An Immersive and Interactive Platform for Cognitive Assessment and Rehabilitation (bWell): Design and Iterative Development Process.

BACKGROUND: Immersive technologies like virtual reality can enable clinical care that meaningfully aligns with real-world deficits in cognitive functioning. However, options in immersive 3D environments are limited, partly because of the unique challenges presented by the development of a clinical care platform. These challenges include selecting clinically relevant features, enabling tasks that capture the full breadth of deficits, ensuring longevity in a rapidly changing technology landscape, and performing the extensive technical and clinical validation required for digital interventions. Complicating development, is the need to integrate recommendations from domain experts at all stages. OBJECTIVE: The Cognitive Health Technologies team at the National Research Council Canada aims to overcome these challenges with an iterative process for the development of bWell, a cognitive care platform providing multisensory cognitive tasks for adoption by treatment providers. METHODS: The team harnessed the affordances of immersive technologies while taking an interdisciplinary research and developmental approach, obtaining active input from domain experts with iterative deliveries of the platform. The process made use of technology readiness levels, agile software development, and human-centered design to advance four main activities: identification of basic requirements and key differentiators, prototype design and foundational research to implement components, testing and validation in lab settings, and recruitment of external clinical partners. RESULTS: bWell was implemented according to the findings from the design process. The main features of bWell include multimodal (fully, semi, or nonimmersive) and multiplatform (extended reality, mobile, and PC) implementation, configurable exercises that pair standardized assessment with adaptive and gamified variants for therapy, a therapist-facing user interface for task administration and dosing, and automated activity data logging. bWell has been designed to serve as a broadly applicable toolkit, targeting general aspects of cognition that are commonly impacted across many disorders, rather than focusing on 1 disorder or a specific cognitive domain. It comprises 8 exercises targeting different domains: states of attention (Egg), visual working memory (Theater), relaxation (Tent), inhibition and cognitive control (Mole), multitasking (Lab), self-regulation (Butterfly), sustained attention (Stroll), and visual search (Cloud). The prototype was tested and validated with healthy adults in a laboratory environment. In addition, a cognitive care network (5 sites across Canada and 1 in Japan) was established, enabling access to domain expertise and providing iterative input throughout the development process. CONCLUSIONS: Implementing an interdisciplinary and iterative approach considering technology maturity brought important considerations for the development of bWell. Altogether, this harnesses the affordances of immersive technology and design for a broad range of applications, and for use in both cognitive assessment and rehabilitation. The technology has attained a maturity level of prototype implementation with preliminary validation carried out in laboratory settings, with next steps to perform the validation required for its eventual adoption as a clinical tool.

Composição corporal e autonomia funcional de mulheres idosas após um programa de treinamento resistido / Composición corporal y autonomía funcional de mujeres adultas mayores después de un programa de entrenamiento resistido / Body composition and functional autonomy of older adult women after a resistance training program

Objectives: To assess the effects of a resistance training program for older adult women's functional autonomy and body composition. Method: A total of 13 volunteer women aged 55±5.1 years participated in this study. Functional autonomy and body composition were assessed. The linear training program lasted for three months with 65, 70 and 75% intensity with 10 maximum repetitions. Results: Statistical improvement in fat percentage (∆% = -6.92%, p=0.04) and the WHR index (∆% = -3.44%, p<0.001) was confirmed. In addition, statistical improvement in functional autonomy was observed in the tests: POTOS (∆% = - 36.9%, p<0.001); 10mW (∆% = - 8.9%, p=0.01); RSP (∆% = - 16.7%, p=0.002); RCWH (∆% = - 16.5%, p<0.001); and in the GDLAM index (∆% = - 14.3%, p<0.001). Conclusion: The resistance training showed positive effects on older adult women's functional capacity and body composition.

Objetivo: Avaliar os efeitos de um programa de treinamento resistido sobre a autonomia funcional e composição corporal de mulheres com idade avançada. Método: Um total de 13 mulheres com 55±5,1 anos de idade participaram da pesquisa. Avaliou-se a autonomia funcional e a composição corporal. O treinamento linear durou três meses com intensidade de 65, 70 e 75% com 10 repetições máximas. Resultados: Verificou-se melhora estatística para o percentual de gordura (∆% = -6,92%, p=0,04) e para a RCQ (∆% = -3,44%, p<0,001). Além disso, observaram-se melhoras estatísticas para a autonomia funcional nos testes: VTC (∆% = - 36,9%, p<0,001); C10m (∆% = - 8,9%, p=0,01); LPS (∆% = - 16,7%, p=0,002); LCLC (∆% = - 16,5%, p<0,001); e no Índice GDLAM (∆% = - 14,3%, p<0,001). Conclusão: O treinamento resistido mostrou efeitos positivos para a capacidade funcional e composição corporal das mulheres em idade avançada.

