Testing a novel method for improving wayfinding by means of a P3b Virtual Reality Visual Paradigm in normal aging

Brain-Computer Interfaces in Visualized Medicine

The brain-computer interface (BCI), also known as a brain-machine interface (BMI), has attracted extensive attention in biomedical applications. More importantly, BCI technologies have substantially revolutionized early predictions, diagnostic techniques, and rehabilitation strategies addressing acute diseases because of BCI's innovations and clinical translations. Therefore, in this chapter, a comprehensive description of the basic concepts of BCI will be exhibited, and various visualization techniques employed in BCI's medical applications will be discussed.

The Computer Simulation for Triggering Anxiety in Panic Disorder Patients Modulates the EEG Alpha Power during an Oddball Task

Aim: The present study investigated the differences between the Panic Disorder (PD) patients groups’ and healthy controls for the EEG alpha dynamics under the frontal cortex and reaction time during the oddball task. Material and Methods: The reaction time during the oddball paradigm concomitant to EEG alpha power was tested in nine PD patients and ten healthy controls before and after a computer simulation presentation. Results: The findings revealed a decrease in EEG alpha power in PD patients concerning the control group (p ≤ 0.0125). However, both groups demonstrated an increased cortical oscillation after the computer simulation, except for the Fp1 electrode during M3 moment in the experimental group. The experimental group has a fast reaction time compared to healthy individuals during the oddball task (p = 0.002). Conclusions: We propose that the decrease in EEG alpha power in the PD patients may indicate an increase in processing related to an anxiogenic stimulus and interference of the anxiety state that compromises the inhibitory control. The reaction time task reveals cognitive symptoms in the experimental group, which may be related to the faster reactivity and high impulsivity to stimuli.

Virtual reality for the assessment and rehabilitation of neglect: where are we now? A 6-year review update

Unilateral spatial neglect (USN) is a frequent repercussion of a cerebrovascular accident, typically a stroke. USN patients fail to orient their attention to the contralesional side to detect auditory, visual, and somatosensory stimuli, as well as to collect and purposely use this information. Traditional methods for USN assessment and rehabilitation include paper-and-pencil procedures, which address cognitive functions as isolated from other aspects of patients' functioning within a real-life context. This might compromise the ecological validity of these procedures and limit their generalizability; moreover, USN evaluation and treatment currently lacks a gold standard. The field of technology has provided several promising tools that have been integrated within the clinical practice; over the years, a "first wave" has promoted computerized methods, which cannot provide an ecological and realistic environment and tasks. Thus, a "second wave" has fostered the implementation of virtual reality (VR) devices that, with different degrees of immersiveness, induce a sense of presence and allow patients to actively interact within the life-like setting. The present paper provides an updated, comprehensive picture of VR devices in the assessment and rehabilitation of USN, building on the review of Pedroli et al. (2015). The present paper analyzes the methodological and technological aspects of the studies selected, considering the issue of usability and ecological validity of virtual environments and tasks. Despite the technological advancement, the studies in this field lack methodological rigor as well as a proper evaluation of VR usability and should improve the ecological validity of VR-based assessment and rehabilitation of USN.

Indoor Environmental Quality of Residential Elderly Care Facilities in Northeast China

The indoor environmental quality is based on the indoor environmental performance of buildings, such as air temperature, lighting, and acoustics. These parameters have a specific impact on users' health and experience. This study explores the relationship between the indoor environment of residential elderly care facilities in cold regions and the sensitivity of the elderly to these facilities with the aim of improving the elderly care environment. This study measured the acoustic, lighting, and thermal environment in four residential elderly care facilities in Northeast China in spring, summer, autumn, and winter through a participant survey. In the residential elderly care facilities surveyed in this study, brightness and illuminance show a nonlinear relationship with lighting evaluation. With an increase in brightness and illuminance, the satisfaction of the lighting environment in different seasons first increases and then decreases. The relative humidity of the different types of rooms varies greatly in spring and less in winter. The average air quality score of the bedroom is higher than that of the activity room. The correlation between odor assessment and overall indoor environmental quality is very poor. The results of the questionnaire survey indicate that the participants were satisfied with the facilities' overall indoor environmental quality. This quality is affected by physical, environmental, and demographic factors. This study provides a reference for the design of other residential elderly care facilities.

