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A System for the Measurement of the Subjective Visual Vertical using a Virtual Reality Device

  • Mobile & Wireless Health
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Abstract

The Subjective Visual Vertical (SVV) is a common test for evaluating the perception of verticality. Altered verticality has been connected with disorders in the otolithic, visual or proprioceptive systems, caused by stroke, Parkinson’s disease or multiple sclerosis, among others. Currently, this test is carried out using a variety of specific, mostly homemade apparatuses that include moving planes, buckets, hemispheric domes or a line projected in a screen. Our aim is to develop a flexible, inexpensive, user-friendly and easily extensible system based on virtual reality for the measurement of the SVV and several related visual diagnostic tests, and validate it through an experimental evaluation. Two different hardware configurations were tested with 50 healthy volunteers in a controlled environment; 28 of them were males and 22 females, with ages ranging from 18 to 49 years, being 23 the average age. The Intraclass Correlation Coefficient (ICC) was computed in each device. In addition, a usability survey was conducted. ICC = 0.85 in the first configuration (CI = 0.75–0.92), ICC = 0.76 in the second configuration (CI = 0.61–0.87), both with 95% of confidence, which means a substantial reliability. Moreover, 92.2% of subjects rated the usability of the system as “very good”. Our evaluation showed that the proposed system is suitable for the measurement of SVV in healthy subjects. The next step is to perform a more elaborated experimentation on patients and compare the results with the measurements obtained from traditional methods.

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Acknowledgements

We acknowledge and appreciate the contributions to this work of Francisco Javier Molina Ortega, Alexander Achalandabaso Ochoa and Daniel Rodríguez Almagro which are members of Physiotherapy Department of the University of Jaén. Their ideas and feedback have been invaluable and they have provided all the subjects for our experimentation sessions.

Funding

This research was supported partially by the Spanish Ministry of Education, Culture and Sports via a doctoral grant to the first author (Ref. FPU16/01439).

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Authors and Affiliations

  1. Department of Computer Science, University of Jaén, Campus Las Lagunillas s/n, A3 building, 23071, Jaén, Spain

    José Negrillo-Cárdenas, Antonio J. Rueda-Ruiz, Carlos J. Ogayar-Anguita & Rafael J. Segura-Sánchez

  2. Department of Health Sciences, University of Jaén, Jaén, Spain

    Rafael Lomas-Vega

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  1. José Negrillo-Cárdenas
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Correspondence to José Negrillo-Cárdenas.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Appendix 1: Inherent errors and sensor precision

Appendix 1: Inherent errors and sensor precision

Our application requires reading the orientation of the mobile device to determine the actual vertical position and compare it with the patient’s subjective vertical. Mobile devices determine their orientation using the accelerometers and gyroscopes integrated into the Inertial Measurement Unit (IMU). This unit provides information about positions and rotations with respect to the three coordinate axes. The position relative to the vertical is directly read from the Y rotation component of the sensor. However, there are several implicit problems related to the information provided by these sensors. First, all devices have an error when they are placed in vertical position. We observed a fixed deviation in the rest position between 0 and 6 degrees, depending on the device used. This sensor bias can be removed by introducing a calibration step in the application that only has to be done once, before the first SVV test. This process is done by placing the device on its side on a flat, firm and perfectly horizontal surface (e.g., a table). The correction value (ε) is automatically saved after the device has been stable for 3 seconds in the indicated position.

A second problem is related to the precision of these sensors. The gyroscope and accelerometer sensors in mobile devices were primarily designed for detecting portrait/landscape orientation changes, stabilizing camera, detecting gestures (e.g., shaking the device) or gaming. Using these sensors in new applications like trajectory reconstruction is challenging because of the impact of the cumulative sum of the measurement errors (see Wang et al. [36], Suvorova et al. [37]). In a similar way, their use for the measurement of biometric identifiers is an important issue. For this reason, we conducted an experiment to assess the precision of these sensors, and determine if a calibration/filtering process needs to be introduce to suppress errors.

For each device, we performed a static test for measuring how much the vertical calibrated position varies over the time. For this purpose, the device was held still in the same position as in the calibration process and one thousand vertical measurements were taken. Then, the average, standard deviation and variance were computed.

With a 99% of confidence, we can conclude that all devices keep the error below one decimal digit (error < 0.1) and 33% of them have more precision (error < 0.01 with 99% of confidence). This precision is totally acceptable for the measurement of the SVV so we use the deviation value approximated to the first decimal, without implementing any filtering. In addition, we observed that the measure is minimally affected by the wireless services of the device such as GPS, 3G/4G, bluetooth, etc. Precision improves if these services are disabled. However, this is not completely possible because our application requires at least a data connection is required for communicating with the server.

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Negrillo-Cárdenas, J., Rueda-Ruiz, A.J., Ogayar-Anguita, C.J. et al. A System for the Measurement of the Subjective Visual Vertical using a Virtual Reality Device. J Med Syst 42, 124 (2018). https://doi.org/10.1007/s10916-018-0981-y

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