Acute hypoxic hypoxia and isocapnic hypoxia effects on oculometric features.

INTRODUCTION: Visual performance impairment after hypoxia is well recognized in military and civilian aviation. The aims of this study were: 1) to assess oculometric features such as blink metrics, pupillary dynamics, fixations, and saccades as cognitive indicators of early signs of hypoxia; and 2) to analyze the impact of different hypoxic conditions ["hypoxic hypoxia" (HH) and "isocapnic hypoxia" (IH)] on specified oculometrics during mental workloads. METHODS: Oculometric data were collected on 25 subjects under 3 conditions: normoxia, HH (8% O2 + balance N2), and IH (7% O2 + 5% CO2 + balance N2). The mental workload task consisted of reading aloud linear arrays of numbers after exposure to gas mixtures. RESULTS: Blink rates were significantly increased under hypoxic conditions (by +100.7% in HH and by +92.8% in IH compared to normoxia). A faster recovery of blink rate was observed in transitioning from IH (23.6% vs. 76.3%) to normoxia. The percentage change in pupil size fluctuation was increased under HH more than under IH (29% vs. 4.4%). Under HH average fixation time and target area size were significantly higher than under IH. Total saccadic times under hypoxic conditions were significantly increased compared with normoxia. CONCLUSIONS: These results suggest that oculometric changes are indicators of hypoxia, which can be monitored using compact, portable, noninvasive eye-tracking devices in a cockpit analogous environment to detect hypoxia-induced physiological changes in aircrew. Comparative results between HH and IH support the potential role of carbon dioxide in augmenting cerebral perfusion and hence improved tissue oxygen delivery.

Electrogastrographic and autonomic responses during oculovestibular recoupling in flight simulation.

INTRODUCTION: Simulator sickness causes vestibulo-autonomic responses that increase sympathetic activity and decrease parasympathetic activity. The purpose of the study was to quantify these responses through electrogastrography and cardiac interbeat intervals during flight simulation. METHODS: There were 29 subjects that were randomly assigned to 2 parallel arms: (1) oculovestibular recoupling, where galvanic vestibular stimulation was synchronous with the visual field; and (2) control. Electrogastrography and interbeat interval data were collected during baseline, simulation, and post-simulation periods. A simulator sickness questionnaire was administered. RESULTS: Statistically significant differences were observed in percentage of recording time with the dominant frequency of electrogastrography in normogastric and bradygastric domains between the oculovestibular recoupling and control groups. Normogastria was dominant during simulation in the oculovestibular recoupling group. In the control group, the percentage of recording time with the dominant frequency decreased by 22% in normogastria and increased by 20% in bradygastria. The percentage change of the dominant power instability coefficient from baseline to simulation was 26% in the oculovestibular recoupling group vs. 108% in the control group. The power of high-frequency components for interbeat intervals did not change significantly in the oculovestibular recoupling group and was decreased during simulation in the control group. DISCUSSION: Electrogastrography and interbeat intervals are sensitive indices of autonomic changes in subjects undergoing flight simulation. These data demonstrate the potential of oculovestibular recoupling to stabilize gastric activity and cardiac autonomic changes altered during simulator and motion sickness.

Early detection of hypoxia-lnduced cognitive impairment using the King-Devick test.

