Characteristics of head-mounted displays and their effects on simulator sickness

Pilot Study Assessing the Safety and Acceptance of a Novel Virtual Reality System to Improve Visual Function

PURPOSE

To assess the feasibility of the clinical use of a novel Virtual Reality (VR) training software designed to be used for active vision therapy in amblyopic patients by determining its preliminary safety and acceptance on the visual function of healthy adults.

METHODS

Pilot study enrolling 10 individuals (3 men, 7 women, mean age: 31.8 ± 6.5 years) with a best-corrected visual acuity (BCVA) of ≥ .90 (decimal) in both eyes were evaluated before and after 20 minutes of exposure to the NEIVATECH VR system using the HTC Vive Pro Eye head mounted display. Visual function assessment included near (40 cm) and distance (6 m) cover test (CT), stereopsis, binocular accommodative facility (BAF), near point of convergence (NPC), near point of accommodation (NPA), accommodative-convergence over accommodation (AC/A) ratio and positive and negative fusional vergences. Safety was assessed using the VR Sickness Questionnaire (VRSQ) and acceptance using the Technology Acceptance Model ;(TAM). Changes in all these variables after VR exposure were analyzed.

RESULTS

Short-term exposure to the NEIVATECH VR system only induced statistically significant changes in distance phoria (p = .016), but these changes were not clinically relevant. No significant changes were observed in VRSQ oculo-motricity and disorientation scores after exposure (p = .197 and .317, respectively). TAM scores showed a good acceptance of the system in terms of perceived enjoyment and perceived ease of use, although some concerns were raised in relation to the intention-to-use domain.

CONCLUSION

Exposure to the NEIVATECH VR system does not seem to adversely affect the visual function in healthy adults and its safety and acceptance profile seems to be adequate for supporting its potential use in other populations, such as amblyopic patients.

Changes in Navigation Controls and Field-of-View Modes Affect Cybersickness Severity and Spatiotemporal Gait Patterns After Exposure to Virtual Environments

OBJECTIVE

To examine the effects of navigation controls and field-of-view modes on cybersickness severity and gait dynamics after cessation of exposure to a virtual environment (VE).

BACKGROUND

The applications of virtual reality are increasing in various fields; however, whether changes in interaction techniques and visual contents could mitigate the potential gait disturbance following VE exposure remains unclear.

METHOD

Thirty healthy adults wore a head-mounted display to complete six sessions of 12-min run-and-gun tasks using different navigation controls (gamepad, head, natural) and field-of-view modes (full, restricted). Forward and backward walking tasks were performed before and after VE exposure. The degrees of cybersickness and presence were evaluated using questionnaires, along with the in-session task performance. Spatiotemporal gait measures and their variabilities were calculated for each walking task.

RESULTS

The participants experienced less cybersickness with the head and natural controls than with the gamepad. Natural control, based on matching body movements, was associated with the highest degree of presence and best performance. VE navigation using the gamepad showed reduced cadences and increased stride times during postexposure forward-walking tasks. When the VE was presented via the restricted field-of-view mode, increased gait variabilities were observed from backward-walking tasks after VE exposure.

CONCLUSION

Body movement-based navigation controls may alleviate cybersickness. We observed gait adaptation during both ambulation tasks, which was influenced by the navigation control method and field-of-view mode.

APPLICATION

This study provides the first evidence for gait adaptation during balance-demanding tasks after VE exposure, which is valuable for designing guidelines for virtual reality interactions.

Analysis of cybersickness in virtual nursing simulation: a German longitudinal study

BACKGROUND

Innovative educational approaches such as simulation-based nursing education using virtual reality (VR) technologies provide new opportunities for nursing education. However, there is a lack of information on side effects, especially health-related side effects, of head-mounted displays (HMDs) on the human body when using VR devices for nursing simulation. This study aims to validate the German version of the Virtual Reality Sickness Questionnaire (VRSQ) and to evaluate its associations with sex and age, as reflected in the VRSQG scores (total score, oculomotor, and disorientation) over time.

METHODS

A longitudinal-sectional study was conducted. In addition to the VRSQG (pre-, post-, and 20 min post-intervention), participants (all nursing students) completed data on personal characteristics. Participants completed a VR simulation of a blood draw. Confirmatory factor analysis (CFA) was used to evaluate whether the measured construct was consistent with the original. In addition to the validity, internal consistency was analyzed and generalized linear models (GLMs) were used for data analysis.

RESULTS

A total of 38 nursing students (mean age 26.8 years; SD = 7.1, 79.0% female) participated. The mean time spent in the VR simulation was 21 min. All participants completed the entire simulation. The CFA indicates (CFI = 0.981, SRMR = 0.040) VRSQG structure is given. Internal consistency showed low values for the subdomain Oculomotor (Cronbach alpha 0.670). For Disorientation and the Total score values showed a sufficient internal consistency. GLMs showed significant between subject associations with age over time with VRSQG total score, oculomotor, and disorientation. Older nursing students start with higher VRSQG-Scores. Over time, an approximation occurs, so that all participants reach a similar level by the final measurement point. No associations were found between sex (male/female) and VRSQG scores.

CONCLUSIONS

The VRSQG is a reliable and valid self-assessment for measuring cybersickness in VR based nursing simulations, with cybersickness symptoms positively associated with age. However, in depth-evaluation regarding age-associations with cybersickness should be done. As well as studies to explore additional associations and emphasizes the importance of establishing cut-off values to assess the clinical relevance of the scores.

Helicopter Pilot Performance and Workload in a Following Task in a Degraded Visual Environment

BACKGROUND: In this study, we investigated the impact of a loss of horizon due to atmospheric conditions on flight performance and workload of helicopter pilots during a low-altitude, dynamic flight task in windy conditions at sea. We also examined the potential benefits of a helmet-mounted display (HMD) for this specific task.METHODS: In a fixed-based helicopter simulator, 16 military helicopter pilots were asked to follow a maneuvering go-fast vessel in a good visual environment (GVE) and in a degraded visual environment (DVE). DVE was simulated by fog, obscuring the horizon and reducing contrast. Both visual conditions were performed once with and once without an HMD, which was simulated by projecting head-slaved symbology in the outside visuals. Objective measures included flight performance, control inputs, gaze direction, and relative positioning. Subjective measures included self-ratings on performance, situation awareness, and workload.RESULTS: The results showed that in DVE the pilots perceived higher workload and were flying closer to the go-fast vessel than in GVE. Consequently, they responded with larger control inputs to maneuvers of the vessel. The availability of an HMD hardly improved flight performance but did allow the pilots to focus their attention more outside, significantly improving their situation awareness and reducing workload. These benefits were found in DVE as well as GVE conditions.DISCUSSION: DVE negatively affects workload and flight performance of helicopter pilots in a dynamic, low-altitude following task. An HMD can help improve situation awareness and lower the workload during such a task, irrespective of the visual conditions.Ledegang WD, van der Burg E, Valk PJL, Houben MMJ, Groen EL. Helicopter pilot performance and workload in a following task in a degraded visual environment. Aerosp Med Hum Perform. 2024; 95(1):16-24.