Brain activity and upper limb movement analysis in children with Down syndrome undergoing transcranial direct current stimulation combined with virtual reality training: study protocol for a randomized controlled trial

BACKGROUND

Children with Down syndrome have poorer functional and sensory skills compared to children with typical development. Virtual reality (VR) training could help improve these skills. Moreover, transcranial direct current stimulation (tDCS) has achieved promising results in terms of enhancing the effects of physical and sensory therapy by modulating cortical excitability.

METHODS/DESIGN

Two investigations are proposed: (1) an observational study with a convenience sample consisting of children with Down syndrome (group 1-cognitive age of 6 to 12 years according to the Wechsler Abbreviated Scale of Intelligence) and children with typical development 6 to 12 years of age (group 2). Both groups will undergo evaluations on a single day involving a three-dimensional analysis of upper limb movements, an analysis of muscle activity of the biceps and brachial triceps muscles and an analysis of visuospatial and cognitive-motor variables. (2) Analysis of clinical intervention: a pilot study and clinical trial will be conducted involving individuals with Down syndrome (cognitive age of 6 to 12 years according to the Wechsler Abbreviated Scale of Intelligence). The sample will be defined after conducting a pilot study with the same methodology as that to be used in the main study. The participants will be randomly allocated to two groups: An experimental group submitted to anodal tDCS combined with a VR game and a manual motor task and a control group submitted to sham tDCS combined with a VR game and a manual motor task. The training protocol will involve 10 sessions of active or sham tDCS during memory and motor task games. Three 20-min sessions will be held per week for a total of 10 sessions. Evaluations will be performed on three different occasions: pre-intervention, post-intervention (after 10 sessions) and follow-up (1 month after the intervention). Evaluations will consist of analyses of electroencephalographic signals, electromyographic signals of the biceps and triceps brachii, and the three-dimensional reconstruction of the reaching movement. The results will be analyzed statistically with the significance level set at 5% (p ≤ 0.05).

DISCUSSION

The optimization of the results obtained with virtual reality training is believed to be related to the interactive experience with a wide range of activities and scenarios involving multiple sensory channels and the creation of exercises, the intensity of which can be adjusted to the needs of children. Therefore, the proposed study aims to complement the literature with further information on tDCS and VR training considering different variables to provide the scientific community with clinical data on this combination of interventions.

TRIAL REGISTRATION

Brazilian Clinical Trials Registry (REBEC) protocol number RBR-43pk59 registered on 2019 March 27 https://ensaiosclinicos.gov.br/rg/RBR-43pk59 and Human Research Ethics Committee number 3.608.521 approved on 2019 September 30. Protocol version 2021 October 20. Any changes to the protocol will be reported to the committees and approved. Informed consent will be obtained from all participants by the clinical research coordinator and principal investigator.

Using Posterior EEG Theta Band to Assess the Effects of Architectural Designs on Landmark Recognition in an Urban Setting

The process of urban landmark-based navigation has proven to be difficult to study in a rigorous fashion, primarily due to confounding variables and the problem of obtaining reliable data in real-world contexts. The development of high-resolution, immersive virtual reality technologies has opened exciting new possibilities for gathering data on human wayfinding that could not otherwise be readily obtained. We developed a research platform using a virtual environment and electroencephalography (EEG) to better understand the neural processes associated with landmark usage and recognition during urban navigation tasks. By adjusting the architectural parameters of different buildings in this virtual environment, we isolated and tested specific design features to determine whether or not they served as a target for landmarking. EEG theta band (4-7 Hz) event-related synchronization/desynchronization over posterior scalp areas was evaluated at the time when participants observed each target building along a predetermined self-paced route. A multi-level linear model was used to investigate the effects of salient architectural features on posterior scalp areas. Our results support the conclusion that highly salient architectural features-those that contrast sharply with the surrounding environment-are more likely to attract visual attention, remain in short-term memory, and activate brain regions associated with wayfinding compared with non-salient buildings. After establishing this main aggregate effect, we evaluated specific salient architectural features and neural correlates of navigation processing. The buildings that most strongly associated extended gaze time, location recall accuracy, and changes in theta-band neural patterns with landmarking in our study were those that incorporated rotational twist designs and natural elements such as trees and gardens. Other building features, such as unusual façade patterns or building heights, were to a lesser extent also associated with landmarking.

