Virtual Reality Tumor Resection: The Force Pyramid Approach

Abstract BACKGROUND The force pyramid is a novel visual representation allowing spatial delineation of instrument force application during surgical procedures. In this study, the force pyramid concept is employed to create and quantify dominant hand, nondominant hand, and bimanual force pyramids during resection of virtual reality brain tumors. OBJECTIVE To address 4 questions: Do ergonomics and handedness influence force pyramid structure? What are the differences between dominant and nondominant force pyramids? What is the spatial distribution of forces applied in specific tumor quadrants? What differentiates “expert” and “novice” groups regarding their force pyramids? METHODS Using a simulated aspirator in the dominant hand and a simulated sucker in the nondominant hand, 6 neurosurgeons and 14 residents resected 8 different tumors using the CAE NeuroVR virtual reality neurosurgical simulation platform (CAE Healthcare, Montréal, Québec and the National Research Council Canada, Boucherville, Québec). Position and force data were used to create force pyramids and quantify tumor quadrant force distribution. RESULTS Force distribution quantification demonstrates the critical role that handedness and ergonomics play on psychomotor performance during simulated brain tumor resections. Neurosurgeons concentrate their dominant hand forces in a defined crescent in the lower right tumor quadrant. Nondominant force pyramids showed a central peak force application in all groups. Bimanual force pyramids outlined the combined impact of each hand. Distinct force pyramid patterns were seen when tumor stiffness, border complexity, and color were altered. CONCLUSION Force pyramids allow delineation of specific tumor regions requiring greater psychomotor ability to resect. This information can focus and improve resident technical skills training.

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Intermanual Differences in Movement-related Interhemispheric Inhibition

Journal of Cognitive Neuroscience ◽

10.1162/jocn.2007.19.2.204 ◽

2007 ◽

Vol 19 (2) ◽

pp. 204-213 ◽

Cited By ~ 151

Author(s):

Julie Duque ◽

Nagako Murase ◽

Pablo Celnik ◽

Friedhelm Hummel ◽

Michelle Harris-Love ◽

...

Keyword(s):

Motor Cortex ◽

Primary Motor Cortex ◽

Critical Role ◽

Hand Movements ◽

Dominant Hand ◽

Interhemispheric Inhibition ◽

Movement Onset ◽

Nondominant Hand ◽

Long Time ◽

The Right

Interhemispheric inhibition (IHI) between motor cortical areas is thought to play a critical role in motor control and could influence manual dexterity. The purpose of this study was to investigate IHI preceding movements of the dominant and nondominant hands of healthy volunteers. Movement-related IHI was studied by means of a double-pulse transcranial magnetic stimulation protocol in right-handed individuals in a simple reaction time paradigm. IHI targeting the motor cortex contralateral (IHIc) and ipsilateral (IHIi) to each moving finger was determined. IHIc was comparable after the go signal, a long time preceding movement onset, in both hands. Closer to movement onset, IHIc reversed into facilitation for the right dominant hand but remained inhibitory for left nondominant hand movements. IHIi displayed a nearly constant inhibition with a trough early in the premovement period in both hands. In conclusion, our results unveil a more important modulation of interhemispheric interactions during generation of dominant than nondominant hand movements. This modulation essentially consisted of a shift from a balanced IHI at rest to an IHI predominantly directed toward the ipsilateral primary motor cortex at movement onset. Such a mechanism might release muscles from inhibition in the contralateral primary motor cortex while preventing the occurrence of the mirror activity in ipsilateral primary motor cortex and could therefore contribute to intermanual differences in dexterity.

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The force pyramid: a spatial analysis of force application during virtual reality brain tumor resection

Journal of Neurosurgery ◽

10.3171/2016.7.jns16322 ◽

2017 ◽

Vol 127 (1) ◽

pp. 171-181 ◽

Cited By ~ 11

Author(s):

Hamed Azarnoush ◽

Samaneh Siar ◽

Robin Sawaya ◽

Gmaan Al Zhrani ◽

Alexander Winkler-Schwartz ◽

...

Keyword(s):

