Virtual Reality Technology in Cognitive Rehabilitation Application: A Bibliometric Analysis (Preprint)

A comprehensive study on unraveling the advances of immersive technologies (VR/AR/MR/XR) in the healthcare sector during the COVID-19: Challenges and solutions

The current COVID-19 pandemic has affected almost every aspect of life but its impact on the healthcare landscape is conspicuously adverse. However, digital technologies played a significant contribution in coping with the challenges spawned by this pandemic. In this list of applied digital technologies, the role of immersive technologies in battling COVID-19 is notice-worthy. Immersive technologies consisting of virtual reality (VR), augmented reality (AR), mixed reality (MR), extended reality (XR), metaverse, gamification, etc. have shown enormous market growth within the healthcare system, particularly with the emergence of pandemics. These technologies supplemented interactivity, immersive experience, 3D modeling, touching sensory elements, simulation, and feedback mechanisms to tackle the COVID-19 disease in healthcare systems. Keeping in view the applicability and significance of immersive technological advancement, the major aim of this study is to identify and highlight the role of immersive technologies concerning handling COVID-19 in the healthcare setup. The contribution of immersive technologies in the healthcare domain for the different purposes such as medical education, medical training, proctoring, online surgeries, stress management, social distancing, physical fitness, drug manufacturing and designing, and cognitive rehabilitation is highlighted. A comprehensive and in-depth analysis of the collected studies has been performed to understand the current research work and future research directions. A state-of-the-artwork is presented to identify and discuss the various issues involving the adoption of immersive technologies in the healthcare area. Furthermore, the solutions to these emerging challenges and issues have been provided based on an extensive literature study. The results of this study show that immersive technologies have the considerable potential to provide massive support to stakeholders in the healthcare system during current COVID-19 situation and future pandemics.

Mapping Knowledge Landscapes and Emerging Trends in AI for Dementia Biomarkers: Bibliometric and Visualization Analysis

BACKGROUND

With the rise of artificial intelligence (AI) in the field of dementia biomarker research, exploring its current developmental trends and research focuses has become increasingly important. This study, using literature data mining, analyzes and assesses the key contributions and development scale of AI in dementia biomarker research.

OBJECTIVE

The aim of this study was to comprehensively evaluate the current state, hot topics, and future trends of AI in dementia biomarker research globally.

METHODS

This study thoroughly analyzed the literature in the application of AI to dementia biomarkers across various dimensions, such as publication volume, authors, institutions, journals, and countries, based on the Web of Science Core Collection. In addition, scales, trends, and potential connections between AI and biomarkers were extracted and deeply analyzed through multiple expert panels.

RESULTS

To date, the field includes 1070 publications across 362 journals, involving 74 countries and 1793 major research institutions, with a total of 6455 researchers. Notably, 69.41% (994/1432) of the researchers ceased their studies before 2019. The most prevalent algorithms used are support vector machines, random forests, and neural networks. Current research frequently focuses on biomarkers such as imaging biomarkers, cerebrospinal fluid biomarkers, genetic biomarkers, and blood biomarkers. Recent advances have highlighted significant discoveries in biomarkers related to imaging, genetics, and blood, with growth in studies on digital and ophthalmic biomarkers.

CONCLUSIONS

The field is currently in a phase of stable development, receiving widespread attention from numerous countries, institutions, and researchers worldwide. Despite this, stable clusters of collaborative research have yet to be established, and there is a pressing need to enhance interdisciplinary collaboration. Algorithm development has shown prominence, especially the application of support vector machines and neural networks in imaging studies. Looking forward, newly discovered biomarkers are expected to undergo further validation, and new types, such as digital biomarkers, will garner increased research interest and attention.

Global research hotspots and trends on robotic surgery in obstetrics and gynecology: a bibliometric analysis based on VOSviewer

Objective

Over the last two decades, the quantity of papers published in relation to robotic surgery in obstetrics and gynecology has continued to grow globally. However, no bibliometric analysis based on VOSviewer has been performed to evaluate the past and present of global research in the field. In this study, we aimed to analyze the bibliometric characteristics of papers on robotic surgery in obstetrics and gynecology to reveal research hotspots and trends in this field.

Methods

The Web of Science Core Collection was searched for scientific papers on robotic surgery in obstetrics and gynecology published between January 1, 1998 and December 31, 2023. Bibliometric metadata of each selected paper was extracted for analysis. The results were visualized by VOSviewer (version 1.6.18).

Results

A total of 1,430 papers met the inclusion criteria. The United States had the highest total link strengths and contributed the most papers (n = 793). The Mayo Clinic produced the largest number of papers (n = 85), and Professor Pedro T Ramirez contributed the most papers (n = 36). The number of citations ranged from 0 to 295 with a total sum of 29,103. The Journal of Minimally Invasive Gynecology published the most relevant papers (n = 252). Keywords were classified into six clusters based on co-occurrence data, of which cluster 1, cluster 4 and cluster 6 had more main keywords with the largest average publication year.

