Immersive virtual reality for interdisciplinary trauma management - initial evaluation of a training tool prototype.

INTRODUCTION: Emergency care of critically ill patients in the trauma room is an integral part of interdisciplinary work in hospitals. Live threatening injuries require swift diagnosis, prioritization, and treatment; thus, different medical specialties need to work together closely for optimal patient care. Training is essential to facilitate smooth performance. This study presents a training tool for familiarization with trauma room algorithms in immersive virtual reality (VR), and a first qualitative assessment. MATERIALS AND METHODS: An interdisciplinary team conceptualized two scenarios and filmed these in the trauma room of the University Medical Center Mainz, Germany in 3D-360°. This video content was used to create an immersive VR experience. Participants of the Department of Anesthesiology were included in the study, questionnaires were obtained and eye movement was recorded. RESULTS: 31 volunteers participated in the study, of which 10 (32,2%) had completed specialist training in anesthesiology. Participants reported a high rate of immersion (immersion(mean) = 6 out of 7) and low Visually Induced Motion Sickness (VIMS(mean) = 1,74 out of 20). Participants agreed that VR is a useful tool for medical education (mean = 1,26; 1 very useful, 7 not useful at all). Residents felt significantly more secure in the matter after training (p < 0,05), specialist showed no significant difference. DISCUSSION: This study presents a novel tool for familiarization with trauma room procedures, which is especially helpful for less experienced residents. Training in VR was well accepted and may be a solution to enhance training in times of low resources for in person training.

Characterizing the Sensing Response of Carbon Nanocomposite-Based Wearable Sensors on Elbow Joint Using an End Point Robot and Virtual Reality.

Physical therapy is often essential for complete recovery after injury. However, a significant population of patients fail to adhere to prescribed exercise regimens. Lack of motivation and inconsistent in-person visits to physical therapy are major contributing factors to suboptimal exercise adherence, slowing the recovery process. With the advancement of virtual reality (VR), researchers have developed remote virtual rehabilitation systems with sensors such as inertial measurement units. A functional garment with an integrated wearable sensor can also be used for real-time sensory feedback in VR-based therapeutic exercise and offers affordable remote rehabilitation to patients. Sensors integrated into wearable garments offer the potential for a quantitative range of motion measurements during VR rehabilitation. In this research, we developed and validated a carbon nanocomposite-coated knit fabric-based sensor worn on a compression sleeve that can be integrated with upper-extremity virtual rehabilitation systems. The sensor was created by coating a commercially available weft knitted fabric consisting of polyester, nylon, and elastane fibers. A thin carbon nanotube composite coating applied to the fibers makes the fabric electrically conductive and functions as a piezoresistive sensor. The nanocomposite sensor, which is soft to the touch and breathable, demonstrated high sensitivity to stretching deformations, with an average gauge factor of ~35 in the warp direction of the fabric sensor. Multiple tests are performed with a Kinarm end point robot to validate the sensor for repeatable response with a change in elbow joint angle. A task was also created in a VR environment and replicated by the Kinarm. The wearable sensor can measure the change in elbow angle with more than 90% accuracy while performing these tasks, and the sensor shows a proportional resistance change with varying joint angles while performing different exercises. The potential use of wearable sensors in at-home virtual therapy/exercise was demonstrated using a Meta Quest 2 VR system with a virtual exercise program to show the potential for at-home measurements.

Visual Feedback and Guided Balance Training in an Immersive Virtual Reality Environment for Lower Extremity Rehabilitation.

Balance training is essential for physical rehabilitation procedures, as it can improve functional mobility and enhance cognitive coordination. However, conventional balance training methods may have limitations in terms of motivation, real-time objective feedback, and personalization, which a virtual reality (VR) setup may better provide. In this work, we present an immersive VR training environment for lower extremity balance rehabilitation with real-time guidance and feedback. The VR training environment immerses the user in a 3D ice rink model where a virtual coach (agent) leads them through a series of balance poses, and the user controls a trainee avatar with their own movements. We developed two coaching styles: positive-reinforcement and autonomous-supportive, and two viewpoints of the trainee avatar: first-person and third-person. The proposed environment was evaluated in a user study with healthy, non-clinical participants (n = 16, 24.4 ± 5.7 years old, 9 females). Our results show that participants showed stronger performance in the positive-reinforcement style compared to the autonomous-supportive style. Additionally, in the third-person viewpoint, the participants exhibited more stability in the positive-reinforcement style compared to the autonomous-supportive style. For viewpoint, participants exhibited stronger performance in the first-person viewpoint compared to third-person in the autonomous-supportive style, while they were comparable in the positive-reinforcement style. We observed no significant effects on the foot height and number of mistakes. Furthermore, we report the analysis of user performance with balance training poses and subjective measures based on questionnaires to assess the user experience, usability, and task load. The proposed VR balance training could offer an interactive, adaptive, and engaging environment and open new potential research directions for lower extremity rehabilitation.

A comparison of input devices for precise interaction tasks in VR-based surgical planning and training.

To exploit the potential of virtual reality (VR) in medicine, the input devices must be selected carefully due to their different benefits. In this work, input devices for common interaction tasks in medical VR planning and training are compared. Depending on the specific purpose, different requirements exist. Therefore, an appropriate trade-off between meeting task-specific requirements and having a widely applicable device has to be found. We focus on two medical use cases, liver surgery planning and craniotomy training, to cover a broad medical domain. Based on these, relevant input devices are compared with respect to their suitability for performing precise VR interaction tasks. The devices are standard VR controllers, a pen-like VR Ink, data gloves and a real craniotome, the medical instrument used for craniotomy. The input devices were quantitatively compared with respect to their performance based on different measurements. The controllers and VR Ink performed significantly better than the remaining two devices regarding precision. Qualitative data concerning task load, cybersickness, and usability and appropriateness of the devices were assessed. Although no device stands out for both applications, most participants preferred using the VR Ink, followed by the controller and finally the data gloves and craniotome. These results can guide the selection of an appropriate device for future medical VR applications.

Toward interprofessional team training for surgeons and anesthesiologists using virtual reality.

PURPOSE: In this work, a virtual environment for interprofessional team training in laparoscopic surgery is proposed. Our objective is to provide a tool to train and improve intraoperative communication between anesthesiologists and surgeons during laparoscopic procedures. METHODS: An anesthesia simulation software and laparoscopic simulation software are combined within a multi-user virtual reality (VR) environment. Furthermore, two medical training scenarios for communication training between anesthesiologists and surgeons are proposed and evaluated. Testing was conducted and social presence was measured. In addition, clinical feedback from experts was collected by following a think-aloud protocol and through structured interviews. RESULTS: Our prototype is assessed as a reasonable basis for training and extensive clinical evaluation. Furthermore, the results of testing revealed a high degree of exhilaration and social presence of the involved physicians. Valuable insights were gained from the interviews and the think-aloud protocol with the experts of anesthesia and surgery that showed the feasibility of team training in VR, the usefulness of the system for medical training, and current limitations. CONCLUSION: The proposed VR prototype provides a new basis for interprofessional team training in surgery. It engages the training of problem-based communication during surgery and might open new directions for operating room training.