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Park, Jong-Hwan, Yung Liao, Du-Ri Kim, Seunghwan Song, Jun Ho Lim, Hyuntae Park, Yeanhwa Lee, and Kyung Won Park. "Feasibility and Tolerability of a Culture-Based Virtual Reality (VR) Training Program in Patients with Mild Cognitive Impairment: A Randomized Controlled Pilot Study." International Journal of Environmental Research and Public Health 17, no. 9 (April 27, 2020): 3030. http://dx.doi.org/10.3390/ijerph17093030.
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The present study examined whether a culture-based virtual reality (VR) training program is feasible and tolerable for patients with amnestic mild cognitive impairment (aMCI), and whether it could improve cognitive function in these patients. Twenty-one outpatients with aMCI were randomized to either the VR-based training group or the control group in a 1:1 ratio. The VR-based training group participated in training for 30 min/day, two days/week, for three months (24 times). The VR-based program was designed based on Korean traditional culture and used attention, processing speed, executive function and memory conditions to stimulate cognitive function. The adherence to the culture-based VR training program was 91.55% ± 6.41% in the VR group. The only adverse events observed in the VR group were dizziness (4.2%) and fatigue (8.3%). Analysis revealed that the VR-based training group exhibited no significant differences following the three-month VR program in Korean Mini-Mental State Examination (K-MMSE) scores, working memory functions such as performance on the digit span test, or in Stroop test performance and word fluency. We conclude that although the 12-week culture-based VR training program did not improve cognitive function, our findings revealed that the culture-based VR training program was feasible and tolerable for participants with aMCI.
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Varas-Diaz, Gonzalo, Shivani Paralkar, Shuaijie Wang, and Tanvi Bhatt. "Kinematic Gait Adjustments to Virtual Environments on Different Surface Conditions: Do Treadmill and Over-Ground Walking Exhibit Different Adaptations to Passive Virtual Immersion?" Rehabilitation Research and Practice 2020 (December 19, 2020): 1–12. http://dx.doi.org/10.1155/2020/8901973.
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Background. The aim of this study was to examine the kinematic gait adjustments performed in response to passive and photorealistic virtual reality environment (VRE) demands during over-ground and treadmill walking conditions and determine whether the surface presentation order affects the gait adjustments in response to different VREs. Methods. Twenty young participants divided into two groups performed two virtual reality (VR) walking protocols which included two different VREs (snowy and crowded conditions). Group A performed the VR over-ground protocol (four natural walking (NW), seven VR snowy, and seven VR crowded trials) followed by the VR treadmill protocol (four NW, one VR snowy, and one VR crowded trials); Group B performed the VR treadmill protocol (four NW, seven VR snowy, and seven VR crowded trials) followed by the VR over-ground protocol (four NW, one VR snowy, and one VR crowded trials). Center of mass (COM) excursion angles and mediolateral (ML) COM excursions were analyzed and used as outcome measures. Results. Group A showed higher COM excursion angles and ML-COM excursion on over-ground VR trials compared to NW trials ( p < 0.05 ), while Group B only showed kinematic changes for the crowded VRE compared to NW trials during the treadmill walking protocol ( p < 0.05 ). Post over-ground exposure, Group A showed greater COM excursion angle and ML-COM excursions on VR trials compared to NW trials during the treadmill walking protocol ( p < 0.05 ). Post treadmill exposure, Group B only showed higher COM excursion angles for the snowy VRE compared to NW trials during the over-ground walking protocol ( p < 0.01 ). Conclusion. Results showed that higher kinematic gait adjustments in response to VRE demands were observed during over-ground walking. Additionally, higher sensorimotor responses to VRE demands were observed when the VR protocol was first performed on the over-ground surface and followed by the treadmill walking condition (Group A) compared to the opposite (Group B).
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Beltrame, Valentina, Mario Gruppo, Sergio Pedrazzoli, Stefano Merigliano, Davide Pastorelli, and Cosimo Sperti. "Mesenteric-Portal Vein Resection during Pancreatectomy for Pancreatic Cancer." Gastroenterology Research and Practice 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/659730.
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The aim of the present study was to determine the outcome of patients undergoing pancreatic resection with (VR+) or without (VR−) mesenteric-portal vein resection for pancreatic carcinoma. Between January 1998 and December 2012, 241 patients with pancreatic cancer underwent pancreatic resection: in 64 patients, surgery included venous resection for macroscopic invasion of mesenteric-portal vein axis. Morbidity and mortality did not differ between the two groups (VR+: 29% and 3%; VR−: 30% and 4.0%, resp.). Radical resection was achieved in 55/64 (78%) in the VR+ group and in 126/177 (71%) in the VR− group. Vascular invasion was histologically proven in 44 (69%) of the VR+ group. Survival curves were not statistically different between the two groups. Mean and median survival time were 26 and 15 months, respectively, in VR− versus 20 and 14 months, respectively, in VR+ groupp=0.52. In the VR+ group, only histologically proven vascular invasion significantly impacted survivalp=0.02, while, in the VR− group, R0 resectionp=0.001and tumor’s gradingp=0.01significantly influenced long-term survival. Vascular resection during pancreatectomy can be performed safely, with acceptable morbidity and mortality. Long-term survival was the same, with or without venous resection. Survival was worse for patients with histologically confirmed vascular infiltration.
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Hayashi, Kazuhiro, Shuichi Aono, Yukiko Shiro, and Takahiro Ushida. "Effects of Virtual Reality-Based Exercise Imagery on Pain in Healthy Individuals." BioMed Research International 2019 (April 17, 2019): 1–9. http://dx.doi.org/10.1155/2019/5021914.
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Objective. Virtual reality (VR) is an advanced technology that can be used to attenuate pain. The present study aimed to investigate which method was more effective for pain management: VR combined with exercise imagery or VR distraction. Methods. Fifty-two healthy students participated in this randomized cross-over controlled trial. One VR-based task aimed to passively use the imagery of driving a car as a distraction intervention (the driving group), whereas the other VR-based task aimed to use exercise imagery (running) to actively engage the participants in movement (the running group). The mechanical pressure pain thresholds of the quadriceps and forearm and the heat pain threshold of the hand of each subject were measured before, during, and after each VR task. The differences between the values at each time point and the differences between the groups were analyzed. Results. The pressure and heat pain thresholds were significantly greater during VR task than those before VR task in both driving and running groups. The changes in the pressure pain thresholds that occurred during VR task were significantly higher in the running group than in the driving group. The difference between groups gradually declined after VR task. Conversely, there was no significant difference in the changes in the heat pain thresholds between the groups both during VR task and after VR task. Conclusions. VR combined with exercise imagery has a greater effect on pressure pain thresholds, but not heat pain thresholds, than VR distraction.
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Ryu, Jung-Hee, Jin-Woo Park, Sang Il Choi, Ji Young Kim, Hyunju Lee, Hee-Jeong Yoo, and Sung-Hee Han. "Virtual Reality vs. Tablet Video as an Experiential Education Platform for Pediatric Patients Undergoing Chest Radiography: A Randomized Clinical Trial." Journal of Clinical Medicine 10, no. 11 (June 4, 2021): 2486. http://dx.doi.org/10.3390/jcm10112486.
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Virtual reality (VR), which offers an immersive experience, has been implemented into the education of pediatric patients to reduce peri-procedural anxiety. This randomized clinical trial evaluated the effect of VR, compared with standard video, on reducing anxiety and distress in pediatric patients undergoing chest radiography. A total of 120 children aged 4 to 8 years with scheduled chest radiography appointments were randomized into either the tablet or the VR group. Children in the tablet group experienced chest radiography indirectly with a 3 min tablet video, whereas those in the VR group received the same content via a VR experience. The distress of children was measured using the Observational Scale of Behavioral Distress (OSBD) scale. Parental presence and procedural outcomes were also recorded. The number of less distressed children (OSBD score < 5) was significantly higher in the VR group than in the tablet group (49 [81.7%]) vs. 32 [53.3%]) (p = 0.001). The OSBD scores, the need for parental presence, the procedure time, and the number of repeated procedures were all lower in the VR group. The immersive VR experience appears to decrease the degree of anxiety in children and increase the efficiency of the procedures compared with the tablet video with the same content.
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Li, Zhicheng, Qiuhua Yu, Haizhen Luo, Wenzhao Liang, Xin Li, Le Ge, Siyun Zhang, Le Li, and Chuhuai Wang. "The Effect of Virtual Reality Training on Anticipatory Postural Adjustments in Patients with Chronic Nonspecific Low Back Pain: A Preliminary Study." Neural Plasticity 2021 (July 27, 2021): 1–13. http://dx.doi.org/10.1155/2021/9975862.
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Objectives. This study is aimed at exploring the effects of virtual reality (VR) training on postural control, measured by anticipatory and compensatory postural adjustments (APAs and CPAs, respectively), in patients with chronic nonspecific low back pain (CNLBP) and the potential neuromuscular mechanism of VR training. Methods. Thirty-four patients were recruited and randomly assigned to the VR group ( n = 11 ), the motor control exercise group (MCE, n = 12 ) and the control group (CG, n = 11 ). The VR group received VR training using Kinect Xbox 360 systems and magnetic therapy. Besides magnetic therapy, the participants in the MCE group performed real-time ultrasound-guided abdominal drawing-in maneuver (ADIM) and four-point kneeling exercise. The CG only received magnetic therapy. Surface muscle electromyography (sEMG) was used to record the muscle activities of transverse abdominis (TrA), multifidus (MF), lateral gastrocnemius (LG), and tibialis anterior (TA) during ball-hitting tasks. The muscle activation time and integrals of the electromyography activities (IEMGs) during the APA and CPA stages were calculated and used in the data analysis. The visual analogue scale (VAS) and Oswestry dysfunction index (ODI) scores were also recorded. Results. A significant interaction effect of time × group was observed on the activation time of TrA ( p = 0.018 ) and MF ( p = 0.037 ). The post-intervention activation time of the TrA was earlier in the VR group ( p = 0.029 ). In contrast, the post-intervention activation time of the MF was significantly delayed in the VR group ( p = 0.001 ). The IEMGs of TrA ( p = 0.002 ) and TA ( p = 0.007 ) during CPA1 significantly decreased only in the VR group after the intervention. The VAS scores of three group participants showed significant decreases after intervention ( p < 0.001 ). Conclusions. Patients with CNLBP showed reciprocal muscle activation patterns of the TrA and MF muscles after VR training. VR training may be a potential intervention for enhancing the APAs of the patients with CNLBP.
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ÖGÜN, Muhammed Nur, Ramazan KURUL, Mustafa Fatih YAŞAR, Sule Aydin TURKOGLU, Şebnem AVCI, and Nebil YILDIZ. "Effect of Leap Motion-based 3D Immersive Virtual Reality Usage on Upper Extremity Function in Ischemic Stroke Patients." Arquivos de Neuro-Psiquiatria 77, no. 10 (October 2019): 681–88. http://dx.doi.org/10.1590/0004-282x20190129.
