1
|
Kirkham R, Kooijman L, Albertella L, Myles D, Yücel M, Rotaru K. Immersive Virtual Reality-Based Methods for Assessing Executive Functioning: Systematic Review. JMIR Serious Games 2024; 12:e50282. [PMID: 38407958 DOI: 10.2196/50282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/26/2023] [Accepted: 12/29/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Neuropsychological assessments traditionally include tests of executive functioning (EF) because of its critical role in daily activities and link to mental disorders. Established traditional EF assessments, although robust, lack ecological validity and are limited to single cognitive processes. These methods, which are suitable for clinical populations, are less informative regarding EF in healthy individuals. With these limitations in mind, immersive virtual reality (VR)-based assessments of EF have garnered interest because of their potential to increase test sensitivity, ecological validity, and neuropsychological assessment accessibility. OBJECTIVE This systematic review aims to explore the literature on immersive VR assessments of EF focusing on (1) EF components being assessed, (2) how these assessments are validated, and (3) strategies for monitoring potential adverse (cybersickness) and beneficial (immersion) effects. METHODS EBSCOhost, Scopus, and Web of Science were searched in July 2022 using keywords that reflected the main themes of VR, neuropsychological tests, and EF. Articles had to be peer-reviewed manuscripts written in English and published after 2013 that detailed empirical, clinical, or proof-of-concept studies in which a virtual environment using a head-mounted display was used to assess EF in an adult population. A tabular synthesis method was used in which validation details from each study, including comparative assessments and scores, were systematically organized in a table. The results were summed and qualitatively analyzed to provide a comprehensive overview of the findings. RESULTS The search retrieved 555 unique articles, of which 19 (3.4%) met the inclusion criteria. The reviewed studies encompassed EF and associated higher-order cognitive functions such as inhibitory control, cognitive flexibility, working memory, planning, and attention. VR assessments commonly underwent validation against gold-standard traditional tasks. However, discrepancies were observed, with some studies lacking reported a priori planned correlations, omitting detailed descriptions of the EF constructs evaluated using the VR paradigms, and frequently reporting incomplete results. Notably, only 4 of the 19 (21%) studies evaluated cybersickness, and 5 of the 19 (26%) studies included user experience assessments. CONCLUSIONS Although it acknowledges the potential of VR paradigms for assessing EF, the evidence has limitations. The methodological and psychometric properties of the included studies were inconsistently addressed, raising concerns about their validity and reliability. Infrequent monitoring of adverse effects such as cybersickness and considerable variability in sample sizes may limit interpretation and hinder psychometric evaluation. Several recommendations are proposed to improve the theory and practice of immersive VR assessments of EF. Future studies should explore the integration of biosensors with VR systems and the capabilities of VR in the context of spatial navigation assessments. Despite considerable promise, the systematic and validated implementation of VR assessments is essential for ensuring their practical utility in real-world applications.
Collapse
Affiliation(s)
- Rebecca Kirkham
- Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Clayton, Australia
| | - Lars Kooijman
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, Australia
| | - Lucy Albertella
- Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Clayton, Australia
| | - Dan Myles
- Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Clayton, Australia
| | - Murat Yücel
- Queensland Institute of Medical Research Berghofer Medical Research Institute, Herston, Australia
- Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Kristian Rotaru
- Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Clayton, Australia
- Monash Business School, Monash University, Caufield, Australia
| |
Collapse
|
2
|
Pau M, Arippa F, Leban B, Porta M, Casu G, Frau J, Lorefice L, Coghe G, Cocco E. Cybersickness in People with Multiple Sclerosis Exposed to Immersive Virtual Reality. Bioengineering (Basel) 2024; 11:115. [PMID: 38391601 PMCID: PMC10886275 DOI: 10.3390/bioengineering11020115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Together with the wide range of possible benefits for the rehabilitation/training of people with multiple sclerosis (pwMS) and other neurologic conditions, exposure to immersive virtual reality (VR) has often been associated with unpleasant symptoms, such as transient dizziness, headache, nausea, disorientation and impaired postural control (i.e., cybersickness). Since these symptoms can significantly impact the safety and tolerability of the treatment, it appears important to correctly estimate their presence and magnitude. Given the existing data scarcity, this study aims to assess the existence and severity of possible adverse effects associated with exposure to immersive VR in a cohort of pwMS using both objective measurements of postural control effectiveness and subjective evaluations of perceived symptoms. To this aim, postural sway under upright quiet posture (in the presence and absence of visual input) of 56 pwMS with an Expanded Disability Status Scale score (EDSS) in the range of 0-6.5 (mean EDSS 2.3) and 33 unaffected individuals was measured before and after a 10-min immersive VR session and at 10 min follow-up on the basis of center of pressure (COP) trajectories. The severity of cybersickness symptoms associated with VR exposure was also self-rated by the participants using the Italian version of the Simulator Sickness Questionnaire (SSQ). Temporary impairments of postural control in terms of significantly increased sway area were observed after the VR session only in pwMS with mild-moderate disability (i.e., EDSS in the range of 2.5-6.5) in the presence of visual input. No changes were observed in pwMS with low disability (EDSS 0-2) and unaffected individuals. In contrast, when the visual input was removed, there was a decrease in sway area (pwMS with mild-moderate disability) and COP path length relating to the use of VR (pwMS with mild-moderate disability and unaffected individuals), thus suggesting a sort of "balance training effect". Even in this case, the baseline values were restored at follow-up. All participants, regardless of their status, experienced significant post-VR side effects, especially in terms of blurred vision and nausea. Taken together, the findings of the present study suggest that a short immersive VR session negatively (eyes open) and positively (eyes closed) impacts the postural control of pwMS and causes significant disorientation. However, such effects are of limited duration. While it is reasonable to state that immersive VR is sufficiently safe and tolerable to not be contraindicated in the rehabilitation/training of pwMS, in order to reduce possible negative effects and maximize the efficacy, safety and comfort of the treatment, it appears necessary to develop specific guidelines that consider important factors like individual susceptibility, maximum exposure time according to the specific features of the simulation, posture to adopt and protocols to assess objective and perceived effects on participants.
Collapse
Affiliation(s)
- Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy
| | - Federico Arippa
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy
| | - Giulia Casu
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy
| | - Jessica Frau
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, 09123 Cagliari, Italy
| | - Lorena Lorefice
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, 09123 Cagliari, Italy
| | - Giancarlo Coghe
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, 09123 Cagliari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, 09123 Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, 09123 Cagliari, Italy
| |
Collapse
|
3
|
Halow SJ, Hamilton A, Folmer E, MacNeilage PR. Impaired stationarity perception is associated with increased virtual reality sickness. J Vis 2023; 23:7. [PMID: 38127329 PMCID: PMC10750839 DOI: 10.1167/jov.23.14.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/05/2023] [Indexed: 12/23/2023] Open
Abstract
Stationarity perception refers to the ability to accurately perceive the surrounding visual environment as world-fixed during self-motion. Perception of stationarity depends on mechanisms that evaluate the congruence between retinal/oculomotor signals and head movement signals. In a series of psychophysical experiments, we systematically varied the congruence between retinal/oculomotor and head movement signals to find the range of visual gains that is compatible with perception of a stationary environment. On each trial, human subjects wearing a head-mounted display execute a yaw head movement and report whether the visual gain was perceived to be too slow or fast. A psychometric fit to the data across trials reveals the visual gain most compatible with stationarity (a measure of accuracy) and the sensitivity to visual gain manipulation (a measure of precision). Across experiments, we varied 1) the spatial frequency of the visual stimulus, 2) the retinal location of the visual stimulus (central vs. peripheral), and 3) fixation behavior (scene-fixed vs. head-fixed). Stationarity perception is most precise and accurate during scene-fixed fixation. Effects of spatial frequency and retinal stimulus location become evident during head-fixed fixation, when retinal image motion is increased. Virtual Reality sickness assessed using the Simulator Sickness Questionnaire covaries with perceptual performance. Decreased accuracy is associated with an increase in the nausea subscore, while decreased precision is associated with an increase in the oculomotor and disorientation subscores.
Collapse
Affiliation(s)
| | - Allie Hamilton
- University of Nevada, Reno, Psychology, Reno, Nevada, USA
| | - Eelke Folmer
- University of Nevada, Reno, Computer Science, Reno, Nevada, USA
| | | |
Collapse
|
4
|
Drazich BF, McPherson R, Gorman EF, Chan T, Teleb J, Galik E, Resnick B. In too deep? A systematic literature review of fully-immersive virtual reality and cybersickness among older adults. J Am Geriatr Soc 2023; 71:3906-3915. [PMID: 37560978 DOI: 10.1111/jgs.18553] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Virtual reality technology holds great promise in improving the health and well-being of older adults; however, this technology is associated with potential risks that may outweigh the benefits. The purpose of this systematic review is to synthesize and critique the existing literature on fully-immersive virtual reality interventions for older adults and the associated risk of cybersickness. METHODS We searched eight databases for studies that utilized fully-immersive virtual reality, stated the population as older adults, provided outcomes related to cybersickness, and were written or translated into the English language. Our search generated 332 articles, 39 of which were selected for inclusion in this systematic synthesis and appraisal. RESULTS We found that the majority of studies utilized a one-time session. The studies generally had weak sample generalizability and methodological design, but strong data collection and participant retention. The studies nearly all used the Simulator Sickness Questionnaire to measure cybersickness, but the scoring for the Simulator Sickness Questionnaire varied or was not mentioned. Most included studies reported only minor cybersickness among older adult participants. CONCLUSION Researchers might conclude that the benefits of virtual reality interventions outweigh the risk of cybersickness in this population. Going forward, researchers should concentrate on the efficacy of virtual reality interventions among older adults, using larger samples and randomized controlled study design, along with measuring dosage effects.
