Осложнения, связанные с использованием терапии на основе виртуальной реальности во время лечения послеоперационной боли

Relevance. The therapy based on virtual reality is used as a method of non-pharmacological treatment of postoperative pain. Possible complications are poorly understood, making it difficult to use in everyday clinical practice.The objective was the evaluation of the development of complications when using therapy based on virtual reality in the treatment of postoperative pain syndrome.Materials and methods. A prospective clinical study was performed. 90 patients who had to perform surgical interventions were included. After randomization, three groups were formed: group I (n = 30) – therapy with a 15-minute session as an addition to standard therapy for postoperative pain, group II (n = 30) – therapy with a 25-minute session, and group III (n = 30) receiving only drug treatment of postoperative pain syndrome. Virtual reality-based therapy (VR-therapy) was performed 3, 7, 12 hours after surgery using the Oculus Quest 2 device. Postoperative nausea, vomiting and dizziness were considered complications of VR-therapy. The development of complications was assessed using the FMS (Fast Motion Sickness Scale) self-assessment of motion sickness and the Postoperative Nausea and Vomiting Scale (PONV). The quality of the patient’s recovery after anesthesia was assessed using the QoR-15 scale.Results. There were no differences in the incidence of visually induced motion sickness between groups with different session durations. The incidence of postoperative nausea and vomiting and the need for antiemetic drugs did not differ between the main and control groups. A positive correlation was found between the occurrence of visually induced motion sickness (VIMS) and the use of opioid drugs in the postoperative period. In patients with a VR-therapy session duration of 25 minutes, the indicators of the quality of recovery after anesthesia were higher than in other groups.Conclusions. The use of VR-therapy with a session of 15 and 25 minutes does not lead to an increase in the incidence of postoperative nausea and vomiting. The duration of therapy did not affect the development of VIMS. The indicators of the quality of recovery after anesthesia in the group with a duration of VR-therapy of 25 minutes were higher than in other groups.Актуальность. Терапия на основе виртуальной реальности применяется как метод немедикаментозного лечения послеоперационной боли. Возможные осложнения плохо изучены, что затрудняет ее использование в повседневной клинической практике.Цель – оценка развития осложнений при использовании терапии на основе виртуальной реальности в лечении послеоперационного болевого синдрома.Материалы и методы. Выполнено проспективное клиническое исследование. Включены 90 пациентов, которым предстояло выполнение хирургических вмешательств. После рандомизации сформированы 3 группы: 1 группа (n = 30) – терапия с сеансом 15 мин как дополнение стандартной терапии послеоперационной боли, 2 группа (n = 30) – терапия с сеансом 25 мин, и 3 группа (n = 30), получающая только медикаментозное лечение послеоперационного болевого синдрома. Терапию на основе виртуальной реальности (ВР-терапия) проводили через 3, 7, 12 ч после операции при помощи устройства Oculus Quest 2. Осложнениями ВР-терапии считали послеоперационную тошноту, рвоту и головокружение. Их развитие оценивали по шкалам самооценки укачивания FMS (Fast Motion Sickness Scale) и послеоперационной тошноты и рвоты (ПОТР). Оценку качества восстановления пациента после анестезии осуществляли с использованием шкалы QoR-15.Результаты. Не было выявлено различий в частоте встречаемости зрительно-индуцированного укачивания между группами с разной продолжительностью сеанса. Частота развития послеоперационной тошноты и рвоты и потребность в противорвотных препаратах не отличались между основными и контрольной группами. Обнаружена положительная корреляция между возникновением зрительно-индуцированного укачивания (ЗИУ) и приемом опиоидных препаратов в послеоперационном периоде. У пациентов с длительностью сеанса ВР-терапии 25 мин показатели качества восстановления после анестезии были выше, чем в других группах.Выводы. Использование ВР-терапии с сеансом 15 и 25 мин не приводит к увеличению частоты возникновения послеоперационной тошноты и рвоты. Продолжительность терапии не влияла на развитие ЗИУ. Показатели качества восстановления после анестезии в группе с длительностью ВР-терапии 25 мин были выше, чем в других группах

Effect of virtual reality exposure therapy on social participation in people with a psychotic disorder (VRETp):study protocol for a randomized controlled trial

Background: Many patients with a psychotic disorder participate poorly in society. When psychotic disorders are in partial remission, feelings of paranoia, delusions of reference, social anxiety and self-stigmatization often remain at diminished severity and may lead to avoidance of places and people. Virtual reality exposure therapy (VRET) is an evidence-based treatment for several anxiety disorders. For patients with a psychotic disorder, the VRETp was developed to help them experience exposure to feared social situations. The present study aims to investigate the effects of VRETp on social participation in real life among patients with a psychotic disorder. Methods/design: The study is a single-blind randomized controlled trial with two conditions: the active condition, in which participants receive the virtual reality treatment together with treatment as usual (TAU), and the waiting list condition, in which participants receive TAU only. The two groups are compared at baseline, at 3 months posttreatment and at 6 months follow-up. All participants on the waiting list are also offered the virtual reality treatment after the follow-up measurements are completed. The primary outcome is social participation. Secondary outcomes are quality of life, interaction anxiety, depression and social functioning in general. Moderator and mediator analyses are conducted with stigma, cognitive schemata, cognitive biases, medication adherence, simulator sickness and presence in virtual reality. If effective, a cost-effectiveness analysis will be conducted. Discussion: Results from the posttreatment measurement can be considered strong empirical indicators of the effectiveness of VRETp. The 6-month follow-up data may provide reliable documentation of the long-term effects of the treatment on the outcome variables. Data from pre-treatment and mid-treatment can be used to reveal possible pathways of change

