Advanced Computational Intelligence Techniques for Virtual Reality in Healthcare

Studies in Computational Intelligence 875

Deepak Gupta Aboul Ella Hassanien Ashish Khanna   Editors

Advanced Computational Intelligence Techniques for Virtual Reality in Healthcare

Studies in Computational Intelligence Volume 875

Series Editor Janusz Kacprzyk, Polish Academy of Sciences, Warsaw, Poland

The series “Studies in Computational Intelligence” (SCI) publishes new developments and advances in the various areas of computational intelligence—quickly and with a high quality. The intent is to cover the theory, applications, and design methods of computational intelligence, as embedded in the fields of engineering, computer science, physics and life sciences, as well as the methodologies behind them. The series contains monographs, lecture notes and edited volumes in computational intelligence spanning the areas of neural networks, connectionist systems, genetic algorithms, evolutionary computation, artificial intelligence, cellular automata, self-organizing systems, soft computing, fuzzy systems, and hybrid intelligent systems. Of particular value to both the contributors and the readership are the short publication timeframe and the world-wide distribution, which enable both wide and rapid dissemination of research output. The books of this series are submitted to indexing to Web of Science, EI-Compendex, DBLP, SCOPUS, Google Scholar and Springerlink.

More information about this series at http://www.springer.com/series/7092

Deepak Gupta Aboul Ella Hassanien Ashish Khanna •

•

Editors

Advanced Computational Intelligence Techniques for Virtual Reality in Healthcare

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Editors Deepak Gupta Department of Computer Science and Engineering Maharaja Agrasen Institute of Technology Guru Gobind Singh Indraprastha University New Delhi, India

Aboul Ella Hassanien Faculty of Computers and Information Cairo University Cairo, Egypt

Ashish Khanna Department of Computer Science and Engineering Maharaja Agrasen Institute of Technology Guru Gobind Singh Indraprastha University New Delhi, India

ISSN 1860-949X ISSN 1860-9503 (electronic) Studies in Computational Intelligence ISBN 978-3-030-35251-6 ISBN 978-3-030-35252-3 (eBook) https://doi.org/10.1007/978-3-030-35252-3 © Springer Nature Switzerland AG 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Dr. Deepak Gupta would like to dedicate this book to his father Sh. R. K. Gupta, his mother Smt. Geeta Gupta, his mentors Dr. Anil Kumar Ahlawat, Dr. Arun Sharma for their constant encouragement, his family members including his wife, brothers, sisters, kids, and to my students close to my heart. Prof. (Dr.) Aboul Ella Hassanien would like to dedicate this book to his beloved wife Azza Hassan El-Saman. Dr. Ashish Khanna would like to dedicate this book to his mentors Dr. A. K. Singh and Dr. Abhishek Swaroop for their constant encouragement and guidance and his family members including his mother, wife and kids. He would also like to dedicate this work to his (Late) father Sh. R. C. Khanna with folded hands for his constant blessings.

Preface

We hereby are delighted to launch our book entitled Advanced Computational Intelligence Techniques for Virtual Reality in Healthcare. This volume is able to attract a diverse range of engineering practitioners, academicians, scholars, and industry delegates, with the reception of abstracts from different parts of the world. Around 25 full-length chapters have been received. Among these manuscripts, 11 chapters have been included in this volume. All the chapters submitted were peer-reviewed by at least two independent reviewers, who were provided with a detailed review proforma. The comments from the reviewers were communicated to the authors, who incorporated the suggestions in their revised manuscripts. The recommendations from two reviewers were taken into consideration while selecting chapters for inclusion in the volume. The exhaustiveness of the review process is evident, given a large number of articles received addressing a wide range of research areas. The stringent review process ensured that each published chapter met the rigorous academic and scientific standards. We would also like to thank the authors of the published chapters for adhering to the time schedule and for incorporating the review comments. We wish to extend my heartfelt acknowledgment to the authors, peer reviewers, committee members, and production staff whose diligent work put shape to this volume. We especially want to thank our dedicated team of peer reviewers who volunteered for the arduous and tedious step of quality checking and critique on the submitted chapters. Lastly, we would like to thank Springer for accepting our proposal for publishing the volume titled Advanced Computational Intelligence Techniques for Virtual Reality in Healthcare. New Delhi, India Cairo, Egypt New Delhi, India

Deepak Gupta Aboul Ella Hassanien Ashish Khanna

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About This Book

Advanced Computational Intelligence Techniques for Virtual Reality in Healthcare addresses the difficult task of integrating computational techniques with virtual reality and healthcare. The book presents world of virtual reality in healthcare, cognitive and behavioral training, understand mathematical graphs, human–computer interaction, fluid dynamics in healthcare industries, accurate real-time simulation, healthcare diagnostics, and so on. By presenting the computational techniques for virtual reality in healthcare, this book teaches readers to use virtual reality in healthcare industry, thus providing a useful reference for educational institutes, industry, researchers, scientists, engineers, and practitioners. New Delhi, India Cairo, Egypt New Delhi, India

Deepak Gupta Aboul Ella Hassanien Ashish Khanna

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Contents

World of Virtual Reality (VR) in Healthcare . . . . . . . . . . . . . . . . . Bright Keswani, Ambarish G. Mohapatra, Tarini Ch. Mishra, Poonam Keswani, Pradeep Ch. G. Mohapatra, Md Mobin Akhtar and Prity Vijay 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Virtual Reality Application in Medicine . . . . . . . . . . . . . . . . . . . 2.1 Medical Teaching and Training . . . . . . . . . . . . . . . . . . . . 2.2 Medical Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 Experimenting Medicine Composition . . . . . . . . . . . . . . . 3 Key Research Opportunities in Medical VR Technology . . . . . . . 4 Computational Intelligence for Visualization of Useful Aspects . . 4.1 General Guidelines for Patient Care . . . . . . . . . . . . . . . . . 5 Surgical VR and Opportunities of CI . . . . . . . . . . . . . . . . . . . . . 5.1 The JIGSAWS Model . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Human Computer Interface in CI Based VR . . . . . . . . . . . . . . . . 6.1 Computer-Aided Design (CAD) Repairing Imitated Model (Design for Artificial Body Part) . . . . . . . . . . . . . . . . . . . 6.2 Test and Treatment for Mental Sickness . . . . . . . . . . . . . . 6.3 Improvement for Treatment Safety . . . . . . . . . . . . . . . . . . 7 Advantages of VR Techniques . . . . . . . . . . . . . . . . . . . . . . . . . 8 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Towards a VIREAL Platform: Virtual Reality in Cognitive and Behavioural Training for Autistic Individuals . . . . . . . . Sahar Qazi and Khalid Raza 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.1 VIREAL: Decoding the Terminology . . . . . . . . . . . 1.2 Historical Background of VIREAL . . . . . . . . . . . . 1.3 Day-to-Day Applications of VIREAL . . . . . . . . . . .

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Autism and VIREAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1 Common Teaching Techniques for Autistic Children . . . . . 2.2 Qualitative and Quantitative Teaching Method – PECS . . . . 2.3 From VIREAL Toilets to Classroom: VR Design and Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Social and Parental Issues Related to VIREAL . . . . . . . . . . . . . . . 4 Computational Intelligence in VIREAL Platforms . . . . . . . . . . . . . 4.1 Where Do VIREAL and Machine Learning Intersect? . . . . . 4.2 SLAM for VIREAL Environments . . . . . . . . . . . . . . . . . . . 4.3 VIREAL on Mobile: Mobile App Developments for Autism 4.4 Mind Versus Machine: Practicality of AI in Autism . . . . . . 4.5 Limitations of Computational Intelligence in VIREAL . . . . 5 Future Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Assisting Students to Understand Mathematical Graphs Using Virtual Reality Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Shirsh Sundaram, Ashish Khanna, Deepak Gupta and Ruby Mann 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.1 Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 Scope of VR in Education . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Literature Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Results and Discussions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Conclusion and Future Scope . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Short Time Frequency Analysis of Theta Activity for the Diagnosis of Bruxism on EEG Sleep Record . . . . . . . . . . . . . . . . . . . . . . . . . . . . Md Belal Bin Heyat, Dakun Lai, Faijan Akhtar, Mohd Ammar Bin Hayat and Shajan Azad 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Stages of Sleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1 Non-rapid Eye Movement (NREM) . . . . . . . . . . . . . . . . . . . . 2.2 Rapid Eye Movement (REM) . . . . . . . . . . . . . . . . . . . . . . . . 3 History of Sleep Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1 Classification of Sleep Disorder . . . . . . . . . . . . . . . . . . . . . . . 4 Electroencephalogram (EEG) Signal . . . . . . . . . . . . . . . . . . . . . . . . . 4.1 EEG Generation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 Classification of EEG Signal . . . . . . . . . . . . . . . . . . . . . . . . .

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Subject Details and Methodology . . . . . 5.1 Welch Method . . . . . . . . . . . . . 5.2 Hamming Window . . . . . . . . . . 6 Analysis of the EEG Signal . . . . . . . . . 7 Results . . . . . . . . . . . . . . . . . . . . . . . . 8 Future Scope of the Proposed Research 9 Conclusion . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . .

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Hand Gesture Recognition for Human Computer Interaction and Its Applications in Virtual Reality . . . . . . . . . . . . . . . . . . . . Sarthak Gupta, Siddhant Bagga and Deepak Kumar Sharma 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Process of Hand Gesture Recognition . . . . . . . . . . . . . . . . . . 2.1 Hand Segmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 Contour Matching . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 Hand Tracking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 Feature Extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Latest Research in Hand Gesture Recognition . . . . . . . . . . . . 4 Applications of Virtual Reality and Hand Gesture Recognition in Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Hand Gesture Recognition Techniques . . . . . . . . . . . . . . . . . . 5.1 Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2 Tracking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3 Recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Further Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Fluid Dynamics in Healthcare Industries: Computational Intelligence Prospective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vishwanath Panwar, Sampath Emani, Seshu Kumar Vandrangi, Jaseer Hamza and Gurunadh Velidi 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 A CI Critical Review in Relation to Fluid Dynamics in Healthcare Industries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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A Novel Approach Towards Using Big Data and IoT for Improving the Efficiency of m-Health Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Kamta Nath Mishra and Chinmay Chakraborty 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 2 Literature Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

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Proposed Architecture of IoT Based m-Health System 3.1 IoT Components . . . . . . . . . . . . . . . . . . . . . . . 3.2 The Architecture of the Internet of Things . . . . 3.3 Proposed Model . . . . . . . . . . . . . . . . . . . . . . . 4 Discussions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Using Artificial Intelligence to Bring Accurate Real-Time Simulation to Virtual Reality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deepak Kumar Sharma, Arjun Khera and Dharmesh Singh 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Applications of VR in Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . 2.1 Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 Surgery Training and Planning . . . . . . . . . . . . . . . . . . . . . . . 2.3 Diagnostics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 Treatment of Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Rendering in Virtual Reality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1 Virtual Reality and 3D Game Systems . . . . . . . . . . . . . . . . . 3.2 Human Vision and Virtual Reality . . . . . . . . . . . . . . . . . . . . 3.3 Virtual Reality Graphics Pipeline . . . . . . . . . . . . . . . . . . . . . 3.4 Motion to Photons Latency . . . . . . . . . . . . . . . . . . . . . . . . . 3.5 Improving Input Performance: Using Predictions for Future Viewpoints Estimation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6 Improving the Rendering Pipeline Performance . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Application of Chicken Swarm Optimization in Detection of Cancer and Virtual Reality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ayush Kumar Tripathi, Priyam Garg, Alok Tripathy, Navender Vats, Deepak Gupta and Ashish Khanna 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1 Machine Learning Methods . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 Feature Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 Genetic Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1 Proposed Chicken Swarm Optimisation . . . . . . . . . . . . . . . . 3.2 Implementation of the Proposed Method . . . . . . . . . . . . . . . 4 Results and Discussions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Comparison . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 Cervical Cancer (Risk Factors) . . . . . . . . . . . . . . . . . . . . . . 5.2 Breast Cancer (Wisconsin) . . . . . . . . . . . . . . . . . . . . . . . . . .

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6 Conclusions and Future Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 Computational Fluid Dynamics Simulations with Applications in Virtual Reality Aided Health Care Diagnostics . . . . . . . . . . Vishwanath Panwar, Seshu Kumar Vandrangi, Sampath Emani, Gurunadh Velidi and Jaseer Hamza 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 A Discussion and Critical Review of CFD Simulations with Applications in VR-Aided Health Care Diagnostics . . . . 3 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Data Analysis and Classification of Cardiovascular Disease and Risk Factors Associated with It in India . . . . . . . . . . . . . . . . . . . . . . . . . . . Sonia Singla, Sanket Sathe, Pinaki Nath Chowdhury, Suman Mishra, Dhirendra Kumar and Meenakshi Pawar 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Prevalence and Mortality Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 A Rate of Cardiovascular Ailment . . . . . . . . . . . . . . . . . . . . . . . . . 4 Spread of Ailment with Age and Beginning of Ailment . . . . . . . . . 5 Risk Ailments of Cardiovascular Infirmities . . . . . . . . . . . . . . . . . . 5.1 Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2 Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3 Diet and Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.4 The Abundance of Sodium . . . . . . . . . . . . . . . . . . . . . . . . . 5.5 Air Pollution Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.6 Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7 Ethnicity or Race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.8 Low Financial Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.9 Psychosocial Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.10 Diabetes and Glucose Intolerance . . . . . . . . . . . . . . . . . . . . . 6 Predictive Data Analysis of Cardiovascular Disease in an Urban and Rural Area for Males and Females . . . . . . . . . . . . . . . . . . . . . 7 Classification of Heart Disease by Naive Bayes Using Weka Tools . 8 Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Various Tests Available for Heart Check up . . . . . . . . . . . . . . . . . . 10 Virtual Reality in Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Implantable Cardioverter Defibrillators . . . . . . . . . . . . . . . . . . . . . . 12 Use of Certain Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Cardiovascular Diseases Types . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Prevention Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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About the Editors

Dr. Deepak Gupta is Eminent Academician and plays versatile roles and responsibilities juggling between lectures, research, publications, consultancy, community service, Ph.D., and postdoctorate supervision, etc. With 12 years of rich expertise in teaching and two years in industry, he focuses on rational and practical learning. He has contributed massive literature in the fields of human–computer interaction, intelligent data analysis, nature-inspired computing, machine learning, and soft computing. He has served as Editor-in-Chief, Guest Editor, and Associate Editor in SCI and various other reputed journals. He has completed his postdoc from Inatel, Brazil, and Ph.D. from Dr. APJ Abdul Kalam Technical University. He has authored/edited 35 books with national/international-level publishers (Elsevier, Springer, Wiley, Katson). He has published 87 scientific research publications in reputed international journals and conferences including 39 SCI Indexed Journals of IEEE, Elsevier, Springer, Wiley, and many more. He is the convener and organizer of “ICICC” Springer Conference Series. Dr. Aboul Ella Hassanien is Founder and Head of the Egyptian Scientific Research Group (SRGE) and Professor of Information Technology at the Faculty of Computer and Information, Cairo University. He is Ex-Dean of the faculty of computers and information, Beni Suef University. He has more than 800 scientific research papers published in prestigious international journals and over 30 books covering such diverse topics as data mining, medical images, intelligent systems, social networks, and smart environment. He won several awards including the Best Researcher of the Youth Award of Astronomy and Geophysics of the National Research Institute, Academy of Scientific Research (Egypt, 1990). He was also granted a scientific excellence award in humanities from the University of Kuwait for the 2004 Award and received the superiority of scientific—University Award (Cairo University, 2013). Also, he honored in Egypt as the best researcher in Cairo University in 2013. He was also received the Islamic Educational, Scientific and Cultural Organization (ISESCO) Prize on Technology (2014) and received the State Award for Excellence in Engineering Sciences in 2015. He was awarded the medal of Sciences and Arts of the first class by the President of the Arab Republic of Egypt, 2017. xvii

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About the Editors

Dr. Ashish Khanna is a highly qualified individual with around 15 years of rich expertise in teaching, entrepreneurship, and research and development with specialization in Computer Science Engineering Subjects. He received his Ph.D. degree from National Institute of Technology, Kurukshetra. He has completed his M. Tech. in 2009 and B. Tech. from GGSIPU, Delhi, in 2004. He has published many research papers in reputed journals and conferences. He also has papers in SCI and Scopus Indexed Journals including some in Springer Journals. He is Co-author in 10 textbooks of various engineering courses. He is Guest Editor in many special issues of IGI Global, Bentham Science, and Inderscience Journals. He is convener and organizer in ICICC-2018 Springer conference. He is also a successful entrepreneur by originating a publishing house named as “Bhavya Books” having 250 solution books and around 50 textbooks. He has also started a research unit under the banner of “Universal Innovator”.

