虚拟现实技术在神经外科医师培训中的应用

目的探讨将虚拟现实技术应用于神经外科医师培训的有效方法与作用。方法运用三维影像工作站训练系统和Dextroscope手术计划系统进行神经外科医师颅内解剖及手术方案设计的培训。结果通过虚拟培训,增进了临床医师对颅内解剖结构的理解,加深了对关键的解剖标志的认识,促进了个性化手术方案的形成。结论虚拟现实技术的应用,对于激发学习兴趣,加强手术基本技能训练,提高培训效率具有重要作用。     

虚拟现实技术在生物医学领域中的应用

背景：虚拟现实也称灵境技术或人工环境,是一种由计算机技术辅助生成的高技术模拟系统,综合集成了计算机图形技术、计算机仿真技术、人工智能、传感技术、显示技术、网络并行处理等技术。 目的：简要介绍虚拟人体、虚拟手术、虚拟实验室以及虚拟现实技术在神经心理学与核医学方面的应用。 方法：由第一作者检索2003/2010 CBM和CNKI数据库中有关文献,以及利用Google搜索引擎检索相关网络信息资源。中文检索词为“虚拟现实、虚拟人、数字人、虚拟手术。”英文检索词为“Virtual Reality,Virtual Human,digital human,virtual surgery。” 结果与结论：虚拟现实技术的应用十分广泛,如：城市规划、能源勘测、工业仿真、古迹复原、建筑虚拟、交通桥梁、港口物流、旅游仿真、虚拟课堂、园林应用、军事仿真等。在生物医学领域,虚拟人、虚拟手术等方面的研究也十分活跃,表现出了很好的效果,并且,虚拟现实技术在生物医学领域的应用也展现出了极好的前景,在核医学与辐射防护领域,虚拟现实系统可用来进行核电站换料任务完成过程中的剂量计算,以及培训在核电站工作的人员,并且虚拟现实暴露疗法对特定恐怖症和其他焦虑障碍有较好的疗效。随着计算机技术的进一步发展,可以预期,在未来几年虚拟现实技术将会成为数字医学最主要的应用工具之一。 关键词：虚拟现实;生物医学;数字人;虚拟手术;医学植入物     

脑穿刺手术模拟训练系统的实验研究

目的通过建立虚拟脑穿刺手术模型进行神经外科手术培训。方法利用虚拟现实技术建立正常成年人脑形态三维图形,机械臂操作系统建立脑穿刺手术模型,计算机实时显示穿刺针进针线路、角度和位置。选择低年资外科医师进行模拟训练。结果医师培训前模拟脑室穿刺平均成功率40%,穿刺实际路径与理想路径夹角(穿刺夹角)为(0.12±0.08)°;经模拟训练后穿刺平均成功率94%,穿刺夹角为(0.09±0.03)°。培训后模拟穿刺成功率较培训前显著性提高(P0.01),穿刺夹角明显缩小(P0.01)。结论虚拟现实技术建立的脑穿刺手术模型,为神经外科临床医师快速、熟练掌握脑穿刺手术技巧,提供安全、有效的辅助训练手段。     

力反馈远程康复训练虚拟驾驶系统的软件设计

背景：国内随着人口老龄化现象加剧,对康复训练的需求日益迫切。机器人技术与康复医学理论、网络通讯技术相结合的康复训练机器人能够有效解决传统康复训练的缺点与不足,已成为康复领域的研究热点。 目的：针对上肢运动功能障碍患者康复训练需要,设计了一套用于远程康复训练的力反馈虚拟驾驶软件系统。 方法：采用异步流式套接字模型进行网络通讯,ADO数据库管理技术进行信息管理,虚拟现实技术构建虚拟驾驶环境。采用数据库管理技术取代传统的基于文件的数据处理技术提高了系统信息管理效率;患者端虚拟驾驶环境的构建增加了康复训练的趣味性;且具有直观清晰的数据和视频显示界面。 结果与结论：该系统具有直观清晰的实时视频和数据显示界面、高效的数据管理技术、有趣的虚拟驾驶环境等特点,为临床应用奠定了基础。     

