methods: We compared the incidence of simulator sickness symptoms in pilots across four setups of flight scenarios (varying according to cognitive load distraction) collected during our previous studies. A total of 77 male military pilots (age 28.3±6.2) with flight experience (810.72 ±969.43 hours) were randomly assigned to one of four groups and then exposed to a 60-min long flight session (12 flight profiles, six involved an SD-conflict) with active control in the Gyro IPT simulator. In addition to the primary flying task, in three flight scenarios, pilots were asked to perform an additional visual (a change detection flicker task [CDFT]), auditory (an auditory N-back task [NBT]), or duration-discrimination task (DDT)). To measure simulator sickness symptoms, the Simulator Sickness Questionnaire (SSQ) was administered pre- and post-simulator exposure. Results: The severity of simulator sickness symptoms due to visual and motion cues did not significantly change when the pilot performed a non-sickening cognitive task (additional visual or auditory task). The total SSQ score and scores for nausea, oculomotor disturbance, and disorientation in the CDFT and DDT were slightly higher than in the control condition (flight without additional task). Despite the observed differences, according to the SSQ scoring criteria, the simulator sickness symptoms reported by the pilots were negligible. Conclusions: The additional tasks (CDFT, auditory NBT, or DDT) applied to improve the effectiveness of SD training in the Gyro-IPT simulator do not significantly change unwanted effects, such as simulator sickness.

Motion Sickness in Mixed-Reality Situational Awareness System

This research focuses on enhancing the user experience within a Mixed-Reality Situational Awareness System (MRSAS). The study employed the Simulator Sickness Questionnaire (SSQ) in order to gauge and quantify the user experience and to compare the effects of changes to the system. As the results of SSQ are very dependant on inherent motion sickness susceptibility, the Motion Sickness Susceptibility Questionnaire (MSQ) was used to normalize the results. The experimental conditions were tested on a simulated setup which was also compared to its real-life counterpart. This simulated setup was adjusted to best match the conditions found in the real system by using post-processing effects. The test subjects in this research primarily consisted of 17–28 years old university students representing both male and female genders as well as a secondary set with a larger age range but predominantly male. In total, there were 41 unique test subjects in this study. The parameters that were analyzed in this study were the Field of View (FoV) of the headset, the effects of peripheral and general blurring, camera distortions, camera white balance and users adaptability to VR over time. All of the results are presented as the average of multiple user results and as scaled by user MSQ. The findings suggest that SSQ scores increase rapidly in the first 10–20 min of testing and level off at around 40–50 min. Repeated exposure to VR reduces MS buildup, and a FoV of 49–54 is ideal for a MRSAS setup. Additionally camera based effects like lens distortion and automatic white balance had negligible effests on MS. In this study a new MSQ based SSQ normalization technique was also developed and utilized for comparison. While the experiments in this research were primarily conducted with the goal of improving the physical Vegvisir system, the results themselves may be applicable for a broader array of VR/MR awareness systems and can help improve the UX of future applications.

Feasibility of a virtual reality course on adult tracheostomy safety skills.

The National Tracheostomy Safety Project has run high-quality, face-to-face skills courses since 2009. The aim of this project was to produce a virtual reality version of the established course and evaluate its impact on participant learning, and participant and faculty satisfaction. Healthcare staff and students were recruited and randomised to attend one of (1) a face-to-face traditional course (control); (2) a virtual reality course at a conference centre with on-site technical support; (3) a fully remote virtual reality course; the virtual reality groups were combined for the analysis of learning outcomes and satisfaction. The primary outcome was the difference in pre/post-course knowledge scores on a 30-item questionnaire; secondary outcomes included knowledge retention, usability, comfort/side effects and participant performance in a simulated tracheostomy emergency. Thirty-seven participants and 15 faculty participated in this study. There was no significant difference between mean pre/post-course scores from the face-to-face (from 21.1 to 23.1; +2) and combined virtual reality (from 17.1 to 21.1; +4) groups, with both showing improvement (p = 0.21). The mean System Usability Scale score for virtual reality was 76.8 (SD 12.6), which is above average; the median Simulator Sickness Questionnaire score was 7.5 (IQR 3.7-22.4), indicating minimal symptoms. All participants resolved the primary clinical problem in the simulated emergency, but the virtual reality (VR) group was slower overall (mean difference 61.8 s, p = 0.003). This technical feasibility study demonstrated that there was no difference in participant knowledge immediately after and 4 weeks following face-to-face and virtual reality courses. Virtual reality offers an immersive experience that can be delivered remotely and offers potential benefits of reducing travel and venue costs for attendees, therefore increasing the flexibility of training opportunities.

