The Health and Safety Issues Regarding the Immersion to Virtual Reality Technology - Essay Example

The Health and Safety Issues Regarding the Immersion to Virtual Reality Technology ABSTRACT BACKGROUND: Virtual Reality (VR) is a technology that generates computer-simulated environment which allows the user to immerse itself into it to feel the virtual environment. GOAL: The aim of this research paper is to outline the health and safety issues regarding the immersion to VR technology and to promote awareness to VR users in choosing the VR system that is applicable to their needs. METHOD: Articles and studies containing the words “virtual reality” were searched and their references were additionally reviewed. RESULTS: Upon immersion, Virtual Reality has both the advantages concerning therapeutic approach and disadvantages concerning side-effects. Among the benefits of VR include: training effect among patients with central nervous system injuries, increased level of self-confidence, well-being, mood and quality of sleep, increased motivation among patients, help patients with Parkinson’s disease in the form of VR glasses, reduce impairment, disability and handicap in neurological rehabilitation, and assess initially the effects of traumatic brain injury. Despite the great effect of VR use in the field of health care, reports have stated that it accompanies bad effects to the environment and the people exposed to it. According to reports, patients exposed may suffer physical, physiological and psychological side-effects. Physical injuries include: unwanted postural demands, Repetitive Strain Injuries (RSI), discomfort and strain in the neck due to big size and heavy weight, harbours fomites which could carry infection, reduced binocular vision, binocular stress, nausea, headache, eye strain and simulator sickness. CONCLUSION: VR technology is of great invention especially in the field of health care, but its consequent effects need to be studied more in order to avoid potential disorders among patients. Thus, we suggest further researches that would study both the benefits and side-effects of VR and determine the factors causing the side effects to the users and the environment as well. INTRODUCTION The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry's membership organization that concerns on providing leadership for the optimal use of healthcare information technology and management systems to improve and develop the health care system and service. This organization frequently surveys most of its members particularly information technology health care corporations and other companies and professionals worldwide. Their most recent studies focus on critical issues and health care information technology trends. The survey reported that one of the essential concerns of the people is patient safety, in which they wanted to improve this through the help of information technology. One of the key technologies includes computerized physician order entry; wireless local area networking, and personal digital assistants; and virtual reality (Simpson, 2002). Virtual reality produces a computer-generated environment through the help of computers and multimedia equipments. It allows the user to feel the virtual environment by immersing ones self to the artificial surroundings. This technology allows the user to generate three dimensional representations of real or imaginary situations. The potential use of virtual reality has widened from computer games up to simulated training of professionals such as surgeons, pilots and engineers. In 1996, Kalawsky pointed out that the main advantages of VR technology are: simulation of complex systems, macroscopic and microscopic visualization, fast and slow time simulation, allow high levels of interactivity, allow a sense of immersion and inherent flexibility/adaptability. The huge potential applications of VR technology made it a great deal to develop these technologies into effective useable systems which may be used in commercial, industrial, and academic institutions. In terms of health care, VR technology has vast applications that assist patient care. It is used as a remote telesurgery and as surgical simulators or trainers. VR techniques also helped surgeon to manipulate instruments by viewing a TV monitor in endoscopy. Virtual environments also play a role as therapy devices to reduce anxiety and phobias such as vertigo. As for health and safety training, it provides an ergonomic assessment of workspace layout and simulation of potentially dangerous environments which helps operators to avoid accident and responds to unexpected crisis or events (Howarth, 1994). But despite of its wide-range beneficial use, there are some reports and researches about the drawbacks of this technology. Many users have reported that they experienced physical, physiological and psychological side-effects after using the equipment especially the fully immersive VR. Other symptoms that may be observed are: drowsiness, faintness, fatigue, fullness of head, general discomfort, heavy breathing, mental depression, postural instability, sweating, visual flashbacks, and in rare cases of vomiting. Some of the potential cause of the