World of Virtual Reality (VR) in Healthcare Bright Keswani, Ambarish G. Mohapatra, Tarini Ch. Mishra, Poonam Keswani, Pradeep Ch. G. Mohapatra, Md Mobin Akhtar and Prity Vijay

Abstract Virtual Reality (VR) technology is widely used in scientific, engineering and educational applications all over the world. The technology is also widely advancing day by day, but, the applications in medical fields are limited. Medical technology is one of the most advancing technologies which are evolving due to unlimited need of health requirement. Further, Computational Intelligence (CI) contributed much promising aspects of many healthcare practices such as treatment, disease diagnosis, direct follow-ups, rehabilitation setups, preventive measures and administrative management practices etc. Dental sciences have witnessed many developments. In many

B. Keswani Department of Computer Applications, Suresh Gyan Vihar University, Mahal Jagatpura, Jaipur, India e-mail: [email protected] A. G. Mohapatra (B) Department of Electronics and Instrumentation Engineering, Silicon Institute of Technology, Bhubaneswar, Odisha, India e-mail: [email protected] T. Ch. Mishra Department of Information Technology, Silicon Institute of Technology, Bhubaneswar, Odisha, India e-mail: [email protected] P. Keswani Akashdeep PG College, Jaipur, Rajasthan, India e-mail: [email protected] P. Ch. G. Mohapatra PCG Medical, Charampa, Bhadrak, Odisha, India e-mail: [email protected] M. M. Akhtar Riyadh Elm University, Riyadh, Saudi Arabia e-mail: [email protected] P. Vijay Suresh Gyan Vihar University, Mahal Jagatpura, Jaipur, India e-mail: [email protected] © Springer Nature Switzerland AG 2020 D. Gupta et al. (eds.), Advanced Computational Intelligence Techniques for Virtual Reality in Healthcare, Studies in Computational Intelligence 875, https://doi.org/10.1007/978-3-030-35252-3_1

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ways, VR based surgery practices are governed by computer assistance. The conjunction of these two technological aspects to a larger extent can solve various issues in modern healthcare systems. With the introduction of newer healthcare technology, the medical issues nevertheless happen to be overcome. Nevertheless the scope in this kind of study is boundless. Keywords Virtual reality · Computational intelligence · Medical technology · Healthcare systems

1 Introduction Virtual Reality (VR) is a leading and wide range aspect of Information Technology (IT). VR can represent a three dimensional (3D) spatial concept with aid of a computer and other gadgets. It can stimulate variety of sensations such as touch, smell, vision and hearing and provide the stimulated output to a user. Using VR enabled equipment a user can interact, control and manage objects that belong to virtual environment.In this context, the VR system can be referred as an artificial and a 3D spatial world from a user perception. The ability of portraying 3D information, user trait towards human computer interfacing, immersing the user in the virtual world, makes VR a class apart from other simulating systems [1]. The VR system stand on 3 I’s namely Interaction, Immersion and Imagination that are complementary to each other (Fig. 1). Depending on the 3 I’s the VR system can be divided into Desktop, Distributed, Immersive and Augmented Virtual Reality systems. Especially, VR in medicine is supposed to have a higher accuracy rate, greater interactivity, and improved reality. So, the Desktop VR has very applications in medicine [2]. Similarly, the Immersive

Fig. 1 A typical VR headset [3]

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VR has Head Mounted Display (HMD) and data gloves thereby isolating the user vision and other sensations, making the user a participant in the internal system. In Augmented VR, a virtual image is superimposed on a real object thus enabling the user to get real time information. The Distributed VR is a network of virtual environments, which can connect a large number of users across virtual environments on various physical locations through communication networks [3–5].VR and ARis widely used in healthcare [6]. Currently, VR and AR applicability in healthcare is as below: • Training in surgical environment • Healthcare Education • Psychic health management such as Post Traumatic Stress Disorder (PTSD), Obsessive Compulsion Disorder (OCD), Stress Management, Phobias • Therapy such as Autistic Spectral Disorder, Occupational Therapy, Sensory Processing Disorder (SPD) • Neuroplasticity in case of Neural Rehabilitation, Cognitive behavior (Fig. 2). Figure 3 provides a report provided by Tractica, which is a forecast of global market between 2014 and 2020 that signifies annual shipment unit and revenue of VR hardware and other related content in various industrial sectors taking HMDs and VR equipment such as motion capture cameras, displays, projectors, gesture tracking devices and related application software [7]. The figure also predicts the growth in the software and content creation tool. The virtual Surgeon training and VR module

Fig. 2 Predicted market size of VR and AR [57]

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Fig. 3 Predicted market size of VR hardware and software [7]

for nurses are examples of VR/AR applications to justify the above. Moreover, the British Startup Medical Realities have its own training tool for armature professionals to be familiar with surgery from a surgeon point of view [8]. Similarly, to adopt the measures so as to curb the risk to a patient VR Healthnet is creating a VR module for nurses and medical professionals [9]. More than a century, virtual consultation by the General Practitioners was a very common; telephonic consultation was a part of virtual consultation. But, this kind of consultation lead towards disappointment due to shorter consultation and longer waiting time. There was a 30% increase in waiting time in 2016 [10]. Similarly, the UK had nearly 90% of the consultations that lasted up to 15 min [11]. That’s how the telemedicine became popular in the recent years and has become of much interest in managing chronic diseases. Recent studies justify that patients suffering from chronic diseases such as blood pressure, cholesterol and diabetes have got significant improvement with consultations using video services and e-mails [12]. In addition to this, virtual consultation is also helpful in curbing mental ailments, especially among the youngsters [10]. The solution in this case is amalgamation of traditional Healthcare and information technology for health; combining referred as Healthcare Information and Communication Technology (ICT). So, eHealth is the answer, which is of course the ICT in healthcare. mHealth, component of eHealth uses Mobile Phone and related services

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Fig. 4 Schematic figure of VR-Health [12]

such as short messaging service (SMS), 3G & 4G mobile technologies using general packet radio service (GPRS), global positioning system (GPS), and Bluetooth technology at the core [13]. However, there is a little bit of difference being mobile and wireless. Wireless health solutions will not always be mobile and vice versa. Mobile technology uses the core technologies discussed above, but Wireless Health integrates technology to customary medical practices such as diagnosis, treatment of illness and monitoring. Similarly, uHealth (the Ubiquitous Health) is capable of providing healthcare solution to anyone anywhere anytime using various broadband technologies, based on many ubiquitous applications [14, 15]. But the uHealth does not have AR and VR technologies. Finally, looking at various aspects such as increase in VR/AR technology and applications, accomplishments in eHealth and mHealth, it is inferred that new innovation in VR/AR healthcare application model is absolutely inevitable. New innovative models in VR/AR is definitely going to help patients and nonetheless the healthcare staff members. Figure 4 justifies the schematic distribution of VR-Health.

2 Virtual Reality Application in Medicine The usability of Virtual Reality (VR) technologies is simply limitless. Pertaining to the field of medicine, the lure of VR technologies are primarily used in expressing 3D space and interactive surgical environment. Moreover, VR has a high significance role in enabling people towards perpetual and sensible information on a measurable and reliable virtual environment, which is useful towards making a clearer view on VR, producing innovation in VR and active information acquisition. Hence, VR technology has a pragmatic superiority in medicine in term of study, surgery training, pharmaceutical tests, diagnosis and treatment. The major aspects of VR technology in medicine are discussed below [16, 17].

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2.1 Medical Teaching and Training VR is useful in learning new technology and methodology. Eventually, VR will take the place of traditional medical experiments and will impart new teaching mechanism. VR uses multi-attribute data that creates and efficient mode for a practitioner to mastering this new technology.

2.1.1

Medical Teaching

For the medial practitioners, different sensation information such as hear, touch and smell and dynamic 3D objects that are lively, can be combined using VR technology and this can be used in classroom training where these things can be felt without their physical existence; human body structure, heart structure and cause of a disease can be found out in this technique. In this process a 3D model of a human body can be created and anyone can get inside the model and can see the muscle, skeletal structure and other organ systems and working and status. Moreover, the condition of an organ can be realized and proper ailment procedure can also be defined. In other words, VR can provide an alternative and interactive process of studying the human anatomy. For example, the Internet resource for surgical education, Vesalius, of Duke University and the brain atlas of Harvard University are considered as the most famous virtual medical multimedia teaching resources [18].

2.1.2

Virtual Surgery Training

During surgical process, 80% of failures occur due to human error thereby making precision in surgery as a priority. The surgery training is absolutely a traditional classroom based process. However, in the classroom the condition of a patient may vary depending on various unforeseen factors resulting in an inappropriate training procedure, which can make the training procedure less effective. In addition to this, the traditional process takes more time, incurs more cost and decrease the operation quality which is not suitable for the patient [19]. On the contrary, VR technology can provide a simulated workbench environment for the doctors. With the help of this, doctors can have a 3D image of human body. Moreover, doctors can learn how they can deal with the actual clinical procedure and can practice surgery on a virtual human body. In addition a doctor can feel the experience of this virtual environment as real with the help of the VR technologies [2]. Taking the feedback of expert professionals the VR system can also provide new dimensions to the surgery system. However, this process can be made recursive. The VR system can evaluate a surgical procedure once complete by considering various parameters and standards. This kind of system are risk free, cost effective, recursive, and self-assistive and can help professional towards improving their skillset [19]. This is given in Fig. 5.

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Fig. 5 Minimally invasive surgical trainer (MIST) system [19]

2.2 Medical Treatment Conventional surgery methods says that the patient statistics are acquired using X-ray images, MRI & CT scanning and then these images are combined to 3D image by image-processing. A doctor recreates the whole procedure in its brain before doing the actual surgery. During the surgery also a doctor need to memorize all the 3D images. In this scenario, a qualitative surgical procedure is expected is the doctor is skillful and experienced [6, 17]. VR technology will be of great help in this kind of scenario by proving its capacity by supporting all channels of the 3D display and shared surgery and thereby increases success rates in complicated surgeries [20].

2.2.1

Analysis and Data Acquisition

VR technology combines 2D images obtained from sources such as CT, PET and MRI to hi-fi images. To establish a 3D model the 2D model is treated, surface is rebuilt and virtual endoscope data are processed. This will help a doctor to investigate a patient data by using 3D images. Moreover, a doctor can also investigate more inside

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a 3D virtual model of a patient that are far reach of an endoscope. This however, is helpful towards proper analysis of sick organs and surrounding tissues so as to avoid redundant invasive diagnosis [21].

2.2.2

Designing a Trial Surgery Program

A surgical simulator sets up a 3D model depending on the actual patient data before a surgery. Next, a doctor, who will be carrying out the surgery, performs a trial surgery in a computerized virtual environment as per a planned surgery procedure. Complicated situations are handled by taking extra precautions like testing edge and angle of the knife. These steps are necessary to produce a flawless operation procedure. Concurrently, all participating members of the surgical group can interchange ideas based on the information they are getting from the 3D surgical environment, where the surgery is done by a computer. Thereby the coordination of the surgical group is enhanced [21].

2.2.3

Result Prediction in Surgery

VR is useful towards guiding and monitoring a surgical process. A patient’s 3D model is created initially and a scanned image is added to the model. This enables a doctor integrate the newly captured data to the patient’s 3D model and predict the result in a real environment [16].

2.2.4

Distance Medical Treatment

This technology is used to broaden the scope of medical treatment with the help of broadband networks and improvises the expertise of a professional to the fullest. Distance diagnosis and distance operations are the two major usage of the distance medical treatment. The distance diagnosis enables a professional to consult to a patient at a distance place remotely using its computer. This process is just like an onsite inspection. In this way the medical services can be rendered to more people. The distance operation, in this context, is used to instruct a local doctor to smoothly conduct a surgery. Distance Medical System when combined with improvised imaging system becomes an efficient mean for training of medical practitioners. Using this academic conferences can be relayed, surgeries can be demonstrated and medical courses can be delivered without detaching medical professional from their regular activities. Satellite technology, broadband network, image processing techniques will aid the distance medical treatment to a perfection.

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2.3 Experimenting Medicine Composition New drug creation is one of the latest applications using VR. Creating new types of drugs is the new era of application in VR. A molecule is complicated in its own structure and the 3D structure is difficult enough to translate it to a 2D display. Using VR the natural and visible 3D environment of molecular structure of compound can be viewed where the interaction traits of a molecule can be determined. VR however provides an opportunity to establish the molecular structure of compound medicine through the provision of a natural and visible 3D environment where the interaction traits of a molecule can be determined. The characteristic of the atoms can also be studied. Figure 6 shows how the UNC can use ceiling mounted Argonne Remote Manipulator (ARM) to test receptor sites for a drug molecule. The medicine once successfully developed in a virtual environment now can be tested in a virtual environment (a virtual body). Effectiveness of the medicine is provided to a computer. A virtual patient (the virtual body) will try the medicine. Physiological reactions of the virtual body will appear under the medicinal action. However, the process of testing a newly designed drug on a virtual patient will speed Fig. 6 The GROPE system [19]

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up the testing process, which has a to stage significance such as cost effectiveness and harm of the new drug on human body.

