Assessing Spatial Relations under Altered Frames of Reference: A Virtual Reality Study Using the Mental Cutting Test

Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Virtual reality (VR) with its engagement, interaction, and real time feedback could be a solution, with immersive VR systems having preliminary evidence in stroke to be more effective in improving UL outcomes in comparison to non-immersive VR. However, immersive VR research is limited within the realm of MS rehabilitation. Therefore, the main aim of the PhD was to explore immersive VR as an approach for UL rehabilitation for people with MS (pwMS). This was achieved in four stages: 1) a systematic review of the current evidence for VR in UL rehabilitation in MS; 2) predevelopment focus groups to determine requirements for the development of bespoke immersive VR games; 3) software development of bespoke VR games to potentially improve UL function for pwMS; and 4) a feasibility study of the games and immersive VR for pwMS’ UL rehabilitation. The systematic review initially yielded ten articles with varying study design, VR intervention and UL outcome measures used. There were some statistically significant improvements after VR interventions in outcomes such as in nine-hole peg test (NHPT), hand grip strength and active range of motion. There were however conflicting results regarding if VR was more effective than conventional approaches. Whilst the review demonstrated there were positive results for VR improving UL function, most of the studies had small sample sizes and were inadequately powered, and the level of immersion on effectiveness in MS remains unknown. The predevelopment focus groups recruited ten pwMS and eight specialist clinicians to explore their views on immersive VR as an approach to UL rehabilitation and determine requirements to develop VR games for this purpose. PwMS commonly reported that their UL problems interfered with activities of daily living and resulted in the loss of meaningful hobbies such as writing. Many pwMS neglected UL exercise and found strategies for adapting to their UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a potential solution, as it was convenient for pwMS to access and could provide a more engaging and disguised approach to exercise. Although, there were shared concerns about cybersickness and disengagement while using VR approaches. Finally, both groups agreed games should be meaningful and adaptable for users but suggested different VR activities, with clinicians suggesting games directly reflecting activities of daily living and pwMS suggesting more abstract activities. Recommendations were made for the development of VR rehabilitation games which could be personalised and customisable for the varying abilities of pwMS. Using theme-based content analysis and requirement analysis, requirements for the software development of immersive VR games were created and developed using Unity game engine. Three games, “Piano”; “Catch-a-falling-star” and “VR Whack-a-mole” which targeted dexterity and strength for pwMS were developed, with different difficulty levels implemented to adapt to varying ability of pwMS. The final stage of this PhD was a randomised, controlled feasibility study to investigate an intervention of immersive VR involving the three co-produced games for pwMS’ UL rehabilitation. Participants were randomised to either an intervention group consisting of 30 minutes of VR co-produced games, twice/week, for eight weeks, or to a control group of usual care. Participants were recruited from the NHS and third sector organisations. Nineteen pwMS were recruited (intervention n=11, control n=8), with a recruitment rate of 3.2 participants/month. Only minor adverse events were reported (n=9), such as fatigue and UL pain. Adherence was good with 87% (±12%) session completed, and two dropouts were reported in the control group. There were positive trends for improving NHPT and hand grip strength, but there was an observed ceiling effect in the Action Research Arm Test. Participants reported high levels of satisfaction and good usability of the co-produced VR games, as measured by the USE questionnaire. Thematic analysis revealed participants enjoyed the distraction and atmospheres that immersive VR provided, and believed the games were fit for purpose with the majority of participants reporting improvements in their UL function. Participants suggested more variety and progression of exercises for future development. Overall, these studies show that immersive VR has the potential to be beneficial for UL rehabilitation and is feasible and safe for pwMS. Therefore, future work should refine VR games for long-term application and explore the clinical and cost effectiveness of this approach.

