Augmented Reality in Physical Therapy: Systematic Review and Meta-analysis

Background: Augmented reality (AR) is a rapidly expanding technology; it comprises the generation of new images from digital information in the real physical environment of a person, which simulates an environment where the artificial and real are mixed. The use of AR in physiotherapy has shown benefits in certain areas of patient health. However, these benefits have not been studied as a whole. Objective: This study aims to ascertain the current scientific evidence on AR therapy as a complement to physiotherapy and to determine the areas in which it has been used the most and which variables and methods have been most effective. Methods: A systematic review registered in PROSPERO (International Prospective Register of Systematic Reviews) was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta - Analyses) recommendations. The search was conducted from July to August 2021 in the PubMed, PEDro, Web of Science, Scopus, and Cochrane Library scientific databases using the keywords augmented reality, physiotherapy, physical therapy, exercise therapy, rehabilitation, physical medicine, fitness, and occupational therapy. The methodological quality was evaluated using the PEDro scale and the Scottish Intercollegiate Guidelines Network scale to determine the degree of recommendation The Cochrane Collaboration tool was used to evaluate the risk of bias. Results: In total, 11 articles were included in the systematic review. Of the 11 articles, 4 (36%) contributed information to the meta-analysis. Overall, 64% (7/11) obtained a good level of evidence, and most had a B degree of recommendation of evidence. A total of 308 participants were analyzed. Favorable results were found for the Berg Balance Scale (standardized mean change 0.473, 95% CI -0.0877 to 1.0338; z=1.65; P=.10) and the Timed Up and Go test (standardized mean change -1.211, 95% CI -3.2005 to 0.7768; z=1.194; P=.23). Conclusions: AR, in combination with conventional therapy, has been used for the treatment of balance and fall prevention in geriatrics, lower and upper limb functionality in stroke, pain in phantom pain syndrome, and turning in place in patients with Parkinson disease with freezing of gait. AR is effective for the improvement of balance; however, given the small size of the samples and the high heterogeneity of the studies, the results were not conclusive. Future studies using larger sample sizes and with greater homogeneity in terms of the devices used and the frequency and intensity of the interventions are needed

The Augmented Reality Systems in a Maintenance of Equipment tutorial context

O desenvolvimento da Realidade Aumentada como um conceito e as técnicas disponíveis relacionadas têm vindo a estabilizar ao longo dos anos, permitindo o aparecimento de uma numerosa quantidade de aplicações de Realidade Aumentada em áreas como a medicina, design, manutenção e reparação, anotação e visualização, planeamento de trajectória de robôs, aviação militar e entretimento que tem recebido mais atenção.Embora muitas dessas áreas tenham demonstrado as vantagens da Realidade Aumentada, ainda existem algumas aberturas por preencher. A montagem e manutenção de equipmento, por exemplo, tem sido um tema de estudo investigado minuciosamente.Várias aplicações têm sido desenvolvidas que demonstram os benefícios da Realidade Aumentada em tarefas de montagem, mas o ponto principal de inovação desta dissertação foca-se em permitir a criação de Tutoriais de montagem utilizando Realidade Aumentada através do mesmo sistema de Realidade Aumentada que permite a execução do tutorial. A criação de tutoriais seria efectuada através da utilização de um digitalizador 3D, de modo a identificar cuidadosamente a localização da próxima peça a ser montada.Augmented Reality's development as a concept and available related techniques have been stabilizing throughout the years, allowing a numerous of AR applications to appear in several areas such as medical, design, maintenance and repair, annotation and visualization, robot path planning, military aircraft and entertainment which has received the most attention.While many of those areas have shown the advantages AR can bring, there are still some loopholes that need to be filled. Assembly and maintenance of equipment, for instance, has been a thoroughly investigated subject of study in AR.Many applications have been developed which demonstrate the benefits of AR in assembly tasks, but this dissertation's main innovative point is to allow the creation of AR assembly tutorials using the same AR system that allows its tutorial execution. The creation of tutorials would be carried out through the use of a manual 3D Digitizer, in order to carefully pinpoint each location of the next assembly component