3 Key Research Opportunities in Medical VR Technology VR in medicine can be termed as the second generation of it. Traditionally 3D scientific visualization in aerospace, geological survey, computer-aided designing and manufacturing (CAD/CAM), transportation, and other nonmedical fields are involved in the research. With the increasing power of computer processing and virtual realism, number of medical applications are emerging in VR in medicine. In VR a person can be viewed as a 3D dataset that can represent a real person. Simulator in academic training, diagnosis using virtual endoscopy are the upcoming research areas in VR in the 21st century VR is a new pathway in medicine. But, there are areas that need to be addressed. Real-time 3d segmentation, interactive clinical system, image segmentation and fusion with Digital Signal Processing (DSP), high volume data transmission and storage and use interface are some of the areas. The virtual realization in surgery started dated back in the 1980s. Figure 7 shows the first ever VR system created by Delp and Rosen for tendon transplant of the lower leg as an alternative surgery process [22]. The very first surgery simulator of abdomen was created by Satava [23] in 1991 (Fig. 8). it used organ images created using simple graphics drawing program Being not so very interactive and realistic the simulators provided an opportunity to explore more and practice in surgical procedures. Merrill of High Techsplanations successfully created a sophisticated graphical version of human torso with organs that simulated physical properties such as bending or stretching when pushed and pulled or edges retracting when cut as given in Fig. 9 [24]. This was a landmark even in 1994 release of the National Library of Medicine’s “Visible Human” project under Dr. M. Ackerman that provided images that were reconstructed from an actual person’s data set. Spitzer and Whitlock of the University of Colorado created a virtual cadaver from 1871 slices and 1 mm thick and were digitized and stored [25]. While condensing there was no photorealism because the whole computing power was vested in image processing. The image achieved were not realistic. Much of the processing were wasted in tissue properties, bleeding, wounding, and instrument interaction. Dr. J. Levy designed a hysteroscopy surgical simulator with a simple haptic device, patient specific anatomy and pathology in 1995. This enabled doctors to be hand on with same virtual pathology at par at with a patient. In case of a complicated anatomy a realistic image with tissue properties and haptic input is achieved like in the case of central venous catheter placement simulator (Fig. 10) by Higgins of HT Medical, Inc. [26]. Boston Dynamics Inc. with Phantom Haptic Device introduced a surgical simulator with high fidelity haptic in 1996 that focused on anastomoses, ligating and dividing, etc. rather than full procedures [27]. Moreover, simulators of

World of Virtual Reality (VR) in Healthcare Fig. 7 Lower limb simulator to evaluate tendon transplant. Courtesy of Dr. S. Delp and J. Rosen, MusculoGraphics, Inc., Evanston, IL. [22]

Fig. 8 Early surgical simulation of the abdomen using simple graphics drawing programs [23]

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Fig. 9 Improved graphic rendering of human torso, which includes organ properties [24]. Courtesy of J. Merril, High Techsplanations, Inc., Rockville, MD.

Fig. 10 Central venous catheter placement simulator for training [27]. Courtesy of Dr. G. Higgins, HT Medical, Inc., Rockville, MD.

catheter systems with balloon angioplasty and stent placement are being developed for catheter based endovascular therapy (Fig. 11). Simulators are having four different levels. These simulators are now ready to be inducted to the medical academia where the matching capabilities of the simulators can be implemented. Levels are as below: • Simulators with needle like needle insertion in vein, catheter placing in central venous, tap in spine, biopsy of lever. • Simulator with scope type where the scope (the movement of control handle) can change the view on monitor; like that of an angioplasty. • Task based simulators with single or multiple instruments like anastomoses, cross clamp. • Simulators with complete surgery procedures.

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Fig. 11 Angioplasty catheter in blood vessel [27]. Courtesy of G. Merrill, HT Medical, Inc., Rockville, MD.

These kind of simulators always provide a value added service whenever there is a need of technical stand point. However, matching the curriculum with technology is of higher significance now a days. The primary focus here is to make a professional to be an expert in the instruments and in anastomoses. A professional expects a realistic model from the technology rather than being getting hands on using a simulator. However, this quotient will increase with the increase in computational power and likewise there will be an increase in the level of realism. With the development in the technology of surgical simulation, real data from a patient that has been captures using VR and ICT, the diagnostic procedure can now be performed on information collected without invasive or minimally invasive procedures applied to a patients; Virtual Endoscopy being an example in this case. Endoscopic procedures are a great applicability of this kind of procedure. However, this can also be applied in areas not directly related to endoscopic procedures. Areas such as internal portion of the eye and ear, which is generally not accessible using an instrument can now be accessed using this technology. Virtual Endoscopy can also perform a regular CT scan of a concerned body part keeping various organs and tissues aside. Using advanced algorithm such as a Flight Path algorithm, a organ can be superimposed with a resulting image being comparable to performing the examination with a video endoscope [28]. Lungs, stomach, uterus, sinus and many more organs are being successfully examined (Fig. 12). Organs such as inner ear, ganglion are getting explored (Fig. 13) [29]. A resolution of 0.3 mm is enough to diagnose irregularity like ulcer, polyps and cancer, which change the surface. Usually, the distortion in the surface are generic texture maps. Hence, anatomy like infection, ischemia, and superficial cancers are not diagnosed properly. A look up table correlating Hounsfield units of a CT scan with organ-specific color and texture can be verified. After solving the real-time registrant and accuracy a virtual organ can have proper anatomy with precise coloring. Hence, virtual endoscopy is useful in diagnosis. Energy directed methods are useful in case of total noninvasive treatment. Cryotherapy can heal using protein denaturing. Data

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Fig. 12 Virtual colonoscopy with internal view of the transversecolon [29]. Courtesy of Dr. R. Robb, Mayo Clinic, Rochester, MN.

Fig. 13 Virtual endoscopy of the inner ear with view of semicircular canals, chochlea, and associated structures [29]. Courtesy of Dr. R. Robb, Mayo Clinic, Rochester, MN.

fusion and stereo taxi are useful by any physician to augment precision location in real-time. Usually, a physician’s chamber has many components like CT scanners, MRI machines, Ultrasound devices and many more. The main objective of these devices is to capture patient data. It is possible that by the time a patient takes a chair beside a physician, a 3D image of the patient will appear in the desktop of the physician (Fig. 14). This visual integration of information are acquired by the scanners in the physician’s chamber. Now, if the patient asks for a problem in the right flank, the doctor can rotate the image and get relevant information. Each pixel of the image stores patient data and eventually creates a new Medical Avatar for a patient. Any such image contains anatomic data, physiological data and historical data of a patient. Information now can be directly searched from the image database instead of searching volumes of written materials. Images are useful in any stage of medical

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Fig. 14 Full 3-D suspended holographic image of a mandible [29]. Courtesy of J. Prince, Dimensional Media Associates, New York.

treatment such as pre-operative procedure and post-operative procedure, analysis of patient data. The patient information can also be shared irrespective of time and place.

4 Computational Intelligence for Visualization of Useful Aspects Earlier Clinical decision support systems (CDSS) was in use as an AI tool for medicine. CDSS used to take symptoms of a disease and demographic information. In the 70s CDSS could diagnose bacteria causing infection and could recommend antibiotics [30]. Mycin was used as a rule based engine. David Heckerman developed Pathfinder, which used Bayesian networks [31]. Pathfinder was a graphical model which could encode probabilistic relationships among variables of interest [31]. It was very helpful in diagnosing lymph-node diseases. Medical imaging like CAD for tumors and polyps also implement AI. This kind of imaging are helpful in mammography, cancer diagnosis, congenital heart diseases and various artery defects [32]. AI and Machine Learning (ML) can be used to create models based on a large patient data; called as population. These models can make real-time predictions like risk, incumbency of a disease and can provide alert at real-time as well [33–35]. These models take huge amount of records collected from ICUs on a regular basis [36]. Neural Network (NN) and decision tree algorithms are used as classifiers of patient state to fire an alert. Time Series Topic Model (a hierarchical Bayesian model), developed by Suchi Saria, which is a physiological assessment for new born infant

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that captures time-series data of a new born in first three hours [34]. This model accurately estimated the risk of infant being infected and risk of cardiopulmonary complications. Physiologic parameters have higher potential predictive capability than that of invasive laboratory processes thereby encouraging study of non-invasive neonatal care [17].

4.1 General Guidelines for Patient Care The advancement of technology pertaining to AI and ML signify the potential of improving patient care. These models concentrate on prediction problems like prediction using discrete-valued attribute and regression to predicting a real valued attribute. These models are useful for specific diseases and it will be considering a small population of data only. Hence, the bigger challenge here is crate models that would be taking large population data and the model would be able to detect problems like automatically. Also, the model would be able to find threats like hospital acquired disease, suboptimal patient care and invent new way of patient care. Question Answering (QA) and Large-scale Anomalous Pattern Detection (LAPD) are the new AI tools having great potential to overcome the above mentioned challenges. IBM and Carnegie Mellon University have developed DeepQA for general QA and can be integrated to IBM Watson [37]. IBM and Memorial Sloan Kettering Cancer Center are designing a tool to diagnose and recommend treatment for various types of cancer. IBM Watson provides probabilistic approach for doctors to take evidence-based decisions. This is also going to be helpful towards learning from user interaction [38]. In this context, Semantic Research Assistant (SRA) is also another QA system pertains to medical domain. SRA creates knowledge base that answers queries from doctors. It provides answers using medical facts, rules and patient records. It is now in use for cardiothoracic surgery, percutaneous coronary and such other diseases. SRA can answer such queries in minutes [39].

5 Surgical VR and Opportunities of CI Surgical motion sensing in real-time is current trend now. Recent developments in this field is the automatic capture of motion of a surgeon and implementing this tracking and training system to a robot. Surgical simulators are available sensing system and recording system so as to record the automatic surgical motion [40– 42]. Thus, huge opportunity like automatic object analysis and training progress of a surgery has been created in this field. This technology is helpful for a doctor to acquire more skill thereby decreasing complications in case of a patient [43]. The automated surgery skill is highly important in healthcare and it is an impregnable step towards building surgical data science [44].

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5.1 The JIGSAWS Model Primarily, the surgical skill evaluation has four objectives: (1) skill evaluation, (2) gesture classification, (3) gesture segmentation and (4) task recognition. Spatiotemporal characteristic by two-thirds power law [45] and the one-sixth power law [46] is used for extracting features from kinematic data. In the similar context, reinforcement learning is also useful in enhancing skill [47]. Recorded video data can be input to a deep learning system to estimating position and accuracy of a surgical robot [48–50]. Primarily, a surgical process is dependent on kinematic data. To classify a surgical task, k-nearest neighbor classifier can be used with Dynamic Time Wrapping [51, 52]. Similarly, boundaries and classification of gesture are required for gesture classification. Spatio-Temporal Features and the Linear Dynamical System (LDS) are used to classify gesture [53]. LDS is able to classify gestures in surgery using the kinematic data. This condition is tested with Gaussian Mixture Models. Dynamic Time Warping is also helpful in gesture classification. In this process an auto-encoder is used with Dynamic Time Wrapping for alignment of the extracted feature. Figure 15 demonstrates trials that last for up to 2 min. A trial is signified by kinematic data (master and slave manipulator) of a surgical robot and is recorded at 30 Hz. The data has 76 variables signifying motion, position and velocity (master and slave manipulator). This is the JIGSAW dataset and were manually segmented to 15 surgical gestures. The system is also able to synchronize video of the trial to kinematic data. Figure 16 shows, for the Suturing task of the JIGSAWS dataset, the two individual 5th trials of subjects B (Novice) and E (Expert), using (x, y, z) coordinates for the right hand.

6 Human Computer Interface in CI Based VR A virtual environment should provide real-life image and sense for a proper interactive system. There is a constant thrive in image processing to improve the quality of

Fig. 15 Snapshots of the three surgical tasks in the JIGSAWS dataset (from left to right): suturing, knot-tying, needle-passing [58]

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Fig. 16 The contactless control interface (Leap Motion) (top) and the RAVEN-II robot (bottom) for surgical training [59]

medical images [2]. The knowledge about Sensation/Sensory mechanism of a normal human being is naïve. For example, the analysis of a tactile sensory is very complicated. Hence, touch/sensory devices are only in prototype stages. Complicated surgery like cutting an organ by hand is yet to be simulated. A smart home with potential health monitoring technology is considered as a method of healthy outcome, better cognitive output and behavioral improvement [54]. The world is moving fast towards an aged population. A smart home with necessary healthcare monitoring mechanism is useful towards a better quality of life and reduced healthcare cost. Earlier research suggest traditional methods to predict an individual’s mental condition, behavioral features, screen neurological conditions [55, 56]. A smart home with monitoring technology can track changes in health in a daily basis and can detect early disease symptoms providing a better healthcare and enhancing well-being [6].

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6.1 Computer-Aided Design (CAD) Repairing Imitated Model (Design for Artificial Body Part) CAD is useful for medical image restructuring and related imagery. It is also helpful in creating a 3D structure of any body part. For example, a hipbone replacement surgery. Before the surgery is carried out, a 3D image with proper dimension and shape is created and is then measured. Using this process the success in the surgical process increased exponentially and eliminates the chance of re-operation by using unsuitable artificial hipbone.

6.2 Test and Treatment for Mental Sickness Mental condition of a person can also be examined using VR by comparing images captured in real environment and virtual figures. Acrophobia, Xenophobia can be treated using VR technology by creating a virtual environment that can trigger a patient’s extremist action where a live repeatedly. Thereby the process can achieve therapeutic effect.

6.3 Improvement for Treatment Safety Radiotherapy, one of the vulnerable treatments, where a doctor can only rely on its experience for the radiation dose. But, a patient is always has a worry of being over-dosed. Using VR a doctor can perform radiation experiment on a virtual human with predefined condition and can decide actual dose for a real patient. Hence, there is an increase in a patient safety. In addition to this, a virtual environment protects a doctor from being exposed to radiation.

7 Advantages of VR Techniques VR is useful in learning new technology and methodology. Eventually, VR will take the place of traditional medical experiments and will impart new teaching mechanism. VR can provide an alternative and interactive process of studying the human anatomy. For example, the Internet resource for surgical education, Vesalius, of Duke University and the brain atlas of Harvard University are considered as the most famous virtual medical multimedia teaching resources [18]. VR technology can provide a simulated workbench environment for the doctors. With the help of this, doctors can have a 3D image of human body. Moreover, doctors can learn how they can deal with the actual clinical procedure and can practice surgery on a virtual human body.

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In addition a doctor can feel the experience of this virtual environment as real with the help of the VR technologies. Taking the feedback of expert professionals the VR system can also provide new dimensions to the surgery system. However, this process can be made recursive. The VR system can evaluate a surgical procedure once complete by considering various parameters and standards. VR technology will be of great help in this kind of treatment scenario by proving its capacity by supporting all channels of the 3D display and shared surgery and thereby increases success rates in complicated surgeries [20]. VR technique is helpful towards proper analysis of sick organs and surrounding tissues so as to avoid redundant invasive diagnosis [21]. New drug creation is one of the latest applications using VR. Creating new types of drugs is the new era of application in VR. A molecule is complicated in its own structure and the 3D structure is difficult enough to translate it to a 2D display. Using VR the natural and visible 3D environment of molecular structure of compound can be viewed where the interaction traits of a molecule can be determined.

8 Conclusion The technologies discussed in this chapter are very effective in nature and probably the technologies will be developed in the manner that has been discussed. It may also happen that technologies with greater impact than that of the currently used technology may come up in the future. However, we are now having cutting edge information tool that has revolutionized the fundamentals of healthcare and patient care tools. These tools and techniques that exist today are based on knowledge and demonstration. In addition to this there is always a requirement of evaluating these technologies and concepts with related and demonstrated scientific factors. This process will increase the endurance of the technology we are using today. The powerful ideas of healthcare and patient care cannot never be discarded because of our preconception on the Industrial Age.

