1
|
Älmqvist Nae J, Nyström A, Luccini F, Magnusson M, Ekvall Hansson E. Video exposure through virtual reality can improve older people's ability to manage postural instability caused by distortive visual environments. PLoS One 2024; 19:e0306834. [PMID: 39167614 PMCID: PMC11338449 DOI: 10.1371/journal.pone.0306834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/24/2024] [Indexed: 08/23/2024] Open
Abstract
In older adults, age-related degenerative processes and disorders often degrade some sensory systems more than others, which can make postural control disproportionally dependent on one kind of sensory information. The study aims were to investigate 1) the postural stability when healthy older adults were repeatedly exposed to a video in an immersive virtual reality (VR) environment, and 2) the relationship between stability during VR video exposure and self-reported physical activity, balance confidence, and nausea during VR. Twenty-seven older adults (18 females, mean age 71.3 years (SD 4.4)) watched a 120-second VR video 5 times with 10 minutes between sessions, while standing on a force platform recording their stability. The first VR video session produced a marked stability challenge, reflected by significantly increased use of anteroposterior and lateral total (p<0.001) and high frequency (p<0.001) energy compared with the control test quiet stance eyes open. However, repeated VR video sessions produced a multidimensional decrease in used total (p<0.001), low (p = 0.002), and high frequency energy (p<0.001). Participants used more energy in anteroposterior compared with lateral direction across sessions within all spectral ranges (p<0.001). Participants with higher physical activity level used less low frequency energy in anteroposterior direction during VR video session 1 (p = 0.033). No association was seen between balance confidence or nausea during VR and energy used during VR video sessions 1 and 5. Healthy older adults adapt fast to distortive visual environments, and thus, CNS can utilize the information provided by a few repeated VR video sessions into suitable movement strategies that have a simultaneous multidimensionally positive effect. VR may introduce numerous opportunities to customize novel rehabilitation approaches to address when the visual system causes and/or suffers from issues. However, a common problem for the older adult was that about 33% of the participants became nauseated by the VR video stimuli.
Collapse
Affiliation(s)
| | - Anastasia Nyström
- Department of Otorhinolaryngology Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Francesca Luccini
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Måns Magnusson
- Department of Otorhinolaryngology Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Eva Ekvall Hansson
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| |
Collapse
|
2
|
Endo Y, Kobayashi Y, Kishi M, Mashiko S. Influence of Visual Stimulus Changes in a Virtual Environment on Postural Control: Focusing on a Hallway Walking Simulation. J Mot Behav 2024:1-9. [PMID: 39099197 DOI: 10.1080/00222895.2024.2375560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 06/10/2024] [Accepted: 06/28/2024] [Indexed: 08/06/2024]
Abstract
The purpose of this study was to clarify the effects of the standing center of gravity sway by providing visual stimulus information as if the subjects were walking in virtual reality (VR) and by monitoring conditions with different corridor widths. We included 25 healthy young individuals in our study. The center of gravity sway was measured during open- and closed-eye static standing using images of walking in corridors of different widths (780 and 1600 mm) presented on a VR and personal computer monitor (Monitor). The parameters measured for the center of gravity sway were swing path length (SPL), height of excursion (HoE), and width of excursion (WoE). The results showed that the SPL and HoE values were significantly greater in the VR group than those in the Monitor group. The greater center of gravity sway in the VR compared with the Monitor group can be attributed to the ability of the head-mounted VR display to cover the entire field of vision and its head-tracking function. There was no change in the center of gravity sway with respect to the corridor width, which may be because the width of the corridor alone did not provide sufficient visual stimulation to affect physical function. This research could lead to further studies which could impact the motivation of patients for rehabilitation therapies.
