Adaptive Tele-Therapies Based on Serious Games for Health for People with Time-Management and Organisational Problems: Preliminary Results

Attention Deficit with Hyperactivity Disorder (ADHD) is one of the most prevalent disorders within the child population today. Inattention problems can lead to greater difficulties in completing assignments, as well as problems with time management and prioritisation of tasks. This article presents an intelligent tele-therapy tool based on Serious Games for Health, aimed at the improvement of time management skills and the prioritisation of tasks. This tele-system is based on the use of decision trees within Django, a high-level Python Web framework. The technologies and techniques used were selected so as to boost user involvement and to enable the system to be easily customised. This article shows the preliminary results of the pilot-phase in an experiment performed to evaluate the use of adaptive tele-therapies within a group of typically developing children and adolescents aged between 12 and 19 years old without ADHD. To do so, we relied on the collection of parameters and the conduct of surveys for assessing time management skills, as well as measuring system usability and availability. The results of a time management survey highlighted that the users involved in the trial did not use any specific or effective time management techniques, scoring 1.98 and 2.30 out of 5 points in this area for ages under 15 and over 16 years old, respectively. The final calculations based on the usability questionnaire resulted in an average score of 78.75 out of 100. The creation of a customisable tool capable of working with different skills, in conjunction with the replication of the current study, may help to understand these users’ needs, as well as boosting time management skills among teenagers with and without ADHD

Occupational therapists’ views of using a virtual reality interior design application within the pre-discharge home visit process

This article has been made available through the Brunel Open Access Publishing Fund.Background: A key role of Occupational Therapists (OTs) is to carry out pre-discharge home visits (PHV) and propose appropriate adaptations to the home environment, to enable patients to function independently after hospital-home discharge. However, research shows that more than 50% of specialist equipment installed as part of home adaptations is not used by patients. A key reason for this is that decisions about home adaptations are often made without adequate collaboration and consultation with the patient. Consequently, there is an urgent need to seek out new and innovative uses of technology to facilitate patient/practitioner collaboration, engagement and shared decision making in the PHV process. Virtual reality interior design applications (VRIDAs) primarily allow users to simulate the home environment and visualise changes prior to implementing them. Customised VRIDAs, which also model specialist occupational therapy equipment, could become a valuable tool to facilitate improved patient/practitioner collaboration if developed effectively and integrated into the PHV process. Objective: To explore the perceptions of occupational therapists with regards to using VRIDAs as an assistive tool within the PHV process. Methods: Task-oriented interactive usability sessions, utilising the think-aloud protocol and subsequent semi-structured interviews were carried out with seven Occupational Therapists who possessed significant experience across a range of clinical settings. Template analysis was carried out on the think-aloud and interview data. Analysis was both inductive and driven by theory, centring around the parameters that impact upon the acceptance, adoption and use of this technology in practice as indicated by the Technology Acceptance Model (TAM). Results: OTs’ perceptions were identified relating to three core themes: (1) perceived usefulness (PU), (2) perceived ease of use (PEoU), and (3) actual use (AU). Regarding PU, OTs believed VRIDAs had promising potential to increase understanding, enrich communications and patient involvement, and improved patient/practitioner shared understanding. However, it was unlikely that VRIDAs would be suitable for use with cognitively impaired patients. For PEoU, all OTs were able to use the software and complete the tasks successfully, however, participants noted numerous specialist equipment items that could be added to the furniture library. AU perceptions were positive regarding use of the application across a range of clinical settings including children/young adults, long-term conditions, neurology, older adults, and social services. However, some “fine tuning” may be necessary if the application is to be optimally used in practice. Conclusions: Participants perceived the use of VRIDAs in practice would enhance levels of patient/practitioner collaboration and provide a much needed mechanism via which patients are empowered to become more equal partners in decisions made about their care. Further research is needed to explore patient perceptions of VRIDAs, to make necessary customisations accordingly, and to explore deployment of the application in a collaborative patient/practitioner-based context

