title: Development of subliminal persuasion system to improve the upper limb posture in laparoscopic training: a preliminary study.
abstract: OBJECTIVE
  Current training for laparoscopy focuses only on the enhancement of manual skill and does not give advice on improving trainees' posture. However, a poor posture can result in increased static muscle loading, faster fatigue, and impaired psychomotor task performance. In this paper, the authors propose a method, named subliminal persuasion, which gives the trainee real-time advice for correcting the upper limb posture during laparoscopic training like the expert but leads to a lower increment in the workload.
  
  
  METHODS
  A 9-axis inertial measurement unit was used to compute the upper limb posture, and a Detection Reaction Time device was developed and used to measure the workload. A monitor displayed not only images from laparoscope, but also a visual stimulus, a transparent red cross superimposed to the laparoscopic images, when the trainee had incorrect upper limb posture. One group was exposed, when their posture was not correct during training, to a short (about 33 ms) subliminal visual stimulus. The control group instead was exposed to longer (about 660 ms) supraliminal visual stimuli.
  
  
  RESULTS
  We found that subliminal visual stimulation is a valid method to improve trainees' upper limb posture during laparoscopic training. Moreover, the additional workload required for subconscious processing of subliminal visual stimuli is less than the one required for supraliminal visual stimuli, which is processed instead at the conscious level.
  
  
  CONCLUSIONS
  We propose subliminal persuasion as a method to give subconscious real-time stimuli to improve upper limb posture during laparoscopic training. Its effectiveness and efficiency were confirmed against supraliminal stimuli transmitted at the conscious level: Subliminal persuasion improved upper limb posture of trainees, with a smaller increase on the overall workload.
authors.affiliation: Faculty of Science and Engineering, Waseda University, Tokyo, Japan.
authors.forename: Di
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Faculty of Science and Engineering, Waseda University, Tokyo, Japan. contact@takanishi.mech.waseda.ac.jp.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sessa
authors.affiliation: Faculty of Science and Engineering, Waseda University, Tokyo, Japan.
authors.forename: Weisheng
authors.initials: W
authors.lastname: Kong
authors.affiliation: Faculty of Science and Engineering, Waseda University, Tokyo, Japan.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cosentino
authors.affiliation: Department of Psychology, Torino University, Torino, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Magistro
authors.affiliation: Faculty of Science and Engineering, Waseda University, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ishii
authors.affiliation: Loughborough University, Loughborough, LE11 3TU, UK.|National Centre for Sports and Exercise Medicine - East Midlands (NCSEM-EM), Loughborough, UK.|NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit (BRU), Loughborough, UK.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Zecca
authors.affiliation: Department of Modern Mechanical Engineering, Waseda University, Tokyo, Japan.|Humanoid Robotics Institute, Waseda University, Tokyo, Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Takanishi
mesh_terms: D000328:Adult; D003198:Computer Simulation; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D008953:Models, Anatomic; D010565:Persuasive Communication; D011187:Posture; D058996:Quality Improvement; D011930:Reaction Time; D013360:Subliminal Stimulation; D034941:Upper Extremity
keywords: Laparoscopy; Subliminal persuasion; Subliminal visual stimuli; Supraliminal visual stimuli; Workload