symptoms that have been developed from side effects could be visual motion, virtual body or display field of view. Many factors including the equipment, environment and individual differences among users may generate side effects in immersive virtual reality but the visual components play a huge role in the onset of side effects. REVIEW OF RELATED LITERATURE Virtual Reality (VR) is a kind of technology which enables a user to experience a computer-simulated environment without moving him/her physically. The sensory organs of the user are controlled, to be able to associate the perceived environment into the preferred Virtual Environment (VE) through a process which is manipulated by a computer model. VR varies from simple environments in a computer to immersive multisensory environments. Immersion plays a pivotal role in Virtual Reality Systems to let the user experience the Virtual Environment. However, immersion can be attained to varying degrees through the introduction of additional modalities, greater degree of body tracking, richer body representations and decreased lag between body movements (Thalmann and Thalmann, 1998). There are three types of VR systems namely: non-immersive systems, semi-immersive projection systems and fully immersive head-mounted displays. The non-immersive systems are the least immersive among VR techniques because it only utilizes a portal window to enable to view the virtual environment. Keyboards, mice and trackballs are used to interact in the virtual environment. The semi-immersive projection systems provide a greater sense of presence compared to the non-immersive system because it use large screen monitor, large screen projector system or multiple television projection systems which enhance the feeling of immersion of the user (Costello, 1997). But among the three types of VR systems, the fully immersive head-mounted systems provides the most direct experience of virtual environment (Bolas,1994). The first device that provided immersive experiences with computer-generated imagery was the head-mounted display (HMD) which was invented in the mid 1960s. It has an optical system that channels images from a screen to the eyes and a motion tracker that continuously lets an image-generating computer adjust the scene to the user's current view. After the extensive development of two NASA Ames scientists, Fisher and McGeevy, HMD technology was produced and commercially available in 1989 (Costello, 1997). Nowadays, fully immersive VR has attained high degree of sophistication. Some of the products of immersive technologies comprise of 3D head-gear with stereoscopic vision, auditory input, voice activation, data gloves, haptic tools for control of virtual objects and suits with biosensors (Ausburn and Ausburn, 2003). Currently, there are many researches about virtual reality that are being done which will benefit the users. One of the benefits of virtual reality is its use as a therapeutic intervention. Flynn et al. (2007) assessed the level of presence, amount of simulator sickness and level of perceived exertion when subjects with central nervous system injury exercised using the Sony PlayStation 2 EyeToy. Four participants with stroke and six with spinal cord injury were recruited and exercised for 1-2 hours per day for 20 sessions. The results of the research suggested that there was a decrease in presence with an increase in simulator sickness among subjects with intact nervous systems. They also stated that there was a training effect among the subjects due to decrease in the Rate of Perceived Exertion Scale. It only shows that the type of training has the ability to boost the user’s motivational strategies and to practice more to recover further. The researchers planned to study further the right threshold for immersion which will not be hazardous among individuals with central nervous system injuries. In 1996, Riva developed the first VR-enhanced orthopaedic appliance for a 26-year old male individual, Nicola, who had a complete paraplegia due to car crash. There were two experimental sessions which consisted of fifteen-minute system trials with a ten-minute pause. There was a virtual trail to the peak of a mountain covered with snow, where Nicola had to walk through in each trial. On the other hand, the second trial had a virtual runner who would compete with him to reach the peak of the snow-covered mountain. Nicola rated his emotional and physical condition before and after the session. The results of the study showed that Nicola felt no simulation sickness and only an increased level of fatigue and a slight pain the ankle were experienced after the first session. The reports revealed that Nicola had improved level of self-confidence, sense of well-being, mood and quality of sleep. Indeed, the advantages of virtual reality system in the rehabilitation medicine over traditional rehabilitation devices are the increased patient motivation and the ability to adapt the features of the rehabilitation environment to the needs of different users. Virtual reality improves the efficacy of rehabilitation process because it could give a wide range of adaptation to the patient’s problems (Riva, 2000). Virtual reality also