Virtual Reality ◽

Medical Student ◽

Spatial Analysis ◽

Medical Students ◽

Brain Tumors ◽

Tumor Resection ◽

Study Groups ◽

Student Groups ◽

Force Application ◽

Tier 3

OBJECTIVEVirtual reality simulators allow development of novel methods to analyze neurosurgical performance. The concept of a force pyramid is introduced as a Tier 3 metric with the ability to provide visual and spatial analysis of 3D force application by any instrument used during simulated tumor resection. This study was designed to answer 3 questions: 1) Do study groups have distinct force pyramids? 2) Do handedness and ergonomics influence force pyramid structure? 3) Are force pyramids dependent on the visual and haptic characteristics of simulated tumors?METHODSUsing a virtual reality simulator, NeuroVR (formerly NeuroTouch), ultrasonic aspirator force application was continually assessed during resection of simulated brain tumors by neurosurgeons, residents, and medical students. The participants performed simulated resections of 18 simulated brain tumors with different visual and haptic characteristics. The raw data, namely, coordinates of the instrument tip as well as contact force values, were collected by the simulator. To provide a visual and qualitative spatial analysis of forces, the authors created a graph, called a force pyramid, representing force sum along the z-coordinate for different xy coordinates of the tool tip.RESULTSSixteen neurosurgeons, 15 residents, and 84 medical students participated in the study. Neurosurgeon, resident and medical student groups displayed easily distinguishable 3D “force pyramid fingerprints.” Neurosurgeons had the lowest force pyramids, indicating application of the lowest forces, followed by resident and medical student groups. Handedness, ergonomics, and visual and haptic tumor characteristics resulted in distinct well-defined 3D force pyramid patterns.CONCLUSIONSForce pyramid fingerprints provide 3D spatial assessment displays of instrument force application during simulated tumor resection. Neurosurgeon force utilization and ergonomic data form a basis for understanding and modulating resident force application and improving patient safety during tumor resection.

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P.103 A spatial analysis of forces applied during virtual reality brain tumor resection: the force pyramid

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.204 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S44-S44

Author(s):

RF Del Maestro ◽

H Azarnoush ◽

S Siar ◽

G Alzhrani ◽

A Winkler-Schwartz ◽

...

Keyword(s):

Virtual Reality ◽

Medical Student ◽

Spatial Analysis ◽

Medical Students ◽

Tumor Resection ◽

Study Groups ◽

Student Groups ◽

3 Dimensional ◽

Force Application ◽

Brain Tumor Resection

Background: Virtual reality simulators allow development of novel methods to analyze neurosurgical performance. Force pyramids provide visual and spatial analysis of 3 dimensional force application by any instrument used during simulated tumor resection. This study was designed to answer three questions: 1) Do study groups have distinct force pyramids? 2) Do handedness and ergonomics influence force pyramid structure? 3) Are force pyramids dependent on visual and haptic characteristics of simulated tumors? Methods: NeuroVR (formerly NeuroTouch), a virtual reality simulator, continually assessed simulated ultrasonic aspirator force application of neurosurgeon, resident and medical student groups during resection of 18 simulated brain tumors with different visual and haptic characteristics. Results: Sixteen neurosurgeons, 15 residents and 84 medical students participated. Neurosurgeon, resident and medical students groups displayed easily distinguishable 3 dimensional ‘force pyramid fingerprints’. Neurosurgeons had the lowest force pyramids, indicating application of the lowest forces, followed by resident and medical student groups. Handedness, ergonomics, visual and haptic tumor characteristics resulted in distinct well-defined 3 dimensional force pyramid patterns. Conclusions: ‘Force pyramid fingerprints’ provide 3 dimensional spatial assessment displays of instrument force application during simulated tumor resections. Neurosurgeon force utilization and ergonomics data form a basis for understanding and modulating resident force application and improving patient safety during tumor resection.

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56. Proficiency at the end of practice predicts retention of a technical clinical skills

Clinical & Investigative Medicine ◽

10.25011/cim.v30i4.2817 ◽

2007 ◽

Vol 30 (4) ◽

pp. 59

Author(s):

H. Carnahan ◽

E. Hagemann ◽

A. Dubrowski

Keyword(s):

Virtual Reality ◽

Clinical Skills ◽

Clinical Skill ◽

Technical Skills ◽

Skills Training ◽

Retention Performance ◽

Specific Criterion ◽

Practice Trials ◽

Practice Time ◽

Criterion Time

A debate is emerging regarding the efficacy of proficiency based versus duration based training of technical skills. It is not clear whether the performance level attained at the end of practice (i.e., proficiency criteria), or the overall amount of practice performed during learning will best predict the retention of a technical clinical skill. The skill learned was the single-handed double square-knot. Forty two trainees learned the skill through video-based instruction and were divided into three groups (14 participants per group) each with a specific criterion time to tie the knot (10, 15, and 20 seconds). Practice continued until participants completed the knot within their criterion time. The total number of trials, and the overall practice time required to obtain each respective criterion were recorded during practice. Participants returned one-week later for a timed retention test consisting of one trial of the knot tying skill with no video instruction. A multiple regression analysis tested whether the amount of practice, the total practice time, or the criterion reached at the end of practice was the best predictor of the time taken to perform the skill during retention. This analysis showed that the number of practice trials was highly correlated with total practice time (r = .82, p = .01), therefore total practice time was withdrawn as a predictor variable from the subsequent analysis. The regression showed that the only significant predictor of retention performance was the criterion reached at the end of practice (p = .03). The number of practice trials was not found to significantly predict the retention performance (p = .87). The results support the notion that proficiency based training results in better retention of a technical clinical skill in comparison to duration based approaches. This provides evidence for the introduction of proficiency based educational approaches in technical skills curricula. Jowett N, LeBlanc V, Xeroulis G, MacRae H, Dubrowski A. Surgical skill acquisition with self-directed practice using computer-based video training. Am J Surg. 2007; 193(2):237-42. Gallagher AG, Ritter EM, Champion H, Higgins G, Fried MP, Moses G, Smith CD, Satava RM. Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg. 2005; 241(2):364-72. Van Sickle KR, Ritter EM, McClusky DA, Lederman A, Baghai M, Gallagher AG, Smith CD. Attempted establishment of proficiency levels for laparoscopic performance on a national scale using simulation: the results from the 2004 SAGES Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) learning center study. Surg Endosc. 2007; 21(1):5-10.