XR, music and neurodiversity: design and application of new mixed reality technologies that facilitate musical intervention for children with autism spectrum conditions

This thesis, accompanied by the practice outputs,investigates sensory integration, social interaction and creativity through a newly developed VR-musical interface designed exclusively for children with a high-functioning autism spectrum condition (ASC).The results aim to contribute to the limited expanse of literature and research surrounding Virtual Reality (VR) musical interventions and Immersive Virtual Environments (IVEs) designed to support individuals with neurodevelopmental conditions. The author has developed bespoke hardware, software and a new methodology to conduct field investigations. These outputs include a Virtual Immersive Musical Reality Intervention (ViMRI) protocol, a Supplemental Personalised, immersive Musical Experience(SPiME) programme, the Assisted Real-time Three-dimensional Immersive Musical Intervention System’ (ARTIMIS) and a bespoke (and fully configurable) ‘Creative immersive interactive Musical Software’ application (CiiMS). The outputs are each implemented within a series of institutional investigations of 18 autistic child participants. Four groups are evaluated using newly developed virtual assessment and scoring mechanisms devised exclusively from long-established rating scales. Key quantitative indicators from the datasets demonstrate consistent findings and significant improvements for individual preferences (likes), fear reduction efficacy, and social interaction. Six individual case studies present positive qualitative results demonstrating improved decision-making and sensorimotor processing. The preliminary research trials further indicate that using this virtual-reality music technology system and newly developed protocols produces notable improvements for participants with an ASC. More significantly, there is evidence that the supplemental technology facilitates a reduction in psychological anxiety and improvements in dexterity. The virtual music composition and improvisation system presented here require further extensive testing in different spheres for proof of concept

Using conceptual graphs for clinical guidelines representation and knowledge visualization

The intrinsic complexity of the medical domain requires the building of some tools to assist the clinician and improve the patient’s health care. Clinical practice guidelines and protocols (CGPs) are documents with the aim of guiding decisions and criteria in specific areas of healthcare and they have been represented using several languages, but these are difficult to understand without a formal background. This paper uses conceptual graph formalism to represent CGPs. The originality here is the use of a graph-based approach in which reasoning is based on graph-theory operations to support sound logical reasoning in a visual manner. It allows users to have a maximal understanding and control over each step of the knowledge reasoning process in the CGPs exploitation. The application example concentrates on a protocol for the management of adult patients with hyperosmolar hyperglycemic state in the Intensive Care Unit

COPE.er Method: Combating Digital Addiction via Online Peer Support Groups

Digital addiction (hereafter DA) denotes a problematic relationship with technology described by being compulsive, obsessive, impulsive and hasty. New research has identified cases where users’ digital behaviour shows symptoms meeting the clinical criteria of behavioural addiction. The online peer groups approach is one of the strategies to combat addictive behaviours. Unlike other behaviours, intervention and addictive usage can be on the same medium; the online space. This shared medium empowers influence techniques found in peer groups, such as selfmonitoring, social surveillance, and personalised feedback, with a higher degree of interactivity, continuity and real-time communication. Social media platforms in general and online peer groups, in particular, have received little guidance as to how software design should take it into account. Careful theoretical understanding of the unique attributes and dynamics of such platforms and their intersection with gamification and persuasive techniques is needed as the ad-hoc design may cause unexpected harm. In this paper, we investigate how to facilitate the design process to ensure a systematic development of this technology. We conducted several qualitative studies including user studies and observational investigations. The primary contribution of this research is twofold: (i) a reference model for designing interactive online platforms to host peer groups and combat DA, (ii) a process model, COPE.er, inspired by the participatory design approach to building Customisable Online Persuasive Ecology by Engineering Rehabilitation strategies for different groups