offered to help patients suffering from Parkinson’s disease. Parkinson’s disease is a degenerative disorder due to a deficiency of dopamine in the brain which made the patients movements hesitant and halting. Researchers developed a path-following technique which uses a virtual reality glass instead of bulky headsets. It was industrial engineer Thomas Furness III and Tom Reiss who developed the VR glasses that demonstrates moving dots, which generate a path for the patient. This VR glass could also be utilised in medicine, entertainment, education and telecommunications (Virtual reality finds role in medicine, 1994). A study of Rose (1996), reported that virtual reality has a potential use to reduce impairment, disability and handicap in neurological rehabilitation. It could also be used as a vital tool to have an initial assessment of the consequences of traumatic brain injury. However, to be able to reach its full potential, the effect of virtual reality to bodily systems must be investigated further to be able to use it clinically (Eberhart and Kizakevich, 1993). Many technologies like virtual reality undertake some form of public criticisms due to the unpleasant effect on the environment and the lives of people or due to the frequency and duration of use (Wilson 1996). Due to the exploitation of this technology, a number of reports implied that users may experience unwanted physical, physiological and psychological side-effects. In the use of virtual reality equipment, physical problems may arise due to the interaction techniques used in the system such as the weight of HMDs. Unwanted postural demands could be largely seen among fully immersive systems. These immersive HMDs provide added load to the body because of its heavy weight. Another physical issue with virtual reality systems is the Repetitive Strain Injuries (RSI). RSI injuries are brought about by the prolonged repeated activities that use rapid carpal and metacarpal movements. It is found to be associated with the use of mice, joysticks and keyboards. Tendonitis, fibrous tissue hyperplasia and ligamentous injury are the injuries due to connected with the use of standard input devices in virtual reality systems (Costello, 1997). Headset weight and fit is one of the biggest problem found among fully immersive systems utilising HMDs because it is relatively big and heavy. This could also cause discomfort and strain on the neck if improperly fitted. An additional strain in the neck could be experienced by the user who is unmoving and additional inertia by the HMD should be considered when the user perform a head movement (So, 1994). Virtual equipment may also harbour fomites, which are harmless object but could have pathogenic organisms and may transmit infections. HMDs and hand controller devices could have airborne pathogens and bacteria in the skin flora. HMDs could also cause sweating among the user because it is fully covered and the displays produces high amount of heat (Gupta, Wantland and Klien, 1996). Transient reduced binocular vision may also be experienced by normal healthy subjects after wearing a head mounted display for just ten minutes which was maybe due to compromised visual experience from the simulation of 3-D visual space from 2-D images (Mon-Williams, Wann and Ruston, 1993). Fully immersive HMD could also pose a risk of injury because the user is functionally blind in real world while wearing an HMD. Collisions with real world objects or VR system cabling might happen due to the immersive scene that could distract the attention of the user even though he has some external visions (Gupta, Wantland and Klien, 1996). Among the side effects of virtual reality systems, physiological problems are the well documented and well researched. Most people were concerned among the visual symptoms and the simulator sickness type symptoms. A visual symptom is nausea after the use of a head mounted display. A study of Mon-Williams, Wann and Ruston in 1993 reported a number of physiological symptoms with use of HMD. Twenty subjects were included in the experiments, wherein 12 reported experiencing headache, eyestrain and nausea and 4 had a transient reduction in binocular visual acuity. Some binocular stress like heterophoria and an increase in near point of convergence were reported by the subjects. These binocular stresses are due to the inconsistency between accommodation and convergence demand when using stereoscopic HMD, poor image quality and close distance of the screens (Mon-Williams and Pascal 1995). A number of oculomotor systems are used in immersive virtual reality environments. The sickness symptoms are produced when there is an incongruity between visual and vestibular motion. Another theory for this simulator sickness was proposed in the 1960s by Steele as perceptual conflict or cue conflict and it happens when signals from the various spatial senses, the eyes, the balance organs and the non-vestibular position senses are in conflict with one another and do not correlate with signals received in past experience. The simulator sickness produces similar symptoms to motion sickness. Some of its symptoms include disorientation, sweating, nausea, headache, and general