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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
Open AccessArticle

Subjective visual vertical assessment with mobile virtual reality system

Department of Otorhinolaryngology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
Department of Software Systems, Faculty of Informatics, Kaunas University of Technology, Lithuania
Biomedical Engineering Institute, Kaunas University of Technology, Lithuania
Sobell Department for Motor Control, University College London, United Kingdom
Author to whom correspondence should be addressed.
Medicina 2017, 53(6), 394-402;
Received: 3 October 2017 / Revised: 18 January 2018 / Accepted: 8 February 2018 / Published: 19 February 2018
Background and objective: The subjective visual vertical (SVV) is a measure of a subject's perceived verticality, and a sensitive test of vestibular dysfunction. Despite this, and consequent upon technical and logistical limitations, SVV has not entered mainstream clinical practice. The aim of the study was to develop a mobile virtual reality based system for SVV test, evaluate the suitability of different controllers and assess the system's usability in practical settings.
Materials and methods: In this study, we describe a novel virtual reality based system that has been developed to test SVV using integrated software and hardware, and report normative values across healthy population. Participants wore a mobile virtual reality headset in order to observe a 3D stimulus presented across separate conditions – static, dynamic and an immersive real-world (‘‘boat in the sea’’) SVV tests. The virtual reality environment was controlled by the tester using a Bluetooth connected controllers. Participants controlled the movement of a vertical arrow using either a gesture control armband or a general-purpose gamepad, to indicate perceived verticality. We wanted to compare 2 different methods for object control in the system, determine normal values and compare them with literature data, to evaluate the developed system with the help of the system usability scale questionnaire and evaluate possible virtually induced dizziness with the help of subjective visual analog scale.
Results: There were no statistically significant differences in SVV values during static, dynamic and virtual reality stimulus conditions, obtained using the two different controllers and the results are compared to those previously reported in the literature using alternative methodologies. The SUS scores for the system were high, with a median of 82.5 for the Myo controller and of 95.0 for the Gamepad controller, representing a statistically significant difference between the two controllers (P < 0.01). The median of virtual reality-induced dizziness for both devices was 0.7.
Conclusions: The mobile virtual reality based system for implementation of subjective visual vertical test, is accurate and applicable in the clinical environment. The gamepad-based virtual object control method was preferred by the users. The tests were well tolerated with low dizziness scores in the majority of patients.
Keywords: Subjective visual vertical; Virtual reality; Vestibular Subjective visual vertical; Virtual reality; Vestibular
MDPI and ACS Style

Ulozienė, I.; Totilienė, M.; Paulauskas, A.; Blažauskas, T.; Marozas, V.; Kaski, D.; Ulozas, V. Subjective visual vertical assessment with mobile virtual reality system. Medicina 2017, 53, 394-402.

AMA Style

Ulozienė I, Totilienė M, Paulauskas A, Blažauskas T, Marozas V, Kaski D, Ulozas V. Subjective visual vertical assessment with mobile virtual reality system. Medicina. 2017; 53(6):394-402.

Chicago/Turabian Style

Ulozienė, Ingrida; Totilienė, Milda; Paulauskas, Andrius; Blažauskas, Tomas; Marozas, Vaidotas; Kaski, Diego; Ulozas, Virgilijus. 2017. "Subjective visual vertical assessment with mobile virtual reality system" Medicina 53, no. 6: 394-402.

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