ObjectiveTo investigate the effects of transcranial direct current stimulation (tDCS) combined with virtual reality (VR) on upper limb dysfunction of stroke patients.MethodsPatients with stroke who were hospitalized in the Department of Rehabilitation Medicine, the Third Affiliated Hospital of Sun Yat-Sen University from July 2018 to January 2020 were selected. The patients were divided into tDCS group, VR group and combined treatment group by random number table method. All three groups received conventional rehabilitation treatment. Based on this, tDCS group received 2.0 mA tDCS treatment, VR group received 20 min VR treatment, and combined treatment group received the same tDCS and VR treatment. Before and 4 weeks after treatment, the Fugl-Meyer assessment-upper limb (FMA-UL), Wolf motor function test (WMFT) and modified barthel index (MBI) were used to evaluate the upper limb motor function and activities of daily life (ADL) of the three groups.ResultsA total of 45 patients were included, 15 in each group. No adverse reactions or fall off occurred during the treatment. Before treatment, there were no significant difference in FMA-UL, WMFT-Times, WMFT functional ability scores (WMFT-FAS), and MBI between the three groups (P>0.05). After 4 weeks of treatment, the FMA-UL, WMFT-Times, WMFT-FAS, and MBI scores of the three groups were significantly improved compared with those before treatment (P<0.05); the MBI score of the combination treatment group was significantly better than the tDCS group and VR group, and the FMA-UL was significantly better than the tDCS group, and the differences were statistically significant (P<0.05). Also, there were no significant differences in the improvement of FMA-UL, WMFT-Times, WMFT-FAS, and MBI scores between the tDCS group and the VR group (P>0.05); the differences of FMA-UL, WMFT-Times, WMFT-FAS, and MBI scores before and after treatment in the combined treatment group, which were significantly better than those in tDCS group and VR group (P<0.05). ConclusiontDCS combined with virtual reality can significantly improve the upper limb motor function and ADL ability of stroke patients, and the effect is superior to tDCS or VR treatment solely.
ObjectiveTo research the value of virtual reality (VR) technology in the preoperative planning of transtrochanteric curved varus osteotomy for avascular necrosis of the femoral head (ANFH) in adults.MethodsBetween June 2018 and November 2018, 7 patients (11 hips) with ANFH, who were treated with transtrochanteric curved varus osteotomy, were enrolled in the study. There were 4 males (7 hips) and 3 females (4 hips) with an average age of 31.9 years (range, 14-46 years). Among them, 3 patients were unilateral ANFH and 4 patients were bilateral ANFH. There was 1 patient (1 hip) of traumatic ANFH, 2 patients (4 hips) of alcohol-induced ANFH, 2 patients (3 hips) of hormonal ANFH, and 2 patients (3 hips) of idiopathic ANFH. All hips were Association Research Circulation Osseous (ARCO) stage Ⅲ. There were 5 hips for Japanese Investigation Committee (JIC) type C1 and 6 hips for type C2. There were 5 hips for China-Japan Friendship Hospital (CJFH) type L1,1 for type L2, and 5 for type L3. The disease duration ranged from 5 to 12 months (mean, 8 months). Preoperative Harris score was 53.91±7.66. The neck-shaft angle ranged from 128 to 143° (mean, 133.9°). VR technology was adopted for the preoperative planning. CT data were imported into the software to construct the morphology of necrotic area, and the transrtrochanteric varus osteotomy was simulated. The varus angle was designed according to the integrity rate of femoral head. The planned varus angle was 6 to 16° (mean, 9.7°). The transtrochanteric curved varus osteotomy was performed according to the preoperative planning, and the varus angle and loading area were confirmed under fluoroscopy. If the planned varus angle was too small, it would continue to increase under the fluoroscopy until a satisfactory varus angle. Postoperative changes of the neck-shaft angle were calculated and compared with the preoperative planned varus angle (error). The hip function was assessed by using the Harris score.ResultsAll incisions healed by first intention. All patients were followed up 6-11 months with an average of 8 months. The X-ray film at 2 days after operation showed that the neck-shaft angle was 112-135° (mean, 123.4°). The difference of the neck-shaft angle between pre- and post-operation was 6-16° (mean, 11.0°). Among them, the difference of the neck-shaft angle was consistent with planned varus angle in 5 hips, while the error of the remaining 6 hips was 1-4°. There was 1 patient (1 hip) of osteotomy nonunion at 4 months after operation, 1 patient (1 hip) of proximal femur fracture at 2 months after operation. The rest 5 patients (9 hips) obtained union at the osteotomy. At last follow-up, the Harris score was 82.18±16.35, showing significant difference when compared with preoperative score (t=–5.195, P=0.000).ConclusionVR technology is a brand-new preoperative planning method for transtrochanteric curved varus osteotomy in treating ANFH.
