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Van Leugenhaege L, Van de Craen N, Maes K, Vanden Bergh L, Timmerman K, Van Aken S, Mestdagh E, Kuipers YJ. Virtual Reality as a Method to Cope With Labor Pain: What Do Women Want? Comput Inform Nurs 2024; 42:574-582. [PMID: 38701038 DOI: 10.1097/cin.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
This study aimed to determine what childbearing women want when using virtual reality as an intrapartum pain management method. Researchers performed a qualitative exploratory study using content analysis. Two focus groups were organized including pregnant women anticipating a vaginal birth and women who recently had given birth, no longer than 6 months ago. The focus groups included a 30-minute virtual reality demo. In total, 10 women participated. Five themes emerged: (1) "try, test and explore": the need to receive information and to get acquainted with virtual reality during the antenatal period; (2) "variety and diversity in physical and digital options": the preference for a variety in virtual content and view virtual reality as a complementary method to methods for intrapartum pain management; (3) "distraction versus focus": virtual reality as a method to distract from pain, from the clinical context or to help them focus; (4) "comfort both physical and digital": measures to ensure a comfortable physical and virtual experience; and (5) "birthing partner": the potential need to include partners. This study is an essential step informing the development, implementation, and research of labor-specific virtual reality and informing antenatal healthcare providers when offering women virtual reality as intrapartum pain management.
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Affiliation(s)
- Luka Van Leugenhaege
- Author Affiliations: Department of Health and Life Science, AP University of Applied Sciences and Arts, Antwerp (Mss Van Leugenhaege, Van de Craen, Maes, and Vanden Bergh and Drs Mestdagh and Kuipers); Centre for Research and Innovation in Care, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium MAXlab, Royal Academy of Fine Arts Antwerp, AP University of Applied Sciences and Arts (Mr Timmerman); and Immersive Lab, Department of Science and Technology, AP University of Applied Sciences and Arts (Dr Van Aken), Antwerp, Belgium; and School of Health and Social Care, Edinburgh Napier University, Scotland (Dr Kuipers)
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Augenstein TE, Nagalla D, Mohacey A, Cubillos LH, Lee MH, Ranganathan R, Krishnan C. A novel virtual robotic platform for controlling six degrees of freedom assistive devices with body-machine interfaces. Comput Biol Med 2024; 178:108778. [PMID: 38925086 DOI: 10.1016/j.compbiomed.2024.108778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 05/14/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
Body-machine interfaces (BoMIs)-systems that control assistive devices (e.g., a robotic manipulator) with a person's movements-offer a robust and non-invasive alternative to brain-machine interfaces for individuals with neurological injuries. However, commercially-available assistive devices offer more degrees of freedom (DOFs) than can be efficiently controlled with a user's residual motor function. Therefore, BoMIs often rely on nonintuitive mappings between body and device movements. Learning these mappings requires considerable practice time in a lab/clinic, which can be challenging. Virtual environments can potentially address this challenge, but there are limited options for high-DOF assistive devices, and it is unclear if learning with a virtual device is similar to learning with its physical counterpart. We developed a novel virtual robotic platform that replicated a commercially-available 6-DOF robotic manipulator. Participants controlled the physical and virtual robots using four wireless inertial measurement units (IMUs) fixed to the upper torso. Forty-three neurologically unimpaired adults practiced a target-matching task using either the physical (sample size n = 25) or virtual device (sample size n = 18) involving pre-, mid-, and post-tests separated by four training blocks. We found that both groups made similar improvements from pre-test in movement time at mid-test (Δvirtual: 9.9 ± 9.5 s; Δphysical: 11.1 ± 9.9 s) and post-test (Δvirtual: 11.1 ± 9.1 s; Δphysical: 11.8 ± 10.5 s) and in path length at mid-test (Δvirtual: 6.1 ± 6.3 m/m; Δphysical: 3.3 ± 3.5 m/m) and post-test (Δvirtual: 6.6 ± 6.2 m/m; Δphysical: 3.5 ± 4.0 m/m). Our results indicate the feasibility of using virtual environments for learning to control assistive devices. Future work should determine how these findings generalize to clinical populations.
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Affiliation(s)
- Thomas E Augenstein
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Deepak Nagalla
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Alexander Mohacey
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Luis H Cubillos
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Mei-Hua Lee
- Department of Kinesiology, Michigan State University, Lansing, MI, USA
| | - Rajiv Ranganathan
- Department of Kinesiology, Michigan State University, Lansing, MI, USA; Department of Mechanical Engineering, Michigan State University, Lansing, MI, USA
| | - Chandramouli Krishnan
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Physical Therapy, University of Michigan, Flint, MI, USA.
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Weibel N, Alwood B, Ramesh V, Liu W, Meyer DM, McQuaid T, Germain ES, Meyer BC. Holo-Stroke: Assessing for Immersive Stroke Care Through Stroke Hologram Teleportation. Telemed J E Health 2024. [PMID: 38995868 DOI: 10.1089/tmj.2024.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
Background: Augmented reality enables the wearer to see both their physical environment and virtual objects. Holograms could allow 3D video of providers to be transmitted to distant sites, allowing patients to interact with virtual providers as if they are in the same physical space. Our aim was to determine if Tele-Stroke augmented with Holo-Stroke, compared with Tele-Stroke alone, could improve satisfaction and perception of immersion for the patient. Methods: Kinect cameras positioned at 90-degree intervals around the hub practitioner were used. Cameras streamed real-time optical video to a unity point-cloud program where the data were stitched together in a 360-degree view. The resultant hologram was positioned in 3D space and was visible through the head-mounted display by the patient. Radiology images were shared in Tele-Stroke and via hologram. Likert satisfaction questions were administered. Wilcoxon signed-rank testing was used. Results: Each of the 30 neurology clinic participants scored both Tele-Stroke and Holo-Stroke. Out of these, 29 patients completed the assessments (1 failure owing to computer reboot). Average age was 52 years, with 53.3% of the patients being female, 70.0% being White, and 13.3% being Hispanic. Likert scale score median "Overall" was 32 Tele-Stroke versus 48 Holo-Stroke (p < 0.00001), "Immersion" was 5 versus 10 (p < 0.00001), "Beneficial Technique" was 6 versus 10 (p < 0.00001), and "Ability to See Images" was 5 versus 10 (p < 0.00001). Discussion: Holo-Stroke 3D holographic Tele-Stroke exams resulted in feasibility, satisfaction, and high perception of immersion for the patient. Patients were enthusiastic for the more immersive, personal discussion with their provider and a robust way to experience radiology images. Though further assessments are needed, Holo-Stroke can help the provider "be there, not just see there!"