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Towards a VIREAL Platform: Virtual Reality in Cognitive and Behavioural Training for Autistic Individuals Sahar Qazi and Khalid Raza

Abstract VIREAL or Virtual Reality (VR) is a bilateral experience created using computers which occurs in a simulated environment encapsulating vocal, visual and sensational feedbacks. This computer generated virtual world looks so similar to the real world that a person can’t distinguish between the two. With the development of computational technologies and techniques, virtual reality has become a powerful aid in eliminating loopholes in the path of research. Autism viz., a neurological cognitive, disturbed-behavioural disorder is observed by problems with social interaction and communication in children, can be effectively treated with the employment of VIREAL which seems to be a compassionate platform for healthcare and especially for Autism Spectrum Disorder (ASD) and related psychiatric disorders. Many scientific studies have shown the benefits of using virtual reality for patients with High Functioning Autism (HFA) or people with interaction difficulties lately. Some software enhancements and affordability of VIREAL gadgets have been kept in mind by the manufacturers so that magnanimous therapeutic experience can be used by everyone. It is also a very practical therapeutic gadget which distracts patients from severe pains. VIREAL is a friendly approach which holds a gigantic efficiency in clinical prognosis and treatment sector. VIREAL based techniques have incorporated two things which are doing wonders with autistic kids and their parents and consultants. With all the benefits, there are some limitations to VIREAL platforms since most parents are not comfortable, mainly due to their parental concerns, and at times, the children may develop a fright by viewing such virtual environments leading to a limitation in their growth and understanding. However, with the rapid progress in VR industry, VIREAL devices intelligently extract emotional response knowledge and thus, give an appropriate rationale to the kids to reaction to any scenario, and with that knowledge can approximate the mind and emotional status of the child, eventually leading to a healthy and a happy learning of children with Autism. Keywords VIREAL · Autism · Applied behaviour analysis (ABA) · Verbal behaviour analysis (VBA) · Picture exchange communication system (PECS) S. Qazi · K. Raza (B) Department of Computer Science, Jamia Millia Islamia, New Delhi 110025, India e-mail: [email protected] © Springer Nature Switzerland AG 2020 D. Gupta et al. (eds.), Advanced Computational Intelligence Techniques for Virtual Reality in Healthcare, Studies in Computational Intelligence 875, https://doi.org/10.1007/978-3-030-35252-3_2

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Abbreviations ABA AI AR ASD CBT CNN DTT GPU HFA HMD LEEP ML PECS PTSD RDI SLAM VADIA VBA VET VIREAL

Applied behaviour analysis Artificial intelligence Augmented reality Autism spectrum disorder Cognitive behavioral therapy Convolutional neural networking Discrete trial training Graphical Processing Unit High functioning autism Head-mounted display Large expanse extra perspective Machine learning Picture exchange communication system Post-traumatic stress disorder Relationship development intervention Simultaneous localization and mapping VR adaptive driving intervention architecture Verbal behaviour analysis Virtual environment theatre Virtual reality

1 Introduction VIREAL or simply virtual reality (VR) is a bilateral experience developed with the use of computers which occurs in a simulated milieu encapsulating vocal, visual and sensational feedbacks. This computer generated virtual world looks so similar to the real world that a person can’t distinguish between the two. Virtual reality creates such an experience which is actually impossible in the ordinary reality and is fascinating for an individual. Autism is neurological cognitive, disturbed-behavioural disorder which is observed by problems with social interaction and communication in children. Parents of such children observe the signs and symptoms within the first 2–3 years of their offspring’s life. Autism is one of those psychiatric disorders today which is still new to the literature and medical fraternity and not much research has been achieved in the same. In order to develop a lucid understanding of the disease, many researchers are trying a multi-faceted strategy by employing many psychological and computational techniques. One of the latest and best approaches for ASD and related disorders has been seen with the introduction of VIREAL. With the development of computational technologies and techniques, virtual reality has become a powerful aid in eliminating loopholes in the path of research. VIREAL seems to be a compassionate platform for healthcare and especially for

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Autism Spectrum Disorder (ASD) and related psychiatric disorders. The only limitation is the lack of evidential tenets for its efficiency in such disorders and implementation. Many scientific studies have shown the benefits of using virtual reality for patients with High Functioning Autism (HFA) or people with interaction difficulties lately [1–4]. Social training with the use of virtual reality has been proved to be beneficial when compared to the traditional social skills. For instance, simple emotion recognition or role play are described as follows [1, 2, 5–9]: (i)

(ii)

(iii)

(iv)

(v)

It has the potential to maintain a secure, free regular real scenario for social interactions. It has helped to decrease the social anxiety when adopted with addition of the Cognitive Behavioral Therapy (CBT) therapy. It also gives an opportunity to people to repeatedly encounter the dynamic social interactions which leads to an extraordinary therapeutic benefit as no two interaction sessions are ever same, focusing on responses from a multi-varied training session. This dynamic interacting session has been able to facilitate the enhancement of social communication skills for everyday life tasks. Furthermore, it also tries to maintain a secure and a supportive milieu which makes the autistic individuals makes less of errors and aids them to interact without any fear or anxiety. Person-to-person interactions usually make such individuals frightened by the fact of rejection. VIREAL interaction sessions provide a manageable environment which is concerned with every individual’s needs and wants and is capable of taking feedbacks from individuals so that it can learn and further improve its performance. VR provides an interactive, learning and personalized platform for autistic individuals and helps them to live a normal life in this rat race of today!

1.1 VIREAL: Decoding the Terminology VIREAL is an amalgam of two words, virtual and reality, where virtual has the reference having the essence but not factually. It was in the year 1938, when Antonin Artuad first explained the delusive and deceptive characteristics of the term “virtual reality” in his collection of essays “la réalitévirtuelle” [10]. VIREAL is somewhat related to ‘Augmented reality’ (AR) which is an interactive and dynamic experience of a so-called real-world milieu wherein the objects which exist in the real world are added/augmented by computationally devised perception information, composed of—visual, verbal, olfactory, haptic and somatosensory features [11]. The additional features which are generated using special software enhance the virtual milieu and provide an extraordinary experience to the user. There are many AR based systems such as Microsoft’s HoloLens, Magic Leap etc., which use cameras in order to capture the user’s environment.

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1.2 Historical Background of VIREAL Before the 1950s, the origin of VIREAL concepts was vague and highly feuded since it was tedious to come up with an exact description of the concept [12]. It was Antonin Artaud who described the illusory aspect of the virtual reality in his stage theatre plays [13]. Science fictions play a pivotal role in giving the descriptions about the modern VIREAL aspects. During the 1950–70s, Morton Heilig penned an “Experience Theatre” which encapsulated all the senses of the real world onscreen. He developed a prototype of his ideation with five short movies to be screened showcasing multiple senses and utilised digital computational device, the Sensorama in 1962. Moreover, he also generated the ‘Telesphere Mask’ which is basically a telescopic television material for personalised usage and has been patented in the year 1960. The device has a sensation of reality with 3D images which may or may not be in colour, sounds, aromas and cool breezes [14]. Another personality around the same time named, Douglas Englebart employed computational screens as input and output devices, whereas, Ivan Sutherland in 1968 along with his abecedarian devised the first ever Head-Mounted Display (HMD) system for simulation purposes which had both a friendly user interface and touch of reality and the graphics for VIREAL were simply wire-frame models. The only disadvantage was that the HMD which was worn by the user was quite heavy and was ceiling suspended. The VIREAL fraternity gives virtual reality based devices and tools for medical, flight simulation, automobile industries and military training from 1970 to 1990 accordingly [15]. At NASA’s Jet Propulsion Laboratory (JPL), David Em, and an American artist (1977– 1984) was the first one to develop navigable virtual world [16]. The MIT in 1978 created the Aspen Movie Map, a program which was a crude virtual simulation of Aspen, Colorado, where the users were mobile on the streets in one of the three versions: summer, winter, or polygons. Back then in 1979, Eric Howlett had devised the ‘Large Expanse Extra Perspective’ (LEEP) optical system, the original system was recreated for NASA Ames Research Centre in 1985 for VIREAL installation executed by Scott Fisher, is a combined system which had the potential to create a stereoscopic image with a field of view wide enough to make a reliable sense of space which allows the users of the system for a deep sensation in the view, corresponding to reality. The system gives the basis for most of the current virtual reality helmets available today in the market [17]. By the 1980s the term “virtual reality” was on the lips of the public because of Jaron Lanier who was one of the modern pioneers of the field and developed several VIREAL devices such as the Data Glove, the EyePhone, and the Audio Sphere [18]. Between the years 1989–92 the first real time, interactive immersive film was created named Angels by Nicole Stenger and the interaction was made available with the help of a data glove and high-resolution oculars. Further in 1992, a researcher named Louis Rosenberg developed the Virtual Fixtures System at the U.S. Air Force’s Armstrong Labs with the help of a full upper-body external skeleton aiding the purpose of a physically realistic 3D VIREAL and this helped in generating the first veritable VIREAL experience sorting for vision, sound, and sensation [19]. The

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1990s were the years when the world saw a spread in production and releases of consumer headsets and in 1991, Sega announced the Sega VR headset for arcade games and the Mega Drive console which used LCD screens in the visor, stereo headphones, and inertial sensors, allowing the system to track, record and react to the mobility of the user’s head [20]. In July 1995, Nintendo in Japan developed the Virtual Boy, while it was developed in August 1995 in North America [21]. Moreover, in the same year, a cave-like 270 degrees projection theatre was created for public demonstrations in Seattle, called as the Virtual Environment Theatre (VET) produced by Chet Dagit and Bob Jacobson, respectively [22]. Entrepreneurs Philip Rosedale formed the Linden Lab with a motivation to develop VIREAL hardware [23]. Z-S Production developed the first PC based cubic room in 2001 named SAS Cube (SAS3) and was installed in Laval, France. By the year 2007, Google introduced Street View which is an aid that shows comprehensive scenes of an increasing number of worldwide positions such as streets, indoor buildings and rural regions and also has stereoscopic 3D mode which was later introduced in the year 2010 [24]. There were around 230 companies which developed VIREAL based products by 2016. The most popular online social network Facebook, focuses on VIREAL platform development. Further, Google, Apple, Amazon, Microsoft, Sony and Samsung etc., are working hard for the introduction and development of VIREAL and Augmented Reality based platforms as well [25]. Sony had ascertained that the company was developing a location tracking technology for the VIVE PlayStation VR platform in the year 2017 [26].

1.3 Day-to-Day Applications of VIREAL VIREAL is one of the branches of information technology (IT) which has effected and it has impacted on human lives. It is because of this reason itself the VIREAL has become so popular and widely successful in the application development platforms. Currently, VIREAL based technologies have showed interest in various day-to-day activities. For a VIREAL experience, one needs to have a HMD, data gloves with an inclusive tracking system. If the user has these basic apparatus, one is ready to feel and live the VIREAL life [27–33]. Some of the day-to day applications are shown in Fig. 1. Currently, Vanderbilt University boffins and software developers have started VIREAL-based driving classes for autistic individuals, named as—“Vanderbilt VR Adaptive Driving Intervention Architecture” (VADIA), which is essentially for adolescents and adults enduring autism. VADIA helps them to learn basic driving and road etiquettes as it has the potential to create different driving situations as per the basic, medium and difficult modes, thus helping the individuals to learn driving safely in any case [34].

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Fig. 1 Applications of virtual reality

2 Autism and VIREAL Autism is a psychiatric disorder which paid heed to VIREAL based interactive therapies. Initially, sandbox playing technique was utilised for special care children and the study found that it was quite difficult to employ for such children. Another study at the University of Nottingham, United Kingdom, which used VIREAL based strategies discerned that not only autism, it was useful for many other complex psychiatric disorders. Autism is a disorder which is serious as it becomes very difficult to understand such children and their expressions. Some software enhancements and affordability of VIREAL gadgets have been kept in mind by the manufacturers so that magnanimous therapeutic experience can be used by everyone and not just the luxurious ones. It is also a very practical therapeutic gadget which distracts patients from severe pains. VIREAL is a friendly approach which holds a gigantic efficiency in clinical prognosis and treatment sector

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[35]. Some of the applications of VIREAL gadgets which are being used for the treatment of autism have been listed in Table 1. These gadgets usually are simple computers which create a realistic environment for children and help to attain focus, attention, error less performance while doing any task, identify emotions, social Table 1 Applications of VIREAL gadgets in ASD treatment [36] VIREAL gear

Number of subjects

Age (years)

Reliant variables

Descriptions

HMD 14–21x (3–5 min)

2

7.5–9

• Completion of task • Attention and focus

Easy to wear helmets for children

HMD 40x 5 min for 6 weeks

2

7.5–9

• Identify the virtual objects

Easy to use and wear

Computer monitor with a mouse

36

13–18

• Understanding virtual milieu • Error-less performance

Children easily grasped the essentials of the tool. An improved performance of children was observed

Computer monitor with a joystick and a mouse

34

13–18

• Performance • Understanding and explanation of participants

A very few children could understand the virtual environment, the rest were simply least interested and not attentive

Computer monitor with mouse

34

7.8–16

• Identification if emotions easily

Most patients were able to recognize and understand emotions easily

Computer monitor with mouse for 30–50 min

7

14–16

• Social skills • Verbal etiquette • Social milieu behavioural understanding

Improved behavior and social skills in children

Touch screens

2

8–15

• Understanding symbolism • Enhanced imagination

Improved functioning, understanding and creative imagination in children was observed (continued)

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Table 1 (continued) VIREAL gear Computer monitor with mouse for 30–40 min

Number of subjects 3

Age (years)

Reliant variables

Descriptions

7–8

• Emotional intelligence • Understanding gestures such as eye contact

–

environment, developing vivid imagination, and understanding emotional, social and environmental behavior respectively [36].