Post-stroke cognitive dysfunction is a common complication of stroke, and active rehabilitation therapy can effectively promote the recovery of patients. As a new treatment method, telecognitive rehabilitation is used in rehabilitation treatment of cognitive disorders. Its main technologies include computer-assisted cognitive rehabilitation, virtual reality technology, and artificial intelligence technology. It can use the Internet platform to provide homogeneous treatment, make patients more convenient for cognitive rehabilitation treatment, help to ensure the continuity of rehabilitation treatment, and save medical costs. This article describes the definition of cognitive telerehabilitation, the development and application of cognitive telerehabilitation technology, and summarizes the existing problems. The purpose is to provide a reference for the clinical application of cognitive telerehabilitation in China and future research directions.
Joint attention deficit is one of the core disorders in children with autism, which seriously affects the development of multiple basic skills such as language and communication. Virtual reality scene intervention has great potential in improving joint attention skills in children with autism due to its good interactivity and immersion. This article reviewed the application of virtual reality based social and nonsocial scenarios in training joint attention skills for children with autism in recent years, summarized the problems and challenges of this intervention method, and proposed a new joint paradigm for social scenario assessment and nonsocial scenario training. Finally, it looked forward to the future development and application prospects of virtual reality technology in joint attention skill training for children with autism.
Objective To study the application of virtual reality bronchoscopy stimulation in novice trainees. Methods Four novice bronchoscopists entered the training programby using a VR bronchoscopy in the clinical skill center. After the program, the dexterity, speed, and accuracy of all the four doctors were tested using the virtual simulation models. Results were compared to four skilled physicians as control group who had performed at least 50 bronchoscopies. Before-training and after-training test scores were compared using paired t tests. For comparisons between after-training novice and skilled physician scores, unpaired twosample t tests were used. Results All of the four trainees finished the training program. The novices significantly improved their dexterity, speed and accuracy. The percentage of observed segments increased from ( 74. 0 ±5. 1) % to ( 89. 3 ±4. 0) % . The number of contacts with the bronchial wall decreased from 87. 5 ±13. 2 to 30. 5 ±9. 3, and total time spent shortened from ( 700. 8 ±56. 6) s to ( 607. 0 ±17. 8) s. There were no statistically significant differences between novice accuracy ( the percentage of observed segments) after training and skilled physician accuracy [ ( 89. 3 ±4. 0) % vs ( 91. 3 ±3. 0) % , P = 0. 456] . Conclusion Practice using a virtual bronchoscopy simulator help novice trainees to attain a level of skill at performing diagnostic bronchoscopy, and it might play an important role in the training of chest physicians.
Objective To explore the application effect of virtual reality (VR) technology in low vision teaching for optometry students. Methods Undergraduate students majoring in optometry at West China School of Medicine of Sichuan University were selected as the research subjects. The students enrolled in 2020 adopted the traditional lecture-based learning (LBL) teaching mode (LBL teaching group), while the students enrolled in 2021 adopted the VR teaching mode (VR teaching group). Both groups of students studied the content of the same chapter on low vision, completed in-class tests after learning, and completed a questionnaire survey. Results There were 28 students in the VR teaching group and 30 students in the LBL teaching group. There was no statistically significant difference in age or gender composition between the two groups of students (P>0.05). The in-class test scores of students in the VR teaching group were higher than those in the LBL teaching group (86.43±6.10 vs. 78.10±7.69, P<0.05). Except for “subjective discomfort with this teaching mode”, the differences in other evaluation results between the two groups were statistically significant (P<0.05). VR teaching group students generally believed that applying VR technology to low vision teaching helped understand the visual experience and daily life status of low vision patients, improved learning efficiency and hands-on ability, reduced learning burden, and hoped to use this teaching mode routinely in other subject teaching. All students in the VR teaching group believed that this teaching mode was interesting, highly innovative, and enhanced teacher-student interaction.Conclusions Applying VR technology to low vision teaching can enable students to personally experience the impact of various diseases on patients’ visual function and daily life. This teaching method not only optimizes and improves teaching effectiveness, but also has a high acceptance rate among students, which is worth further promoting in future optometry teaching.
