 I'm here as a co-host for Marie Postma, my name is Pieter Spoenck, normally email arts is sitting in this chair, but he couldn't be here today, so I'm taking over for him. May I ask the people who are currently in the link in the Zoom call to turn off your screens, you all have that, that's good, and keep your audio off because that would disturb the call here. We will have two speakers today, normally we have three and that tends to be a little tight, so now we have a little bit more time and hopefully we can go a bit more in depth for these talks. We will not go on longer than six o'clock, so this really will be between five and six o'clock. If you have comments during the talks or you have want to ask the speaker some questions, then write them in the chat, we will keep track of the chat and we hopefully can get to these questions at the end of each of the talks and maybe a few at the end of the two talks. Marie, over to you. Thank you, Pieter. So welcome everyone, let me introduce the first speaker for today, that's Philip Brown. Philip Brown is a PhD researcher in the final stages of his PhD project that is being completed at the Department of Cosmetic Science and Artificial Intelligence here in Tilburg under the supervision of Wendy Powell. His project focuses on the use of VR in various settings, primarily with medical applications in mind. And as you may know, there's currently a lot of interest in VR applications and there is great potential for these developments, for instance in areas such as education, health and marketing. Now what a lot of people don't realize until they start working with VR is that one of the issues that VR researchers are shown into is that a lot of users experience motion sickness, cyber sickness while using virtual reality applications. So this is an issue because it concerns about 20% of normal, normally developing population. And there are certain groups that are affected even more. Philip in his research focused on cyber sickness in particular patient groups and came up with results that are relevant, not just for his own research, but for all of us who do contact studies in VR environments. Now one thing that I really had to extract from Phil was information about his hobbies. And you know that in these dyscetogs, we like to also dive into some of the personal interests of our speakers. Phil likes to go for walks. He likes to listen to music, but he didn't like to share information with us about his bands he likes. So that's something you will have to ask him personally. But he does like to play board games. And actually next to me, I have our our university board game expert because Peter is not just conducting research on games and serious gaming, but he also organizes a lot of game events at Tolberg University, one of them being a board game night. Is there something you would like to say about this? Well, the board game nights, we try to do them live, usually in the daybreak building in the center of Tilburg. And we had to stop them for a long time for the last three years because of COVID, but I intend to very soon start them up again. So if you are interested in joining up, leave a message in the in the chat and I will write down your name. And if you do join, then you may also find out about Phil's favorite board game that currently that I understand involves animals and dealing and organizing animals. Okay, so that much about Phil's background. Phil, please, the floor is yours. Tell us about your research. Thank you, Marie. Hello, everyone. Thank you for the lovely introduction. My name is Phil Brownfield or Flip, whichever you prefer. I will be talking to you today. The title is a bit messed up, unfortunately. That should say recognition and interpretation of pain and cyber sickness in virtual reality. I'm a PhD student in the Department of cognitive science and artificial intelligence. Give you a quick about me. PhD student with Dr Wendy Powell. I transferred here from Fort Smith UK in July 2020, during the pandemic. I previously worked as a research assistant at Fort Smith University, where I was working on projects such as the molecular visualization and also the our meeting spaces. My primary research interests, which I will be speaking to you today about is pain detection, alleviation and cyber sickness detection and interpretation. So first off, I'll give you a real quick whistle stop tour of the background of it, sort of dive down into the work, which focused around my PhD. Firstly, in general about pain, so how we actually process and how wide pain distraction, wide virtual reality, sort of consequences of that sort of problems I'm looking at answering as part of my work. So the easiest way I think of thinking about pain is that with our bodies in general, we send signals all the time. Some of these signals will be threatening, some of them are going to be non-threatening signals. And in the case of pain, if you hurt yourself or something happens, which is sort of not so stimuli, you're going to be sending a signal to your brain, which is then going to send a signal back and try and give you a defense mechanism to try and make you not do it again. Now, with virtual reality where that comes in is based on something called gate control theory and how we distract ourselves from pain. So in lots of circumstances with pain, you can say medication and things like this. However, there are also not more non pharmacological interventions that we can use. And pain distraction being one of these traditional methods aside from going into virtual reality, you can think of films, TV, reading books. And the idea behind this is that you can then provide non-threatening signals rather than threatening signals. And then what gate control theory proposes. And then this is how we slide into this is there's an image on the right actually that might help explain some of this is that when we receive these threatening signals, and it travels across spinal colon to our brain to receive this signal, these theoretical gates will open