Cerebellar tDCS combined with augmented reality treadmill for freezing of gait in Parkinson's disease: a randomized controlled trial.

BACKGROUND: Parkinson's disease (PD) is often accompanied by gait disorders and freezing of gait (FoG), disabling symptoms that are resistant to conventional dopamine treatments. Given the cerebellum's connectivity with the motor cortex and basal ganglia, and its implication in PD, combining transcranial direct current stimulation targeting the cerebellum (ctDCS) with physical exercise might improve gait and balance. OBJECTIVE: This study aimed to evaluate the effectiveness of a novel rehabilitation approach that combines noninvasive cerebellar stimulation with motor-cognitive training via an augmented reality treadmill (C-Mill VR+) in individuals with PD and FoG. METHODS: Seventeen individuals with PD exhibiting FoG were enrolled in a randomized controlled trial. The participants were randomly assigned to a group receiving motor-cognitive training on the C-Mill VR+ with either ctDCS or sham ctDCS. Assessments were conducted pre-intervention (T0), post-intervention (T1) after 10 sessions, and at 4-week follow-up (T2), using various clinical scales. Additionally, C-Mill assessments of postural stability and gait were conducted at T0 and T1. RESULTS: Although no significant time*group interactions were observed for any of the clinical variables measured, some were found in the C-Mill measures. Specifically, right lower limb sway in static conditions, both with eyes open (OAD) and eyes closed (OCD), significantly improved at T1 in the ctDCS group compared with the sham group. CONCLUSIONS: C-Mill outcomes indicate that the combined treatment may enhance motor control. Participants who received ctDCS along with augmented reality motor-cognitive training showed better postural stability.

Fiction references as framing devices in extended reality news discourse.

This article examines fiction references in news coverage of extended reality. Based on a mixed methods analysis of 977 news articles from UK mainstream mass media outlets, this study found that fiction references were frequently used as framing devices within the news articles, with a focus on two franchises: The Matrix original trilogy (1999-2003) and Star Trek: The Next Generation (1987-1994). These references were utilised in the following three key ways: claiming fiction is becoming real; as a tool to improve readers' understanding of extended reality; and, to a limited degree, to create dystopic visions of extended reality. Ultimately, this article shows that, despite the dystopic representations of extended reality in fiction, fiction references have primarily been used to portray extended reality as advanced and high-quality. This supports extended reality adoption and the commercial interests of technology companies, raising questions as to whether journalists prioritise the interests of their readers when creating such news.

Augmented reality assisted intraoral scanning of mandibular arch: A proof-of-concept pilot clinical study.

OBJECTIVES: To investigate whether the scanning time, trueness and number of photos are influenced when augmented reality (AR) heads-up display (HUD) is utilized during the intraoral scan of fully dentate mandibular arches. METHODS: A total of 10 patients (6 females and 4 males) were included. The mandibular arch of each patient was scanned twice using an intraoral scanner (Trios4 Pod IOS: 3Shape): one with and one without AR-HUD (ML2; Magic Leap). Further, alginate impression was taken, and the cast was digitized to acquire the reference model for trueness comparison (T310, Medit). The scan time and number of photos were recorded. Trueness was evaluated qualitatively and quantitatively using colored heat maps and RMSE values respectively. t-test was used to evaluate the difference in scan time, trueness, and number of photos between the two groups (α = .05). RESULTS: AR-assisted IOS resulted in significantly faster scan time (44 s) compared to the time consumed following conventional scan method without AR-HUD (63 s) (P = <0.001). The number of photos was also significantly less with AR-assisted IOS (836) compared to IOS using conventional technique without AR-HUD (1209) P = <0.001. No statistical difference was detected in RMSE between the test groups. CONCLUSIONS: Integration of AR technology with IOS process represents a promising potential to acquire digital impressions with reduced scan acquisition time and reduced images count while simultaneously maintaining the trueness of the acquired scans. CLINICAL SIGNIFICANCE: Augmented Reality presents an emerging potential in Prosthodontics to acquire digital impressions with decreased number of images and acquisition time.