Collapse
Affiliation(s)
- Brittany F Drazich
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Rachel McPherson
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Emily F Gorman
- Health Sciences and Human Services Library, University of Maryland, Baltimore, Maryland, USA
| | - Thomas Chan
- Health Equity Research and Education Center & Autonomy Research Center for STEAHM, California State University Northridge, Northridge, California, USA
| | - Jejomar Teleb
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Barbara Resnick
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| |
Collapse
|
5
|
Séba MP, Maillot P, Hanneton S, Dietrich G. Influence of Normal Aging and Multisensory Data Fusion on Cybersickness and Postural Adaptation in Immersive Virtual Reality. Sensors (Basel) 2023; 23:9414. [PMID: 38067787 PMCID: PMC10708879 DOI: 10.3390/s23239414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023]
Abstract
Immersive Virtual Reality (VR) systems are expanding as sensorimotor readaptation tools for older adults. However, this purpose may be challenged by cybersickness occurrences possibly caused by sensory conflicts. This study aims to analyze the effects of aging and multisensory data fusion processes in the brain on cybersickness and the adaptation of postural responses when exposed to immersive VR. METHODS We repeatedly exposed 75 participants, aged 21 to 86, to immersive VR while recording the trajectory of their Center of Pressure (CoP). Participants rated their cybersickness after the first and fifth exposure. RESULTS The repeated exposures increased cybersickness and allowed for a decrease in postural responses from the second repetition, i.e., increased stability. We did not find any significant correlation between biological age and cybersickness scores. On the contrary, even if some postural responses are age-dependent, a significant postural adaptation occurred independently of age. The CoP trajectory length in the anteroposterior axis and mean velocity were the postural parameters the most affected by age and repetition. CONCLUSIONS This study suggests that cybersickness and postural adaptation to immersive VR are not age-dependent and that cybersickness is unrelated to a deficit in postural adaptation or age. Age does not seem to influence the properties of multisensory data fusion.
Collapse
Affiliation(s)
- Marie-Philippine Séba
- Institut des Sciences du Sport Santé de Paris (URP 3625), Université Paris Cité, F-75015 Paris, France; (P.M.); (S.H.); (G.D.)
| | | | | | | |
Collapse
|
6
|
Daşdemir Y. Classification of Emotional and Immersive Outcomes in the Context of Virtual Reality Scene Interactions. Diagnostics (Basel) 2023; 13:3437. [PMID: 37998573 PMCID: PMC10670519 DOI: 10.3390/diagnostics13223437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/25/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
The constantly evolving technological landscape of the Metaverse has introduced a significant concern: cybersickness (CS). There is growing academic interest in detecting and mitigating these adverse effects within virtual environments (VEs). However, the development of effective methodologies in this field has been hindered by the lack of sufficient benchmark datasets. In pursuit of this objective, we meticulously compiled a comprehensive dataset by analyzing the impact of virtual reality (VR) environments on CS, immersion levels, and EEG-based emotion estimation. Our dataset encompasses both implicit and explicit measurements. Implicit measurements focus on brain signals, while explicit measurements are based on participant questionnaires. These measurements were used to collect data on the extent of cybersickness experienced by participants in VEs. Using statistical methods, we conducted a comparative analysis of CS levels in VEs tailored for specific tasks and their immersion factors. Our findings revealed statistically significant differences between VEs, highlighting crucial factors influencing participant engagement, engrossment, and immersion. Additionally, our study achieved a remarkable classification performance of 96.25% in distinguishing brain oscillations associated with VR scenes using the multi-instance learning method and 95.63% in predicting emotions within the valence-arousal space with four labels. The dataset presented in this study holds great promise for objectively evaluating CS in VR contexts, differentiating between VEs, and providing valuable insights for future research endeavors.
Collapse
Affiliation(s)
- Yaşar Daşdemir
- Department of Computer Engineering, Erzurum Technical University, 25050 Erzurum, Turkey
| |
Collapse
|
7
|
Ben-Ari O, Sarfati S, Gordon B, Assa A, Nakdimon I. Anticholinergic Versus Antihistaminic Treatment for Simulator Sickness Prevention. J Clin Pharmacol 2023; 63:1119-1125. [PMID: 37491788 DOI: 10.1002/jcph.2319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/19/2023] [Indexed: 07/27/2023]
Abstract
Flight simulators have an essential role in aircrew training. Occasionally, symptoms of motion sickness, defined as simulator sickness, develop during these sessions. Preventive methods for motion sickness have been investigated thoroughly; however, only a few studies have examined preventive treatments for simulator sickness. The aim of this study was to examine the efficacy of scopolamine (an anticholinergic drug) compared with cinnarizine (an antihistaminic drug) for helicopter simulator sickness prevention. A validated simulator sickness questionnaire (SSQ) score was used to determine the severity of simulator sickness symptoms in this study. Preliminary SSQ scores and SSQ scores after each sortie were calculated. Each participant was given scopolamine, cinnarizine, or a placebo in a double-blind randomized manner before the first sortie of each training day. Forty-one helicopter pilots participated in the trial. The average age was 30.5 ± 7.1 years. SSQ values significantly improved from an average of 73.30 in the preliminary SSQ questionnaire to an average of 30.92 after 2 hours following the administration of cinnarizine (P = .012, 95%CI 8.071-76.703). Scopolamine was found to be less effective than both cinnarizine and the placebo in the alleviation of simulator sickness symptoms. This study is the first to compare scopolamine with cinnarizine for simulator sickness prevention. Based on the results of this study, we recommend the use of cinnarizine over scopolamine for simulator sickness prevention.
Collapse
Affiliation(s)
- Oded Ben-Ari
- Department of Military Medicine, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
- The Israeli Air Force Aeromedical Center, Tel-Hashomer, Ramat Gan, Israel
- Israeli Defense Forces Medical Corps, Tel-Hashomer, Ramat Gan, Israel
- The Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Shani Sarfati
- The Israeli Air Force Aeromedical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Barak Gordon
- Department of Military Medicine, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
- The Israeli Air Force Aeromedical Center, Tel-Hashomer, Ramat Gan, Israel
- Israeli Defense Forces Medical Corps, Tel-Hashomer, Ramat Gan, Israel
| | - Amit Assa
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Idan Nakdimon
- The Israeli Air Force Aeromedical Center, Tel-Hashomer, Ramat Gan, Israel
| |
Collapse
|
8
|
Souchet AD, Lourdeaux D, Burkhardt JM, Hancock PA. Corrigendum: Design guidelines for limiting and eliminating virtual reality-induced symptoms and effects at work: a comprehensive, factor-oriented review. Front Psychol 2023; 14:1261103. [PMID: 37671107 PMCID: PMC10476078 DOI: 10.3389/fpsyg.2023.1261103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyg.2023.1161932.].
Collapse
Affiliation(s)
- Alexis D. Souchet
- Heudiasyc UMR 7253, Alliance Sorbonne Université, Université de Technologie de Compiègne, CNRS, Compiègne, France
- Institute for Creative Technologies, University of Southern California, Los Angeles, CA, United States
| | - Domitile Lourdeaux
- Heudiasyc UMR 7253, Alliance Sorbonne Université, Université de Technologie de Compiègne, CNRS, Compiègne, France
| | | | - Peter A. Hancock
- Department of Psychology, University of Central Florida, Orlando, FL, United States
| |
Collapse
|
9
|
Rmadi H, Maillot P, Artico R, Baudouin E, Hanneton S, Dietrich G, Duron E. Tolerance of immersive head-mounted virtual reality among older nursing home residents. Front Public Health 2023; 11:1163484. [PMID: 37538272 PMCID: PMC10394641 DOI: 10.3389/fpubh.2023.1163484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/26/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction Virtual Reality (VR) is a tool that is increasingly used in the aging population. Head-Mounted Displays (HMDs) are stereoscopic vision devices used for immersive VR. Cybersickness is sometimes reported after head-mounted display (HMD) VR exposure. Cybersickness severity and anxiety state reflect VR low tolerance. We aimed to evaluate HMD VR tolerance among older nursing home residents through cybersickness and anxiety state. Methods A total of 36 participants were included in this preliminary study, 33 of whom (mean age: 89.33 ± 5.48) underwent three individual HMD VR sessions with three different contents. Cybersickness occurrence and severity were scored by the Simulator Sickness Questionnaire (SSQ) after each session. Anxiety state was assessed by the State-Trait Anxiety Inventory form Y-A before and after each session. Anxiety trait (using State-Trait Anxiety Inventory form Y-B) was also evaluated before and after the experiment. In total, 92% (33/36) of patients completed all three sessions, of which 61% (20/33) did not report any cybersickness symptoms (SSQ = 0). Six participants reported significant cybersickness (defined by an SSQ score ⩾10) in at least one session. Discussion Only two participants stopped the study after the first exposure because of cybersickness. Age, cognitive function, anxiety trait, and well-being were not associated with cybersickness. The mean anxiety state decreased significantly from pre- to post-session. This immersive HMD VR experience was well tolerated among nursing home dwellers. Further larger studies in this population aiming to identify CS determinants are needed in order to use HMD VR on a standard basis.