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Affiliation(s)
- Nadir Weibel
- Department of Computer Science and Engineering & Design Lab, University of California, San Diego, California, USA
| | - Ben Alwood
- College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Vishwajith Ramesh
- Department of Computer Science and Engineering & Design Lab, University of California, San Diego, California, USA
| | - Weichen Liu
- Department of Mathematics, University of California, San Diego, California, USA
| | - Dawn M Meyer
- Department of Neurosciences, University of California, San Diego, California, USA
| | - Teri McQuaid
- Department of Neurosciences, University of California, San Diego, California, USA
| | - Emily St Germain
- Telehealth Program, University of California, San Diego, California, USA
| | - Brett C Meyer
- Department of Neurosciences, University of California, San Diego, California, USA
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Malisky JS, Cavalcante-Leão BL, Severiano MI, dos Santos GJB, Teive HAG, José MR, de Araújo CM, Zeigelboim BS. Evaluation of Quality of Life After Use the Virtual Reality in Patients with Neurodegenerative Disease. Int Arch Otorhinolaryngol 2024; 28:e523-e529. [PMID: 38974627 PMCID: PMC11226250 DOI: 10.1055/s-0044-1785681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/28/2023] [Indexed: 07/09/2024] Open
Abstract
Introduction Spinocerebellar ataxias (SCAs) are a heterogeneous group of neurodegenerative diseases. Objective To evaluate the living standard of patients with SCA, by applying the Vestibular Disorders Activities of Daily Living Scale (VADL) and Activitiesspecific Balance Confidence Scale (ABC) questionnaires. Methods An uncontrolled clinical trial study was conducted with 28 patients who underwent anamnesis, ENT evaluation, and vestibular assessment and the application of questionnaires VADL and ABC before and after rehabilitation with virtual reality. Results The vestibular exam was altered in 64.3% of the cases. The result between the correlation of the VADL and ABC questionnaires showed significant results in all cases (p < 0.005). The correlation between the ages and disease length with the VADL and ABC questionnaires was significant in the T3 assessment (p = 0.015). The correlation between the disease length and the VADL questionnaire was significant in all cases (p < 0.005). The comparison of the vestibular rehabilitation result (T1 to T2) showed a significant difference for all the applied games, except for the ski slalom. The comparison of the vestibular rehabilitation result (T1 to T3) showed significant difference for all the applied games (p < 0.005) (1st assessment before the start of rehabilitation designated T1, after 10 rehabilitation sessions, considered T2 and, at the end of 20 rehabilitation sessions, called T3). Conclusion We can point out a direct improvement in the living standard, reflected by the reduction of falls, better balance, and march, contributing to a higher self-confidence in patients in daily activities.
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Affiliation(s)
- Jéssica Spricigo Malisky
- Department of Otoneurology, Postgraduate Program in Communication Disorders, Universidade Tuiuti do Paraná (UTP), Curitiba, PR, Brazil
| | - Bianca Lopes Cavalcante-Leão
- Department of Otoneurology, Postgraduate Program in Communication Disorders, Universidade Tuiuti do Paraná (UTP), Curitiba, PR, Brazil
| | | | | | - Hélio Augusto Guizoni Teive
- Department of Neurology, Movement Disorders Unit, Hospital das Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Maria Renata José
- Department of Otoneurology, Postgraduate Program in Communication Disorders, Universidade Tuiuti do Paraná (UTP), Curitiba, PR, Brazil
| | - Cristiano Miranda de Araújo
- Department of Otoneurology, Postgraduate Program in Communication Disorders, Universidade Tuiuti do Paraná (UTP), Curitiba, PR, Brazil
| | - Bianca Simone Zeigelboim
- Department of Otoneurology, Postgraduate Program in Communication Disorders, Universidade Tuiuti do Paraná (UTP), Curitiba, PR, Brazil
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De Pasquale P, Bonanno M, Mojdehdehbaher S, Quartarone A, Calabrò RS. The Use of Head-Mounted Display Systems for Upper Limb Kinematic Analysis in Post-Stroke Patients: A Perspective Review on Benefits, Challenges and Other Solutions. Bioengineering (Basel) 2024; 11:538. [PMID: 38927774 PMCID: PMC11200415 DOI: 10.3390/bioengineering11060538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
In recent years, there has been a notable increase in the clinical adoption of instrumental upper limb kinematic assessment. This trend aligns with the rising prevalence of cerebrovascular impairments, one of the most prevalent neurological disorders. Indeed, there is a growing need for more objective outcomes to facilitate tailored rehabilitation interventions following stroke. Emerging technologies, like head-mounted virtual reality (HMD-VR) platforms, have responded to this demand by integrating diverse tracking methodologies. Specifically, HMD-VR technology enables the comprehensive tracking of body posture, encompassing hand position and gesture, facilitated either through specific tracker placements or via integrated cameras coupled with sophisticated computer graphics algorithms embedded within the helmet. This review aims to present the state-of-the-art applications of HMD-VR platforms for kinematic analysis of the upper limb in post-stroke patients, comparing them with conventional tracking systems. Additionally, we address the potential benefits and challenges associated with these platforms. These systems might represent a promising avenue for safe, cost-effective, and portable objective motor assessment within the field of neurorehabilitation, although other systems, including robots, should be taken into consideration.
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Affiliation(s)
- Paolo De Pasquale
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (P.D.P.); (A.Q.); (R.S.C.)
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (P.D.P.); (A.Q.); (R.S.C.)
| | - Sepehr Mojdehdehbaher
- Department of Mathematics, Computer Science, Physics and Earth Sciences (MIFT), University of Messina, Viale Ferdinando Stagno d’Alcontres, 31, 98166 Messina, Italy;
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (P.D.P.); (A.Q.); (R.S.C.)
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (P.D.P.); (A.Q.); (R.S.C.)
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Şirvan Tongar S, Yazici-Mutlu Ç. How virtual reality is impacting balance: An examination of postural stability. J Bodyw Mov Ther 2024; 38:81-85. [PMID: 38763620 DOI: 10.1016/j.jbmt.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND The interest in virtual reality (VR) applications has been on the rise in recent years. However, the impact of VR on postural stability remains unclear. RESEARCH QUESTION The study has two primary objectives: first, to compare postural stability in a 3D-immersed virtual reality environment (VE) and a real environment (RE), and second, to investigate the effect of positive and negative visual feedback, which are subconditions of VE on postural stability. METHODS The observational study recruited 20 healthy adults (10 male, 10 female, 22.8 ± 1.8 years) who underwent postural stability assessments in both RE and VE. In VE, participants received visual stimuli in three different ways: without visual feedback, with positive and negative visual feedback that they would consider themselves to be directed towards postural stability outcomes. The RE included two conditions: eyes open (EO) and eyes closed (EC). Postural stability was evaluated with sway velocity, sway area, and perimeter variables obtained from a force platform. RESULTS All postural stability variables were significantly lower in the RE than in the VE (p < 0.05). There was no significant difference between the VE and EC in terms of sway velocity and sway area (p > 0.05). The visual feedback in the VE did not affect participants' postural stability (p > 0.05). VE may cause an increase in postural sway variables compared to RE and postural requirements may be higher in VE compared to RE. SIGNIFICANCE This is the first and only study examining the effect of different visual feedback on postural stability in VE.