Objective To explore the application effect of virtual reality simulation technology (VRST) combined with problem-based learning (PBL) mode in knee arthroscopy teaching in sports medicine department. Methods A total of 76 trainees in sports medicine at Sichuan Provincial Orthopedic Hospital from June 2021 to June 2022 were retrospectively selected. According to the different teaching modes, they were divided into the research group and the control group with 38 trainees in each group. The traditional teaching mode was implemented in the control group, while VRST and PBL mode were implemented in the research group. The objective assessment results and teaching effect feedback of the two groups were compared. Results There was no statistical difference between the two groups in the average theoretical score of the trainees (91.35±1.05 vs. 90.94±1.12, P>0.05). The scores of the three manipulating parts of the research group (9.03±0.24, 9.12±0.31, and 9.24±0.27, respectively) were higher than those of the control group (8.76±0.36, 8.44±0.57, and 8.35±0.51, respectively), moreover, trainees in the research group had higher scores for study enthusiasm, teaching satisfaction, three-dimensional space sense, and virtual reality conversion degree (9.12±0.16, 9.67±0.11, 9.34±0.22, and 9.56±0.18, respectively) than those of the control group (8.89±0.27, 9.16±0.34, 8.67±0.37, and 8.42±0.23, respectively), and the differences were all statistically significant (P<0.05). Conclusion VRST combined with PBL mode could improve trainees’ ability to operate arthroscopy significantly, and stimulate trainees’ subjective learning ability to improve teaching effect.
ObjectiveTo design an interventional cardiology simulation system based on unity 3d virtual reality technology to simulate the multi-sensory feedback in the operation of heart disease. MethodsWe used 3Dmax and Unity3D engine to build a three-dimensional cardiovascular model, and use Falcon Novint and Rift Oculus software and hardware system to build a virtual reality environment to simulate pilot wire intervention surgery. ResultsThe user can use the Falcon Novint force feedback controller to carry out a variety of virtual instrument exercises of percutaneous coronary angioplasty, and also it can restore operation scene through Rift Oculus virtual reality device. ConclusionA simulation system for interventional surgery is designed, which provides the help for the extensive medical training.
ObjectiveTo evaluate the application value of virtual reality (VR) technology in the surgical treatment of coronary artery fistula (CAF) and abnormal origin of coronary artery (AOOCA).MethodsFrom January 2014 to June 2018, with the assistance of virtual reality technology, 4 patients with CAF and 4 patients with AOOCA in the Department of Cardiac Surgery of our hospital underwent treatment method deciding and operation details planning. In the CAF patients, there was 1 male and 3 females and they were 8 years, 16 years, 62 years, and 65 years, respectively. In the AOOCA patients, there was 1 male and 3 females at age of 4-month, 2 years, 14 years, and 29 years, respectively.ResultsThe virtual heart models in all 8 patients were well matched with the real heart. The spatial structure information of CAF/AOOCA and surroundings can be intuitively and fully shown by virtual reality technology in all patients. All of the 4 CAF patients repaired coronary artery incision, including 2 patients with autologous pericardium patch and 2 patients with direct suture. Of the 4 AOOCA patients, 3 underwent coronary directly transplantation but 1 underwent Takeuchi surgery. And 2 had mitral valve plasty at the same time. All the operations were completed successfully, with good recovery and no serious complications. Among the 4 CAF patients, 3 had no residual fistula, and 1 had minor residual fistula. Coronary arteries were all unobstructed in 4 patients of AOOCA; moderate and severe mitral regurgitation in 2 patients were significantly reduced after surgery.ConclusionVR allows doctors to understand the spatial structure information of CAF/AOOCA and surroundings before the operation, and assists them to make accurate treatment decisions and develop detailed surgical plans before the operation, ensuring its safety. Its clinical application value is significant.
Gynecology and obstetrics teaching has strong practicality. Because of the lack of practice on patients who has strong self-protection consciousness and the likely injury due to invasive operation, students and young doctors can’t have many opportunities to make actual clinical operation which limits their abilities of clinical skills. Based on this, the virtual reality medical education in the teaching of obstetrics and gynecology develops fast these days because of its necessity, ethicality, and economical effect, which might be popularized. It plays a very important role in cultivating young doctors’ manipulative ability, training "three basics and three strictness", mastering abstract knowledge, and quantitative assessing effect of clinical teaching.