基于虛擬現(xiàn)實(shí)的下肢主被動(dòng)康復(fù)訓(xùn)練系統(tǒng)研究

郭曉輝，王晶，楊揚(yáng)，等

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·推薦論文摘要·

基于虛擬現(xiàn)實(shí)的下肢主被動(dòng)康復(fù)訓(xùn)練系統(tǒng)研究

郭曉輝，王晶，楊揚(yáng)，等

摘要：針對(duì)傳統(tǒng)下肢康復(fù)訓(xùn)練中病人參與度低、無(wú)法產(chǎn)生主動(dòng)運(yùn)動(dòng)意圖等問(wèn)題，設(shè)計(jì)實(shí)現(xiàn)了基于虛擬現(xiàn)實(shí)的下肢康復(fù)訓(xùn)練系統(tǒng)?；诖竽X鏡像神經(jīng)元和神經(jīng)可塑性理論，利用Matlab和Labview等軟件實(shí)現(xiàn)數(shù)據(jù)實(shí)時(shí)通信與反饋處理，結(jié)合虛擬現(xiàn)實(shí)場(chǎng)景建模和動(dòng)畫(huà)腳本編輯的方法，通過(guò)3D視覺(jué)和聽(tīng)覺(jué)等效果作用于患者神經(jīng)中樞，形成信息傳遞的封閉回路，以實(shí)現(xiàn)對(duì)受損神經(jīng)中樞的主被動(dòng)協(xié)同刺激，激發(fā)大腦運(yùn)動(dòng)區(qū)鏡像神經(jīng)元，強(qiáng)化自主運(yùn)動(dòng)意圖。研究結(jié)果表明，該系統(tǒng)能輔助患者完成主被動(dòng)模式下的康復(fù)訓(xùn)練，并在訓(xùn)練中為患者提供深度虛擬環(huán)境的視覺(jué)交互，大大增強(qiáng)了康復(fù)訓(xùn)練中對(duì)受損神經(jīng)中樞的刺激，提高了患者的訓(xùn)練效率和積極主動(dòng)性。該技術(shù)在神經(jīng)中樞損傷的康復(fù)領(lǐng)域有一定的應(yīng)用前景。 頭戴式虛擬現(xiàn)實(shí)眼鏡可以將人對(duì)外界的視覺(jué)封閉，使觀看者產(chǎn)生沉浸于虛擬環(huán)境中的感覺(jué)。為了實(shí)現(xiàn)這一效果，頭戴式虛擬現(xiàn)實(shí)眼鏡會(huì)將廣角鏡片放置在使用者的眼睛前，使得視頻畫(huà)面聚焦。由于廣角鏡片的使用會(huì)對(duì)畫(huà)面產(chǎn)生枕形畸變，從而影響觀看的效果；因此播放的視頻畫(huà)面要先經(jīng)過(guò)桶形變換以抵消廣角鏡片的影響。此時(shí)使用者可以拷貝經(jīng)過(guò)桶形變換的視頻，從而盜版該視頻。在這種情況下，視頻的版權(quán)信息不僅需要在原始視頻中驗(yàn)證，還需要在經(jīng)過(guò)桶形變換后的視頻中驗(yàn)證。提出了一種用于頭戴式虛擬現(xiàn)實(shí)眼鏡的視頻水印方案；該方案使用基于擴(kuò)頻的水印嵌入方法，將數(shù)字水印模板嵌入到視頻幀的中頻中。對(duì)于遭受了桶形變換的視頻幀而言，首先提出了一種桶形變換參數(shù)估計(jì)方法；然后對(duì)遭受了桶形變換的視頻進(jìn)行枕形變換以期恢復(fù)出桶形變換，前的畫(huà)面；最后，對(duì)恢復(fù)的視頻幀和水印模板進(jìn)行相關(guān)性計(jì)算，以檢測(cè)該視頻中是否含有水印。實(shí)驗(yàn)結(jié)果表明，可以正確地從遭受桶形變換的視頻幀中檢測(cè)出已嵌入的水印，說(shuō)明可以用于頭戴式虛擬現(xiàn)實(shí)眼鏡中的視頻的版權(quán)保護(hù)。 網(wǎng)絡(luò)滲透程序使得遠(yuǎn)端的黑客享有系統(tǒng)的控制權(quán)，從而對(duì)網(wǎng)絡(luò)和計(jì)算機(jī)系統(tǒng)的安全構(gòu)成了極大的威脅。為了讓網(wǎng)絡(luò)安全工作人員更好地了解網(wǎng)絡(luò)滲透攻擊并有效地防御網(wǎng)絡(luò)滲透攻擊，本文提出了網(wǎng)絡(luò)滲透攻擊仿真概念，通過(guò)仿真訓(xùn)練的手法，達(dá)到低成本高質(zhì)量高安全性的網(wǎng)絡(luò)安全培訓(xùn)目的。設(shè)計(jì)了網(wǎng)絡(luò)滲透攻擊的仿真方法，對(duì)網(wǎng)絡(luò)滲透工具進(jìn)行了虛擬實(shí)現(xiàn)，進(jìn)行攻擊策略的模擬，并最終建立了網(wǎng)絡(luò)滲透攻擊仿真訓(xùn)練系統(tǒng)。