Low vision devices for age-related macular degeneration: a systematic review

PURPOSE

Age-related macular degeneration (AMD) is a degenerative condition impacting central vision. Evaluating the effectiveness of low vision devices provides empirical evidence on how devices can rehabilitate and overcome deficits caused by AMD. This evidence could help to facilitate discussion on necessary future improvements to vision enhancement technology.

METHODS

A systematic review of the literature was conducted on low vision device use in AMD populations. Relevant peer-reviewed research articles from six databases were screened.

RESULTS

The findings of thirty-five studies revealed a significant positive impact of low vision devices leading to improvements in visual acuity, reading performance, facial recognition, and more. While the studies were found to have moderate risks of bias, a GRADE assessment of the evidence suggested the certainty of the evidence was low-moderate.

DISCUSSION

Simple hand-held low vision devices (e.g., magnifiers) appear to currently have greater preferential support than newer visual enhancement technology (e.g., head mounted devices). Financial, comfort or usability reasons may influence preferences more than performance-based findings. However, there is a lack of studies examining newer technologies in AMD populations, which future research should address. Moreover, given the presence of bias across the studies and limited controlled experiments, confidence in the results may be low.

CONCLUSIONS

Most studies indicated that low vision devices have positive impacts on reading and visual performance. But, even though they are reported to be a valuable asset to AMD populations, more rigorous research is required to draw conclusive evidence. IMPLICATIONS FOR REHABILITATIONLow vision devices can improve patient outcomes (e.g., vision, reading ability) for age-related macular degeneration populations.A multidisciplinary combination of low vision devices and rehabilitative services (i.e., eccentric viewing training, counselling, education) may enhance quality of life.

The Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ): Estimating Individual Susceptibility to Motion Sickness-Like Symptoms When Using Visual Devices

OBJECTIVE

Two studies were conducted to develop and validate a questionnaire to estimate individual susceptibility to visually induced motion sickness (VIMS).

BACKGROUND

VIMS is a common side-effect when watching dynamic visual content from various sources, such as virtual reality, movie theaters, or smartphones. A reliable questionnaire predicting individual susceptibility to VIMS is currently missing. The aim was to fill this gap by introducing the Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ).

METHODS

A survey and an experimental study were conducted. Survey: The VIMSSQ investigated the frequency of nausea, headache, dizziness, fatigue, and eyestrain when using different visual devices. Data were collected from a survey of 322 participants for the VIMSSQ and other related phenomena such as migraine. Experimental study: 23 participants were exposed to a VIMS-inducing visual stimulus. Participants filled out the VIMSSQ together with other questionnaires and rated their level of VIMS using the Simulator Sickness Questionnaire (SSQ).

RESULTS

Survey: The most prominent symptom when using visual devices was eyestrain, and females reported more VIMS than males. A one-factor solution with good scale reliability was found for the VIMSSQ. Experimental study: Regression analyses suggested that the VIMSSQ can be useful in predicting VIMS (R² = .34) as measured by the SSQ, particularly when combined with questions pertaining to the tendency to avoid visual displays and experience syncope (R² = .59).

CONCLUSION

We generated normative data for the VIMSSQ and demonstrated its validity.

APPLICATION

The VIMSSQ can become a valuable tool to estimate one's susceptibility to VIMS based on self-reports.

The impact of three-dimensional visualisation on midwifery students' application of knowledge of the third stage of labour to practice: Qualitative findings of a pilot randomised controlled trial

PROBLEM

Complex physiological processes are often difficult for midwifery students to comprehend when using traditional teaching and learning approaches. Online resources for midwifery education are limited.

BACKGROUND

Face to face instructional workshops using simulation have had some impact on improving understanding. However, in the 21st century new technologies offer the opportunity to provide alternative learning approaches. Virtual and artificial realities have been shown to increase confidence in decision making during clinical practice.

AIM

Explore the impact of using three-dimensional (3D) visualisation in midwifery education, on student's application, when educating women about the birth of the placenta, and membranes.

METHODS

Face to face individual interviews were performed, to collect deep, meaningful experiences of students, learning about the third stage of labour.

FINDINGS

Prior clinical experiences impacted on student's ability to articulate how they would discuss birth of the placenta and membranes, and the process of haemostasis with women.

DISCUSSION

The narrative findings of this pilot study identified ways that students traditionally learn midwifery, through theory, and clinical practice. Interview narratives illustrated how midwifery students who had previous experiences of witnessing birth, had superior ability to discuss the third stage of labour with women. While students with limited birth experiences, found the 3DMVR assisted them in their understanding of the physiology of the third stage of labour.

CONCLUSION

In an environment of increasing technological advances, clinical placements remain an essential component of midwifery education.

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

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

Validation of a moving base driving simulator for motion sickness research

Increasing levels of vehicle automation are envisioned to allow drivers to engage in other activities but are also likely to increase the incidence of Carsickness or Motion Sickness (MS). Ideally, MS is studied in a safe and controlled environment, such as a driving simulator. However, only few studies address the suitability of driving simulators to assess MS. In this study, we validate a moving base driving simulator for MS research by comparing the symptoms and time course of MS between a real-road driving scenario and a rendition of this scenario in a driving simulator, using a within-subjects design. 25 participants took part as passengers in an experiment with alternating sections (slaloming, stop-and-go) with normal and provocative driving styles. Participants performed Sudoku puzzles (eyes-off-road) during both scenarios and reported MIsery SCale (MISC) scores at 30 s intervals. Motion Sickness Assessment Questionnaire (MSAQ) scores were collected upon completion of either scenario. Overall, the results indicate that MS was more severe in the car than in the simulator. Nevertheless, significant correlations were found between individual MS in the car and simulator for 3 out of 4 MSAQ symptom categories (0.48 < r < 0.73, p < 0.02), with a strong overall correlation (r = 0.57, p = 0.004). MS onset times were similar between the car and the simulator, and sickness fluctuations as a result of driving style showed a similar pattern between scenarios, albeit more pronounced in the car. Based on observed similarities in MS, we conclude these simulator results to have relative validity. We attribute the observed reduction of MS severity in the simulator to the downscaling of the motion by the Motion Cueing Algorithm (MCA). These results suggest that, at least in eyes-off-road conditions, findings on MS from simulator studies may generalize to real vehicles after application of a conversion factor. This conversion factor is likely to depend on simulator and MCA characteristics.

The potential of remote XR experimentation: Defining benefits and limitations through expert survey and case study

Experimentation using extended reality (XR) technology is predominantly conducted in-lab with a co-present researcher. Remote XR experiments, without co-present researchers, have been less common, despite the success of remote approaches for non-XR investigations. In order to understand why remote XR experiments are atypical, this article outlines the perceived limitations, as well as potential benefits, of conducting remote XR experiments, through a thematic analysis of responses to a 30-item survey of 46 XR researchers. These are synthesized into five core research questions for the XR community, and concern types of participant, recruitment processes, potential impacts of remote setup and settings, the data-capture affordances of XR hardware and how remote XR experiment development can be optimized to reduce demands on the researcher. It then explores these questions by running two experiments in a fully “encapsulated” remote XR case study, in which the recruitment and experiment processes is distributed and conducted unsupervised. It discusses the design, experiment, and results from this case study in the context of these core questions.