Collapse
Affiliation(s)
- Hajer Rmadi
- Institut des Sciences du Sport-Santé de Paris (URP3625 – I3SP), Université Paris Cité, Paris, France
| | - Pauline Maillot
- Institut des Sciences du Sport-Santé de Paris (URP3625 – I3SP), Université Paris Cité, Paris, France
| | - Romain Artico
- Laboratoire Complexité, Innovations, Activités Motrices et Sportives (CIAMS, EA4532), Université Paris-Saclay, Orsay, France
| | - Edouard Baudouin
- Inserm, CESP, Team MOODS, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris, Department of Geriatric, Paul Brousse Hospital, Villejuif, France
| | - Sylvain Hanneton
- Institut des Sciences du Sport-Santé de Paris (URP3625 – I3SP), Université Paris Cité, Paris, France
| | - Gilles Dietrich
- Institut des Sciences du Sport-Santé de Paris (URP3625 – I3SP), Université Paris Cité, Paris, France
| | - Emmanuelle Duron
- Inserm, CESP, Team MOODS, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris, Department of Geriatric, Paul Brousse Hospital, Villejuif, France
| |
Collapse
|
10
|
Ardıç FN, Metin U, Gökcan BE. Subjective Visual Vertical test with the 3D virtual reality system: effective factors and cybersickness. Acta Otolaryngol 2023; 143:570-575. [PMID: 37493360 DOI: 10.1080/00016489.2023.2238769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND 3D Virtual Reality (VR) offers new opportunities in vestibular science. It also presents new challenges and problems. AIMS/OBJECTIVES The study aimed to evaluate the effective factors in the 3D VR Subjective Visual Vertical (SVV) test and the impact of cybersickness on the test results. MATERIAL AND METHODS The effect of the foam surface, head position in the yaw axis, moving background, and arm position holding the controller was tested. Cybersickness was evaluated using the Simulator Sickness Questionnaire (SSQ). RESULTS The head position and controller holding style significantly affected the results. The foam surface and the moving background did not have a significant effect. Although 61.4% of the patients fell into the bad category according to the symptoms of the SSQ score, cybersickness did not significantly affect the SVV results. CONCLUSIONS AND SIGNIFICANCE In 3D VR SVV, additional factors should be considered: the headset's weight, head position, and how we hold the controller. The A-effect emerged when the head was 45 degrees turned on the yaw axis. A significant shift was detected in the test, with the arm holding the controller at 90 degrees. Most subjects felt cybersickness at a considerable level. Cybersickness should always be taken into account in VR when planning new applications.
Collapse
Affiliation(s)
- Fazıl Necdet Ardıç
- Department of Otolaryngology, School of Medicine, Pamukkale University, Denizli, Turkey
| | - Ulaş Metin
- Department of Otolaryngology, School of Medicine, Pamukkale University, Denizli, Turkey
| | | |
Collapse
|
11
|
Souchet AD, Lourdeaux D, Burkhardt JM, Hancock PA. Design guidelines for limiting and eliminating virtual reality-induced symptoms and effects at work: a comprehensive, factor-oriented review. Front Psychol 2023; 14:1161932. [PMID: 37359863 PMCID: PMC10288216 DOI: 10.3389/fpsyg.2023.1161932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
Virtual reality (VR) can induce side effects known as virtual reality-induced symptoms and effects (VRISE). To address this concern, we identify a literature-based listing of these factors thought to influence VRISE with a focus on office work use. Using those, we recommend guidelines for VRISE amelioration intended for virtual environment creators and users. We identify five VRISE risks, focusing on short-term symptoms with their short-term effects. Three overall factor categories are considered: individual, hardware, and software. Over 90 factors may influence VRISE frequency and severity. We identify guidelines for each factor to help reduce VR side effects. To better reflect our confidence in those guidelines, we graded each with a level of evidence rating. Common factors occasionally influence different forms of VRISE. This can lead to confusion in the literature. General guidelines for using VR at work involve worker adaptation, such as limiting immersion times to between 20 and 30 min. These regimens involve taking regular breaks. Extra care is required for workers with special needs, neurodiversity, and gerontechnological concerns. In addition to following our guidelines, stakeholders should be aware that current head-mounted displays and virtual environments can continue to induce VRISE. While no single existing method fully alleviates VRISE, workers' health and safety must be monitored and safeguarded when VR is used at work.
Collapse
Affiliation(s)
- Alexis D. Souchet
- Heudiasyc UMR 7253, Alliance Sorbonne Université, Université de Technologie de Compiègne, CNRS, Compiègne, France
- Institute for Creative Technologies, University of Southern California, Los Angeles, CA, United States
| | - Domitile Lourdeaux
- Heudiasyc UMR 7253, Alliance Sorbonne Université, Université de Technologie de Compiègne, CNRS, Compiègne, France
| | | | - Peter A. Hancock
- Department of Psychology, University of Central Florida, Orlando, FL, United States
| |
Collapse
|
12
|
Lundin RM, Yeap Y, Menkes DB. Adverse Effects of Virtual and Augmented Reality Interventions in Psychiatry: Systematic Review. JMIR Ment Health 2023; 10:e43240. [PMID: 37145841 DOI: 10.2196/43240] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/22/2022] [Accepted: 01/05/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Virtual reality (VR) and augmented reality (AR) are emerging treatment modalities in psychiatry, which are capable of producing clinical outcomes broadly comparable to those achieved with standard psychotherapies. OBJECTIVE Because the side effect profile associated with the clinical use of VR and AR remains largely unknown, we systematically reviewed available evidence of their adverse effects. METHODS A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework across 3 mental health databases (PubMed, PsycINFO, and Embase) to identify VR and AR interventions targeting mental health diagnoses. RESULTS Of 73 studies meeting the inclusion criteria, 7 reported worsening clinical symptoms or an increased fall risk. Another 21 studies reported "no adverse effects" but failed to identify obvious adverse effects, mainly cybersickness, documented in their results. More concerningly, 45 of the 73 studies made no mention of adverse effects whatsoever. CONCLUSIONS An appropriate screening tool would help ensure that VR adverse effects are correctly identified and reported.
Collapse
Affiliation(s)
- Robert M Lundin
- Change to Improve Mental Health, Mental Health Drugs and Alcohol Services, Barwon Health, Geelong, Australia
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Yuhern Yeap
- Mental Health and Addictions, Waikato District Health Board, Hamilton, New Zealand
| | - David B Menkes
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| |
Collapse
|
13
|
Keshavarz B, Murovec B, Mohanathas N, Golding JF. The Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ): Estimating Individual Susceptibility to Motion Sickness-Like Symptoms When Using Visual Devices. Hum Factors 2023; 65:107-124. [PMID: 33874752 PMCID: PMC9846380 DOI: 10.1177/00187208211008687] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Two studies were conducted to develop and validate a questionnaire to estimate individual susceptibility to visually induced motion sickness (VIMS). BACKGROUND VIMS is a common side-effect when watching dynamic visual content from various sources, such as virtual reality, movie theaters, or smartphones. A reliable questionnaire predicting individual susceptibility to VIMS is currently missing. The aim was to fill this gap by introducing the Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ). METHODS A survey and an experimental study were conducted. Survey: The VIMSSQ investigated the frequency of nausea, headache, dizziness, fatigue, and eyestrain when using different visual devices. Data were collected from a survey of 322 participants for the VIMSSQ and other related phenomena such as migraine. Experimental study: 23 participants were exposed to a VIMS-inducing visual stimulus. Participants filled out the VIMSSQ together with other questionnaires and rated their level of VIMS using the Simulator Sickness Questionnaire (SSQ). RESULTS Survey: The most prominent symptom when using visual devices was eyestrain, and females reported more VIMS than males. A one-factor solution with good scale reliability was found for the VIMSSQ. Experimental study: Regression analyses suggested that the VIMSSQ can be useful in predicting VIMS (R2 = .34) as measured by the SSQ, particularly when combined with questions pertaining to the tendency to avoid visual displays and experience syncope (R2 = .59). CONCLUSION We generated normative data for the VIMSSQ and demonstrated its validity. APPLICATION The VIMSSQ can become a valuable tool to estimate one's susceptibility to VIMS based on self-reports.
Collapse
Affiliation(s)
- Behrang Keshavarz
- KITE-Toronto Rehabilitation Institute, University Health
Network, Canada
- Ryerson University, Toronto, Canada
- Behrang Keshavarz, KITE-Toronto
Rehabilitation Institute, University Health Network, 550 University Avenue,
Toronto, ON M5G 2A2, Canada;
| | - Brandy Murovec
- KITE-Toronto Rehabilitation Institute, University Health
Network, Canada
- Ryerson University, Toronto, Canada
| | - Niroshica Mohanathas
- KITE-Toronto Rehabilitation Institute, University Health
Network, Canada
- University of Toronto, Canada
| | | |
Collapse
|
14
|
Morizio C, Compagnat M, Boujut A, Labbani-Igbida O, Billot M, Perrochon A. Immersive Virtual Reality during Robot-Assisted Gait Training: Validation of a New Device in Stroke Rehabilitation. Medicina (Kaunas) 2022; 58:medicina58121805. [PMID: 36557007 PMCID: PMC9782023 DOI: 10.3390/medicina58121805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
Background and objective: Duration of rehabilitation and active participation are crucial for gait rehabilitation in the early stage after stroke onset. Virtual reality (VR) is an innovative tool providing engaging and playful environments that could promote intrinsic motivation and higher active participation for non-ambulatory stroke patients when combined with robot-assisted gait training (RAGT). We have developed a new, fully immersive VR application for RAGT, which can be used with a head-mounted display and wearable sensors providing real-time gait motion in the virtual environment. The aim of this study was to validate the use of this new device and assess the onset of cybersickness in healthy participants before testing the device in stroke patients. Materials and Methods: Thirty-seven healthy participants were included and performed two sessions of RAGT using a fully immersive VR device. They physically walked with the Gait Trainer for 20 min in a virtual forest environment. The occurrence of cybersickness, sense of presence, and usability of the device were assessed with three questionnaires: the Simulator Sickness Questionnaire (SSQ), the Presence Questionnaire (PQ), and the System Usability Scale (SUS). Results: All of the participants completed both sessions. Most of the participants (78.4%) had no significant adverse effects (SSQ < 5). The sense of presence in the virtual environment was particularly high (106.42 ± 9.46). Participants reported good usability of the device (86.08 ± 7.54). Conclusions: This study demonstrated the usability of our fully immersive VR device for gait rehabilitation and did not lead to cybersickness. Future studies should evaluate the same parameters and the effectiveness of this device with non-ambulatory stroke patients.
