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Gairing SJ, Schleicher EM, Kaps L, Schulte-Beerbuehl S, Steiner K, Labenz J, Schattenberg JM, Galle PR, Wörns MA, Labenz C. Development and evaluation of a virtual reality driving test for patients with cirrhosis. Hepatol Commun 2023; 7:e0303. [PMID: 37902506 PMCID: PMC10617881 DOI: 10.1097/hc9.0000000000000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/10/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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 (5.67 s) had higher TRTs compared to patients without MHE (5.02 s) and controls without cirrhosis above the age of 50 (4.98 s) (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. CONCLUSIONS 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.
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Affiliation(s)
- Simon J. Gairing
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Eva M. Schleicher
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Leonard Kaps
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Sophia Schulte-Beerbuehl
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Kristina Steiner
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Joachim Labenz
- Department of Medicine, Diakonie Hospital Jung-Stilling, Siegen
| | - Jörn M. Schattenberg
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Metabolic Liver Research Program, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Peter R. Galle
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Marcus-Alexander Wörns
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Department of Gastroenterology, Hematology, Oncology and Endocrinology, Klinikum Dortmund, Germany
| | - Christian Labenz
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Jo S, Lee HJ, Lim WB, Lee HJ, Choi SK. Driving Simulator Brake Reaction Parameters After Total Hip Arthroplasty According to Different Surgical Approaches. J Arthroplasty 2022; 37:1809-1815. [PMID: 35398522 DOI: 10.1016/j.arth.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study is to validate the point of normalization of braking following total hip arthroplasty (THA) and to determine the relevance of the surgical approach. METHODS Brake reaction parameters (BRPs), including brake reaction time, total brake time, and brake pedal depression force were measured in 90 patients who underwent primary arthroplasty of the right hip (42 with direct anterior approach and 48 with posterolateral approach) using a modern driving simulator. The driving parameters were measured preoperatively and every 2 weeks postoperatively until the eighth week. BRPs were measured in 40 subjects without hip problems, and the results were used as a control. Statistical assessment was performed to analyze when the patients' reaction to braking recovered to that of the control group with respect to different surgical approaches and also according to the pain. RESULTS Preoperative BRPs of the patients undergoing THA were prolonged compared to the control group and were normalized at the sixth week following the operation. Although BRPs of the direct anterior approach group showed significantly better improvement compared to the posterolateral approach group (total brake time at week 2, brake reaction time and brake pedal depression at week 4), both groups reached baseline value at week 6. In addition, we found no correlation between the pain score and BRPs. CONCLUSION The results of the current study indicate that the response to braking events normalizes at 6 weeks following THA in young active patients and is irrelevant to the surgical approach.
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Affiliation(s)
- Suenghwan Jo
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, South Korea; Chosun University, School of Medicine, Gwangju, South Korea
| | - Hyeon Joon Lee
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, South Korea
| | - Won Bong Lim
- Chosun University, School of Medicine, Gwangju, South Korea
| | - Hyo Jun Lee
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, South Korea
| | - Soo Kyung Choi
- Chosun University, School of Medicine, Gwangju, South Korea
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de Miguel-Rubio A, Rascón-Maíz J, Alba-Rueda Á, Rodrigues-de-Souza DP. [Driving improvement in spinal cord injury patients using virtual reality. Systematic review]. Rev Neurol 2022; 75:31-40. [PMID: 35822569 PMCID: PMC10186724 DOI: 10.33588/rn.7502.2022091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Spinal cord injury is a pathology which causes motor and sensory impairment under the region damaged by the lesion. This results in limitations in daily activities such as driving. In recent years, improvement in this task has been achieved by means of virtual reality treatment in the rehabilitation of patients with spinal cord injury. The aim of the present study was to analyze, through a systematic review, the effectiveness of using virtual reality on driving skills in patients with spinal cord injury. MATERIALS AND METHODS The literature search was carried out using the following databases: PubMed, Web of Science, PEDro, Cochrane Central Register of Controlled Trials, Medline, Scopus and CINAHL, including articles published from January 2000 to May 2021. RESULTS After the research process, out of a total of 51 articles, 7 were included: 2 applied immersive VR and 5 semi-immersive VR. Road driving simulation was addressed by 4 of them: 1 on sailing, 1 on motorbike and 1 on bicycle. CONCLUSIONS The use of virtual reality in driving skills training has led to improvements in quality of life, driving skills and reduction of fear of driving. Despite these findings, more research, patients, sessions and improvements are needed for a clearer understanding of this topic and its usefulness.