In the realm of virtual reality (VR) research, the synergy of methodological advancements, technical innovation, and novel applications is paramount. Our work encapsulates these facets in the context of spatial ability assessments conducted within a VR environment. This paper presents a comprehensive and integrated framework of VR, eye-tracking, and electroencephalography (EEG), which seamlessly combines measuring participants’ behavioral performance and simultaneously collecting time-stamped eye tracking and EEG data to enable understanding how spatial ability is impacted in certain conditions and if such conditions demand increased attention and mental allocation. This framework encompasses the measurement of participants’ gaze pattern (e.g., fixation and saccades), EEG data (e.g., Alpha, Beta, Gamma, and Theta wave patterns), and psychometric and behavioral test performance. On the technical front, we utilized the Unity 3D game engine as the core for running our spatial ability tasks by simulating altered conditions of space exploration. We simulated two types of space exploration conditions: (1) microgravity condition in which participants’ idiotropic (body) axis is in statically and dynamically misaligned with their visual axis; and (2) conditions of Martian terrain that offers a visual frame of reference (FOR) but with limited and unfamiliar landmarks objects. We specifically targeted assessing human spatial ability and spatial perception. To assess spatial ability, we digitalized behavioral tests of Purdue Spatial Visualization Test: Rotations (PSVT: R), the Mental Cutting Test (MCT), and the Perspective Taking Ability (PTA) test and integrated them into the VR settings to evaluate participants’ spatial visualization, spatial relations, and spatial orientation ability, respectively. For spatial perception, we applied digitalized versions of size and distance perception tests to measure participants’ subjective perception of size and distance. A suite of C# scripts orchestrated the VR experience, enabling real-time data collection and synchronization. This technical innovation includes the integration of data streams from diverse sources, such as VIVE controllers, eye-tracking devices, and EEG hardware, to ensure a cohesive and comprehensive dataset. A pivotal challenge in our research was synchronizing data from EEG, eye tracking, and VR tasks to facilitate comprehensive analysis. To address this challenge, we employed the Unity interface of the OpenSync library, a tool designed to unify disparate data sources in the fields of psychology and neuroscience. This approach ensures that all collected measures share a common time reference, enabling meaningful analysis of participant performance, gaze behavior, and EEG activity. The Unity-based system seamlessly incorporates task parameters, participant data, and VIVE controller inputs, providing a versatile platform for conducting assessments in diverse domains. Finally, we were able to collect synchronized measurements of participants’ scores on the behavioral tests of spatial ability and spatial perception, their gaze data and EEG data. In this paper, we present the whole process of combining the eye-tracking and EEG workflows into the VR settings and collecting relevant measurements. We believe that our work not only advances the state-of-the-art in spatial ability assessments but also underscores the potential of virtual reality as a versatile tool in cognitive research, therapy, and rehabilitation.

(1) Background: The development of new technologies means that the use of virtual reality is increasingly being implemented in rehabilitative approaches for adult stroke patients. Objective: To analyze the existing scientific evidence regarding the application of immersive and non-immersive virtual reality in patients following cerebrovascular incidents and their efficacy in achieving dynamic and static balance. (2) Data sources: An electronic search of the databases Medline, Cochrane Library, PEDro, Scopus, and Scielo from January 2010 to December 2020 was carried out using the terms physiotherapy, physical therapy, virtual reality, immersive virtual reality, non-immersive virtual reality, stroke, balance, static balance, and dynamic balance. Selection of studies: Randomized controlled trials in patients older than 18 developed with an adult population (>18 years old) with balance disorders as a consequence of suffering a stroke in the previous six months before therapeutic intervention, including exercises harnessing virtual reality in their interventions and evaluations of balance and published in English or Spanish, were included. A total of two hundred twenty-seven articles were found, ten of which were included for review and of these, nine were included in the subsequent meta-analysis. (3) Data extraction: Two authors selected the studies and extracted their characteristics (participants, interventions, and validation instruments) and results. The methodological quality of the studies was evaluated using the PEDro scale, and the risk of bias was determined using the Cochrane risk-of-bias tool. Data synthesis: Of the selected studies, three did not show significant improvements and seven showed significant improvements in the intervention groups in relation to the variables. (4) Conclusions: Non-immersive virtual reality combined with conventional rehabilitation could be considered as a therapeutic option.

Extended-Reality Technologies: An Overview of Emerging Applications in Medical Education and Clinical Care.