A method of VR-EEG scene cognitive rehabilitation training

Virtual reality technology can intuitively provide patients of neuropsychological diseases with an almost real environment for cognitive rehabilitation training . In this paper, virtual reality technology is used to construct specific scenes that are universal and related to MCI patients to restore and train patients' scene memory cognitive ability to help patients strengthen or gradually restore scene memory cognitive ability. The construction of virtual reality scenes with different contents such as life, environment, transportation and tourism, real-time detection is carried out in combination with EEG signals of patients in different scenes. The experimental results of the analysis of EEG signals of patients shows that memory rehabilitation training is strengthened by using specific stimulation scenes.

Combining brain-computer interface and virtual reality for rehabilitation in neurological diseases: A narrative review

BACKGROUND

The traditional rehabilitation for neurological diseases lacks the active participation of patients, its process is monotonous and tedious, and the effects need to be improved. Therefore, a new type of rehabilitation technology with more active participation combining brain-computer interface (BCI) with virtual reality (VR) has developed rapidly in recent years and has been used in rehabilitation in neurological diseases.

OBJECTIVES

This narrative review analyzed and characterized the development and application of the new training system (BCI-VR) in rehabilitation of neurological diseases from the perspective of the BCI paradigm, to provide a pathway for future research in this field.

METHODS

The review involved a search of the Web of Science-Science Citation Index/Social Sciences Citation Index and the China National Knowledge Infrastructure databases; 39 papers were selected. Advantages and challenges of BCI-VR - based neurological rehabilitation were analyzed in detail.

RESULTS

Most BCI-VR studies included could be classified by 3 major BCI paradigms: motor imagery, P300, and steady-state visual-evoked potential. Integrating VR scenes into BCI systems could effectively promote the recovery process from nervous system injuries as compared with traditional methods.

CONCLUSION

As compared with rehabilitation based on traditional BCI, rehabilitation based on BCI-VR can provide better feedback information for patients and promote the recovery of brain function. By solving the challenges and continual development, the BCI-VR system can be broadly applied to the clinical treatment of various neurological diseases.

Digital Biomarkers for the Early Detection of Mild Cognitive Impairment: Artificial Intelligence Meets Virtual Reality

Elderly people affected by Mild Cognitive Impairment (MCI) usually report a perceived decline in cognitive functions that deeply impacts their quality of life. This subtle waning, although it cannot be diagnosable as dementia, is noted by caregivers on the basis of their relative’s behaviors. Crucially, if this condition is also not detected in time by clinicians, it can easily turn into dementia. Thus, early detection of MCI is strongly needed. Classical neuropsychological measures – underlying a categorical model of diagnosis - could be integrated with a dimensional assessment approach involving Virtual Reality (VR) and Artificial Intelligence (AI). VR can be used to create highly ecologically controlled simulations resembling the daily life contexts in which patients’ daily instrumental activities (IADL) usually take place. Clinicians can record patients’ kinematics, particularly gait, while performing IADL (Digital Biomarkers). Then, Artificial Intelligence employs Machine Learning (ML) to analyze them in combination with clinical and neuropsychological data. This integrated computational approach would enable the creation of a predictive model to identify specific patterns of cognitive and motor impairment in MCI. Therefore, this new dimensional cognitive-behavioral assessment would reveal elderly people’s neural alterations and impaired cognitive functions, typical of MCI and dementia, even in early stages for more time-sensitive interventions.