discomfort. A study of Regan in 1995 found that generally 61% of 150 subjects reported symptoms during a 20 minute or 10 minute immersion period. But in the study of Costello and Howarth (1996) of one-non immersive and three fully immersive VR systems, there was a significant increase in nausea for the two of the three immersive systems and a statistically significant increase in the reports of disorientation for the three immersive systems. It was suggested that it is difficult to calculate individual susceptibility and effects of the user because simulator sickness is both polygenic and polysymptomatic However, even under the worst simulator, it was reported that only 30% of individuals will become ill (Kennedy and Frank, 1985). Among all the side effects produced by virtual reality systems, little is known about the psychological effects. Some research suggests that people may become obsessed with virtual reality like the ones who did in computer games. The use of virtual reality equipment can be compared to the obsession of people with their hobbies (Howarth, 1994). Hallucinations, dissociation, literalisation and retreat from reality are some of the behavioural effects of virtual reality (Wilson, 1996). DISCUSSION Virtual reality (VR) has a number of potential in its applications which includes training, medicine, industry, scientific research and entertainment. In the context of this report, VR holds potential for new application in rehabilitation medicine and therapeutic intervention. The efficiency of the rehabilitation process improves through the use of VR compared to a traditional rehabilitation device due to its flexible features that adapts to the different needs of its users. VR is also beneficial to reduce impairment, disability and handicap in neurological rehabilitation. Yet despite its promise, VR still needs to be further analysed and systematic research must be carried out to reach its full potential. Concerns have been expressed regarding health and safety of VR. Research does show that some symptoms may occur due to the side effect using VR equipment. Some authors raised issues about the postural demands, strain injuries due to repeated activities and discomfort. Hygiene issues were also raised regarding contact to airborne pathogens and skin flora that thrive in HMDs and controller devices. Concern about the physiological effects were raised especially the visual and the simulator sickness type symptoms brought about perceptual mismatches that occur between the visual and vestibular systems. The simulator sickness type is not just polysymptomatic, but also as polygenic. There could also be other factors that brought up simulator sickness like the user, VR system and the tasked performed in the VE. Other authors have raised concerns on behavioural effects such as being obsessed with VR environment, hallucinations, dissociation, literalisation and retreat from reality although little is know in this field. However due to technological advancements, the VR technology may develop and improve some of its system problems but simulator sickness will be more difficult to resolve and the VE users will continue to experience symptoms in virtual environment. This could make the simulator sickness difficult to prevent and treat. It is essential to understand the problem, for the potential VR users to be aware of the adverse effects so they could provide measures on how to avoid or minimise them. Upon choosing a VR system, one should check at the tasks on which the system will be used and its potential user. The individual must understand the health and safety implications upon the use of a fully immersive system for a task. Likewise, when an individual choose a non-immersive system to minimise health and safety problems, it loses the sense of immersion. It is important to assess the needs of the user and the demands of the task before setting up a VR system. Since VR system has still a lot of health and safety issues, further research must be done to determine the factors that cause the true side effects of VR. There should be a systematic assessment of factors which involves the virtual environment task, VR system and the user. There should also an extensive study on how human could completely adapt to the virtual environment along with the system software and hardware to avoid sensory problems and simulator sickness. Researchers could also study further the behavioural effects of VR because little is still known about this area and it might explain why VR users are getting hooked upon experiencing the virtual environment. Hygiene issues should also be studied because sweating could also provide moisture in the HMD and controlled devices where fungi and other bacteria might thrive and could transmit more pathogenic diseases. BIBLIOGRAPHY Ausburn, L. J., & Ausburn, F. B. “Virtual reality at your desktop.” Paper presented at the meeting of the Association for Career and Technical Education, December 2003, Orlando, Florida. Bolas, M.T. "Human factors in the design of an immersive system." IEEE Computer Graphics and Applications. Vol. 14. 1994. 55-59. Costello, P.J. and P.A. Howarth. 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