The integration of immersive Virtual Reality (VR) and Building Information Modeling (BIM) has many applications within the Architecture, Engineering, and Construction (AEC) industries. In this context VR is often highlighted for its ability to convey scale and details, especially when compared to non-immersive visualizations. However, despite being an active area of research, there is currently a lack of real-world studies exploring immersive VR in a construction-oriented context. In addition, there are still technical challenges and barriers for an efficient integration, such as rendering performance and interoperability issues. This paper addresses these issues by investigating the use of immersive, single- and multi-user VR within the openBIM ecosystem. The contribution is two-fold: (a) an in-depth presentation of algorithms and technical details of a multi-user VR application for immersive visualization of large and complex BIMs and (b) an evaluation of this VR system on several real-world construction projects. In all cases the VR visualization has been directly realized from the design teams IFC-models and the multi-user sessions has been performed both co-located as well as fully remote. The results show that multi-user VR improves communication, understanding, and collaboration, and by letting staff with knowledge and experience from construction production review the project in VR, design errors and constructability issues can be identified and resolved before reaching the actual production stage. Moreover, the use of VR is helpful regarding sequencing and planning, and to identify alternative design solutions.

The rapid development of virtual and augmented reality technologies is currently taking place in almost all spheres of activity. Elements of virtual and augmented reality are used in such areas as education, medicine, transport, gaming, tourism and others. The active spread of these technologies causes the emergence of special competencies in the IT labor market and, as a result, the formation of new professions.Many Russian universities are training students in IT training areas. Specialization in the development of computer games and virtual reality applications has begun recently. The provision of practical classes is accompanied by specific tasks, which gives students the opportunity to improve the use of software and technical devices.The relevance of the research is determined by the current demand for the use of the latest technologies by IT developers in the field of creating computer games. Today, technologies that provide a player’s immersion in virtual reality are becoming more and more popular. One of these technologies is a suit with wearable sensors that track a person’s position in space in real time. However, there are quite a few real described projects in the literature and on the Internet. This study examines the process of developing a task for creating a game application using virtual reality technology: a suit with wearable sensors for teaching students.Materials and methods of research. Timely identification of the needs of the IT market in personnel training allows educational organizations to form new training programs of different levels of training. This approach makes it possible to target the educational and methodological materials being developed to use the latest achievements in the development of the field under study.Using a systematic approach, the study characterizes virtual reality suits and sensors for monitoring the position in the user’s space. Thus, the goal of the task was to ensure the immersiveness and convenience of interaction between the player and the game environment.Based on materials on software, position sensors in space, the approach of pedagogical design was applied and the procedure was formed for a practical task, reflecting the relevant competencies.Results. The study was conducted on the basis in the framework of laboratory and practical work of students, as well as at a real enterprise. Training in the new profile of the direction of training “Applied informatics” is fully equipped with all the latest technologies in this field. As a result of the work, the content of the practical task was developed.Real development of virtual and augmented reality applications is conducted jointly with students. Almost all projects used a suit with body sensors.Conclusion. Our study examines in detail the process of developing an application using a suit with wearable sensors for further training of students. Based on the results, work can be carried out on real projects for any field. Based on the research materials, it is planned to issue a textbook for students with the profile of developing computer games and virtual / augmented reality applications.

Immersive virtual reality can expose humans to novel training and sensory environments, but motor training with virtual reality has not been able to improve motor performance as much as motor training in real-world conditions. An advantage of immersive virtual reality that has not been fully leveraged is that it can introduce transient visual perturbations on top of the visual environment being displayed. The goal of this study was to determine whether transient visual perturbations introduced in immersive virtual reality modify electrocortical activity and behavioral outcomes in human subjects practicing a novel balancing task during walking. We studied three groups of healthy young adults (5 male and 5 female for each) while they learned a balance beam walking task for 30 min under different conditions. Two groups trained while wearing a virtual reality headset, and one of those groups also had half-second visual rotation perturbations lasting ~10% of the training time. The third group trained without virtual reality. We recorded high-density electroencephalography (EEG) and movement kinematics. We hypothesized that virtual reality training with perturbations would increase electrocortical activity and improve balance performance compared with virtual reality training without perturbations. Our results confirmed the hypothesis. Brief visual perturbations induced increased theta spectral power and decreased alpha spectral power in parietal and occipital regions and improved balance performance in posttesting. Our findings indicate that transient visual perturbations during immersive virtual reality training can boost short-term motor learning by inducing a cognitive change, minimizing the negative effects of virtual reality on motor training. NEW & NOTEWORTHY We found that transient visual perturbations in virtual reality during balance training can boost short-term motor learning by inducing a cognitive change, overcoming the negative effects of immersive virtual reality. As a result, subjects training in immersive virtual reality with visual perturbations have equivalent performance improvement as training in real-world conditions. Visual perturbations elicited cortical responses in occipital and parietal regions and may have improved the brain's ability to adapt to variations in sensory input.