Advanced technology in shoulder arthroplasty.

Background: Glenoid component positioning is an important and challenging aspect of total shoulder arthroplasty. The use of freehand technique with standard instrumentation or preoperative planning based on 2-dimensional computed tomography (CT) scans provides an opportunity for improvement in terms of component accuracy, precision, and deformity correction. These techniques have produced varying outcomes. Methods: Preoperative planning software (PPS), patient specific instrumentation (PSI), and intraoperative navigation (NAV) have been developed to improve the accuracy of implant placement and deformity correction with the ultimate goals of improved patient outcomes and implant longevity. Literature search was conducted on published and available studies comparing the accuracy of glenoid component placement and improvements in surgical and patient outcomes amongst the aforementioned techniques. Results: PPS, PSI, and NAV have demonstrated improved accuracy over freehand techniques with standard instrumentation. However, data demonstrating the clinical benefit and cost effectiveness of these new technologies are lacking. Discussion: In this paper, we reviewed the evidence available to answer the question of whether or not advanced shoulder arthroplasty technologies have been beneficial and reviewed future technologies in development such as virtual/mixed-reality and robotic assisted shoulder surgery. Level of Evidence: 4.

Learning to direct attention: Consequences for procedural task training programs.

Procedural training programs such as augmented and virtual reality programs often present cues that direct trainees' attention to particular locations and/or items to facilitate learning. However, the impact of different types of cues on trainees' learning is poorly understood. For example, cues that indicate the location of to-be-pressed buttons might cause a trainee to focus on button locations rather than their icons. If the trainee later needs to use a differently-arranged interface, they may be unable to complete the tasks and may need retraining. The current study trained people with either location cues or icon cues and then had them perform the same tasks with a rearranged layout. The results indicate that what a trainee learns is impacted by the type of cue and the type of icons in the interface. When the interface contained icons that represented their function, participants trained with location cues had poorer accuracy and reported experiencing higher difficulty using the interface than participants trained with icon cues, suggesting that icon cues may lead to greater learning than location cues. Both groups, though, maintained similar accuracy when the interface rearranged, indicating they both learned button icons. When the interface contained abstract icons, participants trained with icon cues were able to maintain higher accuracy with the rearranged interface compared to participants trained with location cues suggesting they had greater knowledge of button icons. This finding indicates designers of procedural training programs should consider how cue type could impact a trainee's learning, particularly with abstract icons.

Usability, Ergonomics, and Educational Value of a Novel Telestration Tool for Surgical Coaching: Usability Study.

BACKGROUND: Telementoring studies found technical challenges in achieving accurate and stable annotations during live surgery using commercially available telestration software intraoperatively. To address the gap, a wireless handheld telestration device was developed to facilitate dynamic user interaction with live video streams. OBJECTIVE: This study aims to find the perceived usability, ergonomics, and educational value of a first-generation handheld wireless telestration platform. METHODS: A prototype was developed with four core hand-held functions: (1) free-hand annotation, (2) cursor navigation, (3) overlay and manipulation (rotation) of ghost (avatar) instrumentation, and (4) hand-held video feed navigation on a remote monitor. This device uses a proprietary augmented reality platform. Surgeons and trainees were invited to test the core functions of the platform by performing standardized tasks. Usability and ergonomics were evaluated with a validated system usability scale and a 5-point Likert scale survey, which also evaluated the perceived educational value of the device. RESULTS: In total, 10 people (9 surgeons and 1 senior resident; 5 male and 5 female) participated. Participants strongly agreed or agreed (SA/A) that it was easy to perform annotations (SA/A 9, 90% and neutral 0, 0%), video feed navigation (SA/A 8, 80% and neutral 1, 10%), and manipulation of ghost (avatar) instruments on the monitor (SA/A 6, 60% and neutral 3, 30%). Regarding ergonomics, 40% (4) of participants agreed or strongly agreed (neutral 4, 40%) that the device was physically comfortable to use and hold. These results are consistent with open-ended comments on the device's size and weight. The average system usability scale was 70 (SD 12.5; median 75, IQR 63-84) indicating an above average usability score. Participants responded favorably to the device's perceived educational value, particularly for postoperative coaching (agree 6, 60%, strongly agree 4, 40%). CONCLUSIONS: This study presents the preliminary usability results of a novel first-generation telestration tool customized for use in surgical coaching. Favorable usability and perceived educational value were reported. Future iterations of the device should focus on incorporating user feedback and additional studies should be conducted to evaluate its effectiveness for improving surgical education. Ultimately, such tools can be incorporated into pedagogical models of surgical coaching to optimize feedback and training.

