Virtual Reality Head-mounted Display Research Articles

A real-time virtual outing using virtual reality for a hospitalized terminal cancer patient who has difficulty going out: a case report

Objective: Even if hospitalized terminal cancer patients wish to go out, it is sometimes difficult for them to realize this because of various symptoms. We have been providing a virtual outing experience using virtual reality (VR) for terminal cancer patients who have difficulty going out, and have often received requests to “talk with people in the virtual outing,” but there is a problem that a large time lag occurs in conversation in a VR space under the general Internet environment. However, with the advent of systems that enable high-speed, low-latency communications, real-time communication is now possible even in VR spaces. Thus, we aimed to explore the feasibility of implementing the real-time virtual outing.Methods: The patient’s preferred virtual outing was to his daughter’s new home. The study operator used a 360° video real-time sharing system to broadcast the view of the daughter’s home. The patient experienced the images using a VR head-mounted display in his room. The patient’s wife, son, daughter, and grandson participated in this delivery using a laptop computer from a dayroom in the hospital, and his daughter’s husband participated using the 360° video real-time sharing system from the daughter’s home with the researcher. Before and after the virtual outing, changes in symptoms and emotions were assessed using the Edmonton Symptom Assessment System Revised Japanese version and the Numerical Rating Scale for headache, dizziness, pleasure, and satisfaction. In addition, we collected the patients’ impressions of the virtual outing.Results: The patient was a male in his early 70s. After approximately 30 min of real-time virtual outings, “tiredness, drowsiness, depression, and wellbeing” were improved and “pleasure, and satisfaction” were increased, while no side effects or worsening of symptoms were observed. In addition, it was observed from the patient’s comments that he felt a sense of presence, as if he were her home.Discussion: The patient and his family could enjoy smooth conversation without time lag even in the VR space. Therefore, it was suggested that real-time virtual outings using VR could help realize the wishes of hospitalized terminal cancer patients who have difficulty going out as a new approach.

Healing Health Care Disparities: Development and Pilot Testing of a Virtual Reality Implicit Bias Training Module for Physicians in the Context of Black Maternal Health

ABSTRACT Grounded in communication models of cultural competence, this study reports on the development and testing of the first module in a larger virtual reality (VR) implicit bias training for physicians to help them better: (a) recognize implicit bias and its effects on communication, patients, and patient care; (b) identify their own implicit biases and exercise strategies for managing them; and (c) learn and practice communicating with BIPOC patients in a culture-centered manner that demonstrates respect and builds trust. Led by communication faculty, a large, interdisciplinary team of researchers, clinicians, and engineers developed the first module tested herein focused on training goal (a). Within the module, participants observe five scenes between patient Marilyn Hayes (a Black woman) and Dr. Richard Flynn (her obstetrician, a White man) during a postpartum visit. The interaction contains examples of implicit bias, and participants are asked to both identify and consider how implicit bias impacts communication, the patient, and patient care. The team recruited 30 medical students and resident physicians to participate in a lab-based study that included a pretest, a training experience of the module using a head-mounted VR display, and a posttest. Following the training, participants reported improved attitudes toward implicit bias instruction, greater importance of determining patients’ beliefs and perspectives for history-taking, treatment, and providing quality health care; and greater communication efficacy. Participants’ agreement with the importance of assessing patients’ perspectives, opinions, and psychosocial and cultural contexts did not significantly change. Implications for medical education about cultural competency and implicit bias are discussed.

A Design for a virtual reality head-mounted display with holographic pancake optics

A Design for a virtual reality head-mounted display with holographic pancake optics

Comparative effectiveness between two types of head-mounted magnification modes using a smartphone-based virtual display.