Gender Effect on Motion Sickness Susceptibility

The study aimed was to determine whether there was a gender difference in sensitivity to visual stimulation-induced motion sickness (MS). Forty-nine participants (Female: 24, Male: 25) volunteered to join in the study. Participants were exposed to a visual video-recording stimulus to evoke the MS. Simulator Sickness Questionnaire (SSQ) was administered before, after, and 30 min after the MS stimulation to determine MS symptoms. Participants' self-report was used to identify motion sickness. Postural sway (PS) was measured before and immediately after MS stimulation. 58.3% of the female and 48.0% of the male reported that they had MS, while 41.7% of the female and 52.0% of the male reported that they did not have MS. Gender and MS distributions were not significant (p=0.469). Participants with MS before the stimulation had higher PS than those who declared no MS (p=0.008), but PS was not different after the stimulation (p=0.102). Although there was no difference in the pre-test (p=0.231), men with MS had higher PS than women with MS at the post-test (p=0.013). There was a significant increase in PS of men who declared that they had MS after the stimulation (p=0.012). The pre-test (p=0.899) and post-test (p=0.434) SSQ scores of men and women with MS were not different, while women had higher SSQ scores than men at the post-test 30 (p=0.020). Finally, there was no correlation between gender and rates of MS. In terms of symptom severity, females appear to be more susceptible to MS. PS may be a precursor to MS.

Tolerance of immersive head-mounted virtual reality among older nursing home residents.

Virtual Reality (VR) is a tool that is increasingly used in the aging population. Head-Mounted Displays (HMDs) are stereoscopic vision devices used for immersive VR. Cybersickness is sometimes reported after head-mounted display (HMD) VR exposure. Cybersickness severity and anxiety state reflect VR low tolerance. We aimed to evaluate HMD VR tolerance among older nursing home residents through cybersickness and anxiety state. A total of 36 participants were included in this preliminary study, 33 of whom (mean age: 89.33 ± 5.48) underwent three individual HMD VR sessions with three different contents. Cybersickness occurrence and severity were scored by the Simulator Sickness Questionnaire (SSQ) after each session. Anxiety state was assessed by the State-Trait Anxiety Inventory form Y-A before and after each session. Anxiety trait (using State-Trait Anxiety Inventory form Y-B) was also evaluated before and after the experiment. In total, 92% (33/36) of patients completed all three sessions, of which 61% (20/33) did not report any cybersickness symptoms (SSQ = 0). Six participants reported significant cybersickness (defined by an SSQ score ⩾10) in at least one session. Only two participants stopped the study after the first exposure because of cybersickness. Age, cognitive function, anxiety trait, and well-being were not associated with cybersickness. The mean anxiety state decreased significantly from pre- to post-session. This immersive HMD VR experience was well tolerated among nursing home dwellers. Further larger studies in this population aiming to identify CS determinants are needed in order to use HMD VR on a standard basis.

Subjective Visual Vertical test with the 3D virtual reality system: effective factors and cybersickness

Background 3D Virtual Reality (VR) offers new opportunities in vestibular science. It also presents new challenges and problems. Aims/objectives The study aimed to evaluate the effective factors in the 3D VR Subjective Visual Vertical (SVV) test and the impact of cybersickness on the test results. Material and methods The effect of the foam surface, head position in the yaw axis, moving background, and arm position holding the controller was tested. Cybersickness was evaluated using the Simulator Sickness Questionnaire (SSQ). Results The head position and controller holding style significantly affected the results. The foam surface and the moving background did not have a significant effect. Although 61.4% of the patients fell into the bad category according to the symptoms of the SSQ score, cybersickness did not significantly affect the SVV results. Conclusions and significance In 3D VR SVV, additional factors should be considered: the headset’s weight, head position, and how we hold the controller. The A-effect emerged when the head was 45 degrees turned on the yaw axis. A significant shift was detected in the test, with the arm holding the controller at 90 degrees. Most subjects felt cybersickness at a considerable level. Cybersickness should always be taken into account in VR when planning new applications.

