简易脑立体定向装置的研制及临床应用

【目的】自行研制简易脑立体定向装置并应用于临床。【方法】采用自制简易颅内三维定位仪及颅内穿刺定向仪,于操作前先计算CT,MR 病灶在自制三维定位仪的位置,然后标记在头皮上对应的部位,算出穿刺病灶中心的深度及病灶在颅内三维方向的具体轮廓及其方位,再作颅内病灶的穿刺或开颅手术皮瓣设计。【结果】①模拟病灶(10 m m ×10 m m ×10 m m) 定位精度平均误差X 轴1 .2 m m ;Y 轴1 .3m m ;Z轴1 .2 m m ;②经模拟试验后应用于神经外科临床共217 例,其中颅内穿刺93 例,指导开颅手术皮瓣设计124 例。颅内穿刺病灶一次命中率100 % 。开颅手术皮瓣设计切口与病灶部位无一偏移。【结论】该立体定向装置定位准确,能满足幕上立体定向手术需要,能有效保护脑功能,符合微侵袭手术原则。其结构简单,使用方便,造价低廉,适用于各级医院尤其在基层医院,具有推广价值     

Using video-capture virtual reality for children with acquired brain injury

Objective.?To assess the use of a video-capture projected VR system for children with acquired brain injury (ABI), and to compare their performance to that of matched healthy controls.

Subjects.?Thirty-three children (age range: 6–11.4 years) were divided into two groups: 17 children with ABI and 16 controls matched for age, gender and maternal education.

Methods.?Participants experienced three video-captured virtual environments and completed the SFQ child at the end of each specific environment. Participants with ABI experienced three virtual reality (VR) sessions over a period of 10 days. Attention was evaluated using the TEA-Ch. Upper extremity motor abilities were evaluated with the Melbourne Assessment, and self-care abilities were evaluated with the PEDI.

Results.?The video-capture projected system differentiated between the performance of children with ABI and control participants. There was a correlation between VR performance and some attention factors and self-care abilities. No significant correlations were found between performance in the Melbourne assessment and performance within VR.

Conclusions.?The results highlight the potential of the video-capture virtual reality as a tool in the rehabilitation process of children with ABI.     

The Morel stereotactic atlas of the human thalamus: atlas-to-MR registration of internally consistent canonical model

In 1997, Morel, Magnin, and Jeanmonod presented a microscopic stereotactic atlas of the human thalamus. Parcellations of thalamic nuclei did not only use cyto- and myeloarchitectonic criteria, but were additionally corroborated by staining for calcium-binding proteins, which bears functional significance. The atlas complies with the Anglosaxon nomenclature elaborated by Jones and the data were sampled in three orthogonal planes in the AC-PC reference space. We report on the generation of three-dimensional digital models of the thalamus based on the three sets of sections (sagittal, horizontal, and frontal). Spatial differences between the three anatomical specimens were evaluated using the centers of gravity of 13 selected nuclei as landmarks. Subsequent linear regression analysis yielded equations, which were used to normalize the frontal and horizontal digital models to the sagittal one. The outcome is an internally consistent Canonical Model of Morel's atlas, which minimizes the linear component of the variability between the three sectioned anatomical specimens. In addition, we demonstrate the feasibility of the atlas-to-MRI registration in conjunction with on-line visualization of the trajectory in the digital models.     

The effect of virtual reality training on the daily participation of patients: A meta-analysis

BackgroundVirtual reality (VR) training are regarded as promising new tools for rehabilitation, but the effect on patients' daily participation is controversial. This study aimed to evaluate the effect of virtual reality (VR) training on different types of patients' daily participation through a meta-analysis.MethodsThe PubMed, Cochrane central register of controlled trials, Embase, and web science databases were searched for studies published through September 2020. Thirty-five randomized controlled trials of virtual reality (VR) training compared with conventional treatment, Other electronic rehabilitation systems, usual care for various types of patients were included. All of the studies were available in English. Standardized mean differences (SMD), 95 % confidence intervals (CI), publication bias, and heterogeneity were calculated.ResultsThe Virtual reality (VR) training group is better than the control group in daily participation improvement on all types of patients. There was a small, significant effect(p＜0.001; SMD = 0.25[95 %CI,0.14 to 0.36], I² = 0.00 %). Observing only the type of Stroke, the VR training group is still better than the control group in improving patients' daily participation (p＜0.001, SMD = 0.24[95 %CI, 0.11 to 0.37], I2 = 0.00 %). Using the cumulative Meta-analysis method to observe the included literature according to the timeline, Using the cumulative Meta-analysis method to observe the included literature according to the timeline, and it has only achieved positive results since 2015 (Nam-YoNg Lee 2015, p = 0.048, SMD = 0.22[95 %CI,0.00 to 0.44]). The heterogeneity of the studies was not detected, but there is obvious publication bias.ConclusionsBecause of controversy over obvious publication bias, we need to be cautious about the conclusion that VR is better than the control group in promoting the patient's daily participation.     

The treatment of phantom limb pain using immersive virtual reality: three case studies

Purpose. This paper describes the design and implementation of a case study based investigation using immersive virtual reality as a treatment for phantom limb pain.

Method. Three participants who experienced phantom limb pain (two with an upper-limb amputation, and one with a lower-limb amputation) took part in between 2 and 5 immersive virtual reality (IVR) sessions over a 3-week period. The movements of participants' anatomical limbs were transposed into the movements of a virtual limb, presented in the phenomenal space of their phantom limb.

Results. Preliminary qualitative findings are reported here to assess proof of principle for this IVR equipment. All participants reported the transferal of sensations into the muscles and joints of the phantom limb, and all participants reported a decrease in phantom pain during at least one of the sessions.