通過(guò)對(duì)知識(shí)庫(kù)的不斷更新，達(dá)到豐富網(wǎng)絡(luò)攻防仿真訓(xùn)練系統(tǒng)的教學(xué)內(nèi)容以及加強(qiáng)其教學(xué)力度的目的。 針對(duì)現(xiàn)有網(wǎng)絡(luò)環(huán)境下的BS模式下三維虛擬現(xiàn)實(shí)場(chǎng)景在加載過(guò)程中因加載大量的不可視的對(duì)象而引起資源消耗過(guò)高、加載速度過(guò)慢的問(wèn)題，提出了一種基于路網(wǎng)的可視動(dòng)態(tài)加載框架。該框架對(duì)三維虛擬現(xiàn)實(shí)場(chǎng)景內(nèi)的靜態(tài)對(duì)象和動(dòng)態(tài)對(duì)象的可視查詢(xún)分別進(jìn)行處理。設(shè)計(jì)了框架內(nèi)的路網(wǎng)、移動(dòng)對(duì)象、靜態(tài)對(duì)象可視關(guān)系表和動(dòng)態(tài)對(duì)象可視關(guān)系表的數(shù)據(jù)模型，并給出了可視關(guān)系表的維護(hù)算法。對(duì)于場(chǎng)景內(nèi)的靜態(tài)對(duì)象的可視查詢(xún)，給出基于靜態(tài)對(duì)象可視關(guān)系表的靜態(tài)可視查詢(xún)框架及算法，避免了復(fù)雜的在線可視計(jì)算；對(duì)于場(chǎng)景內(nèi)的動(dòng)態(tài)對(duì)象的可視查詢(xún)，則給出基于動(dòng)態(tài)對(duì)象可視關(guān)系表的連續(xù)可視范圍查詢(xún)框架及算法。實(shí)驗(yàn)結(jié)果表明，在保持三維虛擬現(xiàn)實(shí)場(chǎng)景觀測(cè)效果不變的情況下，可視動(dòng)態(tài)加載框架能夠大幅度降低虛擬現(xiàn)實(shí)場(chǎng)景中的靜態(tài)和動(dòng)態(tài)對(duì)象的加載數(shù)據(jù)量和更新數(shù)據(jù)量，降低對(duì)于網(wǎng)絡(luò)帶寬和客戶(hù)端硬件的需求。 隨著近年來(lái)計(jì)算機(jī)三維處理能力的增長(zhǎng)和低成本傳感顯示元件的出現(xiàn)，虛擬現(xiàn)實(shí)得到了快速發(fā)展，特別是與現(xiàn)實(shí)世界產(chǎn)生了越來(lái)越多的結(jié)合技術(shù)，從虛擬和現(xiàn)實(shí)的兩個(gè)角度對(duì)虛擬現(xiàn)實(shí)進(jìn)行增強(qiáng)。論文重點(diǎn)圍繞近幾年的發(fā)展趨勢(shì)，論述了增強(qiáng)現(xiàn)實(shí)與增強(qiáng)虛擬環(huán)境的技術(shù)特點(diǎn)，介紹了虛擬現(xiàn)實(shí)增強(qiáng)技術(shù)的相關(guān)硬件設(shè)備發(fā)展；然后分別介紹了增強(qiáng)現(xiàn)實(shí)和增強(qiáng)虛擬環(huán)境技術(shù)的發(fā)展現(xiàn)狀，討論了移動(dòng)互聯(lián)網(wǎng)上的虛實(shí)增強(qiáng)技術(shù)與應(yīng)用，并結(jié)合作者參與ISO/IEC的工作，介紹了相關(guān)國(guó)際標(biāo)準(zhǔn)制定最新情況；最后進(jìn)行總結(jié)并提出需要解決的問(wèn)題。 將腦-機(jī)接口（brain-computer interface，BCI）技術(shù)與虛擬現(xiàn)實(shí)（virtual reality，VR）相結(jié)合構(gòu)成基于虛擬現(xiàn)實(shí)的腦-機(jī)接口（BCI-VR）新技術(shù)是最近在多媒體和娛樂(lè)領(lǐng)域出現(xiàn)的一種BCI應(yīng)用新模式。BCI-VR兼取兩者優(yōu)勢(shì)互補(bǔ)，同時(shí)又相互促進(jìn)創(chuàng)新，顯示出廣闊應(yīng)用前景。