Effects of a Modern Virtual Reality 3D Head-Mounted Display Exergame on Simulator Sickness and Immersion Under Specific Conditions in Young Women and Men: Experimental Study

Background

Many young adults do not reach the World Health Organization’s minimum recommendations for the amount of weekly physical activity. The virtual reality 3D head-mounted display (VR 3D HMD) exergame is a technology that is more immersive than a typical exercise session. Our study considers gender differences in the experience of using VR games for increasing physical activity.

Objective

The aim of this study was to examine the differences in the effects of VR 3D HMD gaming in terms of immersion, simulator sickness, heart rate, breathing rate, and energy expenditure during two 30-minute sessions of playing an exergame of increasing intensity on males and females.

Methods

To examine the effects of the VR 3D HMD exergame, we experimented with 45 participants (23 males and 22 females) exercising with VR 3D HMD Oculus Quest 1, hand controllers, and Zephyr BioHarness 3.0. Players exercised according to the Audio Trip exergame. We evaluated the immersion levels and monitored the average heart rate, maximum heart rate, average breathing rate, maximum breathing rate, and energy expenditure in addition to simulator sickness during two 30-minute exergame sessions of increasing intensity.

Results

Audio Trip was well-tolerated, as there were no dropouts due to simulator sickness. Significant differences between genders were observed in the simulator sickness questionnaire for nausea (F2,86=0.80; P=.046), oculomotor disorders (F2,86=2.37; P=.010), disorientation (F2,86=0.92; P=.040), and total of all these symptoms (F2,86=3.33; P=.04). The measurements after the first 30-minute VR 3D HMD exergame session for all the participants showed no significant change compared to the measurements before the first 30-minute exergame session according to the total score. There were no gender differences in the immersion (F1,43=0.02; P=.90), but the measurements after the second 30-minute exergame session showed an increase in the average points for immersion in women and men. The increase in the level of immersion in the female group was higher than that in the male group. A significant difference between genders was observed in the average breathing rate (F2,86=1.44; P=.04), maximum breathing rate (F2,86=1.15; P=.047), and energy expenditure (F2,86=10.51; P=.001) measurements. No gender differences were observed in the average heart rate and maximum heart rate measurements in the two 30-minute sessions.

Conclusions

Our 30-minute VR 3D HMD exergame session does not cause simulator sickness and is a very immersive type of exercise for men and women users. This exergame allows reaching the minimum recommendations for the amount of weekly physical activity for adults. The second exergame session resulted in simulator sickness in both groups, more noticeably in women, as reflected in the responses in the simulator sickness questionnaire. The gender differences observed in the breathing rates and energy expenditure measurements can be helpful when programming VR exergame intensity in future research.

Evaluation of voice commands for mode change in virtual reality implant planning procedure

Purpose

In dental implantology, the optimal placement of dental implants is important to meet functional and aesthetic requirements. Planning dental implants in virtual three-dimensional (3D) environment is possible using virtual reality (VR) technologies. The three-dimensional stereoscopic virtual reality environment offers advantages over three-dimensional projection on a two-dimensional display. The use of voice commands in virtual reality environment to replace button presses and other simple actions frees the user’s hands and eyes for other tasks.

Methods

Six dentomaxillofacial radiologists experimented using a prototype version of a three-dimensional virtual reality implant planning tool, and used two different tool selection methods, using either only button presses or also voice commands. We collected objective measurements of the results and subjective data of the participant experience to compare the two conditions.

Results

The tool was approved by the experts and they were able to do the multiple-implant planning satisfactorily. The radiologists liked the possibility to use the voice commands. Most of the radiologists were willing to use the tool as part of their daily work routines.

Conclusion

The voice commands were useful, natural, and accurate for mode change, and they could be expanded to other tasks. Button presses and the voice commands should be both available and used in parallel. The input methods can be further improved based on the expert comments.

Chewing gum reduces visually induced motion sickness

Visually induced motion sickness (VIMS) is a common side-effect of exposure to virtual reality (VR). Its unpleasant symptoms may limit the acceptance of VR technologies for training or clinical purposes. Mechanical stimulation of the mastoid and diverting attention to pleasant stimuli-like odors or music have been found to ameliorate VIMS. Chewing gum combines both in an easy-to-administer fashion and should thus be an effective countermeasure against VIMS. Our study investigated whether gustatory-motor stimulation by chewing gum leads to a reduction of VIMS symptoms. 77 subjects were assigned to three experimental groups (control, peppermint gum, and ginger gum) and completed a 15-min virtual helicopter flight, using a VR head-mounted display. Before and after VR exposure, we assessed VIMS with the Simulator Sickness Questionnaire (SSQ), and during the virtual flight once every minute with the Fast Motion Sickness Scale (FMS). Chewing gum (peppermint gum: M = 2.44, SD = 2.67; ginger gum: M = 2.57, SD = 3.30) reduced the peak FMS scores by 2.05 (SE = 0.76) points as compared with the control group (M = 4.56, SD = 3.52), p < 0.01, d = 0.65. Additionally, taste ratings correlated slightly negatively with both the SSQ and the peak FMS scores, suggesting that pleasant taste of the chewing gum is associated with less VIMS. Thus, chewing gum may be useful as an affordable, accepted, and easy-to-access way to mitigate VIMS in numerous applications like education or training. Possible mechanisms behind the effect are discussed.

A meta-analysis of simulator sickness as a function of simulator fidelity

Driving simulators are an increasingly important tool to develop vehicle functionalities and to study driver or passenger responses. A major hindrance to the use and validity of such studies is Simulator Sickness (SS). Several studies have suggested a positive relation between improvements in simulator fidelity and the likelihood of sickness. We hypothesized that this relation only holds true for static (fixed-base) simulators, and that increased fidelity in fact reduces simulator sickness in dynamic (moving-base) simulators. We performed a meta-analysis investigating the relation between sickness and fidelity in static and dynamic systems. A literature search yielded a total of 41 simulator studies that varied aspects of mechanical and/or visual fidelity and assessed SS for the same driving conditions and the same or equivalent participant groups. Evaluation of a model synthesizing the findings of these studies indicates that SS decreases with visual fidelity, and suggests that this effect may be negated for static simulators. The results of the modeling efforts thereby provide some support for the hypothesis that increased fidelity can reduce SS in dynamic simulators. Based on the evaluation of the literature we also note particular shortcomings and gaps in available research. Finally, we make recommendations for specific experiments that may fill these gaps and allow definitive conclusions on the role of simulator fidelity in SS.

