Investigating the Feasibility of a 3D Virtual World Technology for People with Dementia

Three Dimensional Virtual Worlds (3DVWs) are computer-generated, simulated, graphical and multimedia environments, designed so that users can ‘live in’ and engage via their own digital and graphical self-representations known as ‘avatars’. The purpose of this study was to evaluate the feasibility of using 3DVWs to enhance engagement and quality of life in people with dementia. A mixed-methods research design, guided by a feasibility framework, was used, with data collected from semi-structured interviews, observations, and surveys. Eleven residents expressed interest in the 3DVWs intervention after reading an advertisement and attended an introductory session. After this, eight people expressed a desire to participate in the six-session intervention. Participants generally enjoyed the experience of using 3DVWs. Of those who completed all six sessions, two-thirds showed a positive change in their quality of life score. Moreover, those who participated in almost all sessions showed higher satisfaction with the use of the 3DVW than those who dropped out. Both residents and care staff perceived the 3DVW as engaging, fun and memory stimulating. The findings support the feasibility of using 3DVWs with people with dementia, and this justifies the need for further research

Future bathroom: A study of user-centred design principles affecting usability, safety and satisfaction in bathrooms for people living with disabilities

Research and development work relating to assistive technology 2010-11 (Department of Health) Presented to Parliament pursuant to Section 22 of the Chronically Sick and Disabled Persons Act 197

Online Group-exercises for Older Adults of Different Physical Abilities

In this paper we describe the design and validation of a virtual fitness environment aiming at keeping older adults physically and socially active. We target particularly older adults who are socially more isolated, physically less active, and with less chances of training in a gym. The virtual fitness environment, namely Gymcentral, was designed to enable and motivate older adults to follow personalised exercises from home, with a (heterogeneous) group of remote friends and under the remote supervision of a Coach. We take the training activity as an opportunity to create social interactions, by complementing training features with social instruments. Finally, we report on the feasibility and effectiveness of the virtual environment, as well as its effects on the usage and social interactions, from an intervention study in Trento, Ital

Telemedicine and Virtual Reality for Cognitive Rehabilitation: A Roadmap for the COVID-19 Pandemic

The current COVID-19 pandemic presents unprecedented new challenges to public health and medical care delivery. To control viral transmission, social distancing measures have been implemented all over the world, interrupting the access to routine medical care for many individuals with neurological diseases. Cognitive disorders are common in many neurological conditions, e.g., stroke, traumatic brain injury, Alzheimer's disease, and other types of dementia, Parkinson's disease and parkinsonian syndromes, and multiple sclerosis, and should be addressed by cognitive rehabilitation interventions. To be effective, cognitive rehabilitation programs must be intensive and prolonged over time; however, the current virus containment measures are hampering their implementation. Moreover, the reduced access to cognitive rehabilitation might worsen the relationship between the patient and the healthcare professional. Urgent measures to address issues connected to COVID-19 pandemic are, therefore, needed. Remote communication technologies are increasingly regarded as potential effective options to support health care interventions, including neurorehabilitation and cognitive rehabilitation. Among them, telemedicine, virtual reality, augmented reality, and serious games could be in the forefront of these efforts. We will briefly review current evidence-based recommendations on the efficacy of cognitive rehabilitation and offer a perspective on the role of tele- and virtual rehabilitation to achieve adequate cognitive stimulation in the era of social distancing related to COVID-19 pandemic. In particular, we will discuss issues related to their diffusion and propose a roadmap to address them. Methodological and technological improvements might lead to a paradigm shift to promote the delivery of cognitive rehabilitation to people with reduced mobility and in remote regions

Virtual Representations for Cybertherapy: A Relaxation Experience for Dementia Patients

The development of serious games has enabled new challenges for the healthcare sector in psychological, cognitive and motor rehabilitation. Thanks to Virtual Reality, stimulating and interactive experiences can be reproduced in a safe and controlled environment. This chapter illustrates the experimentation conducted in the hospital setting for the non-pharmacological treatment of cognitive disorders associated with Dementia. The therapy aims to relax patients of the agitation cluster through a gaming approach through the immersion in multisensory and natural settings in which sound and visual stimuli are provided. The study is supported by a technological architecture, including the Virtual Wall system for stereoscopic wall projection and rigid body tracking

Recreating living experiences from past memories through virtual worlds for people with dementia

This paper describes a study aimed to understand the use of 3D virtual world (VW) technology to support life engagement for people with dementia in long-term care. Three versions of VW prototypes (reminiscence room, virtual tour and gardening) utilising gestured-base interaction were developed iteratively. These prototypes were tested with older residents (80+) with dementia in care homes and their caregivers. Data collection was based on observations of how the residents and care staff interacted collaboratively with the VW. We discussed in depth the use of VWs in stimulating past memories and how this technology could help enhance their sense of self through various means. We also highlighted key approaches in designing VWs to sustain attention, create ludic experiences and facilitate interaction for older people with dementia

A Reflection on Virtual Reality Design for Psychological, Cognitive & Behavioral Interventions: Design Needs, Opportunities & Challenges

