Factors Associated With Virtual Reality Sickness in Head-Mounted Displays: A Systematic Review and Meta-Analysis

An Immersive Multi-User Virtual Reality for Emergency Simulation Training: Usability Study

BACKGROUND

Virtual reality (VR) is increasingly used as simulation technology in emergency medicine education and training, in particular for training nontechnical skills. Experimental studies comparing teaching and learning in VR with traditional training media often demonstrate the equivalence or even superiority regarding particular variables of learning or training effectiveness.

OBJECTIVE

In the EPICSAVE (Enhanced Paramedic Vocational Training with Serious Games and Virtual Environments) project, a highly immersive room-scaled multi-user 3-dimensional VR simulation environment was developed. In this feasibility study, we wanted to gain initial insights into the training effectiveness and media use factors influencing learning and training in VR.

METHODS

The virtual emergency scenario was anaphylaxis grade III with shock, swelling of the upper and lower respiratory tract, as well as skin symptoms in a 5-year-old girl (virtual patient) visiting an indoor family amusement park with her grandfather (virtual agent). A cross-sectional, one-group pretest and posttest design was used to evaluate the training effectiveness and quality of the training execution. The sample included 18 active emergency physicians.

RESULTS

The 18 participants rated the VR simulation training positive in terms of training effectiveness and quality of the training execution. A strong, significant correlation (r=.53, P=.01) between experiencing presence and assessing training effectiveness was observed. Perceived limitations in usability and a relatively high extraneous cognitive load reduced this positive effect.

CONCLUSIONS

The training within the virtual simulation environment was rated as an effective educational approach. Specific media use factors appear to modulate training effectiveness (ie, improvement through "experience of presence" or reduction through perceived limitations in usability). These factors should be specific targets in the further development of this VR simulation training.

The Use of Virtual Reality Alone Does Not Promote Training Performance (but Sense of Presence Does)

Virtual reality (VR) offers novel ways to develop skills and learning. This technology can be used to enhance the way we educate and train professionals by possibly being more effective, cost-efficient, and reducing training-related risks. However, the potential benefits from virtual training assume that the trained skills can be transferred to the real world. Nevertheless, in the current published scientific literature, there is limited empirical evidence that links VR use to better learning. The present investigation aimed to explore the use of VR as a tool for training procedural skills and compare this modality with traditional instruction methods. To investigate skill development using the two forms of training, participants were randomly divided into two groups. The first group received training through an instructional video, while the second group trained in VR. After the training session, the participants performed the trained task in a real setting, and task performance was measured. Subsequently, the user's experienced sense of presence and simulator sickness (SS) was measured with self-report questionnaires. There were no significant differences between groups for any of the performance measures. There was no gender effect on performance. Importantly, the results of the present study indicate that a high sense of presence during the VR simulation might contribute to increased skill learning. These findings can be used as a starting point that could be of value when further exploring VR as a tool for skill development.

Performance Evaluation of Mixed Reality Display for Guidance During Transcatheter Cardiac Mapping and Ablation

Cardiac electrophysiology procedures present the physician with a wealth of 3D information, typically presented on fixed 2D monitors. New developments in wearable mixed reality displays offer the potential to simplify and enhance 3D visualization while providing hands-free, dynamic control of devices within the procedure room.

OBJECTIVE

This work aims to evaluate the performance and quality of a mixed reality system designed for intraprocedural use in cardiac electrophysiology.

METHOD

The Enhanced Electrophysiology Visualization and Interaction System (ĒLVIS) mixed reality system performance criteria, including image quality, hardware performance, and usability were evaluated using existing display validation procedures adapted to the electrophysiology specific use case. Additional performance and user validation were performed through a 10 patient, in-human observational study, the Engineering ĒLVIS (E2) Study.

RESULTS

The ĒLVIS system achieved acceptable frame rate, latency, and battery runtime with acceptable dynamic range and depth distortion as well as minimal geometric distortion. Bench testing results corresponded with physician feedback in the observational study, and potential improvements in geometric understanding were noted.