Collapse
Affiliation(s)
- Charles Morizio
- HAVAE Laboratory, UR20217, University of Limoges, F-87000 Limoges, France
- Department of Physical Medicine and Rehabilitation, University Hospital Center of Limoges, F-87000 Limoges, France
| | - Maxence Compagnat
- HAVAE Laboratory, UR20217, University of Limoges, F-87000 Limoges, France
- Department of Physical Medicine and Rehabilitation, University Hospital Center of Limoges, F-87000 Limoges, France
| | - Arnaud Boujut
- HAVAE Laboratory, UR20217, University of Limoges, F-87000 Limoges, France
- 3iL Groupe, F-87015 Limoges, France
| | | | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, F-86000 Poitiers, France
| | - Anaick Perrochon
- HAVAE Laboratory, UR20217, University of Limoges, F-87000 Limoges, France
- Correspondence: ; Tel.: +33-679723648
| |
Collapse
|
15
|
Kim YS, Won J, Jang SW, Ko J. Effects of Cybersickness Caused by Head-Mounted Display-Based Virtual Reality on Physiological Responses: Cross-sectional Study. JMIR Serious Games 2022; 10:e37938. [PMID: 36251360 PMCID: PMC9623462 DOI: 10.2196/37938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/06/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although more people are experiencing cybersickness due to the popularization of virtual reality (VR), no official standard for the cause and reduction of cybersickness exists to date. One of the main reasons is that an objective method to assess cybersickness has not been established. To resolve this, research on evaluating cybersickness with physiological responses that can be measured in real time is required. Since research on deriving physiological responses that can assess cybersickness is at an early stage, further studies examining various physiological responses are needed. Objective This study analyzed the effects of cybersickness caused by head-mounted display–based VR on physiological responses. Methods We developed content that provided users with a first-person view of an aircraft that moved (with translation and combined rotation) over a city via a predetermined trajectory. In the experiment, cybersickness and the physiological responses of participants were measured. Cybersickness was assessed by the Simulator Sickness Questionnaire (SSQ). The measured physiological responses were heart rate, blood pressure, body temperature, and cortisol level. Results Our measurement confirmed that all SSQ scores increased significantly (all Ps<.05) when participants experienced cybersickness. Heart rate and cortisol level increased significantly (P=.01 and P=.001, respectively). Body temperature also increased, but there was no statistically significant difference (P=.02). Systolic blood pressure and diastolic blood pressure decreased significantly (P=.001). Conclusions Based on the results of our analysis, the following conclusions were drawn: (1) cybersickness causes significant disorientation, and research on this topic should focus on factors that affect disorientation; and (2) the physiological responses that are suitable for measuring cybersickness are heart rate and cortisol level.
Collapse
Affiliation(s)
- Yoon Sang Kim
- BioComputing Lab, Institute for Bio-engineering Application Technology, Department of Computer Science and Engineering, Korea University of Technology and Education, Cheonan-si, Republic of Korea
| | - JuHye Won
- BioComputing Lab, Department of Computer Science and Engineering, Korea University of Technology and Education, Cheonan-si, Republic of Korea
| | - Seong-Wook Jang
- Assistive Technology Research Team for Independent Living, National Rehabilitation Institute, Seoul, Republic of Korea
| | - Junho Ko
- AirPlug Ltd, Seoul, Republic of Korea
| |
Collapse
|
16
|
Nam S, Jang KM, Kwon M, Lim HK, Jeong J. Electroencephalogram microstates and functional connectivity of cybersickness. Front Hum Neurosci 2022; 16:857768. [PMID: 36072889 PMCID: PMC9441598 DOI: 10.3389/fnhum.2022.857768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Virtual reality (VR) is a rapidly developing technology that simulates the real world. However, for some cybersickness-susceptible people, VR still has an unanswered problem-cybersickness-which becomes the main obstacle for users and content makers. Sensory conflict theory is a widely accepted theory for cybersickness. It proposes that conflict between afferent signals and internal models can cause cybersickness. This study analyzes the brain states that determine cybersickness occurrence and related uncomfortable feelings. Furthermore, we use the electroencephalogram (EEG) microstates and functional connectivity approach based on the sensory conflict theory. The microstate approach is a time-space analysis method that allows signals to be divided into several temporarily stable states, simultaneously allowing for the exploration of short- and long-range signals. These temporal dynamics can show the disturbances in mental processes associated with neurological and psychiatric conditions of cybersickness. Furthermore, the functional connectivity approach gives us in-depth insight and relationships between the sources related to cybersickness. We recruited 40 males (24.1 ± 2.3 years), and they watched a VR video on a curved computer monitor for 10 min to experience cybersickness. We recorded the 5-min resting state EEG (baseline condition) and 10-min EEG while watching the VR video (task condition). Then, we performed a microstate analysis, focusing on two temporal parameters: mean duration and global explained variance (GEV). Finally, we obtained the functional connectivity data using eLoreta and lagged phase synchronization (LPS). We discovered five sets of microstates (A-E), including four widely reported canonical microstates (A-D), during baseline and task conditions. The average duration increased in microstates A and B, which is related to the visual and auditory networks. The GEV and duration decreased in microstate C, whereas those in microstate D increased. Microstate C is related to the default mode network (DMN) and D to the attention network. The temporal dynamics of the microstate parameters are from cybersickness disturbing the sensory, DMN, and attention networks. In the functional connectivity part, the LPS between the left and right parietal operculum (OP) significantly decreased (p < 0.05) compared with the baseline condition. Furthermore, the connectivity between the right OP and V5 significantly decreased (p < 0.05). These results also support the disturbance of the sensory network because a conflict between the visual (V5) and vestibular system (OP) causes cybersickness. Changes in the microstates and functional connectivity support the sensory conflict theory. These results may provide additional information in understanding brain dynamics during cybersickness.
Collapse
Affiliation(s)
- Sungu Nam
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Kyoung-Mi Jang
- Korea Research Institute of Standards and Science, Daejeon, South Korea
| | - Moonyoung Kwon
- Korea Research Institute of Standards and Science, Daejeon, South Korea
| | - Hyun Kyoon Lim
- Korea Research Institute of Standards and Science, Daejeon, South Korea
| | - Jaeseung Jeong
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| |
Collapse
|
17
|
Martingano AJ, Brown E, Telaak SH, Dolwick AP, Persky S. Cybersickness Variability by Race: Findings From 6 Studies and a Mini Meta-analysis. J Med Internet Res 2022; 24:e36843. [PMID: 35648477 PMCID: PMC9201708 DOI: 10.2196/36843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/22/2022] [Accepted: 04/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background With the influx of medical virtual reality (VR) technologies, cybersickness has transitioned from a nuisance experienced during leisure activities to a potential safety and efficacy concern for patients and clinicians. To improve health equity, it is important to understand any potential differences in cybersickness propensity among demographic groups, including racial groups. Objective This study aims to explore whether cybersickness propensity differs across racial groups. Methods We collected self-reported cybersickness ratings from 6 racially diverse independent samples within 1 laboratory group (N=931). In these studies, the participants were asked to perform tasks in VR such as traversing environments, pointing at and selecting objects, and interacting with virtual humans. Results Significant racial differences in cybersickness were found in 50% (3/6) of studies. A mini meta-analysis revealed that, on average, Black participants reported approximately one-third of SD less cybersickness than White participants (Cohen d=−0.31; P<.001), regardless of the nature of the VR experience. There was no overall difference in reported cybersickness between the Asian and White participants (Cohen d=−0.11; P=.51). Conclusions Racial differences in cybersickness indicate that researchers, practitioners, and regulators should consider patient demographics when evaluating VR health intervention outcomes. These findings lay the groundwork for future studies that may explore racial differences in cybersickness directly.
Collapse
Affiliation(s)
- Alison Jane Martingano
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Ellenor Brown
- Office of Science and Engineering Laboratories, US Food and Drug Administration, Silver Spring, MD, United States
| | - Sydney H Telaak
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Alexander P Dolwick
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
18
|
Yu M, Xiao S, Tian F, Li Y. Frontal-occipital network alterations while viewing 2D & 3D movies: a source-level EEG and graph theory approach. BIOMED ENG-BIOMED TE 2022; 67:161-172. [PMID: 35576610 DOI: 10.1515/bmt-2021-0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 04/21/2022] [Indexed: 11/15/2022]
Abstract
Many researchers have measured the differences in electroencephalography (EEG) while viewing 2D and 3D movies to uncover the neuromechanism underlying distinct viewing experiences. Using whole-brain network analyses of scalp EEG, our previous study reported that beta and gamma bands presented higher global efficiencies while viewing 3D movies. However, scalp EEG is influenced by volume conduction, not allowing inference from a neuroanatomy perspective; thus, source reconstruction techniques are recommended. This paper is the first to measure the differences in the frontal-occipital networks in EEG source space during 2D and 3D movie viewing. EEG recordings from 40 subjects were performed during 2D and 3D movie viewing. We constructed frontal-occipital networks of alpha, beta, and gamma bands in EEG source space and analyzed network efficiencies. We found that the beta band exhibited higher global efficiency in 3D movie viewing than in 2D movie viewing; however, the alpha global efficiency was not statistically significant. In addition, a support vector machine (SVM) classifier, taking functional connectivities as classification features, was built to identify whether the frontal-occipital networks contain patterns that could distinguish 2D and 3D movie viewing. Using the 6 most important functional connectivity features of the beta band, we obtained the best accuracy of 0.933. Our findings shed light on uncovering the neuromechanism underlying distinct experiences while viewing 2D and 3D movies.