Automatic splint to prevent self-harm in autistic and brain injured people

This dissertation is aimed at providing a less restrictive alternative to applying restrictive splints to people who display self-injurious behaviour often seen in people with severe autism or brain injuries. An electronic method of controlling an elbow jointed splint is explored, designed, built and tested. The final product, the Dynamic Splint Device (DSD) is a self-contained electronic joint that utilises an electromagnetic brake controlled by an Arduino microcontroller electronics board. Sensors measuring elbow joint rotational velocity, total fist acceleration and bending moments are used to predict potential impact forces. The device will reduce injury by applying a braking force to the joint when the predicted impact is greater than an adjustable set-point. The electronic ratchet developed as part of the braking system has allowed a sense of not being restrained, as the arm is not restricted from moving to a more open position. The ratchet has also increased the battery life of the DSD. Legally, restraints are required to be the least restrictive available. The DSD has the potential to revolutionise the care of people displaying Self Injurious Behaviour (SIB) by reducing the need for full restraint. It allows movement in a safe manner, restores civil liberties, and allows better therapy when compared to full restraint devices currently available on the market. Allowing health professionals and carers to build this device is integral to the design. Open source coding, 3D printable parts and off the shelf components allows anyone with a computer and a 3D printer to make the DSD, with the only limitation being that profit is not made

Expressive language development in minimally verbal autistic children: exploring the role of speech production

Trajectories of expressive language development are highly heterogeneous in autism. I examine the hypothesis that co-morbid speech production difficulties may be a contributing factor for some minimally verbal autistic individuals. Chapters 1 and 2 provide an overview of language variation within autism, and existing intervention approaches for minimally verbal autistic children. These chapters situate this thesis within the existing literature. Chapter 3 describes a longitudinal study of expressive language in minimally verbal 3-5 year olds (n=27), with four assessment points over 12 months. Contrary to expectations, initial communicative intent, parent responsiveness and response to joint attention did not predict expressive language growth or outcome. Speech skills were significant predictors. Chapter 4 describes the design, development and feasibility testing of the BabbleBooster app, a novel, parent-meditated speech skills intervention, in which 19 families participated for 16 weeks. Acceptability feedback was positive but adherence was variable. I discuss how this could be improved in future iterations of the app and intervention protocol. Chapter 5 details how BabbleBooster’s efficacy was evaluated. For interventions with complex or rare populations, a randomized case series design is a useful alternative to an under-powered group trial. There was no evidence that BabbleBooster improved speech production scores, likely due to limited dosage. Future research using this study design could determine optimal treatment intensity and duration with an improved version of the app. Taken together, these studies underscore the contribution of speech production abilities to expressive language development in minimally verbal autistic individuals. I argue that this reflects an additional condition, and is not a consequence of core autism features. The intervention piloted here represents a first step towards developing a scalable tool for parents to support speech development in minimally verbal children, and illustrates the utility of randomized single case series for testing treatment effects in small, heterogeneous cohorts

Augmenting patient therapies with video game technology

PhD ThesisThere is an increasing body of work showing that video games can be used for more than just entertainment, but can also facilitate positive physical and mental changes. For people suffering debilitating side-effects from illnesses such as stroke, there is need to deliver and monitor effective rehabilitative physical therapies; video game technologies could potentially deliver an effective alternative to traditional rehabilitative physical therapy, and alleviate the need for direct therapist oversight. Most existing research into video game therapies has focussed on the use of offthe- shelf games to augment a patient’s ongoing therapy. There has currently been little progress into how best to design bespoke software capable of integrating with traditional therapy, or how to replicate common therapies and medical measurements in software. This thesis investigates the ability for video games to be applied to stroke rehabilitation, using modern gaming peripherals for input. The work presents a quantitative measurement of motion detection quality afforded by such hardware. An extendible game development framework capable of high quality movement data output is also presented, affording detailed analysis of player responsiveness to a video game delivered therapy for acute stroke. Finally, a system by which therapists can interactively create complex physical movements for their patients to replicate in a video game environment is detailed, enabling bespoke therapies to be developed, and providing the means by which rehabilitative games for stroke can provide an assessment of patient ability similar to that afforded by traditional therapies