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Chronic neuropathic pain (NP) is a common and often debilitating secondary condition for persons with spinal cord injury (SCI) and is minimally responsive to existing pharmacological and nonpharmacological treatments. The current preliminary investigation describes the feasibility and initial comparative efficacy of an interactive virtual reality walking intervention, which is a novel extension of visual feedback/illusory walking therapies shown to reduce SCI NP. Virtual reality walking intervention builds on previous research by, for the first time, allowing individuals with SCI NP to volitionally control virtual gait to interact with a fully immersive virtual environment. The current pilot study compared this interactive, virtual walking intervention to a passive, noninteractive virtual walking condition (analogous to previous illusory walking interventions) in 27 individuals with complete paraplegia (interactive condition, n = 17; passive condition, n = 10; nonrandomized design). The intervention was delivered over 2 weeks in individuals' homes. Participants in the interactive condition endorsed significantly greater reductions in NP intensity and NP-related activity interference preintervention to postintervention. Notable improvements in mood and affect were also observed both within individual sessions and in response to the full intervention. These results, although preliminary, highlight the potentially potent effects of an interactive virtual walking intervention for SCI NP. The current study results require replication in a larger, randomized clinical trial and may form a valuable basis for future inquiry regarding the mechanisms and clinical applications of virtual walking therapies.

Research Objectives Brain injury continues to be a leading cause of serious long-term disability. The objective of this project is to develop and implement innovative assessment and intervention strategies, via robotics and virtual reality systems, to improve balance and walking capabilities for persons with neurologic conditions. Design A Human-centered design (HCD) framework is being used to guide the development process and to ensure its end products are usable and useful. HCD develops solutions by involving the stakeholder perspective in all steps of the problem solving process - which includes brainstorming, conceptualizing, developing, and implementing the solution. Setting Remote collaboration between a Neuro-recovery Center and an independent virtual reality (VR) and robotics laboratory (Immersive Experience Laboratories LLC (IXL)). Participants Physical Therapists, Occupational Therapists, persons with traumatic brain injury, and VR application hardware and software developers. Interventions Not Applicable. Main Outcome Measures Description of the development process of a clinician-designed virtual reality (VR) application for deployment with individuals recovering from brain injury; time to initial uptake of technology; patient and clinician preferences; and clinical outcome scores. Results Focus group meetings with clinicians have revealed needs that have strong potential to be effectively addressed by immersive and interactive virtual-reality (VR) interventions, including Identification of Hazards, Care of Others, Garage Time, and Guided Walking. Development of functional platforms for immersive VR training and asset development of indoor household settings is principally complete. Development of treadmill-integrated gait-management platform is principally complete. We currently continue iterative development of content with biweekly feedback from subject-matter-expert clinicians. Conclusions The HCD framework could be readily adaptable to other rehabilitation centers interested in developing and implementing these kinds of technologies for the patients they serve. Author(s) Disclosures No conflicts of interest

To estimate the effect of a virtual reality (VR) anatomic model (VisCubeSX; VisBox, Inc., Saint Joseph, IL) on obstetrics and gynecology residents' knowledge of female pelvic floor anatomy compared with a traditional curriculum.Randomized controlled trial (Canadian Task Force classification I).Academic obstetrics and gynecology resident training program.Traditional independent study curriculum versus traditional curriculum and VisCubeSX VR curriculum MEASUREMENTS AND MAIN RESULTS: Residents were randomized, stratified by year of training, in a 1:1 fashion to traditional independent study curriculum for pelvic anatomy versus traditional curriculum and the VisCubeSX VR anatomic model. Tests were administered to assess baseline and postintervention knowledge. A postintervention assessment of the VisCubeSX VR anatomic model was performed. Baseline, follow-up, and score improvement were compared between groups using Student t tests and Wilcoxon rank sum tests. Thirty-one residents were randomized. There was a significant improvement in pre- and post-test scores within traditional independent study curriculum participants, 8.1 ± 12.0 points (p = .02), and the VisCubeSX group 8.7 ± 6.4 points (p.001), but these improvements did not differ between groups (p = .86). This lack of between-group differences was consistent in resident year-stratified analyses. Residents exposed to the VisCubeSX VR anatomic model reported they "somewhat" or "strongly agree" (15/16 [93.8%] and 14/16 [87.5%] of residents, respectively) that the model improved their knowledge of pelvic anatomy and that the model will improve patient care.Few studies exist that compare educational outcomes of a traditional independent study of female pelvic anatomy curriculum versus immersive simulation with VR models in female pelvic anatomy. Knowledge scores were not significantly increased with the VR model compared with traditional curriculum, but VR technology was perceived as an enhancement to short-term learning.