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ABSTRACT Immersive virtual reality (VR) is a technology that provides a more realistic environmental design and object tracking than ordinary VR. The aim of this study was to investigate the effectiveness of immersive VR on upper extremity function in patients with ischemic stroke. Sixty-five patients with ischemic stroke were included in this randomized, controlled, double-blind study. Patients were randomly divided into VR (n = 33) and control (n = 32) groups. The VR group received 60 minutes of the upper extremity immersive VR rehabilitation program and the control group received 45 minutes of conventional therapy and 15 minutes of a sham VR program. Rehabilitation consisted of 18 sessions of therapy, three days per week, for six weeks. The outcome measures were the Action Research Arm Test (ARAT), Functional Independence Measure (FIM), Fugl-Meyer Upper Extremity Scale (FMUE) and Performance Assessment of Self-Care Skills (PASS). In both the VR and control groups all parameters except the PASS improved over time. However independent t-test results showed that all of the FMUE, ARAT, FIM and PASS scores were significantly higher in the VR group compared with the control (p < 0.05). The minimal clinically important difference (MCID) scores of the FMUE and ARAT were higher than the cut-off MCID scores described in the literature in the VR group, whereas the FIM scores were below the cut-off MCID scores. All scores in the control group were below the cut-off scores. Immersive VR rehabilitation appeared to be effective in improving upper extremity function and self-care skills, but it did not improve functional independence.
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Moon, Jee, Jungho Shin, Jaeyeon Chung, Sang-Hwan Ji, Soohan Ro, and Won Kim. "Virtual Reality Distraction during Endoscopic Urologic Surgery under Spinal Anesthesia: A Randomized Controlled Trial." Journal of Clinical Medicine 8, no. 1 (December 20, 2018): 2. http://dx.doi.org/10.3390/jcm8010002.
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Sedation protocols during spinal anesthesia often involve sedative drugs associated with complications. We investigated whether virtual reality (VR) distraction could be applied during endoscopic urologic surgery under spinal anesthesia and yield better satisfaction than pharmacologic sedation. VR distraction without sedative was compared with pharmacologic sedation using repeat doses of midazolam 1–2 mg every 30 min during urologic surgery under spinal anesthesia. We compared the satisfaction of patients, surgeons, and anesthesiologists, as rated on a 5-point prespecified verbal rating scale. Two surgeons and two anesthesiologists rated the scale and an overall score was reported after discussion. Thirty-seven patients were randomized to a VR group (n = 18) or a sedation group (n = 19). The anesthesiologist’s satisfaction score was significantly higher in the VR group than in the sedation group (median (interquartile range) 5 (5–5) vs. 4 (4–5), p = 0.005). The likelihood of both patients and anesthesiologists being extremely satisfied was significantly higher in the VR group than in the sedation group. Agreement between the scores for surgeons and those for anesthesiologists was very good (kappa = 0.874 and 0.944, respectively). The incidence of apnea was significantly lower in the VR group than in the sedation group (n = 1, 5.6% vs. n = 7, 36.8%, p = 0.042). The present findings suggest that VR distraction is better than drug sedation with midazolam in terms of patient’s and anesthesiologist’s satisfaction and avoiding the respiratory side effects of midazolam during endoscopic urologic surgery under spinal anesthesia.
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DANCHEV, PETER V. "WARFIELD INVARIANTS IN COMMUTATIVE GROUP RINGS." Journal of Algebra and Its Applications 08, no. 06 (December 2009): 829–36. http://dx.doi.org/10.1142/s0219498809003679.
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We calculate, only in terms of a commutative unital ring R of prime characteristic p and an abelian p-mixed group G, the classical Warfield q-invariants Wα,q(VR(G)) of the group VR(G) of all normalized units in the group ring R(G). This continues our results in (Extr. Math., 2005), (Collect. Math., 2008) and (J. Alg. Appl., 2008).
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Loehrl, Todd A., Timothy L. Smith, Ronald J. Darling, Laura Torrico, Thomas E. Prieto, Reza Shaker, Robert J. Toohill, and Safwan S. Jaradeh. "Autonomic dysfunction, vasomotor rhinitis, and extraesophageal manifestations of gastroesophageal reflux." Otolaryngology–Head and Neck Surgery 126, no. 4 (April 2002): 382–87. http://dx.doi.org/10.1067/mhn.2002.123857.
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OBJECTIVE: Several recent reports suggest there may be a relationship between chronic rhinitis and extraesophageal manifestations of gastroe-sophageal reflux (EER). It is hypothesized that this relationship is a result of autonomic nervous system (ANS) dysfunction. STUDY DESIGN: Patients with isolated vasomotor rhinitis (VR), both VR and EER, and a control group were studied by a battery of tests designed to objectively evaluate ANS function. In addition all 3 groups underwent barium esophagogram and 4-site (proximal pharynx, distal pharynx, proximal esophagus, and distal esophagus) ambulatory pH monitoring. Adult patients fulfilling diagnostic criteria for VR, and with both VR and EER underwent objective ANS testing in a recently developed ANS testing laboratory. The control group consisted of age- and sex-matched adults without diagnostic criteria for VR or EER. RESULTS: In patients with VR only (n = 9), 2 patients had a positive esophagogram, whereas a positive pharyngeal reflux probe was found in 1 and an abnormal composite autonomic scoring scale (CASS) was found in 8 (mean VR CASS = 1.750 vs control CASS 0.556, P = .02). The group with VR and EER (n = 12) had a positive esophagogram in 10 patients, positive pharyngeal reflux by probe in 9, and all 12 had an abnormal CASS (mean CASS VR/EER = 2.909 vs CASS control = 0.556, P = .001 and vs VR CASS = 1.750, P = .05). The control patients (n = 9) had normal transesopohageal gastroduo-denoscopy in 8, 1 had a positive pharyngeal probe study, and all 9 had a normal CASS. In addition ANS testing in patients with diagnostic criteria for both VR/EER revealed statistically significant evidence of an adrenergic deficit as compared with control patients on the basis of mean phase II blood pressure response to Valsalva maneuver (mean phase II VR/EER = −16.730 vs control = −7.780, P = .05). In the VR only group, the phase II blood pressure decrease was greater than in control patients, but did not reach statistical significance (mean phase II VR = −9.370 vs control = − 7.780, P = 0.672). CONCLUSION: Patients with VR and VR/EER have objective evidence of ANS dysfunction when compared with a group of age- and sex-matched control patients. Patients with both VR/EER demonstrate a significantly greater degree of ANS dysfunction than patients with isolated VR. The mechanism by which VR and EER interact is not entirely clear, but ANS dysfunction is objectively associated with both disorders. In addition, patients with VR/EER seem to demonstrate hypo-function of the adrenergic component of the ANS, in contrast to the generally held hypothesis that VR results from increased cholinergic activity. Further characterization of the type of ANS abnormality may allow the development of novel pharmacologic therapies for these disorders.
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Goe, Rebecca, Catherine Ipsen, and Stacey Bliss. "Pilot Testing a Digital Career Literacy Training for Vocational Rehabilitation Professionals." Rehabilitation Counseling Bulletin 61, no. 4 (August 16, 2017): 236–43. http://dx.doi.org/10.1177/0034355217724341.
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Digital career literacy encompasses the skills needed to find and maintain employment in the modern job market. Unfortunately, many state vocational rehabilitation (VR) professionals report feeling unprepared to help their consumers with digital career literacy tasks. To address this gap, we developed and tested five training webinars with VR professionals in Montana, Alabama, and Washington. We randomly assigned VR offices to intervention or control group. VR professionals in the intervention group received access to the training webinars. We collected survey data at baseline and 4 months after the intervention’s conclusion ( n = 136). A repeated measures ANOVA showed significant group by factor effects in counselor preparedness to use online tools during the VR process (intervention group: M1 = 24.41, SD1 = 7.62; M2 = 28.76, SD2 = 7.27; control group: M1 = 25.94, SD1 = 8.64; M2 = 27.21, SD2 = 9.14); F(1, 124) = 5.957, p = .016. A McNemar nonparametric test indicated that more VR professionals in the intervention group reported using LinkedIn at the 4-month follow-up, as compared with the control group ( p = .039). There were no significant changes in use of other online tools. This may relate to administrative policies that do not provide clear guidelines for using online tools in the counseling process.
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Moon, Kyung Ji, Myung Chul Lee, Upyong Hong, Soo Rim Noh, Chang Hoon Park, and Kyung Hun Han. "Physiological Response of Imagery Running with or without an Avatar in 3D Virtual Reality: A Preliminary Study." Asian Journal of Kinesiology 23, no. 3 (July 31, 2021): 11–19. http://dx.doi.org/10.15758/ajk.2021.23.3.11.
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OBJECTIVES The present study is aimed at observing the physiological response imagery running with an avatar in 3D virtual reality (VR) and to explore the differences in physiological responses between imagery running with and without an avatar in 3D VR.METHODS We randomly assigned 32 healthy adults to either a group with Avatar (n = 19) or a group without (n = 13). The group with avatar performed imagery exercise with an avatar in 3D VR and the group without Avatar performed it without an avatar in 3D VR. Both groups were instructed to mentally imagine performing running in VR without executing actual physical movements. We recorded electro-physiological data before, during, and after the 20-min intervention. We also measured the participants’ level of presence and intensity of experienced cybersickness.RESULTS In the group with Avatar, all physiological responses increased from the resting to the intervention period. The group with Avatar also showed a higher level of presence and fewer cybersickness symptoms than the group without Avatar.CONCLUSIONS The results suggest imagery running with an avatar in 3D VR might be effective as an alternative exercise.
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L, Shilpa H. "The role of virtual reality on pain during intravenous cannulation and preoperative separation anxiety in paediatric patients: A prospective randomised study." MedPulse International Journal of Anesthesiology 19, no. 2 (2021): 35–38. http://dx.doi.org/10.26611/10151923.
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Background: Pain and anxiety in paediatric patients creates significant problems for the patients and the treating physicians. Virtual reality is a relatively new intervention that can be used to provide distraction. Aim: The aim of the proposed study is to evaluate virtual reality (VR) as a non-pharmacological intervention tool to reduce pain and anxiety in patients of paediatric age group undergoing intravenous cannulation. Methods: This was a prospective randomised trial that enrolled paediatric patients of age group 7-11 years. Patients were randomly allocated to virtual reality group where they were made to wear VR headgear and videos were played and standard Emla cream group where cream was applied at the intended site of intravenous cannulation. Results: Patients using VR exhibited lower pain and anxiety score during intravenous cannulation. Conclusions: This current study found that application of immersive VR had better pain alleviation and parent separation anxiety score when compared with non-VR group patient.
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Steineke, Thomas C., and Daniela Barbery. "Microsurgical clipping of middle cerebral artery aneurysms: preoperative planning using virtual reality to reduce procedure time." Neurosurgical Focus 51, no. 2 (August 2021): E12. http://dx.doi.org/10.3171/2021.5.focus21238.