This work shows the benefits of using two different magnification strategies to improve the reading ability of low-vision patients using a head-mounted technology. The aim of this study was to conduct a comparative clinical trial evaluating the effectiveness of two magnification strategies in a head-mounted virtual reality display. Eighty-eight eligible low-vision subjects were randomized into two arms: (1) the full-field magnification display or (2) the virtual bioptic telescope mode. Subjects completed baseline testing and received training on how to use the device properly and then took the device home for a 2- to 4-week intervention period. An adaptive rating scale questionnaire (Activity Inventory) was administered before and after the intervention (home trial) period to measure the effect of the system. A Simulator Sickness Questionnaire was also administered. Baseline and follow-up results were analyzed using Rasch analysis to assess overall effectiveness of each magnification mode for various functional domain categories. Both magnification modes showed a positive effect for reading, visual information, and the overall goals functional domain categories, with only reading reaching statistical significance after correction for multiple comparisons. However, there were no significant between-group differences between the two modes. The results of the Simulator Sickness Questionnaire showed that the magnification modes of the head-mounted display device were overall well tolerated among low-vision users. Both the full-field and virtual bioptic magnification strategies were effective in significantly improving functional vision outcomes for self-reported reading ability.

Teaching empathy: comparison of a virtual reality experience using head-mounted display versus group streaming

ABSTRACT Empathy, an integral component of bedside manners, correlates with good healthcare provision. Training physician assistant (PA) students using Head-Mounted Display (HMD) virtual reality (VR) contributed to significant empathy increases. This pilot study, which relied on a retrospective analysis, compared a VR experience using HMD to a streamed modality (due to COVID safety) with PA students to measure empathy. We hypothesized that fully immersive and interactive HMD VR would lead to a statistically significant increase in empathy versus the streaming modality. The “Alfred Lab” VR allows viewers to “embody” a 74-year-old African American man with vision and hearing loss. The University of New England PA class of 2021 (n = 47) completed the HMD lab while the class of 2022 (n = 50) viewed the streaming modality as a group. Identical pre/post surveys were completed by each cohort. The analysis utilized paired sample t-tests, ANOVA, frequency analysis (quantitative), and content analysis with thematic coding (qualitative). The results for each cohort revealed a statistically significant increase in empathy (p < 0.05) after completing the VR lab (pre- to post-test results). The comparison of both cohorts (HMD versus group streaming) revealed no noteworthy difference. Streaming VR could improve access to PA programs unable to acquire expensive VR equipment yet still allow for the development of empathy.

Virtual reality games for 3D multimodal designing and knowledge across the curriculum

AbstractImmersive virtual reality (VR) is anticipated to peak in development this decade bringing new opportunities for 3D multimodal designing across all levels of education. The need for students to gain capabilities with multimodal texts—texts that combine two or more modes, such as spoken, written, and visual—is emphasised at all levels of education from P-12 in the Australian Curriculum. Likewise, the use of technology-supported pedagogies is increasing worldwide, rendering multimodal texts ubiquitous across all knowledge domains. This original, qualitative classroom research investigated students’ 3D designing of multimodal texts using an immersive VR head-mounted display. Upper primary students (ages 10–12 years, n = 48) transferred their knowledge of ancient Rome through 2D drawing, writing, speaking, and 3D multimodal designing with VR. The application of multimodal analysis to video data, screen recordings, and think-aloud protocols, and the thematic coding of student and teacher interviews yielded four key findings: (i) VR gaming supported 3D multimodal designing through haptic and embodied experience, (ii) VR improved performance through creative redesigning, (iii) VR-supported knowledge application, consolidation, and transfer, and (iv) pedagogical strengths of VR were situated and transformed practice. This research is timely and significant given the increasing accessibility and affordability of VR and the need to connect research and pedagogical practice to support students’ advanced knowledge and capabilities with multimodal learning across the curriculum.

Comparing a virtual reality head-mounted display to on-screen three-dimensional visualization and two-dimensional computed tomography data for training in decision making in hepatic surgery: a randomized controlled study

