Associations Between Binocular Depth Perception and Performance Gains in Laparoscopic Skill Acquisition.

The ability to perceive differences in depth is important in many daily life situations. It is also of relevance in laparoscopic surgical procedures that require the extrapolation of three-dimensional visual information from two-dimensional planar images. Besides visual-motor coordination, laparoscopic skills and binocular depth perception are demanding visual tasks for which learning is important. This study explored potential relations between binocular depth perception and individual variations in performance gains during laparoscopic skill acquisition in medical students naïve of such procedures. Individual differences in perceptual learning of binocular depth discrimination when performing a random dot stereogram (RDS) task were measured as variations in the slope changes of the logistic disparity psychometric curves from the first to the last blocks of the experiment. The results showed that not only did the individuals differ in their depth discrimination; the extent with which this performance changed across blocks also differed substantially between individuals. Of note, individual differences in perceptual learning of depth discrimination are associated with performance gains from laparoscopic skill training, both with respect to movement speed and an efficiency score that considered both speed and precision. These results indicate that learning-related benefits for enhancing demanding visual processes are, in part, shared between these two tasks. Future studies that include a broader selection of task-varying monocular and binocular cues as well as visual-motor coordination are needed to further investigate potential mechanistic relations between depth perceptual learning and laparoscopic skill acquisition. A deeper understanding of these mechanisms would be important for applied research that aims at designing behavioral interventions for enhancing technology-assisted laparoscopic skills.

Investigating the utility of VR for spatial understanding in surgical planning: evaluation of head-mounted to desktop display.

Recent technological advances have made Virtual Reality (VR) attractive in both research and real world applications such as training, rehabilitation, and gaming. Although these other fields benefited from VR technology, it remains unclear whether VR contributes to better spatial understanding and training in the context of surgical planning. In this study, we evaluated the use of VR by comparing the recall of spatial information in two learning conditions: a head-mounted display (HMD) and a desktop screen (DT). Specifically, we explored (a) a scene understanding and then (b) a direction estimation task using two 3D models (i.e., a liver and a pyramid). In the scene understanding task, participants had to navigate the rendered the 3D models by means of rotation, zoom and transparency in order to substantially identify the spatial relationships among its internal objects. In the subsequent direction estimation task, participants had to point at a previously identified target object, i.e., internal sphere, on a materialized 3D-printed version of the model using a tracked pointing tool. Results showed that the learning condition (HMD or DT) did not influence participants' memory and confidence ratings of the models. In contrast, the model type, that is, whether the model to be recalled was a liver or a pyramid significantly affected participants' memory about the internal structure of the model. Furthermore, localizing the internal position of the target sphere was also unaffected by participants' previous experience of the model via HMD or DT. Overall, results provide novel insights on the use of VR in a surgical planning scenario and have paramount implications in medical learning by shedding light on the mental model we make to recall spatial structures.

Are Spatial Memories for Familiar Environments Orientation Dependent?

In one experiment we examined the organizational structure of spatial memories for familiar environments, comparing it directly with that for unfamiliar environments. Participants in the familiar condition pointed from imagined perspectives towards objects in their own rooms and their performance was compared to that of matched controls in an unfamiliar condition who carried out the same task after studying the same rooms in immersive Virtual Reality. In both conditions, participants were faster and more accurate in pointing from imagined perspectives that were aligned with the geometry of the room (vs. not aligned), suggesting the presence of orientation-dependent representations. Whereas in the unfamiliar condition pointing performance was best along a single axis, performance in the familiar condition was about equal across all 4 orientations that were aligned with the geometric structure of the room. Moreover, performance in the familiar condition was influenced by the orientation from which participants started to preview the room prior to testing; in contrast, in the unfamiliar condition performance was not influenced by the orientation from which encoding started. This finding suggests that post-encoding situational factors (e.g., the starting orientation from which an environment is previewed) can prime the accessibility of information in well-established long-term spatial memories.

Alignment Effects in Spatial Perspective Taking from an External Vantage Point.