Reducing Cybersickness in 360-Degree Virtual Reality

Despite the technological advancements in Virtual Reality (VR), users are constantly combating feelings of nausea and disorientation, the so-called cybersickness. Cybersickness symptoms cause severe discomfort and hinder the immersive VR experience. Here we investigated cybersickness in 360-degree head-mounted display VR. In traditional 360-degree VR experiences, translational movement in the real world is not reflected in the virtual world, and therefore self-motion information is not corroborated by matching visual and vestibular cues, which may trigger symptoms of cybersickness. We evaluated whether a new Artificial Intelligence (AI) software designed to supplement the 360-degree VR experience with artificial six-degrees-of-freedom motion may reduce cybersickness. Explicit (simulator sickness questionnaire and Fast Motion Sickness (FMS) rating) and implicit (heart rate) measurements were used to evaluate cybersickness symptoms during and after 360-degree VR exposure. Simulator sickness scores showed a significant reduction in feelings of nausea during the AI-supplemented six-degrees-of-freedom motion VR compared to traditional 360-degree VR. However, six-degrees-of-freedom motion VR did not reduce oculomotor or disorientation measures of sickness. No changes were observed in FMS and heart rate measures. Improving the congruency between visual and vestibular cues in 360-degree VR, as provided by the AI-supplemented six-degrees-of-freedom motion system considered, is essential for a more engaging, immersive and safe VR experience, which is critical for educational, cultural and entertainment applications.

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.

A comparison of cybersickness symptoms across 360-degree hazard perception and hazard prediction tests for drivers

Hazard perception assessment may benefit from VR-presentation by removing field-of-view restrictions imposed by single-screen tests. One concern is whether VR-induced 'cybersickness' will offset any benefits. Self-reported cybersickness ratings were recorded from 77 participants viewing two variants of a 360-degree hazard test: hazard perception and hazard prediction. The latter was hypothesised to be particularly susceptible as clips abruptly cut to a probe question at hazard onset. Such sudden occlusions are thought to increase cybersickness. Overall cybersickness levels were low, with only four participants excluded for above-threshold sickness ratings. The remaining participants showed unexpectedly lower symptoms for the hazard prediction test and rated this test format as more comfortable and engaging. These findings mitigate concerns over the use of 360-degree videos in formative hazard assessments, even when clips involve sudden occlusions. Nonetheless, removal of any participants due to cybersickness raises problems for using VR for formal assessments of hazard perception skill.

A comparative experimental study of visual brain event-related potentials to a working memory task: virtual reality head-mounted display versus a desktop computer screen

Virtual reality head mounted display (VR HMD) systems are increasingly utilised in combination with electroencephalography (EEG) in the experimental study of cognitive tasks. The aim of our investigation was to determine the similarities/differences between VR HMD and the computer screen (CS) in response to an n-back working memory task by comparing visual electrophysiological event-related potential (ERP) waveforms (N1/P1/P3 components). The same protocol was undertaken for VR HMD and CS with participants wearing the same EEG headcap. ERP waveforms obtained with the VR HMD environment followed a similar time course to those acquired in CS. The P3 mean and peak amplitudes obtained in VR HMD were not significantly different to those obtained in CS. In contrast, the N1 component was significantly higher in mean and peak amplitudes for the VR HMD environment compared to CS at the frontal electrodes. Significantly higher P1 mean and peak amplitudes were found at the occipital region compared to the temporal for VR HMD. Our results show that successful acquisition of ERP components to a working memory task is achievable by combining VR HMD with EEG. In addition, the higher amplitude N1/P1 components seen in VR HMD indicates the potential utility of this VR modality in the investigation of early ERPs. In conclusion, the combination of VR HMD with EEG/ERP would be a useful approach to advance the study of cognitive function in experimental brain research.

Non-Contact Measurement of Motion Sickness Using Pupillary Rhythms from an Infrared Camera

Both physiological and neurological mechanisms are reflected in pupillary rhythms via neural pathways between the brain and pupil nerves. This study aims to interpret the phenomenon of motion sickness such as fatigue, anxiety, nausea and disorientation using these mechanisms and to develop an advanced non-contact measurement method from an infrared webcam. Twenty-four volunteers (12 females) experienced virtual reality content through both two-dimensional and head-mounted device interpretations. An irregular pattern of the pupillary rhythms, demonstrated by an increasing mean and standard deviation of pupil diameter and decreasing pupillary rhythm coherence ratio, was revealed after the participants experienced motion sickness. The motion sickness was induced while watching the head-mounted device as compared to the two-dimensional virtual reality, with the motion sickness strongly related to the visual information processing load. In addition, the proposed method was verified using a new experimental dataset for 23 participants (11 females), with a classification performance of 89.6% (n = 48) and 80.4% (n = 46) for training and test sets using a support vector machine with a radial basis function kernel, respectively. The proposed method was proven to be capable of quantitatively measuring and monitoring motion sickness in real-time in a simple, economical and contactless manner using an infrared camera.

User discomfort while using a virtual reality headset as a personal viewing system for text-intensive office tasks

Ergonomics issues while using virtual reality (VR) headsets for text-intensive applications have not been studied. Measures of neck and shoulder discomfort and simulator sickness symptoms were quantified while participants were performing a document creation task for 60 min using a VR headset and a desktop monitor. During the task with the headset, participants rotated the head 2.7 times more frequently and used the neck extensor muscles 25.9% more, in average. They also rated the neck and shoulder discomfort 60% and 17.5% higher after the task. The simulator sickness symptoms were also rated significantly higher (p < .05) for the headset condition, with more pronounced differences in the symptoms related to visual discomfort. Results indicate that the physical discomforts due to the frequent head rotations and the headset weight, and visual discomforts due to difficulty in reading texts were the main issues of the VR headset for common office tasks. Practitioner summary: Ergonomics issues associated with the use of a VR headset for conducting office productivity work tasks have been evaluated in an experiment. Study results indicate that the development in the neck physical discomfort and visual discomfort may be the main barriers to the use of current VR headsets for office works. Abbreviations: VR: virtual reality; VDT: video display terminal; EMG: electromyography; MVC: maximum voluntary contraction; SSQ: simulator sickness questionnaire; ECG: electrocardiogram; NEMG: normalised electromyography.

Mitigating Cybersickness in Virtual Reality Systems through Foveated Depth-of-Field Blur

Cybersickness is one of the major roadblocks in the widespread adoption of mixed reality devices. Prolonged exposure to these devices, especially virtual reality devices, can cause users to feel discomfort and nausea, spoiling the immersive experience. Incorporating spatial blur in stereoscopic 3D stimuli has shown to reduce cybersickness. In this paper, we develop a technique to incorporate spatial blur in VR systems inspired by the human physiological system. The technique makes use of concepts from foveated imaging and depth-of-field. The developed technique can be applied to any eye tracker equipped VR system as a post-processing step to provide an artifact-free scene. We verify the usefulness of the proposed system by conducting a user study on cybersickness evaluation. We used a custom-built rollercoaster VR environment developed in Unity and an HTC Vive Pro Eye headset to interact with the user. A Simulator Sickness Questionnaire was used to measure the induced sickness while gaze and heart rate data were recorded for quantitative analysis. The experimental analysis highlighted the aptness of our foveated depth-of-field effect in reducing cybersickness in virtual environments by reducing the sickness scores by approximately 66%.