2.1 Common Teaching Techniques for Autistic Children The common teaching techniques for autistic children are as follows [37]: (a) Applied Behaviour Analysis and Verbal Behaviour Analysis: Applied Behaviour Analysis (ABA) is a modus operand based on behaviour inclusive of speech, education and academic and life skills can be taught using scientific principles. This teaching approach assumes that children have repetitive behaviour includes a “bait” and there are less chances to continue behaviour which are not inclusive of baits in autistic children. Reinforcement is gradually reduced so that children can learn without any bait. Commonly practised ABA is—Discrete Trial Training (DTT), where life skills, such as, eye contact, imitation and mimicking, self help, conversation etc., are chiselled into small chunks and then taught separately to autistic children. Another approach in ABA is Errorless Learning, where the therapist appreciates children for their good response with a present and prompts for every negative response, but won’t be told “no” straightaway. Instead, the therapist will guide to get the correct response. Verbal Behaviour Analysis (VBA) is the state-of-the-art panache of ABA which utilises B. F. Skinner’s 1957 analysis of Verbal Behaviour to teach life skills and communication to autistic children. A VBA approach is focused on making children understand that speaking and communication will help them get what they want. It is a more natural technique of teaching when compared to ABA. (b) Relationship Development Intervention: Relationship Development Intervention (RDI) is a parent-based clinical therapy session which aims to treat autism at its roots. Autistic children usually prefer to be aloof, obvious reason being, lack of communication. Life skills, communicating and exchanging personal experiences with others, are common aspects which people do and makes them feel connected and lively with the world. Emotional intelligence is something which is often skipped while training autistic children. It simply refers to the process of expressing ones true feelings—both good and bad. This approach

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helps children to interact positively with other people, even without language. The whole idea is to let children “express” openly so that these children feel light and can enjoy themselves around people. (c) Sensory Integration Therapy: Sensing stimulus is one of the signs which help children to learn about this world. Children with autism have difficulties to patiently sense noise, touch, sight, olfactory, and/or movement. Autistic children may or may not necessarily respond to these senses and thus, are sometimes confused of being deaf, dumb or blind. If children cannot distinguish or have difficulty in responding to these senses, then they are typically diagnosed with sensory integration dysfunction, and it is very common with autistic children. Occupational therapists are trained specialists who use some sensory techniques which engage such children in joyful activities, helping them to process information that they receive from their senses. The main aim of this technique is not to ‘teach’, but to allow children to focus on their senses and act accordingly. (d) EduBOSS: EduBOSS viz. adapted from BOSS GNU/Linux, are simply education-based applications for higher academia purposes for children with special needs, such as Autism. It includes subjects like, Math, Science and Social Studies, and their tests, quizzes, supportive material etc. [38]. (e) TEACCH: Treatment and Education of Autistic and related Communicationhandicapped CHildren (TEACCH) is a structured classroom which is encapsulated with different classes for different purposes. It is heavily dependent on observational learning. Here, images or verbose are used for making a timeschedule for autistic children so that they can accomplish their assigned tasks of the day easily [39].

2.2 Qualitative and Quantitative Teaching Method – PECS Picture Exchange Communication System (PECS) is a qualitative and a quantitative methodology, generally utilized to study and understand the observations of autistic children using PECS teaching modus operandi [40]. PECS is simply an interactive method which doesn’t require any speech/vocals and is widely accepted these days for autistic and other related disorders, and is mainly based on an interchange of an image of an actual object by searching and then reaching for someone’s help in order to convey messages efficiently. Henceforth, main principle of PECS is that the child starts to interact and communicate, can easily approach others, and thus can use only a single image so as to avoid perplexed behaviour [41]. It is not aimed to teach ‘speech’, but, children enrolled with this program grasp basics of efficient communication with PECS. The program starts off with normal and basic activities inclusive of approaches: chaining, prompting/cuing, modelling, and environmental engineering [42]. The images with which the autistic children are exposed to are coloured or can be black and white, tangible scribbles or even photographs. Mayer-Johnson pictures symbols, often called PCS are also commonly used as stimulus.

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2.3 From VIREAL Toilets to Classroom: VR Design and Analysis Virtual reality as a domain has been successful in attracting much attention to its expansion in almost all fields including psychiatric disorders. VIREAL is simple and an organised e-learner for special children and aids them to live, not a perfect, but a healthy life. Autistic children need special attention and support system which helps them to learn and understand this not-so-perfect life. Classrooms are simply interactive systems which help individuals to come into one domain where they learn and understand concepts of life [43]. A real classroom has walls, windows, black/white board, chairs and tables etc., while a VIREAL-based classroom provides children exactly the same environment like that of a real one. A virtual classroom’s main component in the internet accessibility. It is hard to imagine how strong the connectivity is of the World Wide Web. VIREAL-based classrooms have mainly three principles: (a) Ease of usage, (b) Flexibility for both teacher and students and (c) Concerned with constraints (both, intrinsic & extrinsic), which is a wide aspect to ponder upon. The preliminary design analogy is stated as: “The usability of a VIREAL classroom increases only if the learning milieu is satisfying all the classroom constraints”. Intrinsic constraints are focused with cognitive learning while extrinsic constraints are more dependent on amalgamating productive technologies for better classroom experiences for autistic children. The extrinsic constraints are more liable to disturb the perfect scenario for a robust and an efficient virtual classroom. For this purpose, Cuendet et al. [44] proposed their five mantras for curbing this common problem and providing an amazing exhilarating experience of VIREAL classrooms as shown in Fig. 2. The latent components of VIREAL-based classrooms, are dependent on the hardware known as TinkerLamp. It is a camera-projector system which contains a camera and a projector pointed towards a tabletop. There are four versions of the TinkerLamp, all supporting the camera-projector system but vary in myriad ways and have been shown in Fig. 3. The initial version (a) lacks a mirror, henceforth, has a smaller projection area and lacks an embedded computer making it even more tedious to use. The rest of the versions (b, c & d) are better than (a) since all of these have a small computer installed within the hardware making things and utilisation easy for the user.

3 Social and Parental Issues Related to VIREAL With all the benefits, there are some limitations to VIREAL platforms since most parents are not comfortable, mainly due to their parental concerns, and at times, the children may develop a fright by viewing such virtual environments leading to a limitation in their growth and understanding [45, 46]. Although, there are myriad options of VR platforms, but only a few are chosen for training of autistic children.

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Fig. 2 Five mantras of VIREAL classrooms

Fig. 3 The four versions of the hardware TinkerLamp [44]

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There is a big need for paying heed for developing and efficient and child-friendly VIREAL platforms, which not only train such children but also bring out their unique talents and help them to face the cut-throat competitive world of today! [47]. The common social and parental issues which revolve around VIREAL platforms are described as follows [48]: • Safety Issues: Individuals wearing a headset could end up injuring themselves if they bang themselves with surrounding walls, which can turn dangerous. Some solutions have been debated for this, like employing circular walking arc to enable straight walking, but it still has some loopholes which are to be worked upon. • User Addiction: Virtual reality becomes so alluring to some people that they tend to live it, which causes serious risks to their health and lifestyle. Addiction is the biggest concern of parents which makes them hesitant towards VIREAL. • Criminality: Though, VR teaches children or adults how to take care of themselves in serious situations, or how to handle discombobulant situations. It also teaches tricks and tips to execute any criminal action. For instance, very famous virtual game: The Grand Theft Auto uses many gestures for pulling a trigger of a gun or pistol, or thumb movement for stabbing a person with knife or sword. • Reality Blues: Who would want to come out of a world where everything is perfect, where there is less of anxiety and worries? The goodness of a virtual world often disturbs the reality of an individual, which ultimately leads to his/her troubled real-life affair and could damage their relationships. • Post-Traumatic Stress Disorder (PTSD): Some games which are meant to enhance real life experiences, often turn very depressing for children. Psychological issues do arise with VIREAL-based games which leave a long term effect on children. • VIREAL-based Torture: Usually, military personnel use VIREAL for criminals to torture them by subjecting them to horrendous and atrocious images or videos. But, it is very dangerous as it lacks control. Such an act is inhumane and immoral which must not be appreciated. • Privacy Policy: Any individual before stepping for a novel technology thinks about his/her privacy. VIREAL-based platforms are surely exciting to work on with, but the user needs to submit some personal and private information before using, which can be misused.

4 Computational Intelligence in VIREAL Platforms Today, we are more inclined towards the “mixing” two or more things which can thus become more productive than their individual forms. Henceforth, computational power and virtual reality have joined their hands in providing bigger and better resources. Machine learning techniques when applied to VIREAL need quantification and assessment. Some of the important aspects of Computational Intelligence in VIREAL platforms are discussed in the following sections.

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4.1 Where Do VIREAL and Machine Learning Intersect? Virtual Reality and machine learning go hand-in-hand. For instance, VIREAL ocular gears, commonly called as Oculus Rift, may require an ultra precise quantification for empowering its performance for virtual games [49]. Here, there is a need to apply an algorithm which can automatically regulate and assess the general parameters such as height, stimulation, etc., for an overall exciting experience by individuals playing the VR game [50]. Machine learning is the janitor for keeping up the artificial intelligence (AI) for VIREAL gaming and related platforms. It contemplates the user movements and understands how the user will interact in a specific environment. The algorithm must have the potential to be ‘responsive’ as AI will have 4D duties in such a case. In the state-of-the-art studies, artificial intelligence (AI) has been observed to pay much heed to global intelligence and robotic simulation in order to completely identify the correct collective behaviours of human beings in specific situations. Boffins around the globe have been trying hard to improvise simulations by employing artificial intelligence for better outcomes, viz., undoubtedly a challenging process. A study by Cipresso and Riva [51], have successfully presented simulation of virtual worlds using a hybrid platform where the experimentations were executed easily and by two ways: (a) the operators behaviour is regulated by the virtual reality based behaviour of human who is exposed to simulation milieu and (b) the hybrid technology shifts these rules into the virtual world, thus forming a closed knit of real behaviours which are incorporated into virtual operators. The best masterpieces which showcase the combined power of VIREAL and Machine learning are described as follows [52]: (a) Natural Language Processing (NLP): Amazon’s Alexa [53] or Google Assistant [54], are the best examples of VIREAL–ML based assistants which are nothing less than today’s Aladdin’s Djinn. They are voice-controlled and so, the user simply has to ask these assistants for execution of tasks such as playing music, movies, launching games etc. The voice recognition of these assistants have been found perfect in British English, while for US English, there were a few error rates. The only problem being the translation to other languages, which is being worked upon still. (b) Hand Tracking Movements: Controlling technology today is easy, either the user can use his/her voice or hands movements. The VIREAL world is full of games, classrooms, etc., which use hand movements for controlling or authenticating access to some by some special hand tracked passwords set by the user. (c) Video Games Reinforced: Convolutional Neural Networking (CNN), Graphical Processing Unit’s (GPU’s) and some other essential requisites are mandatory for enforcing reinforcement machine learning to video gaming fraternity for a better and fast processing. Reinforcement machine learning is basically focused on rewarding the machine for a positive action else, no rewards are assigned. However, due to time management problem for the action and reward assignment, this domain is not used commonly.

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Much work is still pending in this domain of computational intelligence and current research regarding computational intelligence in VIREAL is puerile [50].

4.2 SLAM for VIREAL Environments SLAM (Simultaneous Localization and Mapping) is a VIREAL application viz. more of a concept than a single algorithm and is used for mobile robots which assess the headset position code and thus then acts accordingly, can be used for both 2D and 3D motion [50]. SLAM is difficult as it requires a map viz. needed for localization and a good position approximation is needed for mapping. SLAM based on the tradition problem of ‘The Chicken-or-Egg’, where a map is needed for localization and a position approximation is required for mapping. Figure 4 represents an entire SLAM flowchart [55]. Statistical approaches employ estimations based on algorithms such as Kalman filters and Monte Carlo methods, which give an approximation of the posterior probability for the position of the robot and the features of the maps. The set-membership techniques are for interval constraint propagation [56, 57] and give a collection of best positions of the robot along with an estimation of the map. Many steps are involved with the SLAM application and can be applied by using different algorithms. It is composed of many parts such as—landmark extraction, data association, state estimation, state update and landmark update and there are myriad ways one can solve each of these smaller parts. The objective of SLAM is to aid one in applying and using for their own newer approach. The new approach can be anything, be it implementation of SLAM on a mobile robot in an indoor environment or for an entirely different environment. It can be of great use for training autistic children as they can get habitual of such comfortable and a user friendly environment. The benefit of SLAM is that it can be used in different environments and different

Fig. 4 Flowchart of an entire SLAM model [55]

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algorithms can be applied to it giving an extension to the user [58]. The entire SLAM model checks for the entire path and map and uses this equation: p(x 0:t , m|z1:t , u1:t ).

4.3 VIREAL on Mobile: Mobile App Developments for Autism VIREAL technology has grown enormously since the past decade and is still growing and evolving rapidly. Many companies such a Google, Facebook, Amazon, etc., have already started to work with VR and have come up with beneficial tools for the society which have helped in day-to-day activities. Mobile app development companies have also stepped in for VIREAL-based tools which given a dynamic and robust functioning to mobile phones, and thus, are now called as VIREAL gadgets [59]. This technology has streamlined interaction business and has given better opportunities to their customers. This mobile app development is not only limited to general communication business, but, also is open for autism. Although, it is currently at a stage wherein VIREAL, ML and AI are in collision with one another, but, a company named, Niantic, is planning to develop a virtual reality game based on the Harry Potter Series, titled as: “The Harry Potter version of Pokemon GO”, where AI is controlling the surrounding area with the help of SLAM and cameras, sensors and radars, etc. [50].

4.4 Mind Versus Machine: Practicality of AI in Autism What is difficult with autism is the fact that it is hard to understand what such children feel if they don’t receive what they ask for or feel for. For instance, an autistic child asks his/her mother for an apple, the mother instead, gives the child a banana, which it is hard to understand how will the child react to this situation? It is a very common psychology, not only for autism, but in general: ‘if someone wants something and gets it, they feel ecstatic, and if they don’t, they feel sad and upset’ [60]. The human mind is always considered superior to the mechanical one as it is known to be ‘Emotionally Intelligent’. However, more often, humans fail to understand critical emotions of others and tend to hurt them intentionally or unintentionally. When it is a case with children and that too with, with special needs, one has to be extra cautious. VIREAL technologies have paved a way to a new dimension of mechanics and robotics, which are not only smart with their efficiency and robustness, but also, have emotional intelligence. Their emotional intelligence can be used for understanding the psychology of autistic children (Fig. 5). The VIREAL industry has a magnanimous and a pivotal role in changing mindsets of consultants, specialists, therapists, parents, nursing and staff to help autistic children to give their best in both- academia and social skills. Virtual reality developers,

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Fig. 5 VIREAL-based healthcare

creators, producers and workers have given their best in developing apps, games, and educational programs to help children with autism to live a normal life. Not only that, VIREAL has helped children with neurodegenerative problems to interact and communicate freely without any hesitation [61]. VIREAL based techniques have incorporated two things which are doing wonders with autistic kids and their parents and consultants. These devices intelligently extract emotional response knowledge and thus, give an appropriate rationale to the kids to reaction to any scenario, and with that knowledge can approximate the mind and emotional status of the child. For the treatment of autism, VIREAL systems can be considered to be beneficial w.r.t. myriad number of different therapeutic items given to a child, referring to nonredundant mode of therapy, which is way different from the usual ABA and VBA therapies for autism. VIREAL systems are not to decline the traditional ways of treatment, but can be useful to the practitioners and therapists. The therapist/consultant will have to learn the basics of such VIREAL platforms so that better treatment outcomes are obtained [60].

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4.5 Limitations of Computational Intelligence in VIREAL The entire chapter has discussed the blossoms of VIREAL platforms for autism but there are some limitations. The World Wide Web based virtual systems not only provide the best of knowledge but also have some imprudent information which can be very cataclysmic for children, especially in their growing years. As the adage goes: ‘Excess of everything is bad’, excessive use of VIREAL systems can lead to severe health issues. The VIREAL based gadgets, such as the oculus rift come along with big and bold warnings such as- epileptic seizures, growth issues in children, trip-and-fall and collision warnings, blackouts, disturbances, dizziness and nausea, redundant stress experiences etc. [62]. VIREAL sickness (Cybersickness) is a common sign of a person who is deeply exposed to virtual reality and causes symptoms such as: disturbances, headache, nausea, puke, sweating, fatigue, numbness of body and head, drowsiness, irritation, unconsciousness, and apathy [63] All such symptoms are experienced because the VIREAL system does not have a high frame rate, or if there is a time lag between ones movement and the onscreen visual image reaction to it [64]. Around 25–40% people experience VIREAL sickness, and general remedies for these are to soak ones hands in ice water or chewing ginger. Thus, the manufacturing companies are really working hard to find solutions to reduce it [65].