本文從BCI-VR系統(tǒng)基本構(gòu)成、BCI對(duì)VR控制和VR對(duì)BCI影響等方面，較詳細(xì)介紹了近年來(lái)BCI-VR的主要研究方法、研究進(jìn)展和成就，并根據(jù)作者體會(huì)小結(jié)了目前存在的難點(diǎn)與未來(lái)的可能發(fā)展動(dòng)向，以與讀者交流、共同促進(jìn)BCI-VR新技術(shù)的快速發(fā)展。 通過(guò)運(yùn)用虛擬現(xiàn)實(shí)技術(shù)仿真機(jī)器人的動(dòng)作，可以在機(jī)器人制造之前就能夠清晰的設(shè)計(jì)機(jī)器人的工作任務(wù)和工作空間。首先介紹了利用三維繪圖軟件生成運(yùn)動(dòng)可控的機(jī)械臂虛擬現(xiàn)實(shí)模型的方法，然后介紹了利用Matlab中的虛擬現(xiàn)實(shí)工具箱技術(shù)，在Simulink環(huán)境下搭建出一個(gè)三自由度機(jī)械臂的虛擬現(xiàn)實(shí)仿真模型。這種仿真方法不僅改變了傳統(tǒng)仿真只由數(shù)據(jù)和坐標(biāo)來(lái)反映模型運(yùn)動(dòng)軌跡的不足，而且增加了視景節(jié)點(diǎn)，使觀察者可以在仿真的過(guò)程中從各個(gè)視點(diǎn)來(lái)觀察模型的運(yùn)動(dòng)軌跡，從而可以更加直觀、生動(dòng)的對(duì)模型進(jìn)行描述。 在當(dāng)前的人機(jī)交互領(lǐng)域，移動(dòng)平臺(tái)上增強(qiáng)現(xiàn)實(shí)技術(shù)的應(yīng)用越來(lái)越廣泛。然而由于對(duì)認(rèn)知心理學(xué)在增強(qiáng)現(xiàn)實(shí)領(lǐng)域重要作用的忽視和互動(dòng)信息展示形式的匱乏，導(dǎo)致此類(lèi)軟件的用戶(hù)體驗(yàn)欠佳。該文提出了一套基于心智模型的虛擬現(xiàn)實(shí)與增強(qiáng)現(xiàn)實(shí)混合式移動(dòng)導(dǎo)覽系統(tǒng)。在遵循以用戶(hù)為中心的設(shè)計(jì)原則下，結(jié)合微觀和宏觀心智模型理論分析用戶(hù)的需求，通過(guò)反復(fù)的可用性測(cè)試對(duì)交互界面進(jìn)行迭代設(shè)計(jì)，使得系統(tǒng)界面的交互體驗(yàn)不斷趨近用戶(hù)的心理預(yù)期。此外，通過(guò)虛擬現(xiàn)實(shí)和增強(qiáng)現(xiàn)實(shí)兩個(gè)空間的自由切換，用戶(hù)可以獲得兩種截然不同的互動(dòng)體驗(yàn)。這種新穎的交互模式豐富了互動(dòng)內(nèi)容的展現(xiàn)方式。實(shí)驗(yàn)結(jié)果表明，基于該交互模式的移動(dòng)導(dǎo)覽系統(tǒng)調(diào)動(dòng)了用戶(hù)主動(dòng)進(jìn)行交互的積極性，提高了人機(jī)交互的易用性和時(shí)效性。 在科技高速發(fā)展的今天,各種計(jì)算機(jī)技術(shù)滲透到建筑和城市規(guī)劃領(lǐng)域，虛擬現(xiàn)實(shí)技術(shù)作為21世紀(jì)十大高新技術(shù)之一，引起了建筑設(shè)計(jì)和城市規(guī)劃從業(yè)者的廣泛關(guān)注。本文利用虛擬現(xiàn)實(shí)平臺(tái)Quest3D，以上海長(zhǎng)風(fēng)商務(wù)區(qū)云嶺東路地下空間為研究對(duì)象，實(shí)現(xiàn)了地下綜合體的虛擬現(xiàn)實(shí)交互技術(shù)，以期促進(jìn)計(jì)算機(jī)虛擬現(xiàn)實(shí)技術(shù)在地下空間規(guī)劃設(shè)計(jì)中的廣泛應(yīng)用。 結(jié)合多智能體和虛擬現(xiàn)實(shí)技術(shù)，建立了井下安全事故仿真虛擬環(huán)境模型，通過(guò)構(gòu)建典型事故致災(zāi)智能體的行為規(guī)則與通信機(jī)制，仿真井下事故中人—機(jī)—環(huán)境致災(zāi)因素間的復(fù)雜交互特性。構(gòu)建了虛擬礦工智能體模型，將反映井下礦工生理心理特征的內(nèi)部屬性與其行為選擇機(jī)制結(jié)合，實(shí)現(xiàn)了井下事故中人的行為仿真。通過(guò)井下典型掘進(jìn)跑車(chē)事故的虛擬現(xiàn)實(shí)仿真實(shí)驗(yàn)，實(shí)現(xiàn)了井下安全事故致災(zāi)因素的交互式分析，為煤礦井下安全事故仿真提供了具體方法。