Collapse
Affiliation(s)
- Yoshiaki Endo
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Otawara-shi, Japan
| | - Yoshino Kobayashi
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Otawara-shi, Japan
| | - Mana Kishi
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Otawara-shi, Japan
| | - Saki Mashiko
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Otawara-shi, Japan
| |
Collapse
|
3
|
Schedler S, Gramann K, Hill MW, Muehlbauer T. Balance performance of healthy young individuals in real versus matched virtual environments: a systematic scoping review. Front Hum Neurosci 2024; 18:1422581. [PMID: 39135758 PMCID: PMC11317253 DOI: 10.3389/fnhum.2024.1422581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
BackgroundDue to technological advancements and the development of consumer-oriented head mounted displays (HMDs), virtual reality (VR) is used in studies on balance performance and balance trainability more and more frequently. Yet, it may be assumed that balance performance is affected by the physical characteristics of the HMD (e.g., weight) as well as by the virtual visual environment. Moreover, it has been shown that balance is age-dependent with children and adolescents showing worse performances compared to young adults, which may also affect their balance performance in virtual environments.ObjectivesThe present systematic scoping review aims to provide an overview on the current evidence regarding balance performance of healthy, young individuals (6–30 years) in real and matched virtual environments.MethodsA systematic literature search in the electronic databases PubMed, Web of Science, and SPORTDiscus (from their inception date to February 2024) resulted in 9,554 studies potentially eligible for inclusion. Eligibility criteria were: (i) investigation of healthy, young individuals (6–30 years), (ii) balance assessment in the real and a matched virtual environment, (iii) use of a fully immersive HMD, (iv) reporting of at least one balance parameter. A total of 10 studies met the predefined inclusion criteria and were thus included in this review. All studies were conducted with healthy, young adults (19–30 years).ResultsFive studies assessed static balance, four studies quantified dynamic balance, and one study measured static as well as dynamic balance performance. In healthy young adults, static balance performance was similar with and without VR during simple standing tasks (e.g., two-legged stance), but worse in VR during more challenging tasks (e.g., one-legged stance). Concerning dynamic balance, four out of five studies reported worse performance in VR, while one study did not find differences between visual environments. Most importantly, none of the studies investigating healthy children (6–12 years) and/or adolescents (13–18 years) met the predefined inclusion criteria.ConclusionIn healthy young adults, balance performance seems to be affected by VR only during challenging static (e.g., one-legged stance) as well as during dynamic balance tasks. The underlying causes remain unclear, but factors such as perceived presence in VR, a shift in sensory organization and/or perceptual distortion may play a role. Of particular importance is the finding that there is a void in the literature on the influence of VR on balance performance of healthy children and adolescents.
Collapse
Affiliation(s)
- Simon Schedler
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, Essen, Germany
| | - Klaus Gramann
- Department of Biological Psychology and Neuroergonomics, TU Berlin, Berlin, Germany
- School of Software, University of Technology Sydney, Sydney, NSW, Australia
| | - Mathew W. Hill
- Centre for Physical Activity, Sport and Exercise Sciences, Coventry University, Coventry, United Kingdom
| | - Thomas Muehlbauer
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
4
|
Tashiro T, Maeda N, Abekura T, Mizuta R, Terao Y, Arima S, Onoue S, Urabe Y. Adaptation of Postural Sway in a Standing Position during Tilted Video Viewing Using Virtual Reality: A Comparison between Younger and Older Adults. SENSORS (BASEL, SWITZERLAND) 2024; 24:2718. [PMID: 38732825 PMCID: PMC11085622 DOI: 10.3390/s24092718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024]
Abstract
This study aimed to investigate the effects of wearing virtual reality (VR) with a head-mounted display (HMD) on body sway in younger and older adults. A standing posture with eyes open without an HMD constituted the control condition. Wearing an HMD and viewing a 30°-tilt image and a 60°-tilt image in a resting standing position were the experimental conditions. Measurements were made using a force plate. All conditions were performed three times each and included the X-axis trajectory length (mm), Y-axis trajectory length (mm), total trajectory length (mm), trajectory length per unit time (mm/s), outer peripheral area (mm2), and rectangular area (mm2). The results showed a significant interaction between generation and condition in Y-axis trajectory length (mm) and total trajectory length (mm), with an increased body center-of-gravity sway during the viewing of tilted VR images in older adults than in younger adults in both sexes. The results of this study show that body sway can be induced by visual stimulation alone with VR without movement, suggesting the possibility of providing safe and simple balance training to older adults.