5 Future Perspectives VIREAL is an industry-academic effort. VIREAL platforms have unleashed a new way of living a life dreamed by people in real, which are evolving and revolutionising, and are one of the leading domains where computational research is on a high! There is much more to VIREAL systems and is being worked upon by the boffins and computational engineers. They will get more physical and real with time. These systems will also change our lifestyle. One can explore a new place which is distant to ones residence by simply putting on a headset/ocular gears. In terms of surgery, VIREAL can also be helpful for saving more people than the traditional ways. It can also be vital for amateur pilots to learn how to fly an aeroplane by using simulation strategies. For psychological disorders, such as ASD, Phobias, Dravet Syndrome, Epilepsy, etc., VIREAL is already very helpful in their treatments. Autistic children can live a normal and a happy life just like other children do. If the manufacturing companies fix the loopholes and assure parents and consultants about its safety and privacy policy, it would be one of the optimum therapies for the disorder [66] (Fig. 6). The VR and AI are interfacing each other for potential commercial applications including healthcare sector. It is expected that VR, AI and Internet technology will put an end to the traditional way of doing things, including within healthcare sectors. They will make the adaptation of new technologies more simpler and straightforward. It will also help in presenting contextual data in proper order to open up channels

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Fig. 6 The future of VIREAL in healthcare

for healthcare. Big healthcare data helps to develop insight about patients and at the same time leveraging machine learning will offer more personalized and tailored healthcare to the patients. AI is a leading driver of growth in healthcare and medicine, and hence we can conclude that ‘VR + AI = Future Healthcare’.

6 Conclusion VIREAL or virtual reality (VR) is a vivid experience developed with the use of computers which occurs in a simulated milieu encapsulating vocal, visual and sensational feedbacks. The computationally developed world looks so similar to the real world that a person can’t distinguish between the two. VIREAL is a combination of two words, virtual and reality, where virtual has the reference having the essence but not factually. It was in the year 1938, when Antonin Artuad first explained the delusive and deceptive characteristics of the term “virtual reality” in his collection of essays “la réalité virtuelle” respectively. VIREAL is somewhat similar to ‘Augmented reality’ which is an interactive and dynamic experience of a so-called real-world milieu wherein the objects which exist in the real world are added/augmented by computationally devised perception information which is composed of—visual, verbal, olfactory, haptic and somatosensory

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features respectively. The additional features which are generated using special software enhance the virtual milieu and provide an extraordinary experience to the user. There are many AR based systems such as Microsoft’s HoloLens, Magic Leap etc., which use cameras in order to capture the user’s environment. For a VIREAL experience, one needs to have a Head Mounted Displays, data gloves with an inclusive tracking system. If the user has these basic apparatus, one is ready to feel and live the VIREAL life. VIREAL based technologies have showed interest in various day-today activities as well such as- gaming world, crime investigations, virtual tourism, education, treatment of various neurological and psychological disorders, movies, events and concerts, military training, etc. Autism is neurological behavioural disorder which is observed by problems with social interaction and communication in children and is one of those psychiatric disorders today which is still is new to the literature and medical fraternity and not much research has been achieved in the same. With the rise of computational technologies, virtual reality has become a powerful aid in eliminating loopholes in the path of research. VIREAL seems to be a compassionate platform for healthcare and especially for autism and related psychiatric disorders its only limitation is the lack of evidential tenets for its efficiency in such disorders and implementation. Many scientific studies have shown the benefits of using virtual reality. Social training with the use of virtual reality has been proved to be beneficial when compared to the traditional social skills for instance, simple emotion recognition. Applied Behaviour Analysis (ABA) is a modus operand used for teaching autistic children and is based on behaviour inclusive of speech, education and academic and life skills can be taught using scientific principles. This teaching approach assumes that children have repetitive behaviour includes a “bait” and there are less chances to continue behaviour which are not inclusive of baits in autistic children. Reinforcement is gradually reduced so that children can learn without any bait. Verbal Behaviour Analysis (VBA) is similar to ABA, but is preferred. Relationship Development Intervention is another therapy involving parents, which aims to treat autism at its roots. Occupational therapists are trained specialists who use some sensory techniques for Sensory Integration Therapy, and engage autistic children in joyful activities, helping them to process information that they receive from their senses. The main aim of this technique is not to ‘teach’, but to allow children to focus on their senses and act accordingly. Picture Exchange Communication System (PECS) is a qualitative and a quantitative methodology utilized to study and understand the observations of autistic children using PECS teaching modus operandi. VIREAL is simple and an organised e-learner for special children and aids them to live, not a perfect, but a healthy life. Autistic children need special attention and support system which helps them to learn and understand this not-so-perfect life. A VIREAL classroom’s main component is the internet accessibility and has mainly three principles: (a) Ease of usage, (b) Flexibility for both teacher and students and (c) Concerned with constraints (both, intrinsic & extrinsic), which is obviously a wide aspect to ponder upon.

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With all the benefits, there are some limitations to VIREAL platforms since most parents are not comfortable, mainly due to their parental concerns, and at times, the children may develop a fright by viewing such virtual environments leading to a limitation in their growth and understanding. There is a big need for paying heed for developing and efficient and child-friendly VIREAL platforms, which not only train such children but also bring out their unique talents and help them to face the cutthroat competitive world of today! The VIREAL based gadgets, such as the oculus rift come along with big and bold warnings such as- epileptic seizures, growth issues in children, trip-and-fall and collision warnings, blackouts, disturbances, dizziness and nausea, redundant stress experiences etc. The VIREAL industry has a magnanimous and a pivotal role in changing mindsets of consultants, specialists, therapists, parents, nursing and staff to help autistic children to give their best in both- academia and social skills. Virtual reality developers, creators, producers and workers have given their best in developing apps, games, educational programs to help children with autism to live a normal life. Not only that, VIREAL has helped children with neurodegenerative problems to interact and communicate freely without any hesitation [61]. VIREAL based techniques have incorporated two things which are doing wonders with autistic kids and their parents and consultants. These devices intelligently extract emotional response knowledge and thus, give an appropriate rationale to the kids to reaction to any scenario, and with that knowledge can approximate the mind and emotional status of the child. Acknowledgements Sahar Qazi is supported by DST-INSPIRE fellowship provided by Department of Science & Technology, Government of India.

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35. Benyoucef, Y., Lesport, P., & Chassagneux, A. (2017). The emergent role of virtual reality in the treatment of neuropsychiatric disease. Frontiers in Neuroscience, 11, 491. 36. Bellani, M., Fornasari, L., et al. (2011). Virtual reality in autism: State of the art. Epidemiology and Psychiatric Sciences, 20, 235–238. 37. http://vikaspedia.in/education/education-best-practices/teaching-methods-childrens-withautism. Accessed on October 17th, 2018. 38. https://www.bosslinux.in/eduboss. Accessed on November 27th, 2018. 39. https://teacch.com/. Accessed on November 27th, 2018. 40. Bondy, A. S., & Frost, L. A. (1994). The picture exchange communication system. Focus on Autism and Other Developmental Disabilities, 9(3), 1–19. 41. Bondy, A., & Frost, L. (2002). A picture’s worth: Pecs and other visual communication strategies in autism. Topics in autism. Woodbine House, 6510 Bells Mill Rd., Bethesda, MD 20817. 42. https://www.iidc.indiana.edu/pages/What-is-the-Picture-Exchange-Communication-Systemor-PECS. Accessed on October 17th, 2018. 43. https://medium.com/inborn-experience/case-study-the-portal-75c27f58f898. Accessed on 29th July, 2018. 44. Cuendet, S., Bonnard, Q., et al. (2013). Designing augmented reality for the classroom. Computers & Education, 1–13. 45. Zander, E. (2004). An introduction to autism, AUTISMFORUM. Stockholm: Handikapp & Habilitering. 46. Ramachandiran, C. R., Jomhari, N., et al. (2015). Virtual reality based behavioural learning for autistic children. The Electronic Journal of e-Learning, 13(5), 357–365. 47. https://virtualrealityineducation.wordpress.com/assisted-learning/. Accessed on July 29th, 2018. 48. https://thenextweb.com/contributors/2018/04/18/9-ethical-problems-vr-still-solve/. Accessed on October 18th, 2018. 49. https://www.oculus.com/rift/#oui-csl-rift-games=mages-tale. Accessed on July 29th, 2018. 50. https://www.re-work.co/blog/the-power-of-machine-learning-and-vr-combined. Accessed on July 29th, 2018. 51. Cipresso, P., & Riva, G. (2015). Virtual reality for artificial intelligence: Human-centered simulation for social science. Annual Review of Cybertherapy and Telemedicine, 219, 177–181. 52. https://blog.goodaudience.com/3-cool-ways-in-which-machine-learning-is-being-used-invirtual-reality-12b8ece6d2c0. Accessed on October 23rd, 2018. 53. https://www.amazon.com/Amazon-Echo-And-Alexa-Devices/b?ie=UTF8&node= 9818047011. Accessed on October 23rd, 2018. 54. https://support.google.com/assistant/answer/7172657?co=GENIE.Platform%3DAndroid& hl=en. Accessed on October 23rd, 2018. 55. http://ais.informatik.uni-freiburg.de/teaching/ss12/robotics/slides/12-slam.pdf. Accessed on October 25th, 2018. 56. Jaulin, L. (2009). A nonlinear set membership approach for the localization and map building of underwater robots. IEEE Transactions on Robotics, 25(1). 57. Jaulin, L. (2011). Range-only SLAM with occupancy maps: A set-membership approach. IEEE Transactions on Robotics, 27(5). 58. https://ocw.mit.edu/courses/aeronautics-and-astronautics/16-412j-cognitive-robotics-spring2005/projects/1aslam_blas_repo.pdf. Accessed on July 30th, 2018. 59. https://www.dotcominfoway.com/blog/how-app-development-will-drive-vr-market. Accessed on October 25th, 2018. 60. Jarrold, W. L. (2007). Treating autism with the help of artificial intelligence: A value proposition. In: Proceedings of Agent-Based Systems for Human Learning and Entertainment (ABSHLE) Workshop at AAMAS (pp. 1–8). 61. https://www.vrfitnessinsider.com/how-vr-is-helping-children-with-autism-navigate-theworld-around-them/. Accessed on October 27th, 2018.

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Assisting Students to Understand Mathematical Graphs Using Virtual Reality Application Shirsh Sundaram, Ashish Khanna, Deepak Gupta and Ruby Mann

Abstract Many face difficulties in understanding mathematical equations and their graphs. Implementing virtual reality to plot graphs of the mathematical equation will help to understand the equations better. Virtual reality (VR) is a computergenerated environment in which a client can explore and collaborate with it. Virtual reality system allows a user to view three-dimensional images. VR has a wide range of applications. VR is being utilized in entertainment for gaming or 3D movies, in medicine for simulating the surgical environment, in robotics development and many more. VR has a wide scope of application in the education system though only a few kinds of research have been proposed. In this paper, we have introduced a new approach to making the user understand any mathematical equation better by plotting their graph using virtual reality application. Unity, a real-time engine and C# are being used to develop this novel approach. The proposed method will be compared with current method of learning mathematical equations. Keywords Virtual reality · Three-dimensional displays · Mathematical equations · Computer-generated environment

1 Introduction Virtual reality (VR) is an instinctive PC made understanding used to supplant your world with some mimicked condition. It comprises of primarily sound what’s more, S. Sundaram · A. Khanna · D. Gupta (B) · R. Mann Maharaja Agrasen Institute of Technology, Delhi, India e-mail: [email protected] S. Sundaram e-mail: [email protected] A. Khanna e-mail: [email protected] R. Mann e-mail: [email protected]

© Springer Nature Switzerland AG 2020 D. Gupta et al. (eds.), Advanced Computational Intelligence Techniques for Virtual Reality in Healthcare, Studies in Computational Intelligence 875, https://doi.org/10.1007/978-3-030-35252-3_3

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visual information, however may similarly allow different sorts of sensory feedback like haptic. This clear condition can resemble this present reality or it might be fantastical. Current VR technology most usually utilizes virtual reality headsets or multiprojected environments, some of the time in mix with physical situations or props, to produce realistic pictures, sounds and different vibes that simulate a client’s physical proximity in a virtual or nonexistent environment. Basically, three things make VR more vivid than different sorts of media, 3D Stereovision, client dynamic control of perspective, and an encompassing knowledge. Individual using virtual reality hardware can “glance around” the fake world, move around in it, and connect with virtual features or things. The effect is typically made by VR headsets including a head-mounted exhibit with a little screen before the eyes, yet can moreover be made through uncommonly organized rooms with various huge screens. If you compare watching a film on a small TV to watching the same movie in a cinema or in an IMAX cinema, where you have a massive screen, the experiences can be very different. Basically, the more of your field of view is covered by the screen, the more immersed you will feel. The screen size of these headsets might be tiny, but there is no escape. In a cinema when you look around, you can see your friend sitting next to you. But with these headsets, you are trapped. When you look around in this headset, you still see images from the virtual world instead of this present reality. The interesting thing is that this kind of experience is overwhelming and persistent. It doesn’t diminish over time.

1.1 Applications VR is most commonly used in diversion applications, for instance, gaming and 3D film. Customer virtual reality headsets were first released by video game associations in the early-mid 1990s. Beginning during the 2010s, front line business fastened headsets were released by Oculus (Rift), HTC (Vive) and Sony (PlayStation VR), setting off another surge of usage development [1]. 3D cinema has been used for games, artistic work, music accounts, and short films. Since 2015, crazy rides and amusement parks have combined computer-generated simulation to arrange uncommon perceptions with haptic feedback [2]. In apply autonomy, virtual reality has been utilized to control robots in telepresence and telerobotic frameworks [3]. It has been utilized in mechanical technology advancement. For instance, in trials that examine how robots—through virtual enunciations—can be applied as an instinctive human UI. Another model is the utilization of robots that are remotely controlled in risky situations, for example, space. Here, virtual reality simulation not just offers bits of information into the control and motion of mechanical development yet likewise demonstrates open doors for inspection [4]. In humanistic systems and cerebrum science, virtual reality offers a financially savvy apparatus to think about and repeat connections in a controlled environment [5]. It can be used as a kind of remedial mediation. For instance, there is the circumstance of the computer generated simulation introduction treatment (VRET), a sort of

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introduction treatment for treating nervousness issue, for example, post horrendous pressure issue (PTSD) and phobias [6]. In medicine, simulated VR surgical environments—under the supervision of specialists—can give reasonable and repeatable training at a low cost, enabling students to perceive and change blunders as they happen [7].