關(guān)鍵詞：下肢康復(fù)訓(xùn)練系統(tǒng)；視覺(jué)交互；虛擬現(xiàn)實(shí) 頭戴式虛擬現(xiàn)實(shí)眼鏡；桶形變換；視頻水印 網(wǎng)絡(luò)安全；網(wǎng)絡(luò)滲透攻擊；仿真訓(xùn)練系統(tǒng) 三維互聯(lián)網(wǎng)；路網(wǎng)；連續(xù)可視范圍查詢(xún)；可視關(guān)系表 增強(qiáng)虛擬環(huán)境；增強(qiáng)現(xiàn)實(shí)；虛實(shí)增強(qiáng)；混合現(xiàn)實(shí) 腦-機(jī)接口；虛擬現(xiàn)實(shí)環(huán)境；視覺(jué)刺激；反饋；想象動(dòng)作；穩(wěn)態(tài)視覺(jué)誘發(fā)電位；事件相關(guān)電位 機(jī)械臂；虛擬現(xiàn)實(shí)；仿真控制；Simulink 虛擬現(xiàn)實(shí)；增強(qiáng)現(xiàn)實(shí)；心智模型；用戶(hù)體驗(yàn)設(shè)計(jì)；移動(dòng)互聯(lián)網(wǎng) 虛擬現(xiàn)實(shí)技術(shù)；Quest3D；地下空間綜合體 虛擬現(xiàn)實(shí)；增強(qiáng)現(xiàn)實(shí)；心智模型；用戶(hù)體驗(yàn)設(shè)計(jì)；移動(dòng)互聯(lián)網(wǎng)