The Effects of Age, Gender, and Control Device in a Virtual Reality Driving Simulation

The application of virtual reality in a driving simulation is not novel, yet little is known about the use of this technology by senior populations. The effects of age, gender, control device (joystick or handlebar), and task type on wayfinding proficiency using a virtual reality (VR) driving simulation were explored. The driving experiment model involved 96 randomly recruited participants, namely, 48 young people and 48 seniors (split evenly by gender in each group). Experiment results and statistical analyses indicated that, in a VR driving scenario, task type significantly affected VR driving performance. Navigational scores were significantly higher for the straight (easy/symmetrical straight route) task than those for the curved (difficult/asymmetrical curved route) task. The aging effect was the main reason for the significant and interacting effects of gender and control device. Interactions between age and gender difference indicated that the young group exhibited better wayfinding performance than the senior group did, and in the young group, males had better performance than that of females. Similarly, interactions between age and control device indicated that the handlebar control-device type resulted in better performance than the joystick device did in the young group, but no difference was found in the senior group due to age or learning effects. Findings provide an understanding of the evaluation of the interface designs of navigational-support systems, taking into consideration any effects of age, gender, control device, and task type within three-dimensional VR games and driving systems. With a VR driving simulator, seniors can test-drive inaccessible products such as electric bicycles or cars by using a computer at home.

Enrichment of Human-Computer Interaction in Brain-Computer Interfaces via Virtual Environments

Tridimensional representations stimulate cognitive processes that are the core and foundation of human-computer interaction (HCI). Those cognitive processes take place while a user navigates and explores a virtual environment (VE) and are mainly related to spatial memory storage, attention, and perception. VEs have many distinctive features (e.g., involvement, immersion, and presence) that can significantly improve HCI in highly demanding and interactive systems such as brain-computer interfaces (BCI). BCI is as a nonmuscular communication channel that attempts to reestablish the interaction between an individual and his/her environment. Although BCI research started in the sixties, this technology is not efficient or reliable yet for everyone at any time. Over the past few years, researchers have argued that main BCI flaws could be associated with HCI issues. The evidence presented thus far shows that VEs can (1) set out working environmental conditions, (2) maximize the efficiency of BCI control panels, (3) implement navigation systems based not only on user intentions but also on user emotions, and (4) regulate user mental state to increase the differentiation between control and noncontrol modalities.

How high level of anxiety in Panic Disorder can interfere in working memory? A computer simulation and electrophysiological investigation

Panic disorder (PD) is characterized by repeated and unexpected attacks of intense anxiety, which are not restricted to a determined situation or circumstance. The coherence function has been used to investigate the communication among brain structures through the quantitative EEG (qEEG). The objective of this study is to analyze if there is a difference in frontoparietal gamma coherence (GC) between panic disorder patients (PDP) and healthy controls (HC) during the Visual oddball paradigm; and verify if high levels of anxiety (produced by a computer simulation) affect PDP's working memory. Nine PDP (9 female with average age of 48.8, SD: 11.16) and ten HC (1 male and 9 female with average age of 38.2, SD: 13.69) were enrolled in this study. The subjects performed the visual oddball paradigm simultaneously to the EEG record before and after the presentation of computer simulation (CS). A two-way ANOVA was applied to analyze the factors Group and the Moment for each pair of electrodes separately, and another one to analyze the reaction time variable. We verified a F3-P3 GC increased after the CS movie, demonstrating the left hemisphere participation during the anxiety processing. The greater GC in HC observed in the frontal and parietal areas (P3-Pz, F4-F8 and Fp2-F4) points to the participation of these areas with the expected behavior. The greater GC in PDP for F7-F3 and F4-P4 pairs of electrodes assumes that it produces a prejudicial "noise" during information processing, and can be associated to interference on the communication between frontal and parietal areas. This "noise" during information processing is related to PD symptoms, which should be better known in order to develop effective treatment strategies.