The Effect of Motion Direction and Eccentricity on Vection, VR Sickness and Head Movements in Virtual Reality

Virtual Reality (VR) experienced through head-mounted displays often leads to vection, discomfort and sway in the user. This study investigated the effect of motion direction and eccentricity on these three phenomena using optic flow patterns displayed using the Valve Index. Visual motion stimuli were presented in the centre, periphery or far periphery and moved either in depth (back and forth) or laterally (left and right). Overall vection was stronger for motion in depth compared to lateral motion. Additionally, eccentricity primarily affected stimuli moving in depth with stronger vection for more peripherally presented motion patterns compared to more central ones. Motion direction affected the various aspects of VR sickness differently and modulated the effect of eccentricity on VR sickness. For stimuli moving in depth far peripheral presentation caused more discomfort, whereas for lateral motion the central stimuli caused more discomfort. Stimuli moving in depth led to more head movements in the anterior-posterior direction when the entire visual field was stimulated. Observers demonstrated more head movements in the anterior-posterior direction compared to the medio-lateral direction throughout the entire experiment independent of motion direction or eccentricity of the presented moving stimulus. Head movements were elicited on the same plane as the moving stimulus only for stimuli moving in depth covering the entire visual field. A correlation showed a positive relationship between dizziness and vection duration and between general discomfort and sway. Identifying where in the visual field motion presented to an individual causes the least amount of VR sickness without losing vection and presence can guide development for Virtual Reality games, training and treatment programmes.

Action Video Game Players Do Not Differ in the Perception of Contrast-Based Motion Illusions but Experience More Vection and Less Discomfort in a Virtual Environment Compared to Non-Action Video Game Players

Action video game players (AVGPs) show enhanced visual perceptual functions compared to their non-video game playing peers (NVGPs). Whether AVGPs are more susceptible towards static contrast motion illusions, such as Fraser Wilcox illusions, has not been addressed so far. Based on their improved perceptual skills, AVGPs are expected to be more susceptible to the illusions and perceive more motion in them. The experience of illusory self-motion (vection) is believed to be dependent on top-down attentional processes; AVGPs should therefore experience stronger vection compared to NVGPs based on their improved attentional skills. Lastly, due to their extensive prior experience with virtual environments, AVGPs should experience less discomfort in VR compared to NVGPs. We presented rotating and expanding motion illusions in a virtual environment and asked 22 AVGPs and 21 NVGPs to indicate the strength of illusory motion, as well as the level of discomfort and vection experienced when exposed to these motion illusions. Results indicated that AVGPs and NVGPs perceived the same amount of motion when viewing these illusions. However, AVGPs perceived more vection and less discomfort compared to NVGPs, possibly due to factors such as enhanced top-down attentional control and adaptation. No differences in the perception of expanding and rotating illusions were found. Discomfort experienced by AVGPs was related to illusion strength, suggesting that contrast illusions might evoke the perceived discomfort rather than the virtual environment. Further studies are required to investigate the relationship between contrast sensitivity, migraine and the perception of illusion in AVGPs which should include illusory motion onset and duration measures.

Application of Human Factors in the Development Process of Immersive Visual Technologies: Challenges and Future Improvements

This study investigates how Human Factors (HF) is applied when designing and developing Immersive Visual Technologies (IVT), including Augmented Reality, Mixed Reality, and Virtual Reality. We interviewed fourteen people working at different organizations, that develop IVT applications in the Nordic region. We used thematic analysis to derive themes from the interviews. The results showed an insufficient knowledge and application of HF in IVT development, due to the lack of awareness of both scope and significance of HF, resource allocation strategy, market inertia, stakeholder's involvement, standardization of HF application and IVT uses, and technology maturity. This situation could be improved by allocating experts, adjusting organizational strategy to balance resource allocation, training developers and user organizations to raise awareness and to encourage co-creative design and knowledge sharing, create a sense of ownership amongst stakeholders, and ensure the usefulness of the technology to the user's work.

Exploratory factor analysis and validity of the virtual reality symptom questionnaire and computer use survey

The widespread use of virtual reality head-mounted-displays (HMDs) calls for a re-examination of the impact of prolonged exposure to fixed visual displays at close ocular proximity. The purpose of this study is to validate the Virtual Reality Symptoms Questionnaire (VRSQ), created to understand symptoms of prolonged HMDs use, and Computer Use Survey (CUS), created to assess general physical and visual discomfort symptoms. Participants (N = 100) recorded their general discomfort symptoms using the CUS, performed an interactive task using a HMD for thirty minutes, and then answered the CUS again along with the VRSQ. VRSQ, analysed using an exploratory factor analysis, indicated a clear two-factor solution, and demonstrated very good internal consistency (α = 0.873). The CUS, also analysed using an exploratory factor analysis, indicated a four-factor solution, and demonstrated good internal consistency (α = 0.838). Practitioner Summary: A quantitative-experimental study was conducted to explore the factor structure and validate both the Virtual Reality Symptoms Questionnaire (VRSQ), and the Computer Use Survey (CUS). Findings indicate the VRSQ and CUS are precise and accurate survey instruments for evaluating discomfort after VR-HMD use and the latter for computer use. Abbreviations: VRSQ: virtual reality symptom questionnaire; CUS: computer use survey; OLED: organic light-emitting diode; MSQ: pensacola motion symptom questionnaire; SSQ: simulator sickness questionnaire; 3 D: three-dimensional computer generated space; VR: virtual reality; VR-HMD: virtual reality head-mounted-display; HMDs: head-mounted-displays; EFA: exploratory factor analysis.

Choice of Leisure Activities by Adolescents and Adults With Internet Gaming Disorder: Development and Feasibility Study of a Virtual Reality Program

Background

Excessive internet game use frequently leads to various physical, psychological, and social problems, and internet gaming disorder (IGD) has become a serious public health issue worldwide. Recently, virtual reality (VR) therapy has emerged as a promising method to increase psychological treatment motivation and accessibility. However, few studies have examined the potential of VR technology for the management of IGD, and VR content tailored to IGD characteristics remains scarce.

Objective

This preliminary study aimed to examine the potential of a VR-based program that was designed to help users identify their leisure time use patterns, especially those related to gaming, and to modify their gaming overuse by alternative activities provided in the VR content. Moreover, to investigate whether users’ VR activities reflect various clinical variables of IGD in youth, we examined the relationships among the leisure time activity selection pattern, built-in response, and speech data obtained from the VR program, as well as symptom severity of internet gaming, psychiatric comorbidities, and motivation of participants reported through relevant questionnaire data.