用于頭戴式虛擬現(xiàn)實(shí)眼鏡的視頻水印

田華偉，肖延輝，馮文剛，等

來(lái)源出版物：科學(xué)技術(shù)與工程, 2016, 16(5): 193-220

聯(lián)系郵箱：田華偉，hwtian@ live.cn

基于虛擬現(xiàn)實(shí)技術(shù)的網(wǎng)絡(luò)滲透仿真訓(xùn)練系統(tǒng)設(shè)計(jì)

滕翠，梁川

來(lái)源出版物：自動(dòng)化與儀器儀表, 2016(2): 197-200

基于路網(wǎng)的三維虛擬現(xiàn)實(shí)場(chǎng)景間接可視查詢(xún)框架

孔徳瀚，劉永山

來(lái)源出版物：計(jì)算機(jī)學(xué)報(bào), 2016, 39(12): 1-16

聯(lián)系郵箱：劉永山，ysulys@ysu.edu.cn

虛擬現(xiàn)實(shí)增強(qiáng)技術(shù)綜述

周忠，周頤，肖江劍

來(lái)源出版物：中國(guó)科學(xué)信息科學(xué)（中文版）, 2015, 45(2): 157-180

聯(lián)系郵箱：周忠，zz@vrlab.buaa.edu.cn

基于虛擬現(xiàn)實(shí)環(huán)境的腦機(jī)接口技術(shù)研究進(jìn)展

孔麗文，薛召軍，陳龍，等

來(lái)源出版物：電子測(cè)量與儀器學(xué)報(bào), 2015, 29(3): 317-327

聯(lián)系郵箱：孔麗文，837172057@163.com

多自由度機(jī)械臂的虛擬現(xiàn)實(shí)仿真實(shí)現(xiàn)