1.2 Scope of VR in Education Students don’t learn much with the help of books, they are expected to learn without much scope for an immersive and experimental learning. They need to get a practical idea of what is being taught to them, in order to achieve this VR can play a significant job in the field of teaching for future generations. Virtual reality (VR) is the utilization of three dimensional (3D) computer graphics in combination with interface devices to make an interactive, immersive environment [8]. Because of upgrades in innovation and decreases in cost, the utilization of VR in education has expanded incredibly in the course of recent years [9]. VR provides an immersive experience in learning, it can show a proper use case scenario of any topic with the help of real life examples. The best way to teach something is when students are themselves able to implement anything, this is possible with the help of VR. Virtual reality also removes barriers associated with transport and logistics in real world and opens up immense opportunities to be explored. Students for instance can go on a field trip to the Amazon rainforest from the comfort of their classroom anywhere in the world. Experience near impossible tasks such as a field trip to the moon or the surface of Mars can now be explored from the within the comforts and safety of a classroom. Such a realistic multi-dimensional experience delivers a truly immersive learning experience, making the knowledge gained much more holistic. VR and technology generally are accepted to encourage learning through commitment, inundation, and intuitiveness [10]. In this project we are trying to simulate a virtual reality environment to plot 3D graphs of mathematical equations that will help to understand the equations better. The equations will be given as input by the users. The user can interact with the graph, move around in it, in the VR simulated environment. This paper is structured as following: in Sect. 2 literature review has been done to change following which the methodology and implementation of the proposed model has been discussed in Sects. 3 and 4 respectively. In Sect. 5 the results obtained from the proposed model are discussed. At last, the conclusion future scope of the paper and the references have been presented.

2 Literature Review Numerous investigations have demonstrated that scholar gain best knowledge when assortments of training techniques are utilized and those different scholars react

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best to various strategies. This paper tends to the use of virtual reality as another educational means, intended to get scholars all the more profoundly inundated in the computer simulations, and to display educational experiences unrealistic utilizing other methods [11]. Virtual environments are characteristically three-dimensional. They can furnish intuitive play areas with a level of intuitiveness that goes a long ways past what is conceivable in all actuality. In the event that utilizing VR as a tool for mathematics education, it in a perfect world offers an additional advantage to learning in a wide scope of mathematical areas. A few points that are incorporated into most arithmetic educational programs worldwide are foreordained for being instructed in VR situations. For scholars aged 10–18, such topics are, for example, 3D geometry, vector polynomial math, graph visualization all in all and curve sketching, complex numbers (representations), and trigonometry, just as other three-dimensional applications and issues. Scholars in elementary school profit by the high level of intelligence and immersion all through their initial four years, when learning the four basic operations, yet additionally when finding out about fractions and settling real life problems [12]. Understanding the properties of a function over complex numbers can be substantially more troublesome than with a function over real numbers. This work gives one methodology in the area of visualization and augmented reality to pick up understanding into these properties. The applied visualization techniques utilize the full palette of a 3D scene graph’s essential components, the complex function can be seen and comprehended through the area, the shape, the shading and even the animation of a subsequent visual object [13]. For beneficial use in the study hall, various conditions must be suited: Support for an assortment of social settings including scholars working alone and together, an educator working with a scholar or showing an entire class, scholar or the entire class taking a test, and so forth. A coordinated effort in these circumstances is to a great extent controlled by roles, and the educator ought to have the option to hold power over the activities [14]. We depict our endeavors in building up a framework for the improvement of spatial abilities and boost of exchange of learning. So as to help various educator-scholars interaction scenarios we implemented adaptable strategies for context and user dependent rendering of parts of the construction [15]. The basic supposition that the learning procedure will occur normally through the simple investigation and revelation of the Virtual Environment ought to be reviewed. In spite of the estimation of exploratory learning, when the information context is excessively unstructured, the learning procedure can move toward becoming difficult. Another Possibility is to carefully characterize explicit errands to the clients/scholars through interaction with the educator. We recommend the utilization of various learning modes in virtual environments from instructor upheld to self-teaching learning [16]. Numerical information is regularly crucial when taking care of real-life issues. Especially, issues arranged in a few-dimensional area that require spatial aptitudes are now and again hard to fathom for researchers. Numerous researchers experience issues with a spatial creative mind and need spatial capacities. Spatial abilities, conversely, present a noteworthy fragment of human insight, just as intelligent reasoning [17]. Our point was not to make an expert 3D displaying bundle yet rather a fundamental and intuitive 3D advancement tools in a distinctive virtual condition for

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instructive purposes. Like the CAD3D bundle co-made by the third creator, which won the German-Austrian scholastic programming grant in 1993, our chief target was to keep the UI as fundamental as possible to encourage learning and profitable use. The standard regions of the use of our structure in science and geometry education are vector analysis, spellbinding geometry, and geometry with everything taken into account. These regions have not been unequivocally tended to by past frameworks [18]. VRMath is an online application that uses VR (Virtual Reality) technology joined with the intensity of a Logo-like programming language and hypermedia and the Internet to encourage the learning of 3-Dimensional (3D) geometry concepts and procedures. VRMath is being planned inside the structure of a design experiment (The Design-Based Research Collective, 2003) during which VRMath will advance through a progression of emphasis cycles of plan establishment reflection update into an educational tool that will provide mathematics teachers with new and all the more powerful methods for encouraging the development of 3D geometry knowledge [19]. Of the educational technologies at present being used, VR is seen as promising in view of its special ability to submerge students in situations they are examining, for example, in old urban communities, fabricating environments, or an investigate the human body. The investigation into the adequacy of innovation-based instructive devices, including VR, has shown substantial advantages, for example, decreased learning time and better learning outcomes [20]. The use of visual advancements for instructing and learning in modern training has delivered dramatic expansions of the once conventional talks, showings, and hands-on experiences. From the introduction of shading photography with full-movement video to computer-generated presentations with graphics and animations, visual advances have upgraded the arrangement of workforce specialists and experts by bringing into study halls and research centers an expansiveness and profundity of authenticity that has improved comprehension expanded learning performance and decreased preparing time. At times, in any case, there shows up a training technology that causes an acknowledgment that “this makes a huge difference.” Such innovation is virtual reality [21]. This article talks about the present utilization of virtual reality tools and their potential in science and engineering education. One programming tool specifically, the Virtual Reality Modeling Language. One contribution of this article is to show software tools and give models that may urge instructors to create virtual reality models to upgrade education in their own order [9].

3 Methodology This work proposes a new method for visualisations of the graphs using virtual reality. Visualisation plays a vital role in understanding something as different visualisation can lead to different perceptions. The complex function graph is hard to understand and when the graph is 3-dimensional, it increases complexity creating more confusion

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among the students. For instance, we have the function f (x) = x + 1. We can substitute a number for x, say 3. That prompts f (3) = 3 + 1 = 4 and can make numerous sets of the form. For instance (5,6) and (8,9) and (1,2) and (6,7). But it is more clear to the function when we request the sets by the input number. (1,2) and (2,3) and (3,4) and so on. It is easier to understand that but for a more complex function to understand, for instance, f (x) = (x − 1)(x − 1)4 + 5x 3 − 8x 2 is harder. We could write down a couple of input-output sets, yet that presumable won’t give a decent handle of the mapping it represents. In this paper we have presented a new method for visualisation of graphs using virtual reality. The methodology is divided into two parts; A. Visualisation of graphs using Virtual reality; B. Visualisations of scatter plots using VR. A. Visualisation of graphs using virtual reality Here the graphs are made from the equation passed to the proposed model and graph can be visualised in virtual reality simulated environment. The pseudocode of the proposed model using which the graphs are made are given below: Pseudocode 1: The proposed model Input: The equation whose graph is required to be plotted Output: The graph is plotted in virtual reality simulated environment 1. Set the values of upper range and lower range of variables x and z(only if the equation is three dimensional) 2. Set the values of variables: resolution, step, scale, . 3. Create a prefab and instantiate it 4. Initialize the variable t holding the time information from unity 5. float xStep = (xUpperRange + Mathf.Abs(xLowerRange)); 6. float zStep = (zUpperRange + Mathf.Abs(zLowerRange)); 7. int i = 0; 8. for (float z = 0; z 20 year) was 159 for each thousand for both Urban and Rural zone in 1995 [19]. In year 2009– 2012 for each 20 urban networks Delhi, Karnataka (Bangalore, Mysore), Andhra Pradesh (Hyderabad, Vishakhapatnam), Maharashtra (Pune, Ambernath, Ahmednagar), Uttar Pradesh (Agra, Kanpur), Rajasthan (Jodhpur), Himachal Pradesh (Manali), Chandigarh, Uttrakhand (Dehradun, Mussourrie), Orissa (Chandipur), Assam (Tejpur), Jammu and Kashmir (Leh), Madhya Pradesh (Gwalior), Tamil Nadu (Chennai) and Kerala (Kochi) the general regularity for diabetes was 16% with little refinement in individuals approx. 16.6 and 12.7%, transcendence of hypertension was 21%, normality for dyslipidemia was high about 45.6%. The Men and Women are at high peril of CAD [4]. In 2010–2012, in Vellore, cross-sectional examination done by Rose angina survey and electrocardiography found the inescapability rate for coronary Heart contamination among commonplace men was 3.4 and 7.3% in urban men, in provincial women was 7.4 and 13.4% in urban women high among female than the male from prevalence rate drove between 1991 and 1994 [20]. In 2010–2012, the cross-sectional survey shows prevalence rate increased in urban and rural area as compared to 1991–1994. The use of alcohol, overweight, raised blood pressure, smoking has put Delhi in high risk of cardiovascular disease. The mean body mass index in urban Delhi was found to be 24.4–26.0 kg/m2 ; and that in rural from 20.2 to 23.0 kg/m2 , systolic blood pressure in urban was found to be 121.2–129.8 mm Hg, and in rural about 114.9–123.1 mm Hg, and diastolic blood pressure in urban was found to be 74.3–83.9 mm Hg; in rural about 73.1–82.3 mm Hg [21].

3 A Rate of Cardiovascular Ailment In the year 2010–2011 sudden cardiac death at the age of 35 years and above of patients who underwent an autopsy, occurred in 39.7/100,000 of the population during the study interval. It was 4.6 times more in males than females with approx. incidence of 65.8/100,000 compared to 14.3/100,000 among females [22]. The incidence rate is 145 per 100,000 per year [23].

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4 Spread of Ailment with Age and Beginning of Ailment Mean period of commencement of smoking in the urban and rustic region was 22.24 ± 7.2 and 21.1 ± 7.4 [24]. Mean age at commencement of smoking in young person was 19 years ± 2.34 years [25]. The mean age for sudden heart failure was observed to be 55 + 10 years [22].

5 Risk Ailments of Cardiovascular Infirmities 5.1 Smoking Tobacco is used in chewing, smoking by children at the age of 10–13 years, but found more in the age of 14–19 years. According to world bank report, around 82,000–99,000 children smoke every day. Approx. 6 million people pass on overall on account of eating up tobacco and interfacing with smoke [26]. Tobacco used as cigarette contains chemical compounds,such as Acetone ((CH3 )2CO) used in nail cleaning, Acetic Acid (CH3 COOH) in hair shading, Ammonia (NH3 ) in cleaning house, Arsenic (As) as bug splashes and in rechargeable battery, Benzene(C6 H6 ) as an essential part of gas, Butane (C4 H10 ) which on reaction with plenty of oxygen forms Carbon dioxide and if oxygen is present in limited amount carbon monoxide is formed. Carbon Monoxide in car exhaust fumes, Hexamine in barbecue lighter fluid, Lead in batteries, Naphthalene as an ingredient in mothballs, Methanol in rocket fuel, Nicotine as an insecticide, Tar as material for paving roads, and Toluene, for making paint [27]. These synthetic compounds prompt swelling of a cell of veins making it confined and provoking various heart conditions, for instance, atherosclerosis in which cholesterol solidifies with other substance in blood making a plaque which blocks the stream of blood, and Abdominal aortic aneurysm in which stomach aorta is week’s end and can prompt an aneurysm [28]. In India at the age of approx. 15 years 47% men and 14% of women’s either smoke or use tobacco as cigarette, beedis or hookah, chillum, and pipe, etc. [29]. In the year 2005, data from private and government schools of Noida shows prevalence rate between age 11–19 years more in young men than young women. Early start of smoking or gnawing tobacco, among 70% young fellows and 80% young women starts at an age not actually or identical to 15 years, generally is found more in non-state funded schools than in government schools [30].

5.2 Hypertension For CVD, hypertension is a most important risk factor which increases with age. The prevalence rate was found more in men as compared to a woman [31].

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5.3 Diet and Nutrition Low intake of fruits and vegetables and more intake of fast foods such as pizza, burger increases high blood pressure due to the presence of saturated fats and cholesterol which in turn forms a plaque in the wall of blood vessels causing the reduction in its diameter and elasticity [32].

5.4 The Abundance of Sodium Young, and grown-ups are more taking overabundance measure of salt into the body by eating various types of items bought from the market.As indicated by the World Health Organization (WHO) in 2003 < 2.0 g/day of sodium taken by grown-ups which imply 5 g/day and they are at high danger of hypertension [33, 34]

5.5 Air Pollution Effects India named as a sevnth most polluted nation with regards to air pollution. The harmful gases mostly come from vehicles. Air contamination contains organic substances, particulate issue, and synthetic substances to the air which makes harm people and other living life forms [35]. Contaminated air has a negative influence on various organs. It ranges from minor upper respiratory, coronary illness, lung tumor and intense respiratory contaminations in youngsters and constant bronchitis in grownups, exasperating previous heart, and lung infection, or asthmatic assaults [36] This year 2018 before Diwali PM2.5 and NO2 value have increased as compared to previous Diwali day in areas of Delhi Anand Vihar, R.K Puram, and Punjabi Bagh. These areas are quite unsafe for people to breath as they are more at risk in developing heart, COPD and cancer disease [37] (Tables 1, 2 and Figs. 2, 3, 4). Table 1 The remarks for AQI index are given as below as taken from CPCB [37]

AQ1

Remark

0–50

Good

51–100

Satisfactory

101–200

Moderate

201–300

Poor

301–400

Very poor

401–500

Severe

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Table 2 Prevalence of ever tobacco use among boys and girls Tobacco

Boys

Girls

Total

Place

References

Smoking or chewing or both

12.2

10.2

11.2

Noida

[30]

Never tobacco

87.8

89.8

88.8

Noida

[30]

Fig. 2 India map showing AQI index on Diwali day 2018 [37]

Fig. 3 PM2.5 value in Anand Vihar, Punjabi Bagh and RK Puram [37]

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Fig. 4 The correlation coefficient for PM2.5 NO2 is 0.468688 and for that of PM2.5 and PM10 IS 0.8 [37]

5.6 Gender Women’s after their menopause is at high danger of creating cardiovascular sickness than young women’s and men [38]. After menopause the cholesterol and low thickness lipoprotein (LDL) builds 10–14% while high thickness lipoprotein level stays unaltered, the low LDL and cholesterol can to some degree help in expanding the life expectancy in women [39].

5.7 Ethnicity or Race Ethnicity plays a role in CVD. South Asian have triple vessel infection as compared to European [7].

