Quantifying the Outcomes of a Virtual Reality (VR)-Based Gamified Neck Rehabilitation

Neck pain is a major global public health concern and adds a significant financial burden to both the healthcare system as well as people suffering from it. Additionally, it presents measurement and evaluation challenges for clinicians as well as adherence challenges and treatment barriers for the patients. We have developed a virtual reality (VR)-based video game that can be used to capture outcomes that may aid in the assessment and treatment of neck pain. We investigated: (i) performance metrics of overall accuracy, accuracy based on movement difficulty, duration, and total envelope of movement; (ii) stability across sessions; (iii) accuracy across difficulty levels; (iv) association between gaming experience and performance; and (v) any adverse effects resulting from VR immersion in healthy people (N = 52). Results demonstrate poor stability across sessions, significantly higher accuracy in single-plane movements, no effect of prior gaming experience on performance, and no severe adverse effects of VR immersion. Results suggest that duration and single-plane accuracy demonstrate the potential for identifying people with neck pain or impaired mobility. Lack of association between prior gaming experiences coupled with no severe adverse symptoms suggests that VR may be a feasible tool to be used for neck rehabilitation

Motion sickness diagnostic criteria: Consensus document of the classification committee of the Bárány society

We present diagnostic criteria for motion sickness, visually induced motion sickness (VIMS), motion sickness disorder (MSD), and VIMS disorder (VIMSD) to be included in the International Classification of Vestibular Disorders. Motion sickness and VIMS are normal physiological responses that can be elicited in almost all people, but susceptibility and severity can be high enough for the response to be considered a disorder in some cases. This report provides guidelines for evaluating signs and symptoms caused by physical motion or visual motion and for diagnosing an individual as having a response that is severe enough to constitute a disorder. The diagnostic criteria for motion sickness and VIMS include adverse reactions elicited during exposure to physical motion or visual motion leading to observable signs or symptoms of greater than minimal severity in the following domains: nausea and/or gastrointestinal disturbance, thermoregulatory disruption, alterations in arousal, dizziness and/or vertigo, headache and/or ocular strain. These signs/symptoms occur during the motion exposure, build as the exposure is prolonged, and eventually stop after the motion ends. Motion sickness disorder and VIMSD are diagnosed when recurrent episodes of motion sickness or VIMS are reliably triggered by the same or similar stimuli, severity does not significantly decrease after repeated exposure, and signs/symptoms lead to activity modification, avoidance behavior, or aversive emotional responses. Motion sickness/MSD and VIMS/VIMSD can occur separately or together. Severity of symptoms in reaction to physical motion or visual motion stimuli varies widely and can change within an individual due to aging, adaptation, and comorbid disorders. We discuss the main methods for measuring motion sickness symptoms, the situations conducive to motion sickness and VIMS, and the individual traits associated with increased susceptibility. These additional considerations will improve diagnosis by fostering accurate measurement and understanding of the situational and personal factors associated with MSD and VIMSD

Effects of Head Motion on Postural Stability in Participants with Chronic Motion Sensitivity

Background: Motion sensitivity, or motion sickness, is common among individuals in modern vehicular and visually stimulating environments; notably, people with normal vestibular function are susceptible to this condition. Motion-provoked dizziness often causes postural instability. Purposes: This study aimed to compare the effects of head motion on postural stability in healthy adults with and without chronic motion sensitivity (CMS) and to determine the effects of head motion direction (horizontal versus vertical) on postural stability. Methods: Sixty healthy adult males and females aged 20 to 40 years old were assigned to two groups, 30 participants with CMS and 30 participants without CMS. Pre-data collection, all participants were trained on specific parameters of cervical rotation, flexion, and extension. Then, postural stability measurements were taken during three conditions (static, horizontal, and vertical head movements) using the Bertec Balance Advantage Dynamic Computerized Dynamic Posturography (CDP). Results: There was a significant difference between the CMS and non-CMS groups in mean postural stability during head movement in both horizontal and vertical head motions (p = 0.005 and p = 0.024, respectively); however, no significant difference was shown in mean postural stability between horizontal and vertical head motions within each group (p = 0.297 in CMS group and p = 0.179 in non-CMS group). Conclusions: The results indicate that healthy young adults without CMS have better postural stability during head motion than those with CMS, and that head motion direction (horizontal versus vertical) does not influence postural stability within each study group