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Affiliation(s)
- Sahra Şirvan Tongar
- Department of Physiotherapy and Rehabilitation, Yeditepe University, Istanbul, Atasehir, Turkey.
| | - Çiğdem Yazici-Mutlu
- Department of Physiotherapy and Rehabilitation, Yeditepe University, Istanbul, Atasehir, Turkey
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Wang CC, Hu TM, Lin YJ, Chen CL, Hsu YC, Kao CL. Use of noninvasive brain stimulation and neurorehabilitation devices to enhance poststroke recovery: review of the current evidence and pitfalls. J Int Med Res 2024; 52:3000605241238066. [PMID: 38603599 PMCID: PMC11010770 DOI: 10.1177/03000605241238066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/22/2024] [Indexed: 04/13/2024] Open
Abstract
Neurorehabilitation devices and technologies are crucial for enhancing stroke recovery. These include noninvasive brain stimulation devices that provide repetitive transcranial magnetic stimulation or transcranial direct current stimulation, which can remodulate an injured brain. Technologies such as robotics, virtual reality, and telerehabilitation are suitable add-ons or complements to physical therapy. However, the appropriate application of these devices and technologies, which target specific deficits and stages, for stroke therapy must be clarified. Accordingly, a literature review was conducted to evaluate the theoretical and practical evidence on the use of neurorehabilitation devices and technologies for stroke therapy. This narrative review provides a practical guide for the use of neurorehabilitation devices and describes the implications of use and potential integration of these devices into healthcare.
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Affiliation(s)
- Chien-Chih Wang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan, ROC
- Intelligent Long Term Medical Care Research Center, Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Tsung-Ming Hu
- Department of Future Studies and LOHAS Industry, Fo Guang University, Yilan, Taiwan, ROC
- Department of Psychiatry, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan, ROC
| | - Yung-Jie Lin
- Department of Family Medicine, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan, ROC
| | - Chien-Lung Chen
- Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan, ROC
- National Yang Ming Chao Tung University, Institute of Hospital and Health Care Administration, Taipei Taiwan, ROC
| | - Yu-Chuan Hsu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chung-Lan Kao
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan, ROC
- Center For Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao Tung University, Hsinchu, Taiwan, ROC
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Ko H, Lim HJ, Park J, Kim K, Suh H, Lee BD, Lee YM, Moon E, Kim DR, Park JH, Shin MJ, Lee YH. Subjective Experience on Virtual Reality-Assisted Mental Health Promotion Program. Psychiatry Investig 2024; 21:380-386. [PMID: 38695045 PMCID: PMC11065531 DOI: 10.30773/pi.2023.0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/18/2023] [Accepted: 01/12/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE Mental health promotion programs using virtual reality (VR) technology have been developed in various forms. This study aimed to investigate the subjective experience of a VR-assisted mental health promotion program for the community population, which was provided in the form of VR experience on a bus to increase accessibility. METHODS Ninety-six people participated in this study. The relationship between the subjective experience and mental health states such as depression, anxiety, perceived stress, and quality of life was explored. The subjective experience on depression and stress before and after VR program treatment was compared using the Wilcoxon signed-rank test. The satisfaction with the VR-assisted mental health promotion program was examined after using the VR program. RESULTS The VR-assisted mental health promotion program on a bus significantly improved subjective symptoms such as depression (p=0.036) and perceived stress (p=0.010) among all the participants. Among the high-risk group, this VR program significantly relieved subjective depressive feeling score (p=0.033), and subjective stressful feeling score (p=0.035). In contrast, there were no significant changes in subjective depressive feelings (p=0.182) and subjective stressful feelings (p=0.058) among the healthy group. Seventy-two percent of the participants reported a high level of satisfaction, scoring 80 points or more. CONCLUSION The findings of this study suggest that the VR-assisted mental health promotion program may effectively improve the subjective depressive and stressful feelings. The use of VR programs on buses to increase of accessibility for the community could be a useful approach for promoting mental health among the population.
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Affiliation(s)
- Hyebin Ko
- Department of Psychiatry, Pusan National University Hospital, Busan, Republic of Korea
| | - Hyun Ju Lim
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Psychology, Gyeoungsang National University, Jinju, Republic of Korea
| | - Jeonghyun Park
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Kyungwon Kim
- Department of Psychiatry, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Psychology, Gyeoungsang National University, Jinju, Republic of Korea
| | - Hwagyu Suh
- Department of Psychiatry, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Psychology, Gyeoungsang National University, Jinju, Republic of Korea
| | - Byung Dae Lee
- Department of Psychiatry, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Young Min Lee
- Department of Psychiatry, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Eunsoo Moon
- Department of Psychiatry, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Du-Ri Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Health Convergence Medicine Laboratory, Pusan National University Hospital, Busan, Republic of Korea
| | - Jong-Hwan Park
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Health Convergence Medicine Laboratory, Pusan National University Hospital, Busan, Republic of Korea
| | - Myung-Jun Shin
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
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Ramazan K, Devran AY, Muhammed ON. An old approach to a novel problem: effect of combined balance therapy on virtual reality induced motion sickness: a randomized, placebo controlled, double-blinded study. BMC MEDICAL EDUCATION 2024; 24:156. [PMID: 38374042 PMCID: PMC10875861 DOI: 10.1186/s12909-024-05152-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND The objective of this study was to investigate the impact of a rehabilitation program aimed at addressing vestibular and proprioceptive deficits, which are believed to underlie the pathophysiology of motion sickness. METHODS A total of 121 medical students with motion sickness participated in this study and were randomly divided into intervention (n = 60) and placebo control (n = 61) groups. The intervention group underwent combined balance, proprioception, and vestibular training three times a week for 4 weeks, while the control group received placebo training. The study assessed various measurements, including the Virtual reality sickness questionnaire (VRSQ), tolerance duration, enjoyment level measured by VAS, stability levels using Biodex, and balance with the Flamingo balance test (FBT). All measurements were conducted both at baseline and 4 weeks later. RESULTS There was no significant difference in pre-test scores between the intervention and control groups, suggesting a similar baseline in both groups (p > 0.05). The results showed a significant improvement in VRSQ, tolerance duration, VAS, Biodex, and FBT scores in the intervention group (p < 0.05). While, the control group showed a significant increase only in VAS scores after 4 weeks of training (p < 0.05). A statistically significant improvement was found between the groups for VRSQ (p < 0.001), tolerance duration (p < 0.001), VAS (p < 0.001), Biodex (p = 0.015), and FBT scores (p < 0.05), in favor of the intervention group. CONCLUSIONS A combined balance training program for motion sickness proves to be effective in reducing motion sickness symptoms, enhancing user enjoyment, and extending the usage duration of virtual reality devices while improving balance and stability. In contrast, placebo training did not alter motion sickness levels. These findings offer valuable insights for expanding the usage of virtual reality, making it accessible to a broader population.