ObjectiveEvaluation of the benefits of a virtual reality (VR) environment with a head-mounted display (HMD) for decision-making in liver surgery.BackgroundTraining in liver surgery involves appraising radiologic images and considering the patient’s clinical information. Accurate assessment of 2D-tomography images is complex and requires considerable experience, and often the images are divorced from the clinical information. We present a comprehensive and interactive tool for visualizing operation planning data in a VR environment using a head-mounted-display and compare it to 3D visualization and 2D-tomography.MethodsNinety medical students were randomized into three groups (1:1:1 ratio). All participants analyzed three liver surgery patient cases with increasing difficulty. The cases were analyzed using 2D-tomography data (group “2D”), a 3D visualization on a 2D display (group “3D”) or within a VR environment (group “VR”). The VR environment was displayed using the “Oculus Rift ™” HMD technology. Participants answered 11 questions on anatomy, tumor involvement and surgical decision-making and 18 evaluative questions (Likert scale).ResultsSum of correct answers were significantly higher in the 3D (7.1 ± 1.4, p < 0.001) and VR (7.1 ± 1.4, p < 0.001) groups than the 2D group (5.4 ± 1.4) while there was no difference between 3D and VR (p = 0.987). Times to answer in the 3D (6:44 ± 02:22 min, p < 0.001) and VR (6:24 ± 02:43 min, p < 0.001) groups were significantly faster than the 2D group (09:13 ± 03:10 min) while there was no difference between 3D and VR (p = 0.419). The VR environment was evaluated as most useful for identification of anatomic anomalies, risk and target structures and for the transfer of anatomical and pathological information to the intraoperative situation in the questionnaire.ConclusionsA VR environment with 3D visualization using a HMD is useful as a surgical training tool to accurately and quickly determine liver anatomy and tumor involvement in surgery.

Comparative Study of HMD-based Virtual and Augmented Realities for Immersive Museums: User Acceptance, Medium, and Learning

Technologies like Head Mounted Display (HMD)-based Virtual Reality (VR) and Augmented Reality (AR) have made HMD-based immersive museums possible. To investigate the user acceptance, medium, and interaction experience for HMD-based immersive museums, an app entitled The Extended Journey has been designed, developed, and deployed on both VR headsets and AR headsets. Subsequently, a between-subjects design experiment with 62 participants was conducted to measure the user experience and learning outcome in HMD VR and HMD AR conditions. Quantitative results revealed that HMD VR museums had statistically significantly better immersion and empathy compared to HMD AR museums. Qualitative data indicated HMD-based immersive museums were embraced by most young participants while HMD VR had better user acceptance than HMD AR for immersive museums. The interview also demonstrated that the advantage of the HMD-based immersive museum over the traditional online museum is not only the sensory immersion from the medium itself but also the interactive narrative experience that the HMD medium facilitates, especially the natural interaction with the CG characters and the environment in the story.

The effect of Immersive Virtual Reality on balance: an exploratory study on the feasibility of head-mounted displays for balance evaluation

Global interest in applying virtual reality (VR) in research and medicine has grown significantly, with potential benefits for patients suffering from balance disorders, instability, and a high risk of falling. This exploratory study assesses the impact of immersive VR (IVR) delivered through a head-mounted display (HMD) on balance and explores the feasibility of using the HMD VR unit as a standalone posturography tool. Using the Meta Quest 2 HMD and a mid-range Android smartphone equipped with standard sensors, the research employed a VR environment that simulated a ship at sea, with thirty-eight healthy participants with no otoneurologic abnormalities. Measurements were conducted in repeated trials, including static assessments on both stable ground and foam, as well as a 3-m walk. This was conducted in two settings: one within a VR environment with three different intensity levels and the other in non-VR settings. Statistical analysis and clinical evaluation revealed that IVR with HMD influences head-level sway velocity, which correlates with increased visual disturbance, suggesting its potential as a low-risk standalone posturography tool.

Schizotypy and perceptual span in a non-clinical sample: a virtual reality study

ABSTRACT Introduction Individuals with high schizotypy or schizophrenia exhibit difficulties in distributing their attention across space, leading to a reduction in their “perceptual span” – the extent of visual space that can be attended to at once. In this study, we aim to explore the correlation between schizotypy and perceptual span in a non-clinical sample to investigate whether perceptual span correlates with schizotypy across its range. Methods Schizotypy was assessed in fifty-five participants using the Schizotypy Personality Questionnaire (SPQ; Raine, 1991). Participants were required to attend to two dynamic targets displayed in a head-mounted virtual reality display. Perceptual span was estimated as the lateral angle of separation between the two targets beyond which performance in the task dropped to threshold. Results Participants with higher schizotypy scores performed significantly worse on the task. Of all the factors associated with schizotypy, the shared variance between Disorganisation and Cognitive/Perceptual Factors was most predictive of task performance. Conclusion The results support the hypothesis that schizotypy predicts perceptual span in non-clinical samples. Furthermore, the demonstration of a reduced perceptual span in individuals with higher trait schizotypy shows that variations in an individual’s capacity to divide attention across space can be accurately captured using a virtual reality head-mounted display.