Evaluation techniques used to evaluate extended reality (XR) head mounted displays (HMDs) used in healthcare: A literature review

Extended Reality (XR) Head Mounted Displays (HMDs) are used across various healthcare pathways for staff/student education and training, and for improving patient experiences. As XR HMDs become affordable, accessible and their acceptance increases, it is critical to document the techniques used for evaluating the technology, processes of user engagement and immersion, and outcomes. At present there is limited research on evaluation techniques used to evaluate XR HMDs. This manuscript presents findings from 104 clinical studies that use XR HMDs. The aim of this review is to give the user an insight into the current healthcare XR HMD landscape by presenting the different HMDs used, variety of XR interventions and their applications across medical pathways and intended research outcomes of the XR applications. The manuscript further guides the reader toward a detailed documentation of evaluation techniques used to investigate antecedents and consequences of using XR and delivers a critical discussion and suggestions for improvement of XR evaluation practices. This paper will be of excellent use to clinicians, academics, funding bodies and hospital decision makers who would like suggestions for evaluating the efficacy and effectiveness of XR HMDs. The authors hope to encourage discussions on the importance of improving XR evaluation practices

Creation of a Virtual Interface for Stress-Trauma Investigations through Open World Navigation: An Exploration of Tolerability and Physiological Reactions

It is estimated that as many as 50% of people suffering from Whiplash Associated Disorders (WAD) may experience chronic alterations of their activities of daily living as much as 1-year post injury. Despite their burden, there is little to evidence to suggest why some people may be more likely to acquire WAD or develop chronic symptomology. Additionally, the link between biomechanical forces at the time of impact and symptom development or recovery is poor. As a result, interest in alternative theories such as stress system reactivity have received interest in recent literature, but empirical methods to test them has been lacking. Thus, the purpose of this thesis was to explore the relationship between stress and trauma using a known stressor and a newly developed virtual reality (VR)-based car crash simulator to better understand the immediate reaction to being involved in a motor vehicle crash (MVC). In Chapter 2, we evaluated conditioned pain modulation (CPM) in reaction to the cold pressor task and measured associations with indices of sympathetic and hypothalamic-pituitary-adrenal function. It was found that only 30% of participants experienced inhibitory CPM. Within this group, there was a positive moderate correlation between CPM and the absolute change in skin conductance pre-to-post cold pressor task. In Chapter 3, we explored the initial tolerability to a novel VR-based car crash simulator in healthy subjects and also evaluated sense of presence and simulator sickness. The system was well tolerated by a majority of participants, and it appeared that the sense of presence and simulator sickness shared an inverse relationship. In Chapter 4, we evaluated the pain and stress response to our VR-based car crash simulator in the form of pain pressure detection thresholds, CPM, heart rate variability, and salivary cortisol. Over 40% of participants were more sensitive to pain following the simulation, and this may have been associated with an increase in parasympathetic nervous system activity and salivary cortisol. These results may help to explain some of the heterogeneity of WAD presentations after a MVC and signify that the pain/stress response to simulated trauma is variable

Aerospace medicine and biology: A cumulative index to a continuing bibliography (supplement 384)

This publication is a cumulative index to the abstracts contained in Supplements 372 through 383 of Aerospace Medicine and Biology: A Continuing Bibliography. It includes seven indexes: subject, personal author, corporate source, foreign technology, contract number, report number, and accession number

Aerospace medicine and biology: A continuing bibliography with indexes (supplement 375)

This bibliography lists 212 reports, articles, and other documents recently introduced into the NASA Scientific and Technical Information System database. Subject coverage includes the following: aerospace medicine and physiology, life support systems and man/system technology, protective clothing, exobiology and extraterrestrial life, planetary biology, and flight crew behavior and performance