All Publications

  • Awe Inducing Elements in Virtual Reality Applications: A Prospective Study of Hospitalized Children and Caregivers. Games for health journal He, E. M., Arshad, F., Li, B. S., Brinda, R., Ganesan, A., Zhang, L., Fehr, S., Renavikar, M., Rodriguez, S. T., Wang, E., Rosales, O., Caruso, T. J. 2024

    Abstract

    Background: Hospitalized pediatric patients and their caregivers often experience anxiety and fear, resulting in withdrawal and aggression. Despite virtual reality (VR) being a safe and effective anxiolytic, it is unknown what software design aspects contribute to its effectiveness. This prospective observational study evaluated which VR application elements increased awe, which is correlated with improved behavior and satisfaction. Methods: Patients aged 6 to 25 years and their caregivers at an academic pediatric hospital interacted with a custom VR application that compared design aspects, including environment, graphics fidelity, and presence of a motivational character. Outcomes investigated self-reported awe, vastness, accommodation, and engagement. Data were analyzed using repeated measure ANOVA tests and correlation analyses. Results: A total of 202 participants were enrolled, and 179 (88 pediatric patients, 91 adult caregivers) were included in the final analysis. A fictional environment was more effective at increasing awe in pediatric patients (P = 0.030) compared with a realistic environment. However, increased graphics fidelity was more effective at increasing awe in caregiver adults (P = 0.023) compared with low resolution graphics. Presence of a motivational character did not influence awe in either patients or caregivers (P = 0.432, P = 0.904, respectively). All measures of awe were positively correlated with application engagement (P < 0.005). Conclusion: In conclusion, when software developers design VR software for pediatric patients and their caregivers, fictional settings and increased graphic fidelity should be considered for pediatric patients and adults, respectively. Future studies will explore other VR elements in gameplay settings.

    View details for DOI 10.1089/g4h.2024.0050

    View details for PubMedID 39109578

  • Virtual Reality Facilitated Exercise Increases Sympathetic Activity and Reduces Pain Perception: A Randomized Crossover Study. American journal of physical medicine & rehabilitation Rodriguez, S. T., Makarewicz, N., Wang, E. Y., Zuniga-Hernandez, M., Titzler, J., Jackson, C., Suen, M. Y., Rosales, O., Caruso, T. J. 2024

    Abstract

    Both virtual reality (VR) and exercise reduce pain while avoiding the risks of traditional pharmacotherapy. The aim of this study was to assess how VR-facilitated exercise modulates sympathetic activity and pain perception.Healthy adult volunteers were randomized by hand dominance and then subjected to a standardized cold pressor test while experiencing a VR application. After a 5-minute washout, participants were crossed-over and repeated the test on their other hand while undergoing a VR-facilitated exercise application. Sympathetic activation, pain sensation, and pain tolerance data were collected identically during both conditions.110 participants were analyzed. Sympathetic activity increased in both conditions but was higher in the VR-facilitated exercise condition (p < 0.0001). Pain sensation scores were initially higher with VR-facilitated exercise but dropped below the VR-only condition by the end of the intervention (p = 0.0175). There were no differences in pain tolerance between conditions (p = 0.18).The decrease in pain perception with VR-facilitated exercise condition compared to VR alone indicates VR-facilitated exercise can be a useful tool for managing pain. Though this effect did not translate into higher pain tolerance, VR-facilitated exercise may be a useful intervention in the setting of physical therapy or for patients with chronic pain.

    View details for DOI 10.1097/PHM.0000000000002550

    View details for PubMedID 38842101

  • Understanding the Nuances of First-Generation College Students: How the Culture of College Factors Into Academic Success JOURNAL OF COLLEGE STUDENT DEVELOPMENT Rosales, O., Gutierrez, C., Padilla, A. M. 2024; 65 (1)

    View details for DOI 10.1353/csd.2024.a919350

    View details for Web of Science ID 001208364100008

  • Virtual reality facilitated exercise improves pain perception: A crossover study. Journal of clinical anesthesia Rodriguez, S. T., Makarewicz, N., Wang, E. Y., Zuniga-Hernandez, M., Titzler, J., Jackson, C., Suen, M. Y., Rosales, O., Caruso, T. J. 2023; 91: 111257