针对甲基苯丙胺依赖探索并建立基于评估的精准综合干预模式

甲基苯丙胺(methamphetamine, MA)具有神经毒性大、心理依赖更强的特点, 目前MA依赖尚缺乏有效干预措施。本课题组针对MA依赖的脑病理损害及临床特征, 开发构建虚拟现实渴求评估系统, 认知、冲动损害评估, 态势分析法分析社会心理因素等新型多维度评估指标;并研发计算机化认知康复训练技术、针对降低心理渴求的精准化神经调控干预、正念防复吸和音乐治疗技术及基于移动医疗技术社区戒毒电子系统。在此基础上, 我们提出针对MA依赖建立基于评估的精准综合干预模式, 即全病程(whole course)、精准化(accurate)、持续的(repeatedly)、基于临床评估的(measurement-based)综合干预模式, 简称WARM模式。WARM模式从MA依赖者不同阶段面临的问题入手, 致力于实现MA患者的多维度康复, 并将进一步探索人工智能辅助的新布局。     

一种组合式远程康复训练机器人的研制：适用性及其安全性

背景：国内对康复机器人的研究起步比较晚,辅助型康复机器人的研究相对较多,而康复训练机器人的研究相对较少,医工跨学科的结合有待加强,国内的康复器械远远不能满足市场对智能化、人机工程化的康复机器人的需求。 目的：针对国内康复专家少而患者较多这一问题,将遥操作机器人技术与康复医疗器械相结合,以期研制一种基于力反馈的组合式远程康复训练机器人系统。 方法：充分考虑到患者的安全性,采用磁流变阻尼器加上直流电机的模式,设计了一种组合式机械臂,将遥操作机器人技术应用于肢体残障者的康复训练,使患者可以根据康复治疗师的远程设定进行康复锻炼,并将虚拟现实技术与康复训练相结合,把枯燥的康复训练变成轻松有趣的游戏。 结果及结论：该系统的服务对象是上肢有运动障碍的患者,通过对机械臂的拆卸和组合,可给患者提供康复需要的不同训练模式和治疗方案;运用计算机网络技术可使患者根据康复医师的远程设定进行康复训练;身临其境的虚拟现实技术显著提高了康复训练的积极性与效果。实验结果表明,所研制的远程康复训练机器人系统具有良好的适用性和安全性。     

混合现实技术辅助神经外科精准手术研究进展

混合现实技术(Mixed Reality,MR)的进展,为实现外科精准手术实时术中定位导航提供了可能。在神经外科精准手术的理念下,MR技术在优化手术设计、精准术中定位、促进医患沟通、提升医疗教学方面,具备临床应用价值与潜力。本文结合MR技术特点,阐述现阶段MR技术在神经外科辅助穿刺引流、肿瘤切除、医患沟通及医师培训等方面的应用现状,探讨其在辅助临床决策、优化手术方案、促进神经外科精准诊疗的研究进展。     

基于BP人工神经网络模型构建电子病历系统的数据分析

背景：电子病历中包含大量能够辅助临床诊断和决策的医疗信息。 目的：利用BP人工神经网络进行电子病历的数据挖掘。 方法：针对BP人工神经网络的原理及算法进行了分析,提出BP人工神经网络模型构建的6个步骤,分别为训练数据集的确定,数据准备,网络模型的建立,进行数据挖掘,评估BP网络得到的结果及预测结果的应用。并分析了BP人工神经网络在电子病历中的相关应用。 结果与结论：利用BP人工神经网络可以对电子病历进行分析预测,查找存在的危险因素。证实BP人工神经网络在电子病历系统数据分析中具有实际应用价值。     

焦虑障碍虚拟现实暴露治疗的效果研究进展

本文目的是对虚拟现实暴露疗法治疗焦虑障碍各亚型效果的研究进展进行综述,以期为临床应用提供参考。虚拟现实技术的日益普及与发展,为焦虑障碍的治疗提供了新的有效方法。近年来,大量研究表明虚拟现实暴露疗法治疗焦虑障碍有一定的效果。本文探讨了虚拟现实暴露疗法治疗焦虑障碍各亚型的效果以及药物对虚拟现实暴露治疗的增效作用,并总结了虚拟现实暴露疗法的优点及不足。     