and close. If it's a painful signal, this theoretical gate will open. And then that will send back the painful response. If it's a non-threatening signal, then it might it will hopefully keep the gates closed more often. And that's what we're trying to achieve. We're trying to keep these gates closed. So then for we reduce the sensation of pain that the user is experiencing. So why VR? And what's all happens in VR? VR is fantastic at producing these non-threatening signals. So therefore keeping these theoretical gates closed, or that they are open. And we put this down to the sense and the elicitation of presence, which is fantastic at. So if we are able to place ourselves elsewhere, other than where the painful stimuli may be, when we were able to immerse ourselves in other environments, then we hope to be able to increase the sense present starts reducing the threatening signals, which are being listed. The consequence of this is that virtual reality also makes people feel sick. Cyber-sickness also referred to maybe as a simulated sickness, visually induced motion sickness. But the idea is that they are symptoms similar to motion sickness. So if you've ever tried virtuality, you may know yourself, but you may feel sort of dizziness, nausea, headache. And this cyber-sickness interferes for a sense of presence. So it's doing the opposite of what we wanted to do. And instead, we are producing more of these threatening signals, not enough of these non-threatening signals, our theoretical gates they open, the painful signals being sent to us, which is undesirable. A bit of a side step here, but I think important to my work, especially how I'll explain it, is how we actually measure pain and cyber-sickness. And most of these are done using self-report methods. There's an example of a pain self-report method on the right, just below the diagram. And we use scales. So normally for pain, for example, you can use stuff like numerical rating scales, visual analogue scales, where you'll ask the participant or patient on a scale of one to 10, how you're feeling, and they'll give you the answer. Cyber-sickness similarly, there are a few different methods, pain and self-report once again, although the most prominent being the similar sickness questionnaire, 16 points questionnaire, scale of zero to three, asking you on a scale of severity, how about a certain symptoms such as, like I mentioned earlier, dizziness, nausea, headache. So what problem am I trying to achieve in my work, knowing all of this information? Well, I initially went into this work from the perspective of what role VR has to play in distracting people from pain. So initially, and you will see from my first study, which I'll go through in a moment with a couple of publications that you've asked it, was concerned with what about VR is actually causing this distraction. We hypothesize and we theorize about the present side of things and that if we feel more present, maybe we can provide more distraction. However, is that enough? What about the media is actually distracting? Do we need something to be engaging? Do we need something interactive? Is something past that actually able to produce this same energy slick? And then from that, with the results of that study and what I've gone on to now and what is forming the final stages of thesis, is actually why we are using self-reports and maybe how we can look for alternatives to this. Number of reasons for this, and especially that I found through my own work letter in the literature itself, it can be quite unreliable, can be very subjective. It can lead to bias, especially from experimenters as well, get gender bias in there. It could be quite undesirable, especially from a self-report perspective. It's quite hard to actually ask someone during an immersion how much pain they are in or how sick they are feeling. Once again, that sort of ties back around to breaking the present that will reduce the thing, etc. And then also on feasibility, very time-specific, if I ask you post intervention, what's happened to you? You are using almost like a memory recall to tell me what happened. I don't understand why it actually happened at that time. So there's a number of things around this as to why I am interested in using alternatives to self-reports. So into my work state, I will break this up into sort of publications which have come out of this thus far. But the way I'll try and constitute this to you is that there was a study which I did initially, which I spoke about where it was examining the arch-roll as a distractor among persons, and this was specific with people with assistant and chronic pain. Further from that, with the work that came out of that, we are actually noticing irregularities, especially in cybersignals reporting. So we made further publication where we were looking at the extrapolation identification that the current theories concerning cybersignals reporting may be incorrect. And then thirdly, during the pandemic, when human participant research was needed to go ahead, we actually elaborated on these results further. We conducted a survey of a study where we were examining potentially incorrect assumptions of cybersignal space lines. So I'd like to go through this a little bit more in depth with you anyway and sort of discuss some of the results that we got from these. The first publication from this new study we did was titled Virtual Reality as a Pain Destruction Modality for Experimentally Induced Pain and Conquering Population. We had two hypotheses from this specifically. We were looking at whether the pain tolerance would differ between active and passive interventions, of which we found that people tolerated pain significantly greater in the active compared to a passive intervention. And then secondly, whether a presence would be positively correlated with the pain tolerance. So in this regard, we found significant positive correlations between presence and the active intervention. And then similarly, no correlation between pain tolerance. And