Collapse
Affiliation(s)
- Minchang Yu
- School of Communication and Information Engineering, Shanghai University, Shanghai, China
| | - Shasha Xiao
- School of Communication and Information Engineering, Shanghai University, Shanghai, China
| | - Feng Tian
- Shanghai Film Academy, Shanghai University, Shanghai, China
| | - Yingjie Li
- School of Life Sciences, College of International Education, Institute of Biomedical Engineering, Shanghai University, Shanghai, China
| |
Collapse
|
19
|
Adhanom I, Halow S, Folmer E, MacNeilage P. VR Sickness Adaptation With Ramped Optic Flow Transfers From Abstract To Realistic Environments. Front Virtual Real 2022; 3:848001. [PMID: 36873792 PMCID: PMC9979719 DOI: 10.3389/frvir.2022.848001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
VR sickness is a major concern for many users as VR continues its expansion towards widespread everyday use. VR sickness is thought to arise, at least in part, due to the user's intolerance of conflict between the visually simulated self-motion and actual physical movement. Many mitigation strategies involve consistently modifying the visual stimulus to reduce its impact on the user, but this individualized approach can have drawbacks in terms of complexity of implementation and non-uniformity of user experience. This study presents a novel alternative approach that involves training the user to better tolerate the adverse stimulus by tapping into natural adaptive perceptual mechanisms. In this study, we recruited users with limited VR experience that reported susceptibility to VR sickness. Baseline sickness was measured as participants navigated a rich and naturalistic visual environment. Then, on successive days, participants were exposed to optic flow in a more abstract visual environment, and strength of the optic flow was successively increased by increasing the visual contrast of the scene, because strength of optic flow and the resulting vection are thought to be major causes of VR sickness. Sickness measures decreased on successive days, indicating that adaptation was successful. On the final day, participants were again exposed to the rich and naturalistic visual environment, and the adaptation was maintained, demonstrating that it is possible for adaptation to transfer from more abstract to richer and more naturalistic environments. These results demonstrate that gradual adaptation to increasing optic flow strength in well-controlled, abstract environments allows users to gradually reduce their susceptibility to sickness, thereby increasing VR accessibility for those prone to sickness.
Collapse
Affiliation(s)
- Isayas Adhanom
- Department of Computer Science and Engineering, University of Nevada, Reno, NV, United States
| | - Savannah Halow
- Department of Psychology, University of Nevada, Reno, NV, United States
| | - Eelke Folmer
- Department of Computer Science and Engineering, University of Nevada, Reno, NV, United States
| | - Paul MacNeilage
- Department of Psychology, University of Nevada, Reno, NV, United States
| |
Collapse
|
20
|
Nam Y, Hong U, Chung H, Noh SR. Eye Movement Patterns Reflecting Cybersickness: Evidence from Different Experience Modes of a Virtual Reality Game. Cyberpsychol Behav Soc Netw 2022; 25:135-139. [PMID: 34962156 DOI: 10.1089/cyber.2021.0167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study investigated whether the degree of cybersickness varies depending on different virtual reality experience modes (playing vs. watching) and whether specific eye movement parameters reflect changes in cybersickness. Simulator Sickness Questionnaire results from 20 participants (10 playing and 10 watching) showed that cybersickness was much more severe in the watching mode, particularly during the second of the three total trials. Moreover, cybersickness' changing pattern was reflected in the center gaze ratio and scan-path length. These findings imply the importance of physiological measurements for a deeper understanding of cybersickness in theoretical and practical respects.
Collapse
Affiliation(s)
- Yunju Nam
- KU Institute for Communication Studies, Konkuk University, Seoul, Korea
| | - Upyong Hong
- Department of Media and Communication, Konkuk University, Seoul, Korea
| | - Hyenyeong Chung
- Department of Media and Communication, Konkuk University, Seoul, Korea
| | - Soo Rim Noh
- Department of Psychology, Chungnam National University, Daejeon, Korea
| |
Collapse
|
21
|
Qu C, Che X, Ma S, Zhu S. Bio-physiological-signals-based VR cybersickness detection. CCF Trans. Pervasive Comp. Interact. 2022; 4:268-284. [PMCID: PMC9125551 DOI: 10.1007/s42486-022-00103-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/27/2022] [Indexed: 11/25/2023]
Abstract
With the gradual maturity of virtual reality (VR) technology in recent years, VR industry is in a trend of rapid growth, providing new possibilities for content design. Although VR technology has been able to provide users with excellent immersive experience, side effects that affect the user experience still exist, especially the cybersickness. It would cause extreme physical discomfort to the users and the discontinuation of use. Many researchers have tried to find the inducement of cybersickness and to detect and limit the occurrence of this symptom, but most of the current detection and analysis methods rely on subjective questionnaires to collect users’ posterior states, such as dizziness, nausea, cold sweats, disorientation, eyestrain and so on. There is no mature real-time cybersickness detection system for VR developers to evaluate the susceptibility of their products to cybersickness so far, which has hindered the adoption of VR to some extent. The purpose of this study is to implement the real-time monitoring of cybersickness using physiological sensors to measure data and quantify the influence factors of cybersickness through deep learning model. Besides, we have developed a VR experimental platform and passive navigation task to induce user cybersickness. During the experiment, to train the LSTM Attention neural network model, we collected the user’s real-time physiological signals, including skin electrical activity (EDA) and electrocardiogram (ECG), as well as the position and bone rotation data of the users’ virtual avatar. The model can detect the level of users’ cybersickness in real-time during VR experience. And the model has been verified by the fivefold cross-validation that the average accuracy of 96.85% was achieved for classification of cybersickness level, showing great performance compared with other relevant studies. The results show the feasibility of accurate classification of cybersickness using the model we proposed. Also the model can provide reference for VR researchers and developers to improve the user experience.
Collapse
Affiliation(s)
- Chenxin Qu
- School of Software Engineering, Beijing Jiaotong University, Beijing, 100044 China
| | - Xiaoping Che
- School of Software Engineering, Beijing Jiaotong University, Beijing, 100044 China
| | - Siqi Ma
- School of Software Engineering, Beijing Jiaotong University, Beijing, 100044 China
| | - Shuqin Zhu
- School of Software Engineering, Beijing Jiaotong University, Beijing, 100044 China
| |
Collapse
|
22
|
Clark RA, Szpak A, Michalski SC, Loetscher T. Rest Intervals during Virtual Reality Gaming Augments Standing Postural Sway Disturbance. Sensors (Basel) 2021; 21:s21206817. [PMID: 34696030 PMCID: PMC8539689 DOI: 10.3390/s21206817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
Immersive virtual reality (VR) can cause acute sickness, visual disturbance, and balance impairment. Some manufacturers recommend intermittent breaks to overcome these issues; however, limited evidence examining whether this is beneficial exists. The aim of this study was to examine whether taking breaks during VR gaming reduced its effect on postural sway during standing balance assessments. Twenty-five people participated in this crossover design study, performing 50 min of VR gaming either continuously or with intermittent 10 min exposure/rest intervals. Standing eyes open, two-legged balance assessments were performed immediately pre-, immediately post- and 40 min post-exposure. The primary outcome measure was total path length; secondary measures included independent axis path velocity, amplitude, standard deviation, discrete and continuous wavelet transform-derived variables, and detrended fluctuation analysis. Total path length was significantly (p < 0.05) reduced immediately post-VR gaming exposure in the intermittent rest break group both in comparison to within-condition baseline values and between-condition timepoint results. Conversely, it remained consistent across timepoints in the continuous exposure group. These changes consisted of a more clustered movement speed pattern about a lower central frequency, evidenced by signal frequency content. These findings indicate that caution is required before recommending rest breaks during VR exposure until we know more about how balance and falls risk are affected.
Collapse
Affiliation(s)
- Ross Allan Clark
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia
- Correspondence:
| | - Ancret Szpak
- Cognitive Aging and Impairment Neurosciences, Justice and Society, University of South Australia, Adelaide, SA 5001, Australia; (A.S.); (S.C.M.); (T.L.)
| | - Stefan Carlo Michalski
- Cognitive Aging and Impairment Neurosciences, Justice and Society, University of South Australia, Adelaide, SA 5001, Australia; (A.S.); (S.C.M.); (T.L.)
| | - Tobias Loetscher
- Cognitive Aging and Impairment Neurosciences, Justice and Society, University of South Australia, Adelaide, SA 5001, Australia; (A.S.); (S.C.M.); (T.L.)
| |
Collapse
|
23
|
Oh S, Kim DK. Machine-Deep-Ensemble Learning Model for Classifying Cybersickness Caused by Virtual Reality Immersion. Cyberpsychol Behav Soc Netw 2021; 24:729-736. [PMID: 34375142 DOI: 10.1089/cyber.2020.0613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study aims to classify cybersickness (CS) caused by virtual reality (VR) immersion through a machine-deep-ensemble learning model. The heart rate variability and respiratory signal parameters of 20 subjects were measured, while watching a VR video for ∼5 minutes. After the experiment, the subjects were examined for CS and questioned to determine their CS states. Based on the results, we constructed a machine-deep-ensemble learning model that could identify and classify VR immersion CS among subjects. The ensemble model comprised four stacked machine learning models (support vector machine [SVM], k-nearest neighbor [KNN], random forest, and AdaBoost), which were used to derive prediction data, and then, classified the prediction data using a convolution neural network. This model was a multiclass classification model, allowing us to classify subjects' CS into three states (neutral, non-CS, and CS). The accuracy of SVM, KNN, random forest, and AdaBoost was 94.23 percent, 92.44 percent, 93.20 percent, and 90.33 percent, respectively, and the ensemble model could classify the three states with an accuracy of 96.48 percent. This implied that the ensemble model has a higher classification performance than when each model is used individually. Our results confirm that CS caused by VR immersion can be detected as physiological signal data with high accuracy. Moreover, our proposed model can determine the presence or absence of CS as well as the neutral state. Clinical Trial Registration Number: 20-2021-1.