Natural freehand grasping of virtual objects for augmented reality

Grasping is a primary form of interaction with the surrounding world, and is an intuitive interaction technique by nature due to the highly complex structure of the human hand. Translating this versatile interaction technique to Augmented Reality (AR) can provide interaction designers with more opportunities to implement more intuitive and realistic AR applications. The work presented in this thesis uses quantifiable measures to evaluate the accuracy and usability of natural grasping of virtual objects in AR environments, and presents methods for improving this natural form of interaction. Following a review of physical grasping parameters and current methods of mediating grasping interactions in AR, a comprehensive analysis of natural freehand grasping of virtual objects in AR is presented to assess the accuracy, usability and transferability of this natural form of grasping to AR environments. The analysis is presented in four independent user studies (120 participants, 30 participants for each study and 5760 grasping tasks in total), where natural freehand grasping performance is assessed for a range of virtual object sizes, positions and types in terms of accuracy of grasping, task completion time and overall system usability. Findings from the first user study in this work highlighted two key problems for natural grasping in AR; namely inaccurate depth estimation and inaccurate size estimation of virtual objects. Following the quantification of these errors, three different methods for mitigating user errors and assisting users during natural grasping were presented and analysed; namely dual view visual feedback, drop shadows and additional visual feedback when adding user based tolerances during interaction tasks. Dual view visual feedback was found to significantly improve user depth estimation, however this method also significantly increased task completion time. Drop shadows provided an alternative, and a more usable solution, to dual view visual feedback through significantly improving depth estimation, task completion time and the overall usability of natural grasping. User based tolerances negated the fundamental problem of inaccurate size estimation of virtual objects, through enabling users to perform natural grasping without the need of being highly accurate in their grasping performance, thus providing evidence that natural grasping can be usable in task based AR environments. Finally recommendations for allowing and further improving natural grasping interaction in AR environments are provided, along with guidelines for translating this form of natural grasping to other AR environments and user interfaces