Collapse
Affiliation(s)
| | - Noriaki Maeda
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; (T.T.); (T.A.); (R.M.); (S.A.); (S.O.)
| | | | | | | | | | | | - Yukio Urabe
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; (T.T.); (T.A.); (R.M.); (S.A.); (S.O.)
| |
Collapse
|
5
|
Gandolfi M, Sandri A, Menaspà Z, Avanzino L, Pelosin E, Geroin C, Vidale D, Fiorio M, Tinazzi M. How Does Postural Control in Patients with Functional Motor Disorders Adapt to Multitasking-Based Immersive Virtual Reality? Mov Disord Clin Pract 2024; 11:337-345. [PMID: 38178646 PMCID: PMC10982601 DOI: 10.1002/mdc3.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/27/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Motor symptoms in functional motor disorders (FMDs) refer to involuntary, but learned, altered movement patterns associated with aberrant self-focus, sense of agency, and belief/expectations. These conditions commonly lead to impaired posture control, raising the likelihood of falls and disability. Utilizing visual and cognitive tasks to manipulate attentional focus, virtual reality (VR) integrated with posturography is a promising tool for exploring postural control disorders. OBJECTIVES To investigate whether postural control can be adapted by manipulating attentional focus in a 3D immersive VR environment. METHODS We compared postural parameters in 17 FMDs patients and 19 age-matched healthy controls over a single session under four increasingly more complex and attention-demanding conditions: simple fixation task (1) in the real room and (2) in 3D VR room-like condition; complex fixation task in a 3D VR city-like condition (3) avoiding distractors and (4) counting them. Dual-task effect (DTE) measured the relative change in performance induced by the different attention-demanding conditions on postural parameters. RESULTS Patients reduced sway area and mediolateral center of pressure displacement velocity DTE compared to controls (all, P < 0.049), but only under condition 4. They also showed a significant reduction in the sway area DTE under condition 4 compared to condition 3 (P = 0.025). CONCLUSIONS This study provides novel preliminary evidence for the value of a 3D immersive VR environment combined with different attention-demanding conditions in adapting postural control in patients with FMDs. As supported by quantitative and objective posturographic measures, our findings may inform interventions to explore FMDs pathophysiology.
Collapse
Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC)University of VeronaVeronaItaly
- Neurorehabilitation UnitAOUIVeronaItaly
| | - Angela Sandri
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Zoe Menaspà
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Laura Avanzino
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Experimental MedicineSection of Human Physiology, University of GenoaGenoaItaly
| | - Elisa Pelosin
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Experimental MedicineSection of Human Physiology, University of GenoaGenoaItaly
| | - Christian Geroin
- Department of Surgery, Dentistry, Pediatrics and GynecologyUniversity of VeronaItaly
| | | | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| |
Collapse
|
6
|
Rosiak O, Pietrzak N, Szczęsna A, Kulczak I, Zwoliński G, Kamińska D, Konopka W, Jozefowicz-Korczynska M. The effect of Immersive Virtual Reality on balance: an exploratory study on the feasibility of head-mounted displays for balance evaluation. Sci Rep 2024; 14:3481. [PMID: 38347127 PMCID: PMC10861529 DOI: 10.1038/s41598-024-54274-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/10/2024] [Indexed: 02/15/2024] Open
Abstract
Global interest in applying virtual reality (VR) in research and medicine has grown significantly, with potential benefits for patients suffering from balance disorders, instability, and a high risk of falling. This exploratory study assesses the impact of immersive VR (IVR) delivered through a head-mounted display (HMD) on balance and explores the feasibility of using the HMD VR unit as a standalone posturography tool. Using the Meta Quest 2 HMD and a mid-range Android smartphone equipped with standard sensors, the research employed a VR environment that simulated a ship at sea, with thirty-eight healthy participants with no otoneurologic abnormalities. Measurements were conducted in repeated trials, including static assessments on both stable ground and foam, as well as a 3-m walk. This was conducted in two settings: one within a VR environment with three different intensity levels and the other in non-VR settings. Statistical analysis and clinical evaluation revealed that IVR with HMD influences head-level sway velocity, which correlates with increased visual disturbance, suggesting its potential as a low-risk standalone posturography tool.
Collapse
Affiliation(s)
- Oskar Rosiak
- Department of Otolaryngology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
| | - Nikodem Pietrzak
- Department of Otolaryngology, Student's Scientific Circle, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Anna Szczęsna
- Department of Otolaryngology, Student's Scientific Circle, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Izabela Kulczak
- Department of Otolaryngology, Student's Scientific Circle, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Grzegorz Zwoliński
- Institute of Mechatronics and Information Systems, Lodz University of Technology, Lodz, Poland.