INTRODUCTION: Hypoxic incapacitation continues to be a significant threat to safety and operations at high altitude. Noninvasive neurocognitive performance testing is desirable to identify presymptomatic cognitive impairment, affording operators at altitude a tool to quantify their performance and safety. METHODS: There were 25 subjects enrolled in this study. Cognitive performance was assessed by using the King-Devick (K-D) test. The performance of the subjects on the K-D test was measured in normoxia followed by hypoxia (8% 02 equivalent to 7101 m) and then again in normoxia. RESULTS: K-D test completion time in hypoxia for 3 min was significantly longer than the Baseline Test (54.5 +/- 12.4 s hypoxic vs. 46.3 +/- 10.4 s baseline). Upon returning to normoxia the completion time was significantly shorter than in hypoxia (47.6 +/- 10.6 s post test vs. 54.5 +/- 12.4 s hypoxic). There was no statistically significant difference between baseline test and post test times, indicating that all subjects returned to their normoxic baseline levels. SpO2 decreased from 98 +/- 0.9% to 80 +/- 7.8% after 3 min on hypoxic gas. During the hypoxic K-D test, SpO2 decreased further to 75.8 +/- 8.3%. CONCLUSIONS: In this study the K-D test has been shown to be an effective neurocognitive test to detect hypoxic impairment at early presymptomatic stages. The K-D test may also be used to afford a reassessment of traditional measures used to determine hypoxic reserve time.

Oculo-vestibular recoupling using galvanic vestibular stimulation to mitigate simulator sickness.

INTRODUCTION: Despite improvement in the computational capabilities of visual displays in flight simulators, intersensory visual-vestibular conflict remains the leading cause of simulator sickness (SS). By using galvanic vestibular stimulation (GVS), the vestibular system can be synchronized with a moving visual field in order to lessen the mismatch of sensory inputs thought to result in SS. METHODS: A multisite electrode array was used to deliver combinations of GVS in 21 normal subjects. Optimal electrode combinations were identified and used to establish GVS dose-response predictions for the perception of roll, pitch, and yaw. Based on these data, an algorithm was then implemented in flight simulator hardware in order to synchronize visual and GVS-induced vestibular sensations (oculo-vestibular-recoupled or OVR simulation). Subjects were then randomly exposed to flight simulation either with or without OVR simulation. A self-report SS checklist was administered to all subjects after each session. An overall SS score was calculated for each category of symptoms for both groups. RESULTS: The analysis of GVS stimulation data yielded six unique combinations of electrode positions inducing motion perceptions in the three rotational axes. This provided the algorithm used for OVR simulation. The overall SS scores for gastrointestinal, central, and peripheral categories were 17%, 22.4%, and 20% for the Control group and 6.3%, 20%, and 8% for the OVR group, respectively. CONCLUSIONS: When virtual head signals produced by GVS are synchronized to the speed and direction of a moving visual field, manifestations of induced SS in a cockpit flight simulator are significantly reduced.

Visual Vestibular Conflict Mitigation in Virtual Reality Using Galvanic Vestibular Stimulation.

BACKGROUND: Virtual reality (VR) is an effective technique to reduce cost and increase fidelity in training programs. In VR, visual and vestibular cues are often in conflict, which may result in simulator-induced motion sickness. The purpose of this study is to investigate the integration of Galvanic Vestibular Stimulation (GVS) with a VR flight training simulator by assessing flight performance, secondary task performance, simulator sickness and presence.METHODS: There were 20 participants who performed 2 separate VR flight simulation sessions, with and without GVS (control). Flight performance, secondary task performance, and electrogastrogram were measured during VR flight simulation. The standardized simulator sickness and presence questionnaires were administered.RESULTS: Electrogastrogram measures such as dominant power instability coefficient (DPIC) and percentages of bradygastric waves (%B) were lower in the GVS session than the control session in the flight simulation (DPIC: 0.44 vs. 0.54; %B: 21.2% vs. 30.5%) and postflight (DPIC: 0.38 vs. 0.53; %B: 22.8% vs. 31.4%) periods. Flight performance (#hit-gates) was improved in the GVS session compared to the control (GVS: 17, Control: 15.5). Secondary task performance (%hits) was improved with GVS for the Easy task (GVS: 55.5%, Control: 43.1%).DISCUSSION: This study demonstrates the potential of synchronizing GVS with visual stimuli in VR flight training to reduce visual-vestibular sensory conflict to improve fidelity and performance. These results provide initial evidence, but continued research is warranted to further understand the benefits and applications of GVS in VR simulator training.Pradhan GN, Galvan-Garza RC, Perez AM, Stepanek J, Cevette MJ. Visual vestibular conflict mitigation in virtual reality using galvanic vestibular stimulation. Aerosp Med Hum Perform. 2022; 93(5):406-414.