Virtual Reality Simulation for Suicide Risk Assessment Training: Prevalence of Adverse Effects.

Virtual reality (VR) simulation is changing the landscape of simulation-based medical education. Immersive VR allows users to interact with a computer-generated environment and digital avatars using a VR headset and controllers. However, current literature regarding the use of immersive VR simulation in psychiatric medical education is sparse. This study describes its use and considerations regarding tolerability. At a mental health hospital in Canada, two immersive VR suicide risk assessment (SRA) case simulations were developed. These simulations have participants interview VR patients to characterize their suicide risk, offering a novel and safe way to engage healthcare providers in SRA training. Regarding user tolerability of these VR simulations, the Simulator Sickness Questionnaire (SSQ) was administered to participants after the simulation to characterize any motion sickness symptoms experienced. Of the 22 participants in this study, the overall SSQ scores demonstrated good tolerability of the VR SRA, with the majority of participants reporting no or minimal simulator sickness symptoms. Moreover, the majority of participants reported being satisfied with this training and that the VR SRA simulation enhanced their learning experience. These study findings are novel, given the current dearth of data regarding the use of immersive VR in simulation-based psychiatric medical education. Further studies exploring the educational effectiveness of VR SRA in simulation-based psychiatric medical education are indicated.

THE INCIDENCE OF SIMULATOR SICKNESS IN PILOTS AND NON-PILOTS EXPOSED TO SPATIAL DISORIENTATION EVENTS IN THE GYRO-IPT SIMULATOR

Introduction: A previous study conducted in the Gyro-IPT simulator revealed that applied flight scenarios induced minor severity of simulator sickness symptoms in participants. In this study, however, we did not investigate how the severity of symptoms differs between pilots and non-pilots. Therefore, the presented study aimed to examine whether the symptoms of simulator sickness induced in pilots and non-pilots during spatial disorientation (SD) training are significantly different. We were particularly interested in whether the standard flight scenario used in SD training could be a contributing factor in increasing simulator sickness in novice, inexperienced pilots. Method: We used the data from the previous study, where twenty male military pilots (age 31.6 ±8.22) with flight experience (total flight hours 1300 ±1167.4) and 20 non-pilots (age 30.9 ±7.72) were assigned to one of two groups and then exposed to a 1-hour long flight session (12 flight profiles, six involved an SD-conflict) with active control in the Gyro IPT simulator. To measure simulator sickness symptoms, the Simulator Sickness Questionnaire (SSQ) was administered pre and post-simulator exposure. In the presented study, the SSQ scores were analyzed independently for the total SSQ and subscores for nausea, oculomotor, and disorientation, and then were compared between groups. Results: The score of the total severity and for each subscale of SSQ symptoms in the non-pilots‘ group were higher than those in the pilots group, however, these differences were not significant. Despite the observed differences, according to the SSQ scoring criteria the simulator sickness symptoms reported by the participants after exposure to the applied flight scenario were negligible. Conclusion: The flight scenarios used in SD training did not generate significantly different symptoms of simulator sickness between non-pilots and pilots. The low level of severity of simulator sickness symptoms in these two study groups may indicate difficulty in predicting simulator sickness based on SSQ only.

Fusing the Virtual and Physical Worlds to Identify Declines in Instrumental Activities of Daily Living Associated with Parkinson’s Disease (S37.008)

