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Transcript of Moving Beyond Single User, Local Virtual Environments for Rehabilitation Patrice L. (Tamar) Weiss...
Moving Beyond Single User, Local Virtual Environments for
Rehabilitation
Patrice L. (Tamar) WeissDepartment of Occupational Therapy
Faculty of Social Welfare and Health Sciences University of Haifa, Israel
Evelyne KlingerArts & Métiers Paris Tech Angers
Team Handicaps et Innovations Technologiques P&I Lab, Laval, France
Applications of Virtual Reality
Veridian System
Virtual Reality Assets for Rehabilitation and Special Education
Ecological validity
Grade cognitive & motor demands
Convenient times & locations
Performance can be documented
Easy to test & change
Safe for user
Virtual Reality Continuum for Rehabilitation
Presence Cost Complexity
HighTech
LowTech
Example
VAP-S: Virtual Action Planning Supermarket
to assess and treat executive function
deficits
Traditional Executive Function Assessment
• Standard neurocognitive tests: – Lack of sensitivity – Far away from everyday life
situations (Godefroy et al., 2004)
• Ecological neurocognitive tests: – Real time, Real situation (MET)– Limited use for patients without
autonomy (Shallice & Burgess, 1991)
• Test of scripts : – Plan generation– No action (Abbott et al., 1985)
WCST
VAP-S: Virtual Action Planning Supermarket
Designed with two main software: 3DStudioMax and Virtools
Klinger E., Marié R.M. et al., 2002-2005, GREYC-ENSICAEN, CHU de Caen
Shopping Task
• Verbal information:– In the supermarket, you
should buy: • one baguette• green apples• 2 kg bag of detergent• one kilo of flour• one t-shirt for child• two artichokes• beige socks.
– You may pay by clicking on the purse icon that is on the screen.
List display on the screenMarié et al., 2003
• The user– Selects items by
using the mouse
The items
Appear in the cart
Disappear from the icon list Record of trajectory, time and actions
Assessment Session
Performance comparison
Control:
Duration : 8 min
Distance : 215 m
Stops : 25
Patient with PD:
Duration : 25 min
Distance : 469 m
Stops : 67
Klinger et al., 2006
Example
IREX for Physical Fitness of young adults with intellectual
disabilities
Objective
To test the effectiveness of a VR-based exercise program in improving the physical fitness of adults with IDD.
Methods• Research group (N=30)
• mean age = 52.3 ± 5.8 years• IDD level - moderate)
• Matched control group (no VR-based exercise)• Two sub-groups: ambulatory and wheelchair users • Fitness program
• 5-6 weeks • two 30 min sessions per week • game-like exercises provided by the IREX or Sony PlayStation II EyeToy video capture VR system
• Pre & post-intervention changes in physical fitness• Energy Expenditure Index (EEI)• modified 12 min walk\run Cooper test • Total Heart Bit Index (THBI)
Study ParticipantsVariablesResearch
(n=28)Control(n=31)
DemographicsMean age (yr)52.354Age range (yr)37-6034-60Males1615Females1216Mean weight (kg)62.866.5Mean height (m)1.51.6Mean rest pulse (bpm)80.472.9Mean activity pulse 97.194.6
Assistive technology
Wheelchair1215Rolator1314Crutches22Walking cane10
FacilityQuitmann1312Kfar Nahman156Ruhama----6Bare Dror----9
Pre-Post Intervention TestsGroupNAmbulation
styleCooper test (m)
Mean ± (SD)Energy
Expenditure Index (EEI)
Mean
Total heart Beat Index
(HB/m )Mean
PrePostPrePostPrePost
Research28All211.8304.3**
*3.472.7428.315.6*
16Walking Aid
340.1486.7**1.20.878.13.9
12Wheelchair40.761.1**6.55.353.531.3
Control31All175.6183.92.12.315.214.8
15Walking Aid
253.3261.41.92.17.58.8
16Wheelchair87.696.12.52.523.921.5
P value <0.05-0.01*P value <0.01-0.001**P value <0.001***
Link to video clip for slide 15
Tele-rehabilitation
Second Life
StoryTable, NNR-Table
DiamondTouch Interactive Table
• Mitsubishi Electronic Research Lab (MERL)
• Large horizontal interactive surface
• Table-top interaction modality
• Operated through PC using Flash programming
• Images are top projected 18
19
DiamondTouch Interactive Table
Multi User Actions (MUAs): Interaction modality that requires the simultaneous participation of two or more users
Story Table
– Interface to support pairs of children in the activity of collaborative storytelling