Collapse
Affiliation(s)
- SeungJun Oh
- Department of Sports ICT Convergence, Sangmyung University Graduate School, Seoul, Republic of Korea
| | - Dong-Keun Kim
- Department of Human-Centered Artificial Intelligence, Institute of Intelligence Informatics Technology, Sangmyung University, Seoul, Republic of Korea
| |
Collapse
|
24
|
Cerritelli F, Chiera M, Abbro M, Megale V, Esteves J, Gallace A, Manzotti A. The Challenges and Perspectives of the Integration Between Virtual and Augmented Reality and Manual Therapies. Front Neurol 2021; 12:700211. [PMID: 34276550 PMCID: PMC8278005 DOI: 10.3389/fneur.2021.700211] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
Virtual reality (VR) and augmented reality (AR) have been combined with physical rehabilitation and psychological treatments to improve patients' emotional reactions, body image, and physical function. Nonetheless, no detailed investigation assessed the relationship between VR or AR manual therapies (MTs), which are touch-based approaches that involve the manipulation of tissues for relieving pain and improving balance, postural stability and well-being in several pathological conditions. The present review attempts to explore whether and how VR and AR might be integrated with MTs to improve patient care, with particular attention to balance and to fields like chronic pain that need an approach that engages both mind and body. MTs rely essentially on touch to induce tactile, proprioceptive, and interoceptive stimulations, whereas VR and AR rely mainly on visual, auditory, and proprioceptive stimulations. MTs might increase patients' overall immersion in the virtual experience by inducing parasympathetic tone and relaxing the mind, thus enhancing VR and AR effects. VR and AR could help manual therapists overcome patients' negative beliefs about pain, address pain-related emotional issues, and educate them about functional posture and movements. VR and AR could also engage and change the sensorimotor neural maps that the brain uses to cope with environmental stressors. Hence, combining MTs with VR and AR could define a whole mind-body intervention that uses psychological, interoceptive, and exteroceptive stimulations for rebalancing sensorimotor integration, distorted perceptions, including visual, and body images. Regarding the technology needed to integrate VR and AR with MTs, head-mounted displays could be the most suitable devices due to being low-cost, also allowing patients to follow VR therapy at home. There is enough evidence to argue that integrating MTs with VR and AR could help manual therapists offer patients better and comprehensive treatments. However, therapists need valid tools to identify which patients would benefit from VR and AR to avoid potential adverse effects, and both therapists and patients have to be involved in the development of VR and AR applications to define truly patient-centered therapies. Furthermore, future studies should assess whether the integration between MTs and VR or AR is practically feasible, safe, and clinically useful.
Collapse
Affiliation(s)
| | | | - Marco Abbro
- Foundation COME Collaboration, Pescara, Italy
| | | | | | | | - Andrea Manzotti
- Foundation COME Collaboration, Pescara, Italy
- RAISE Lab, Foundation COME Collaboration, Milan, Italy
- SOMA Istituto Osteopatia Milano, Milan, Italy
| |
Collapse
|
25
|
Veličković P, Milovanović M. Improvement of the Interaction Model Aimed to Reduce the Negative Effects of Cybersickness in VR Rehab Applications. Sensors (Basel) 2021; 21:E321. [PMID: 33418838 PMCID: PMC7824908 DOI: 10.3390/s21020321] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 11/17/2022]
Abstract
Virtual reality (VR) has the potential to be applied in many fields, including medicine, education, scientific research. The e-health impact of VR on medical therapy for people cannot be ignored, but participants reported problems using them, as the capabilities and limitations of users can greatly affect the effectiveness and usability of the VR in rehabilitation. Previous studies of VR have focused on the development and use of the technology itself, and it is only in recent years that emphasis has been placed on usability problems that include the human factor. In this research, different ways of adapting interaction in VR were tested. One approach was focused on means of navigating through a VR, while the second dealt with the impact of the amount of animation and moving elements through a series of tests. In conclusion, the way of navigation and the amount of animation and moving elements, as well as their combination, are proven to have a great influence on the use of VR systems for rehabilitation. There is a possibility to reduce the occurrence of problems related to cybersickness if the results of this research are taken into consideration and applied from an early stage of designing VR rehabilitation applications.
Collapse
Affiliation(s)
- Predrag Veličković
- Faculty of Organisational Sciences, Jove Ilića 154, 11000 Belgrade, Serbia;
| | | |
Collapse
|
26
|
Bouchard S, Berthiaume M, Robillard G, Forget H, Daudelin-Peltier C, Renaud P, Blais C, Fiset D. Arguing in Favor of Revising the Simulator Sickness Questionnaire Factor Structure When Assessing Side Effects Induced by Immersions in Virtual Reality. Front Psychiatry 2021; 12:739742. [PMID: 34803762 PMCID: PMC8604025 DOI: 10.3389/fpsyt.2021.739742] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Two issues are increasingly of interest in the scientific literature regarding unwanted virtual reality (VR) induced side effects: (1) whether the latent structure of the Simulator Sickness Questionnaire (SSQ) is comprised of two or three factors, and (2) if the SSQ measures symptoms of anxiety that can be misattributed to unwanted negative side effects induced by immersions in VR. Study 1 was conducted with a sample of 876 participants. A confirmatory factor analysis clearly supported a two-factor model composed of nausea and oculomotor symptoms instead of the 3-factor structure observed in simulators. To tease-out symptoms of anxiety from unwanted negative side effects induced by immersions in VR, Study 2 was conducted with 88 participants who were administered the Trier Stress Social Test in groups without being immersed in VR. A Spearman correlation showed that 11 out of 16 side effects correlated significantly with anxiety. A factor analysis revealed that items measuring general discomfort, difficulty concentrating, sweating, nausea, and vertigo loaded significantly on the anxiety factor comprised of items from the State-Trait Anxiety Inventory. Finally, a multiple regression indicated that the items measuring general discomfort and difficulty concentrating significantly predicted increases in anxiety. The overall results support the notion that side effects associated with immersions in VR consist mostly of a nausea and an oculomotor latent structure and that a few items are confounding anxiety and cybersickness. The data support the suggestion to revise the scoring procedures of the Simulator Sickness Questionnaire when using this instrument with immersions in VR.
Collapse
Affiliation(s)
- Stéphane Bouchard
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, QC, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada.,Centre de recherche du Centre Intégré de Santé et des Services Sociaux de l'Outaouais, Gatineau, QC, Canada
| | | | - Geneviève Robillard
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, QC, Canada.,Innovation, Science and Economic Development Canada, Ottawa, ON, Canada
| | - Hélène Forget
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, QC, Canada
| | - Camille Daudelin-Peltier
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, QC, Canada
| | - Patrice Renaud
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, QC, Canada
| | - Caroline Blais
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, QC, Canada
| | - Daniel Fiset
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, QC, Canada
| |
Collapse
|
27
|
Saredakis D, Szpak A, Birckhead B, Keage HAD, Rizzo A, Loetscher T. Factors Associated With Virtual Reality Sickness in Head-Mounted Displays: A Systematic Review and Meta-Analysis. Front Hum Neurosci 2020; 14:96. [PMID: 32300295 PMCID: PMC7145389 DOI: 10.3389/fnhum.2020.00096] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/02/2020] [Indexed: 01/20/2023] Open
Abstract
The use of head-mounted displays (HMD) for virtual reality (VR) application-based purposes including therapy, rehabilitation, and training is increasing. Despite advancements in VR technologies, many users still experience sickness symptoms. VR sickness may be influenced by technological differences within HMDs such as resolution and refresh rate, however, VR content also plays a significant role. The primary objective of this systematic review and meta-analysis was to examine the literature on HMDs that report Simulator Sickness Questionnaire (SSQ) scores to determine the impact of content. User factors associated with VR sickness were also examined. A systematic search was conducted according to PRISMA guidelines. Fifty-five articles met inclusion criteria, representing 3,016 participants (mean age range 19.5–80; 41% female). Findings show gaming content recorded the highest total SSQ mean 34.26 (95%CI 29.57–38.95). VR sickness profiles were also influenced by visual stimulation, locomotion and exposure times. Older samples (mean age ≥35 years) scored significantly lower total SSQ means than younger samples, however, these findings are based on a small evidence base as a limited number of studies included older users. No sex differences were found. Across all types of content, the pooled total SSQ mean was relatively high 28.00 (95%CI 24.66–31.35) compared with recommended SSQ cut-off scores. These findings are of relevance for informing future research and the application of VR in different contexts.
Collapse
Affiliation(s)
- Dimitrios Saredakis
- Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, SA, Australia
| | - Ancret Szpak
- Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, SA, Australia
| | - Brandon Birckhead
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Hannah A D Keage
- Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, SA, Australia
| | - Albert Rizzo
- Institute for Creative Technologies, University of Southern California, Los Angeles, CA, United States
| | - Tobias Loetscher
- Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, SA, Australia
| |
Collapse
|
28
|
Abstract
The aim of this study was to assess what drives gender-based differences in the experience of cybersickness within virtual environments. In general, those who have studied cybersickness (i.e., motion sickness associated with virtual reality [VR] exposure), oftentimes report that females are more susceptible than males. As there are many individual factors that could contribute to gender differences, understanding the biggest drivers could help point to solutions. Two experiments were conducted in which males and females were exposed for 20 min to a virtual rollercoaster. In the first experiment, individual factors that may contribute to cybersickness were assessed via self-report, body measurements, and surveys. Cybersickness was measured via the simulator sickness questionnaire and physiological sensor data. Interpupillary distance (IPD) non-fit was found to be the primary driver of gender differences in cybersickness, with motion sickness susceptibility identified as a secondary driver. Females whose IPD could not be properly fit to the VR headset and had a high motion sickness history suffered the most cybersickness and did not fully recover within 1 h post exposure. A follow-on experiment demonstrated that when females could properly fit their IPD to the VR headset, they experienced cybersickness in a manner similar to males, with high cybersickness immediately upon cessation of VR exposure but recovery within 1 h post exposure. Taken together, the results suggest that gender differences in cybersickness may be largely contingent on whether or not the VR display can be fit to the IPD of the user; with a substantially greater proportion of females unable to achieve a good fit. VR displays may need to be redesigned to have a wider IPD adjustable range in order to reduce cybersickness rates, especially among females.