Immersive virtual reality (VR) enhances ecological validity and facilitates intuitive and ergonomic hand interactions for performing neuropsychological assessments. However, its comparability to traditional computerized methods remains unclear. This study investigates the convergent validity, user experience and usability of VR-based versus PC-based assessments of short-term and working memory, as well as psychomotor skills, while also examining how demographic and IT-related skills influence performance in both modalities. Sixty-six participants performed the Digit Span Task (DST), Corsi Block Task (CBT) and Deary-Liewald Reaction Time Task (DLRTT) in both VR- and PC-based formats. Participants' experience in using computers and smartphones, and playing videogames, was considered. User experience and system usability of the formats were also evaluated. While performance on DST was similar across modalities, PC assessments enabled better performance on CBT and faster reaction times in DLRTT. Significant correlations between VR and PC versions supported convergent validity. Regression analyses revealed that performance on PC versions was influenced by computing and gaming experience, whereas performance on VR versions was largely independent of these factors, except for gaming experience predicting performance on CBT backward recall. Moreover, VR assessments received higher ratings for user experience and usability than PC-based assessments. Immersive VR assessments provide an engaging alternative to traditional computerized methods, with minimal reliance on prior IT experience and demographic factors. This resilience to individual differences suggests that VR may offer a more equitable and accessible platform for automated cognitive assessment. Future research should explore the long-term reliability of VR-based assessments.

Physical walking is consistently considered a natural and intuitive way to acquire viewpoints in a virtual environment. However, research findings also show that walking requires cognitive resources. To understand how this tradeoff affects the interaction design for virtual environments; we evaluated the performance of 32 participants, ranging from 18 to 44 years old, in a demanding visual and spatial task. Participants wearing a virtual reality (VR) headset counted features in a complex 3D structure while walking or while using a 3D interaction technique for manipulation. Our results indicate that the relative performance of the interfaces depends on the spatial ability and game experience of the participants. Participants with previous game experience but low spatial ability performed better using the manipulation technique. However, walking enabled higher performance for participants with high spatial ability or without significant game experience. These findings suggest that the optimal design choices for demanding visual tasks in VR should consider both controller experience and the spatial ability of the target users.

Objective: Surgical left atrial appendage (LAA) closure using epicardial clips has become popular in stroke prevention in patients with atrial fibrillation. Optimal placement of the clip is essential to achieve complete LAA occlusion and to prevent complications due to compression of the circumflex artery. We determine the added value of immersive virtual reality (VR) in accurately assessing LAA base size and selection of an appropriately sized clip. Methods: We studied the feasibility of measuring the LAA base using VR and conventional computed tomography (CT). A retrospective analysis was performed of LAA base measurements in 15 patients who had undergone thoracoscopic LAA clipping. Subsequently, we compared the placed clip size with imaging-acquired LAA base size to retrospectively evaluate intraprocedural sizing. Results: We successfully applied a VR platform to measure LAA base size. The median LAA base size measured in CT (23.8 mm, interquartile range [IQR] 22.3 to 26.4 mm) and intracardial virtual reality (23.4 mm, IQR 21.6 to 25.5 mm) did not differ significantly (P = 0.416). VR measurements of the LAA base in surgeon's view (25.7 mm, IQR 24.2 to 29.2) were significantly higher than those of 2-dimensional CT (P = 0.037) and intracardial 3-dimensional (3D) VR (P < 0.05) measurements. All measurements differed significantly with placed clip sizes (P < 0.05). There were no clip malpositioning-related events. Conclusions: Immersive VR is a feasible method for obtaining anatomical information on LAA base size. In this retrospective analysis, CT and VR-based measurements of LAA base size differed significantly from intraoperatively placed LAA clips, indicating potential oversizing when measured intraoperatively. Using intuitive 3D VR-based imaging might be a useful method to assist in accurate preprocedural sizing of LAA base and can potentially prevent oversizing.