Methods

Three types of VR content (understanding my daily activities at home, finding an alternative activity to internet gaming at home, expressing contradictory opinions toward a friend’s gaming beliefs) were developed by simulating the daily situations in which patients with IGD can select alternative free-time leisure activities. We examined internet addiction, mental health problems, and motivation for 23 IGD and 29 control participants. Behavioral and self-rated responses from VR, such as alternative activity selection data and speech patterns (speech time, speech satisfaction, and speech accordance), and results from various questionnaires were compared between groups. The correlations between IGD behaviors in VR and real-life behaviors assessed by questionnaire measures were analyzed.

Results

Significant correlations were found between internet gaming behavior and user activity data, such as speech and activity selection pattern, in our VR program. Our results showed that the IGD group had fewer leisure activities and preferred game or digital activities to other types of activities compared to controls, even in VR. There was a positive relationship between the viability of alternative leisure activities the participants selected in VR and the amount of perceived satisfaction from that activity (r=.748, P<.001). Speech accordance in the IGD group was lower than in the control group and was correlated negatively with Internet Addiction Test and Internet Addiction Test–gaming scores (r=.300, P=.03) but positively with users’ motivation (r=.312, P=.02).

Conclusions

The results from our VR program can provide information about daily activity patterns of youths with IGD and the relationship between user VR activities and IGD symptoms, which can be useful in applying VR technology to IGD management.

The role of virtual reality in the changing landscape of surgical training

BACKGROUND

The current coronavirus disease 2019 pandemic has caused unprecedented challenges to surgical training across the world. With the widespread cancellations of clinical and academic activities, educators are looking to technological advancements to help 'bridge the gap' and continue medical education.

SOLUTIONS

Simulation-based training as the 'gold standard' for medical education has limitations that prevent widespread adoption outside suitably resourced centres. Virtual reality has the potential to surmount these barriers, whilst fulfilling the fundamental aim of simulation-based training to provide a safe, effective and realistic learning environment.

CURRENT LIMITATIONS AND INSIGHTS FOR FUTURE

The main limitations of virtual reality technology include comfort and the restrictive power of mobile processors. There exists a clear developmental path to address these restrictions. Continued developments of the hardware and software set to deepen immersion and widen the possibilities within surgical education.

CONCLUSION

In the post coronavirus disease 2019 educational landscape, virtual, augmented and mixed reality technology may prove invaluable in the training of the next generation of surgeons.

Thermal comfort and virtual reality headsets

This study proposed to investigate the thermal properties and subjective thermal discomfort of five virtual reality headsets, and their relationships. Twenty-seven university students used each of the five headsets for 45 min. Microclimate temperature and relative humidity were measured by miniature dataloggers. Infrared thermography was used to measure temperature distribution on the contact points between user's face and the headsets. Participants reported subjective thermal discomfort associated with using each headset. The average microclimate temperature and relative humidity increased by 7.8 °C and 3.5% respectively after headset use. Overall subjective thermal discomfort increased along with duration of use and came primarily from the display. Applying the linear mixed-effects model showed that subjective thermal discomfort is positively correlated with duration of use, microclimate temperature, relative humidity and display coverage area. Conversely, thermal discomfort is negatively correlated with total coverage area, with microclimate temperature acting as the most significant contributing factor. The headsets were ranked by pairing the objective measurements with subjective evaluations.

Factors Associated With Virtual Reality Sickness in Head-Mounted Displays: A Systematic Review and Meta-Analysis

The use of head-mounted displays (HMD) for virtual reality (VR) application-based purposes including therapy, rehabilitation, and training is increasing. Despite advancements in VR technologies, many users still experience sickness symptoms. VR sickness may be influenced by technological differences within HMDs such as resolution and refresh rate, however, VR content also plays a significant role. The primary objective of this systematic review and meta-analysis was to examine the literature on HMDs that report Simulator Sickness Questionnaire (SSQ) scores to determine the impact of content. User factors associated with VR sickness were also examined. A systematic search was conducted according to PRISMA guidelines. Fifty-five articles met inclusion criteria, representing 3,016 participants (mean age range 19.5–80; 41% female). Findings show gaming content recorded the highest total SSQ mean 34.26 (95%CI 29.57–38.95). VR sickness profiles were also influenced by visual stimulation, locomotion and exposure times. Older samples (mean age ≥35 years) scored significantly lower total SSQ means than younger samples, however, these findings are based on a small evidence base as a limited number of studies included older users. No sex differences were found. Across all types of content, the pooled total SSQ mean was relatively high 28.00 (95%CI 24.66–31.35) compared with recommended SSQ cut-off scores. These findings are of relevance for informing future research and the application of VR in different contexts.

Investigating the Learning Process of Folk Dances Using Mobile Augmented Reality

Learning how to dance is not an easy task and traditional teaching methods are the main approach. Digital technologies (such as video recordings of dances) have already been successfully used in combination with the traditional methods. However, there are other emerging technologies such as virtual and augmented reality that have the potential of providing greater assistance, in order to speed up the process as well as assisting the learners. This paper presents a prototype mobile augmented reality application for assisting the process of learning folk dances. Initially, a folk dance was digitized based on recordings from professional dancers. Avatar representations (of either male or female) are synchronized with the digital representation of the dance. To assess the effectiveness of mobile augmented reality, it was comparatively evaluated with a large back-projection system in laboratory conditions. Twenty healthy participants took part in the study, and their movements were captured using motion capture system and then compared with the recordings from the professional dancers. Experimental results indicate that augmented reality (AR) application has the potential to be used for learning process.

Psychometric evaluation of Simulator Sickness Questionnaire and its variants as a measure of cybersickness in consumer virtual environments

Cybersickness, i.e. visually induced motion sickness, remains as a negative effect that is detrimental to the user experience of VEs (virtual environments) developed for VR (virtual reality) consumers. As the VR technology evolves, it is rather triggered by application aspects rather than hardware limitations. For this reason, there is still a need for a measurement method to assess and compare VEs for cybersickness effects. SSQ (Simulation Sickness Questionnaire) is used for measuring users' level of sickness symptoms and is highly appreciated in VR research. However, it is criticized for its psychometric qualities and applicability in VR, as a measure of cybersickness. Recently, two variants of SSQ were offered for measuring cybersickness, CSQ (Cybersickness Questionnaire) and VRSQ (Virtual Reality Sickness Questionnaire). There is also another variant with a different factor structure, which we call FSSQ, that is based on French translation of SSQ. Our study compares SSQ and these variants for their psychometric qualities; construct validity, discriminant validity, internal reliability, test-retest reliability and sensitivity to distinguish application aspects of VEs that are related to cybersickness. Using a within-subjects experiment design, we evaluated 7 different VEs with 32 participants through 9 sessions, resulting with 288 responses to the 16-item SSQ. Results suggested that both VRSQ and CSQ were valid and reliable measures of cybersickness, as well as being sensitive to application aspects such as translational and rotational movements required by users for navigation in VEs. Compared to SSQ and FSSQ; the cybersickness questionnaires, CSQ and VRSQ, revealed better indicators of validity. On the other hand, we assume that the development of the two cybersickness scales had limitations in sample size to represent VR consumers and limitations in stimuli to represent the applications aspects of consumer VEs. We suggest further evaluation of cybersickness symptoms with larger samples and broader range of applications to identify the symptoms and the construct of a subjective measurement tool.