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Virtual reality in social skills training programs for people with schizophrenia: A systematic review and focus group

British Journal of Occupational Therapy ◽

10.1177/03080226211011391 ◽

2021 ◽

pp. 030802262110113

Author(s):

Catarina Oliveira ◽

Raquel Simões de Almeida ◽

António Marques

Keyword(s):

Mental Health ◽

Systematic Review ◽

Virtual Reality ◽

Social Skills ◽

Focus Group ◽

Social Skills Training ◽

Occupational Therapists ◽

Skills Training ◽

Training Programme ◽

Cochrane Library

Introduction This study aims to determine the guidelines for the design of a social skills training programme for people with schizophrenia using virtual reality. Methods This article encompasses two studies: Study 1, a systematic review of five articles indexed in the databases B-on, PubMed, Clinical trials and Cochrane Library (2010–2020); Study 2, a focus group of occupational therapists trained in mental health and multimedia professionals, in which they discussed the outline of such a programme. Results A set of guidelines were identified as central and consensual which should be included in the programme. It must have multilevel logic and gradual learning, with simulations of everyday situations, in which it is possible to practise the skills of conversation and communication. Virtual reality provides people with schizophrenia with unlimited opportunities, enhancing a personalized intervention. Conclusion Social skills training could be part of the treatment for people with schizophrenia, and virtual reality is a promising tool to complement traditional training, although still little implemented in mental health services. Occupational therapists have a prominent role in the development and application of this because of their knowledge of activity analysis and their ability to facilitate the generalization of skills in different contexts.

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Screwdriver torque strength and physiological cost of muscles dependent on hand preference and direction of rotation

Occupational Ergonomics ◽

10.3233/oer-1998-1103 ◽

1998 ◽

Vol 1 (1) ◽

pp. 13-22

Author(s):

Helmut Strasser ◽

Baoquiu Wang

Keyword(s):

Hand Preference ◽

Dominant Hand ◽

Muscle Forces ◽

Maximum Torque ◽

Physiological Cost ◽

Nondominant Hand ◽

Physiological Differences ◽

Torque Values ◽

The Right

The focus of this research was to investigate how maximum torque and muscle forces were affected by pronation and supination, i.e., inward and outward rotation of the forearm in a series of screwdriver tests with 6 varied handles. Consecutively, maximum torque for pronation and supination was determined, submaximum isometric levels of torque were demanded, and, finally, an equal dynamic screwing work for all subjects was simulated. Physiological cost of performance was simultaneously measured by registrations of electromyographic activities (EA) from 4 muscles, which were expected to be involved intensively in screwing tasks. Significant and essential differences between maximum torque values produced by pronation and supination of the right and the left arm of the mainly right-handed subjects were found. For clockwise work, as it is necessary e.g., for driving in screws, inward rotations (pronations) of the nondominant hand are at least as strong as outward rotations of the dominant hand. Differences of about 8% favour of pronations were found. Yet, for counter clockwise work involved e.g., in removing a tightened screw, inward rotations of the dominant hand yielded a much more stronger torque strength than outward rotations of the nondominant hand. Differences of more than 50% right-handed subjects were measured. Also, EA values of the 4 muscles monitored on the right arm differed significantly. Systematically operational and physiological differences due to the varied screwdriver grips, as results of investigations which were not the main objective of the study, corresponded well with the findings of prior studies.

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What are the risks of Virtual Reality data? Learning Analytics, Algorithmic Bias and a Fantasy of Perfect Data

New Media & Society ◽

10.1177/14614448211012794 ◽

2021 ◽

pp. 146144482110127

Author(s):

Marcus Carter ◽

Ben Egliston

Keyword(s):

Virtual Reality ◽

Learning Process ◽

Learning Analytics ◽

Soft Skills ◽

Education Technology ◽

Skills Training ◽

Emerging Technology ◽

Critical Issues ◽

Vr Training ◽

Algorithmic Bias

Virtual reality (VR) is an emerging technology with the potential to extract significantly more data about learners and the learning process. In this article, we present an analysis of how VR education technology companies frame, use and analyse this data. We found both an expansion and acceleration of what data are being collected about learners and how these data are being mobilised in potentially discriminatory and problematic ways. Beyond providing evidence for how VR represents an intensification of the datafication of education, we discuss three interrelated critical issues that are specific to VR: the fantasy that VR data is ‘perfect’, the datafication of soft-skills training, and the commercialisation and commodification of VR data. In the context of the issues identified, we caution the unregulated and uncritical application of learning analytics to the data that are collected from VR training.

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