– Implements “Enforced Collaboration” paradigm
20
Alternate story backgrounds
Story characters
Voice recording
Lady bugs to hold audio snippets
Story sequence
Story Table: Initial Study
21
OUTCOME MEASURES1. Behavioral Checklist
(based on Bauminger, Aviezer & Rogers, 2004)
• positive social interactions (e.g., look at peer with positive affect)
• negative social interactions (e.g., ignoring action of peer)
• autistic behaviors (e.g. perseveration)
2. Analysis of language usage in the interactions and in the narrations
22
Story Table: Initial Study
MarbleWorks Free structure play construction game
Pre- and Post-tests
Low-Tech ST scenarios with cardboard figures
Story Table: Initial Study
Link to video clip for slide 23
Comparison of Pre and Post outcomes
•increase in key positive social interactions• decrease in negative interactions• increase in narrative and play ability
Story Table: Initial Study
Tele-Rehabilitation
Patient
Home Unit
Central System(phase II)
Central DB
(phase II)
Therapist /
Clinician
Unit
Link to video clip for slide 27b
Link to video clip for slide 27a
Second Life is an Internet-based virtual world launched in 2003 by Linden’s Lab (http://lindenlab.com).
“Residents” inhabit virtual worlds and interact via avatars
Users participate in individual and group activities, and to create and trade items and services using Linden dollars
By the end of March 2008, 13 million registered accounts. About 38,000 residents are logged on to Second Life at any particular moment.
number of medical & health educational projects: Nutrition Game Occupational Therapy at the Virtual Neurological
Education Centre Brigadoon designed for people with Asperger’s
syndrome. Brigadoon - a controlled environment where users are encouraged to feel comfortable and learn socialization skills at their own pace (Lester).
Issues For Future Consideration
User perspective - effectiveness of providing users with first, third or bird's eye perspectives .
In past such decisions based primarily on the technology selected to render VE.
In the future, should be also driven by educational or therapeutic needs of users.
Issues For Future Consideration
User perspective
Role of virtual presence – generally assumed that increasing the level of virtual presence helps to facilitate the achievement of therapeutic goals due to its impact on motivation and performance.
Important to establish the role of virtual presence in multi-user, remote location VEs due to the added difficulty in achieving it in such settings.
Issues For Future Consideration
User perspective
Role of virtual presence
Technology considerations – Access to remote locations, especially in real-time, adds additional cost and technical complexity to the design and implementation of VEs.
Considerations of increased band width and the use of sensors capable of transmitting high fidelity data must be taken into account.
Issues For Future Consideration
User perspective
Role of virtual presence
Technology considerations
Compliance – user’s motivation to be a willing partner in any educational process of great importance. One of VRs major assets has been the use of game-like environments to increase motivation, participation and performance. Will this be lost in remote settings?
Issues For Future Consideration
User perspective
Role of virtual presence
Technology considerations
Compliance
Ethical considerations – Use of VEs in the traditional single user, local setting retained all elements of privacy that were guarded during conventional rehabilitation.
The addition of other users and the transmission of data, images, and communication over the Internet clearly introduce ethical issues not previously considered.
Issues For Future ConsiderationUser perspective
Role of virtual presence
Technology considerations
Compliance
Ethical considerations
Availability of software supporting functional VEs – most functional VEs have been customized by specific research groups, and often unavailable to other educators and clinicians. Recently publicized NeuroVR initiative (www.neurovr.org) provides a cost-free VE editor, which allows non-expert users to easily setup and tune VEs