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OBJECTIVE The authors sought to evaluate the impact of virtual reality (VR) applications for preoperative planning and rehearsal on the total procedure time of microsurgical clipping of middle cerebral artery (MCA) ruptured and unruptured aneurysms compared with standard surgical planning. METHODS A retrospective review of 21 patients from 2016 to 2019 was conducted to determine the impact on the procedure time of MCA aneurysm clipping after implementing VR for preoperative planning and rehearsal. The control group consisted of patients whose procedures were planned with standard CTA and DSA scans (n = 11). The VR group consisted of patients whose procedures were planned with a patient-specific 360° VR (360VR) model (n = 10). The 360VR model was rendered using CTA and DSA data when available. Each patient was analyzed and scored with a case complexity (CC) 5-point grading scale accounting for aneurysm size, incorporation of M2 branches, and aspect ratio, with 1 being the least complex and 5 being the most complex. The mean procedure times were compared between the VR group and the control group, as were the mean CC score between the groups. Comorbidities and aneurysm conduction (ruptured vs unruptured) were also taken into consideration for the comparison. RESULTS The mean CC scores for the control group and VR group were 2.45 ± 1.13 and 2.30 ± 0.48, respectively. CC was not significantly different between the two groups (p = 0.69). The mean procedure time was significantly lower for the VR group compared with the control group (247.80 minutes vs 328.27 minutes; p = 0.0115), particularly for the patients with a CC score of 2 (95% CI, p = 0.0064). A Charlson Comorbidity Index score was also calculated for each group, but no statistical significance was found (VR group, 2.8 vs control group, 1.8, p = 0.14). CONCLUSIONS In this study, usage of 360VR models for planning the craniotomy and rehearsing with various clip sizes and configurations resulted in an 80-minute decrease in procedure time. These findings have suggested the potential of VR technology in improving surgical efficiency for aneurysm clipping procedures regardless of complexity, while making the procedure faster and safer.
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Kim, Byeol, Yue-Hin Loke, Paige Mass, Matthew R. Irwin, Conrad Capeland, Laura Olivieri, and Axel Krieger. "A Novel Virtual Reality Medical Image Display System for Group Discussions of Congenital Heart Disease: Development and Usability Testing." JMIR Cardio 4, no. 1 (December 8, 2020): e20633. http://dx.doi.org/10.2196/20633.
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Background The complex 3-dimensional (3D) nature of anatomical abnormalities in congenital heart disease (CHD) necessitates multidisciplinary group discussions centered around the review of medical images such as magnetic resonance imaging. Currently, group viewings of medical images are constrained to 2-dimensional (2D) cross-sectional displays of 3D scans. However, 2D display methods could introduce additional challenges since they require physicians to accurately reconstruct the images mentally into 3D anatomies for diagnosis, staging, and planning of surgery or other therapies. Virtual reality (VR) software may enhance diagnosis and care of CHD via 3D visualization of medical images. Yet, present-day VR developments for medicine lack the emphasis on multiuser collaborative environments, and the effect of displays and level of immersion for diagnosing CHDs have not been studied. Objective The objective of the study was to evaluate and compare the diagnostic accuracies and preferences of various display systems, including the conventional 2D display and a novel group VR software, in group discussions of CHD. Methods A total of 22 medical trainees consisting of 1 first-year, 10 second-year, 4 third-year, and 1 fourth-year residents and 6 medical students, who volunteered for the study, were formed into groups of 4 to 5 participants. Each group discussed three diagnostic cases of CHD with varying structural complexity using conventional 2D display and group VR software. A group VR software, Cardiac Review 3D, was developed by our team using the Unity engine. By using different display hardware, VR was classified into nonimmersive and full-immersive settings. The discussion time, diagnostic accuracy score, and peer assessment were collected to capture the group and individual diagnostic performances. The diagnostic accuracies for each participant were scored by two experienced cardiologists following a predetermined answer rubric. At the end of the study, all participants were provided a survey to rank their preferences of the display systems for performing group medical discussions. Results Diagnostic accuracies were highest when groups used the full-immersive VR compared with the conventional and nonimmersive VR (χ22=9.0, P=.01) displays. Differences between the display systems were more prominent with increasing case complexity (χ22=14.1, P<.001) where full-immersive VR had accuracy scores that were 54.49% and 146.82% higher than conventional and nonimmersive VR, respectively. The diagnostic accuracies provided by the two cardiologists for each participant did not statistically differ from each other (t=–1.01, P=.31). The full-immersive VR was ranked as the most preferred display for performing group CHD discussions by 68% of the participants. Conclusions The most preferred display system among medical trainees for visualizing medical images during group diagnostic discussions is full-immersive VR, with a trend toward improved diagnostic accuracy in complex anatomical abnormalities. Immersion is a crucial feature of displays of medical images for diagnostic accuracy in collaborative discussions.
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Canares, Therese, Carisa Parrish, Christine Santos, Alia Badawi, Alyssa Stewart, Keith Kleinman, Kevin Psoter, and Joseph McGuire. "Pediatric Coping During Venipuncture With Virtual Reality: Pilot Randomized Controlled Trial." JMIR Pediatrics and Parenting 4, no. 3 (July 28, 2021): e26040. http://dx.doi.org/10.2196/26040.
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Background Virtual reality (VR) has shown promise in reducing children’s pain and anxiety during venipuncture, but studies on VR lack objective observations of pediatric coping. Notably, the process of capturing objective behavioral coping data can be labor- and personnel-intensive. Objective The primary aims of this pilot trial were to assess the feasibility of conducting a trial of VR in a pediatric emergency department and the feasibility of documenting observed coping behaviors during pediatric procedures. Secondarily, this study examined whether VR affects child and caregiver coping and distress during venipuncture in the pediatric emergency department. Methods This stratified, randomized, controlled pilot trial compared coping and distress between child life–supported VR engagement and child life specialist support without VR during painful procedures in children aged 7-22 years in the pediatric emergency department. An external control (reference group) received no standardized support. Primary feasibility outcomes included rates of recruitment, rates of withdrawal from VR, and rates of completed Child Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF) observations. Secondary clinical outcomes were applied to venipuncture procedures and included CAMPIS-SF coping and distress (range 0-1.0), pain and anxiety on a visual analog scale (range 0-10), and cybersickness symptoms. Results Overall recruitment was 93% (66/71), VR withdrawal rate was 27% (4/15), and of the completed procedures, 100% (63/63) CAMPIS-SF observations were completed. A total of 55 patients undergoing venipuncture in the pediatric emergency department were included in the analyses of clinical outcomes: 15 patients (15 caregivers) randomized to VR, 20 patients (15 caregivers) randomized to child life specialist support, and 20 patients (17 caregivers) in the reference group. Patient coping differed across groups with higher coping in the VR group and child life specialist group than in the reference group (P=.046). There were no significant differences in the distress and pain ratings for patients and caregivers between the groups. Caregivers rated the lowest perceived anxiety in the child life specialist group (P=.03). There was no apparent change in cybersickness symptoms before and after VR use (P=.37). Conclusions Real-time documentation of observed behaviors in patients and caregivers was feasible during medical procedures in which VR was utilized, particularly with the availability of research staff. VR and child life specialists improved coping in children during venipuncture procedures. Given the high participation rate, future studies to evaluate the efficacy of VR are recommended to determine whether an off-the-shelf VR headset can be a low-cost and low-risk tool to improve children’s coping during venipuncture or other related procedures. Trial Registration ClinicalTrials.gov NCT03686176; https://clinicaltrials.gov/ct2/show/NCT03686176
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Trottier, E. D., E. Osmanlliu, B. Bailey, M. Lagacé, M. Certain, C. Khadra, M. Sanchez, et al. "LO52: Distraction in the ED using Virtual reality for Intravenous Needs in Children to Improve comfort- DEVINCI - a pilot RCT." CJEM 22, S1 (May 2020): S26. http://dx.doi.org/10.1017/cem.2020.107.
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Introduction: Venipuncture is a frequent cause of pain and distress in the pediatric emergency department (ED). Distraction, which can improve patient experience, remains the most studied psychological intervention. Virtual reality (VR) is a method of immersive distraction that can contribute to the multi-modal management of procedural pain and distress. Methods: The main objectives of this study were to determine the feasibility and acceptability of Virtual Reality (VR) distraction for pain management associated with venipunctures and to examine its preliminary effects on pain and distress in the pediatric ED. Children 7-17 years requiring a venipuncture in the pediatric ED were recruited. Participants were randomized to either a control group (standard care) or intervention group (standard of care + VR). Principal clinical outcome was the mean level of procedural pain, measured by the verbal numerical rating scale (VNRS). Distress was also measured using the Child Fear Scale (CFS) and the Procedure Behavior Check List (PBCL) and memory of pain using the VNRS. Side effects were documented. Results: A total of 63 patients were recruited. Results showed feasibility and acceptability of VR in the PED and overall high satisfaction levels (79% recruitment rate of eligible families, 90% rate of VR game completion, and overall high mean satisfaction levels). There was a significantly higher level of satisfaction among healthcare providers in the intervention group, and 93% of those were willing to use this technology again for the same procedure. Regarding clinical outcomes, no significant difference was observed between groups on procedural pain. Distress evaluated by proxy (10/40 vs 13.2/40, p = 0.007) and memory of pain at 24 hours (2.4 vs 4.2, p = 0.027) were significantly lower in the VR group. Venipuncture was successful on first attempt in 23/31 patients (74%) in the VR group and 15/30 (50%) patients in the control group (p = 0.039). Five of the 31 patients (16%) in the VR group reported side effects Conclusion: The addition of VR to standard care is feasible and acceptable for pain and distress management during venipunctures in the pediatric ED. There was no difference in self-reported procedural pain between groups. Levels of procedural distress and memory of pain at 24 hours were lower in the VR group.
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OLLILA, JOONAS, and OTTO SORMUNEN. "OPTIMIZING LOCOMOTIVE MAINTENANCE TIMES FOR VR GROUP LTD. IN FINLAND." Impact 2018, no. 2 (July 3, 2018): 36–38. http://dx.doi.org/10.1080/2058802x.2018.1514788.
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Bakhos, David, John Galvin, Jean-Marie Aoustin, Mathieu Robier, Sandrine Kerneis, Garance Bechet, Norbert Montembault, Stéphane Laurent, Benoit Godey, and Charles Aussedat. "Training outcomes for audiology students using virtual reality or traditional training methods." PLOS ONE 15, no. 12 (December 3, 2020): e0243380. http://dx.doi.org/10.1371/journal.pone.0243380.
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Due to limited space and resources, it can be difficult to train students on audiological procedures adequately. In the present study, we compared audiology training outcomes between a traditional approach and a recently developed immersive virtual reality (VR) approach in audiology students. Twenty-nine first-year audiology students participated in the study; 14 received traditional training (“TT group”), and 15 received the VR training (“VRT group”). Pre- and post-training evaluation included a 20-item test developed by an audiology educator. Post-training satisfaction and self-confidence were evaluated using Likert scales. Mean post-training test scores improved by 6.9±9.8 percentage points in the TT group and by 21.1±7.8 points in the VRT group; the improvement in scores was significant for both groups. After completing the traditional training, the TT group was subsequently trained with the VR system, after which mean scores further improved by 7.5 points; there was no significant difference in post-VR training scores between the TT and VRT groups. After training, the TT and VRT groups completed satisfaction and self-confidence questionnaires. Satisfaction and self-confidence ratings were significantly higher for the VR training group, compared to the traditional training group. Satisfaction ratings were “good” (4 on Likert scale) for 74% of the TT group and 100% of the VRT group. Self-confidence ratings were “good” for 71% of the TT group and 92% of the VRT group. These results suggest that a VR training approach may be an effective alternative or supplement to traditional training for audiology students.