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Affiliation(s)
- Kurul Ramazan
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey.
| | - Altuntas Yasin Devran
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Ogun Nur Muhammed
- Department of Neurology, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Ferguson A, Goldsmith DM, Flatley Brennan P. Visualization of health information within immersive virtual reality environments. J Am Med Inform Assoc 2024; 31:531-535. [PMID: 37352392 PMCID: PMC10797262 DOI: 10.1093/jamia/ocad103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/09/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023] Open
Abstract
The Advanced Visualization Branch of the National Institute of Nursing Research uses computer technologies to study information visualization in support of self-care management. Advanced technologies, such as immersive virtual reality (IVR), afford researchers the opportunity to study health information visualization where user-initiated information search in visually dense settings precedes acquisition, interpretation, and use. While IVR has broad applicability in healthcare, we chose to target lay people managing chronic disease because of the growing unmet need to translate clinical recommendations into everyday behaviors. To explore how lay people seek, acquire, and interpret health information in everyday settings, we developed an IVR grocery store. In this environment, a person can locate food products, read and compare nutrition labels, and use information to make food selections. The goal of this perspective is to introduce the opportunities afforded by IVR to both present and study health information visualization and to highlight critical design considerations.
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Affiliation(s)
- Allyson Ferguson
- National Institute of Nursing Research, Advanced Visualization Branch, Bethesda, Maryland, USA
| | - Denise M Goldsmith
- National Institute of Nursing Research, Advanced Visualization Branch, Bethesda, Maryland, USA
| | - Patricia Flatley Brennan
- National Institute of Nursing Research, Advanced Visualization Branch, Bethesda, Maryland, USA
- National Library of Medicine, Bethesda, Maryland, USA
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Burin-Chu S, Baillet H, Leconte P, Lejeune L, Thouvarecq R, Benguigui N. Effectiveness of virtual reality interventions of the upper limb in children and young adults with cerebral palsy: A systematic review with meta-analysis. Clin Rehabil 2024; 38:15-33. [PMID: 37499213 DOI: 10.1177/02692155231187858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To examine the characteristics and the effectiveness of virtual reality systems on upper limb impairments in children and young adults with cerebral palsy. DATA SOURCES An electronic search was conducted on PubMed, PEDro, Web of Science, Central, and EMBASE. METHODS The protocol of this review was prospectively registered in the PROSPERO database (CRD42022302271). Randomized controlled trials that tested the effects of virtual reality-based interventions on the upper limb of participants with cerebral palsy were included. The methodological quality of the studies was measured by the PEDro scale. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation. The data of the studies were analyzed in meta-analysis and presented in forest plots and narrative synthesis. RESULTS Twenty-two studies involving 746 participants were included. Ten different virtual reality systems were used in the interventions, of which six were designed specifically for rehabilitation and four commercial video games. We found an effect in favor of virtual reality when it was used in combination with conventional therapy for upper limb activity (SMD = 0.65; 95% CI (0.19 to 1.11)). However, the certainty of the evidence of the comparisons ranged from very low to low. CONCLUSION Virtual reality seems to be an effective tool for upper limb activity in children and young adults with cerebral palsy. Nevertheless, future studies should present a better methodological quality, a larger sample size, and well-defined rehabilitation programs to reduce the inconsistency of the evidence in this domain.
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Affiliation(s)
| | - Héloïse Baillet
- Normandie Univ, UNICAEN, ENSICAEN, CNRS, GREYC, Caen, France
| | | | - Laure Lejeune
- Normandie Univ, UNICAEN, ENSICAEN, CNRS, GREYC, Caen, France
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12
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Séba MP, Maillot P, Hanneton S, Dietrich G. Influence of Normal Aging and Multisensory Data Fusion on Cybersickness and Postural Adaptation in Immersive Virtual Reality. SENSORS (BASEL, SWITZERLAND) 2023; 23:9414. [PMID: 38067787 PMCID: PMC10708879 DOI: 10.3390/s23239414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023]
Abstract
Immersive Virtual Reality (VR) systems are expanding as sensorimotor readaptation tools for older adults. However, this purpose may be challenged by cybersickness occurrences possibly caused by sensory conflicts. This study aims to analyze the effects of aging and multisensory data fusion processes in the brain on cybersickness and the adaptation of postural responses when exposed to immersive VR. METHODS We repeatedly exposed 75 participants, aged 21 to 86, to immersive VR while recording the trajectory of their Center of Pressure (CoP). Participants rated their cybersickness after the first and fifth exposure. RESULTS The repeated exposures increased cybersickness and allowed for a decrease in postural responses from the second repetition, i.e., increased stability. We did not find any significant correlation between biological age and cybersickness scores. On the contrary, even if some postural responses are age-dependent, a significant postural adaptation occurred independently of age. The CoP trajectory length in the anteroposterior axis and mean velocity were the postural parameters the most affected by age and repetition. CONCLUSIONS This study suggests that cybersickness and postural adaptation to immersive VR are not age-dependent and that cybersickness is unrelated to a deficit in postural adaptation or age. Age does not seem to influence the properties of multisensory data fusion.
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Affiliation(s)
- Marie-Philippine Séba
- Institut des Sciences du Sport Santé de Paris (URP 3625), Université Paris Cité, F-75015 Paris, France; (P.M.); (S.H.); (G.D.)
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13
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Benelli A, Neri F, Cinti A, Pasqualetti P, Romanella SM, Giannotta A, De Monte D, Mandalà M, Smeralda C, Prattichizzo D, Santarnecchi E, Rossi S. Frequency-Dependent Reduction of Cybersickness in Virtual Reality by Transcranial Oscillatory Stimulation of the Vestibular Cortex. Neurotherapeutics 2023; 20:1796-1807. [PMID: 37721646 PMCID: PMC10684476 DOI: 10.1007/s13311-023-01437-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 09/19/2023] Open
Abstract
Virtual reality (VR) applications are pervasive of everyday life, as in working, medical, and entertainment scenarios. There is yet no solution to cybersickness (CS), a disabling vestibular syndrome with nausea, dizziness, and general discomfort that most of VR users undergo, which results from an integration mismatch among visual, proprioceptive, and vestibular information. In a double-blind, controlled trial, we propose an innovative treatment for CS, consisting of online oscillatory imperceptible neuromodulation with transcranial alternating current stimulation (tACS) at 10 Hz, biophysically modelled to reach the vestibular cortex bilaterally. tACS significantly reduced CS nausea in 37 healthy subjects during a VR rollercoaster experience. The effect was frequency-dependent and placebo-insensitive. Subjective benefits were paralleled by galvanic skin response modulation in 25 subjects, addressing neurovegetative activity. Besides confirming the role of transcranially delivered oscillations in physiologically tuning the vestibular system function (and dysfunction), results open a new way to facilitate the use of VR in different scenarios and possibly to help treating also other vestibular dysfunctions.