Generating Flight Illusions Using Galvanic Vestibular Stimulation in Virtual Reality Flight Simulations.

Background: Vestibular flight illusions remain a significant source of concern for aviation training. Most fixed-based simulation training environments, including new virtual reality (VR) technology, lack the ability to recreate vestibular flight illusions as vestibular cues cannot be provided without stimulating the vestibular end organs. Galvanic vestibular stimulation (GVS) has long been used to create vestibular perception. The purpose of this study is to evaluate the ability of GVS to simulate common flight illusions by intentionally providing mismatched GVS during flight simulation scenarios in VR. Methods: Nineteen participants performed two flight simulation tasks-take off and sustained turn-during two separate VR flight simulation sessions, with and without GVS (control). In the GVS session, specific multi-axis GVS stimulation (i.e., electric currents) was provided to induce approximate somatogravic and Coriolis illusions during the take-off and sustained turn tasks, respectively. The participants used the joystick to self-report their subjective motion perception. The angular joystick movement along the roll, yaw, and pitch axes was used to measure cumulative angular distance and peak angular velocity as continuous variables of motion perception across corresponding axes. Presence and Simulator Sickness Questionnaires were administered at the end of each session. Results: The magnitude and variability of perceived somatogravic illusion during take-off task in the form of cumulative angular distance (p < 0.001) and peak velocity (p < 0.001) along the pitch-up axis among participants were significantly larger in the GVS session than in the NO GVS session. Similarly, during the sustained turn task, perceived Coriolis illusion in the form of cumulative angular distances (roll: p = 0.005, yaw: p = 0.015, pitch: p = 0.007) and peak velocities (roll: p = 0.003, yaw: p = 0.01, pitch: p = 0.007) across all three axes were significantly larger in the GVS session than in the NO GVS session. Subjective nausea was low overall, but significantly higher in the GVS session than in the NO GVS session (p = 0.026). Discussion: Our findings demonstrated that intentionally mismatched GVS can significantly affect motion perception and create flight illusion perceptions during fixed-based VR flight simulation. This has the potential to enhance future training paradigms, providing pilots the ability to safely experience, identify, and learn to appropriately respond to flight illusions during ground training.

Using Biometric Technology for Telehealth and Telerehabilitation.

This article discusses the use of physical and biometric sensors in telerehabilitation. It also discusses synchronous tele-physical assessment using haptics and augmented reality and asynchronous physical assessment using remote pose estimation. The article additionally focuses on computational models that have the potential to monitor and evaluate changes in kinematic and kinetic properties during telerehabilitation using biometric sensors such as electromyography and other wearable and noncontact sensors based on force and speed. And finally, the article discusses how virtual reality environments can be facilitated in telerehabilitation.

Oculometric Feature Changes During Acute Hypoxia in a Simulated High-Altitude Airdrop Scenario.

BACKGROUND: Severe acute hypoxia results in a rapid deterioration of cognitive functioning and thus poses a risk for human operations in high altitude environments. This study aimed at investigating the effects of oxygen system failure during a high-altitude high-opening (HAHO) parachute jump scenario from 30,000 ft (9144 m) on human physiology and cognitive performance using a noncontact eye-tracking task.METHODS: Nine healthy male volunteers (ages 27-48) were recruited from the Norwegian Special Operations Commandos. Eye-tracking data were collected to derive information on cognitive performance in the context of rapid dynamic changes in pressure altitude while performing a modified King-Devick test. The baseline data was collected at 8000 ft (2438 m) while breathing 100% oxygen during decompression. For every test, the corresponding arterial blood gas analysis was performed.RESULTS: The study subjects endured severe hypoxia, which resulted in significant prolongations of fixation time (range: 284.1-245.6 ms) until 23,397 ft (131 m) and fixation size (range: 34.6-32.4 mm) until 25,389 ft (7739 m) as compared to the baseline (217.6 ± 17.8 ms and 27.2 ± 4.5 mm, respectively). The increase in the saccadic movement and decrease in the saccadic velocity was observed until 28,998 ft and 27,360 ft (8839 and 8339 m), respectively.DISCUSSION: This is the first study to investigate cognitive performance from measured oculometric variables during severe hypobaric hypoxia in a simulated high-altitude airdrop mission scenario. The measurement of altered oculometric variables under hypoxic conditions represents a potential avenue to study altered cognitive performance using noncontact sensors that can derive information and serve to provide the individual with a warning from impending incapacitation.Pradhan GN, Ottestad W, Meland A, Kåsin JI, Høiseth LØ, Cevette MJ, Stepanek J. Oculometric feature changes during acute hypoxia in a simulated high-altitude airdrop scenario. Aerosp Med Hum Perform. 2021; 92(12):928-936.