| | - Dorota Kamińska
- Institute of Mechatronics and Information Systems, Lodz University of Technology, Lodz, Poland
| | - Wiesław Konopka
- Department of Otolaryngology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Magdalena Jozefowicz-Korczynska
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
| |
Collapse
|
7
|
Pau M, Arippa F, Leban B, Porta M, Casu G, Frau J, Lorefice L, Coghe G, Cocco E. Cybersickness in People with Multiple Sclerosis Exposed to Immersive Virtual Reality. Bioengineering (Basel) 2024; 11:115. [PMID: 38391601 PMCID: PMC10886275 DOI: 10.3390/bioengineering11020115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Together with the wide range of possible benefits for the rehabilitation/training of people with multiple sclerosis (pwMS) and other neurologic conditions, exposure to immersive virtual reality (VR) has often been associated with unpleasant symptoms, such as transient dizziness, headache, nausea, disorientation and impaired postural control (i.e., cybersickness). Since these symptoms can significantly impact the safety and tolerability of the treatment, it appears important to correctly estimate their presence and magnitude. Given the existing data scarcity, this study aims to assess the existence and severity of possible adverse effects associated with exposure to immersive VR in a cohort of pwMS using both objective measurements of postural control effectiveness and subjective evaluations of perceived symptoms. To this aim, postural sway under upright quiet posture (in the presence and absence of visual input) of 56 pwMS with an Expanded Disability Status Scale score (EDSS) in the range of 0-6.5 (mean EDSS 2.3) and 33 unaffected individuals was measured before and after a 10-min immersive VR session and at 10 min follow-up on the basis of center of pressure (COP) trajectories. The severity of cybersickness symptoms associated with VR exposure was also self-rated by the participants using the Italian version of the Simulator Sickness Questionnaire (SSQ). Temporary impairments of postural control in terms of significantly increased sway area were observed after the VR session only in pwMS with mild-moderate disability (i.e., EDSS in the range of 2.5-6.5) in the presence of visual input. No changes were observed in pwMS with low disability (EDSS 0-2) and unaffected individuals. In contrast, when the visual input was removed, there was a decrease in sway area (pwMS with mild-moderate disability) and COP path length relating to the use of VR (pwMS with mild-moderate disability and unaffected individuals), thus suggesting a sort of "balance training effect". Even in this case, the baseline values were restored at follow-up. All participants, regardless of their status, experienced significant post-VR side effects, especially in terms of blurred vision and nausea. Taken together, the findings of the present study suggest that a short immersive VR session negatively (eyes open) and positively (eyes closed) impacts the postural control of pwMS and causes significant disorientation. However, such effects are of limited duration. While it is reasonable to state that immersive VR is sufficiently safe and tolerable to not be contraindicated in the rehabilitation/training of pwMS, in order to reduce possible negative effects and maximize the efficacy, safety and comfort of the treatment, it appears necessary to develop specific guidelines that consider important factors like individual susceptibility, maximum exposure time according to the specific features of the simulation, posture to adopt and protocols to assess objective and perceived effects on participants.
Collapse
Affiliation(s)
- Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy
| | - Federico Arippa
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy
| | - Giulia Casu
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy
| | - Jessica Frau
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, 09123 Cagliari, Italy
| | - Lorena Lorefice
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, 09123 Cagliari, Italy
| | - Giancarlo Coghe
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, 09123 Cagliari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, 09123 Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, 09123 Cagliari, Italy
| |
Collapse
|
8
|
Ruiz V, Simoneau-Buessinger E, Gillet C, Elie D, Wallard L. Does an outdoor virtual environment projected in a head-mounted display affect balance in healthy young adults? J Bodyw Mov Ther 2024; 37:83-89. [PMID: 38432846 DOI: 10.1016/j.jbmt.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/24/2023] [Accepted: 11/11/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Virtual reality head-mounted display (VR-HMD) is increasingly used for balance evaluation and rehabilitation. However, more studies must be conducted on virtual environments (VE) effects. This study aimed to assess the impact of an outdoor VE projected in a high-quality VR-HMD and of the VR-HMD mass on postural stability, postural control and leaning. METHODS This study involved ten healthy young men who performed five 30-s stabilometric trials. Four experimental conditions were randomly performed: eyes open (EO) or eyes closed (EC), with (VR) or without (No VR) VR-HMD. Postural stability (antero-posterior (AP) and medio-lateral (ML) ranges of the center of pressure (CoP), 90% confidence ellipse area), postural control (CoP velocity (global, AP and ML)) and standard deviation of the CoP mean position), and postural leaning (AP/ML CoP mean position) were assessed. The comparisons between EO VR and EO No VR were used to analyze the VE effects and comparisons between EC VR and EC No VR for the VR-HMD mass effects. RESULTS Spatiotemporal parameters that characterised postural stability and postural control, except ML velocity (p > 0.05), were significantly influenced by the simulated VE with higher values in EO VR than EO No VR (p < 0.05), but not by the VR-HMD mass. The mean position of the CoP showed no significant differences between conditions. SIGNIFICANCE Postural stability and postural control modification due to the VE used in this study revealed that this VE could be interesting for VR-HMD rehabilitation and assessment. VR-HMD is not a factor to be considered for stabilometric analysis.