Conclusions

This is the first VOSviewer-based bibliometric analysis of robotic surgery research in obstetrics and gynecology. The United States was the leading country, and the Journal of Minimally Invasive Gynecology was the most productive journal in the field. Scientists and institutions from around the world should push their boundaries to bring about deep collaboration. The main research topic has always been the use of robotic surgery in the treatment of gynecologic malignancies. More randomized controlled trials need to be conducted to compare surgical outcomes of robotic surgery with other surgical approaches. Robotic sacrocolpopexy for pelvic organ prolapse has become a new research hotspot, and robotic surgery for sentinel lymph node detection in gynecologic malignancies are more potential directions for future research.

Digital Marker for Early Screening of Mild Cognitive Impairment Through Hand and Eye Movement Analysis in Virtual Reality Using Machine Learning: First Validation Study

BACKGROUND

With the global rise in Alzheimer disease (AD), early screening for mild cognitive impairment (MCI), which is a preclinical stage of AD, is of paramount importance. Although biomarkers such as cerebrospinal fluid amyloid level and magnetic resonance imaging have been studied, they have limitations, such as high cost and invasiveness. Digital markers to assess cognitive impairment by analyzing behavioral data collected from digital devices in daily life can be a new alternative. In this context, we developed a "virtual kiosk test" for early screening of MCI by analyzing behavioral data collected when using a kiosk in a virtual environment.

OBJECTIVE

We aimed to investigate key behavioral features collected from a virtual kiosk test that could distinguish patients with MCI from healthy controls with high statistical significance. Also, we focused on developing a machine learning model capable of early screening of MCI based on these behavioral features.

METHODS

A total of 51 participants comprising 20 healthy controls and 31 patients with MCI were recruited by 2 neurologists from a university hospital. The participants performed a virtual kiosk test-developed by our group-where we recorded various behavioral data such as hand and eye movements. Based on these time series data, we computed the following 4 behavioral features: hand movement speed, proportion of fixation duration, time to completion, and the number of errors. To compare these behavioral features between healthy controls and patients with MCI, independent-samples 2-tailed t tests were used. Additionally, we used these behavioral features to train and validate a machine learning model for early screening of patients with MCI from healthy controls.

RESULTS

In the virtual kiosk test, all 4 behavioral features showed statistically significant differences between patients with MCI and healthy controls. Compared with healthy controls, patients with MCI had slower hand movement speed (t49=3.45; P=.004), lower proportion of fixation duration (t49=2.69; P=.04), longer time to completion (t49=-3.44; P=.004), and a greater number of errors (t49=-3.77; P=.001). All 4 features were then used to train a support vector machine to distinguish between healthy controls and patients with MCI. Our machine learning model achieved 93.3% accuracy, 100% sensitivity, 83.3% specificity, 90% precision, and 94.7% F1-score.

CONCLUSIONS

Our research preliminarily suggests that analyzing hand and eye movements in the virtual kiosk test holds potential as a digital marker for early screening of MCI. In contrast to conventional biomarkers, this digital marker in virtual reality is advantageous as it can collect ecologically valid data at an affordable cost and in a short period (5-15 minutes), making it a suitable means for early screening of MCI. We call for further studies to confirm the reliability and validity of this approach.

Knowledge mapping and emerging trends of ferroptosis in ischemia reperfusion injury research: A bibliometric analysis (2013-2022)

Objective

Ischemia/reperfusion (I/R) injury is an inevitable dilemma when previously ischemic multiple organs and tissues are returned to a state of blood flow, with confirming a critical role of ferroptosis in molecular, pathway mechanisms, subcellular structure. Discovering the potential relationship may provide useful approaches for the clinical treatment and prognosis of the pathophysiological status of IRI. Therefore, a comprehensive visualization and scientometric analysis were conducted to systematically summarize and discuss the "ferroptosis in ischemia reperfusion injury" research to demonstrate directions for scholars in this field.

Methods

We retrieved all publications focusing on I/R injury and ferroptosis from the Web of Science Core Collection (WoSCC), published from 2013 to October 2022. Next, scientometric analysis of different items was performed using various bibliometrics softwares to explore the annual trends, countries/regions, institutions, journals, authors and their multi-dimensional relationship pointing to current hotspots and future advancement in this field.