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Giachero, A., M. Calati, L. Pia, L. La Vista, M. Molo, C. Rugiero, C. Fornaro, and P. Marangolo. "Conversational Therapy through Semi-Immersive Virtual Reality Environments for Language Recovery and Psychological Well-Being in Post Stroke Aphasia." Behavioural Neurology 2020 (August 6, 2020): 1–15. http://dx.doi.org/10.1155/2020/2846046.
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Aphasia is a highly disabling acquired language disorder generally caused by a left-lateralized brain damage. Even if traditional therapies have been shown to induce an adequate clinical improvement, a large percentage of patients are left with some degree of language impairments. Therefore, new approaches to common speech therapies are urgently needed in order to maximize the recovery from aphasia. The recent application of virtual reality (VR) to aphasia rehabilitation has already evidenced its usefulness in promoting a more pragmatically oriented treatment than conventional therapies (CT). In the present study, thirty-six chronic persons with aphasia (PWA) were randomly assigned to two groups. The VR group underwent conversational therapy during VR everyday life setting observation, while the control group was trained in a conventional setting without VR support. All patients were extensively tested through a neuropsychological battery which included not only measures for language skills and communication efficacy but also self-esteem and quality of life questionnairies. All patients were trained through a conversational approach by a speech therapist twice a week for six months (total 48 sessions). After the treatment, no significant differences among groups were found in the different measures. However, the amount of improvement in the different areas was distributed over far more cognitive and psychological aspects in the VR group than in the control group. Indeed, the within-group comparisons showed a significant enhancement in different language tasks (i.e., oral comprehension, repetition, and written language) only in the VR group. Significant gains, after the treatment, were also found, in the VR group, in different psychological dimensions (i.e., self-esteem and emotional and mood state). Given the importance of these aspects for aphasia recovery, we believe that our results add to previous evidence which points to the ecological validity and feasibility of VR treatment for language recovery and psychosocial well-being.
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Kang, Yohan, Myung Hwan Yun, and Sungho Kim. "Verbal Reports Influence on Pilot Flight Performance and Mental Stress Under Spatial Disorientation." Aerospace Medicine and Human Performance 91, no. 12 (December 1, 2020): 948–55. http://dx.doi.org/10.3357/amhp.5620.2020.
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BACKGROUND: Circumstances in flight can adversely affect a pilots spatial abilities and lead to spatial disorientation (SD), increasing the potential for fatal accidents. To systematically understand the impact of SD, it is important to quantitatively and qualitatively analyze pilots flight performance and mental stress, and to verify the effectiveness of verbal reports (VR) in enabling pilots to deal with an SD situation. This study investigated the effects of VR execution and type of SD on flight performance and mental stress.METHODS: SD simulation experiments were conducted on 30 Air Force fighter pilots (15 in the VR group and 15 in the non-VR group) with electrocardiography (ECG) sensors attached. The pilots gave their VRs by immediately verbalizing their attention to instrument information and six potentially disorientating scenarios were implemented in each flight phase. Flight performance was analyzed using instructor evaluation and self-evaluation scores, and mental stress was measured using heart rate variability (HRV) and perceived distress score.RESULTS: In maintaining flight performance, the VR group, respectively, had 8% and 10% higher scores for altitude and speed than the non-VR group. The self-evaluation scores were lowest for Coriolis, while Graveyard Spin was scored lowest in the instructor evaluations. Regarding mental stress, the VR group tended to have higher HFs and lower LF/HF ratios among HRV measures than the non-VR group, and an 11% lower perceived distress score. The highest perceived distress score was for Coriolis.DISCUSSION: We suggest that pilots can be assisted to understand and overcome SD situations through VR.Kang Y, Yun MH, Kim S. Verbal reports influence on pilot flight performance and mental stress under spatial disorientation. Aerosp Med Hum Perform. 2020; 91(12):948955.
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Koo, Chang-Hoon, Jin-Woo Park, Jung-Hee Ryu, and Sung-Hee Han. "The Effect of Virtual Reality on Preoperative Anxiety: A Meta-Analysis of Randomized Controlled Trials." Journal of Clinical Medicine 9, no. 10 (September 29, 2020): 3151. http://dx.doi.org/10.3390/jcm9103151.
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Virtual reality (VR), a technology that provides a stimulated sensory experience, has recently been implemented in various fields of medicine. Several studies have investigated the efficacy of VR on preoperative anxiety. The purpose of this meta-analysis was to validate whether VR could relieve preoperative anxiety in patients undergoing surgery. Electronic databases were searched to identify all randomized controlled trials (RCTs) investigating the effect of VR on preoperative anxiety. The primary outcome was defined as the preoperative anxiety scores. We estimated the effect size using the standard mean difference (SMD) with a 95% confidence interval (CI) using a random effect model. Ultimately, 10 RCTs, with a total of 813 patients, were included in the final analysis. Preoperative anxiety was significantly lower in the VR group than in the control group (SMD −0.64, 95% CI −1.08 to −0.20, p = 0.004). In a subgroup analysis, the preoperative anxiety scores were lower in the VR group than in the control group in pediatric patients (SMD −0.71, 95% CI −1.14 to −0.27, p = 0.002), whereas a significant difference was not observed between the two groups in adult patients (p = 0.226). The results of this meta-analysis indicated that VR could decrease preoperative anxiety, especially in pediatric patients.
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Ding, Jie, Yanyan He, Lishan Chen, Bili Zhu, Qiuping Cai, Keli Chen, and Guoyan Liu. "Virtual reality distraction decreases pain during daily dressing changes following haemorrhoid surgery." Journal of International Medical Research 47, no. 9 (July 25, 2019): 4380–88. http://dx.doi.org/10.1177/0300060519857862.
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Objective To investigate whether immersive virtual reality (VR) distraction could decrease pain during postoperative dressing changes. Methods This was a prospective, open-label randomized clinical trial that enrolled patients that had undergone haemorrhoidectomy. Patients were randomly assigned to one of two groups: a control group that received the standard pharmacological analgesic intervention during dressing change and a VR group that received VR distraction during dressing change plus standard pharmacological analgesic intervention. Pain scores and physiological measurements were collected before, during and after the first postoperative dressing change. Results A total of 182 patients were randomly assigned to the control and VR groups. The baseline characteristics of the VR and control groups were comparable. There was no significant difference in mean pain scores prior to and after the dressing change procedure between the two groups. The mean pain scores at the 5-, 10-, 15- and 20-min time-points during the first dressing change were significantly lower in the VR group compared with the control group. Heart rates and oxygen saturation were not significantly different between the two groups. Conclusion Immersive VR was effective as a pain distraction tool in combination with standard pharmacological analgesia during dressing change in patients that had undergone haemorrhoidectomy.
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Chang, Joseph, Sen Ninan, Katherine Liu, Alfred Marc Iloreta, Diana Kirke, and Mark Courey. "Enhancing Patient Experience in Office-Based Laryngology Procedures With Passive Virtual Reality." OTO Open 5, no. 1 (January 2021): 2473974X2097502. http://dx.doi.org/10.1177/2473974x20975020.
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Objectives Virtual reality (VR) has been used as nonpharmacologic anxiolysis benefiting patients undergoing office-based procedures. There is little research on VR use in laryngology. This study aims to determine the efficacy of VR as anxiolysis for patients undergoing in-office laryngotracheal procedures. Study Design Randomized controlled trial. Setting Tertiary care center. Methods Adult patients undergoing office-based larynx and trachea injections, biopsy, or laser ablation were recruited and randomized to receive standard care with local anesthesia only or local anesthesia with adjunctive VR. Primary end point was procedural anxiety measured by the Subjective Units of Distress Scale (SUDS). Subjective pain, measured using a visual analog scale, satisfaction scores, and procedure time, and baseline anxiety, measured using the Hospital Anxiety and Depression Scale (HADS), were also collected. Results Eight patients were randomized to the control group and 8 to the VR group. SUDS scores were lower in the VR group than in the control group with mean values of 26.25 and 53.13, respectively ( P = .037). Baseline HADS scores did not differ between groups. There were no statistically significant differences in pain, satisfaction, or procedure time. Average satisfaction scores in VR and control groups were 6.44 and 6.25, respectively ( P = .770). Average pain scores were 3.53 and 2.64, respectively ( P = .434). Conclusion This pilot study suggests that VR distraction may be used as an adjunctive measure to decrease patient anxiety during office-based laryngology procedures. Procedures performed using standard local anesthesia resulted in low pain scores and high satisfaction scores even without adjunctive VR analgesia. Level of Evidence 1
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Tian, Run, Fang Han, Jun Yang, Hai-Yan Zhao, Yan Mei, Ai-Ping Deng, Lin Fang, and Xi-Rui Zhang. "VR-10 Thrombospondin-1 Synthetic Polypeptide’s Impact on Rhesus Choroid-Retinal Endothelial Cells." Cellular Physiology and Biochemistry 46, no. 2 (2018): 609–17. http://dx.doi.org/10.1159/000488628.
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Background/Aims: This study aimed to investigate the effects of the VR-10 TSP-1 synthetic polypeptide on cytokines and the proliferation and migration of endothelial cells, as well as exploring a new method for anti-ocular neoangiogenesis. Methods: We measured the proliferation of RF/6A cells by an MTT assay and investigated the migration of RF/6A cells by a Transwell chamber assay. We examined the mRNA transcript levels of TGF-β2, VEGF, PEDF, Bcl-2 and FasL in RF/6A cells by RT-PCR and evaluated the expression of Fas and caspase-3 proteins in RF/6A cells by western blot analysis. Results: 1. TSP-1 (1 µg/ml) and synthetic peptide VR-10 (0.1 µg/ml, 1 µg/ml and 10 µg/ml) inhibited the proliferation of RF/6A cells in a time and dose-dependent way. 2. TSP-1 and synthetic peptide VR-10 could inhibit the migration of RF/6A cells in a Transwell chamber (P < 0.001). It was demonstrated that 10 µg/ml synthetic peptide VR-10 had the strongest effect. 3. The expression of TGF-β2 mRNA in RF/6A cells increased after treatment with 1 µg/ml TSP-1 (P < 0.0001). However, there was no significant difference between the synthetic peptide VR-10 and the control group (P > 0.05). Expression of PEDF mRNA in RF/6A cells was increased after treatment with 1 µg/ml TSP-1 and synthetic peptide VR-10. We demonstrated that 10 µg/ml synthetic peptide VR-10 had the strongest effect (P < 0.001). There were significant differences between groups (P < 0.001). Expression of TGF-β2 mRNA in RF/6A cells increased after treatment with 1 µg/ml TSP-1 (P = 0.000). There was no significant difference between the synthetic peptide VR-10 and the control group (P > 0.05). PEDF mRNA expression in RF/6A cells decreased after 1 µg/ml TSP-1 and synthetic peptide VR-10 therapy, among which 10 µg/ml synthetic peptide VR-10 demonstrated the strongest effect (P < 0.001). There were significant differences between groups (P < 0.001), except for the 1 µg/ml synthetic peptide VR-10 and 1 µg/ml synthetic peptide VR-10 groups (P = 0.615). 4. Compared with the control group, FasL mRNA expression was significantly increased in the 10 µg/ml synthetic peptide VR-10 treatment group; however, Bcl-2 mRNA expression was decreased. 5. Western blotting showed that RF/6A cells in the control group mainly expressed the 32 kD procaspase-3 forms. For the 10 µg/ml synthetic peptide, VR-10 treatment group, it showed decreased expression of procaspase-3 (32 kD) and concomitant increased expression of its shorter pro apoptotic forms (20 kD). Compared with the control group, Fas protein expression significantly increased in the 10 µg/ml synthetic peptide VR-10 treatment group. Conclusions: Synthetic peptide VR-10 had an inhibitory action on the proliferation and migration of RF/6A cells. VR-10 inhibited angiogenesis by its combined actions, which included up-regulating the expression of an anti-angiogenesis gene, namely, pigment epithelium-derived factor (PEDF), down-regulating the expression of the pro-angiogenic vascular endothelial growth factor (VEGF), and mediated endothelial cell apoptosis.