<h3>Objective:</h3> The objective of this study was to utilize a novel virtual reality paradigm, Cleveland Clinic Virtual Reality Shopping (CC-VRS), to identify changes in instrumental activities of daily living (IADL) associated with Parkinson’s disease (PD). <h3>Background:</h3> Understanding the effects of medication or surgical interventions on PD IADL performance is necessary to ensure optimized function and maximize independence. The CC-VRS combines virtual reality content with an omnidirectional treadmill to create an immersive full-scale grocery shopping environment that presents cognitive and physical challenges, objectively and quantitatively evaluating cognitive and motor function. <h3>Design/Methods:</h3> Fourteen individuals with PD (UPDRS-III 25.9 ± 13.9, ON antiparkinsonian medication), and 14 age- and gender-matched healthy adults completed Basic and Complex shopping scenarios; the latter includes additional cognitive and physical demands while shopping. During the scenario, participants physically navigated through the virtual grocery store on the omnidirectional treadmill that allowed them to walk in a straight line and perform 90° and 180° turns. The store route, shopping items, and distractors were standardized across participants. <h3>Results:</h3> Motor and cognitive performance differed across PD and control groups. From a motor perspective, PD patients exhibited significantly shorter step length (<i>p</i>&lt;0.05) and experienced multiple freezing episodes while turning. Cognitive function was evaluated through list observation behaviors; PD patients spent significantly more time looking at their virtual shopping list (<i>p</i>&lt;0.01) and time for each list activation was nearly twice that of controls (<i>p</i>&lt;0.01). Both groups tolerated the virtual environment well, as Simulator Sickness Questionnaire scores for both groups were minimal following completion of CC-VRS. <h3>Conclusions:</h3> The CC-VRS platform successfully quantifies PD motor symptoms and subtle cognitive declines in mild PD versus healthy controls. The CC-VRS platform was well-tolerated across groups and offers an innovative approach to objectively quantifying IADL performance, with potential for use in titrating medication and tuning deep brain stimulation parameters. <b>Disclosure:</b> Morgan McGrath has nothing to disclose. Anson Rosenfeldt has received personal compensation for serving as an employee of Cleveland Clinic. Anson Rosenfeldt has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Enspire DBS. The institution of Anson Rosenfeldt has received research support from Michael J. Fox Foundation. The institution of Anson Rosenfeldt has received research support from National Institute of Health. The institution of Anson Rosenfeldt has received research support from Department of Defense. Anson Rosenfeldt has received intellectual property interests from a discovery or technology relating to health care. Mr. Waltz has nothing to disclose. Mandy Koop has nothing to disclose. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerevel. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Fernandez has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Fernandez has received research support from Biogen. The institution of Dr. Fernandez has received research support from Michael J Fox Founda. The institution of Dr. Fernandez has received research support from Roche. The institution of Dr. Fernandez has received research support from Parkinson Foundation. The institution of Dr. Fernandez has received research support from UCB. Dr. Fernandez has received publishing royalties from a publication relating to health care. Dr. Fernandez has received personal compensation in the range of $10,000-$49,999 for serving as a Steering Committee/Advisory Committee Member with Parkinson Study Group. The institution of Dr. Alberts has received research support from NIH. Dr. Alberts has received intellectual property interests from a discovery or technology relating to health care. Dr. Alberts has received personal compensation in the range of $500-$4,999 for serving as a Member, Health and Wellness Council with Peloton Interactive.

Recovery time from VR sickness due to susceptibility: Objective and quantitative evaluation using electroencephalography

With the increasing use of virtual reality (VR) devices, interest in reducing their negative effects, such as VR sickness, is also increasing. This study used electroencephalography (EEG) to investigate participants’ VR sickness recovery time after watching a VR video. We tested 40 participants in advance using a motion sickness susceptibility questionnaire (MSSQ). We classified the participants into two groups (sensitive group/non-sensitive group) depending on their MSSQ scores. We used a simulator sickness questionnaire (SSQ) and EEG to evaluate VR sickness. The SSQ score increased significantly after watching the VR sickness-inducing video (VR video) in both groups (p < 0.001). The recovery time based on the SSQ was 11.3 ± 6.6 min for the sensitive group and 9.1 ± 5.2 min for the non-sensitive group. The difference in recovery time between the two groups was not significant (p > 0.05). EEG results showed that recovery time took an average of 11.5 ± 7.1 min in both groups. The EEG data showed that the delta wave increased significantly across all brain areas (p < 0.01). There was no statistical difference between groups in recovering VR sickness depending on individual characteristics. However, we confirmed that subjective and objective VR recovery required at least 11.5 min. This finding can inform recommendations regarding the VR sickness recovery times.

Acceptability, Feasibility, and Effectiveness of Immersive Virtual Technologies to Promote Exercise in Older Adults: A Systematic Review and Meta-Analysis.