Collapse
Affiliation(s)
- Kay Stanney
- Design Interactive, Inc., Orlando, FL, United States
| | | | - Linda Foster
- Lockheed Martin Corporate, Washington, DC, United States
| |
Collapse
|
29
|
Chirico A, Maiorano P, Indovina P, Milanese C, Giordano GG, Alivernini F, Iodice G, Gallo L, De Pietro G, Lucidi F, Botti G, De Laurentiis M, Giordano A. Virtual reality and music therapy as distraction interventions to alleviate anxiety and improve mood states in breast cancer patients during chemotherapy. J Cell Physiol 2020; 235:5353-5362. [PMID: 31957873 DOI: 10.1002/jcp.29422] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/19/2019] [Indexed: 01/22/2023]
Abstract
Psychological distress is a common consequence of breast cancer diagnosis and treatment and could further exacerbate therapy side effects. Interventions increasing treatment tolerance are crucial to improve both patients' quality of life and adherence to therapies. Virtual reality (VR) has emerged as an effective distraction tool for different medical procedures. Here, we assessed the efficacy of immersive and interactive VR in alleviating chemotherapy-related psychological distress in a cohort of Italian breast cancer patients, also comparing its effects with those of music therapy (MT). Thirty patients were included in the VR group, 30 in the MT group, and 34 in the control group, consisting of patients receiving standard care during chemotherapy. Our data suggest that both VR and MT are useful interventions for alleviating anxiety and for improving mood states in breast cancer patients during chemotherapy. Moreover, VR seems more effective than MT in relieving anxiety, depression, and fatigue.
Collapse
Affiliation(s)
- Andrea Chirico
- Department of Social and Developmental Psychology, "Sapienza" University of Rome, Rome, Italy.,Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania
| | - Patrizia Maiorano
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Paola Indovina
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania.,Institute for High Performance Computing and Networking, National Research Council of Italy (ICAR-CNR), Naples, Italy
| | - Carla Milanese
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giovan Giacomo Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania
| | - Fabio Alivernini
- National Institute for the Evaluation of the Education System (INVALSI), Rome, Italy
| | - Giovanni Iodice
- Breast Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Luigi Gallo
- Institute for High Performance Computing and Networking, National Research Council of Italy (ICAR-CNR), Naples, Italy
| | - Giuseppe De Pietro
- Institute for High Performance Computing and Networking, National Research Council of Italy (ICAR-CNR), Naples, Italy
| | - Fabio Lucidi
- Department of Social and Developmental Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Gerardo Botti
- Pathology Division, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Michelino De Laurentiis
- Breast Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| |
Collapse
|
30
|
Kourtesis P, Collina S, Doumas LAA, MacPherson SE. Validation of the Virtual Reality Neuroscience Questionnaire: Maximum Duration of Immersive Virtual Reality Sessions Without the Presence of Pertinent Adverse Symptomatology. Front Hum Neurosci 2019; 13:417. [PMID: 31849627 PMCID: PMC6901952 DOI: 10.3389/fnhum.2019.00417] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/11/2019] [Indexed: 12/01/2022] Open
Abstract
There are major concerns about the suitability of immersive virtual reality (VR) systems (i.e., head-mounted display; HMD) to be implemented in research and clinical settings, because of the presence of nausea, dizziness, disorientation, fatigue, and instability (i.e., VR induced symptoms and effects; VRISE). Research suggests that the duration of a VR session modulates the presence and intensity of VRISE, but there are no suggestions regarding the appropriate maximum duration of VR sessions. The implementation of high-end VR HMDs in conjunction with ergonomic VR software seems to mitigate the presence of VRISE substantially. However, a brief tool does not currently exist to appraise and report both the quality of software features and VRISE intensity quantitatively. The Virtual Reality Neuroscience Questionnaire (VRNQ) was developed to assess the quality of VR software in terms of user experience, game mechanics, in-game assistance, and VRISE. Forty participants aged between 28 and 43 years were recruited (18 gamers and 22 non-gamers) for the study. They participated in 3 different VR sessions until they felt weary or discomfort and subsequently filled in the VRNQ. Our results demonstrated that VRNQ is a valid tool for assessing VR software as it has good convergent, discriminant, and construct validity. The maximum duration of VR sessions should be between 55 and 70 min when the VR software meets or exceeds the parsimonious cut-offs of the VRNQ and the users are familiarized with the VR system. Also, the gaming experience does not seem to affect how long VR sessions should last. Also, while the quality of VR software substantially modulates the maximum duration of VR sessions, age and education do not. Finally, deeper immersion, better quality of graphics and sound, and more helpful in-game instructions and prompts were found to reduce VRISE intensity. The VRNQ facilitates the brief assessment and reporting of the quality of VR software features and/or the intensity of VRISE, while its minimum and parsimonious cut-offs may appraise the suitability of VR software for implementation in research and clinical settings. The findings of this study contribute to the establishment of rigorous VR methods that are crucial for the viability of immersive VR as a research and clinical tool in cognitive neuroscience and neuropsychology.
Collapse
Affiliation(s)
- Panagiotis Kourtesis
- Human Cognitive Neuroscience, Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom.,Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom.,Lab of Experimental Psychology, Suor Orsola Benincasa University of Naples, Naples, Italy.,Interdepartmental Centre for Planning and Research "Scienza Nuova", Suor Orsola Benincasa University of Naples, Naples, Italy
| | - Simona Collina
- Lab of Experimental Psychology, Suor Orsola Benincasa University of Naples, Naples, Italy.,Interdepartmental Centre for Planning and Research "Scienza Nuova", Suor Orsola Benincasa University of Naples, Naples, Italy
| | - Leonidas A A Doumas
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah E MacPherson
- Human Cognitive Neuroscience, Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom.,Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
31
|
Kourtesis P, Collina S, Doumas LAA, MacPherson SE. Technological Competence Is a Pre-condition for Effective Implementation of Virtual Reality Head Mounted Displays in Human Neuroscience: A Technological Review and Meta-Analysis. Front Hum Neurosci 2019; 13:342. [PMID: 31632256 PMCID: PMC6783565 DOI: 10.3389/fnhum.2019.00342] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/18/2019] [Indexed: 11/13/2022] Open
Abstract
Immersive virtual reality (VR) emerges as a promising research and clinical tool. However, several studies suggest that VR induced adverse symptoms and effects (VRISE) may undermine the health and safety standards, and the reliability of the scientific results. In the current literature review, the technical reasons for the adverse symptomatology are investigated to provide suggestions and technological knowledge for the implementation of VR head-mounted display (HMD) systems in cognitive neuroscience. The technological systematic literature indicated features pertinent to display, sound, motion tracking, navigation, ergonomic interactions, user experience, and computer hardware that should be considered by the researchers. Subsequently, a meta-analysis of 44 neuroscientific or neuropsychological studies involving VR HMD systems was performed. The meta-analysis of the VR studies demonstrated that new generation HMDs induced significantly less VRISE and marginally fewer dropouts. Importantly, the commercial versions of the new generation HMDs with ergonomic interactions had zero incidents of adverse symptomatology and dropouts. HMDs equivalent to or greater than the commercial versions of contemporary HMDs accompanied with ergonomic interactions are suitable for implementation in cognitive neuroscience. In conclusion, researchers' technological competency, along with meticulous methods and reports pertinent to software, hardware, and VRISE, are paramount to ensure the health and safety standards and the reliability of neuroscientific results.
Collapse
Affiliation(s)
- Panagiotis Kourtesis
- Human Cognitive Neuroscience, Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom.,Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom.,Lab of Experimental Psychology, Suor Orsola Benincasa University of Naples, Naples, Italy.,Interdepartmental Centre for Planning and Research "Scienza Nuova", Suor Orsola Benincasa University of Naples, Naples, Italy
| | - Simona Collina
- Lab of Experimental Psychology, Suor Orsola Benincasa University of Naples, Naples, Italy.,Interdepartmental Centre for Planning and Research "Scienza Nuova", Suor Orsola Benincasa University of Naples, Naples, Italy
| | - Leonidas A A Doumas
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah E MacPherson
- Human Cognitive Neuroscience, Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom.,Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
32
|
Feodoroff B, Konstantinidis I, Froböse I. Effects of Full Body Exergaming in Virtual Reality on Cardiovascular and Muscular Parameters: Cross-Sectional Experiment. JMIR Serious Games 2019; 7:e12324. [PMID: 31464194 PMCID: PMC6737891 DOI: 10.2196/12324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/27/2019] [Accepted: 06/28/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In recent years, many studies have associated sedentary behavior in front of screens with health problems in infants, children, and adolescents. Yet options for exergaming-playing video games that require rigorous physical exercise-seem to fall short of the physical activity levels recommended by the World Health Organization. OBJECTIVE The purpose of this study was to investigate the effect of a fully immersive virtual reality (VR)-based training system on cardiovascular and muscular parameters of young adults. METHODS A cross-sectional experiment design was used to analyze muscle activity (surface electromyography), heart rate, perceived exertion (RPE), cybersickness symptoms, perceived workload, and physical activity enjoyment (PACES) in 33 participants performing two 5-minute flights on a new training device. RESULTS Participants' performance of the planking position required to play the game resulted in moderate aerobic intensity (108 [SD 18.69] bpm). Due to the mainly isometric contraction of the dorsal muscle chain (with a mean activation between 20.6% [SD 10.57] and 26.7% [SD 17.39] maximum voluntary isometric contraction), participants described the exercise as a moderate to vigorous activity (RPE 14.6 [SD 1.82]). The majority reported that they enjoyed the exercise (PACES 3.74 [SD 0.16]). However, six participants had to drop out because of cybersickness symptoms and two because of muscle pain due to prior injuries. CONCLUSIONS Our findings suggest that fully immersive VR training systems can contribute to muscle-strengthening activities for healthy users. However, the dropout rate highlights the need for technological improvements in both software and hardware. In prevention and therapy, movement quality is a fundamental part of providing effective resistance training that benefits health. Exergaming on a regular basis has the potential to develop strong muscles and a healthy back. It is essential that future VR-based training systems take into account the recommendations of sport and exercise science.