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Kang, Jae Myeong, Nambeom Kim, Sook Young Lee, Soo Kyun Woo, Geumjin Park, Byeong Kil Yeon, Jung Woon Park, et al. "Effect of Cognitive Training in Fully Immersive Virtual Reality on Visuospatial Function and Frontal-Occipital Functional Connectivity in Predementia: Randomized Controlled Trial." Journal of Medical Internet Research 23, no. 5 (May 6, 2021): e24526. http://dx.doi.org/10.2196/24526.
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Background Cognitive training can potentially prevent cognitive decline. However, the results of recent studies using semi-immersive virtual reality (VR)-assisted cognitive training are inconsistent. Objective We aimed to examine the hypothesis that cognitive training using fully immersive VR, which may facilitate visuospatial processes, could improve visuospatial functioning, comprehensive neuropsychological functioning, psychiatric symptoms, and functional connectivity in the visual brain network in predementia. Methods Participants over 60 years old with subjective cognitive decline or mild cognitive impairment from a memory clinic were randomly allocated to the VR (n=23) or the control (n=18) group. The VR group participants received multidomain and neuropsychologist-assisted cognitive training in a fully immersive VR environment twice a week for 1 month. The control group participants did not undergo any additional intervention except for their usual therapy such as pharmacotherapy. Participants of both groups were evaluated for cognitive function using face-to-face comprehensive neuropsychological tests, including the Rey-Osterrieth Complex Figure Test (RCFT) copy task; for psychiatric symptoms such as depression, apathy, affect, and quality of life; as well as resting-state functional magnetic resonance imaging (rsfMRI) at baseline and after training. Repeated-measures analysis of variance was used to compare the effect of cognitive training between groups. Seed-to-voxel–based analyses were used to identify the cognitive improvement–related functional connectivity in the visual network of the brain. Results After VR cognitive training, significant improvement was found in the total score (F1,39=14.69, P=.001) and basic components score of the RCFT copy task (F1,39=9.27, P=.005) compared with those of the control group. The VR group also showed improvements, albeit not significant, in naming ability (F1,39=3.55, P=.07), verbal memory delayed recall (F1,39=3.03, P=.09), and phonemic fluency (F1,39=3.08, P=.09). Improvements in psychiatric symptoms such as apathy (F1,39=7.02, P=.01), affect (F1,39=14.40, P=.001 for positive affect; F1,39=4.23, P=.047 for negative affect), and quality of life (F1,39=4.49, P=.04) were found in the VR group compared to the control group. Improvement in the RCFT copy task was associated with a frontal-occipital functional connectivity increase revealed by rsfMRI in the VR group compared to the control group. Conclusions Fully immersive VR cognitive training had positive effects on the visuospatial function, apathy, affect, quality of life, and increased frontal-occipital functional connectivity in older people in a predementia state. Future trials using VR cognitive training with larger sample sizes and more sophisticated designs over a longer duration may reveal greater improvements in cognition, psychiatric symptoms, and brain functional connectivity. Trial Registration Clinical Research Information Service KCT0005243; https://tinyurl.com/2a4kfasa
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Junior, Vitor Antônio dos Santos, Matheus de Sales Santos, Nildo Manoel da Silva Ribeiro, and Igor Lima Maldonado. "Combining Proprioceptive Neuromuscular Facilitation and Virtual Reality for Improving Sensorimotor Function in Stroke Survivors: A Randomized Clinical Trial." Journal of Central Nervous System Disease 11 (January 2019): 117957351986382. http://dx.doi.org/10.1177/1179573519863826.
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Aim: To assess a program combining virtual reality (VR) games and proprioceptive neuromuscular facilitation (PNF) and to compare it with the standalone techniques in stroke survivors. Methods: A randomized controlled clinical trial. A total of 48 participants were recruited in the outpatient clinic of a University Hospital in Salvador, Brazil. They were randomly assigned to 3 groups (n = 16 each): PNF, VR, and PNF/VR. Participants attended twice-weekly 50-minute sessions over a 2-month period. The PNF/VR group performed both PNF and VR exercises employing Nintendo Wii electronic games. Motor performance was assessed before and immediately after the treatment using the Fugl-Meyer Assessment scale. Results: An improvement in the mean scores was observed after treatment independent of the allocation group with significant intragroup changes: 14.5, 10.5, and 10.4 for PNF, VR, and PNF/VR, respectively. Score changes were also observed in the analyses of specific sections as follows: (1) a significant improvement in the passive movement and pain score was observed in the PNF and PNF/VR groups; (2) the same was observed for the motor function of the upper limb in all groups, for the motor function of the lower limb in the VR group and for balance in the PNF and PNF/VR groups. Conclusions: The use of a program combining virtual rehabilitation and PNF presented results that were comparable with those obtained with the isolated techniques.
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Qi, Fangfang, Yixiang Gan, Shengwen Wang, Yizhe Tie, Jiewen Chen, and Chunhai Li. "Efficacy of a virtual reality–based basic and clinical fused curriculum for clinical education on the lumbar intervertebral disc." Neurosurgical Focus 51, no. 2 (August 2021): E17. http://dx.doi.org/10.3171/2021.5.focus20756.
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OBJECTIVE Today, minimally invasive procedures have become mainstream surgical procedures. Percutaneous endoscopic transforaminal discectomy for lumbar disc herniation (LDH) requires profound knowledge of the laparoscopic lumbar anatomy. Immersive virtual reality (VR) provides three-dimensional patient-specific models to help in the process of preclinical surgical preparation. In this study, the authors investigated the efficacy of VR application in LDH for training orthopedic residents and postgraduates. METHODS VR images of the lumbar anatomy were created with immersive VR and mAnatomy software. The study was conducted among 60 residents and postgraduates. A questionnaire was developed to assess the effect of and satisfaction with this VR-based basic and clinical fused curriculum. The teaching effect was also evaluated through a postlecture test, and the results of the prelecture surgical examination were taken as baselines. RESULTS All participants in the VR group agreed that VR-based education is practical, attractive, and easy to operate, compared to traditional teaching, and promotes better understanding of the anatomical structures involved in LDH. Learners in the VR group achieved higher scores on an anatomical and clinical fusion test than learners in the traditional group (84.67 ± 14.56 vs 76.00 ± 16.10, p < 0.05). CONCLUSIONS An immersive VR-based basic and clinical fused curriculum can increase residents’ and postgraduates’ interest and support them in mastering the structural changes and complicated symptoms of LDH. However, a simplified operational process and more realistic haptics of the VR system are necessary for further surgical preparation and application.
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Waliño-Paniagua, Carmen Nélida, Cristina Gómez-Calero, María Isabel Jiménez-Trujillo, Leticia Aguirre-Tejedor, Alberto Bermejo-Franco, Rosa María Ortiz-Gutiérrez, and Roberto Cano-de-la-Cuerda. "Effects of a Game-Based Virtual Reality Video Capture Training Program Plus Occupational Therapy on Manual Dexterity in Patients with Multiple Sclerosis: A Randomized Controlled Trial." Journal of Healthcare Engineering 2019 (April 22, 2019): 1–7. http://dx.doi.org/10.1155/2019/9780587.
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Neurorehabilitation is a fundamental aspect in the treatment approach for multiple sclerosis (MS), in which new technologies have gained popularity, especially the use of virtual reality (VR). The aim of this paper is to analyze an occupational therapy (OT) intervention compared with OT + VR (OT + VR) on the manual dexterity of patients with MS. 26 MS subjects were initially recruited from an MS patient association and randomized into two groups. The OT group received 20 conventional OT sessions distributed in two sessions per week. The OT + VR group received 20 sessions of VR interventions, twice weekly and lasting 30 minutes, consisting of VR games accessed via the online web pagemotiongamingconsole.com, in addition to the conventional OT sessions. Pre- and postintervention assessments were based on the Purdue Pegboard Test, the Jebsen-Taylor Hand Function Test, and the Grooved Pegboard Test. Clinical improvements were found regarding the precision of movements, the execution times, and the efficiency of certain functional tasks in the Purdue Pegboard Test and Jebsen-Taylor Hand Function Test tests in the OT + VR group. Although significant differences were not found in the manual dexterity between the OT and OT + VR groups, improvements were found regarding the precision and effectiveness of certain functional tasks.
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Umoren, Rachel, Sherri Bucher, Daniel S. Hippe, Beatrice Nkolika Ezenwa, Iretiola Bamikeolu Fajolu, Felicitas M. Okwako, John Feltner, et al. "eHBB: a randomised controlled trial of virtual reality or video for neonatal resuscitation refresher training in healthcare workers in resource-scarce settings." BMJ Open 11, no. 8 (August 2021): e048506. http://dx.doi.org/10.1136/bmjopen-2020-048506.
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ObjectiveTo assess the impact of mobile virtual reality (VR) simulations using electronic Helping Babies Breathe (eHBB) or video for the maintenance of neonatal resuscitation skills in healthcare workers in resource-scarce settings.DesignRandomised controlled trial with 6-month follow-up (2018–2020).SettingSecondary and tertiary healthcare facilities.Participants274 nurses and midwives assigned to labour and delivery, operating room and newborn care units were recruited from 20 healthcare facilities in Nigeria and Kenya and randomised to one of three groups: VR (eHBB+digital guide), video (video+digital guide) or control (digital guide only) groups before an in-person HBB course.Intervention(s)eHBB VR simulation or neonatal resuscitation video.Main outcome(s)Healthcare worker neonatal resuscitation skills using standardised checklists in a simulated setting at 1 month, 3 months and 6 months.ResultsNeonatal resuscitation skills pass rates were similar among the groups at 6-month follow-up for bag-and-mask ventilation (BMV) skills check (VR 28%, video 25%, control 22%, p=0.71), objective structured clinical examination (OSCE) A (VR 76%, video 76%, control 72%, p=0.78) and OSCE B (VR 62%, video 60%, control 49%, p=0.18). Relative to the immediate postcourse assessments, there was greater retention of BMV skills at 6 months in the VR group (−15% VR, p=0.10; −21% video, p<0.01, –27% control, p=0.001). OSCE B pass rates in the VR group were numerically higher at 3 months (+4%, p=0.64) and 6 months (+3%, p=0.74) and lower in the video (−21% at 3 months, p<0.001; −14% at 6 months, p=0.066) and control groups (−7% at 3 months, p=0.43; −14% at 6 months, p=0.10). On follow-up survey, 95% (n=65) of respondents in the VR group and 98% (n=82) in the video group would use their assigned intervention again.ConclusioneHBB VR training was highly acceptable to healthcare workers in low-income to middle-income countries and may provide additional support for neonatal resuscitation skills retention compared with other digital interventions.