Supplemental CO2 improves oxygen saturation, oxygen tension, and cerebral oxygenation in acutely hypoxic healthy subjects.

Oxygen is viewed in medicine as the sole determinant of tissue oxygenation, though carbon dioxide homeostasis is equally important and clinically often ignored. The aims of this study were as follows: (a) to examine the effects of different acute hypoxic conditions on partial pressure of arterial oxygen ( PaO2 ), arterial oxygen saturation of hemoglobin ( SaO2 ), and regional cerebral saturation of hemoglobin (rSO2 ); and (b) to evaluate supplemental CO2 as a tool to improve oxygenation in acutely hypoxic individuals. We hypothesized that exposure to gas mixtures with added CO2 would improve oxygenation in hypoxic human subjects. Twenty healthy subjects were exposed to 5-min intervals of two gas mixtures: hypoxic gas mixture containing 8% oxygen, and a CO2 -enriched mixture containing 8% oxygen plus either 3% or 5% CO2 . Ten subjects received the 3% CO2 -enriched mixture, and the remaining 10 subjects received the 5% CO2 -enriched mixture. The order of exposure was randomized. Blood gases, pulse oximetry, end-tidal CO2 , and cerebral oximetry were measured. Compared to the purely hypoxic gas group, PaO2 was increased in the 3% and 5% CO2 -enriched groups by 14.9 and 9.5 mmHg, respectively. Compared to pure hypoxia, SaO2 was increased in the 3% and 5% CO2 -enriched groups by 16.8% and 12.9%, respectively. Both CO2 -enriched gas groups had significantly higher end-exposure rSO2 and recovered to baseline rSO2 within 1 min, compared to the pure hypoxic gas group, which returned to baseline in 5 min. These results suggest that in acutely hypoxic subjects, CO2 supplementation improves blood oxygen saturation and oxygen tension as well as cerebral oxygenation measures.

Discovering Oculometric Patterns to Detect Cognitive Performance Changes in Healthy Youth Football Athletes.

In this paper, we focus on the application of oculometric patterns extracted from raw eye movements during a mental workload task to assess changes in cognitive performance in healthy youth athletes over the course of a typical sport season. Oculometric features pertaining to fixations and saccades were measured on 116 athletes in pre- and post-season testing. Participants were between 7 and 14 years of age at pre-season testing. Due to varied developmental rates, there were large interindividual performance differences during a mental workload task consisting of reading numbers. Based on different reading speeds, we classified three profiles (slow, moderate, and fast) and established their corresponding baselines for oculometric data. Within each profile, we describe changes in oculomotor function based on changes in cognitive performance during the season. To visualize these changes in multidimensional oculometric data, we also present a multidimensional visualization tool named DiViTo (diagnostic visualization tool). These experimental, computational informatics and visualization methodologies may serve to utilize oculometric information to detect changes in cognitive performance due to mild or severe cognitive impairment such as concussion/mild traumatic brain injury, as well as possibly other disorders such as attention deficit hyperactivity disorders, learning/reading disabilities, impairment of alertness, and neurocognitive function.