In this paper, we propose efficient and robust unstructured mesh generation methods based on computed tomography (CT) and magnetic resonance imaging (MRI) data, in order to obtain a patient-specific geometry for high-fidelity numerical simulations. Surface extraction from medical images is carried out mainly using open source libraries, including the Insight Segmentation and Registration Toolkit and the Visualization Toolkit, into the form of facet surface representation. To create high-quality surface meshes, we propose two approaches. One is a direct advancing front method, and the other is a modified decimation method. The former emphasizes the controllability of local mesh density, and the latter enables semi-automated mesh generation from low-quality discrete surfaces. An advancing-front-based volume meshing method is employed. Our approaches are demonstrated with high-fidelity tetrahedral meshes around medical geometries extracted from CT/MRI data. Copyright © 2005 John Wiley & Sons, Ltd.

Background Surgery is a highly technical field that combines continuous decision-making with the coordination of spatiovisual tasks. Objective We designed a virtual interactive presence and augmented reality (VIPAR) platform that allows a remote surgeon to deliver real-time virtual assistance to a local surgeon, over a standard Internet connection. Methods The VIPAR system consisted of a "local" and a "remote" station, each situated over a surgical field and a blue screen, respectively. Each station was equipped with a digital viewpiece, composed of 2 cameras for stereoscopic capture, and a high-definition viewer displaying a virtual field. The virtual field was created by digitally compositing selected elements within the remote field into the local field. The viewpieces were controlled by workstations mutually connected by the Internet, allowing virtual remote interaction in real time. Digital renderings derived from volumetric MRI were added to the virtual field to augment the surgeon's reality. For demonstration, a fixed-formalin cadaver head and neck were obtained, and a carotid endarterectomy (CEA) and pterional craniotomy were performed under the VIPAR system. Results The VIPAR system allowed for real-time, virtual interaction between a local (resident) and remote (attending) surgeon. In both carotid and pterional dissections, major anatomic structures were visualized and identified. Virtual interaction permitted remote instruction for the local surgeon, and MRI augmentation provided spatial guidance to both surgeons. Camera resolution, color contrast, time lag, and depth perception were identified as technical issues requiring further optimization. Conclusion Virtual interactive presence and augmented reality provide a novel platform for remote surgical assistance, with multiple applications in surgical training and remote expert assistance.

Computational Fluid Dynamics (CFD) has become a crucial tool to predict and analyze flow field within a domain. When engineers understand the complex flow patterns, reliable results can be provided. However, accuracy improvement, confidence development, throughput increase, and cost reduction are the four key challenges to CFD. Solution throughput in the generation of aerodynamics, propulsion, and fluid dynamics simulations that involve parametric and sensitivity studies of design and analysis must be significantly improved. Such parametric and sensitivity studies require a large number of CFD simulation runs. However, preparing and managing such a large number of CFD simulation jobs is a challenging problem even for experienced users; compounded by the complexity of running these simulations with different cluster environments on the Department of Defense (DoD) High Performance Computing (HPC) systems. Moreover, different groups of users may prefer a different CFD solver that requires a different input file format and outputs solutions in various flavors.