Psychometric evaluation of the Simulator Sickness Questionnaire as a measure of cybersickness

Some users of virtual reality (VR) technology experience negative symptoms, known as cybersickness, sometimes severe enough to cause discontinuation of VR use. Despite decades of research, there has been relatively little progress understanding the underlying causal mechanisms of cybersickness. Review of the measures used to assess cybersickness symptoms, particularly the subjective psychological components of cybersickness, indicated that extant questionnaires may exhibit psychometric problems that could affect interpretation of results. In the present study, new data were collected (N = 202) to evaluate the psychometric properties of the Simulator Sickness Questionnaire (SSQ), the most commonly reported measure of cybersickness symptoms, in the context of virtual reality. Findings suggest that the SSQ, as commonly used, is not applicable to VR. An alternative approach to measure cybersickness is suggested. Overall, incidence and severity of cybersickness was very low and participants rated the VR experience as highly entertaining

Dynamic Viewport-Adaptive Rendering in Distributed Interactive VR Streaming: Optimizing viewport resolution under latency and viewport orientation constraints

In streaming Virtual Reality to thin clients one of the main concerns is the massive bandwidth requirement of VR video. Additionally, streaming VR requires a low latency of less than 25ms to avoid cybersickness and provide a high Quality of Experience. Since a user is only viewing a portion of the VR content sphere at a time, researchers have leveraged this to increase the relative quality of the user viewport compared to peripheral areas. This way bandwidth can be saved, since the peripheral areas are streamed at a lower bitrate. In streaming $360\degree$ video this has resulted in the common strategy of tiling a video frame and delivering different quality tiles based on current available bandwidth and the user's viewport location. However, such an approach is not suitable for real-time Interactive VR streaming. Furthermore, streaming only the user's viewport results in the user observing unrendered or very low-quality areas at higher latency values. In order to provide a high viewport quality in Interactive VR, we propose the novel method of Dynamic Viewport-Adaptive Rendering. By rotating the frontal direction of the content sphere with the user gaze, we can dynamically render more or less of the peripheral area and thus increase the proportional resolution of the frontal direction in the video frame. We show that DVAR can successfully compensate for different system RTT values while offering a significantly higher viewport resolution than other implementations. We further discuss how DVAR can be easily extended by other optimization methods and discuss how we can incorporate head movement prediction to allow DVAR to optimally determine the amount of peripheral area to render, thus providing an optimal viewport resolution given the system constraints

The Effect of Varying Latency in a Head-Mounted Display on Task Performance and Motion Sickness

The purpose of this study was to determine how latency in a head-mounted display affects human performance. Virtual environments are used frequently for training, however simulator sickness is a common problem and may affect transfer of training. Aspects of virtual environments that cause simulator sickness are not fully understood, but varying latency has been shown to increase simulator sickness symptoms. The impact of varying latency on task performance and the interaction between performance and simulator sickness symptoms has not been examined. Twenty-nine subjects (15 male) participated in a repeated measures study in which they were exposed to two different latency conditions in a Head-Mounted Display (HMD): constant (70 ms) and varying (70 ms – 270 ms). Experimental sessions were separated by 14-daysto minimize the effects of adaptation. While wearing the HMD, subjects used a laser pointer to repeatedly shoot at 8 laser targets, arrayed in a 180-degree arc around the lab,over the course of 200 trials per session, presented in 5 blocks of 40 trials. Sickness levels, accuracy and time-to-hit data were recorded for analysis. Subjects scored fewer hits and took longer to hit targets in the varying latency condition, F (1,54) = 35.20, p \u3c .01, 2p = .40, than in the constant latency condition F (4,51) = 13.50, p \u3c .01, 2 p = .51. These findings indicate that individuals exposed to varying latency performed worse than individuals exposed to constant latency. However, it is unclear if the performance effects are due mostly to the latency itself or another underlying causal influence such as simulator sickness

Motion Generation and Planning System for a Virtual Reality Motion Simulator: Development, Integration, and Analysis