張蓬，王曉沖，陳建義

來(lái)源出版物：機(jī)械設(shè)計(jì)與制造, 2015 (1): 128-130

基于心智模型的虛擬現(xiàn)實(shí)與增強(qiáng)現(xiàn)實(shí)混合式移動(dòng)導(dǎo)覽系統(tǒng)的用戶(hù)體驗(yàn)設(shè)計(jì)

林一，陳靖，劉越，等

來(lái)源出版物：計(jì)算機(jī)學(xué)報(bào), 2015, 38(2): 408-422

聯(lián)系郵箱：林一，inyi_bit@163.com

基于Quest3D平臺(tái)的地下綜合體虛擬現(xiàn)實(shí)技術(shù)

彭芳樂(lè)，宋尚，王印鵬，等

來(lái)源出版物：地下空間與工程學(xué)報(bào), 2014, 10(1): 1506-1513

聯(lián)系郵箱：彭芳樂(lè)，pengfangle@ #edu.cn

基于多智能體的井下安全事故虛擬現(xiàn)實(shí)仿真

蔡林沁，張優(yōu)東，楊卓，等

來(lái)源出版物：系統(tǒng)仿真學(xué)報(bào), 2014, 26(12): 2914-2920

來(lái)源出版物：Science and Engineering Ethics, 2016, 22(1): 1-29

聯(lián)系郵箱：O’Brolchain, F; Fiachra.obrolchain@dcu.ie

Impaired spatial selectivity and intact phase precession in two-dimensional virtual reality

Aghajan, ZM; Acharya, L; Moore, JJ; et al.

來(lái)源出版物：Nature Neuroscience, 2015, 18(1): 121-128

聯(lián)系郵箱：Mehta, MR; mayankmehta@ucla.edu

Fundamental arthroscopic skill differentiation with virtual reality simulation

Rose, K; Pedowitz, R

來(lái)源出版物：The Journal of Arthroscopic & Related Surgery, 2015, 31(2): 299-305

聯(lián)系郵箱：Rose, K; karose@mednet.ucla.edu

A randomized, double-blind evaluation of dcycloserine or alprazolam combined with virtual reality exposure therapy for posttraumatic stress disorder in Iraq and Afghanistan war veterans

Rothbaum, BO; Price, M; Jovanovic, T; et al.

來(lái)源出版物：Journal of Geophysical Research-Planets, 2014, 119(6): 1110-1133

Individualized deliberate practice on a virtual reality simulator improves technical performance of surgical novices in the operating room a randomized controlled trial

Palter, VN; Grantcharov, TP

來(lái)源出版物：Annals of Surgery, 2014, 259(3): 443-448

聯(lián)系郵箱：Palter, VN; vanessa.palter@utoronto.ca

Embodied social interaction constitutes social cognition in pairs of humans: A minimalist virtual reality experiment

Froese, T; Iizuka, H; Ikegami, T

來(lái)源出版物：Scientific Reports, 2014, 4: 3672

聯(lián)系郵箱：Froese, T; t.froese@gmail.com

Assessing performance in brain tumor resection using a novel virtual reality simulator

Gelinas-Phaneuf, N; Choudhury, N; Al-Habib, AR; et al.

來(lái)源出版物：International Journal of Computer Assisted Radiology and Surgery, 2014, 9(1): 1-9

聯(lián)系郵箱：Gelinas-Phaneuf, N; nicholas.g.phaneuf@ gmail.com.

Using virtual-reality simulation to assess performance in endobronchial ultrasound

Konge, L; Annema, J; Clementsen, P; et al.

來(lái)源出版物：Respiration, 2013, 86(1): 59-65

聯(lián)系郵箱：Konge, L; lkonge@yahoo.dk

Prospective, randomized assessment of transfer of training (ToT) and transfer effectiveness ratio (TER) of virtual reality simulation training for laparoscopic skill acquisition

Gallagher, AG; Seymour, NE; Jordan-Black, JA; et al.

來(lái)源出版物：Annals of Surgery, 2013, 257(6): 1025-1031

聯(lián)系郵箱：Gallagher, AG; anthonyg.gallagher@ btinternet.com

編輯：王微

來(lái)源出版物：西安交通大學(xué)學(xué)報(bào), 2016, 50(2): 124-131

來(lái)源出版物：Methods of Information in Medicine, 2016, 55(1): 89-92

聯(lián)系郵箱：Luque-Moreno, C; carloslm@us.es

Virtual reality to assess and treat lower extremity disorders in post-stroke patients

Luque-Moreno, C; Oliva-Pascual-Vaca, A; Kiper, P; et al.