Virtual reality exposure therapy to decrease anxiety before surgical invasive procedures in hemodialysis patients: an interventional study

BackgroundHemodialysis patients are prone to anxiety and depression due to physiological changes and psychological tensions that leave irreversible effects on the patients. In this regard, the present study was an attempt to provide a simulated situation by using virtual reality on the anxiety level of dialysis patients before performing surgical procedures.MethodsThis non-equivalent groups pre-posttest quasi-experimental study was conducted in 2022 in a hemodialysis ward of Imam Khomeini General Hospital affiliated with Tehran University of Medical Sciences. The study population was patients suffering from kidney failure referred to this hospital. The participants were 30 patients selected from the study population, who were allocated into two groups (15 in each experimental and control group). The control group received routine training in the ward. The experimental group participants watched five educational virtual reality (VR) contents in addition to the routine training. They used head-mounted display VR (VR BOX headset 2.0 virtual reality glasses) to immerse in a virtual environment similar to the real world covering the experience of entering the operating room, during the surgery, and after surgery. The data gathering instrument was a valid and reliable anxiety inventory. The collected data was analyzed at a significance level of 0.05.ResultsThe study findings indicated that the anxiety scores of the experimental and control groups had no significant difference before intervention. However, after the intervention of virtual reality, the state and trait anxiety of the experimental group participants were significantly lower than the control group (P-value < 0.01).ConclusionThe application of VR for maintenance hemodialysis patients before invasive surgical procedures decreases patients’ anxiety. Considering the devastating and undeniable impacts of anxiety on the lives of patients referring to hemodialysis centers, the application of VR is suggested to decrease their anxiety.

Effects of color cues on eye-hand coordination training with a mirror drawing task in virtual environment.

Mirror drawing is a motor learning task that is used to evaluate and improve eye-hand coordination of users and can be implemented in immersive Virtual Reality (VR) Head-Mounted Displays (HMDs) for training purposes. In this paper, we investigated the effect of color cues on user motor performance in a mirror-drawing task between Virtual Environment (VE) and Real World (RW), with three different colors. We conducted a 5-day user study with twelve participants. The results showed that the participants made fewer errors in RW compared to VR, except for pre-training, which indicated that hardware and software limitations have detrimental effects on the motor learning of the participants across different realities. Furthermore, participants made fewer errors with the colors close to green, which is usually associated with serenity, contentment, and relaxation. According to our findings, VR headsets can be used to evaluate participants' eye-hand coordination in mirror drawing tasks to evaluate the motor-learning of participants. VE and RW training applications could benefit from our findings in order to enhance their effectiveness.

Spatially dependent veiling glare degrades image quality in medical extended reality

Spatially dependent veiling glare in medical extended reality (MXR) degrades image quality and needs to be characterized across technologies. Measurement methods of veiling glare on virtual and augmented reality (VR and AR) head-mounted displays (HMDs) have not been established in regulatory evaluation of MXR devices or display measurement standards. We describe an experimental bench setup enabling highly flexible translations and rotations of the light measuring device in five degrees of freedom within the eye box. Glare point spread functions (PSFs) of multiple VR and AR headsets are extracted and compared across the display field of view (FOV) in dark environment. At the center, the evaluated VR headsets (HTC VIVE Pro and VIVE Pro 2) demonstrate reduced long-range glare compared to the tested AR HMDs (Microsoft HoloLens 2 and Epson Moverio BT-300). The measured PSFs at multiple locations are spatially invariant for the HoloLens 2. However, veiling glare on the evaluated VR HMDs substantially increases toward the periphery of the FOV primarily due to optical aberration. For VR devices in medical use, increased peripheral glare can lead to image quality degradation and poor visualization of anatomical details.

Omnidirectional Virtual Visual Acuity: A User-Centric Visual Clarity Metric for Virtual Reality Head-Mounted Displays and Environments.