    Abstract

    STUDY OBJECTIVE: Both virtual reality (VR) and exercise are recognized for their analgesic and anxiolytic properties. The purpose of this study is to evaluate the ability of VR-facilitated exercise to modulate pain.DESIGN: Within-subject cross-over clinical trial.SETTING: The Stanford Chariot Program conducted this study at Lucile Packard Children's Hospital Stanford (LCPHS).PATIENTS: Healthy participants meeting inclusion criteria were recruited by volunteer solicitation from LCPHS.INTERVENTIONS: Participants were randomized by hand dominance and subjected to a standardized cold pressor test with no VR or exercise. After a 5-min wash-out period, participants repeated the test on their other hand while experiencing a VR-facilitated exercise condition. Pain sensitivity, pain tolerance, and sympathetic activation data were collected during both conditions.MEASUREMENTS: Pain sensitivity was scored 0-10 and collected every 30s. Pain tolerance was recorded as the duration a participant could endure the painful stimuli. Sympathetic activation was measured by skin conductance response density (SCRD) and recorded in 30s epochs by a biosensor. In all analyses, data were nested by participant.MAIN RESULTS: Forty-one participants completed both interventions. Pain sensitivity was reduced in the VR-facilitated exercise condition (p<0.0001). There was no difference in pain tolerance between conditions. While both conditions resulted in an increase in sympathetic activity, SCRD was higher at all time points in the VR-facilitated exercise condition.CONCLUSIONS: The reduction in pain sensitivity indicates VR-facilitated exercise results in improved pain perception. VR-facilitated exercise may be especially useful for patients with chronic pain or other conditions requiring physical therapy, where pain may be exacerbated by exercise.

    View details for DOI 10.1016/j.jclinane.2023.111257

    View details for PubMedID 37708601

  • Effects of bicultural competence and racial identity on intrinsic motivation: The mediating role of belonging to Native American tribal colleges CONTEMPORARY EDUCATIONAL PSYCHOLOGY LaFromboise, T., Rosales, O., Hosseini, Z. 2023; 74

    View details for DOI 10.1016/j.cedpsych.2023.102203

    View details for Web of Science ID 001024009100001

  • Prehospital Pediatric Emergency Training Using Augmented Reality Simulation: A Prospective, Mixed Methods Study. Prehospital emergency care Friedman, N., Zuniga-Hernandez, M., Titzler, J., Suen, M. Y., Wang, E., Rosales, O., Graham, J., D'Souza, P., Menendez, M., Caruso, T. J. 2023: 1-18

    Abstract

    ObjectivePediatric emergencies are high-stakes yet low-volume clinical encounters for emergency medical services (EMS) clinicians, necessitating innovative approaches to training. We sought to explore the acceptability, usability, and ergonomics of a novel augmented reality (AR) software for EMS crisis management training.MethodsThis was a prospective, mixed-methods study employing qualitative and quantitative analyses. We enrolled emergency medical technicians (EMTs) and paramedics at a municipal fire service in Northern California. We ran the Chariot Augmented Reality Medical simulation software (#details_redacted_for_peer_review) on the ML1 headset (Magic Leap, Inc., Plantation, FL), which enabled participants to view an AR image of a patient overlaid with real-world training objects. Participants completed a simulation of a pediatric hypoglycemia-induced seizure and cardiac arrest. Participants subsequently engaged in structured focus group interviews assessing acceptability, which we coded and thematically analyzed. We evaluated the usability of the AR system and ergonomics of the ML1 headset using previously validated scales, and we analyzed findings with descriptive statistics.ResultsTwenty-two EMS clinicians participated. We categorized focus group interview statements into seven domains after an iterative thematic analysis: general appraisal, realism, learning efficacy, mixed reality feasibility, technology acceptance, software optimization, and alternate use cases. Participants valued the realism and the mixed reality functionality of the training simulation. They reported that AR could be effective for practicing pediatric clinical algorithms and task prioritization, building verbal communication skills, and promoting stress indoctrination. However, participants also noted challenges with integrating AR images with real-world objects, the learning curve required to adapt to the technology, and areas for software improvement. Participants favorably evaluated the ease of use of the technology and comfortability of wearing the hardware; however, most participants reported that they would need technical support.ConclusionParticipants positively evaluated the acceptability, usability, and ergonomics of an AR simulator for pediatric emergency management training, and participants identified current technological limitations and areas for improvement. AR simulation may serve as an effective training adjunct for prehospital clinicians.

    View details for DOI 10.1080/10903127.2023.2224876

    View details for PubMedID 37318845

  • Cultural taxation or "tax credit'? Understanding the nuances of ethnoracially minoritized student labor in higher education ETHNIC AND RACIAL STUDIES Rosales, O., Schell, E. P., Gutierrez, C., Padilla, A. 2022

    View details for DOI 10.1080/01419870.2022.2143717

    View details for Web of Science ID 000884231000001