5.8 Low Financial Status Utilization of Tobacco, low nourishment diet, and consumption of low-quality liquor is increasing in low financial status, although diabetes, hypertension is progressively normal [40]. Utilization of unsafe and low-quality liquor was found with low-salary and absence of training living in provincial territories [32]. Mental sickness, anxiety, was seen among individuals suffering from heart disease [41]. Patients enduring with mental clutters including Schizophrenia, serious mental confusion has 53% CVD [19].

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5.9 Psychosocial Stress Youngsters are likely to be influenced by this issue mainly because of online networking sites like Facebook, Twitter, and so on. The absent of family support and that of luxurious living have great effects [32]. Stress may prompt hypertension, discombobulation, bitterness, and change in conduct. Patients experiencing these are bound to have heart disease [42]. Women’s living in urban, provincial towns experience the ill effects of social factors and fears of sexual viciousness all of which adds to psychosocial stress [43].

5.10 Diabetes and Glucose Intolerance The prevalence rates of diabetes for urban and rural are increasing rapidly, and so the risk of heart disease also is increasing, patients suffering with acute chronic disease should undergoes diabetes screening with glucose tolerance test [12, 42]. There is very much less awareness of diabetes among rural population [42].

6 Predictive Data Analysis of Cardiovascular Disease in an Urban and Rural Area for Males and Females Predictive data analysis by excel shows rises in Urban and Rural cases for 2030 [9]. Coronary corridor infection (CAD) represents 60% everything being equal and 47% of weight of maladies which is continuously expanding in rustic populace as far as outright numbers [44] (Figs. 5, 6, 7 and 8).

7 Classification of Heart Disease by Naive Bayes Using Weka Tools Heart patients are regularly not recognized until a later phase of the ailment or the advancement of entanglements [45] (Tables 3, 4 and Figs. 9, 10). Time taken to build model: 0.01 s. The dataset from GitHub was taken [38]. We used Weka Tools for the classification model for patients of heart and analyzed it by Naive Bayes classification algorithms as Naive Bayes Classification shows more accuracy than other algorithms. To test the developed model, we used 10-fold cross-validation. The outcomes can be used to make a control plan for Heart patients since Heart patients are regularly not recognized until a later phase of the ailment or the advancement of entanglements [45].

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Fig. 5 Showing the data analysis in urban area and likely to rise in 2030 in the age group 20–29 years [9]

Fig. 6 Forecast data for the female in an Urban area for age 20–29 years [9]

Fig. 7 Forecast data for the male in the rural area for age 20–29 years [9]

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Fig. 8 Forecast for females in the rural area till 2030 for age 20–29 years [9] Table 3 Classification by Naïve Bayes algorithm [45]

Correctly classified instances

Table 4 Hypertension Prevalence rate in some states

State

Men

Woman

Total

Andhra Pradesh

16.2

10.0

13.1

Assam

19.6

16.0

17.8

Sikkim

27.3

16.5

21.9

Rajasthan

12.4

6.9

9.7

Uttar Pradesh

10.1

7.6

8.9

Incorrectly classified instances

Fig. 9 Prevalence of overweight in young students

226

83.7037%

44

16.2963%

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Fig. 10 Prevalence of obesity among young students

8 Medication List of medication being provided to patient• ACE inhibitors (angiotensin-converting enzyme inhibitors)—It helps relaxing blood vessel by preventing the enzyme to produce. • Angiotensin II which narrows the blood vessels. It is used for treating high blood pressure [46]. • Angiotensin-II antagonists (ARBs)—It prevents the binding of Angiotensin II to receptors of the muscle surrounding the blood vessels thus preventing high blood pressure. Few examples of them are as below [47]. (1) (2) (3) (4) (5) (6) (7) (8)

Azilsartan (Edarbi) Candesartan (Atacand) Eprosartan Irbesartan (Avapro) Losartan (Cozaar) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan)

• ARNi (angiotensin-II receptor-neprilysin inhibitor) • Antiarrhythmic medicines—It is given to prevent heart attack and stroke. It is used to treat Arrhythmia i.e. irregular heart beats [48]

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• Anticoagulant medicines—Anticoagulant medicines such as warfarin are given to prevent blood clot. It is recommended to the patients with high risk of developing clots to prevent stroke and heart attack. Other medicines include rivaroxaban (Xarelto), dabigatran (Pradaxa), apixaban (Eliquis) and edoxaban (Lixiana) [49] • Antiplatelet medicines: Platelets plays a role in the development of arterial thrombosis despite smallest blood cells, which can prove beneficial for reducing the formation of thrombus and thus reduce the mortality in patients suffering from coronary artery disease. Antiplatelet medicines such as Aspirin prevents blood clot by preventing blood cells from sticking together and 75 mg tablets prevents the heart attack and stroke in patients [50]. • Beta-blockers: Beta-blockers such as BisoprololFumarate is used for the treatment of heart failure and provides protection to the heart, thus is useful in treatment of various CAD [51]. • Calcium channel blockers—Calcium channel blockers like Amlodipine improve blood flow by widening the blood vessels. It is used to treat high blood pressure, chest pain and CAD. Some examples of Calcium channel blockers are as below and they are prescribed along with cholesterol lowering drugs [52] • Amlodipine (Norvasc) • Diltiazem (Cardizem, Tiazac, others) • Felodipine • Isradipine • Nicardipine • Nifedipine (Adalat CC, Afeditab CR, Procardia) • Nisoldipine (Sular) • Verapamil (Calan, Verelan) • Cholesterol-lowering medicines (lipid-lowering medicines) such as statins: It is used to lower cholesterol and triglycerides in the blood. Atorvastatin is taken to reduce risk of heart disease [53]. • Digoxin—It forces the heart to pump more bloods, by increasing its activity, and reduce shortness of breath [54].

9 Various Tests Available for Heart Check up Electrocardiogram (ECG)—It is done to check whether your heart is working properly or not, it measures the electrical activity of the heart. It can show up following problems related to heart [55]. 1. 2. 3. 4.

Any blockage by cholesterol or other substance—CAD. Abnormal heart rhythms condition known as arrhythmias. Any past Heart attacks. Cardiomyopathy.

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Magnetic Resonance Imaging (MRI)—It is useful for checking of effect of coronary artery disease, and anatomy of heart with congenital heart disease [56] (Figs. 11 and 12). Angiography—It is used to check the blood vessels and is like X-rays. Normal X-rays don’t show up the clear picture, so angiography is done, by injecting a small cut around the wrist and small thin tube is inserted into artery containing dye, and Xrays are taken as dye flows through blood vessels. It is useful for checking peripheral artery disease, angina, atherosclerosis, blood supply to lungs, kidney and brain [57]. Risk factors associated with AngiographyHaematoma—It is collection of blood where small cut is made which leads to bruises. Haemorrhage—Even small amount of bleeding from the cut site may be deleterious in some cases. Pseudoaneurysm—Bleeding from the cut side leading to the formation of a lump and need to be operated. Arrhythmias—As the name suggest disturbance cause to the rhythm of the heart which can settle without drug treatment or with use of it. Cerebrovascular accident—A clot or bleed in vessel in the brain causing stroke. Myocardial infarction—Heart attack occurring due to blockage in the arteries which can be treated by angioplasty and may be even led to death in very rare cases. Reaction to dye—Although rare but it is caused by allergic reaction against the dye which can be treated with drugs and can sometimes become serious. Pulmonary embolism—A clot in veins going towards lungs which can be treated with drugs.

Fig. 11 ECG Report with patient suffering from depression

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Fig. 12 ECG report with patient suffering from cardiovascular heart disease

10 Virtual Reality in Health Care Virtual reality has been standing out as truly newsworthy for its capability to change the manners in which we interface with our surroundings. Leap forward innovations like the Oculus Rift headset have made for fantastically similar encounters, strikingly in gaming and different types of computerized excitement. Mounting long stretches of clinical experience have built up the utility of printed models of patient life structures in various treatment and showing situations, most remarkably as pre- and intra-procedural arranging instruments controlling basic leadership for innate coronary illness and catheter-based mediations. To some extent because of a proceeded with absence of repayment and under-characterized (and moderate to advance) administrative status, these utilization cases remain to a great extent investigational even as they become progressively normal. Patients, doctors, as well as imaging focuses consequently stay troubled by the related expense to make such models, and the perceptual and basic leadership upgrades, while self-evident noteworthy, still may not plainly or freely legitimize a possibly surprising expense. Reproduction and implantable gadget applications may speak to a more profound well of hidden an incentive in cardiovascular mediation; be that as it may, further advancement of these applications depends on-and is throttled by-advance in material science and tissue-building research. The significance of reenactment applications

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as of late is additionally now in rivalry with advanced analogs including expanded and computer-generated reality. Beside its blast in the media area, augmented reality has likewise risen as a creative device in social insurance. Both virtual and expanded reality advancements are springing up in social insurance settings, for example, working rooms, or being gushed to buyers by means of telehealth correspondences. Much of the time, augmented reality has empowered therapeutic experts to execute care even more securely and viably. Computer generated reality that enables specialists to picture the heart in three measurements could help in the analysis of heart conditions. A pilot examines distributed today in the open access diary Cardiovascular Ultrasound uncovers that specialists can analyse heart conditions rapidly and effectively from virtual threedimensional enlivened pictures or ‘3D images’ of the heart. Three-dimensional (3D) 3D images enable specialists to ‘jump’ into the pulsating heart and see inside pieces of the organ [58].

11 Implantable Cardioverter Defibrillators Implantable Cardioverter Defibrillators (ICD) An ICD is a little electrical gadget used to treat a few sorts of unusual heart cadence, or arrhythmia, which can be hazardous. It’s a little greater at that point coordinate box in size, and its normally embedded simply under your collarbone. It’s made up of a pulse generator i.e. battery powered electronic circuit, and one or more electrode leads which are placed in heart through vein [14].

12 Use of Certain Medication Medication used for mental-illness for example a condition Schizophrenia have certain rare side effects of the medicine used i.e. Aripiprazole, leads to slower heartbeat, heart attack, chest pain, etc. [59].

13 Cardiovascular Diseases Types Stroke—It happens when the blood supply to the brain is cut off. It occurs because of two reasons either blood supply to the brain is blocked as blood gets clot which is popularly known as ischaemic and another reason is haemorrhagic in which blood vessel supplying to the brain bursts out [14].

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Arrhythmia—As the name suggests is related with abnormal heart beat. The types of Arrhythmia are atrial fibrillation in which the heart beat is faster, another type is bradycardia in which heart beat is slow, ventricular fibrillation in which person can become unconscious and if not treated can have sudden death [60]. Coronary heart disease—CAD also known as ischaemic heart disease which is caused by the blockage of heart blood supply by certain kind of substance formed with cholesterol or fat called as atheroma. The wall of artery gets covered with it called as atherosclerosis and is main cause of death worldwide. It can be caused by smoking, high blood pressure due to hypertension, alcohol and diabetes [61]. Heart failure—It is the condition in which heart is unable to pump the blood. The main cause of heart failure is CAD, high blood pressure, cardiomyopathy, congenital heart disease, etc. [62].

14 Prevention Measures Change in routine lifestyle, quitting of tobacco, physical exercise, yoga, check-up of blood pressure and cholesterol along with intake of fruit and vegetable rich diet, less salt intake and low alcohol consumption can be some of the preventive measures. Government should increase the taxes on tobacco, alcohol and fast foods, and spread awareness about CVD in order to check the spread of this disease [63]. It has been found that stress and physical inactivity promotes risk for cardiovascular disease and yoga is highly beneficial to reduce stress among patients [64].

15 Role of Yoga in Treatment of Heart Disease While inquiry about on utilizing yoga as a treatment for heart patients is still in its logical early stages, there is developing proof to recommend that yogic practices positively affect both counteractive action and fix of coronary illness. A few yogic practices strike at the main drivers of the malady by lessening hypertension, bringing down elevated cholesterol levels, just as better overseeing mental and passionate pressure. At the point when performed normally under master direction, and joined with an appropriate eating routine, Yogic practices can help decrease blockages, help in the quicker development of pledges, increment blood flow, quiet the thoughtful sensory system which oversees producing pressure hormones, and actuate positive reasoning (along these lines lessening heart hypochondria). In any case, particularly in the therapeutic phase of coronary illness, Yoga treatment must work related to restorative treatment and all practices must be attempted simply after conference with the doctor. Yoga Nidra: A propelled unwinding method which incorporates breath mindfulness and representation to support the mending procedure. In the field of coronary illness, this training is viewed as a viable preventive, therapeutic and palliative in all

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degrees of heart strain and disappointment. Unwinding has been appeared to bring down the pulse, decline circulatory strain and mitigate the working strain upon heart muscles. This system can even be utilized while the patient is still in the Intensive Care Unit, recuperating from a heart assault. Reflection and Chanting: OMKAR or different mantras make positive vibrations which impact the body and mind and decrease mental and passionate pressure [52]. Cardiovascular patients are urged to exercise and remain dynamic for different advantages, including improvement of fiery markers and vascular reactivity. HF patients normally have comorbidities that keep them from taking part in customary exercise programs and require individualized exercise medicine. The metabolic interest of yoga is adaptable, extending from seat based to consistent stream. Alternatives for the conveyance of yoga to HF patients may run from support in a heart restoration office or a regulated locally situated program utilizing savvy and associated innovation, empowering a feeling of authority and association. Distributed research to date underpins that yoga is a protected and successful expansion to the administration of HF patients and their QoL. Brilliant and associated advancements to increase yogabased restorative mediation for centre or home settings could profit hard-to-achieve populaces. Endeavours utilizing 3D room sensors, for example, Microsoft Kinect for subjective investigation of yoga and Tai Chi stances [65] could prompt widescale selection through economical channels. These ease equipment/programming cell phones or gaming stages could evaluate helpful results, for example, consistence to perfect stances, breath, or vitality consumption. These applications can connect with various members for inspiration and adherence [66]. Studies analysing bunch yoga versus at-home yoga versus a control could be of an incentive to gauge the advantages of social help for patients in danger for or determined to have cardiovascular ailment [67].

16 Burden of Disease According to health data the most causes of death in India is due to Ischemic heart disease [68]. The proportion of IHD to stroke mortality in India is essentially higher than the worldwide normal and is tantamount to that of Western industrialized nations. Together, IHD and stroke are in charge of more than one-fifth (21.1%) everything being equal and one-tenth of the long stretches of life lost in India (long periods of life lost is a measure that evaluates untimely mortality by weighting more youthful passing’s more than more seasoned deaths) 0.8. The long periods of life lost owing to CVD in India expanded by 59% from 1990 to 2010 (23.2 million to 37 million) [65].

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Fig. 13 The percentage change from 2007 to 2017

17 Conclusion CVD is found to be the main reason behind more death in India and around the world. Ischemic coronary artery disease and stroke are the primary cause of about 70% of CVD deaths [10]. The knowledge of CVD and its hazard factors are considerably less in urban and rural zones along with the school children’s. The family ancestors and ethnicity are additional factors in CVD. Young with family ancestry of smoking and diabetes have more chances of heart disease. Air pollution is also the biggest problem in India and is more in the three states Delhi, UP and Haryana. It is also one of the causes of respiratory, cardiovascular disease and skin cancer (Fig. 13).

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