Despite the substantial research interest in using Virtual Reality (VR) in healthcare in general and in Psychological, Cognitive, and Behavioral (PC&B) interventions in specific, as well as emerging research supporting the efficacy of VR in healthcare, the design process of translating therapies into VR to meet the needs of critical stakeholders such as users and clinicians is rarely addressed. In this paper, we aim to shed light onto the design needs, opportunities and challenges in designing efficient and effective PC&B-VR interventions. Through analyzing the co-design processes of four user-centered PC&B-VR interventions, we examined how therapies were adapted into VR to meet stakeholders’ requirements, explored design elements for meaningful experiences, and investigated how the understanding of healthcare contexts contribute to the VR intervention design. This paper presents the HCI research community with design opportunities and challenges as well as future directions for PC&B-VR intervention design

Automatic detection of disorientation among people with dementia

Ageing is characterized by decline in cognition including visuospatial function, necessary for independently executing instrumental activities of daily living. The onset of Alzheimer’s disease dementia exacerbates this decline, leading to major challenges for patients and increased burden for caregivers. An important function affected by this decline is spatial orientation. This work provides insight into substrates of real-world wayfinding challenges among older adults, with emphasis on viable features aiding the detection of spatial disorientation and design of possible interventions

가상현실 내 정보 불일치를 활용한 인지기능 평가: 탐색적 고찰

학위논문(박사) -- 서울대학교대학원 : 인문대학 협동과정 인지과학전공, 2022.2. 이경민.본 박사논문의 목적은 가상현실 내에서 발생하는 정보불일치에 대해서 알아보고, 정보 불일치로 인한 인지적 반응을 인지기능 평가에 활용할 수 있는 방안을 고찰하고자 함이다. 가상현실 주방과제를 구현하여 과제 수행 중 나타나는 움직임과 인지작용의 특성을 알아보고자 하였다. 또한 VR에서 과제수행 시 나타나는 인지 부하의 요인을 탐색하였다. 특히, 감각운동 조절 측면에서 가상현실 내 발생하는 정보불일치로 인한 인지 과부하를 살펴보았다. 첫째, 가상현실과 실제환경에서 작동하는 인지과정이 어떻게 다른지 알아보기 위해 두 환경 간의 과제 수행 차이를 비교하였다. 젊은 성인 그룹에서는 어려운 주방과제 수행 시 가상현실과 실제환경 간의 수행시간에 유의한 차이가 있었지만 쉬운 주방 과제에서는 차이가 없었다. 반면 노인 집단에서는 과제의 난이도와 관계없이 두 환경 간의 수행 시간에 상당한 차이가 있었다. 노인의 경우 가상현실에서 감각운동 조절의 어려움을 보였다. 즉 노인의 경우 젊은 성인에 비해 가상현실 내에서의 감각운동 조절이 더 어렵기 때문에 이로 인한 인지적 부하가 과제 수행 자체의 인지적 부하에 가중되어 과제 난이도가 어려워지면 인지용량의 한계를 초과하게 된다. 둘째, 가상 주방과제 수행 시 인지기능이 저하됨에 따라 갑자기 휙 움직이는(jerky) 패턴을 보이는 것으로 나타났다. 이는 인지기능이 저하된 노인의 경우 환경에 대한 예측력이 저하되어 최소 저크운동 조절(minimal jerk movement control)에 어려움이 있음을 시사한다. 또한 인지기능이 높은 그룹보다 인지기능이 낮은 노인 그룹의 경우 과제가 완료될 때까지의 일련의 움직임 단계가 더 많았다. 인지기능이 저하됨에 따라 비효율적이고 분주한 움직임을 보인다고 할 수 있다. 또한 다중회귀분석 결과, 노인이 가상현실 주방과제를 효율적으로 수행함에 있어 연령 및 학력 보다는 인지기능이 가장 영향을 미치는 요인으로 나타났다. 즉 가상현실 기반 과제수행은 순수 인지기능만을 평가하는 새로운 대안으로 제시할 수 있다. 마지막으로 감각운동 피드백의 예측불가능성(unpredictability)이 가상현실에서 인지부하를 유발하는 방식을 알아보고자 하였다. 섭동의 예측 가능성에 따른 반응 시간과 이동 속도를 암묵적 5°와 명시적 15° 섭동 조건에서 각각 측정하였다. 그 결과 암묵적 운동 제어 시 섭동의 변화를 예측할 수 없을 때 움직임의 정확도를 높이기 위해 움직임이 느려지는 전략(accuracy and speed trade-off)을 사용하는 것으로 나타났다. 즉, 감각운동조절 과정 상에서 정보 불일치로 인한 예측 불가능성에 대해 우리의 뇌는 다른 인지전략을 취한다고 설명할 수 있다. 결론적으로 가상현실은 기술적 충실도(fidelity) 문제로 인해 감각 피드백이 예측 불가능하고 가변적이기 때문에 실제 환경보다 더 많은 인지 부하를 유발한다. 특히 가상현실에서의 감각운동 조절은 실제환경에서 인간의 운동 시스템이 적응된 방식과는 다르다고 볼 수 있다. 즉 가상현실 내에서는 감각운동 시스템이 예측할 수 없는 환경에 적응하기 위해 다른 인지 전략을 취하게 된다. 환경에 따른 효율적인 인지전략의 전환은 중앙 집행기능(central executive)과 관련 있으며, 이러한 특징을 활용한 가상현실기반 과제는 새로운 인지기능 평가의 대안으로 제시할 수 있다.The purpose of this dissertation was to investigate information mismatch in virtual reality (VR) and explore the possibility of using the cognitive reaction arising from information mismatch for cognitive evaluation. The virtual kitchen task was used to observe the subjects’ behaviors while performing the task, and to investigate the characteristics of movement and cognitive processes appearing during the performance of the virtual task. In addition, an attempt was made to explore the factors of cognitive overload in VR that determine the difference compared to a performance in the real environment. In particular, this study aimed to investigate how information mismatch occurring in VR causes cognitive overload in terms of sensorimotor control. First, it questioned how the cognitive process in VR differs from the real environment and also investigated the factors affecting the performance of tasks in VR. In the young adult group, while there was a significant difference between the execution time in VR and in the real environment in the difficult kitchen