Collapse
Affiliation(s)
- Valentin Ruiz
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France.
| | | | - Christophe Gillet
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
| | - Dimitri Elie
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
| | - Laura Wallard
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
| |
Collapse
|
9
|
Harel D, Lubetzky AV. Portable technology for postural control measurement: Comparing head position with center of pressure data. Technol Health Care 2024; 32:2965-2979. [PMID: 38875054 DOI: 10.3233/thc-231338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
BACKGROUND Standing is a basic human function that healthy adults take for granted, yet it is a complex perceptual-motor process that requires sensation of position and motion from the sensory systems. OBJECTIVE We assessed agreement between center of pressure data from a laboratory force-platform and head position data from an HTC Vive head-mounted display (HMD) for the evaluation of standing postural control. We investigated the impact of different statistical choices when assessing the relationship between two measurements. Specifically: 1) How does correlation and agreement statistics relate before and after logarithmic transformation? 2) Is there systemic or proportional bias between the force-platform and HMD measurements? METHODS We tested 37 adults (26 controls, 11 with unilateral vestibular hypofunction) standing on foam, observing a static or dynamic visual scene projected from the HMD. We quantified anterior-posterior and medio-lateral sway via Directional Path, Root Mean Square Velocity, Variance, and Power Spectral Density (PSD) from a force-platform and the HMD. RESULTS Intra-class correlations (ICCs) were moderate-to-good for the non-transformed data and good-to-excellent after logarithmic transformation for all outcomes except for PSD above 1 Hz. Correlations were higher than ICCs. Bland-Altman plots indicated proportional bias but not after logarithmic transformation. CONCLUSIONS Both devices correlated linearly, and measure people's postural responses but cannot be used interchangeably, mostly because they appear to diverge with larger sway as evident on Bland-Altman plots of non-transformed data. Agreement between devices was excellent for low frequency movement but poor for high frequency small corrective movements.
Collapse
Affiliation(s)
- Daphna Harel
- Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY, USA
| | | |
Collapse
|
10
|
Séba MP, Maillot P, Hanneton S, Dietrich G. Influence of Normal Aging and Multisensory Data Fusion on Cybersickness and Postural Adaptation in Immersive Virtual Reality. SENSORS (BASEL, SWITZERLAND) 2023; 23:9414. [PMID: 38067787 PMCID: PMC10708879 DOI: 10.3390/s23239414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023]
Abstract
Immersive Virtual Reality (VR) systems are expanding as sensorimotor readaptation tools for older adults. However, this purpose may be challenged by cybersickness occurrences possibly caused by sensory conflicts. This study aims to analyze the effects of aging and multisensory data fusion processes in the brain on cybersickness and the adaptation of postural responses when exposed to immersive VR. METHODS We repeatedly exposed 75 participants, aged 21 to 86, to immersive VR while recording the trajectory of their Center of Pressure (CoP). Participants rated their cybersickness after the first and fifth exposure. RESULTS The repeated exposures increased cybersickness and allowed for a decrease in postural responses from the second repetition, i.e., increased stability. We did not find any significant correlation between biological age and cybersickness scores. On the contrary, even if some postural responses are age-dependent, a significant postural adaptation occurred independently of age. The CoP trajectory length in the anteroposterior axis and mean velocity were the postural parameters the most affected by age and repetition. CONCLUSIONS This study suggests that cybersickness and postural adaptation to immersive VR are not age-dependent and that cybersickness is unrelated to a deficit in postural adaptation or age. Age does not seem to influence the properties of multisensory data fusion.