Heat pain modulation with virtual water during a virtual hand illusion

Immersive virtual reality is a powerful method to modify the environment and thereby influence experience. The present study used a virtual hand illusion and context manipulation in immersive virtual reality to examine top-down modulation of pain. Participants received painful heat stimuli on their forearm and placed an embodied virtual hand (co-located with their real one) under a virtual water tap, which dispensed virtual water under different experimental conditions. We aimed to induce a temperature illusion by a red, blue or white light suggesting warm, cold or no virtual water. In addition, the sense of agency was manipulated by allowing participants to have high or low control over the virtual hand's movements. Most participants experienced a thermal sensation in response to the virtual water and associated the blue and red light with cool/cold or warm/hot temperatures, respectively. Importantly, the blue light condition reduced and the red light condition increased pain intensity and unpleasantness, both compared to the control condition. The control manipulation influenced the sense of agency, but did not influence pain ratings. The large effects revealed in our study suggest that context effects within an embodied setting in an immersive virtual environment should be considered within VR based pain therapy.

A Psychophysiological and Behavioural Study of Slot Machine Near-Misses Using Immersive Virtual Reality

During slot machine gambling, near-miss outcomes occur when the final winning icon lands one position off the pay-line. To understand how near-misses promote gambling behaviour in healthy populations, autonomic arousal is often used to index outcome response valence. Findings remain equivocal, possibly owing to the limited ecological validity of computer simulations. Relevant psychological traits, such as impulsivity, which increase the risk of problem gambling, are often not examined. Here, we used immersive virtual reality (VR) to investigate near-miss-induced changes in physiological arousal and VR gambling behaviour. Sixty adult participants with no history of problem gambling were immersed in a VR casino-bar where they engaged with a self-selected slot machine. Real-time heart rate (HR) data were acquired during immersion. Within-subjects analyses were conducted on HR and post-reinforcement pauses (PRPs; i.e., time taken to initiate next-spin) across wins, losses and near-misses. Significant HR acceleration occurred for both near-misses and losses compared to wins, indexing an initial orientation response. Both types of losses were associated with faster next-spin responses. Near-misses did not apparently have unique HR or PRP profiles from losses, although this may reflect our loss control condition, which in itself may have been a subtler near-miss outcome. Impulsivity measured by the SUPPS-P was not associated with near-miss responses. Losses may encourage gambling as participants experience more immediate HR acceleration (indexing arousal unique to losing) and initiate faster responses. Future studies should clarify this effect by investigating problem gambling cohorts and develop VR paradigms taking into consideration the current findings and limitations.

Moving base driving simulators' potential for carsickness research

We investigated whether motion sickness analogous to carsickness can be studied in a moving base simulator, despite the limited motion envelope. Importantly, to avoid simulator sickness, vision outside the simulator cabin was restricted. Participants (N = 16) were exposed blindfolded to 15-min lateral sinusoidal motion at 0.2 Hz and 0.35 Hz on separate days. These conditions were selected to realize optimal provocativeness of the stimulus given the simulator's maximum displacement and knowledge on frequency-acceleration interactions for motion sickness. Average motion sickness on an 11-point scale was 2.21 ± 1.97 for 0.2 Hz and 1.93 ± 1.94 for 0.35 Hz. The motion sickness increase over time was comparable to that found in studies using actual vehicles. We argue that motion base simulators can be used to incite motion sickness analogous to carsickness, provided considerable restrictions on vision. Future research on carsickness, potentially more prevalent in autonomous vehicles, could benefit from employing simulators.

Postural instability according to virtual reality program

Background: The popularity of virtual reality (VR) grew rapidly. Short guidelines with a lack of emphasis on safe use appears prior to usage. It is necessary for the user to realize how much potentially dangerous VR is. Aims/objectives: The aim of this study is to investigate the effect of VR on balance in normal people. Materials and methods: Mean equilibrium score (MES) of 15 adults who have normal sense of balance were obtained by using the sensory organization test (SOT). Conditions 1 and 2 were performed. Multiple VR programs were classified as three levels (Easy, Average, and Challenging) by the visual analog scale. Further SOT tests were performed during watching VR programs. MES of each test was used for statistical analysis. Results: MES of condition 1 was significantly higher than condition 2. Although there was no statistical difference between Eye open and Easy program (p = .097), MES of average and Challenging programs showed significantly decreased scores compared to Eye open. In addition, MES of Average and Challenging programs were significantly decreased than that of Easy program. Conclusions and significance: VR can cause postural imbalance to users. It is necessary to establish quantifiable and objective methods to measure imbalance caused by VR use.

Combining VR Visualization and Sonification for Immersive Exploration of Urban Noise Standards

Urban traffic noise situations are usually visualized as conventional 2D maps or 3D scenes. These representations are indispensable tools to inform decision makers and citizens about issues of health, safety, and quality of life but require expert knowledge in order to be properly understood and put into context. The subjectivity of how we perceive noise as well as the inaccuracies in common noise calculation standards are rarely represented. We present a virtual reality application that seeks to offer an audiovisual glimpse into the background workings of one of these standards, by employing a multisensory, immersive analytics approach that allows users to interactively explore and listen to an approximate rendering of the data in the same environment that the noise simulation occurs in. In order for this approach to be useful, it should manage complicated noise level calculations in a real time environment and run on commodity low-cost VR hardware. In a prototypical implementation, we utilized simple VR interactions common to current mobile VR headsets and combined them with techniques from data visualization and sonification to allow users to explore road traffic noise in an immersive real-time urban environment. The noise levels were calculated over CityGML LoD2 building geometries, in accordance with Common Noise Assessment Methods in Europe (CNOSSOS-EU) sound propagation methods.

Research on 3D Painting in Virtual Reality to Improve Students’ Motivation of 3D Animation Learning

The purpose of this study was to investigate the use of 6-DoF high immersive virtual reality for stereoscopic spatial mapping to assess the impact of perceived spatial capabilities on 3D software learning motivation. This study wasn’t a bound course with mandatory participation, and students were free to participate in the trial, and employed HTC VIVE, which provides highly immersive experiences, to elicit strong emotional responses. A total of 111 students from a university digital media department were invited to participate in a 3D VR painting experiment in which students created paintings using Google Tilt Brush. A 5-point scale based on the ARCS learning motivation model was adopted to collect student data. Perform a factor analysis of the data twice to select the appropriate factor (p = 0.000 < 0.05). Specifically, exploratory factor analysis was used to classify factors based on four constructs. The Cronbach alpha values of ARCS were 0.920, 0.929, 0.693 and 0.664, respectively, both >0.6, which still indicate favorable reliability. The results show that immersive VR can promote students’ motivation and interest in learning 3D animation. However, the practical application of this technology requires solving problems related to hardware and space.