Evaluación de aplicaciones educativas de AR con estudiantes adultos

There is a growing interest in the educational applications of Augmented Reality (AR). While most applications of these technologies have been examined in the context of children education, our knowledge about their usefulness in adult education is deficient and particularly more in the category of Location-Based Augmented Reality (LBMAR) games, so the aim of this thesis is to examine the opinions of adult learners (young, middle-aged and elderly) about one particular LBMAR game, the “Ingress”. The main problems addressed by this research comprise questions relating to the usefulness of some key technological components of AR in education (secondarily) and to aspects of training adults by using AR (primarily). As concerns the technological aspects, i.e. "which one of the three types of AR (marker-based, markerless, location-based) is more often associated with naturalistic approaches and what are their relative advantages?”, this research showed that naturalistic approaches applied to marker-based AR enhance active participation in virtual environments, motivate learners, promote personal involvement in conquering new information, offer different perspectives of the content and arouse interest for knowledge. In the case of markerless AR, naturalistic designs foster participants’ collaboration in games, enhance interactivity, offer panoramic views, visualization, and the possibility to examine the role of visual controls. Moreover, naturalistic approaches applied to location-based AR are suitable for designing multidisciplinary applications, can be used for training and have the possibility to be designed so as to account for locality and context. The fact that, as appears from the peer-reviewed literature that was examined, the location-based AR technologies are more appropriate for education and for smartphones, hints that a deeper examination of their potential usefulness for education (and for adult education in particular) might be interesting. As concerns the educational aspects, which also constitute the main focus of the thesis, these focus on the exploration of the usefulness of the LBMAR game “Ingress” in adult education, by answering two intertwined questions: a) how to assess opinions of adult learners about the LBMAR game “Ingress”? and b) what do adult learners think about this game and how do they perceive its features? Providing answers to these questions is tantamount to receiving adequate results from quantitative and qualitative empirical research which would be designed so as to explore their opinions, views and attitudes with respect to this LBMAR game. Hence, 45 adult persons from Greece, aged 20 to 62,cooperated as subjects of this research. They followed a short introductory informal training (on AR, VR, MAR and the games that are relevant to these technologies) by the researcher of this thesis and were subsequently given the instructions of how to use “Ingress” on a smartphone. The quantitative research was carried out before and after training and all trainees participated by filling 31 Likert-type closed questions before and after training. The qualitative research was based on the analysis of their responses to two different sets of open-ended questions. The first set consisted in 5 such questions to which answered 24 participants and the second set had 2 broader questions to which responded 36 participants. This research showed the advantages for adult education of integrating the ARCS model into the learning phase of an LBMAR game. Specifically, it was shown that using Keller’s widely known “ARCS model” (Attention – Relevance – Confidence - Satisfaction) enabled the classification of users’ responses with respect to their interaction with the game and is therefore useful in evaluating adult education with LBMAR games. The players’ responses did not change linearly with their age and the training has had different impact on each age group of learners. Also, statistical analyses proved that training increased the scores of the factors of ARCS model. Other results of this research showed that those over 36 years old focused more on the facts that the play of “Ingress” is primarily a geographical game and its scenario reflects interesting discussions about the evolution of humanity. Participants in the age groups 20–35 and >52 agreed that the game does not have idle phases, that it combines excitement with insecurity, and that it is pleasant to play locally a game of planetary proportions.Another age-related observation concerned the answers to the question (“How do you feel when you endow the geographical space with personal preferences?”) between age groups with age groups agreeing in pairs: the first two age groups (20–30) and (30–40) agreed more than with the last two (40–50) and (50–60). Yet, in question “Do you think that the game offers opportunities for learning and teaching geography, building on your previous geographical knowledge?” , there was an overlap in the responses of participants among age groups. As for the first question, the most critical concept was: “the users feel a kind of nostalgia”, followed by the concept “the users consider portals as personal creations”. In the case of the second question, the most critical concept was that the participants believe that the game offers entirely new opportunities for education in geography, compared with their previous experiences. This fosters an evidence of constructivist approaches to adult education and, also, relevance of some other prominent theories of adult education such as humanism. Methodologically, this research it was shown that content analysis is a valuable method for exploring opinions