Conclusion. The authors suggest the need for further research using control trials.     

Bench to Bedside: Brain Edema and Cerebral Resuscitation: The Present and Future

Sudden cardiac arrest (CA) claims approximately 1,200 lives daily in the United States. Cardiopulmonary resuscitation attempts have so far achieved suboptimal results, and even when restoration of spontaneous circulation (ROSC) is achieved, about 30% of survivors suffer permanent brain damage. This illustrates the need for an improved basic scientific understanding of the pathophysiology of global cerebral injury caused by whole-body ischemia/reperfusion (I/R) injury following CA. Brain edema has been recently documented in experimental CA followed by one hour of ROSC. Brain edema has also been documented in CA and stroke patients by computed tomography or magnetic resonance imaging scanning, and has been shown to predict a poor neurologic outcome. The mechanisms underlying brain edema formation elicited by CA are unclear. New scientific findings of the roles of blood-brain barrier (BBB) permeability, matrix metalloproteinases (MMPs) of a family of proteases, aquaporin 4 (AQP4) of a family of membrane water-channel proteins, and the N-methyl-D-aspartate (NMDA) receptors in the mechanisms underlying CA-elicited brain edema were reviewed. By defining the roles of BBB permeability, MMPs, AQP4, and NMDA receptors in CA-induced brain edema formation, effective new therapeutic strategies to extend cellular and tissue survival, and preserve neurologic function following CA may be feasible.     

The treatment of phantom limb pain using immersive virtual reality: Three case studies

Purpose. This paper describes the design and implementation of a case study based investigation using immersive virtual reality as a treatment for phantom limb pain.

Method. Three participants who experienced phantom limb pain (two with an upper-limb amputation, and one with a lower-limb amputation) took part in between 2 and 5 immersive virtual reality (IVR) sessions over a 3-week period. The movements of participants' anatomical limbs were transposed into the movements of a virtual limb, presented in the phenomenal space of their phantom limb.

Results. Preliminary qualitative findings are reported here to assess proof of principle for this IVR equipment. All participants reported the transferal of sensations into the muscles and joints of the phantom limb, and all participants reported a decrease in phantom pain during at least one of the sessions.

Conclusion. The authors suggest the need for further research using control trials.     

Training situational awareness for scrub nurses: Error recognition in a virtual operating room

Virtual reality simulation provides interesting opportunities to train nurses in a safe environment. While the virtual operating room has proven to be a useful training tool for technical skills, it has been less studied for non-technical skills. This study aimed to assess “Error recognition in a virtual operating room”, using a simulation scenario designed to improve situation awareness. Eighteen scrub-nurse students and 8 expert scrub-nurses took part in the experiment. They were immersed in a virtual operating room and reported any errors they observed. There were nineteen errors with various degrees of severity. Measures were retrieved from logs (number of errors, time for detection, movements) and from questionnaires (situation awareness, subjective workload, anxiety and user experience). The results showed that the participants who detected most errors had a higher level of situation awareness, detected high-risk errors faster and felt more immersed in the virtual operating room than those detecting fewer errors. They also felt the workload was lighter and experienced more satisfaction. Students explored the operating room more than experts did and detected more errors, especially those with moderate risk. Debriefings confirmed that virtual simulation is acceptable to trainees and motivates them. It also provides useful and original material for debriefings.     

A review of virtual reality technologies in the field of communication disability: implications for practice and research

Abstract

Background: Technology devices and applications including virtual reality (VR) are increasingly used in healthcare research and practice as tools to promote health and wellbeing. However, there is limited research examining the potential for VR to enable improved communication for people with communication disability.

Aims: To review: (a) current research using VR in speech-language pathology; and (b) the ethical and safety considerations of VR research, to inform an agenda for future research applying VR in the field of speech-language pathology.

Main contribution: This review reveals that there is an emergent body of literature applying VR to improve or develop physical, psychological and communication interventions. Use of non-immersive virtual environments to provide speech-language pathology assessment or intervention for people with communication disability has demonstrated positive outcomes, with emerging evidence of the transfer of functional communication skills from virtual to real-world environments. However, the use of VR technology and immersive virtual environments in communication disability practice and research introduces safety and ethical issues that must be carefully considered.

Conclusions: Research employing VR is in its infancy in the field of speech-language pathology. Early evidence from other healthcare disciplines suggests that VR is an engaging means of delivering immersive and interactive training to build functional skills that can be generalized to the real world. While the introduction of new technology requires careful consideration of research ethics and patient safety, future VR communication research could proceed safely with adequate engagement of interdisciplinary teams and technology specialists.

• Implications for rehabilitation

• Immersive virtual reality may be used in rehabilitation to simulate natural environments to practice and develop communication skills.

• The sense of immersion that can be achieved using virtual reality may promote the generalization of skills learnt during clinical rehabilitation to real-world situations.

• Ethical and safety considerations, including cybersecurity and cybersickness, must be carefully monitored during all virtual reality research.

     

The ScanTrainer obstetrics and gynaecology ultrasound virtual reality training simulator: A cost model to determine the cost viability of replacing clinical training with simulation training

The aim of this study was to produce an economic cost model comparing the use of the Medaphor ScanTrainer virtual reality training simulator for obstetrics and gynaecology ultrasound to achieve basic competence, with the traditional training method. A literature search and survey of expert opinion were used to identify resources used in training. An executable model was produced in Excel. The model showed a cost saving for a clinic using the ScanTrainer of £7114 per annum. The uncertainties of the model were explored and it was found to be robust. Threshold values for the key drivers of the model were identified. Using the ScanTrainer is cost saving for clinics with at least two trainees per year to train, if it would take at least six lists to train them using the traditional training method and if a traditional training list has at least two fewer patients than a standard list.