This review aimed to synthesize the literature on the acceptability, feasibility, and effectiveness of immersive virtual technologies to promote physical exercise in older people. We performed a literature review, based on four databases (PubMed, CINAHL, Embase, and Scopus; last search: 30 January 2023). Eligible studies had to use immersive technology with participants aged 60 years and over. The results regarding acceptability, feasibility, and effectiveness of immersive technology-based interventions in older people were extracted. The standardized mean differences were then computed using a random model effect. In total, 54 relevant studies (1853 participants) were identified through search strategies. Concerning the acceptability, most participants reported a pleasant experience and a desire to use the technology again. The average increase in the pre/post Simulator Sickness Questionnaire score was 0.43 in healthy subjects and 3.23 in subjects with neurological disorders, demonstrating this technology's feasibility. Regarding the effectiveness, our meta-analysis showed a positive effect of the use of virtual reality technology on balance (SMD = 1.05; 95% CI: 0.75-1.36; p < 0.001) and gait outcomes (SMD = 0.7; 95% CI: 0.14-0.80; p < 0.001). However, these results suffered from inconsistency and the number of trials dealing with these outcomes remains low, calling for further studies. Virtual reality seems to be well accepted by older people and its use with this population is feasible. However, more studies are needed to conclude its effectiveness in promoting exercise in older people.

Determining Work-Rest Schedules for Visual Tasks That Use Optical Head-Mounted Displays Based on Visual Fatigue and Visually Induced Motion Sickness Recovery.

This study aimed to determine work-rest schedules for visual tasks of different lengths by evaluating visual fatigue and visually induced motion sickness (VIMS) using an optical head-mounted display (OHMD). Thirty participants were recruited to perform 15 and 30 min visual tasks using an OHMD. After completing each visual task, participants executed six levels of rest time. Critical flicker fusion frequency (CFF) values, relative electroencephalography indices, and Simulator Sickness Questionnaire (SSQ) scores were collected and analyzed. Results indicated that after completing the 15 and 30 min visual tasks, participants experienced visual fatigue and VIMS. There was no significant difference between baseline CFF values, four electroencephalography relative power index values, and SSQ scores when participants completed a 15 min visual task followed by a 20 min rest and a 30 min visual task followed by a 30 min rest. Based on our results, a 20 min rest for visual fatigue and VIMS recovery after a 15 min visual task on an OHMD and a 25 min rest for visual fatigue and VIMS recovery after a 30 min visual task on an OHMD are recommended. This study suggests a work-rest schedule for OHMDs that can be used as a reference for OHMD user guidelines to reduce visual fatigue and visually induced motion sickness.

Can the Perceived Timing of Multisensory Events Predict Cybersickness?

Humans are constantly presented with rich sensory information that the central nervous system (CNS) must process to form a coherent perception of the self and its relation to its surroundings. While the CNS is efficient in processing multisensory information in natural environments, virtual reality (VR) poses challenges of temporal discrepancies that the CNS must solve. These temporal discrepancies between information from different sensory modalities leads to inconsistencies in perception of the virtual environment which often causes cybersickness. Here, we investigate whether individual differences in the perceived relative timing of sensory events, specifically parameters of temporal-order judgement (TOJ), can predict cybersickness. Study 1 examined audiovisual (AV) TOJs while Study 2 examined audio-active head movement (AAHM) TOJs. We deduced metrics of the temporal binding window (TBW) and point of subjective simultaneity (PSS) for a total of 50 participants. Cybersickness was quantified using the Simulator Sickness Questionnaire (SSQ). Study 1 results (correlations and multiple regression) show that the oculomotor SSQ shares a significant yet positive correlation with AV PSS and TBW. While there is a positive correlation between the total SSQ scores and the TBW and PSS, these correlations are not significant. Therefore, although these results are promising, we did not find the same effect for AAHM TBW and PSS. We conclude that AV TOJ may serve as a potential tool to predict cybersickness in VR. Such findings will generate a better understanding of cybersickness which can be used for development of VR to help mitigate discomfort and maximize adoption.

Effects of Cybersickness Caused by Head-Mounted Display-Based Virtual Reality on Physiological Responses: Cross-sectional Study.