Presence and Cybersickness in Virtual Reality Are Negatively Related: A Review

In order to take advantage of the potential offered by the medium of virtual reality (VR), it will be essential to develop an understanding of how to maximize the desirable experience of "presence" in a virtual space ("being there"), and how to minimize the undesirable feeling of "cybersickness" (a constellation of discomfort symptoms experienced in VR). Although there have been frequent reports of a possible link between the observer's sense of presence and the experience of bodily discomfort in VR, the amount of literature that discusses the nature of the relationship is limited. Recent research has underlined the possibility that these variables have shared causes, and that both factors may be manipulated with a single approach. This review paper summarizes the concepts of presence and cybersickness and highlights the strengths and gaps in our understanding about their relationship. We review studies that have measured the association between presence and cybersickness, and conclude that the balance of evidence favors a negative relationship between the two factors which is driven principally by sensory integration processes. We also discuss how system immersiveness might play a role in modulating both presence and cybersickness. However, we identify a serious absence of high-powered studies that aim to reveal the nature of this relationship. Based on this evidence we propose recommendations for future studies investigating presence, cybersickness, and other related factors.

Response Inhibition as a Function of Movement Complexity and Movement Type Selection

This study aims to determine whether response inhibition shows the same degree of effectiveness for two sources of motor complexity: (1) Movement complexity, which is measured through two actions with different motor requirements (simple lifting action vs. complex reaching action), and (2) Movement type selection, which is measured in movements performed separately (no active-movement type selection) vs. selectively (active-movement type selection). Activation–suppression model was tested in three experiments to measure activation of the preponderant responses and subsequent suppression in a Simon task. More errors and higher magnitude of congruence effect (which reflects greater effectiveness of response suppression) were expected for more difficult motor conditions. Reaction time, movement time, kinematic errors, and movement errors were recorded. Results of Experiment 1, in which movement type selection was not active, showed that both movements did not differ in their activation and suppression, as they presented similar kinematic error rates and Simon effects. Experiment 2, in which movement type selection was active, resulted in a higher kinematic error rate and higher magnitude of Simon effect in lifting. These results were confirmed in Experiment 3, in which participants performed all experimental motor complexity conditions. Finally, Experiment 4 showed that responses with similar movement complexity did not differ in their activation and suppression, even when movement type selection was active. Thus, the present study provides evidence on the varying effectiveness of response inhibition as a function of movement complexity, but only in demanding situations in which movement type selection is active. These results can be attributed to a top-down strategy to minimize error for actions most prone to develop kinematic error.

Can Simulator Sickness Be Avoided? A Review on Temporal Aspects of Simulator Sickness

Simulator sickness is a syndrome similar to motion sickness, often experienced during simulator or another virtual reality (VR) exposure. Many theories have been developed or adapted from the motion sickness studies, in order to explain the existence of the syndrome. The simulator sickness can be measured using both subjective and objective methods. The most popular self-report method is the Simulator Sickness Questionnaire. Attempts have also been made to discover a physiological indicator of the described syndrome, but no definite conclusion has been reached on this issue. In the present paper, three temporal aspects of the simulator sickness are discussed: the temporal trajectory of the progression of simulator sickness, possibility of adapting VR users in advance and persistence of the symptoms after VR exposure. Evidence found in 39 articles is widely described. As for the first aspect, it is clear that in most cases severity of the simulator sickness symptoms increases with time of exposure, although it is impossible to develop a single, universal pattern for this effect. It has also been proved, that in some cases a threshold level or time point exists, after which the symptoms stop increasing or begin to decrease. The adaptation effect was proved in most of the reviewed studies and observed in different study designs - e.g., with a couple of VR exposures on separate days or on 1 day and with a single, prolonged VR exposure. As for the persistence of the simulator sickness symptoms after leaving the VR, on the whole the study results suggest that such an effect exists, but it varies strongly between individual studies - the symptoms may persist for a short period of time (10 min) or a relatively long one (even 4 h). Considering the conclusions reached in the paper, it is important to bear in mind that the virtual reality technology still evokes unpleasant sensations in its users and that these sensations should be cautiously controlled while developing new VR tools. Certainly, more research on this topic is necessary.

Safety and Feasibility of a First-Person View, Full-Body Interaction Game for Telerehabilitation Post-Stroke

This study explored the feasibility and safety of pairing the Microsoft Kinect® sensor with the Oculus Rift® Head Mounted Display (HMD) as a telerehabilitation technology platform for persons post-stroke. To test initial safety, fourteen participants without disabilities (age 30 ± 8.8 years) engaged in a game-based task using the Microsoft Kinect® with a first-person view using the Oculus Rift®. These tasks were repeated for five participants post-stroke (age 56 ± 3.0 years). No significant adverse events occurred in either study population. When using the Oculus Rift® HMD, three participants without disabilities reported dizziness and nausea. All of the participants post-stroke required hands-on assistance for balance and fall prevention. The intensive nature of physical support necessary for this type of interaction limits the application as a telerehabilitation intervention. Given the increasing availability of HMDs for commercial use, it is crucial that the safety of immersive games and technologies for telerehabilitation is fully explored.

Comparison study of the use of 360-degree video and non-360-degree video simulation and cybersickness symptoms in undergraduate healthcare curricula

The increasing use of emerging technologies in healthcare simulation, particularly virtual reality, has caused in increase in both use and misuse. It is the exploration and study of these types of technology that are key to their success-or failure-in simulation learning and teaching. Therefore, this exploratory study evaluated the most common perceived side effect of virtual reality, that of cybersickness. A total of n=60 undergraduate healthcare students participated in one of four identical learning outcome simulation events, using different simulation techniques. This study compared these four common simulation tools, high-fidelity manikin, standardised patient, video case study and 360-degree virtual reality video, and analysed the self-reported cybersickness symptoms. The results show that some virtual reality tools, in this case 360-degree video, are no more likely to provoke cybersickness symptoms than the other simulation methods used in this study. In addition, virtual reality is reported as less fatiguing than other methods of simulation learning. Virtual reality technologies may be a useful addition to the spectrum of simulation tools and techniques currently in use. This study suggests that there is no greater risk of cybersickness symptoms and this potential barrier to use is not borne out by this study.

Virtual reality sickness questionnaire (VRSQ): Motion sickness measurement index in a virtual reality environment

This study aims to develop a motion sickness measurement index in a virtual reality (VR) environment. The VR market is in an early stage of market formation and technological development, and thus, research on the side effects of VR devices such as simulator motion sickness is lacking. In this study, we used the simulator sickness questionnaire (SSQ), which has been traditionally used for simulator motion sickness measurement. To measure the motion sickness in a VR environment, 24 users performed target selection tasks using a VR device. The SSQ was administered immediately after each task, and the order of work was determined using the Latin square design. The existing SSQ was revised to develop a VR sickness questionnaire, which is used as the measurement index in a VR environment. In addition, the target selection method and button size were found to be significant factors that affect motion sickness in a VR environment. The results of this study are expected to be used for measuring and designing simulator sickness using VR devices in future studies.