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Mok, Tsz-Ngai, Junyuan Chen, Jinghua Pan, Wai-Kit Ming, Qiyu He, Tat-Hang Sin, Jialin Deng, Jieruo Li, and Zhengang Zha. "Use of a Virtual Reality Simulator for Tendon Repair Training: Randomized Controlled Trial." JMIR Serious Games 9, no. 3 (July 12, 2021): e27544. http://dx.doi.org/10.2196/27544.
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Background Virtual reality (VR) simulators have become widespread tools for training medical students and residents in medical schools. Students using VR simulators are provided with a 3D human model to observe the details by using multiple senses and they can participate in an environment that is similar to reality. Objective The aim of this study was to promote a new approach consisting of a shared and independent study platform for medical orthopedic students, to compare traditional tendon repair training with VR simulation of tendon repair, and to evaluate future applications of VR simulation in the academic medical field. Methods In this study, 121 participants were randomly allocated to VR or control groups. The participants in the VR group studied the tendon repair technique via the VR simulator, while the control group followed traditional tendon repair teaching methods. The final assessment for the medical students involved performing tendon repair with the “Kessler tendon repair with 2 interrupted tendon repair knots” (KS) method and the “Bunnell tendon repair with figure 8 tendon repair” (BS) method on a synthetic model. The operative performance was evaluated using the global rating scale. Results Of the 121 participants, 117 participants finished the assessment and 4 participants were lost to follow-up. The overall performance (a total score of 35) of the VR group using the KS method and the BS method was significantly higher (P<.001) than that of the control group. Thus, participants who received VR simulator training had a significantly higher score on the global rating scale than those who received traditional tendon repair training (P<.001). Conclusions Our study shows that compared with the traditional tendon repair method, the VR simulator for learning tendon suturing resulted in a significant improvement of the medical students in the time in motion, flow of operation, and knowledge of the procedure. Therefore, VR simulator development in the future would most likely be beneficial for medical education and clinical practice. Trial Registration Chinese Clinical Trial Registry ChiCTR2100046648; http://www.chictr.org.cn/hvshowproject.aspx?id=90180
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Lima, Jessica, Hanna McCabe-Bennett, and Martin M. Antony. "Treatment of Storm Fears Using Virtual Reality and Progressive Muscle Relaxation." Behavioural and Cognitive Psychotherapy 46, no. 2 (October 30, 2017): 251–56. http://dx.doi.org/10.1017/s1352465817000674.
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Background: The present study examined the efficacy of virtual reality (VR) exposure therapy for treating individuals with storm fears by comparing a one-session VR exposure treatment with a one-session progressive muscle relaxation (PMR) and psychoeducation session. Aims: It was predicted that there would be a reduction in storm-related fear post-treatment for individuals in both conditions, but that this reduction would be greater for those in the VR exposure condition. It was predicted that improvements would be maintained at 30-day follow-up only for those in the VR exposure condition. Method: Thirty-six participants each received one of the two treatment conditions. Those in the PMR treatment group received approximately 30 minutes of PMR and approximately 15 minutes of psychoeducation regarding storms. Those in the VR treatment group received approximately 1 hour of VR exposure. Additionally, participants were asked to complete a pre-treatment and post-treatment 5-minute behavioural approach test to assess changes in storm fears. They were also asked to complete a measure assessing storm phobia. Results: There was a significant interaction between treatment group and self-reported fear at post-treatment, such that fear decreased for both groups, although the reduction was stronger in the VR group. Results also showed that reductions in storm fear were maintained at 30-day follow-up for both groups. Conclusions: Although this study used a small non-clinical sample, these results offer preliminary support for the use of VR exposure therapy in the treatment of storm-related fear.
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Shen, Yang, Zhaoxue Wang, Aimin Hao, Peng Yu, Xuesong Zhai, and Haipeng Wang. "Investigating the Effect of VR + Haptics Approach on Students’ Flow Experience and Outcomes: An Empirical Study on VR Laparoscopy." Complexity 2021 (August 31, 2021): 1–10. http://dx.doi.org/10.1155/2021/9496152.
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Background. Virtual reality-based surgery training has become a promising trend in the sector of clinical education. Prior studies have confirmed the effectiveness of VR-based surgical simulators on training surgeons. Most existing papers employing subjective methods explored the students’ overall perceptions of surgical skills. However, few studies, from the multidimension perspective of learning performance, investigate how VR improves surgery skills. Participants. 37 college students were recruited in comparative experimental research. The experimental group was equipped with a VR + haptic surgical simulator, while the VR simulator without haptic feedback was used for the control group. Method. The study resorted to physiological approaches to investigate the influence of the VR laparoscopic surgical training system on students’ performance. Results. The experimental group scored higher than the control group in flow experience and has better performance in the four dimensions of operation evaluation skills. Conclusion. The study deposited that learners are more likely to exert to flow experience in a learning situation with haptic feedback, which will further improve medical students’ performance.
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Gandolfi, Marialuisa, Christian Geroin, Eleonora Dimitrova, Paolo Boldrini, Andreas Waldner, Silvia Bonadiman, Alessandro Picelli, et al. "Virtual Reality Telerehabilitation for Postural Instability in Parkinson’s Disease: A Multicenter, Single-Blind, Randomized, Controlled Trial." BioMed Research International 2017 (2017): 1–11. http://dx.doi.org/10.1155/2017/7962826.
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Introduction. Telerehabilitation enables patients to access remote rehabilitation services for patient-physiotherapist videoconferencing in their own homes. Home-based virtual reality (VR) balance training has been shown to reduce postural instability in patients with Parkinson’s disease (PD). The primary aim was to compare improvements in postural stability after remotely supervised in-home VR balance training and in-clinic sensory integration balance training (SIBT). Methods. In this multicenter study, 76 PD patients (modified Hoehn and Yahr stages 2.5–3) were randomly assigned to receive either in-home VR telerehabilitation (n=38) or in-clinic SIBT (n=38) in 21 sessions of 50 minutes each, 3 days/week for 7 consecutive weeks. VR telerehabilitation consisted of graded exergames using the Nintendo Wii Fit system; SIBT included exercises to improve postural stability. Patients were evaluated before treatment, after treatment, and at 1-month follow-up. Results. Analysis revealed significant between-group differences in improvement on the Berg Balance Scale for the VR telerehabilitation group (p=0.04) and significant Time × Group interactions in the Dynamic Gait Index (p=0.04) for the in-clinic group. Both groups showed differences in all outcome measures over time, except for fall frequency. Cost comparison yielded between-group differences in treatment and equipment costs. Conclusions. VR is a feasible alternative to in-clinic SIBT for reducing postural instability in PD patients having a caregiver.
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Krebs, David E., Kathleen M. Gill-Body, Patrick O. Riley, and Stephen W. Parker. "Double-Blind, Placebo-Controlled Trial of Rehabilitation for Bilateral Vestibular Hypofunction: Preliminary Report." Otolaryngology–Head and Neck Surgery 109, no. 4 (October 1993): 735–41. http://dx.doi.org/10.1177/019459989310900417.
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Vestibular rehabilitation (VR) is increasingly popular, but few data exist to support enthusiasts' claims of efficacy in improving functional abilities of patients with bilateral vestibular hypofunction (BVH). A double-blind, controlled study of eight subjects (mean, 64 ± 12 years; seven females, one male) with bilateral vestibular hypofunction was conducted. Subjects in group A Received 8 weeks of VR followed by 8 weeks of home VR exercises, whereas those in group B Received 8 weeks of control treatment (isometric strengthening exercises) followed by 8 weeks of VR. At the end of 8 weeks, group A walked 8% faster and, during paced gait and stair-climbing, with greater stability, evidenced by a 10% larger maximum moment arm and a 17% decreased double-support duration during gait and stair stance. Group B improved less than 1% during the control treatment. Self-reported Dizziness Handicap Inventory scores did not differ significantly between control and active VR. All subjects improved compared with baseline tests at the 16-week post-test on both functional testing and on the Self-reported Dizziness Handicap Inventory scale. We conclude that in this small sample, VR effectively improved functional, dynamic stability during locomotion, but even strengthening exercises result in self-reported symptomatic improvement.
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Rutkowski, Sebastian, Jan Szczegielniak, and Joanna Szczepańska-Gieracha. "Evaluation of the Efficacy of Immersive Virtual Reality Therapy as a Method Supporting Pulmonary Rehabilitation: A Randomized Controlled Trial." Journal of Clinical Medicine 10, no. 2 (January 18, 2021): 352. http://dx.doi.org/10.3390/jcm10020352.
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Anxiety has been estimated to occur in 21–96% and depression in 27–79% of patients with chronic obstructive pulmonary disorder (COPD). We found a scarcity of literature providing evidence on how virtual reality (VR) therapy affects the intensity of depressive and anxiety symptoms and stress levels in COPD patients undergoing in-hospital pulmonary rehabilitation (PR). This study enrolled 50 COPD patients with symptoms of stress, depression, and anxiety, randomly assigned to one of two groups. The two groups participated in the traditional PR programme additionally: the VR-group performed 10 sessions of immersive VR-therapy and the control group performed 10 sessions of Schultz autogenic training. Comparison of the changes in stress levels and depressive and anxiety symptoms was the primary outcome. Analysis of the results showed a reduction in stress levels only in the VR-group (p < 0.0069), with a medium effect size (d = 0.353). The symptoms of depression (p < 0.001, d = 0.836) and anxiety (p < 0.0009, d = 0.631) were statistically significantly reduced only in the VR-group, with a strong effect size. The enrichment of pulmonary rehabilitation with immersive VR therapy brings benefits in terms of mood improvement and reduction in anxiety and stress in patients with COPD.
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Jin, Seunghee. "The Effects of Digital Virtual Reality Game-Based Language Learning on English Language Learners’ Development of Vocabulary and Cultural Knowledge and Affective Attitudes." STEM Journal 22, no. 3 (August 31, 2021): 78–94. http://dx.doi.org/10.16875/stem.2021.22.3.78.
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The current study investigated the effects of using a 3D virtual reality (VR) game on university EFL students’ development of vocabulary and cultural knowledge. In addition, it explored how this new approach affected the students’ affective attitudes such as interest, confidence, and learning motivation. Furthermore, it examined the students’ perception and attitude toward VR game-based language learning. Over one semester, an experimental group of 25 students participated in the VR game-based language learning, while a control group of 24 students followed the regular curriculum of the university EFL course. To collect data, 1) pre- and post-tests for both vocabulary and cultural knowledge, 2) a pre- and post-questionnaire for affective attitudes, 3) an online survey for students’ perceptions and attitudes, and 4) a qualitative interview were administered. The results revealed that the VR game-based language learning group outperformed the traditional learning group in both vocabulary and cultural knowledge gains. In addition, VR game instruction was effective in increasing students’ interest, confidence, and learning motivation. Furthermore, the students reported overall positive perceptions and attitudes toward this new kind of instruction. This study suggested that VR game-based language learning is a new, effective way to promote students’ vocabulary and cultural knowledge.
