Enhancing stroke assessment simulation experience in clinical training using augmented reality

The development of extended reality in recent years is opening doors for using extended reality devices (virtual reality, augmented, and mixed reality devices) in education and healthcare. The purpose of this pilot study was to test the use of augmented reality in teaching healthcare practitioners in a stroke assessment simulation designed for clinical training, where students at nursing school are targets in the study. To conduct our feasibility, a simulation application was developed for the mixed reality device that projects a human face displaying facial drooping (a symptom of stroke) onto a computerized training mannequin. Nursing students were then placed in a clinical simulation wherein they wore the mixed reality device and performed an assessment of their mannequin patient to identify the symptom of stroke and act accordingly. The students completed a survey following their simulations, and then provided feedback on the device and the quality of their experience. The results of the study show that most students enjoyed the simulation and felt that extended reality would be a very useful educational tool for clinical training and healthcare. Further development of the program and device is underway, and future tests will be conducted. The results from this study will be helpful in further progressing the development of extended reality, and the use of these devices in healthcare training.

[1]  Gary A. Ford,et al.  Diagnostic Accuracy of Stroke Referrals From Primary Care, Emergency Room Physicians, and Ambulance Staff Using the Face Arm Speech Test , 2003, Stroke.

[2]  P. Dicker,et al.  Development and evaluation of a trauma decision-making simulator in Oculus virtual reality. , 2018, American journal of surgery.

[3]  Edwin Olson,et al.  AprilTag: A robust and flexible visual fiducial system , 2011, 2011 IEEE International Conference on Robotics and Automation.

[4]  Shih-Chung Kang,et al.  Strategies to accelerate the computation of erection paths for construction cranes , 2016 .

[5]  Hiroyuki Mori,et al.  An earbud-type wearable (A hearable) with vital parameter sensors for early detection and prevention of heat-stroke , 2019, 2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[6]  Iulian Radu,et al.  Augmented reality in education: a meta-review and cross-media analysis , 2014, Personal and Ubiquitous Computing.

[7]  Masashi Akaike,et al.  Simulation-based medical education in clinical skills laboratory. , 2012, The journal of medical investigation : JMI.

[8]  P. Milgram,et al.  A Taxonomy of Mixed Reality Visual Displays , 1994 .

[9]  Dana Tschannen,et al.  Second Life®: A New Strategy in Educating Nursing Students , 2012 .

[10]  Kamel S. Saidi,et al.  Real-time drill monitoring and control using building information models augmented with 3D imaging data , 2013 .

[11]  John Ahmet Erkoyuncu,et al.  A systematic review of augmented reality applications in maintenance , 2018 .

[12]  Michelle Aebersold,et al.  Using Simulation to Improve the Use of Evidence-Based Practice Guidelines , 2011, Western journal of nursing research.

[13]  Peter Jaye,et al.  Simulation training for hyperacute stroke unit nurses. , 2011, British journal of nursing.

[14]  Vineet R. Kamat,et al.  GPS and 3DOF Tracking for Georeferenced Registration of Construction Graphics in Outdoor Augmented Reality , 2006, EG-ICE.

[15]  Min Li,et al.  LEARNING ASSESSMENT STRATEGIES FOR AN EDUCATIONAL CONSTRUCTION SAFETY VIDEO GAME , 2012 .

[16]  Carol C. Menassa,et al.  A vision-based marker-less pose estimation system for articulated construction robots , 2019, Automation in Construction.

[17]  Elizabeth A. Carlson,et al.  The Use of Virtual Simulation and a Modified TeamSTEPPS™ Training for Multiprofessional Education , 2015 .

[18]  Silvana Quaglini,et al.  Role of Monitoring in Management of Acute Ischemic Stroke Patients , 2003, Stroke.

[19]  Asif Iqbal,et al.  A collaborative augmented reality based modeling environment for construction engineering and management education , 2011, Proceedings of the 2011 Winter Simulation Conference (WSC).