In the past five years, the advent of virtual reality devices has significantly influenced research in the field of immersion in a virtual world. In addition to the visual input, the motion cues play a vital role in the sense of presence and the factor of engagement in a virtual environment. This thesis aims to develop a motion generation and planning system for the SP7 motion simulator. SP7 is a parallel robotic manipulator in a 6RSS-R configuration. The motion generation system must be able to produce accurate motion data that matches the visual and audio signals. In this research, two different system workflows have been developed, the first for creating custom visual, audio, and motion cues, while the second for extracting the required motion data from an existing game or simulation. Motion data from the motion generation system are not bounded, while motion simulator movements are limited. The motion planning system commonly known as the motion cueing algorithm is used to create an effective illusion within the limited capabilities of the motion platform. Appropriate and effective motion cues could be achieved by a proper understanding of the perception of human motion, in particular the functioning of the vestibular system. A classical motion cueing has been developed using the model of the semi-circular canal and otoliths. A procedural implementation of the motion cueing algorithm has been described in this thesis. We have integrated all components together to make this robotic mechanism into a VR motion simulator. In general, the performance of the motion simulator is measured by the quality of the motion perceived on the platform by the user. As a result, a novel methodology for the systematic subjective evaluation of the SP7 with a pool of juries was developed to check the quality of motion perception. Based on the results of the evaluation, key issues related to the current configuration of the SP7 have been identified. Minor issues were rectified on the flow, so they were not extensively reported in this thesis. Two major issues have been addressed extensively, namely the parameter tuning of the motion cueing algorithm and the motion compensation of the visual signal in virtual reality devices. The first issue was resolved by developing a tuning strategy with an abstraction layer concept derived from the outcome of the novel technique for the objective assessment of the motion cueing algorithm. The origin of the second problem was found to be a calibration problem of the Vive lighthouse tracking system. So, a thorough experimental study was performed to obtain the optimal calibrated environment. This was achieved by benchmarking the dynamic position tracking performance of the Vive lighthouse tracking system using an industrial serial robot as a ground truth system. With the resolution of the identified issues, a general-purpose virtual reality motion simulator has been developed that is capable of creating custom visual, audio, and motion cues and of executing motion planning for a robotic manipulator with a human motion perception constraint

Can Simulator Sickness Be Avoided? A Review on Temporal Aspects of Simulator Sickness

Simulator sickness is a syndrome similar to motion sickness, often experienced during simulator or another virtual reality (VR) exposure. Many theories have been developed or adapted from the motion sickness studies, in order to explain the existence of the syndrome. The simulator sickness can be measured using both subjective and objective methods. The most popular self-report method is the Simulator Sickness Questionnaire. Attempts have also been made to discover a physiological indicator of the described syndrome, but no definite conclusion has been reached on this issue. In the present paper, three temporal aspects of the simulator sickness are discussed: the temporal trajectory of the progression of simulator sickness, possibility of adapting VR users in advance and persistence of the symptoms after VR exposure. Evidence found in 39 articles is widely described. As for the first aspect, it is clear that in most cases severity of the simulator sickness symptoms increases with time of exposure, although it is impossible to develop a single, universal pattern for this effect. It has also been proved, that in some cases a threshold level or time point exists, after which the symptoms stop increasing or begin to decrease. The adaptation effect was proved in most of the reviewed studies and observed in different study designs – e.g., with a couple of VR exposures on separate days or on 1 day and with a single, prolonged VR exposure. As for the persistence of the simulator sickness symptoms after leaving the VR, on the whole the study results suggest that such an effect exists, but it varies strongly between individual studies – the symptoms may persist for a short period of time (10 min) or a relatively long one (even 4 h). Considering the conclusions reached in the paper, it is important to bear in mind that the virtual reality technology still evokes unpleasant sensations in its users and that these sensations should be cautiously controlled while developing new VR tools. Certainly, more research on this topic is necessary

Virtual reality and body rotation: 2 flight experiences in comparison

Embodied interfaces, represented by devices that incorporate bodily motion and proprioceptive stimulation, are promising for Virtual Reality (VR) because they can improve immersion and user experience while at the same time reducing simulator sickness compared to more traditional handheld interfaces (e.g.,gamepads). The aim of the study is to evaluate a novel embodied interface called VitruvianVR. The machine is composed of two separate rings that allow its users to bodily rotate onto three different axes. The suitability of the VitruvianVR was tested in a Virtual Reality flight scenario. In order to reach the goal we compared the VitruvianVR to a gamepad using perfomance measures (i.e., accuracy, fails), head movements and position of the body. Furthermore, a series of data coming from questionnaires about sense of presence, user experience, cognitive load, usability and cybersickness was retrieved.Embodied interfaces, represented by devices that incorporate bodily motion and proprioceptive stimulation, are promising for Virtual Reality (VR) because they can improve immersion and user experience while at the same time reducing simulator sickness compared to more traditional handheld interfaces (e.g.,gamepads). The aim of the study is to evaluate a novel embodied interface called VitruvianVR. The machine is composed of two separate rings that allow its users to bodily rotate onto three different axes. The suitability of the VitruvianVR was tested in a Virtual Reality flight scenario. In order to reach the goal we compared the VitruvianVR to a gamepad using perfomance measures (i.e., accuracy, fails), head movements and position of the body. Furthermore, a series of data coming from questionnaires about sense of presence, user experience, cognitive load, usability and cybersickness was retrieved