Collapse
Affiliation(s)
- Boris Feodoroff
- Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Cologne, Germany
| | - Ippokratis Konstantinidis
- Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Cologne, Germany
| | - Ingo Froböse
- Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Cologne, Germany
| |
Collapse
|
33
|
Gallagher M, Dowsett R, Ferrè ER. Vection in virtual reality modulates vestibular-evoked myogenic potentials. Eur J Neurosci 2019; 50:3557-3565. [PMID: 31233640 DOI: 10.1111/ejn.14499] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 06/05/2019] [Accepted: 06/17/2019] [Indexed: 11/28/2022]
Abstract
The popularity of virtual reality (VR) has increased rapidly in recent years. While significant technological advancements are apparent, a troublesome problem with VR is that between 20% and 80% of users will experience unpleasant side effects such as nausea, disorientation, blurred vision and headaches-a malady known as Cybersickness. Cybersickness may be caused by a conflict between sensory signals for self-motion: while vision signals that the user is moving in a certain direction with certain acceleration, the vestibular organs provide no corroborating information. To resolve the sensory conflict, vestibular cues may be down-weighted leading to an alteration of how the brain interprets actual vestibular information. This may account for the frequently reported after-effects of VR exposure. Here, we investigated whether exposure to vection in VR modulates vestibular processing. We measured vestibular-evoked myogenic potentials (VEMPs) during brief immersion in a vection-inducing VR environment presented via head-mounted display. We found changes in VEMP asymmetry ratio, with a substantial increase in VEMP amplitude recorded on the left sternocleidomastoid muscle following just one minute of exposure to vection in VR. Our results suggest that exposure to vection in VR modulates vestibular processing, which may explain common after-effects of VR.
Collapse
Affiliation(s)
- Maria Gallagher
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Ross Dowsett
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | | |
Collapse
|
34
|
Mittelstädt JM, Wacker J, Stelling D. Emotional and Cognitive Modulation of Cybersickness: The Role of Pain Catastrophizing and Body Awareness. Hum Factors 2019; 61:322-336. [PMID: 30320515 DOI: 10.1177/0018720818804382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The goal was to investigate the influence of the tendency to catastrophize somatic symptoms and body awareness on motion-related sickness. BACKGROUND Influences of emotional and cognitive-evaluative processes on the genesis of motion sickness or cybersickness have rarely been investigated. Brain imaging studies showed activation during cybersickness, resembling the pattern found for pain processing. Two aspects often investigated in this context are pain catastrophizing and body awareness. The present two studies investigated the relationship of motion-related sickness to two tendencies involved in pain processing: pain catastrophizing and body awareness. METHOD In the first study, 115 participants reported their motion sickness history, pain catastrophizing, and body awareness. In the second study, 40 participants were exposed to a virtual reality and reported their experience of cybersickness as well as their pain catastrophizing and body awareness. RESULTS Pain catastrophizing was positively correlated to motion sickness history and cybersickness. Body awareness did not show a linear effect on motion sickness history or cybersickness. However, the interaction effect of pain catastrophizing and body awareness was significant in both studies. CONCLUSION Pain catastrophizing seems to have a detrimental effect on cybersickness symptoms. Body awareness moderated the relationship in the sense that the combination of high pain catastrophizing and low body awareness lead to the highest sickness levels. APPLICATION Affective and cognitive modulation of cybersickness symptoms should be considered when exposing risk groups to motion-related adverse stimuli.
Collapse
Affiliation(s)
| | - Jan Wacker
- Universität Hamburg (University of Hamburg), Germany
| | - Dirk Stelling
- Deutsches Zentrum für Luft- und Raumfahrt (German Aerospace Center), Hamburg, Germany
| |
Collapse
|
35
|
Weech S, Kenny S, Barnett-Cowan M. Presence and Cybersickness in Virtual Reality Are Negatively Related: A Review. Front Psychol 2019; 10:158. [PMID: 30778320 PMCID: PMC6369189 DOI: 10.3389/fpsyg.2019.00158] [Citation(s) in RCA: 181] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/16/2019] [Indexed: 12/21/2022] Open
Abstract
In order to take advantage of the potential offered by the medium of virtual reality (VR), it will be essential to develop an understanding of how to maximize the desirable experience of "presence" in a virtual space ("being there"), and how to minimize the undesirable feeling of "cybersickness" (a constellation of discomfort symptoms experienced in VR). Although there have been frequent reports of a possible link between the observer's sense of presence and the experience of bodily discomfort in VR, the amount of literature that discusses the nature of the relationship is limited. Recent research has underlined the possibility that these variables have shared causes, and that both factors may be manipulated with a single approach. This review paper summarizes the concepts of presence and cybersickness and highlights the strengths and gaps in our understanding about their relationship. We review studies that have measured the association between presence and cybersickness, and conclude that the balance of evidence favors a negative relationship between the two factors which is driven principally by sensory integration processes. We also discuss how system immersiveness might play a role in modulating both presence and cybersickness. However, we identify a serious absence of high-powered studies that aim to reveal the nature of this relationship. Based on this evidence we propose recommendations for future studies investigating presence, cybersickness, and other related factors.
Collapse
Affiliation(s)
- Séamas Weech
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
- The Games Institute, University of Waterloo, Waterloo, ON, Canada
| | - Sophie Kenny
- The Games Institute, University of Waterloo, Waterloo, ON, Canada
| | - Michael Barnett-Cowan
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
- The Games Institute, University of Waterloo, Waterloo, ON, Canada
| |
Collapse
|
36
|
Mazloumi Gavgani A, Walker FR, Hodgson DM, Nalivaiko E. A comparative study of cybersickness during exposure to virtual reality and "classic" motion sickness: are they different? J Appl Physiol (1985) 2018; 125:1670-1680. [PMID: 30284516 DOI: 10.1152/japplphysiol.00338.2018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Existing evidence suggest that cybersickness may be clinically different from "classic", motion-induced motion sickness; this evidence was however obtained in separate studies that focussed on just one of the two conditions. Our aim was to bring clarity to this issue, by directly comparing subjective symptoms and physiological effects of motion sickness induced by physical motion (Coriolis cross-coupling) and by immersion in virtual reality (ride on a roller coaster) in the same subjects. A cohort of 30 young healthy volunteers was exposed to both stimulations in a counter-balance order on two separate days at least one week apart. Nausea scores were recorded during the exposure, and Motion Sickness Assessment Questionnaire (MSAQ) was used to profile subjective symptoms post-experiment. Tonic and phasic forehead skin conductance level (SCL) was measured before and during exposure in both stimulation methods. We found that nausea onset times and maximum nausea ratings were significantly correlated during both provocations (r=0.40, p=0.03 and r=0.56, p=0.0012, respectively). Symptom profiling with the MSAQ revealed substantial and significant correlations between total symptom scores (r=0.69, p<0.0001), between each of four symptom clusters and between 15/18 individual symptoms assessed in both conditions. Both provocations caused increase in tonic SCL associated with nausea, with a close correlation between the conditions (r=0.48, p=0.04). This was accompanied by a significant increase in the amplitude of phasic skin conductance transients in both experiments. We conclude that symptoms and physiological changes occurring during cybersickness and "classical" motion sickness are quite similar, at least during advanced stages of these malaises.
Collapse
|
37
|
Pot-Kolder R, Veling W, Counotte J, van der Gaag M. Anxiety Partially Mediates Cybersickness Symptoms in Immersive Virtual Reality Environments. Cyberpsychol Behav Soc Netw 2018; 21:187-193. [PMID: 29356575 DOI: 10.1089/cyber.2017.0082] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The use of virtual reality (VR) in psychological treatment is expected to increase. Cybersickness (CS) is a negative side effect of VR exposure and is associated with treatment dropout. This study aimed to investigate the following: (a) if gender differences in CS can be replicated, (b) if differences in anxiety and CS symptoms between patients and controls can be replicated, and (c) whether the relationship between exposure to VR and CS symptoms is mediated by anxiety. A sample (N = 170) of participants with different levels of psychosis liability was exposed to VR environments. CS and anxiety were assessed with self-report measures before and after the VR experiment. This study replicated gender differences in CS symptoms, most of which were present before exposure to VR. It also replicated findings that a significant correlation between anxiety and CS can be found in healthy individuals, but not in patients. In a VR environment, anxiety partially mediated CS symptoms, specifically nausea and disorientation. A partial explanation for the differences found between patients and controls may lie in a ceiling effect for the symptoms of CS. A second explanation may be the partial overlap between CS symptoms and physiological anxiety responses. CS symptoms reported at baseline cannot be explained by exposure to VR, but are related to anxiety. Caution is required when interpreting studies on both CS and anxiety, until the specificity in measurements has been improved. Since anxiety mediated the CS symptoms, CS is expected to decline during treatment together with the reduction of anxiety.
Collapse
Affiliation(s)
- Roos Pot-Kolder
- 1 Parnassia Psychiatric Institute , Research and Innovation, The Hague, Netherlands .,2 Department of Clinical Psychology, Amsterdam Public Health Research Institute , Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Wim Veling
- 3 Department of Psychiatry, University Medical Center Groningen, University of Groningen , Groningen, Netherlands
| | - Jacqueline Counotte
- 1 Parnassia Psychiatric Institute , Research and Innovation, The Hague, Netherlands
| | - Mark van der Gaag
- 1 Parnassia Psychiatric Institute , Research and Innovation, The Hague, Netherlands .,2 Department of Clinical Psychology, Amsterdam Public Health Research Institute , Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|