[20]  Barbara B. Kawulich,et al.  Teaching qualitative research methods with Second Life, a 3-dimensional online virtual environment , 2018, Virtual Reality.

[21]  Marjorie E Bunch,et al.  Barriers to the use of intravenous tissue plasminogen activator for in-hospital strokes. , 2012, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[22]  Craig Blackmore,et al.  Effectiveness of an Interdisciplinary, Nurse Driven In-Hospital Code Stroke Protocol on In-Patient Ischemic Stroke Recognition and Management. , 2019, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[23]  Vineet R. Kamat,et al.  Augmented reality visualization: A review of civil infrastructure system applications , 2015, Adv. Eng. Informatics.

[24]  Vineet R. Kamat,et al.  Evaluation of Human Robot Collaboration in Masonry Work Using Immersive Virtual Environments , 2015 .

[25]  Vineet R. Kamat,et al.  Enhancing Perceived Safety in Human–Robot Collaborative Construction Using Immersive Virtual Environments , 2018, Automation in Construction.

[26]  Shaun K. McGovern,et al.  Feasibility of an augmented reality cardiopulmonary resuscitation training system for health care providers , 2019, Heliyon.

[27]  Elizabeth E. Weiner,et al.  Using the Virtual Reality World of Second Life to Teach Nursing Faculty Simulation Management , 2010, MedInfo.

[28]  Sara de Freitas,et al.  The use of 'exploratory learning' for supporting immersive learning in virtual environments , 2009, Comput. Educ..

[29]  Dana Tschannen,et al.  Using a Virtual Environment to Deliver Evidence-Based Interventions: The Facilitator's Experience , 2015, JMIR serious games.

[30]  M. Wintermark,et al.  Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association , 2013, Stroke.

[31]  Dana Tschannen,et al.  Use of Simulation in Stroke Unit Education , 2011, The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses.

[32]  Carol C. Menassa,et al.  Stacked Hourglass Networks for Markerless Pose Estimation of Articulated Construction Robots , 2018 .

[33]  Chia-Chi Teng,et al.  Interactive Augmented Live Virtual Reality Streaming: A Health Care Application , 2018, ICMHI '18.

[34]  Eng H. Lo,et al.  The Science of Stroke: Mechanisms in Search of Treatments , 2010, Neuron.

[35]  Fred D. Davis.  Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology , 1989, MIS Q..

[36]  Egui Zhu,et al.  Augmented reality in healthcare education: an integrative review , 2014, PeerJ.

[37]  Vineet R. Kamat,et al.  Collaborative visualization of engineering processes using tabletop augmented reality , 2013, Adv. Eng. Softw..

[38]  Robert Levine,et al.  First-Person Point-of-View–Augmented Reality for Central Line Insertion Training: A Usability and Feasibility Study , 2016, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[39]  Vineet R. Kamat,et al.  Plane Registration Leveraged by Global Constraints for Context‐Aware AEC Applications , 2013, Comput. Aided Civ. Infrastructure Eng..

[40]  Vineet R. Kamat,et al.  Real-Time Hybrid Virtuality for Prevention of Excavation Related Utility Strikes , 2014, J. Comput. Civ. Eng..

[41]  Vineet R. Kamat,et al.  Integrated Information Modeling and Visual Simulation of Engineering Operations using Dynamic Augmented Reality Scene Graphs , 2011, J. Inf. Technol. Constr..

[42]  Michelle Aebersold,et al.  Simulation-Based Learning: No Longer a Novelty in Undergraduate Education , 2018 .

[43]  Leo Kobayashi,et al.  Exploratory Application of Augmented Reality/Mixed Reality Devices for Acute Care Procedure Training , 2017, The western journal of emergency medicine.

[44]  Gustavo Saposnik,et al.  Do All Age Groups Benefit From Organized Inpatient Stroke Care? , 2009, Stroke.

[45]  Ann P Rafferty,et al.  Lack of Association Between Stroke Symptom Knowledge and Intent to Call 911: A Population-Based Survey , 2010, Stroke.