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Affiliation(s)
- Alberto Benelli
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Francesco Neri
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- Oto-Neuro-Tech Conjoined Lab, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Alessandra Cinti
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Sara M Romanella
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- Precision Neuroscience & Neuromodulation Program, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alessandro Giannotta
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - David De Monte
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Marco Mandalà
- Oto-Neuro-Tech Conjoined Lab, Policlinico Le Scotte, University of Siena, Siena, Italy
- Otolaryngology, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Carmelo Smeralda
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Domenico Prattichizzo
- Oto-Neuro-Tech Conjoined Lab, Policlinico Le Scotte, University of Siena, Siena, Italy
- Siena Robotics and Systems (SiRS) Lab, Department of Information Engineering and Mathematics, University of Siena, Siena, Italy
| | - Emiliano Santarnecchi
- Precision Neuroscience & Neuromodulation Program, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Simone Rossi
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
- Oto-Neuro-Tech Conjoined Lab, Policlinico Le Scotte, University of Siena, Siena, Italy.
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14
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Ma CW, Cheng PS, Chan YS, Tipoe GL. Virtual reality: a technology to promote active learning of physiology for students across multiple disciplines. ADVANCES IN PHYSIOLOGY EDUCATION 2023; 47:594-603. [PMID: 37382503 DOI: 10.1152/advan.00172.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 06/30/2023]
Abstract
The usefulness of virtual reality (VR) technology in physiology education is largely unexplored. Although VR has the potential to enrich learning experience by enhancing the spatial awareness of students, it is unclear whether VR contributes to active learning of physiology. In the present study, we used a mixed-method research approach to investigate students' perceptions of physiology learning based on VR simulations. Quantitative and qualitative data indicate that the implementation of VR learning environments improves the quality of physiology education by promoting active learning in terms of interactive engagement, interest, problem-solving skills, and feedback. In the Technology-Enabled Active Learning Inventory, which consisted of 20 questions to which students responded along a 7-point Likert scale, the majority of students agreed that VR learning of physiology not only stimulated their curiosity (77%; P < 0.001) but also allowed them to obtain knowledge through diverse formats (76%; P < 0.001), participate in thought-provoking dialogue (72%; P < 0.001), and interact better with peers (72%; P < 0.001). Positive responses in the social, cognitive, behavioral, and evaluative domains of active learning were received from students across different disciplines, including medicine, Chinese medicine, biomedical sciences, and biomedical engineering. Their written feedback showed that VR enhanced their interest in physiology and facilitated the visualization of physiological processes to improve their learning. Overall, this study supports that the integration of VR technology into physiology courses can be an effective teaching strategy.NEW & NOTEWORTHY Virtual reality (VR) improves physiology education by promoting active learning in terms of interactive engagement, interest, problem-solving skills, and feedback. Positive responses toward multiple components of active learning were received from students across different disciplines. The majority of students agreed that VR learning of physiology not only stimulated their curiosity but also allowed them to obtain knowledge through diverse formats, participate in thought-provoking dialogue, and interact better with peers.
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Affiliation(s)
- Chun-Wai Ma
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Pui-Sum Cheng
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ying-Shing Chan
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - George Lim Tipoe
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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15
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Morsch R, Landgraeber S, Strauss DJ. [New perspectives in orthopedics : Developments through neurotechnology and metaverse]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04400-7. [PMID: 37289216 DOI: 10.1007/s00132-023-04400-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/09/2023]
Abstract
The combination of neurotechnology and metaverse holds high potentials for orthopedics, as it offers a broad spectrum of possibilities to overcome the limits of traditional medical care. The vision of a medical metaverse providing the infrastructure as a link for innovative technologies opens up new opportunities for therapy, medical collaborations and practical, personalized training for aspiring physicians. However, risks and challenges, such as security and privacy, health-related issues, acceptance by patients and doctors, as well as technical hurdles and access to the technologies, remain. Hence, future research and development is paramount. Nonetheless, due to technological progress, the exploration of new research areas, and the improved availability of the technologies paired with cost reduction, the prospects for neurotechnology and metaverse in orthopedics are promising.
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Affiliation(s)
- Richard Morsch
- Systems Neuroscience & Neurotechnology Unit, Medizinische Fakultät, Universität des Saarlandes, Homburg, Deutschland.
- Klinik für Orthopädie und Orthopädische Chirurgie, Universität des Saarlandes, Homburg, Deutschland.
- Universität des Saarlandes, Saarbrücken, Deutschland.
| | - Stefan Landgraeber
- Klinik für Orthopädie und Orthopädische Chirurgie, Universität des Saarlandes, Homburg, Deutschland
- Universität des Saarlandes, Saarbrücken, Deutschland
| | - Daniel J Strauss
- Systems Neuroscience & Neurotechnology Unit, Medizinische Fakultät, Universität des Saarlandes, Homburg, Deutschland
- Hochschule für Technik und Wirtschaft des Saarlandes, Saarbrücken, Deutschland
- Universität des Saarlandes, Saarbrücken, Deutschland
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16
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Majewska AA, Vereen E. Using Immersive Virtual Reality in an Online Biology Course. JOURNAL FOR STEM EDUCATION RESEARCH 2023:1-16. [PMID: 37359318 PMCID: PMC10175900 DOI: 10.1007/s41979-023-00095-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 06/28/2023]
Abstract
Interest in virtual reality (VR) for teaching and learning in higher education is growing, given its many potential applications. VR offers a socially interactive environment with novel ways to engage students with materials, objects, and activities and provide students with experiences such as "field trips" that would be otherwise very difficult. Preliminary work indicates overall positive gains in student learning across disciplines compared to other technology and traditional techniques, although more studies are needed to better our understanding of this tool. We employed an "immersive" VR (with a head-mounted display) in an online course which provided students with the opportunity to interact with peers and engage in activities. We asked about perceptions of the learning experience with the technology and how using VR impacts students' performance. We also noted the benefits and challenges of VR in an online course. Students perceived VR as a helpful component of the course, although performance on the cardiovascular unit assessment did not differ compared to the previous semester without VR. Supplementary Information The online version contains supplementary material available at 10.1007/s41979-023-00095-9.