so this answered the initial question I had with part of my thesis or certainly starts to build upon that which was, what about VR do we need? Do we need it to be engaging? Is it enough just to wear a headset? Is it enough to what part of this do we actually need to identify as being the distractor? And in this case, it was very clear that the media of VR itself isn't a sufficient distractor and that the media is actually important to this. But furthermore, especially with the work that I'm doing now, what was identified is that the use of self-report question is not necessarily ideal methodologically and this or there wasn't any next publication which I have. So following publication based off the same data set of the same participants was titled pre-exposure, cyber sickness assessment among clinical populations. So as a quick background again, when you administer something like the SSQ if you're not familiar, that's a similar sentence question, you will traditionally ask them post intervention and you use a pre-intervention assumption that people are coming in with a zero baseline score. So you can assume that everyone is feeling perfectly healthy before they go in, in lieu of some experiments which may ask people or may actually exclude participants if they are feeling anything other than healthy, which you can imagine with a baby a pain population isn't indicative at all, because you're going to have people coming in showing symptoms, which will probably correlate quite highly to some of the symptoms you're asking on questionnaires. And so that's what we were actually looking at here, is that zero baseline correct? Because what we found, especially in our small participant pool, is that was incorrect. So the main two policies that we actually got out of this, specifically we were looking at whether the pain population have significantly higher pre-exposure scores than the normal assumed baseline. Now this was fairly much a given based on the work we've previously done, because in the table to the right you can see the pre-exposure, post-exposure scores of the 12 participants we had in this study, only two of them actually exhibited a zero baseline, meaning that every other participant actually ended with a non-zero baseline. And then further more, we were actually looking at the differences between the assumed baseline and our actual known baseline. And what we found here is that the differences between the assumed baseline and the post-exposure scores was significantly greater than the difference between the pre and the post-exposure scores. And what this was actually trying to highlight this result is that if you use an assumption you are going to get drastically different results than what you would actually, if you collected, say, a pre-exposure what that actually indicates. We conclude from here that non-zero SSG baselines were reported among Spain populations. And assessing based on an assumed baseline may be incorrect, may incorrectly conclude that height and size this was experienced. Now, there's a couple of parts with this is why we followed on with the survey-based study afterwards, which I'll flip to now. And this was a study which we conducted amongst a much more general population and it wasn't a specific population. So this publication, which is just coming together now, which is about to be submitted, and this is tentatively titled the Simulator-Sitness Questionnaire and the Erroneous Zero Baseline Assumption. Now, what we did here is we actually recruited just under 100 participants and we asked them at a time of day which would mimic study conditions for a much reality study to take the Simulator-Sitness Questionnaire. We were not eliminating participants based on any health condition instead of what we actually did. We asked for disclosure of any predetermined health conditions or medication which they were taking and therefore we would group them afterwards as being part of either a healthy or a medical population. And what we were looking for here is is this zero baseline existing in the general population? We hypothesized that it wasn't. We hypothesized based on previous work as well. The last study sample would be higher, significantly higher than our zero baseline assumption which was correct. We also hypothesized further that the healthy sub-pop would be greater than zero baseline which would be found to be true. Similarly for the medical sub-population which we found to be true once again. But one thing based on our previous work which we were looking at or what we thought anyway was that medical sub-populations for a number of factors such as medication use again confounding with some less sickness answers or questions which are being asked. States of the health condition itself which may confound also. We thought that they would actually score significantly greater than healthy sub-populations total scores. Although we found this to be incorrect. If you see on the right the violin charts at the top is the actual distributions of participants. And you can see they're actually very similar. Although healthy participants did an average score less than the medical population participants. It's certainly not a zero baseline and it's actually nowhere. If you look at the table down towards the bottom only three of our 93 participants actually did score a zero baseline. The vast majority of them you can see 73 percent of them actually scored higher and then based upon the initial publications categorization of how good a intervention is categorized as having a bad intervention. And this is pretty this is before anyone's even conducted or anyone's even gone through a virtual reality intervention. So it's not great as far as from this population anyway. And what we do conclude from this is that non-zero baseline scores in medical and health populations. A couple of caveats again to this though. However, this was a predominantly student population which we recruited from. And this was also during the COVID-19 lockdowns. So it could be said