and attitudes of adult users towards MAR games and Jaccard indices can be used to quantitatively explore themes emerging from content analysis. Content analysis was performed on the users’ responses qualitatively in order to identify characteristic sentences expressing attitudes and opinions. For the quantitative assessment of similarities between responses for each question and subconcept, the Jaccard similarity index was calculated pair-wise for every pair of participants. In addition to the Jaccard indices and furthering the scope of new methods for content analysis, this thesis shows how to use Social Network Analysis (SNA) to model concept maps, thus opening up excellent opportunities to create visualizations of concepts and their inter-relationships. Quantitative aspects of SNA analysis (i.e. by using radial centrality and information centrality) provide mechanisms suitable to measure internal relationships in concept maps (in addition to visual inspection) that would not otherwise be visible. Using SNA enabled the classification of users’ responses with respect to their interaction with the game and therefore was a fruitful approach for education that involves MAR games. Furthermore, with this novelty, it is shown how texts derived from interviews or from responses to open questions by different individuals can be analyzed both qualitatively and quantitatively with SNA. Concluding, this research has produced novelties at both the educational and the methodological levels. As concerns adult education, it was shown that i) LBMAR games are suitable for it, ii) adult education about them can be enhanced by following Keller’s ARCS model, iii) perception and satisfaction of adult learners depends on age, and iv) certain theories of adult education (i.e. constructivism and humanism) can be relevant when adult learners use LBMAR games such as “Ingress”. As concerns methods of educational research, this research suggested entirely new methods, for first time ever, for analyzing data that are derived from trainees' responses to open questions. These new methods are content analysis of the participants’ responses with the use of Jaccard indices and methods of SNA and can have a wider applicability to educational research.Existe un creciente interés por las aplicaciones educativas de la Realidad Aumentada (RA). Mientras que la mayoría de las aplicaciones de estas tecnologías se han examinado en el contexto de la educación infantil, nuestro conocimiento sobre su utilidad en la educación de adultos es deficiente y, en particular, más en la categoría de juegos de Realidad Aumentada Basada en la Localización (LBMAR), por lo que el objetivo de esta tesis es examinar las opiniones de los estudiantes adultos (jóvenes, de mediana edad y mayores) sobre un juego LBMAR, el "Ingress". Los principales problemas que aborda esta investigación comprenden cuestiones relacionadas con la utilidad de algunos componentes tecnológicos de la RA en la educación (secundariamente) y con aspectos de la formación de adultos mediante el uso de la RA (principalmente). En cuanto a los aspectos tecnológicos, es decir "¿cuál de los tres tipos de RA (basada en marcadores, sin marcadores, basada en la localización) se asocia más a los enfoques naturalistas y cuáles son sus ventajas relativas?", esta investigación demostró que los enfoques naturalistas aplicados a la RA basada en marcadores potencian la participación activa en entornos virtuales, motivan a los alumnos, promueven la implicación personal en la conquista de nueva información, ofrecen diferentes perspectivas del contenido y despiertan el interés por el conocimiento. En el caso de la RA sin marcadores, los diseños naturalistas fomentan la colaboración de los participantes en los juegos, mejoran la interactividad, ofrecen vistas panorámicas, visualización y la posibilidad de examinar los controles visuales. Además, los enfoques naturalistas aplicados a la RA basada en la localización son adecuados para el diseño de aplicaciones multidisciplinares, pueden utilizarse para la formación y tienen la posibilidad de diseñarse teniendo en cuenta la localidad y el contexto. El hecho de que, como se desprende de la literatura revisada por pares que se examinó, las tecnologías de RA basadas en la localización son más apropiadas para la educación y para los teléfonos smartphones, sugiere que podría ser interesante un examen más profundo de su utilidad potencial para la educación (y para la educación de adultos en particular). En cuanto a los aspectos educativos, que también constituyen el foco principal de la tesis, éstos se centran en la exploración de la utilidad del juego LBMAR "Ingress" en la educación de adultos, respondiendo a dos preguntas entrelazadas: a) ¿cómo evaluar las opiniones de los alumnos adultos sobre el juego LBMAR "Ingress"? y b) ¿qué piensan los alumnos adultos sobre este juego y cómo perciben sus características? Dar respuesta a estas preguntas equivale a recibir resultados adecuados de una investigación empírica, cuantitativa y cualitativa, que se diseñaría para explorar sus opiniones, puntos de vista y actitudes con respecto a este juego LBMAR. Por lo tanto, 45 personas adultas de Grecia, con edades entre 20 y 62 años, colaboraron como sujetos de esta investigación. Siguieron una breve formación informal introductoria por parte del investigador de esta tesis (sobre RA, realidad virtual, RA móvil, y sobre los juegos relacionados con estas tecnologías) y posteriormente se les dieron las instrucciones de cómo utilizar "Ingress" en un smartphone. La investigación cuantitativa se llevó a cabo antes y después de la formación y todos los alumnos participaron respondiendo a 31 preguntas cerradas del tipo Likert antes y después