CONCLUSION

The ĒLVIS system, based on current commercially available mixed reality hardware, is capable of meeting the hardware performance, image quality, and usability requirements of the electroanatomic mapping display for intraprocedural, real-time use in electrophysiology procedures. Verifying off the shelf mixed reality hardware for specific clinical use can accelerate the adoption of this transformative technology and provide novel visualization, understanding, and control of clinically relevant data in real-time.

Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study

Background

Apathy is a common symptom in neurological disorders, including dementia, and is associated with a faster rate of cognitive decline, reduced quality of life, and high caregiver burden. There is a lack of effective pharmacological treatments for apathy, and nonpharmacological interventions are a preferred first-line approach to treatment. Virtual reality (VR) using head-mounted displays (HMDs) is being successfully used in exposure- and distraction-based therapies; however, there is limited research on using HMDs for symptoms of neurological disorders.

Objective

This feasibility study aimed to assess whether VR using HMDs could be used to deliver tailored reminiscence therapy and examine the willingness to participate, response rates to measures, time taken to create tailored content, and technical problems. In addition, this study aimed to explore the immediate effects between verbal fluency and apathy after exposure to VR.

Methods

A mixed methods study was conducted in a sample of older adults residing in aged care, and 17 participants were recruited. Apathy was measured using the Apathy Evaluation Scale (AES), and verbal fluency was used as a proxy measure of improvements in apathy and debriefing interviews to assess feedback from participants. Side effects that can occur from using HMDs were also measured.

Results

We recruited participants from a high socioeconomic status setting with a high education level, and the participation rate was 85% (17/20); most responses to measures were positive. Access to a wide range of freely available content and the absence of technical difficulties made the delivery of a VR reminiscence intervention highly feasible. Participants had improved semantic scores (t₁₄=−3.27; P=.006) but not phonemic fluency scores (t₁₄=0.55; P=.59) immediately after the intervention. Those with higher levels of apathy demonstrated the greatest cognitive improvements after a VR reminiscence experience, which was indicated by a strong positive relationship between the AES and semantic verbal fluency change scores postminus pre-VR (r=0.719; 95% CI 0.327 to 0.900; P=.003). All participants enjoyed the experience despite 35% (6/17) of participants experiencing temporary side effects.

Conclusions

This study provides initial evidence that it is feasible to use VR with HMDs for therapy to treat symptoms of apathy in older adults in residential aged care. However, there is a need to closely monitor the side effects of HMD use in older adults. Further research is needed using an active control group to compare the use of VR with traditional forms of reminiscence therapy.

Guidelines for immersive virtual reality in psychological research

Virtual reality (VR) holds immense promise as a research tool to deliver results that are generalizable to the real world. However, the methodology used in different VR studies varies substantially. While many of these approaches claim to use 'immersive VR', the different hardware and software choices lead to issues regarding reliability and validity of psychological VR research. Questions arise about quantifying presence, the optimal level of graphical realism, the problem of being in dual realities and reproducibility of VR research. We discuss how VR research paradigms could be evaluated and offer a list of practical recommendations to have common guidelines for psychological VR research.

A Psychophysiological Model of Firearms Training in Police Officers: A Virtual Reality Experiment for Biocybernetic Adaptation

Crucial elements for police firearms training include mastering very specific psychophysiological responses associated with controlled breathing while shooting. Under high-stress situations, the shooter is affected by responses of the sympathetic nervous system that can impact respiration. This research focuses on how frontal oscillatory brainwaves and cardiovascular responses of trained police officers (N = 10) are affected during a virtual reality (VR) firearms training routine. We present data from an experimental study wherein shooters were interacting in a VR-based training simulator designed to elicit psychophysiological changes under easy, moderate and frustrating difficulties. Outcome measures in this experiment include electroencephalographic and heart rate variability (HRV) parameters, as well as performance metrics from the VR simulator. Results revealed that specific frontal areas of the brain elicited different responses during resting states when compared with active shooting in the VR simulator. Moreover, sympathetic signatures were found in the HRV parameters (both time and frequency) reflecting similar differences. Based on the experimental findings, we propose a psychophysiological model to aid the design of a biocybernetic adaptation layer that creates real-time modulations in simulation difficulty based on targeted physiological responses.