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Affiliation(s)
- Ania A. Majewska
- Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, GA 30602 Athens, USA
| | - Ethell Vereen
- Department of Biology, Morehouse College, Atlanta, GA 30314 USA
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17
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Koohsari MJ, McCormack GR, Nakaya T, Yasunaga A, Fuller D, Nagai Y, Oka K. The Metaverse, the Built Environment, and Public Health: Opportunities and Uncertainties. J Med Internet Res 2023; 25:e43549. [PMID: 36780208 PMCID: PMC9972199 DOI: 10.2196/43549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 02/14/2023] Open
Abstract
There has been a growing interest in the "metaverse," and discourse about how this platform may contribute to different fields of science is already beginning to emerge. In this paper, we discuss key opportunities and uncertainties about how a metaverse might contribute to advancing knowledge in the interdisciplinary field of the built environment and public health aimed at reducing noncommunicable diseases.
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Affiliation(s)
- Mohammad Javad Koohsari
- School of Knowledge Science, Japan Advanced Institute of Science and Technology, Nomi, Japan.,Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Gavin R McCormack
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,School of Architecture, Planning and Landscape, University of Calgary, Calgary, AB, Canada
| | - Tomoki Nakaya
- Graduate School of Environmental Studies, Tohoku University, Sendai, Japan
| | - Akitomo Yasunaga
- Faculty of Liberal Arts and Sciences, Bunka Gakuen University, Tokyo, Japan
| | - Daniel Fuller
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatchewan, SK, Canada
| | - Yukari Nagai
- School of Knowledge Science, Japan Advanced Institute of Science and Technology, Nomi, Japan
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
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18
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Marek K, Zubrycki I, Miller E. Immersion Therapy with Head-Mounted Display for Rehabilitation of the Upper Limb after Stroke-Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:9962. [PMID: 36560328 PMCID: PMC9785384 DOI: 10.3390/s22249962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Immersive virtual therapy technology is a new method that uses head-mounted displays for rehabilitation purposes. It offers a realistic experience that puts the user in a virtual reality. This new type of therapy is used in the rehabilitation of stroke patients. Many patients after this disease have complications related to the upper extremities that limit independence in their everyday life, which affects the functioning of society. Conventional neurological rehabilitation can be supplemented by the use of immersive virtual therapy. The system allows patients with upper limb dysfunction to perform a motor and task-oriented training in virtual reality that is individually tailored to their performance. The complete immersion therapy itself is researched and evaluated by medical teams to determine the suitability for rehabilitation of the upper limb after a stroke. The purpose of this article is to provide an overview of the latest research (2019-2022) on immersive virtual reality with head-mounted displays using in rehabilitation of the upper extremities of stroke patients.
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Affiliation(s)
- Klaudia Marek
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
| | - Igor Zubrycki
- Institute of Automatic Control, Lodz University of Technology, Stefanowskiego 18, 90-537 Lodz, Poland
| | - Elżbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
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19
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Wu Y, Mondal P, Stewart M, Ngo R, Burbridge B. Bringing Radiology Education to a New Reality: A Pilot Study of Using Virtual Reality as a Remote Educational Tool. Can Assoc Radiol J 2022; 74:251-263. [PMID: 36471627 DOI: 10.1177/08465371221142515] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: We investigated virtual reality (VR) during a 2-week, undergraduate, radiology elective to determine if it improved learning outcomes and user satisfaction. Methods: Eighteen students enrolled between August 2021 and February 2022. Each student had a collaborative Zoom teaching session with a preceptor using a Picture Archive and Communications System (PACS)-like viewing system Online DICOM Image Navigator (ODIN), followed by a teaching session using a VR, Digital Imaging and Communications in Medicine (DICOM) viewer (SieVRt). After each teaching session, the students independently reviewed 8 imaging cases and completed case related questions. The students completed a survey, rating their subjective experiences using ODIN and SieVRt. Results: There was no difference in total test scores between the two learning strategies. However, students did perform statistically better on two of five questions designed to test the detection/measurement capabilities of SieVRt vs ODIN. Students stated that they preferred using SieVRt over ODIN and agreed that they were able to view subtle imaging findings and abnormalities better using SieVRt. However, students found that some of the functions of SieVRt (measuring angles/lengths, and multitasking) were difficult. There were technical challenges with VR and minor undesirable physical effects (dizziness, nausea, etc.). Conclusions: Virtual reality has the potential to enhance radiology education by providing an immersive and engaging experience. Objectively, students were able to perform two tasks better with SieVRt. Subjectively, the VR platform received favourable reviews from students for a variety of features. There were reported technical and physical challenges related to using VR. Future developments in VR systems should focus on improving the user experience.
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Affiliation(s)
- Yuhao Wu
- Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Prosanta Mondal
- Clinical Research Support Unit, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Matthew Stewart
- Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Richard Ngo
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Brent Burbridge
- Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
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20
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Anðelić B, Bianco A, Maksimović N, Todorović N, Drid P. A milestone in the era of esports: The Olympics through the lens of virtual reality. Front Psychol 2022; 13:990189. [PMID: 36389446 PMCID: PMC9664081 DOI: 10.3389/fpsyg.2022.990189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/10/2022] [Indexed: 01/24/2023] Open
Affiliation(s)
- Bogdan Anðelić
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Antonino Bianco
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Nemanja Maksimović
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Nikola Todorović
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia,*Correspondence: Patrik Drid
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21
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Design of Three-Dimensional Virtual Simulation Experiment Platform for Integrated Circuit Course. ELECTRONICS 2022. [DOI: 10.3390/electronics11091437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The integrated circuit (IC) is a subject for which researchers need practical experience, but its experiment cost is high, the risk involved is high, and it is not easy to carry out experiments on a large scale. This paper designs a three-dimensional integrated circuit virtual experiment platform based on Unity3d. The platform uses the Unity3d and 3ds Max tools to build a three-dimensional model of instruments, equipment, electronic components, and ultra cleanroom laboratory scenes in an integrated circuit experiment. In addition, it uses C# script to develop the functions and three-dimensional simulation of general virtual instruments and equipment and deploys the experimental website using the frame of the jspxcms open source website. The experimental platform arranges the three-dimensional web file WebGL file in the cloud. Students can use video and text materials to acquire basic IC knowledge at any time and conduct IC virtual experiments safely, efficiently, and without constraints. At present, the platform has been tested and used in teaching and has received high praise and recognition from students.