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Schmid, Ludwig, Andrea Glässel, and Corina Schuster-Amft. "Therapists’ Perspective on Virtual Reality Training in Patients after Stroke: A Qualitative Study Reporting Focus Group Results from Three Hospitals." Stroke Research and Treatment 2016 (2016): 1–12. http://dx.doi.org/10.1155/2016/6210508.
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Background. During the past decade, virtual reality (VR) has become a new component in the treatment of patients after stroke. Therefore aims of the study were (a) to get an insight into experiences and expectations of physiotherapists and occupational therapists in using a VR training system and (b) to investigate relevant facilitators, barriers, and risks for implementing VR training in clinical practice.Methods. Three focus groups were conducted with occupational therapists and physiotherapists, specialised in rehabilitation of patients after stroke. All data were audio-recorded and transcribed verbatim. The study was analysed based on a phenomenological approach using qualitative content analysis.Results. After code refinements, a total number of 1289 codes emerged out of 1626 statements. Intercoder reliability increased from 53% to 91% until the last focus group. The final coding scheme included categories on a four-level hierarchy: first-level categories are (a) therapists and VR, (b) VR device, (c) patients and VR, and (d) future prospects and potential of VR developments.Conclusions. Results indicate that interprofessional collaboration is needed to develop future VR technology and to devise VR implementation strategies in clinical practice. In principal, VR technology devices were seen as supportive for a general health service model.
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Roxburgh, Thomas, Anthony Li, Charles Guenancia, Patrice Pernollet, Claire Bouleti, Benjamin Alos, Matthieu Gras, et al. "Virtual Reality for Sedation During Atrial Fibrillation Ablation in Clinical Practice: Observational Study." Journal of Medical Internet Research 23, no. 5 (May 27, 2021): e26349. http://dx.doi.org/10.2196/26349.
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Background Connected devices are dramatically changing many aspects in health care. One such device, the virtual reality (VR) headset, has recently been shown to improve analgesia in a small sample of patients undergoing transcatheter aortic valve implantation. Objective We aimed to investigate the feasibility and effectiveness of VR in patients undergoing atrial fibrillation (AF) ablation under conscious sedation. Methods All patients who underwent an AF ablation with VR from March to May 2020 were included. Patients were compared to a consecutive cohort of patients who underwent AF ablation in the 3 months prior to the study. Primary efficacy was assessed by using a visual analog scale, summarizing the overall pain experienced during the ablation. Results The AF cryoablation procedure with VR was performed for 48 patients (mean age 63.0, SD 10.9 years; n=16, 33.3% females). No patient refused to use the device, although 14.6% (n=7) terminated the VR session prematurely. Preparation of the VR headset took on average 78 (SD 13) seconds. Compared to the control group, the mean perceived pain, assessed with the visual analog scale, was lower in the VR group (3.5 [SD 1.5] vs 4.3 [SD 1.6]; P=.004), and comfort was higher in the VR group (7.5 [SD 1.6] vs 6.8 [SD 1.7]; P=.03). On the other hand, morphine consumption was not different between the groups. Lastly, complications, as well as procedure and fluoroscopy duration, were not different between the two groups. Conclusions We found that VR was associated with a reduction in the perception of pain in patients undergoing AF ablation under conscious sedation. Our findings demonstrate that VR can be easily incorporated into the standard ablation workflow.
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Hernández-Serrano, Olga, Alexandra Ghiţă, Natàlia Figueras-Puigderrajols, Jolanda Fernández-Ruiz, Miquel Monras, Lluïsa Ortega, Silvia Mondon, et al. "Predictors of Changes in Alcohol Craving Levels during a Virtual Reality Cue Exposure Treatment among Patients with Alcohol Use Disorder." Journal of Clinical Medicine 9, no. 9 (September 18, 2020): 3018. http://dx.doi.org/10.3390/jcm9093018.
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Background/Objective: Determining the predictive variables associated with levels of alcohol craving can ease the identification of patients who can benefit from treatments. This study aimed to describe changes (improvement or no change/deterioration) in alcohol craving levels and explore the predictors of these changes from admission to discharge in outpatients with alcohol use disorder (AUD) undergoing treatment-as-usual (TAU), or treatment-as-usual supplemented with virtual reality cue-exposure therapy (TAU + VR-CET). Method: A prospective cohort study was conducted amongst 42 outpatients with AUD (n = 15 TAU + VR-CET and n = 27 TAU) from a clinical setting. Changes in the levels of alcohol craving between admission and discharge were assessed with the Multidimensional Alcohol Craving Scale. Sociodemographic characteristics (age, gender, education, and socioeconomic and civil status), cognitive-affective behavioral patterns (AUD severity, abstinence duration, psychiatric comorbidity, state anxiety, attentional bias, and substance use), and type of treatment (TAU + VR-CET and only TAU) were also evaluated. Results: The TAU + VR-CET group showed greater changes of improvement in the levels of alcohol craving than the TAU group (χ2 = 10.996; p = 0.001). Intragroup changes in alcohol craving from pre to post-treatment were significant in the TAU + VR-CET group (χ2 = 13.818; p = 0.003) but not within the TAU group (χ2 = 2.349; p = 0.503). The odds of an improvement in any of the craving levels between pre- and post-test was 18.18 (1/0.055) times higher in the TAU + VR-CET group with respect to the TAU group. The use of illicit drugs in the month prior to the test increased the odds of having a positive change by 18.18 (1/0.055) with respect to not having consumed. Conclusions: Including VR-CET in TAU programs may provide benefits in the treatment of AUDs mainly among patients with intense alcohol craving and individuals having used illicit substances prior to treatment.
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Noben, Lore, Simone Maria Theresia Anna Goossens, Sophie Eva Marieke Truijens, Marijn Marthe Georgine van Berckel, Christel Wilhelmina Perquin, Gerrit Dirk Slooter, and Stefanus Johannes van Rooijen. "A Virtual Reality Video to Improve Information Provision and Reduce Anxiety Before Cesarean Delivery: Randomized Controlled Trial." JMIR Mental Health 6, no. 12 (December 18, 2019): e15872. http://dx.doi.org/10.2196/15872.
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Background Anxiety levels before cesarean delivery (CD) can lead to a negative birth experience, which may influence several aspects of the woman’s life in the long term. Improving preoperative information may lower preoperative anxiety and lead to a more positive birth experience. Objective This study aimed to determine whether a virtual reality (VR) video in addition to standard preoperative information decreases anxiety levels before a planned CD. Methods Women scheduled to undergo term elective CD were recruited from the outpatient clinic. They were randomized and stratified based on history of emergency CD (yes or no). All participants received standard preoperative information (folder leaflets and counseling by the obstetrician); the VR group additionally watched the VR video showing all aspects of CD such as the ward admission, operating theater, spinal analgesia, and moment of birth. The primary outcome measure was a change in score on the Visual Analogue Scale for Anxiety (ΔVAS-A) measured at admission for CD, compared with the baseline VAS-A score. Results A total of 97 women were included for analysis. The baseline characteristics were similar in both groups, except for a significantly higher level of education in the control group. There was no significant decrease in the VAS-A score of the women in the VR group (n=49) compared with those in the control group (n=48; ΔVAS-A=1.0; P=.08; 95% CI −0.1 to 2.0). Subgroup analysis for the group of women with a history of emergency CD showed a trend toward decreased preoperative anxiety, despite the small sample size of this subgroup (n=17; P=.06). Of the 26 participants who provided completed questionnaires, 22 (85%) in the VR group reported feeling more prepared after seeing the VR video; of the 24 participants’ partners who completed the questionnaires, 19 (79%) agreed with the participants. No discomfort or motion sickness was reported. Conclusions A VR video may help patients and their partners feel better prepared when planning a CD. This study showed that VR does not lead to a decrease in preoperative anxiety. However, subgroups such as women with a history of emergency CD may benefit from VR videos. Trial Registration International Standard Randomised Controlled Trial Number (ISRCTN) 74794447; http://www.isrctn.com/ISRCTN74794447 (retrospectively registered)
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Vlah, Daria, Vanja Čok, and Uroš Urbas. "VR as a 3D Modelling Tool in Engineering Design Applications." Applied Sciences 11, no. 16 (August 18, 2021): 7570. http://dx.doi.org/10.3390/app11167570.
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The study aims to explore the usefulness of existing VR 3D modelling tools for use in mechanical engineering. Previous studies have investigated the use of VR 3D modelling tools in conceptual phases of the product development process. Our objective was to find out if VR tools are useful in creating advanced freeform CAD models that are part of the embodiment design phase in the context of mechanical design science. Two studies were conducted. In the preliminary study, the group of participants modelled a 3D part in a standard desktop CAD application, which provided information about the key characteristics that must be satisfied to obtain a solid model from a surface model. In the research study conducted with a focus group of participants, who were firstly trained in the use of VR, the same part was modelled using a VR headset. The results were analysed and the fulfilment of key characteristics in the use of VR was evaluated. It was found that using VR tools provides a fast way to create complex part geometries, however, it has certain drawbacks. Finally, the ease of use and specific features of the VR technology were discussed.
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Joo, So Young, Yoon Soo Cho, Seung Yeol Lee, Hyun Seok, and Cheong Hoon Seo. "Effects of Virtual Reality-Based Rehabilitation on Burned Hands: A Prospective, Randomized, Single-Blind Study." Journal of Clinical Medicine 9, no. 3 (March 9, 2020): 731. http://dx.doi.org/10.3390/jcm9030731.
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Hands are the most frequent burn injury sites. Appropriate rehabilitation is essential to ensure good functional recovery. Virtual reality (VR)-based rehabilitation has proven to be beneficial for the functional recovery of the upper extremities. We investigated and compared VR-based rehabilitation with conventional rehabilitation (CON) in patients with burned hands. Fifty-seven patients were randomized into a VR or CON group. Each intervention was applied to the affected hand for four weeks, and clinical and functional variables were evaluated. Hand function was evaluated before intervention and four weeks after intervention using the Jebsen-Taylor hand function test (JTT), Grasp and Pinch Power Test, Purdue Pegboard test (PPT), and Michigan Hand Outcomes Questionnaire (MHQ). The JTT scores for picking up small objects and the MHQ scores for hand function, functional ADL, work, pain, aesthetics, and patient satisfaction were significantly higher in the VR group than in the CON group (p < 0.05). The results suggested that VR-based rehabilitation is likely to be as effective as conventional rehabilitation for recovering function in a burned hand. VR-based rehabilitation may be considered as a treatment option for patients with burned hands.