Abstract:Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Methodologies, Models and Algorithms for Patients Rehabilitation”. Objectives: To identify support of a virtual reality system in the kinematic assessment and physiotherapy approach to gait disorders in individuals with stroke. Methods: We adapt Virtual Reality Rehabilitation System (VRRS), software widely used in the functional recovery of the upper limb, for its use on the lower limb of hemiplegic patients. Clinical scales have been used to relate them with the kinematic assessment provided by the system. A description of the use of reinforced feedback provided by the system on the recovery of deficits in several real cases in the field of physiotherapy is performed. Specific examples of functional tasks have been detailed, to be considered in creating intelligent health technologies to improve post-stroke gait. Results: Both participants improved scores on the clinical scales, the kinematic parameters in leg stance on plegic lower extremity and walking speed > Minimally Clinically Important Difference (MCID). Conclusion: The use of the VRRS software attached to a motion tracking capture system showed their practical utility and safety in enriching physiotherapeutic assessment and treatment in post-stroke gait disorders. The rapid evolution of information, communication and entertainment technologies will transform the lives of citizens and ultimately transform society. This paper focuses on ethical issues associated with the likely convergence of virtual realities (VR) and social networks (SNs), hereafter VRSNs. We examine a scenario in which a significant segment of the world's population has a presence in a VRSN. Given the pace of technological development and the popularity of these new forms of social interaction, this scenario is plausible. However, it brings with it ethical problems. Two central ethical issues are addressed: those of privacy and those of autonomy. VRSNs pose threats to both privacy and autonomy. The threats to privacy can be broadly categorized as threats to informational privacy, threats to physical privacy, and threats to associational privacy. Each of these threats is further subdivided. The threats to autonomy can be broadly categorized as threats to freedom, to knowledge and to authenticity. Again, these three threats are divided into subcategories. Having categorized the main threats posed by VRSNs, a number of recommendations are provided so that policy-makers, developers, and users can make the best possible use of VRSNs. During real-world (RW) exploration, rodent hippocampal activity shows robust spatial selectivity, which is hypothesized to be governed largely by distal visual cues, although other sensory-motor cues also contribute. Indeed, hippocampal spatial selectivity is weak in primate and human studies that use only visual cues. To determine the contribution of distal visual cues only, we measured hippocampal activity from body-fixed rodents exploring a two-dimensional virtual reality (VR). Compared to that in RW, spatial selectivity was markedly reduced during random foraging and goal-directed tasks in VR. Instead we found small but significant selectivity to distance traveled. Despite impaired spatial selectivity in VR, most spikes occurred within similar to 2-s-long hippocampal motifs inbook=33,ebook=37both RW and VR that had similar structure, including phase precession within motif fields. Selectivity to space and distance traveled were greatly enhanced in VR tasks with stereotypical trajectories. Thus, distal visual cues alone are insufficient to generate a robust hippocampal rate code for space but are sufficient for a temporal code. Purpose: The purpose of this study was to investigate the use and validity of virtual reality modules as part of the educational approach to mastering arthroscopy in a safe environment by assessing the ability to distinguish between experience levels. Additionally, the study aimed to evaluate whether experts have greater ambidexterity than do novices. Methods: Three virtual reality modules (Swemac/Augmented Reality Systems, Linkoping, Sweden) were created to test fundamental arthroscopic skills. Thirty participants-10 experts consisting of faculty, 10 intermediate participants consisting of orthopaedic residents, and 10 novices consisting of medical students-performed each exercise. Steady and Telescope was designed to train centering and image stability. Steady and Probe was designed to train basic triangulation. Track and Moving Target was designed to train coordinated motions of arthroscope and probe. Metrics reflecting speed, accuracy, and efficiency of motion were used to measure construct validity. Results: Steady and Probe and Track a Moving Target both exhibited construct validity, with better performance by experts and intermediate participants than by novices (P<0.05), whereas Steady and Telescope did not show validity. There was an overall trend toward better ambidexterity as a function of greater surgical experience, with experts consistently more proficient than novices throughout all 3 modules. Conclusions: This study represents a new way to assess basic arthroscopy skills using virtual reality modules developed through task deconstruction. Participants with the most arthroscopic experience performed better and were more consistent than novices on all 3 virtual reality modules. Greater arthroscopic experience correlates with more symmetry of ambidextrous performance. However, further adjustment of the modules may better simulate fundamental arthroscopic skills and discriminate between experience levels. Clinical Relevance: Arthroscopy training is a critical element of orthopaedic surgery resident training. Developing techniques to safely and effectively train these skills is critical for patient safety and resident education. Objective: The authors examined the effectiveness of virtual. reality exposure augmented with D-cycloserine or alprazolam, compared with placebo, in reducing posttraumatic stress disorder (PTSD) due to military trauma. Method: After an introductory session, five sessions of virtual reality exposure were augmented with D-cycloserine (50 mg) or alprazolam (0.25 mg) in a double-blind, placebo-controlled randomized clinical trial for 156 Iraq and Afghanistan war veterans with PTSD. Results: PTSD symptoms significantly improved from pre-to posttreatment across all conditions and were maintained at 3, 6, and 12 months. There were no overall differences in symptoms between D-cycloserine and placebo at any time. Alprazolam and placebo differed significantly on the Clinician-Administered PTSD Scale score at posttreatment and PTSD diagnosis at 3 months posttreatment; the alprazolam group showed a higher rate of PTSD (82.8%) than the placebo group (47.8%). Betweensession extinction learning was a treatment-specific enhancer of outcome for the D-cycloserine group only. At posttreatment the D-cycloserine group had the lowest cortisol reactivity and smallest startle response during virtual reality scenes. Conclusions: A six-session virtual reality treatment was associated with reduction in PTSD diagnoses and symptoms in Iraq and Afghanistan veterans, although there was no control condition for the virtual reality exposure. There was no advantage of D-cycloserine for PTSD symptoms in primary analyses. In secondary analyses, alprazolam impaired recovery and D-cycloserine enhanced virtual reality outcome in patients who demonstrated within-session learning. D-Cycloserine augmentation reduced cortisol and startle reactivity more than did alprazolam or placebo, findings that are consistent with those in the animal literature. Objective: The purpose of this study was to investigate whether individualized deliberate practice on a virtual reality (VR) simulator results in improved technical performance in the operating room. Background: Training on VR simulators has been shown to improve technical performance in the operating room (OR). Currently described VR curricula consist of trainees practicing the same tasks until expert proficiency is reached. It has yet to be investigated whether the individualized deliberate practice, where curricula tasks vary