Results

We included a total of 421 English articles in set timespan. The number of publications increased steadily annually. China produced the highest number of publications, followed by the United States. Most publications were from Central South University, followed by Sichuan University and Wuhan University. The most authoritative academic journal was Oxidative Medicine and Cellular Longevity. Cell occupied the first rank of co-cited journal list. Andreas Linkermann and Scott J Dixon may have the highest influence in this intersected field with the highest number of citations and co-cited references respectively. The essential biological reactions such as oxidative stress response, lipid peroxidation metabolism, anti-inflammmatory and pro-inflammatory procedure, and related molecular pathways were knowledge base and current hotspots. Molecules pathways exploration, effective inhibition of I/R injury and promising strategy of improving allografts may become future trends and focuses.

Conclusions

Research on ferroptosis in I/R injury had aroused great interest recently. This first bibliometric study comprehensively analyzed the research landscape of ferroptosis and I/R injury, and also provided a reliable reference for related scholars to facilitate further advancement in this field.

Cognitive Training With Head-Mounted Display Virtual Reality in Neurorehabilitation: Pilot Randomized Controlled Trial

BACKGROUND

Neurological rehabilitation is technologically evolving rapidly, resulting in new treatments for patients. Stroke, one of the most prevalent conditions in neurorehabilitation, has been a particular focus in recent years. However, patients often need help with physical and cognitive constraints, whereby the cognitive domain in neurorehabilitation does not technologically exploit existing potential. Usually, cognitive rehabilitation is performed with pen and paper or on a computer, which leads to limitations in preparation for activities of daily living. Technologies such as virtual reality (VR) can bridge this gap.

OBJECTIVE

This pilot study investigated the use of immersive VR in cognitive rehabilitation for patients undergoing inpatient neurorehabilitation. The goal was to determine the difference in rehabilitation effectiveness between a VR serious game that combines everyday activities with cognitive paradigms and conventional computerized cognitive training. We hypothesized the superiority of the VR serious game regarding cognitive abilities and patient-reported outcomes as well as transfer to daily life.

METHODS

We recruited 42 patients with acute brain affection from a German neurorehabilitation clinic in inpatient care with a Mini Mental Status Test score >20 to participate in this randomized controlled trial. Participants were randomly assigned to 2 groups, with 1 receiving the experimental VR treatment (n=21). VR training consisted of daily life scenarios, for example, in a kitchen, focusing on treating executive functions such as planning and problem-solving. The control group (n=21) received conventional computerized cognitive training. Each participant received a minimum of 18 treatment sessions in their respective group. Patients were tested for cognitive status, subjective health, and quality of life before and after the intervention (Alters-Konzentrations-Test, Wechsler Memory Scale-Revised, Trail Making Test A and B, Tower of London-German version, Short Form 36, European Quality of Life 5 Dimensions visual analog scale, and Fragebogen zur Erfassung der Performance in VR).

RESULTS

Repeated-measures ANOVA revealed several significant main effects in the cognitive tests: Tower of London-German version (P=.046), Trail Making Test A (P=.01), and Wechsler Memory Scale-Revised (P=.006). However, post hoc tests revealed that the VR group showed significant improvement in the planning, executive control, and problem-solving domains (P=.046, Bonferroni P=.02). In contrast, no significant improvement in the control group between t₀ and t₁ was detected (all P>.05). Furthermore, a nonsignificant trend was observed in visual speed in the VR group (P=.09, Bonferroni P=.02).

CONCLUSIONS

The results of this pilot randomized controlled trial showed that immersive VR training in cognitive rehabilitation had greater effectiveness than the standard of care in treating patients experiencing stroke in some cognitive domains . These findings support the further use and study of VR training incorporating activities of daily living in other neurological disorders involving cognitive dysfunction.

TRIAL REGISTRATION

Federal Registry of Clinical Trials of Germany (DRKS) DRKS00023605; https://drks.de/search/de/trial/DRKS00023605.

Evolving landscape of research on cancer-related cognitive impairment: A bibliometric analysis

Objective

This study describes the state of the art in the field of cancer-related cognitive impairment (CRCI) to facilitate research opportunities in future CRCI research.

Methods

Five databases were searched: PubMed, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health (CINAHL), and PsycINFO, from inception to August 20, 2022. Python, VOSviewer, and CiteSpace software were used for data preprocessing and analysis.

Results

The published articles were predominantly from the United States, followed by China and Canada. Breast cancer and brain tumors were the dominant cancer types. The study population consisted mainly of adult cancer survivors. Prospective and multicenter studies were the most frequently used study designs. Keyword co-occurrence and mutation analysis indicated major themes: drug therapy was the most common treatment cluster, and adverse effects were another major cluster. The etiology of CRCI was a research hotspot and included the exploration of chemotherapy-associated and psychosocial factors by using measurement tools, such as neuropsychological tests and treatment outcomes.

Conclusions

This study's findings highlight CRCI as a major research area, on the basis of the significantly increasing number of annual publications. Keyword co-occurrence analysis provided a quantitative visualization of the current research status for CRCI, but this method cannot provide in-depth qualitative insights explaining the potential emerging trends in this field.