Users' perceived image quality of virtual reality head-mounted displays (VR HMDs) is determined by multiple factors, including the HMD's structure, optical system, display and render resolution, and users' visual acuity (VA). Existing metrics such as pixels per degree (PPD) have limitations that prevent accurate comparison of different VR HMDs. One of the main limitations is that not all VR HMD manufacturers released the official PPD or details of their HMDs' optical systems. Without these details, developers and users cannot know the precise PPD or calculate it for a given HMD. The other issue is that the visual clarity varies with the VR environment. Our work has identified a gap in having a feasible metric that can measure the visual clarity of VR HMDs. To address this gap, we present an end-to-end and user-centric visual clarity metric, omnidirectional virtual visual acuity (OVVA), for VR HMDs. OVVA extends the physical visual acuity chart into a virtual format to measure the virtual visual acuity of an HMD's central focal area and its degradation in its noncentral area. OVVA provides a new perspective to measure visual clarity and can serve as an intuitive and accurate reference for VR applications sensitive to visual accuracy. Our results show that OVVA is a simple yet effective metric for comparing VR HMDs and environments.

The Use of Virtual Screens in Perceptual Studies on Electric Light: A Comparison Between 2D, Panoramic, Cardboard, and Head-Mounted Displays

ABSTRACT This paper introduces the results of an experiment on lighting perception and reading speed where data collected in a physical space is compared to that collected in representations of that space simulated through a web survey and three VR Head-Mounted Displays (HMDs). The results build on an experiment, where perceptions of electric lighting conditions in a physical space were compared to those of the same space simulated in a single VR HMD (HTC Vive Pro). This study extends the previous scope to compare three VR HMD groups (cardboard VR, Oculus Quest 2, and HTC Vive Pro) to ratings of the same lighting conditions viewed through 2D-perspective or immersive panoramic images displayed in a web survey. Past research has compared perceptions of daylight and electric lighting scenes between physical and VR environments, but there is a lack of research that compares ratings of lighting conditions between VR HMDs and to other conventional image formats. For the VR HMD groups, the results revealed significant differences in reading speed between the physical space and cardboard VR HMD groups. An analysis of our subjective ratings showed all three VR HMDs producing fewer significantly different ratings from the physical space than either of the web groups, but ratings in the panoramic group outperformed the 2D-perspective group. The findings suggest that the type of VR HMD impacts reading speed in virtual lighting scenes and more immersive images produce less error than 2D-perspective images when compared to ratings in a physical space.

Patient experience of a virtual reality calm room in a psychiatric inpatient care setting in Sweden: a qualitative study with inpatients

ObjectiveCalm rooms have been developed and implemented in psychiatric inpatient care settings to offer patients a dedicated space for relaxation in a convenient and safe environment. Recent technology developments have...

Measuring trust with the Wayfinding Task: Implementing a novel task in immersive virtual reality and desktop setups across remote and in-person test environments.

Trust is a key feature of social relationships. Common measures of trust, questionnaires and economic games, lack ecological validity. Hence, we sought to introduce an immersive, virtual reality (VR) measure for the behavioral assessment of trust across remote and in-person settings, building on the maze task of Hale et al. (2018). Our 'Wayfinding Task' consists of an interconnected urban environment for participants to navigate on the advice of two characters of differing trustworthiness. We present four studies implementing the Wayfinding Task in remote and in-person testing environments and comparing performance across head-mounted display (HMD)-based VR and desktop setups. In each study, the trustworthiness of two virtual characters was manipulated, through either a fact sheet providing trustworthiness information, or a behavior-based trustworthiness manipulation task termed the Door Game, based on Van der Biest et al., 2020. Participants then completed the Wayfinding Task. Overall, we found that participant behavior in the Wayfinding Task reflected the relative trustworthiness of the two characters; in particular, the trustworthy character was approached more often for advice, reflecting data from our Door Game. We found mostly null results for our novel outcome measure, interpersonal distance. Remote testing successfully achieved these effects. While HMD-based VR and desktop setups both showed these effects, there was a stronger effect of trustworthiness in the HMD VR version of the task. These results have implications for the measurement of trust in behavioral settings and the use of remote and VR-based testing in social experiments.