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22
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Carus EG, Albayrak N, Bildirici HM, Ozmen SG. Immersive virtual reality on childbirth experience for women: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:354. [PMID: 35461248 PMCID: PMC9034564 DOI: 10.1186/s12884-022-04598-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of immersive virtual reality (VR) on patient satisfaction as a distractive tool and pain relief among laboring women. METHODS This was a randomized, controlled clinical trial with 42 laboring women allocated to VR intervention and control groups. Among women in the VR group, patient satisfaction with the use of VR was assessed by a Virtual Reality Satisfaction Survey, measured by a Visual Analog Scale (VAS) score and evaluated by questioning them about whether they would choose VR in future labor. As a primary outcome, patient satisfaction scores regarding the overall childbirth experience were compared between women in the two groups. A secondary outcome was pain assessed by a visual pain rating scale in the early and active phases of labor in women in both groups. Psychometric information was also collected from participants in each group using the Beck Anxiety Inventory and Beck Depression Inventory. RESULTS We observed a high level of patient satisfaction with the use of immersive VR during labor. The VAS revealed a mean satisfaction score of 87.7 ± 12.9 out of a maximum of 100. Twenty out of 21 (95%) women in the VR group stated that they would like to use VR again in future labor. VR improved pain scores in early labor and contributed positively to the overall childbirth experience. The mean pain score pre-VR was 2.6 ± 1.2 compared to 2.0 ± 1.3 post-VR (p < 0.01). Anxiety and depression scores were similar in participants in the intervention and control groups (p = 0.103 and p = 0.13, respectively). CONCLUSION Immersive VR application during labor was associated with higher patient satisfaction based on our study findings. VR also improved participants' pain scores in early labor before epidural administration. Immersive VR may find a place as an adjunct in labor and delivery units to improve lengthy labor experiences for women. Studies with larger groups of participants are needed to confirm these observations. TRIAL REGISTRATION ClinicalTrials.gov: NCT05032456.
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Affiliation(s)
- Elif Gizem Carus
- Graduate School of Health Sciences, Neuroscience Master's Program, Bahcesehir University, Istanbul, Turkey.
| | - Nazli Albayrak
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Selen Gur Ozmen
- Department of Physiotherapy and Rehabilitation, Faculty Of Health Sciences, Bahcesehir University, Istanbul, Turkey
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23
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Conventional Cervical Exercises Compared with a Mixed-Reality-Based Game in Asymptomatic Subjects: An Exploratory Crossover Pilot Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mixed reality presents itself as a potential technological tool for the management of people with musculoskeletal disorders, without having as many adverse side effects as immersive virtual reality. The objective of this study was to explore the possibilities of a mixed-reality game, performing task-oriented cervical exercises compared to conventional therapeutic exercises in sensorimotor outcome measures in asymptomatic subjects. A randomized crossover pilot study was performed with two intervention groups: a mixed-reality group (MRG) and a conventional exercise group (CEG). The cervical joint position error test (CJPET) and deep cervical flexor endurance test (DCFET) were measured as sensorimotor outcomes. Statistically significant differences were found in the pre–post comparison in the DCFET for both groups (MRG: t = −3.87, p < 0.01; CEG: t = −4.01, p < 0.01) and in the extension of the CJPET for the MRG (t = 3.50, p < 0.01). The rest of the measurements showed no significant differences comparing both groups pre- and postintervention (p > 0.05). Mixed reality has apparently the same positive effects as conventional exercises in sensorimotor outcomes in asymptomatic subjects. These results could help in future studies with mixed virtual reality in the management of people with musculoskeletal disorders.
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24
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Găină MA, Szalontay AS, Ștefănescu G, Bălan GG, Ghiciuc CM, Boloș A, Găină AM, Ștefănescu C. State-of-the-Art Review on Immersive Virtual Reality Interventions for Colonoscopy-Induced Anxiety and Pain. J Clin Med 2022; 11:jcm11061670. [PMID: 35329993 PMCID: PMC8949336 DOI: 10.3390/jcm11061670] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Colonoscopy related fear impairs the current gold standard screening of colorectal cancer. Compared to other minimally invasive procedures for cancer screening, colonoscopy-induced anxiety exceeds the procedure through bowel preparation. Immersive virtual reality's (iVR) role in alleviating the complex stress-pain relationship encountered during medical procedures is directly proportional to the rising affordability of state-of-the-art Head-Mounted-Displays (HMDs). OBJECTIVE to assess the effect of iVR on patients' colonoscopy-induced anxiety and pain. MATERIALS AND METHODS A systematic search was conducted in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Embase and Scopus databases up to January 2022. Clinical trials evaluating anxiety as an outcome were included without language restriction. RESULTS Four clinical trials were included: three on the patients' intraprocedural anxiety and one on patient education. Intraprocedural iVR interventions for colonoscopy-induced anxiety and pain revealed a similar effect as conventional sedation, while a statistically significant reduction was reported for non-sedated patients. iVR patient education improved the quality of bowel preparation and reduced patient anxiety before colonoscopy. CONCLUSIONS The current research highlights the need to use high-end HMDs and appropriate interactive iVR software content for colonoscopy-induced anxiety. Methodological frameworks regarding the eligibility of participants, double-blinding and randomization of iVR studies can facilitate the development of iVR implementation for anxiety and pain management.
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Affiliation(s)
- Marcel-Alexandru Găină
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.S.S.); (A.B.); (C.Ș.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
- Correspondence:
| | - Andreea Silvana Szalontay
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.S.S.); (A.B.); (C.Ș.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Gabriela Ștefănescu
- Medical Semiology and Gastroenterology, Department of Medicine I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (G.Ș.); (G.G.B.)
- 2nd Gastroenterology Ward, Saint “Spiridon” County Hospital, Independence Bvd. No 1, 700111 Iasi, Romania
| | - Gheorghe Gh Bălan
- Medical Semiology and Gastroenterology, Department of Medicine I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (G.Ș.); (G.G.B.)