虚拟现实技术在髋臼手术中的应用

背景：目前国外已经对医学虚拟现实,尤其是在虚拟医学手术仿真训练等方面都进行了一定的研究和实践,但并不能完全适应骨科手术的临床需要。而髋臼骨折因其复杂性治疗困难,临床医师选择适当治疗方案和手术入路的主要依据来源于影像学检查,常难以准确判断空间立体关系。 目的：综合分析虚拟现实技术在髋臼手术中的应用情况。 方法：作者于2010-10通过互联网计算机检索了中国期刊全文数据库(CNKI)、PubMed数据库、万方数据库及维普数据库1980-01/2010-10以中文或英文公开发表的有关髋臼虚拟手术系统研究方面的论文,以有限元模型(Finite element model)、髋臼骨折(Acetabular fracture)、虚拟手术(Virtual Surgery)为检索词,排除方法重复、相关参数未做详细介绍的论文。 结果与结论：初检得到115篇文献,保留其中32篇文献进一步分析。结果显示,髋臼虚拟手术系统可对髋臼的复杂特性进行分析,并提供在三维虚拟空间进行交互操作,以方便医生对患者的病患部位进行观察和虚拟的手术模拟,从而做出及时、准确的诊断并确定手术方案。建立可供骨科手术和手术前规划使用的虚拟平台,在医学骨科手术教学和仿真训练等方面都有良好的应用前景。     

五维力反馈虚拟手术装置的优化设计

虚拟手术是虚拟现实技术在医学领域的重要应用,医生借助虚拟手术系统与虚拟环境进行交互,可以进行手术规划、手术培训和远程手术。虚拟手术系统中的力反馈设备是其重要组成部分,也是制约当前虚拟手术发展的瓶颈问题之一。力反馈技术可以使医生获得与虚拟对象交互产生的力觉,如同进行真实手术操作一样,可以使训练更真实、准确、可靠。虚拟手术系统的开发和利用可以节约培训医务人员的成本和时间。文章主要介绍了一套用于虚拟手术系统的五自由度力反馈装置,该装置不仅能跟踪人手的五维运动而且能输出五维的触觉力。以自行设计的装置为研究对象,分析其设计不完善的方面,重点分析了减速比对装置响应速度滞后的影响,并在分析的基础上对该装置进行了设计优化。     

磁共振血管成像和功能性磁共振成像与虚拟现实技术进行运动区脑膜瘤显微手术

目的：探讨磁共振血管成像、功能性磁共振成像和虚拟现实技术在运动皮质区脑膜瘤显微手术中的应用价值。方法：运动功能区脑膜瘤患者30例,术前行头颅CT和MRI检查,将图像数据输入Dextroscope系统进行重建、融合和提取等处理,再进行观察、测量和手术模拟等操作,在术前获得肿瘤与皮质和血管相互关系的信息,以制定周密的手术计划。在显微镜下分离非功能区一侧肿瘤包膜,阻断部分血供,显露肿瘤,行瘤内分块切除,然后在显微镜下将肿瘤切除。结果：30例患者均成功实现术前三维立体虚拟现实影像重建;术前计划对病灶及局部解剖学特征的判断与术中实际情况吻合。结论：术前模拟手术过程,有助于选择适宜的手术入路和避免术中损伤矢状窦、中央沟静脉和脑功能区皮质,对预防术后脑水肿和保护运动功能有重要价值。     

Virtual reality training improves balance function

Virtual reality is a new technology that simulates a three-dimensional virtual world on a com- puter and enables the generation of visual, audio, and haptic feedback for the full immersion of users. Users can interact with and observe objects in three-dimensional visual space without limitation. At present, virtual reality training has been widely used in rehabilitation therapy for balance dysfunction. This paper summarizes related articles and other articles suggesting that virtual reality training can improve balance dysfunction in patients after neurological diseases. When patients perform virtual reality training, the prefrontal, parietal cortical areas and other motor cortical networks are activated. These activations may be involved in the reconstruction of neurons in the cerebral cortex. Growing evidence from clinical studies reveals that virtual reality training improves the neurological function of patients with spinal cord injury, cerebral palsy and other neurological impairments. These findings suggest that virtual reality training can acti- vate the cerebral cortex and improve the spatial orientation capacity of patients, thus facilitating the cortex to control balance and increase motion function.     

Virtual reality measures in neuropsychological assessment: a meta-analytic review

Objective: Virtual reality-based assessment is a new paradigm for neuropsychological evaluation, that might provide an ecological assessment, compared to paper-and-pencil or computerized neuropsychological assessment. Previous research has focused on the use of virtual reality in neuropsychological assessment, but no meta-analysis focused on the sensitivity of virtual reality-based measures of cognitive processes in measuring cognitive processes in various populations. Method: We found eighteen studies that compared the cognitive performance between clinical and healthy controls on virtual reality measures. Results: Based on a random effects model, the results indicated a large effect size in favor of healthy controls (g = .95). For executive functions, memory and visuospatial analysis, subgroup analysis revealed moderate to large effect sizes, with superior performance in the case of healthy controls. Participants’ mean age, type of clinical condition, type of exploration within virtual reality environments, and the presence of distractors were significant moderators. Conclusions: Our findings support the sensitivity of virtual reality-based measures in detecting cognitive impairment. They highlight the possibility of using virtual reality measures for neuropsychological assessment in research applications, as well as in clinical practice.     