[46]  J B Cooper,et al.  A brief history of the development of mannequin simulators for clinical education and training , 2004, Quality and Safety in Health Care.

[47]  Åsa Fast-Berglund,et al.  Testing and validating Extended Reality (xR) technologies in manufacturing , 2018 .

[48]  E. Samaniego,et al.  Inpatient and Community Ischemic Strokes in a University Hospital , 2007, Neuroepidemiology.

[49]  Elisa Cuadrado-Godia,et al.  Acute stroke unit care and early neurological deterioration in ischemic stroke , 2008, Journal of Neurology.

[50]  S. Daniels,et al.  Using Medical Mannequins to Train Nurses in Stroke Swallowing Screening , 2016, Dysphagia.

[51]  Eleni Stroulia,et al.  Healthcare Training Enhancement Through Virtual Reality and Serious Games , 2014 .

[52]  Wm. LeRoy Heinrichs,et al.  Learning medicine through collaboration and action: collaborative, experiential, networked learning environments , 2008, Virtual Reality.

[53]  Lorenz Breuer,et al.  Avoiding in Hospital Delays and Eliminating the Three-Hour Effect in Thrombolysis for Stroke , 2011, International journal of stroke : official journal of the International Stroke Society.

[54]  Jiejie Zhu,et al.  Virtual Reality and Mixed Reality for Virtual Learning Environments , 2006, Edutainment.

[55]  Vineet R. Kamat,et al.  Real-Time Construction Site Layout and Equipment Monitoring , 2018 .

[56]  Hanna Wüller,et al.  A scoping review of augmented reality in nursing , 2019, BMC Nursing.

[57]  Steven K. Ayer,et al.  Using Mixed Reality for electrical construction design communication , 2018 .

[58]  John Wiggers,et al.  Knowledge of Stroke Risk Factors, Warning Symptoms, and Treatment Among an Australian Urban Population , 2001, Stroke.

[59]  Charles E. Hughes,et al.  Mixed reality in education, entertainment, and training , 2005, IEEE Computer Graphics and Applications.

[60]  Chia-Chi Teng,et al.  Mixed Reality Patients Monitoring Application for Critical Care Nurses , 2019, ICMHI.

[61]  Yu Yuan,et al.  All Reality: Virtual, Augmented, Mixed (X), Mediated (X, Y), and Multimediated Reality , 2018, ArXiv.

[62]  Vineet R. Kamat,et al.  Interactive Augmented Reality Visualization for Improved Damage Prevention and Maintenance of Underground Infrastructure , 2009 .

[63]  Phillip S. Dunston,et al.  An Immersive Virtual Reality Mock-Up for Design Review of Hospital Patient Rooms , 2011, Collaborative Design in Virtual Environments.

[64]  Francesca N. Delling,et al.  Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association , 2019, Circulation.

[65]  Ronald Azuma,et al.  A Survey of Augmented Reality , 1997, Presence: Teleoperators & Virtual Environments.

[66]  Karen Chen,et al.  Shorter Intensive Care Unit Stays?: The Majority of Post-Intravenous tPA (Tissue-Type Plasminogen Activator) Symptomatic Hemorrhages Occur Within 12 Hours of Treatment , 2018, Stroke.

[67]  Lam Tran,et al.  A cross-sectional analysis of 2017 stroke symptoms recognition at the US regional level , 2020, Chronic illness.

[68]  Jose-Miguel Yamal,et al.  Benefits of stroke treatment delivered using a mobile stroke unit trial , 2018, International journal of stroke : official journal of the International Stroke Society.

[69]  Iva Petkovska,et al.  Virtual TeleStroke support for the emergency department evaluation of acute stroke. , 2004, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[70]  Shih-Chung Kang,et al.  A virtual reality tool for training in global engineering collaboration , 2019, Universal Access in the Information Society.

[71]  Robert Levine,et al.  Interactive Anatomy-Augmented Virtual Simulation Training. , 2018, Clinical simulation in nursing.