Collapse
Affiliation(s)
- Marie-Philippine Séba
- Institut des Sciences du Sport Santé de Paris (URP 3625), Université Paris Cité, F-75015 Paris, France; (P.M.); (S.H.); (G.D.)
| | | | | | | |
Collapse
|
11
|
Kim J, Heo N, Kang H. Validity and reliability of positive attitudes toward and perceived importance of wearable display technology as an effective learning tool among nursing students. Nurse Educ Pract 2023; 73:103812. [PMID: 37922737 DOI: 10.1016/j.nepr.2023.103812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
AIM This study aims to verify the validity and reliability of two separate instruments used for measuring nursing students' positive attitudes toward and perceived importance of wearable display technology as an effective learning tool. BACKGROUND Healthcare professionals and undergraduates, including nursing students, use wearable display technologies, such as smart glasses and head-mounted displays, as learning tools. However, the validation of the instruments used to evaluate the perception of such use is insufficient. DESIGN This methodological study assessed an instrument used to measure nursing students' positive attitudes toward and perceived importance of wearable display technology. METHODS In total, 284 students from eight universities in six regions across South Korea participated in this study. The collected data were analyzed using SPSS/WIN 25.0 and Amos 22.0. The construct validity (exploratory factor analysis, confirmatory factor analysis and group comparison) and reliability (internal consistency) were analyzed. RESULTS Three factors and thirteen items related to positive attitudes toward wearable displays were extracted through exploratory factor analysis, with a cumulative explanatory power of 66.22%. One factor and six items were extracted, with an explanatory power of 74.61% for the perceived importance of the wearable display subscale. In the group comparison, differences in the positive attitudes toward and perceived importance of wearable display technology were observed according to the level of satisfaction with college life, level of satisfaction with the nursing major, whether the participants owned a wearable display and whether they would consider purchasing a wearable display. Each factor loading was adequate, according to the confirmatory factor analysis results. Cronbach's α for positive attitudes toward wearable displays was.79, while that for perceived importance of wearable displays was.93. CONCLUSION The developed instrument can be used to evaluate nursing students' positive attitudes toward and perceived importance of wearable display technology as an effective learning tool in the future. This study can serve as a basis for developing and applying wearable display technologies in nursing education.
Collapse
Affiliation(s)
- Jiyoung Kim
- Department of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, the Republic of Korea.
| | - Narae Heo
- Department of Nursing, Hansei University, 30, Hansei-ro, Gunpo-city, Gyeonggi-do 15852, the Republic of Korea
| | - Hyuncheol Kang
- Department of Big Data AI, Hoseo University, 20, Hoseo-ro79beon-gil, Baebang-eup, Asan-si, Chungcheongnam-do 31499, the Republic of Korea
| |
Collapse
|
12
|
Nikitas C, Kikidis D, Pardalis A, Tsoukatos M, Papadopoulou S, Bibas A, Bamiou DE. Head mounted display effect on vestibular rehabilitation exercises performance. J Frailty Sarcopenia Falls 2023; 8:66-73. [PMID: 37275662 PMCID: PMC10233325 DOI: 10.22540/jfsf-08-066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 06/07/2023] Open
Abstract
Objectives Vestibular rehabilitation clinical guidelines document the additional benefit offered by the Mixed Reality environments in the reduction of symptoms and the improvement of balance in peripheral vestibular hypofunction. The HOLOBalance platform offers vestibular rehabilitation exercises, in an Augmented Reality (AR) environment, projecting them using a low- cost Head Mounted Display. The effect of the AR equipment on the performance in three of the commonest vestibular rehabilitation exercises is investigated in this pilot study. Methods Twenty-five healthy adults (12/25 women) participated, executing the predetermined exercises with or without the use of the AR equipment. Results Statistically significant difference was obtained only in the frequency of head movements in the yaw plane during the execution of a vestibular adaptation exercise by healthy adults (0.97 Hz; 95% CI=(0.56, 1.39), p<0.001). In terms of difficulty in exercise execution, the use of the equipment led to statistically significant differences at the vestibular-oculomotor adaptation exercise in the pitch plane (OR=3.64, 95% CI (-0.22, 7.50), p=0.049), and in the standing exercise (OR=28.28. 95% CI (23.6, 32.96), p=0.0001). Conclusion Τhe use of AR equipment in vestibular rehabilitation protocols should be adapted to the clinicians' needs.
