Stability and Workload of the Virtual Reality-Based Simulator-2

Deepan C. Kamaraj, Brad E. Dicianno, Harshal P. Mahajan, Alhaji M. Buhari, Rory A. Cooper

Research output: Contribution to journalArticlepeer-review


Objective: To assess the stability of clinicians' and users' rating of electric-powered wheelchair (EPW) driving while using 4 different human-machine interfaces (HMIs) within the Virtual Reality-based SIMulator-version 2 (VRSIM-2) and in the real world (accounting for a total of 5 unique driving conditions). Design: Within-subjects repeated-measures design. Setting: Simulation-based assessment in a research laboratory. Participants: A convenience sample of EPW athletes (N=21) recruited at the 31st National Veterans Wheelchair Games. Interventions: Not applicable. Main Outcome Measures: Composite PMRT scores from the Power Mobility Road Test (PMRT); Raw Task Load Index; and the 6 subscale scores from the Task Load Index developed by the National Aeronautics and Space Administration (NASA-TLX). Results: There was moderate stability (intraclass correlation coefficient between.50 and.75) in the total composite PMRT scores (P<.001) and the users' self-reported performance scores (P<.001) among the 5 driving conditions. There was a significant difference in the workload among the 5 different driving conditions as reflected by the Raw Task Load Index (P=.009). Subanalyses revealed this difference was due to the difference in the mental demand (P=.007) and frustration (P=.007) subscales. Post hoc analyses revealed that these differences in the NASA-TLX subscale scores were due to the differences between real-world and virtual driving scores, particularly attributable to the conditions (1 and 3) that lacked the rollers as a part of the simulation. Conclusions: Further design improvements in the simulator to increase immersion experienced by the EPW user, along with a standardized training program for clinicians to deliver PMRT in VRSIM-2, could improve the stability between the different HMIs and real-world driving.

Original languageEnglish (US)
Pages (from-to)1085-1092.e1
JournalArchives of Physical Medicine and Rehabilitation
Issue number7
StatePublished - Jul 1 2016
Externally publishedYes


  • Durable medical equipment
  • Process assessment (health care)
  • Rehabilitation
  • Reproducibility of results
  • Simulation training
  • Virtual reality exposure therapy
  • Wheelchairs

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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