Acupuncture navigation method integrated with augmented reality.

BACKGROUND: Acupuncture and moxibustion are effective in alleviating symptoms, but the large number of acupoints can make accurate needle placement and training difficult. OBJECTIVE: To address these challenges, this study aims to develop an augmented reality (AR) acupuncture navigation system designed to improve the accuracy and intuitiveness of acupoint localization. METHODS: The proposed system employs a six-point registration and positioning technique, enabling the AR navigation model to adapt to the specific characteristics of each patient. RESULTS: In testing, discrepancies between virtual and actual acupuncture points ranged from 0.6 mm to 3.9 mm, which is within the acceptable tolerance range for acupuncture. CONCLUSION: This AR-based system shows promise in enhancing the precision of acupuncture point localization, potentially leading to improved treatment outcomes.

Using augmented reality to assess spatial neglect: The Free Exploration Test (FET).

BACKGROUND: To capture the distortion of exploratory activity typical of patients with spatial neglect, traditional diagnostic methods and new virtual reality applications use confined workspaces that limit patients' exploration behavior to a predefined area. Our aim was to overcome these limitations and enable the recording of patients' biased activity in real, unconfined space. METHODS: We developed the Free Exploration Test (FET) based on augmented reality technology. Using a live stream via the back camera on a tablet, patients search for a (non-existent) virtual target in their environment, while their exploration movements are recorded for 30 s. We tested 20 neglect patients and 20 healthy participants and compared the performance of the FET with traditional neglect tests. RESULTS: In contrast to controls, neglect patients exhibited a significant rightward bias in exploratory movements. The FET had a high discriminative power (area under the curve = 0.89) and correlated positively with traditional tests of spatial neglect (Letter Cancellation, Bells Test, Copying Task, Line Bisection). An optimal cut-off point of the averaged bias of exploratory activity was at 9.0° on the right; it distinguished neglect patients from controls with 85% sensitivity. DISCUSSION: FET offers time-efficient (execution time: ∼3 min), easy-to-apply, and gamified assessment of free exploratory activity. It supplements traditional neglect tests, providing unrestricted recording of exploration in the real, unconfined space surrounding the patient.

Efficacy of virtual reality and augmented reality in anatomy education: A systematic review and meta-analysis.

Anatomy is the cornerstone of medical education. Virtual reality (VR) and augmented reality (AR) technologies are becoming increasingly popular in the development of anatomy education. Various studies have evaluated VR and AR in anatomy education. This meta-analysis aims to evaluate the effectiveness of VR and AR in anatomical education. The protocol was registered in Prospero. Scopus, PubMed, Web of Science, and Cochrane Library databases were searched. From the 4487 articles gathered, 24 randomized controlled trials were finally selected according to inclusion criteria. According to the results of the meta-analysis, VR had a moderate and significant effect on the improvement of knowledge scores in comparison with other methods (standardized mean difference = 0.58; 95% CI = 0.22, 0.95; p < 0.01). Due to the high degree of heterogeneity (I2 = 87.44%), subgroup analyses and meta-regression were performed on eight variables. In enhancing the "attitude," VR was found to be more "useful" than other methods (p = 0.01); however, no significant difference was found for "enjoyable" and "easy to use" statements. Compared with other methods, the effect of AR on knowledge scores was non-significant (SMD = -0.02; 95% CI = -0.39, 0.34; p = 0.90); also, in subgroup analyses and meta-regression, the results were non-significant. The results indicate that, unlike AR, VR could be used as an effective tool for teaching anatomy in medical education. Given the observed heterogeneity across the included studies, further research is warranted to identify those variables that may impact the efficacy of VR and AR in anatomy education.