In three experiments, we examined, using a perceptual task, the difficulties of spatial perspective taking. Participants imagined adopting perspectives around a table and pointed from them towards the positions of a target. Depending on the condition, the scene was presented on a virtual screen in Virtual Reality or projected on an actual screen in the real world (Experiment 1), or viewed as immediate in Virtual Reality (Experiment 2). Furthermore, participants pointed with their arm (Experiments 1 and 2) vs. a joystick (Experiment 3). Results showed a greater alignment effect (i.e., a larger difference in performance between trials with imagined perspectives that were aligned vs. misaligned with the orientation of the participant) when executing the task in a virtual rather than in the real environment, suggesting that visual access to body information and room geometry, which is typically lacking in Virtual Reality, influences perspective taking performance. The alignment effect was equal across the Virtual Reality conditions of Experiment 1 and Experiment 2, suggesting that being an internal (compared to an external) observer to the scene induces no additional difficulties for perspective taking. Equal alignment effects were also found when pointing with the arm vs. a joystick, indicating that a body-dependent response mode such as pointing with the arm creates no further difficulties for reasoning from imagined perspectives.

Orientation-dependent spatial memories for scenes viewed on mobile devices.

We examined whether spatial representations for scenes experienced on the screens of mobile devices are orientation dependent and whether the type of movement (physical vs. simulated) during learning affects the encoding and the retrieval of spatial information. Participants studied a spatial layout depicted on a tablet and then carried out perspective-taking trials in which they localized objects from imagined perspectives. Depending on condition, participants either rotated the tablet along with their body or remained stationary and swiped with their finger on the screen to change their viewpoint within the scene. Results showed that participants were faster and more accurate to point to objects from an imagined perspective that was aligned than misaligned to their initial physical orientation during learning, suggesting that they had formed an orientation-dependent representation. Although no differences were found between movement conditions during pointing, participants were faster to encode spatial information with physical than simulated movement.

Updating spatial relations to remote locations described in narratives.

In four experiments we examined whether sensorimotor encoding influences readers' reasoning about spatial scenes acquired through narratives. Participants read a narrative that described the geometry of a store and then pointed to the memorized locations of described objects from imagined perspectives. In Experiment 1, participants walked during learning towards the direction of every described object and then visualized these objects as being in the immediate environment. In Experiment 2 they rotated their body to the direction of the described objects instead of walking to them, while in Experiment 3 they only turned their heads towards the objects. In Experiment 4, we eliminated the instructions to visualize the objects altogether. Results from the first three experiments revealed a performance benefit for responding from the perspective that participants physically occupied at testing. However, results from Experiment 4 showed that only participants who, in a post-task questionnaire, indicated that they had linked the described environment to their immediate environment exhibited such a benefit. Findings indicate that (1) the physical change in orientation influences reasoning about described environments if the remote environments are linked to participants' sensorimotor framework and, (2) visualization instructions are sufficient to produce such a link.

The protagonist's first perspective influences the encoding of spatial information in narratives.

Three experiments examined the first-perspective alignment effect that is observed when retrieving spatial information from memory about described environments. Participants read narratives that described the viewpoint of a protagonist in fictitious environments and then pointed to the memorized locations of described objects from imagined perspectives. Results from Experiments 1 and 2 showed that performance was best when participants responded from the protagonist's first perspective even though object locations were described from a different perspective. In Experiment 3, in which participants were physically oriented with the perspective used to describe object locations, performance from that description perspective was better than that from the protagonist's first perspective, which was, in turn, better than performance from other perspectives. These findings suggest that when reading narratives, people default to using a reference frame that is aligned with their own facing direction, although physical movement may facilitate retrieval from other perspectives.

What's so difficult with adopting imagined perspectives?

Research on spatial cognition suggests that transformation processes and/or spatial conflicts may influence performance on mental perspective-taking tasks. However, conflicting findings have complicated our understanding about the processes involved in perspective-taking, particularly those giving rise to angular disparity effects, whereby performance worsens as the imagined perspective adopted deviates from one's actual perspective. Based on data from experiments involving mental perspective-taking in immediate and remote spatial layouts, we propose here a novel account for the difficulty with perspective-taking. According to this account, the main difficulty lies in maintaining an imagined perspective in working memory, especially in the presence of salient sensorimotor information.