Although more people are experiencing cybersickness due to the popularization of virtual reality (VR), no official standard for the cause and reduction of cybersickness exists to date. One of the main reasons is that an objective method to assess cybersickness has not been established. To resolve this, research on evaluating cybersickness with physiological responses that can be measured in real time is required. Since research on deriving physiological responses that can assess cybersickness is at an early stage, further studies examining various physiological responses are needed. This study analyzed the effects of cybersickness caused by head-mounted display-based VR on physiological responses. We developed content that provided users with a first-person view of an aircraft that moved (with translation and combined rotation) over a city via a predetermined trajectory. In the experiment, cybersickness and the physiological responses of participants were measured. Cybersickness was assessed by the Simulator Sickness Questionnaire (SSQ). The measured physiological responses were heart rate, blood pressure, body temperature, and cortisol level. Our measurement confirmed that all SSQ scores increased significantly (all Ps<.05) when participants experienced cybersickness. Heart rate and cortisol level increased significantly (P=.01 and P=.001, respectively). Body temperature also increased, but there was no statistically significant difference (P=.02). Systolic blood pressure and diastolic blood pressure decreased significantly (P=.001). Based on the results of our analysis, the following conclusions were drawn: (1) cybersickness causes significant disorientation, and research on this topic should focus on factors that affect disorientation; and (2) the physiological responses that are suitable for measuring cybersickness are heart rate and cortisol level.

Mild simulator sickness can alter heart rate variability, mental workload, and learning outcomes in a 360° virtual reality application for medical education: a post hoc analysis of a randomized controlled trial

Virtual reality (VR) applications could be beneficial for education, training, and treatment. However, VR may induce symptoms of simulator sickness (SS) such as difficulty focusing, difficulty concentrating, or dizziness that could impair autonomic nervous system function, affect mental workload, and worsen interventional outcomes. In the original randomized controlled trial, which explored the effectiveness of using a 360° VR video versus a two-dimensional VR video to learn history taking and physical examination skills, only the former group participants had SS. Therefore, 28 undergraduate medical students who participated in a 360° VR learning module were included in this post hoc study using a repeated measures design. Data of the Simulator Sickness Questionnaire (SSQ), heart rate variability (HRV) analysis, Task Load Index, and Mini-Clinical Evaluation Exercise were retrospectively reviewed and statistically analyzed. Ten (36%) participants had mild SS (total score > 0 and ≤ 20), and 18 (64%) had no SS symptom. Total SSQ score was positively related to the very low frequency (VLF) band power, physical demand subscale, and frustration subscale, and inversely related to physical examination score. Using multilevel modeling, the VLF power mediated the relationship between total SSQ score and physical examination score. Furthermore, frustration subscale moderated the mediating effects of the VLF power. Our results highlight the importance of documenting SS to evaluate a 360° VR training program. Furthermore, the combination of HRV analysis with mental workload measurement and outcome assessments provided the important clinical value in evaluating the effects of SS in VR applications in medical education.

Magnetic resonance cholangiopancreatography enhanced by virtual reality as a novel tool to improve the understanding of biliary anatomy and the teaching of surgical trainees

ObjectiveThe novel picture archiving and communication system (PACS), compatible with virtual reality (VR) software, displays cross-sectional images in VR. VR magnetic resonance cholangiopancreatography (MRCP) was tested to improve the anatomical understanding and intraoperative performance of minimally invasive cholecystectomy (CHE) in surgical trainees.DesignWe used an immersive VR environment to display volumetric MRCP data (Specto VRTM). First, we evaluated the tolerability and comprehensibility of anatomy with a validated simulator sickness questionnaire (SSQ) and examined anatomical landmarks. Second, we compared conventional MRCP and VR MRCP by matching three-dimensional (3D) printed models and identifying and measuring common bile duct stones (CBDS) using VR MRCP. Third, surgical trainees prepared for CHE with either conventional MRCP or VR MRCP, and we measured perioperative parameters and surgical performance (validated GOALS score).SettingThe study was conducted out at Clarunis, University Center for Gastrointestinal and Liver Disease, Basel, Switzerland.ParticipantsFor the first and second study step, doctors from all specialties and years of experience could participate. In the third study step, exclusively surgical trainees were included. Of 74 participating clinicians, 34, 27, and 13 contributed data to the first, second, and third study phases, respectively.ResultsAll participants determined the relevant biliary structures with VR MRCP. The median SSQ score was 0.75 (IQR: 0, 3.5), indicating good tolerability. Participants selected the corresponding 3D printed model faster and more reliably when previously studying VR MRCP compared to conventional MRCP: We obtained a median of 90 s (IQR: 55, 150) and 72.7% correct answers with VR MRCP versus 150 s (IQR: 100, 208) and 49.6% correct answers with conventional MRCP, respectively (p < 0.001). CBDS was correctly identified in 90.5% of VR MRCP cases. The median GOALS score was higher after preparation with VR MRCP than with conventional MRCP for CHE: 16 (IQR: 13, 22) and 11 (IQR: 11, 18), respectively (p = 0.27).ConclusionsVR MRCP allows for a faster, more accurate understanding of displayed anatomy than conventional MRCP and potentially leads to improved surgical performance in CHE in surgical trainees.