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Affiliation(s)
- Amaranta de Miguel-Rubio
- Departamento de Enfermería, Farmacología y Fisioterapia. Facultad de Medicina y Enfermería. Universidad de Córdoba. Córdoba, EspañaUniversidad de CórdobaUniversidad de CórdobaCórdobaEspaña
| | - Javier Rascón-Maíz
- Departamento de Enfermería, Farmacología y Fisioterapia. Facultad de Medicina y Enfermería. Universidad de Córdoba. Córdoba, EspañaUniversidad de CórdobaUniversidad de CórdobaCórdobaEspaña
| | - Álvaro Alba-Rueda
- Departamento de Enfermería, Farmacología y Fisioterapia. Facultad de Medicina y Enfermería. Universidad de Córdoba. Córdoba, EspañaUniversidad de CórdobaUniversidad de CórdobaCórdobaEspaña
| | - Daiana P. Rodrigues-de-Souza
- Departamento de Enfermería, Farmacología y Fisioterapia. Facultad de Medicina y Enfermería. Universidad de Córdoba. Córdoba, EspañaUniversidad de CórdobaUniversidad de CórdobaCórdobaEspaña
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Jo S, Lee SH, Jang SW, Choi HB, Kim BR, Jeong JH, Kim SA. Time taken to resume driving following hip arthroscopy. BMC Musculoskelet Disord 2020; 21:643. [PMID: 32998710 PMCID: PMC7528249 DOI: 10.1186/s12891-020-03662-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/20/2020] [Indexed: 11/21/2022] Open
Abstract
Background Resuming driving is a common concern among patients undergoing hip arthroscopy. The present study aimed to assess whether patients who had undergone right hip arthroscopy presented with poorer driving performance than patients with normal hips and to analyze the time required to regain preoperative driving performance. Methods Forty-seven patients who had undergone right hip arthroscopy and consented to our test protocol were included in this study. Using an immersive driving simulator, the patients were tested for their brake reaction time (BRT), total brake time (TBT), and brake pedal depression (BPD) preoperatively and postoperatively. The first postoperative assessments were conducted when the patients could comfortably sit on the driving seat, and the follow-up assessments were conducted for 6 consecutive weeks at weekly intervals. The patients were divided into the following two groups based on the type of surgery that they underwent: the femoroacetabular impingement (FAI) surgery group and the simple hip arthroscopy (SA) group. Twenty healthy volunteers underwent driving assessments thrice at weekly intervals and constituted the control group. The braking parameters were compared between preoperative and postoperative measurements and among the FAI surgery, SA, and control groups. Results The preoperative braking parameters of the patients who underwent arthroscopy did not differ significantly from those of the controls (p = 0.373, 0.763, and 0.447 for the BRT, TBT, and BPD, respectively). All braking parameters returned to normal in 2 weeks in the FAI surgery group and in 1 week in the SA group. Conclusions Our study suggests that the driving performance of patients who underwent right hip arthroscopy is comparable to that of individuals with normal hips and that the braking parameters may normalize to the preoperative state at 1 week after SA and 2 weeks after FAI surgery.
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Affiliation(s)
- Suenghwan Jo
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, South Korea.,School of Medicine, Chosun University, 365 Pilmundae-ro, Dong-gu, Gwangju, 61453, South Korea.,Postoperative Complication Study Group, Chosun University, Gwangju, South Korea
| | - Sang Hong Lee
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, South Korea.,School of Medicine, Chosun University, 365 Pilmundae-ro, Dong-gu, Gwangju, 61453, South Korea
| | - Se Woong Jang
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, South Korea
| | - Hyun Bai Choi
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, South Korea
| | - Ba Rom Kim
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, South Korea
| | - Jae Han Jeong
- School of Medicine, Chosun University, 365 Pilmundae-ro, Dong-gu, Gwangju, 61453, South Korea.,Postoperative Complication Study Group, Chosun University, Gwangju, South Korea
| | - Soo Ah Kim
- School of Medicine, Chosun University, 365 Pilmundae-ro, Dong-gu, Gwangju, 61453, South Korea. .,Postoperative Complication Study Group, Chosun University, Gwangju, South Korea. .,Department of Obstetrics and Gynecology, Chosun University Hospital, Gwangju, South Korea.
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Effect of Road Markings and Traffic Signs Presence on Young Driver Stress Level, Eye Movement and Behaviour in Night-Time Conditions: A Driving Simulator Study. SAFETY 2020. [DOI: 10.3390/safety6020024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The study investigates how the presence of traffic signalling elements (road markings and traffic signs) affects the behaviour of young drivers in night-time conditions. Statistics show that young drivers (≤30 years old) are often involved in road accidents, especially those that occur in night-time conditions. Among other factors, this is due to lack of experience, overestimation of their ability or the desire to prove themselves. A driving simulator scenario was developed for the purpose of the research and 32 young drivers took two runs using it: (a) one containing no road markings and traffic signs and (b) one containing road markings and traffic signs. In addition to the driving simulator, eye tracking glasses were used to track eye movement and an electrocardiograph was used to monitor the heart rate and to determine the level of stress during the runs. The results show statistically significant differences (dependent samples t-test) between the two runs concerning driving speed, lateral position of the vehicle, and visual scanning of the environment. The results prove that road markings and traffic signs provide the drivers with timely and relevant information related to the upcoming situation, thus enabling them to adjust their driving accordingly. The results are valuable to road authorities and provide an explicit confirmation of the importance of traffic signalling for the behaviour of young drivers in night-time conditions, and thus for the overall traffic safety.
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