Virtual Reality (VR) allows for an immersion into virtual landscapes. This immersion may offer advantages to communicating and assessing landscape change in participatory planning. In an explorative study we prepared and presented GIS-based immersive VR in order to identify technical and practical issues as well as potentials of immersive VR as planning media. We assessed the effect of two different VR presented with the head mounted display Oculus Rift DK2 through guided interviews with and observation of study participants. The results show that perceiving the VR from a pedestrian's perspective and exploring it individually supported the participant’s presence in the virtual scene. The visual level of realism and the navigation were identified as crucial issues as low quality of these aspects distracted participants significantly. As the immersive VR proved useful to activate people assessing the landscape in the VR, further research should focus on identifying suitable and valid immersive VR for quality assessment of landscape change from a user’s perspective.

Functional near-infrared spectroscopy (fNIRS) allows for a reliable assessment of oxygenated blood flow in relevant brain regions. Recent advancements in immersive virtual reality (VR)-based technology have generated many new possibilities for its application, such as in stroke rehabilitation. In this study, we asked whether there is a difference in oxygenated hemoglobin (HbO2) within brain motor areas during hand/arm movements between immersive and non-immersive VR settings. Ten healthy young participants (24.3 ± 3.7, three females) were tested using a specially developed VR paradigm, called "bus riding", whereby participants used their hand to steer a moving bus. Both immersive and non-immersive conditions stimulated brain regions controlling hand movements, namely motor cortex, but no significant differences in HbO2 could be found between the two conditions in any of the relevant brain regions. These results are to be interpreted with caution, as only ten participants were included in the study.

Virtual reality (VR) and head mount displays (HMDs) have been advanced for multimedia and information technologies but have scarcely been used in surgical training. Motion sickness and individual psychological changes have been associated with VR. The goal was to observe first experiences and performance scores using a new combined highly immersive virtual reality (IVR) laparoscopy setup. During the study, 10 members of the surgical department performed three tasks (fine dissection, peg transfer, and cholecystectomy) on a VR simulator. We then combined a VR HMD with the VR laparoscopic simulator and displayed the simulation on a 360° video of a laparoscopic operation to create an IVR laparoscopic simulation. The tasks were then repeated. Validated questionnaires on immersion and motion sickness were used for the study. Participants' times for fine dissection were significantly longer during the IVR session (regular: 86.51s [62.57s; 119.62 s] vs. IVR: 112.35s [82.08s; 179.40 s]; p = 0.022). The cholecystectomy task had higher error rates during IVR. Motion sickness did not occur at any time for any participant. Participants experienced a high level of exhilaration, rarely thought about others in the room, and had a high impression of presence in the generated IVR world. This is the first clinical and technical feasibility study using the full IVR laparoscopy setup combined with the latest laparoscopic simulator in a 360° surrounding. Participants were exhilarated by the high level of immersion. The setup enables a completely new generation of surgical training.

Impact of immersing university and high school students in educational linear narratives using virtual reality technology

BackgroundIn neurorehabilitation, problems with visuospatial attention, including unilateral spatial neglect, are prevalent and routinely assessed by pen-and-paper tests, which are limited in accuracy and sensitivity. Immersive virtual reality (VR), which motivates a much wider (more intuitive) spatial behaviour, promises new futures for identifying visuospatial atypicality in multiple measures, which reflects cognitive and motor diversity across individuals with brain injuries.MethodsIn this pilot study, we had 9 clinician controls (mean age 43 years; 4 males) and 13 neurorehabilitation inpatients (mean age 59 years; 9 males) recruited a mean of 41 days post-injury play a VR visual search game. Primary injuries included 7 stroke, 4 traumatic brain injury, 2 other acquired brain injury. Three patients were identified as having left sided neglect prior to taking part in the VR. Response accuracy, reaction time, and headset and controller raycast orientation quantified gameplay. Normative modelling identified the typical gameplay bounds, and visuospatial atypicality was defined as gameplay beyond these bounds.ResultsThe study found VR to be feasible, with only minor instances of motion sickness, positive user experiences, and satisfactory system usability. Crucially, the analytical method, which emphasized identifying 'visuospatial atypicality,' proved effective. Visuospatial atypicality was more commonly observed in patients compared to controls and was prevalent in both groups of patients—those with and without neglect.ConclusionOur research indicates that normative modelling of VR gameplay is a promising tool for identifying visuospatial atypicality after acute brain injury. This approach holds potential for a detailed examination of neglect.