Objetivo: Evaluar los efectos de un programa de entrenamiento resistido sobre la autonomía funcional y la composición corporal de mujeres adultas mayores. Método: Un total de 13 mujeres de 55±5,1 años de edad participaron en el estudio. Se evaluó la autonomía funcional y la composición corporal. El entrenamiento linear tuvo una duración de tres meses con intensidad de 65, 70 y 75% de 10 repeticiones máximas. Resultados: Hubo mejoría estadística en el porcentaje de grasa (Δ% = -6,92%, p = 0,04) y la RCC (Δ% = -3,44%, p <0,001). Además, se observó mejoría estadística de la autonomía funcional en las pruebas: PSC (Δ% = - 36,9%, p <0,001); C10M (Δ% = - 8,9%, p = 0,01); LPS (Δ% = - 16,7%, p = 0,002); LSCC (Δ% = - 16,5%, p <0,001); y en el índice GDLAM (Δ% = - 14,3%, p <0,001). Conclusión: El entrenamiento resistido mostró efectos positivos para la capacidad funcional y la composición corporal de las mujeres adultas mayores.

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

PURPOSE: 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. METHODS: 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. RESULTS: 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 ultrasonic aspirator 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. CONCLUSION: 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.

The development of a virtual simulator for training neurosurgeons to perform and perfect endoscopic endonasal transsphenoidal surgery.

BACKGROUND: A virtual reality (VR) neurosurgical simulator with haptic feedback may provide the best model for training and perfecting surgical techniques for transsphenoidal approaches to the sella turcica and cranial base. Currently there are 2 commercially available simulators: NeuroTouch (Cranio and Endo) developed by the National Research Council of Canada in collaboration with surgeons at teaching hospitals in Canada, and the Immersive Touch. Work in progress on other simulators at additional institutions is currently unpublished. OBJECTIVE: This article describes a newly developed application of the NeuroTouch simulator that facilitates the performance and assessment of technical skills for endoscopic endonasal transsphenoidal surgical procedures as well as plans for collecting metrics during its early use. METHODS: The main components of the NeuroTouch-Endo VR neurosurgical simulator are a stereovision system, bimanual haptic tool manipulators, and high-end computers. The software engine continues to evolve, allowing additional surgical tasks to be performed in the VR environment. Device utility for efficient practice and performance metrics continue to be developed by its originators in collaboration with neurosurgeons at several teaching hospitals in the United States. Training tasks are being developed for teaching 1- and 2-nostril endonasal transsphenoidal approaches. Practice sessions benefit from anatomic labeling of normal structures along the surgical approach and inclusion (for avoidance) of critical structures, such as the internal carotid arteries and optic nerves. CONCLUSION: The simulation software for NeuroTouch-Endo VR simulation of transsphenoidal surgery provides an opportunity for beta testing, validation, and evaluation of performance metrics for use in neurosurgical residency training. ABBREVIATIONS: CTA, cognitive task analysisVR, virtual reality.

Modeling the thermal effect of the bipolar electrocautery for neurosurgery simulation.

Real-time surgical simulation requires computationally-fast models describing the interaction between surgical instrument and tissues. In this study, a model for predicting the temperature distribution in brain tissue when using a bipolar electrocautery is proposed and validated against experimental in vitro animal data. Joule heat generation and heat conduction in the tissue are considered. The agreement between simulated temperature distributions and experimental data could be improved by modeling the output power as a function of electrical resistance between the electrodes, and by considering the heat exchange with surrounding air and bipolar tips.

Assessment of spinal flexibility in adolescent idiopathic scoliosis: suspension versus side-bending radiography.

STUDY DESIGN: Prospective evaluation of a new suspension test to determine curve flexibility in adolescent idiopathic scoliosis (AIS) in comparison with erect side-bending. OBJECTIVE: To verify whether the suspension is a better method than side-bending to estimate curve reducibility and to assess spine flexibility. SUMMARY OF BACKGROUND DATA: Spinal flexibility is a decisive biomechanical parameter for the planning of AIS surgery. Side-bending is often referred as the gold standard, but it has a low reproducibility and there is no agreement amongst surgeons about the most advantageous method to use. Even more, every technique evaluates reducibility instead of flexibility since the forces involved in the change in shape of the spine are not considered. METHODS: Eighteen patients scheduled for AIS surgery were studied. Preoperative radiological evaluation consisted of 4 radiographs: standing posteroanterior, left and right erect side-bending, and suspension. The side-bending and the suspension tests were compared on the basis of the apical vertebrae derotation and the scoliosis curve reduction. Frontal and axial flexibility indices, expressed as the ratio between the moment induced by the body weight and the reduction, were calculated from the suspension data. RESULTS: The average scoliosis curve reduction and apical vertebra derotation were 21 degrees (37%) and 3 degrees (12%), respectively for erect side-bending and 26 degrees (39%) and 7 degrees (28%), respectively for suspension. The erect side-bending test generated a larger curve reduction (P = 0.05) when considering the moderate curves only and the suspension test (P = 0.02) when considering the severe curves. The suspension test produced a larger axial derotation (P = 0.007) when considering all the curves. The average traction force during suspension was 306 N (187 N-377 N). The average estimation for the frontal flexibility index was 1.64 degrees/Nm (0.84-2.82) and 0.51 degrees/Nm (0.01-1.39) for the axial flexibility index. CONCLUSION: Results of this study demonstrate the feasibility to really evaluate the spine flexibility with the suspension test. The estimated flexibility values are realistic and similar to those reported in vitro. Suspension should be used in the future for spine flexibility assessment.