Extended Reality in Revolutionizing Neurological Disease: A New Era for Chronic Condition Treatment.

Extended reality (XR), which includes virtual reality (VR), augmented reality (AR), and mixed reality (MR), provides promising advancements in managing chronic neurological disorders such as Parkinson's disease (PD), multiple sclerosis (MS), Alzheimer's disease, and stroke. This review examines the impact of XR technologies on neurological care, highlighting their ability to create immersive, interactive environments that enhance rehabilitation through tailored motor and cognitive exercises. XR supports neuroplasticity by providing engaging, contextually relevant exercises and real-time feedback, offering innovative alternatives to traditional methods. The technical issues, clinical validation, and accessibility must be addressed despite the potential benefits. Future developments should focus on refining XR applications, integrating them with complementary technologies, and establishing robust policies to guide their effective and ethical use. XR is poised to revolutionize neurological rehabilitation, promising improved patient outcomes and transforming medical training.

Augmented Reality-Guided Mastoidectomy Simulation: A Randomized Controlled Trial Assessing Surgical Proficiency.

OBJECTIVE: Mastoidectomy surgical training is challenging due to the complex nature of the anatomical structures involved. Traditional training methods based on direct patient care and cadaveric temporal bone training have practical shortcomings. 3D-printed temporal bone models and augmented reality (AR) have emerged as promising solutions, particularly for mastoidectomy surgery, which demands an understanding of intricate anatomical structures. Evidence is needed to explore the potential of AR technology in addressing these training challenges. METHODS: 21 medical students in their clinical clerkship were recruited for this prospective, randomized controlled trial assessing mastoidectomy skills. The participants were randomly assigned to the AR group, which received real-time guidance during drilling on 3D-printed temporal bone models, or to the control group, which received traditional training methods. Skills were assessed on a modified Welling scale and evaluated independently by two senior otologists. RESULTS: The AR group outperformed the control group, with a mean overall drilling score of 19.5 out of 25, compared with the control group's score of 12 (p < 0.01). The AR group was significantly better at defining mastoidectomy margins (p < 0.01), exposing the antrum, preserving the lateral semicircular canal (p < 0.05), sharpening the sinodural angle (p < 0.01), exposing the tegmen and attic, preserving the ossicles (p < 0.01), and thinning and preserving the external auditory canal (p < 0.05). CONCLUSION: AR simulation in mastoidectomy, even in a single session, improved the proficiency of novice surgeons compared with traditional methods. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

Usability of an augmented reality bedtime routine application for autistic children.

Sleep problems are highly prevalent in autism and negatively impact the physical and mental health of children and their caregivers. Sleep education programs are often recommended as a first line-treatment to help parents implement healthy sleeping habits and a bedtime routine at home; however, the accompanying paper-based toolkits used in the bedtime routines have limitations related to engagement and adherence. To address these gaps, we iteratively developed and tested the usability of an augmented reality (AR) bedtime routine application. Our single participant design study (n = 7 child/parent dyads) found 86% compliance with the program and suggested good-excellent usability of the app with a trend toward increased willingness and faster completion of children's bedtime routines. This work supports the feasibility of using technology-based tools in sleep education programs and informs future clinical studies examining the effectiveness of these approaches for mitigating sleep difficulties.

Adapting Novel Augmented Reality Devices for Patient Simulations in Medical Education.