Collapse
Affiliation(s)
- Christos Nikitas
- 1 Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Dimitris Kikidis
- 1 Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Athanasios Pardalis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Michalis Tsoukatos
- 1 Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Sofia Papadopoulou
- 1 Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Athanasios Bibas
- 1 Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Doris E. Bamiou
- Ear Institute, University College London, London, United Kingdom
- Biomedical Research Centre Hearing and Deafness, University College London Hospitals, London, United Kingdom
| |
Collapse
|
13
|
Moura Neto ED, Fonseca BHDS, Rocha DS, Souza LAPSD, Abdalla DR, Viana DA, Luvizutto GJ. Additional acute effects of virtual reality head-mounted displays on balance outcomes in non-disabled individuals: a proof-of-concept study. MOTRIZ: REVISTA DE EDUCACAO FISICA 2022. [DOI: 10.1590/s1980-657420220006721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
14
|
García-Muñoz C, Casuso-Holgado MJ, Hernández-Rodríguez JC, Pinero-Pinto E, Palomo-Carrión R, Cortés-Vega MD. Feasibility and safety of an immersive virtual reality-based vestibular rehabilitation programme in people with multiple sclerosis experiencing vestibular impairment: a protocol for a pilot randomised controlled trial. BMJ Open 2021; 11:e051478. [PMID: 34810187 PMCID: PMC8609940 DOI: 10.1136/bmjopen-2021-051478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Vestibular system damage in patients with multiple sclerosis (MS) may have a central and/or peripheral origin. Subsequent vestibular impairments may contribute to dizziness, balance disorders and fatigue in this population. Vestibular rehabilitation targeting vestibular impairments may improve these symptoms. Furthermore, as a successful tool in neurological rehabilitation, immersive virtual reality (VRi) could also be implemented within a vestibular rehabilitation intervention. METHODS AND ANALYSIS This protocol describes a parallel-arm, pilot randomised controlled trial, with blinded assessments, in 30 patients with MS with vestibular impairment (Dizziness Handicap Inventory ≥16). The experimental group will receive a VRi vestibular rehabilitation intervention based on the conventional Cawthorne-Cooksey protocol; the control group will perform the conventional protocol. The duration of the intervention in both groups will be 7 weeks (20 sessions, 3 sessions/week). The primary outcomes are the feasibility and safety of the vestibular VRi intervention in patients with MS. Secondary outcome measures are dizziness symptoms, balance performance, fatigue and quality of life. Quantitative assessment will be carried out at baseline (T0), immediately after intervention (T1), and after a follow-up period of 3 and 6 months (T2 and T3). Additionally, in order to further examine the feasibility of the intervention, a qualitative assessment will be performed at T1. ETHICS AND DISSEMINATION The study was approved by the Andalusian Review Board and Ethics Committee, Virgen Macarena-Virgen del Rocio Hospitals (ID 2148-N-19, 25 March 2020). Informed consent will be collected from participants who wish to participate in the research. The results of this research will be disseminated by publication in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT04497025.
Collapse
Affiliation(s)
| | | | | | | | - Rocío Palomo-Carrión
- Department of Nursery, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, Toledo, Spain
- GIFTO, Physiotherapy Research Group, Toledo, Spain
| | | |
Collapse
|
15
|
Ahn MK, Lee CM. [Development and Effects of Head-Mounted Display-Based Home-Visits Virtual Reality Simulation Program for Nursing Students]. J Korean Acad Nurs 2021; 51:465-477. [PMID: 34497255 DOI: 10.4040/jkan.21051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to evaluate the effects of head monted display based home-visits virtual reality simulation (HVRS) program developed for undergraduate nursing students. METHODS A nonequivalent control group with a non-synchronized design was utilized and 84 participants (experimental group, 44; control group, 40) were recruited from August 31, 2020 to November 8, 2020 in Gwangju metropolitan city. The HVRS program consisted of scenarios of three nursing cases, hypertension, diabetes mellitus, and stroke. Data were analyzed SPSS version 25.0 for Windows. RESULTS At the completion of HVRS, significant differences were found between groups in knowledge of home-visits (t = 4.73, p < .001), self-confidence (t = 6.63, p < .001), self-efficacy (t = 3.13, p = .002), and clinical competency (t = 4.13, p < .001). No significant difference was shown between groups in nursing knowledge about strokes, a subcategory of knowledge pertaining to home visits. CONCLUSION The HVRS program developed for undergraduate nursing students is effective in improving knowledge of home-visits, self-confidence, self-efficacy, and clinical competency for nursing students.
Collapse
Affiliation(s)
- Min Kweon Ahn
- Department of Nursing, Chosun Nursing College, Gwangju, Korea
| | - Chong Mi Lee
- Department of Nursing, Chosun Nursing College, Gwangju, Korea.
| |
Collapse
|