Correlating Multi-dimensional Oculometrics with Cognitive Performance in Healthy Youth Athletes.

There is a need for a practical objective measure to detect mild changes in cognitive performance as early signs of concussion in youth or other special populations. In this paper, we propose a novel correlation model that establishes the relationship between oculometrics extracted from raw eye movements during a mental workload task and cognitive performance. We assessed differences in cognitive performance in terms of age for youth athletes based on oculometrics pertaining to fixations and saccades. In this cross-sectional study, oculometrics were measured on 440 healthy youth athletes aged 7 to 15 years. Oculometrics pertaining to fixations (fixation time, fixation size, and surface area of fixation) and saccades (total saccadic amplitude, average saccadic amplitude, and saccadic velocity) were measured and compiled into a multivariate oculometric database by age. We discovered that the combined power of fixations and saccades provided the strongest correlation with cognitive performance-a finding that is evident across all ages as well as all levels of mental workload difficulty. Specifically, the combined observations of fixation time, saccadic velocities, and saccadic amplitudes provided us an understanding of cognitive performance during different levels of mental workload difficulty across all age groups. This study is the first step towards establishing normative, multi-dimensional oculometrics for fixations and saccades in young athletes (7 to 15 years) who are at risk for concussion in sports and recreational activities.

Association Rule Mining in Multiple, Multidimensional Time Series Medical Data.

Time series pattern mining (TSPM) finds correlations or dependencies in same series or in multiple time series. When numerous instances of multiple time series data are associated with different quantitative attributes, they form a multiple multidimensional framework. In this paper, we consider real-life time series data of muscular activities of human participants obtained from multiple electromyogram (EMG) sensors and discover patterns in these EMG time series data. Each EMG time series data is associated with quantitative attributes such as energy of the signal and onset time, which are required to be mined along with EMG time series patterns. We propose a two-stage approach for this purpose: in the first stage, our emphasis is on discovering frequent patterns in multiple time series by doing sequential mining across time slices. And in the next stage, we focus on the quantitative attributes of only those time series that are present in the patterns discovered in the first stage. Our evaluation with large sets of time series data from multiple EMG sensors demonstrate that our two-stage approach speeds up the process of finding association rules in such multidimensional environment as compared to other methods and scales up linearly in terms of number of time series involved. Our approach is generic in finding association rules in other medical sensor databases containing multiple time series associated with quantitative attributes, which can be used in extending research areas like rehabilitation programs or designing better prosthetic devices.

The effect of galvanic vestibular stimulation on distortion product otoacoustic emissions.

Galvanic stimulation has long been used as a nonmechanical means of activating the vestibular apparatus through direct action on the vestibular nerve endings. This stimulation has been reported to be safe, but no studies have examined the potential changes in the corresponding cochlear receptors. The aim of the present study was to evaluate the effect of galvanic vestibular stimulation (GVS) on distortion product otoacoustic emissions (DPOAEs). Fourteen subjects underwent DPOAEs during several conditions of GVS. The DPOAEs ranged from ∼ 1 kHz to ∼ 8 kHz at 65/55 dB for f1/f2 and with an f2/f1 ratio of 1.2. The subjects were evaluated at 10 stimulation conditions that ranged from -2.0 mA to +2.0 mA for each frequency. Statistical analysis showed no significant differences in DPOAE amplitudes for all conditions with and without GVS. Results also showed no significant differences between DPOAE amplitudes before and after GVS. Multivariate analysis found subject variability in DPOAE amplitude, which was not thought to be GVS related. Results indicated that GVS produced neither temporary nor permanent changes in DPOAEs.

Indexing 3-D human motion repositories for content-based retrieval.

Content-based retrieval of the similar motions for the human joints has significant impact in the fields of physical medicine, biomedicine, rehabilitation, and motion therapy. In this paper, we propose an efficient indexing approach for 3-D human motion capture data, supporting queries involving both subbody motions as well as whole-body motions.