Extended reality (XR) simulations are becoming increasingly common in educational settings, particularly in medical education. Advancing XR devices to enhance these simulations is a booming field of research. This study seeks to understand the value of a novel, non-wearable mixed reality (MR) display during interactions with a simulated holographic patient, specifically in taking a medical history. Twenty-one first-year medical students at the University of North Carolina at Chapel Hill participated in the virtual patient (VP) simulations. On a five-point Likert scale, students overwhelmingly agreed with the statement that the simulations helped ensure they were progressing along learning objectives related to taking a patient history. However, they found that, at present, the simulations can only partially correct mistakes or provide clear feedback. This finding demonstrates that the novel hardware solution can help students engage in the activity, but the underlying software may need adjustment to attain sufficient pedagogical validity.

A review on organ deformation modeling approaches for reliable surgical navigation using augmented reality.

Augmented Reality (AR) holds the potential to revolutionize surgical procedures by allowing surgeons to visualize critical structures within the patient's body. This is achieved through superimposing preoperative organ models onto the actual anatomy. Challenges arise from dynamic deformations of organs during surgery, making preoperative models inadequate for faithfully representing intraoperative anatomy. To enable reliable navigation in augmented surgery, modeling of intraoperative deformation to obtain an accurate alignment of the preoperative organ model with the intraoperative anatomy is indispensable. Despite the existence of various methods proposed to model intraoperative organ deformation, there are still few literature reviews that systematically categorize and summarize these approaches. This review aims to fill this gap by providing a comprehensive and technical-oriented overview of modeling methods for intraoperative organ deformation in augmented reality in surgery. Through a systematic search and screening process, 112 closely relevant papers were included in this review. By presenting the current status of organ deformation modeling methods and their clinical applications, this review seeks to enhance the understanding of organ deformation modeling in AR-guided surgery, and discuss the potential topics for future advancements.

Data of history: An open-source and multiformat wall image dataset of Panam city, a historical place.

Historical data on monuments offers valuable insights into that period's past sculpture, architecture, and preferences. Realising the importance of historical data and the scarcity of data on historical places, this study presents a dataset collected from Panam City. Panam City, established in the late 1300s century, was the capital of the fifteenth-century Bengal ruler Isa Khan. The city was once an important trading and political centre and is now considered a world heritage site by the United Nations Educational Scientific and Cultural Organisation (UNESCO). Panam City is located in Sonargaon, Dhaka, Bangladesh. The aim of data collection is to capture past architectural design, materials used for the building, and the current state of the walls and structures of Panam City. This dataset can benefit researchers, architects, archaeologists, and cultural organisations. Historians and architects can gain insights into the wall's construction methods and materials, informing future restoration efforts. Historic datasets can create exciting AR/VR experiences by digitizing and 3D modelling historical artefacts and environments, integrating them into AR/VR platforms using game engines and development tools, and enhancing the user experience with interactive storytelling and educational content. Tourism boards and cultural heritage organisations can leverage this resource to develop engaging experiences that highlight the rich history and significance of Panama City. By making this data accessible, this study contributes to understanding and appreciating Panam City's historical significance while promoting innovative approaches to heritage preservation in the digital age. This dataset contains 2292 images of degraded wall classes such as Artistic, Corroded Brick, Corroded Plaster, Fungus, and Living Plant.

Augmented reality and radiology: visual enhancement or monopolized mirage.

Augmented reality (AR) exists on a spectrum, a mixed reality hybrid of virtual projections onto real surroundings. Superimposing conventional medical imaging onto the living patient offers vast potential for radiology, potentially revolutionising practice. The digital technology and user-interfaces that allow us to appreciate this enhanced environment however are complex, expensive, and development mainly limited to major commercial technology (Tech) firms. Hence, it is the activity of these consumer-based businesses that will inevitably dictate the available technology and therefore clinical application of AR. The release of mixed reality head-mounted displays in 2024, must therefore prompt a review of the current status of AR research in radiology, the need for further study and a discussion of the complicated relationship between consumer technology, clinical utility, and the risks of monopolisation.