as well that people could be answering more skewed towards some of the questions which could be, for instance, difficulty focusing and fatigue based questions. So that could be something to actually explore further in the future and especially as well since there was there wasn't any priming that they were going to be experiencing of their intervention. So there could be sort of some different questions being answered there. Now I'd like to sort of look on to what's happening now alongside this publication. I'm also just about to start the final study on my PhD. And for this specifically, we are hopefully not doing away with the self reports, but we're hopefully going to be start implementing some more physiological measures to infer pain and cyber sickness. A lot of the literature, especially for pain and cyber sickness suggests that we can indicate maybe not at the moment how much they are experiencing, but certainly elevations of these. The most proposed at the moment are with heart rate variability and electro dermal activity specifically in conductance, although the literature will highlight that both of these are relative to pain and cyber sickness. So especially if we have an intervention where we are trying to look at both, these two alone aren't necessarily going to be indicative of what's going on. So we're proposing actually including some other physiological indicators such as Eiblin, Creighton, Pupil dilation, which may be better inferences identifying what's elevated on both the cut and furthermore actually going to be using EOG facial responses, specifically from Corrigate and Frontalis muscle movement to try and indicate whether we have elevations in pain or cyber sickness. And these will then be correlated to their soft core counterparts. So also what is happening is that I'm involved in a weekend funded projects absolutely titled VR for ER where we're actually looking at novel applications of pain distraction within emergence from departments. This is just starting at the moment when we conclude for about another year. But we are hopefully going to be incorporating as well some pain identification modalities using physiological methods to do an emergency from setting. And I think sort of blitz through that a little bit. I think that's most of the work that I've actually got so far. So I'm also happy to answer any questions you might have. And thank you very much. Thank you for a very interesting talk. So just to ask a question about cyber sickness. It's something that is triggered by the use of the VR headset. And also what's happening in the simulated environment. But is there also something in the movement of the user that can actually increase the experience of cyber sickness and maybe also alleviate it. So I'm thinking about particular movements of the head. Yes. So what we actually also hypothesize from the side perspective is that it's actually the imbalance. So the fact of when you have movement happening virtually to you, but then you're actually stood in the same place, your body can actually comprehend what is happening. So it makes you feel like the stomach is almost going up inside of you because you are not able to regulate that movement to what you are seeing. So what is happening now is actually some research looking into moving platforms, for example, where there'll be the vibrations or movements so that it will not feel so disproportionate between. OK. But we would need extra equipment for that. It's not something that you could design as a feature of the simulated environment. So that we, for instance, use head tilts to. Yeah, no. And again, specifically where you'll find this happening more so is say in environments or in applications whereby the user will not be moving of their own free will. And the camera will maybe moving through the environment for them. Again, it's that displacement that irregularity between what you are seeing and what you are feeling and then what is actually happening to your body. Other things that are being used there's actually was this in the corner of our room where we've got walking platforms which are hopefully alleviating this as well. So not just being used these things as sort of movement technologies, but actually as an aviation as well. Yeah, so what kind of applications would you use in that emergency room to alleviate pain? That's what I was thinking about. So it's difficult as well. So specifically for the project that we're looking into, it will be ankle breaks, dislocation. So you do not have your hands available to might have an IV in one hand and the other one broken or dislocated. So at the moment we're exploring using there are very passive experience with 360 videos. There are animations as well. And there are such applications as well, which you can use eye gaze direction as well to actually navigate around it. So they're not interactive maybe in the sense of VR as we think they are. However, they still need to be engaging enough because it's still to catch that sense of presence. You still need to be engaged and get reduced as long-term obstacles. So when we completely passive, but it won't be as interactive, maybe what we used to. Thank you. Is there a question in the chat? So it's somebody says, thank you for sharing your insight. Phil, I work in the industry where VR and AR devices are used in support of everyday operations of business. Based on your studies, do you expect similar results for AR devices? I'm probably not the best answer to speak by AR devices, unfortunately. I'm not sure myself. I haven't looked into so much of the literature, especially from a side perspective with AR. I wouldn't have thought so quite so much because you do have, especially with AR, the perspective of things around you. So like I said before about that imbalance between movement, you're actually able to regulate that a lot more. I believe in AR. But again, I'm probably not the answer to that. Thank you. I think we have to go to the next speaker. Thank you, Phil. Thank you very much. Thank you.