Bogus visual feedback alters onset of movement-evoked pain in people with neck pain.

Pain is a protective perceptual response shaped by contextual, psychological, and sensory inputs that suggest danger to the body. Sensory cues suggesting that a body part is moving toward a painful position may credibly signal the threat and thereby modulate pain. In this experiment, we used virtual reality to investigate whether manipulating visual proprioceptive cues could alter movement-evoked pain in 24 people with neck pain. We hypothesized that pain would occur at a lesser degree of head rotation when visual feedback overstated true rotation and at a greater degree of rotation when visual feedback understated true rotation. Our hypothesis was clearly supported: When vision overstated the amount of rotation, pain occurred at 7% less rotation than under conditions of accurate visual feedback, and when vision understated rotation, pain occurred at 6% greater rotation than under conditions of accurate visual feedback. We concluded that visual-proprioceptive information modulated the threshold for movement-evoked pain, which suggests that stimuli that become associated with pain can themselves trigger pain.

Virtualizing living and working spaces: Proof of concept for a biomedical space-replication methodology.

The physical spaces within which the work of health occurs - the home, the intensive care unit, the emergency room, even the bedroom - influence the manner in which behaviors unfold, and may contribute to efficacy and effectiveness of health interventions. Yet the study of such complex workspaces is difficult. Health care environments are complex, chaotic workspaces that do not lend themselves to the typical assessment approaches used in other industrial settings. This paper provides two methodological advances for studying internal health care environments: a strategy to capture salient aspects of the physical environment and a suite of approaches to visualize and analyze that physical environment. We used a Faro™ laser scanner to obtain point cloud data sets of the internal aspects of home environments. The point cloud enables precise measurement, including the location of physical boundaries and object perimeters, color, and light, in an interior space that can be translated later for visualization on a variety of platforms. The work was motivated by vizHOME, a multi-year program to intensively examine the home context of personal health information management in a way that minimizes repeated, intrusive, and potentially disruptive in vivo assessments. Thus, we illustrate how to capture, process, display, and analyze point clouds using the home as a specific example of a health care environment. Our work presages a time when emerging technologies facilitate inexpensive capture and efficient management of point cloud data, thus enabling visual and analytical tools for enhanced discharge planning, new insights for designers of consumer-facing clinical informatics solutions, and a robust approach to context-based studies of health-related work environments.

SafeHOME: Promoting Safe Transitions to the Home.

This paper introduces the SafeHome Simulator system, a set of immersive Virtual Reality Training tools and display systems to train patients in safe discharge procedures in captured environments of their actual houses. The aim is to lower patient readmission by significantly improving discharge planning and training. The SafeHOME Simulator is a project currently under review.

Neck Pain and Proprioception Revisited Using the Proprioception Incongruence Detection Test.

BACKGROUND: Proprioceptive imprecision is believed to contribute to persistent pain. Detecting imprecision in order to study or treat it remains challenging given the limitations of current tests. OBJECTIVES: The aim of this study was to determine whether proprioceptive imprecision could be detected in people with neck pain by testing their ability to identify incongruence between true head motion and a false visual reference using the Proprioception Incongruence Detection (PID) Test. DESIGN: A cross-sectional study was conducted. METHODS: Twenty-four people with neck pain and 24 matched controls repeatedly rotated to specific markers within a virtual world and indicated if their true head rotation was more or less than the rotation suggested by the visual feedback. Visual feedback was manipulated at 6 corrections, ranging from 60% of true movement to 140% of true movement. A standard repositioning error (RPE) test as undertaken for comparison. RESULTS: Healthy controls were better able to detect incongruence between vision and true head rotation (X̅=75.6%, SD=8.5%) than people with neck pain were (X̅=69.6%, SD=12.7%). The RPE test scores were not different between groups. The PID Test score related to self-reported pain intensity but did not relate to RPE test score. LIMITATIONS: Causality cannot be established from this cross-sectional study, and further work refining the PID Test is needed for it to offer clinical utility. CONCLUSIONS: Proprioceptive precision for neck movement appears worse in people with neck pain than in those without neck pain, and the extent of the deficit appears to be related to usual pain severity. The PID Test appears to be a more sensitive test than the RPE test and is likely to be useful for assessment of proprioceptive function in research and clinical settings.