depending on prior levels of technical proficiency, would translate into the OR. Methods: This single-blinded prospective trial randomized 16 novice surgical residents to a deliberate practice (DP) group and a conventional residency training group. Both groups performed a laparoscopic cholecystectomy in the OR that was video-recorded. Technical performance of DP group residents in the OR was assessed using 3 validated assessment tools. A score of less than 60% on any component of the assessment tool resulted in the trainee practicing a specific task on the VR simulator. The DP group practiced on the simulator as per their individualized schedule. Both groups then performed another laparoscopic cholecystectomy. A blinded expert assessed the OR recordings using a validated global rating scale. Results: Although both groups had similar technical abilities preintervention [DP: median score, 13.5 (9.3-15.0); control: median score, 14.5 (9.3-17.8); P=0.45], the DP residents had a superior technical performance postintervention [DP: median score, 17.0 (15.3-18.5); control: median score, 12.5 (7.5-14.0); P=0.03]. Of 8 DP residents, 6 practiced 5 basic VR tasks (median 1 trial to pass), and 7 of 8 practiced 2 advanced tasks (median 4 trials to pass). Conclusions: A curriculum of deliberate individualized practice on a VR simulator improves technical performance in the OR. This has implications to greatly improve the feasibility of implementing simulation-based curricula in residency training programs, rather then having them being limited to research protocols. Scientists have traditionally limited the mechanisms of social cognition to one brain, but recent approaches claim that interaction also realizes cognitive work. Experiments under constrained virtual settings revealed that interaction dynamics implicitly guide social cognition. Here we show that embodied social interaction can be constitutive of agency detection and of experiencing another’s presence. Pairs of participants moved their “avatars” along an invisible virtual line and could make haptic contact with three identical objects, two of which embodied the other’s motions, but only one, the other’s avatar, also embodied the other’s contact sensor and thereby enabled responsive interaction. Co-regulated interactions were significantly correlated with identifications of the other's avatar and reports of the clearest awareness of the other's presence. These results challenge folk psychological notions about the boundaries of mind, but make sense from evolutionary and developmental perspectives: an extendible mind can offload cognitive work into its environment. NeuroTouch is a virtual reality (VR) simulator developed for neurosurgical skill training. Validation demonstrating that the system is useful and reliable is required for formal adoption into training curriculums. Face and content validity have been demonstrated for some neurosurgical simulators, but construct validity remains difficult to establish. A pilot validation study was conducted for a NeuroTouch training exercise. Participants completed the internal resection of a simulated convexity meningioma and filled out questionnaires to provide feedback on the experience. Performance metrics included volume of tissues removed, tool path lengths, duration of excessive forces applied and efficient use of the aspirator. Results were analyzed according to participants’ level of training, gender, handedness, surgical experience in meningioma removal and hours/week playing musical instruments or video games. Seventy-two participants (10 medical students, 18 junior residents and 44 senior residents) were enrolled. Analyses demonstrated statistically significant increase in tumor removed and efficiency of ultrasonicbook=35,ebook=39aspirator use between medical students and residents, but not between junior and senior residents. After covariate adjustment for the number of meningioma cases operated on, multivariate analysis of the level of training became nonsignificant. Participants judged the exercise appropriate and realistic, desiring use of the system in current training programs. We have conducted a pilot validation study for the NeuroTouch tumor resection scenario and demonstrated for the first time, face, content and construct validity of a VR neurosurgical simulation exercise. Future full-scale studies will be conducted in noncompetitive settings and incorporate expert participants. Background: For optimal treatment of patients with non-small cell lung carcinoma, it is essential to have physicians with competence in endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA). EBUS training and certification requirements are under discussion and the establishment of basic competence should be based on an objective assessment of performance. Objectives: The aims of this study were to design an evidence- based and credible EBUS certification based on a virtual-reality (VR) EBUS simulator test. Methods: Twentytwo respiratory physicians were divided into 3 groups: experienced EBUS operators (group 1, n=6), untrained novices (group 2, n=8) and simulator-trained novices (group 3, n=8). Each physician performed two standardized simulated EBUS-TBNA procedures. Simulator metrics with discriminatory ability were identified and reliability was explored. Finally, the contrasting-groups method was used to establish a pass/fail standard, and the consequences of this standard were explored. Results: Successfully sampled lymph nodes and procedure time were the only simulator metrics that showed statistically significant differences of P=0.047 and P=0.002, respectively. The resulting quality score (QS, i.e. sampled lymph nodes per minute) showed an acceptable reliability and a generalizability coefficient of 0.67. Reliability of 0.8 could be obtained by testing in 4 procedures. Median QS was 0.24 (range 0.21-0.26) and 0.098 (range 0.04-0.21) for groups 1 and 2, respectively (P=0.001). The resulting pass/fail standard was 0.19. Group 3 had a median posttraining QS of 0.11 (range 0-0.17). None of them met the pass/fail standard. Conclusions: With careful design of standardized tests, a credible standard setting and appropriate transfer studies, VR simulators could be an important first line in credentialing before proceeding to supervised performance on patients. Objectives: We assessed the effectiveness of ToT from VR laparoscopic simulation training in 2 studies. In a second study, we also assessed the TER. ToT is a detectable performance improvement between equivalent groups, and TER is the observed percentage performance differences between 2 matched groups carrying out the same task but with 1 group pretrained on VR simulation. Concordance between simulated and in-vivo procedure performance was also assessed. Design: Prospective, randomized, and blinded. Participants: In Study 1, experienced laparoscopic surgeons (n=195) and in Study 2 laparoscopic novices (n=30) were randomized to either train on VR simulation before completing an equivalent real-world task or complete the real-world task only. Results: Experienced laparoscopic surgeons and novices who trained on the simulator performed significantly better than their controls, thus demonstrating ToT. Their performance showed a TER between 7% and 42% from the virtual to the real tasks. Simulation training impacted most on procedural error reduction in both studies (32%-42%). The correlation observed between the VR and real-world task performance was r > 0.96 (Study 2). Conclusions: VR simulation training offers a powerful and effective platform for training safer skills.

The convergence of virtual reality and social networks: Threats to privacy and autonomy

O’Brolchain, F; Jacquemard, T; Monaghan D; et al.

Keywords:social networks; virtual reality; ethics; privacy; autonomy; freedom simulation; surgical education; technical skills; virtual reality neurotouch; virtual reality simulation; haptic feedback; brain tumor resection; neurosurgical oncology; performance metrics endobronchial ultrasound; transbronchial needle aspiration; virtual-reality simulator operating room (OR); simulation; transfer of training (ToT); transfer effectiveness ratio (TER); virtual reality (VR)