Augmented Reality as an Aid to Behavior Therapy for Anxiety Disorders: A Narrative Review.

Anxiety disorders are among the most common mental disorders worldwide. These conditions are characterized by excessive anxiety that is difficult to control. In most anxiety disorders, symptoms are triggered by exposure to specific objects or situations. This leads sufferers to avoid such exposures, leading to impaired social and occupational functioning and reduced quality of life. Therapies based on behavioral principles, either alone or in combination with cognitive techniques, are the most effective psychological interventions for anxiety disorders. However, the effectiveness of these therapies may be limited due to a lack of generalization from clinic to real-world settings. Augmented reality (AR) is a technology that provides an interactive experience by superimposing computer-generated content, often in multiple sensory modalities, on the real world. Emerging evidence suggests that AR may be useful in treating a broad range of mental disorders, including anxiety disorders. This review examines the evidence for the use of AR-based techniques as an aid to behavioral or cognitive-behavioral therapies for anxiety disorders. The available evidence suggests that this method may offer significant advantages over conventional therapies, particularly in the case of specific phobias, but also in social anxiety disorder. AR can also be combined with other novel technologies to monitor psychophysiological markers of anxiety and its reduction over the course of treatment. The advantages of AR could be related to its combination of real and simulated content, allowing for better generalization of the benefits of conventional exposure-based therapy. Though the safety, efficacy, and cost-effectiveness of this method need to be confirmed in larger samples, it could lead to a paradigm shift in the way behavioral therapies for anxiety disorders are conceptualized and delivered.

Operative Adjuncts in Pediatric Brain Tumor Surgery with a Focus on Suprasellar Tumors.

The primary objective of surgery for brain tumor resection has always been maximizing safe resection while minimizing the risk to normal brain tissue. Technological advances applied in the operating room help surgeons to achieve this objective. This chapter discusses specific tools and approaches in the operating environment that target safe surgery for brain tumors in children, with a focus on pathologies in the sellar/suprasellar region. Particular focus is given to tools that help with safe patient positioning; intraoperative imaging modalities; and chemical visualization adjuncts. Both static (preoperative images used for neuronavigation) and dynamic (images updated during the procedure) intraoperative imaging modalities are discussed. There is further overview of operative rehearsal and preparation strategies, which are rapidly evolving as virtual reality systems become more commonplace. While the rapid evolution of intraoperative adjuncts in neurosurgery means the status of a given technology as novel is quite transient, this chapter offers a snapshot of the current state of advanced intraoperative tools for pediatric brain tumor surgery.

Enhancing surgical navigation: a robust hand-eye calibration method for the Microsoft HoloLens 2.

PURPOSE: Optical-see-through head-mounted displays have the ability to seamlessly integrate virtual content with the real world through a transparent lens and an optical combiner. Although their potential for use in surgical settings has been explored, their clinical translation is sparse in the current literature, largely due to their limited tracking capabilities and the need for manual alignment of virtual representations of objects with their real-world counterparts. METHODS: We propose a simple and robust hand-eye calibration process for the depth camera of the Microsoft HoloLens 2, utilizing a tracked surgical stylus fitted with infrared reflective spheres as the calibration tool. RESULTS: Using a Monte Carlo simulation and a paired-fiducial registration algorithm, we show that a calibration accuracy of 1.65 mm can be achieved with as little as 6 fiducial points. We also present heuristics for optimizing the accuracy of the calibration. The ability to use our calibration method in a clinical setting is validated through a user study, with users achieving a mean calibration accuracy of 1.67 mm in an average time of 42 s. CONCLUSION: This work enables real-time hand-eye calibration for the Microsoft HoloLens 2, without any need for a manual alignment process. Using this framework, existing surgical navigation systems employing optical or electromagnetic tracking can easily be incorporated into an augmented reality environment with a high degree of accuracy.