Effects of instructed meditation augmented by computer-rendered artificial virtual environment on heart rate variability

Evaluation of Tympanic Temperature, Heart Rate Variability and Finger-Foot Reaction Using VR in the Elderly

We evaluated tympanic temperatures, heart rate variability, as well as finger and foot reaction times in elderly using VR simulations of amusement park attractions. The subjects were 8 elderly people (mean age ± S.D., 75±7 year, range 61–85 year), including four females. A roller coaster, swing ride, and rotating cart were used for the amusement park attractions. Subjects were requested to wear VR headsets, rest for 3 minutes, and then were asked to run through the same virtual amusement ride 3 times in a row, which takes 3 minutes and 30 seconds. After another 3 minutes of resting, the subjects were requested to answer a simulator sickness questionnaire (SSQ). In addition, PVT and PS-PVT were performed before and after the attraction rides. Results showed that HRV were not significantly different, but time phase change of tympanic temperature showed increasing trend (P=0.095). As the results of SSQ, increasing trend of nausea was observed in roller coaster than rotating cart (P=0.097). The results of PVT and PS-PVT showed that finger reaction time was significantly faster after the swing ride (P=0.023) and foot reaction time was significantly faster after the rotating cart (P=0.034). It is considered that the tympanic temperature increases when VR sickness occurs. Work performance improved after using VR simulations of amusement park attractions. It is suggested that the moving stimulus of VR vehicles improves finger-foot reactivity and activates concentration in elderly people.

Using a 360° Virtual Reality or 2D Video to Learn History Taking and Physical Examination Skills for Undergraduate Medical Students: Pilot Randomized Controlled Trial

BACKGROUND

Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills.

OBJECTIVE

The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills.

METHODS

This pilot system-design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, the National Aeronautics and Space Administration Task Load Index, and secondary-task reaction time. Cardiac autonomic function was assessed using HRV measurements. Learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at a two-sided P value of <.01.

RESULTS

All 32 participants received the intended intervention. The sample consisted of 20 (63%) males and 12 (38%) females, with a median age of 24 (IQR 23-25) years. The 360° VR video group seemed to have a higher Milestone level than the 2D video group (P=.04). The reaction time at the 10th minute in the 360° VR video group was significantly higher than that in the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with a reaction time at the 10th minute of ≥3.6 seconds (exp B=18.8, 95% CI 3.2-110.8; P=.001) and a Milestone level of ≥3 (exp B=15.0, 95% CI 2.3-99.6; P=.005). However, a reaction time at the 10th minute of ≥3.6 seconds was not related to a Milestone level of ≥3. A low-frequency to high-frequency ratio between the 5th and 10th minute of ≥1.43 seemed to be inversely associated with a hedonic stimulation score of ≥2.0 (exp B=0.14, 95% CI 0.03-0.68; P=.015) after adjusting for video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2D video module was easy to follow but tedious.

CONCLUSIONS

Our preliminary results showed that 360° VR video learning may be associated with a better Milestone level than 2D video learning, and that this did not seem to be related to cognitive load estimates or HRV indexes in the novice learners. Of note, an increase in sympathovagal balance may have been associated with a lower hedonic stimulation score, which may have met the learners' needs and prompted learning through the different video modules.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641.