Advanced Visualization Branch

National Institute Of Nursing Research

Investigators

Linked publications, trials & patents

Abstract

The purpose of the AVB is to improve self-management among persons with complex chronic disease. The primary research instrument we use is immersive virtual reality (IVR, VR), which allows the participant to experience familiar environments and conduct self-management activities in a highly controlled space that allows for precise measurement of movement and assessment of the cognitive and behavioral task effort. To this aim, we develop virtual environments that depict scenes familiar to the lay person (homes, grocery stores) and insure that these are accessible to a broad range of individuals including those with limited digital experience, across a broad age-range, diverse backgrounds, and potentially those with some cognitive or physical limitation. Now that we have demonstrated that the virtual shopping environment and interface works for a broad range of individuals, we will submit additional protocols evaluating specific aspects of self-management. We completed our first study over a period of 10 weeks and are in the process of analyzing the data collected from the study and are in the process of preparing presentations and manuscripts to disseminate the findings. The results of our first study support our aims to create accessible experiences to a broad range of participants, even those with minor disabilities. Phase 2 of the study has been postponed to Fall, 2022. Phase 2 will explore participants abilities to demonstrate compliance with dietary restrictions, including food choice selection and compliance with sodium restrictions. We already have an extensive wait-list of individuals wanting to participate. For outcome assessment we employ standard measures of cognitive burden (VAS-Cognition) and task burden (NASA TLX). We empty observational measures such as time to perform tasks, duration of IVR immersion, and simulator sickness assessment to evaluate the acceptability of the IVR experience on participants. We applied the same multipurpose immersive VR platform to create a second environment to assess participants abilities to perform medication self management within the home environment. As correctly placing pills in a pillbox is a complex cognitive process, we have created a simple version of the task to identify individual cognitive factors that may contribute to errors in pill sorting. Our current environment enables us to determine if individuals can visually differentiate pill types, match to a calendar showing proper pill placement and then determining how quickly this information is processed. A subset of participants completed the pillbox task during phase 1 of the protocol. Each participant successfully learned and performed the task with minimal difficulty. The pillbox task will be used as a performance decrement indicator in phase 2 of our cognitive fatigue study. This task and virtual environment are a jumping off point for a future protocol evaluating the cognitive and environmental factors influencing medication management. Our lab has a strong commitment to training, including hosting two post-bac trainees (Sara Flash and Allyson Ferguson) and one summer intern (Nikhil Pradeep). Trainees participate in all phased of design and evaluation of our IVR environments, and gain additional experiences using big data, and supporting common data elements work. Sara Flash worked closely with our nurse consultant, Denise Goldsmith, to evaluate locomotion in IRV space (poster presented at NIH) and completed NIH presentations based on data extracted from the All of Us project. We presented posters at the American Medical Informatics Association annual meeting, thus integrating VR into the biomedical informatics community. Our trainees each have an experience proposing and answering questions using the All of Us Researchers workbench. The data provided a platform for training in research statistics using existing data and scientific presenting. Additionally, our studies have included data that supports NINR common data elements and initiatives including the social determinants of health and PROMIS measures. We are interested in extending our research through collaborations and are exploring options with NIMHD and NIDA. Our current staff includes the Principal Investigator, two post-bac trainees, and 3 remote contractors including a full-time graphic designer, a part-time engineer, and a part-time clinical nurse. Our team is geographically spread across the country in different time zones and varying work schedules. We lost our lead scientist and have been unsuccessful in recruiting a computer engineer. We have temporarily paused engaging human subjects in our research and will resume as soon as our staffing complement is complete. We will add an additional post-bac (Will Thompson) to aid in the next phase of research protocols and to increase our training efforts. Despite a small staff, under mostly remote telework, the AVB has moved forward with a complex research agenda and has completed proof of concept that immersive technology has potential to be a useful tool in the healthcare arena. We anticipate an acceleration of our scientific program over the next year.