de la formación. La investigación cualitativa se basó en el análisis de sus respuestas a dos conjuntos diferentes de preguntas abiertas. El primer conjunto constaba de 5 preguntas de este tipo (a las que respondieron 24 participantes) y el segundo conjunto tenía 2 preguntas más amplias, a las que respondieron 36 participantes. La investigación cuantitativa mostró las ventajas para la educación de adultos de integrar el modelo ARCS en la fase de aprendizaje de un juego LBMAR. En concreto, se demostró que la utilización del conocido "modelo ARCS" de Keller (Atención - Relevancia - Confianza - Satisfacción) permitió clasificar las respuestas de los usuarios con respecto a sus interacciones con el juego y, también, es útil para evaluar la educación de adultos con juegos LBMAR. Las respuestas de los jugadores no cambiaron linealmente con su edad y el entrenamiento ha tenido un impacto diferente en cada grupo de edad de los alumnos. Además, los análisis estadísticos demostraron que el entrenamiento aumentó las puntuaciones de los factores del modelo ARCS. Otros resultados de esta investigación mostraron que los mayores de 36 años se centraron más en el hecho de que el juego "Ingress" es principalmente un juego geográfico y su escenario refleja interesantes debates sobre la evolución de la humanidad. Las opiniones de los participantes de los grupos de edad de 20-35 y >52 coincidieron en que el juego no tiene fases ociosas, que combina la emoción con la inseguridad y que es agradable jugar a nivel local a un juego de proporciones planetarias. Otra observación relacionada con la edad se refería a las respuestas a la pregunta ("¿Cómo te sientes cuando dotas al espacio geográfico de preferencias personales?") entre grupos de edad que coincidían: los dos primeros grupos de edad (20-30) y (30-40) estaban más de acuerdo que los dos últimos (40-50) y (50-60). Sin embargo, en la pregunta "¿Crees que el juego ofrece oportunidades para aprender y enseñar geografía, aprovechando tus conocimientos geográficos previos?" hubo un solapamiento en las respuestas de los participantes entre los grupos de edad. En cuanto a la primera pregunta, el concepto más crítico fue: "los usuarios sienten una especie de nostalgia", seguido del concepto "los usuarios consideran los portales como creaciones personales". En el caso de la segunda pregunta, el concepto más crítico fue que los participantes creen que el juego ofrece oportunidades totalmente nuevas para la educación en geografía en comparación con sus experiencias anteriores. Esto fomenta una evidencia de los enfoques constructivistas de la educación de adultos y, también, la relevancia de algunas otras teorías prominentes de la educación de adultos, como el humanismo. Metodológicamente, esta investigación demostró también que el análisis de contenido es un método valioso para explorar las opiniones y actitudes de los usuarios adultos hacia los juegos MAR y los índices de Jaccard pueden utilizarse para explorar cuantitativamente los temas que surgen del análisis de contenido. El análisis de contenido se realizó sobre las respuestas de los usuarios de forma cualitativa para identificar las frases características que expresan actitudes y opiniones. Para la evaluación cuantitativa de las similitudes entre las respuestas de cada pregunta y subconcepto, se calculó el índice de similitud de Jaccard por parejas para cada par de participantes. Además de los índices de Jaccard y de ampliar el alcance de los nuevos métodos de análisis de contenido, esta tesis muestra cómo utilizar el Análisis de Redes Sociales (Social Networks Analysis - SNA) para modelar los mapas conceptuales, abriendo así excelentes oportunidades para crear visualizaciones de los conceptos y sus interrelaciones. Los aspectos cuantitativos del análisis SNA (es decir mediante el uso de la centralidad radial y la centralidad de la información) proporcionan mecanismos adecuados para medir las relaciones internas en los mapas conceptuales (además de la inspección visual) que de otro modo no serían visibles. El uso del SNA permitió la clasificación de las respuestas de los usuarios con respecto a su interacción con el juego y, por lo tanto, fue un enfoque fructífero para la educación que involucra los juegos MAR. Además, con esta novedad, se muestra cómo los textos derivados de las entrevistas o de las respuestas a las preguntas abiertas de diferentes individuos pueden ser analizados tanto cualitativamente como cuantitativamente usando SNA. En conclusión, esta investigación ha aportado novedades, tanto a nivel educativo como metodológico. En lo que respecta a la educación de adultos, se ha demostrado que i) los juegos LBMAR son adecuados para ella, ii) la educación de adultos sobre ellos puede mejorarse siguiendo el modelo ARCS de Keller, iii) la percepción y la satisfacción de los alumnos adultos depende de la edad, y iv) ciertas teorías de la educación de adultos (es decir, el constructivismo y el humanismo) pueden ser relevantes cuando los alumnos adultos utilizan juegos LBMAR como "Ingress". En cuanto a los métodos de investigación educativa, esta investigación sugirió métodos totalmente nuevos para analizar los datos que se derivan de las respuestas de los alumnos a las preguntas abiertas. Estos nuevos métodos son el análisis de contenido de las respuestas de los participantes con el uso de los índices de Jaccard y los métodos de SNA y pueden tener una aplicabilidad más amplia a la investigación educativa

Creación de experiencias de realidad aumentada realistas por usuarios finales

Programa de Doctorado en Ciencia y Tecnología Informática por la Universidad Carlos III de MadridPresidente: Juan Manuel Dodero Beardo.- Secretario: Andrea Bellucci.- Vocal: Camino Fernández Llama