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Birckhead, Brandon, Carine Khalil, Xiaoyu Liu, Samuel Conovitz, Albert Rizzo, Itai Danovitch, Kim Bullock, and Brennan Spiegel. "Recommendations for Methodology of Virtual Reality Clinical Trials in Health Care by an International Working Group: Iterative Study." JMIR Mental Health 6, no. 1 (January 31, 2019): e11973. http://dx.doi.org/10.2196/11973.
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BackgroundTherapeutic virtual reality (VR) has emerged as an efficacious treatment modality for a wide range of health conditions. However, despite encouraging outcomes from early stage research, a consensus for the best way to develop and evaluate VR treatments within a scientific framework is needed.ObjectiveWe aimed to develop a methodological framework with input from an international working group in order to guide the design, implementation, analysis, interpretation, and communication of trials that develop and test VR treatments.MethodsA group of 21 international experts was recruited based on their contributions to the VR literature. The resulting Virtual Reality Clinical Outcomes Research Experts held iterative meetings to seek consensus on best practices for the development and testing of VR treatments.ResultsThe interactions were transcribed, and key themes were identified to develop a scientific framework in order to support best practices in methodology of clinical VR trials. Using the Food and Drug Administration Phase I-III pharmacotherapy model as guidance, a framework emerged to support three phases of VR clinical study designs—VR1, VR2, and VR3. VR1 studies focus on content development by working with patients and providers through the principles of human-centered design. VR2 trials conduct early testing with a focus on feasibility, acceptability, tolerability, and initial clinical efficacy. VR3 trials are randomized, controlled studies that evaluate efficacy against a control condition. Best practice recommendations for each trial were provided.ConclusionsPatients, providers, payers, and regulators should consider this best practice framework when assessing the validity of VR treatments.
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Gómez-Polo, Cristina, Ana-Aida Vilches, David Ribas, Antonio Castaño-Séiquer, and Javier Montero. "Behaviour and Anxiety Management of Paediatric Dental Patients through Virtual Reality: A Randomised Clinical Trial." Journal of Clinical Medicine 10, no. 14 (July 7, 2021): 3019. http://dx.doi.org/10.3390/jcm10143019.
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Clinicians should appreciate the effectiveness of virtual reality (VR) headsets for managing both the anxiety and the behaviour of non-cooperative paediatric patients who require treatment over several dental appointments. The aim of this study was to assess the effectiveness of using a VR headset as a distraction for managing the anxiety and behaviour of paediatric patients during their dental treatment. Eighty patients, aged between five and ten years old and who required dental treatment over three or more appointments, were randomly allocated into two groups. One group used a VR headset during all their appointments, and the other one did not use any distraction technique. The patients were asked to take a Facial Image Scale Test during their first and last appointments to assess their level of anxiety. Additionally, the dentist completed the Frankl Test to quantify the child’s behaviour at the beginning and the end of their treatment. The results obtained, both from the group using the VR headset and from the control group, were compared using the chi-square test. The use of a VR headset during dental treatment significantly reduced anxiety (95% of the children were happy) and improved behaviour (100% positive behaviour) as compared with the control group (40% and 57.5%, respectively). A VR headset can effectively distract a paediatric patient, helping to reduce anxiety and manage behaviour during dental treatment
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Bourrelier, Julien, Lilian Fautrelle, Etienne Haratyk, Patrick Manckoundia, Frédéric Mérienne, France Mourey, and Alexandre Kubicki. "Enhancement of Anticipatory Postural Adjustments by Virtual Reality in Older Adults with Cognitive and Motor Deficits: A Randomised Trial." Geriatrics 6, no. 3 (July 22, 2021): 72. http://dx.doi.org/10.3390/geriatrics6030072.
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Background: Postural activities involved in balance control integrate the anticipatory postural adjustments (APA) that stabilize balance and posture, facilitating arm movements and walking initiation and allowing an optimal coordination between posture and movement. Several studies reported the significant benefits of virtual reality (VR) exercises in frail older adults to decrease the anxiety of falling and to induce improvements in behavioural and cognitive abilities in rehabilitation processes. The aim of this study was thus to test the efficiency of a VR system on the enhancement of the APA period, compared to the use of a Nintendo Wii system. Methods: Frail older adults (n = 37) were included in this study who were randomized and divided into a VR exercises group (VR group) or a control group using the Nintendo Wii system (CTRL group). Finally, 22 patients were included in the data treatment. APA were studied through muscular activation timings measured with electromyographic activities. The functional reach test, the gait speed, and the time up and go were also evaluated before and after a 3-week training phase. Results and discussion: As the main results, the training phase with VR improved the APA and the functional reach test score along the antero-posterior axis. Together, these results highlight the ability of a VR training phase to induce neuromuscular adaptations during the APA period in frail older adults. Then, it underlines the effective transfer from learning carried out during the VR training movements to control balance abilities in a more daily life context.
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Ohsuga, Mieko, Yumiko Inoue, Wataru Hashimoto, and Fumitaka Nakaizumi. "VR Applied Asobi-Litation System for Dementia Elderly in Group Homes." Journal of Robotics and Mechatronics 19, no. 6 (December 20, 2007): 698–704. http://dx.doi.org/10.20965/jrm.2007.p0698.
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The “Asobilitation” (Japanese “asobi,” meaning “play,” replaces the “rehab” in “rehabilitation”) system we developed using virtual reality and targeting physical and mental improvement in elderly people with dementia was applied to residents of a group home for the aged, “Nishiyama no Sato.” A pair of residents, or a resident and a caregiver, took part in a cooperative game using bicycling or a balancing exercise. First experiment was executed to evaluate system acceptance and over two thirds of the residents participated indicating that they found the system at least interesting and easy enough to try out. Second experiment was designed for effect assessment of system use, however it showed no clear positive effect of the system on walking, despite our objectives of having the system improve mobility and reverse lower-leg muscle deterioration. A study is thus needed on the system’s continuous, long-term effects, and we must develop an easier way to assess walking function in the elderly with dementia.
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Peng, Yun, Kimberly D. Goff, M. Carolina dos Ramos, and Clare McCabe. "Developing a predictive group-contribution-based SAFT-VR equation of state." Fluid Phase Equilibria 277, no. 2 (March 2009): 131–44. http://dx.doi.org/10.1016/j.fluid.2008.11.008.
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Wenninger, Stephan, Sarah A. Cumming, Kristina Gutschmidt, Kees Okkersen, Aura Cecilia Jimenez-Moreno, Ferroudja Daidj, Hanns Lochmüller, et al. "Associations Between Variant Repeat Interruptions and Clinical Outcomes in Myotonic Dystrophy Type 1." Neurology Genetics 7, no. 2 (March 9, 2021): e572. http://dx.doi.org/10.1212/nxg.0000000000000572.
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ObjectiveTo assess the association between variant repeat (VR) interruptions in patients with myotonic dystrophy type 1 (DM1) and clinical symptoms and outcome measures after cognitive behavioral therapy (CBT) intervention.MethodsAdult patients with DM1 were recruited within the OPTIMISTIC trial (NCT02118779). Disease-related history, current clinical symptoms and comorbidities, functional assessments, and disease- and health-related questionnaires were obtained at baseline and after 5 and 10 months. After genetic analysis, we assessed the association between the presence of VR interruptions and clinical symptoms' long-term outcomes and compared the effects of CBT in patients with and without VR interruptions. Core trial outcome measures analyzed were: 6-minute walking test, DM1-Activ-C, Checklist Individual Strength Fatigue Score, Myotonic Dystrophy Health Index, McGill-Pain questionnaire, and Beck Depression inventory—fast screen. Blood samples for DNA testing were obtained at the baseline visit for determining CTG length and detection of VR interruptions.ResultsVR interruptions were detectable in 21/250 patients (8.4%)—12 were assigned to the standard-of-care group (control group) and 9 to the CBT group. Patients with VR interruptions were significantly older when the first medical problem occurred and had a significantly shorter disease duration at baseline. We found a tendency toward a milder disease severity in patients with VR interruptions, especially in ventilation status, mobility, and cardiac symptoms. Changes in clinical outcome measures after CBT were not associated with the presence of VR interruptions.ConclusionsThe presence of VR interruptions is associated with a later onset of the disease and a milder phenotype. However, based on the OPTIMISTIC trial data, the presence of VR interruptions was not associated with significant changes on outcome measures after CBT intervention.Trial Registration InformationClinicalTrials.govNCT02118779.
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LE DU, Katell, Anne-Lise Septans, Frédéric Maloisel, Hélène Vanquaethem, Anna Schmitt, Marielle Le Goff, Marie Pierre Moles, et al. "A new option in pain prevention with bliss, a therapeutic virtual reality solution in bone marrow biopsy context: Results of a French open-label multicenter randomized phase II/III study (REVEH Trial)." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 6573. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.6573.
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6573 Background: The prevention of care-induced pain is a central concern for all healthcare teams in hematology units. Use of MEOPA (Oxygen + Nitrous Oxide) is today a standard of care for relaxation procedure. Distraction through immersion in virtual reality (VR) has already documented its analgesic effects in several phase II trials but comparison with standard treatments in a large randomized study is needed. Methods: We conducted an open-label multicenter randomized phase III trial (ClinicalTrials.gov identifier: NCT03483194). We assessed the safety and efficacy of a new therapeutic virtual reality solution for pain distraction, Bliss, in prevention of pain and anxiety before performing a bone marrow biopsy. Bliss is a VR software with four imaginary interactive environments in three dimensions with binaural sound (head-mounted display). Efficacy was evaluated by pain intensity with visual analog scale (score from 0 to 10) just after the biopsy and anxiety by 2 questionnaires (fear of pain before the biopsy and revised STAI questionnaire before and after the biopsy). The primary end point was patient-assessed pain intensity after the bone marrow procedure. Results: A total of 126 patients were enrolled with previously untreated malignant hemopathy between September 6, 2018 and May 18, 2020. They were randomly assigned in a 1:1 ratio to receive pain prevention with MEOPA (n=63) or Bliss (n=63) before and during their bone marrow biopsy. All patients received a local anesthesia with lidocaïne before the biopsy. Median age of the study population was 65.5 years old (range 18 to 87) and 54,2% were men. The average pain intensity was 3.5 (standard deviation 2.6) for the MEOPA group and 3.0 (SD 2.4) for the VR group (p=0,26) without any significant difference according to age, gender or hemopathy. Concerning anxiety, 67.5% of patients were afraid before the biopsy and anxiety scores were moderate to very high in 26.3% of patients before the biopsy (STAI questionnaire) and 9.0% after the biopsy for all patients (17.3% of reduction in anxiety for the MEOPA group and 17.2% for the VR group, p=0.83). Immersion in VR was well tolerated in 100% of patients included in the VR group. Physicans were very satisfied by the relaxation procedure in 64.9% of cases (52.5% in the MEOPA group and 77.6% in the VR group, p=0.01) and recommended re-use of the technique in 54.2% in the MEOPA group and 79,1% in the VR group (p=0.02). Conclusion: The intensity of pain did not significantly differ in both arms. Bliss-based relaxation method was well tolerated and the satisfaction of patients and physicians was very high in VR group. This study validates the use of immersion in VR with Bliss as a new digital therapeutics and support the integration of the software in the panel of supportive care. Key words: virtual reality, bone marrow biopsy, pain. Clinical trial information: 03483194.