task, there was no such difference in the easy kitchen task. Meanwhile, among the elderly, there was a significant difference between the execution time in VR and in the real environment regardless of whether the task was difficult or easy. It was thought that cognitive load was caused due to difficulties in sensorimotor control in VR. It was found that the cognitive capacity is challenged when the task is difficult because the load of task performance itself and the load of sensorimotor control are doubling. Second, it was found that as the cognitive function decreased, an abrupt and jerky movement pattern was exhibited during the virtual kitchen task. The number of sequences in movement until the task was completed was also busier in the elderly group with lower cognitive function in contrast with those with higher cognitive function. In the case of the elderly with deteriorated cognitive function, it is suggested that there is difficulty in minimal jerk movement control because the predictive ability responding to environment is decreased. In addition, according to the results of multiple regression, cognitive function of the elderly is the most influential factor in performing VR tasks, other than age and educational background, which means that purely evaluating cognitive function may be suggested. Third, an attempt was made to verify how the unpredictability of sensorimotor feedback causes cognitive load in VR. The reaction time and speed of movement depending on the predictability of perturbation were measured in implicit 5 degrees and explicit 15 degrees perturbation. When the subject was unable to predict the variation of perturbation only in implicit motor control, reaching became slower and it took more time due to the accuracy and speed trade-off. In other words, unpredictability due to information mismatch leads to the use of different cognitive strategies in brain mechanisms. In conclusion, VR induces more cognitive load than the real environment because the sensory feedback is unpredictable and variable due to technical fidelity problems. The sensorimotor control in VR is challenged by the way the human motor system is adapted. Further, it was found that an unpredictable environment requires different cognitive strategies for the sensorimotor system to adapt to it. The manner in which effective cognitive strategies are taken represents an efficient central executive function. From this perspective, VR-based cognitive evaluation, using such attributes, is thought to be an alternative method for early screening of cognitive decline.Chapter 1. Introduction 7 1.1 Research motivation and introductory overview 7 1.2 Research goal and questions 7 1.2.1 Overall research goal 7 1.2.2 Research questions 8 1.2.3 Research contributions 8 1.3 Thesis structure 8 Chapter 2. Literature Review 10 2.1 Virtual Reality (VR) as ecological method for cognitive evaluation 10 2.2 Sub-types of VR based tasks according to target cognitive function 12 2.2.1. VR task for spatial navigation 13 2.2.2. VR task for memory 14 2.2.3. VR task for executive function 16 2.3 Factors affecting on VR performance 19 2.3.1. General 19 2.3.2. Age effects on VR performance 20 2.3.3. Cognitive challenges in VR 21 2.3.4. Feasibility of VR task for dementia 22 2.4 Cognitive load in VR 23 2.4.1. Immersive versus non-immersive VR 23 2.4.2. Sense of presence and situated cognition 26 2.4.3. Sensorimotor adaptation in VR 28 2.5 Sensorimotor control in VR 29 2.5.1 Predictive brain and internal model for motor control 29 2.5.2 Explicit and implicit process in motor control 31 2.5.3 Accuracy & speed tradeoff in cognitive control 31 2.6 Executive control for information mismatch in information processing 32 Chapter 3. Differences in Cognitive Load Between Real and VR Environment 34 3.1 Introduction 34 3.2 Method 37 3.3 Results 40 3.4 Discussion 45 Chapter 4. The Efficiency of Movement Trajectory and Sequence in VR According to Cognitive Function in the Elderly 50 4.1 Introduction 50 4.2 Method 52 4.3 Results 53 4.4 Discussion 56 Chapter 5. Factors that Affect the Performance of Immersive Virtual Kitchen Tasks in the Elderly 59 5.1 Introduction 59 5.2 Method 62 5.3 Results 64 5.4 Discussion 70 Chapter 6. Effect of Predictability of Sensorimotor Feedback on Cognitive Load in VR 74 6.1 Introduction 74 6.2 Method 77 6.3 Results 79 6.4 Discussion 84 Chapter 7. Conclusion 88 7.1 Summary of findings 88 7.2 Future direction of research 90 References 92박