Development and evaluation of a virtual reality driving test for patients with cirrhosis.

Patients with cirrhosis and especially those with HE may have impaired driving skills and may be prone to car accidents. This proof-of-concept study aimed to develop and evaluate the applicability of a virtual reality (VR)-based driving test in patients with cirrhosis. Additionally, the association between the results in the VR test and car accidents was investigated. A short driving test using a VR head-mounted display (HTC Vive Pro Eye) was developed to simulate five hazardous situations. The patient has to pull the brake when the hazardous situations occur. The time from triggering the event to pressing the brake is recorded as reaction time. Total reaction time (TRT) is defined as the combined reaction time to all 5 events. Car accidents were assessed retrospectively (previous 12 months) and patients were followed prospectively for 6 months. Minimal HE (MHE) was diagnosed using Psychometric Hepatic Encephalopathy Score. In total, 112 outpatients with cirrhosis and 52 controls without cirrhosis were recruited. MHE was detected in 14% (n = 15). Patients with cirrhosis and MHE (5.67s) had higher TRTs compared to patients without MHE (5.02s) and controls without cirrhosis above the age of 50 (4.98s) (MHE vs. no MHE or controls p<0.01, no MHE vs. controls: not significant). Seven patients reported car accidents during the twelve months prior to study inclusion. TRTs were numerically higher in patients with reported car accidents (p = 0.099). When patients who stopped driving for HE-related/cirrhosis-related reasons (n = 14) were added to the group of patients with accidents, then a longer TRT was significantly associated with the modeled outcome in univariable (p<0.01) and multivariable analyses (OR 2.83, p<0.01). Two car accidents occurred during follow-up. Both patients had TRTs above the 90th percentile. The VR driving test is easy and rapid to perform in patients with cirrhosis and could be helpful as a point-of-care tool for predicting car accidents.

Constructing hermeneutical relations: a postphenomenological inquiry into immersive VR memory palaces

While VR adaptations of the mnemonic Method of Loci (or the ‘Memory Palace’ technique) show promising results in increasing mnemonic capabilities, little to no research has explored the use and integration of Virtual Memory Palaces over time in a context of self-initiated studying. To explore the use of Virtual Memory Palaces (VMPs) contextually, we conducted an in-the-wild study where we gave ten participants a VR Head-Mounted Display through which they could access and furnish their VMP over eight weeks. We conducted go-along interviews in our participants’ VMPs at various intervals throughout the eight-week study, exploring their creations and querying them about their experience. Based on our findings, this article discusses individual and contextual factors that come into play when a VMP is approached as a personal project in the midst of an already-established study routine. We frame our study as a postphenomenological inquiry into the mediating effects of VMPs, where our primary interest lies in what relationship the students developed to the VMP.

Comparing the effects of immersive and non-immersive real estate experience on behavioral intentions

Nowadays, the web presents real estate sites providing the possibility to use low-cost virtual reality (VR) solutions without sacrificing the high quality of graphic visualization of their contents to attract customers through enhanced digital experiences and increase the probability of selling their products. However, whether immersive VR technologies improve the chances of selling real estate is unclear. This study examines the effects induced by a real estate website that offers the opportunity to evaluate the potential purchase of a property in two ways: by viewing photos of the house (non-immersive conditions) and by taking a virtual tour of the same house using a VR head-mounted display (immersive conditions). Forty participants interested in evaluating the purchase of a new house, randomly assigned to one of the experimental conditions, participated in the experiment. During the real estate experience, electroencephalography (EEG) and skin conductance (SC) were recorded to collect biological data about the emotional effects raised by each condition. After the study, psychological self-reported questionnaires were collected measuring: emotions, presence, user experience (UX), and a three-item ad hoc scale exploring behavioral intentions (e.g., the perceived pleasantness of the house, the willingness to visit the house, and the purchase intention). Results show that immersive navigation is associated with more positive emotions (EEG), more intense physiological arousal (SC), higher scores on the presence questionnaire, and higher scores on the UX questionnaire compared to the non-immersive one. The psychological scales measuring emotions did not yield significant results. No significant difference in the three-item ad-hoc self-questionnaire was found, except for the item examining willingness to visit the real house building. Implications are also discussed.