A digital intervention using virtual reality helmets to reduce dental anxiety of children under local anesthesia and primary teeth extraction: A randomized clinical trial.

IntroductionBehavior management of children during dental treatment is an important but challenging issue. As a new technique, VR has been applied in pediatric dental anxiety. But there is no final conclusion whether VR reduces children's dental anxiety.MethodsThe aim of the study is to assess the effectiveness of a digital intervention using virtual reality (VR) helmets on dental anxiety, pain perception, and behavior triggered for children, as well as occurrence of simulator sickness in local anesthesia and primary teeth extraction. A total of 128 children, who needed primary teeth extraction under local anesthesia, were randomly allocated into two groups: use VR helmets and traditional behavior guidance procedures (control). Modified Child Fear Survey Schedule Dental Subscale (CFSS‐DS), Wong‐Baker FACES Pain Scale, Houpt Scale, and Simulator sickness questionnaire (SSQ) were used to assess children's dental anxiety, pain perception, and behavior triggered and occurrence of simulator sickness.ResultsCFSS‐DS score in the VR group was significantly decreased after dental treatment (34.58±6.90 before operation and 32.32±15.58 after operation, p = .02). The score of Wong Baker Scale in the VR group (3.47±0.76) was significantly lower than that in the control group (5.56±1.13, p = .015). There was no significant difference in the Houpt Behavior Scale score and the SSQ score between the VR group and the control group (p = .35, p = .305).ConclusionThe use of VR helmets in primary teeth extraction can significantly reduce dental anxiety and pain perception in children without occurrence of simulator sickness.

Why VR Games Sickness? An Empirical Study of Capturing and Analyzing VR Games Head Movement Dataset

Virtual reality (VR) technology is gaining popularity in a variety of fields, including education, games, movies, medicine, and engineering, to name a few. 360$^\circ$∘ VR video could provide an immersive experience and attract more researchers’ and developers’ attention. Some literature focused on the head movement when users watched 360$^\circ$∘ videos and released head tracking datasets. With the popularity of VR games, how the game contexts influence players’ head movement and the effect of head movement on VR sickness is a topic worth studying. In this article, we collected a head movement dataset of 30 participants while playing five different VR games (Aircar, Beat Saber, Moss, Arizona Sunshine, and SUPERHOT), and the participants filled the Simulator Sickness Questionnaire (SSQ) after playing VR games. Finally, we analyzed the SSQ scores and the impact of VR games on VR sickness. To the best of our knowledge, this is the first available head movement trajectory dataset based on playing several types of VR games.

Estimating objective (EEG) and subjective (SSQ) cybersickness in people with susceptibility to motion sickness

Cybersickness refers to the uncomfortable side effects, such as headaches, dizziness, and nausea, felt while experiencing virtual reality (VR). This study investigated cybersickness in people with sensitivity to motion sickness using electroencephalography (EEG), the Simulator Sickness Questionnaire (SSQ), and simple VR content. Based on the scores from the Motion Sickness Susceptibility Questionnaire (MSSQ), 40 males in their twenties were selected as the sensitive group (n = 20) and non-sensitive group (n = 20). The experiment contained two conditions: a baseline condition representing a resting state and a cybersickness condition in which watching VR content induced cybersickness. The SSQ score increased significantly after watching the VR content in both groups. The sensitive group showed significantly lower absolute power in the beta and gamma bands than the non-sensitive group. The cybersickness condition showed significantly increased delta and decreased alpha compared to the baseline condition. We evaluated EEG and SSQ to identify subjective symptoms and objective physiological changes associated with cybersickness.