- 2nd Gastroenterology Ward, Saint “Spiridon” County Hospital, Independence Bvd. No 1, 700111 Iasi, Romania
| | - Cristina Mihaela Ghiciuc
- Pharmacology, Clinical Pharmacology and Algeziology, Department of Morpho-Functional Sciences II, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Alexandra Boloș
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.S.S.); (A.B.); (C.Ș.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Alexandra-Maria Găină
- 1st Neurology Ward, Hospital of Neurosurgery “Prof. Dr. Nicolae Oblu” Iasi, 2 Ateneului Street, 700309 Iasi, Romania;
| | - Cristinel Ștefănescu
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.S.S.); (A.B.); (C.Ș.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
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Croghan IT, Hurt RT, Aakre CA, Fokken SC, Fischer KM, Lindeen SA, Schroeder DR, Ganesh R, Ghosh K, Bauer BA. Virtual Reality for Health Care Professionals During a Pandemic: A Pilot Program. J Prim Care Community Health 2022; 13:21501319221086716. [PMID: 35352605 PMCID: PMC8972930 DOI: 10.1177/21501319221086716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: The purpose of this pilot study was to evaluate the safety and use of a nature-based virtual reality (VR) experience among health care providers (HCP) during a pandemic. Methods: Twenty-four frontline HCP participated in this crossover pilot where the viewing order of the experiences were randomized. All participants attended in-person consent, baseline, and end-of-study visits. The intervention consisted of viewing 2 nature-based scenes (“walk in the woods” and “forest of focus”) through 3-D VR and with computer 4K graphic imagery. Randomization took place with regards to the viewing order (VR vs 4K computer video, scene 1 and 2). Outcomes measured were safety, acceptability and changes in intensity of anxiety feelings, resilience, emotional distress, cognitive function, and self-efficacy. Results: Among the 26 HCP expressing interest in the study, 24 enrolled in this study. The majority were male (58.3%), white (66.7%) and of an average age of 46.3 ± 10.5 years (standard deviation (SD)). End of the study survey showed that almost all participants (96%) would participate in the study again and recommend it to others. Twenty-three of the 24 participants also felt relaxed after seeing the imagery. With respect to anxiety (as measured by the STAI Y1), the VR “walk in the woods” had the greatest reduction from pre to post (6.4 points, SD = 5.98) followed by VR “forest of focus” (5.8 points, SD = 9.29), computer screen “forest of focus” (5.0 points, SD = 8.89), and computer screen “walk in the woods” (4.1 points, SD = 6.22). All 4 sessions had a significant decrease in score from pre to post (P-values ≤.005), but there was no significant difference in the change from pre- to post-session between the 4 groups (P-value = .5835). Conclusion: The use of the VR among HCP has promise for reducing stress among health care providers during a high stress period, such as a pandemic but much larger studies are needed.
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Lee DK, Im CW, Jo YH, Chang T, Song JL, Luu C, Mackinnon R, Pillai S, Lee CN, Jheon S, Ahn S, Won SH. Comparison of extended reality and conventional methods of basic life support training: protocol for a multinational, pragmatic, noninferiority, randomised clinical trial (XR BLS trial). Trials 2021; 22:946. [PMID: 34930418 PMCID: PMC8687636 DOI: 10.1186/s13063-021-05908-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/03/2021] [Indexed: 11/11/2022] Open
Abstract
Background Conventional cardiopulmonary resuscitation (CPR) training for the general public involves the use of a manikin and a training video, which has limitations related to a lack of realism and immersion. To overcome these limitations, virtual reality and extended reality technologies are being used in the field of medical education. The aim of this study is to explore the efficacy and safety of extended reality (XR)-based basic life support (BLS) training. Methods This study is a prospective, multinational, multicentre, randomised controlled study. Four institutions in 4 countries will participate in the study. A total of 154 participants will be randomly assigned to either the XR group or the conventional group stratified by institution and sex (1:1 ratio). Each participant who is allocated to either group will be sent to a separate room to receive training with an XR BLS module or conventional CPR training video. All participants will perform a test on a CPR manikin after the training. The primary outcome will be mean compression depth. The secondary outcome will be overall BLS performance, including compression rate, correct hand position, compression, and full release and hands-off time. Discussion Using virtual reality (VR) to establish a virtual educational environment can give trainees a sense of realism. In the XR environment, which combines the virtual world with the real world, trainees can more effectively learn various skills. This trial will provide evidence of the usefulness of XR in CPR education. Trial registration ClinicalTrials.gov NCT04736888. Registered on 29 January 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05908-z.
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Affiliation(s)
- Dong Keon Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 13620, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Republic of Korea.,Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Woo Im
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 13620, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Republic of Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 13620, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Republic of Korea. .,Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Todd Chang
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Joo Lee Song
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Cindy Luu
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Ralph Mackinnon
- Department of Anaesthesia, Royal Manchester Children's Hospital, Manchester, UK
| | - Suresh Pillai
- Centre for Healthcare Simulation, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chuen Neng Lee
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Centre, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Hyun Won
- Division of Statistics, Medical Research Collaborating Centre, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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27
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Bui I, Bhattacharya A, Wong SH, Singh HR, Agarwal A. Role of Three-Dimensional Visualization Modalities in Medical Education. Front Pediatr 2021; 9:760363. [PMID: 34950617 PMCID: PMC8691210 DOI: 10.3389/fped.2021.760363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/25/2021] [Indexed: 01/26/2023] Open
Abstract
For the past two decades, slide-based presentation has been the method of content delivery in medical education. In recent years, other teaching modalities involving three-dimensional (3D) visualization such as 3D printed anatomical models, virtual reality (VR), and augmented reality (AR) have been explored to augment the education experience. This review article will analyze the use of slide-based presentation, 3D printed anatomical models, AR, and VR technologies in medical education, including their benefits and limitations.
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Affiliation(s)
- Ivy Bui
- Department of Clinical and Applied Sciences Education, School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, TX, United States.,Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Arunabh Bhattacharya
- Department of Clinical and Applied Sciences Education, School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, TX, United States
| | - Si Hui Wong
- Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Harinder R Singh
- Children's Hospital of San Antonio, San Antonio, TX, United States.,Baylor College of Medicine, Houston, TX, United States
| | - Arpit Agarwal
- Children's Hospital of San Antonio, San Antonio, TX, United States.,Baylor College of Medicine, Houston, TX, United States
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28
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The direction of postural threat alters balance control when standing at virtual elevation. Exp Brain Res 2020; 238:2653-2663. [PMID: 32944785 DOI: 10.1007/s00221-020-05917-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
Anxiogenic settings lead to reduced postural sway while standing, but anxiety-related balance may be influenced by the location of postural threat in the environment. We predicted that the direction of threat would elicit a parallel controlled manifold relative to the standing surface, and an orthogonal uncontrolled manifold during standing. Altogether, 14 healthy participants (8 women, mean age = 27.5 years, SD = 8.2) wore a virtual reality (VR) headset and stood on a matched real-world walkway (2 m × 40 cm × 2 cm) for 30 s at ground level and simulated heights (elevated 15 m) in two positions: (1) parallel to walkway, lateral threat; and (2) perpendicular to walkway, anteroposterior threat. Inertial sensors measured postural sway acceleration (e.g., 95% ellipse, root mean square (RMS) of acceleration), and a wrist-worn monitor measured heart rate coefficient of variation (HR CV). Fully factorial linear-mixed effect regressions (LMER) determined the effects of height and position. HR CV moderately increased from low to high height (p = 0.050, g = 0.397). The Height × Position interaction approached significance for sway area (95% ellipse; β = - 0.018, p = 0.062) and was significant for RMS (β = - 0.022, p = 0.007). Post-hoc analyses revealed that sagittal plane sway accelerations and RMS increased from low to high elevation in parallel standing, but were limited when facing the threat during perpendicular standing. Postural response to threat varies depending on the direction of threat, suggesting that the control strategies used during standing are sensitive to the direction of threat.
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