虚拟现实技术在前颅底脑膜瘤术前计划中的应用探讨

目的:探讨虚拟现实技术在前颅底脑膜瘤术前计划和手术中的应用价值.方法:利用新加坡VI公司Dextroscope系统对10例前颅底脑膜瘤患者的头颅CT、MRI和MRA等影像学资料进行三维重建,获得肿瘤与颅底颅骨、脑组织、脑神经以及颅底动脉等解剖关系图像,并运用系统工具进行模拟手术.结果:10例患者均成功制定了手术计划和模拟手术操作,可直观地显示脑膜瘤的位置、大小及其与颅底动脉的解剖关系.本组病例均按照术前模拟方案实施手术,术中情况与术前模拟基本一致.10例患者均全切肿瘤,取得良好效果,术后无后遗症.结论:虚拟现实技术在前颅底脑膜瘤手术前应用,能在术前获得肿瘤和颅骨、血管的解剖信息;对选择合适的手术入路,减少对脑组织、血管和神经的损伤有益.     

A new virtual reality tool for unilateral cerebral palsy rehabilitation: Two single-case studies

Abstract

Objective: To examine the “clinical utility” of a new virtual rehabilitation tool in order to treat upper-limb motor deficit in cerebral palsy (CP) patient.

Methods: Single-case experimental designs. Virtual reality intervention was performed in two left unilateral spastic CP adolescent patients. The virtual reality intervention was given for 60 minutes per session, two sessions a day, and 5 days a week over 2 weeks.

Results: For each patient and for both hands, the number of blocks transported within one minute (box and block test scores) is increased. The nonoverlap of all pairs indices for the paretic hand were calculated as 0.95 for subject 1 and 0.93 for subject 2, and the nonoverlap of all pairs indices for the nonparetic hand were calculated, respectively, as 0.92 and 1.

Conclusion: We provide empirical evidence in support of a new simple Virtual Rehabilitation system in CP patient to improve upper-limb motor function.     

Virtual reality in mental health

BACKGROUND: Several virtual reality (VR) applications for the understanding, assessment and treatment of mental health problems have been developed in the last 10 years. The purpose of this review is to outline the current state of virtual reality research in the treatment of mental health problems. METHODS: PubMed and PsycINFO were searched for all articles containing the words "virtual reality". In addition a manual search of the references contained in the papers resulting from this search was conducted and relevant periodicals were searched. Studies reporting the results of treatment utilizing VR in the mental health field and involving at least one patient were identified. RESULTS: More than 50 studies using VR were identified, the majority of which were case studies. Seventeen employed a between groups design: 4 involved patients with fear of flying; 3 involved patients with fear of heights; 3 involved patients with social phobia/public speaking anxiety; 2 involved people with spider phobia; 2 involved patients with agoraphobia; 2 involved patients with body image disturbance and 1 involved obese patients. There are both advantages in terms of delivery and disadvantages in terms of side effects to using VR. Although virtual reality based therapy appears to be superior to no treatment the effectiveness of VR therapy over traditional therapeutic approaches is not supported by the research currently available. CONCLUSIONS: There is a lack of good quality research on the effectiveness of VR therapy. Before clinicians will be able to make effective use of this emerging technology greater emphasis must be placed on controlled trials with clinically identified populations.     

Virtual reality training to enhance behavior and cognitive function among children with attention-deficit/hyperactivity disorder: brief report

ABSTRACT

Purpose: To examine the feasibility and efficacy of a combined motor-cognitive training using virtual reality to enhance behavior, cognitive function and dual-tasking in children with Attention-Deficit/Hyperactivity Disorder (ADHD).

Methods: Fourteen non-medicated school-aged children with ADHD, received 18 training sessions during 6 weeks. Training included walking on a treadmill while negotiating virtual obstacles. Behavioral symptoms, cognition and gait were tested before and after the training and at 6-weeks follow-up.

Results: Based on parental report, there was a significant improvement in children’s social problems and psychosomatic behavior after the training. Executive function and memory were improved post-training while attention was unchanged. Gait regularity significantly increased during dual-task walking. Long-term training effects were maintained in memory and executive function.

Conclusion: Treadmill-training augmented with virtual-reality is feasible and may be an effective treatment to enhance behavior, cognitive function and dual-tasking in children with ADHD.