Photo-realistic interactive virtual environments for neurorehabilitation in mild cognitive impairment (NeuroVRehab.PT) : a participatory design and proof-of-concept study

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).Mild cognitive impairment (MCI) is characterized by cognitive, psychological, and functional impairments. Digital interventions typically focus on cognitive deficits, neglecting the difficulties that patients experience in instrumental activities of daily living (IADL). The global conjecture created by COVID-19 has highlighted the seminal importance of digital interventions for the provision of healthcare services. Here, we investigated the feasibility and rehabilitation potential of a new design approach for creating highly realistic interactive virtual environments for MCI patients' neurorehabilitation. Through a participatory design protocol, a neurorehabilitation digital platform was developed using images captured from a Portuguese supermarket (NeuroVRehab.PT). NeuroVRehab.PT's main features (e.g., medium-sized supermarket, the use of shopping lists) were established according to a shopping behavior questionnaire filled in by 110 older adults. Seven health professionals used the platform and assessed its rehabilitation potential, clinical applicability, and user experience. Interviews were conducted using the think-aloud method and semi-structured scripts, and four main themes were derived from an inductive semantic thematic analysis. Our findings support NeuroVRehab.PT as an ecologically valid instrument with clinical applicability in MCI neurorehabilitation. Our design approach, together with a comprehensive analysis of the patients' past experiences with IADL, is a promising technique to develop effective digital interventions to promote real-world functioning.TThis research was carried out as part of the doctoral studies of the first author (Ref: PDE/BDE/127784/2016) and for which she received scholarships from the following entities: Nippon Gases Portugal and Fundação para a Ciência e a Tecnologia through the European Social Fund and Human Capital Operational Programme, co-financed by Portugal 2020 and European Union. The work was partially supported by LASIGE Research Unit, ref. UIDB/00408/2020 and ref. UIDP/00408/2020.info:eu-repo/semantics/publishedVersio

System development guidelines from a review of motion-based technology for people with MCI or dementia

As the population ages and the number of people living with dementia or mild cognitive impairment (MCI) continues to increase, it is critical to identify creative and innovative ways to support and improve their quality of life. Motion-based technology has shown significant potential for people living with dementia or MCI by providing opportunities for cognitive stimulation, physical activity and participation in meaningful leisure activities, while simultaneously functioning as a useful tool for research and development of interventions. However, many of the current systems created using motion-based technology have not been designed specifically for people with dementia or MCI. Additionally, the usability and accessibility of these systems for these populations has not been thoroughly considered. This paper presents a set of system development guidelines derived from a review of the state of the art of motion-based technologies for people with dementia or MCI. These guidelines highlight three overarching domains of consideration for systems targeting people with dementia or MCI: (i) cognitive, (ii) physical, and (iii) social. We present the guidelines in terms of relevant design and use considerations within these domains and the emergent design themes within each domain. Our hope is that these guidelines will aid in designing motion-based software to meet the needs of people with dementia or MCI such that the potential of these technologies can be realized

Use of nonintrusive sensor-based information and communication technology for real-world evidence for clinical trials in dementia

Cognitive function is an important end point of treatments in dementia clinical trials. Measuring cognitive function by standardized tests, however, is biased toward highly constrained environments (such as hospitals) in selected samples. Patient-powered real-world evidence using information and communication technology devices, including environmental and wearable sensors, may help to overcome these limitations. This position paper describes current and novel information and communication technology devices and algorithms to monitor behavior and function in people with prodromal and manifest stages of dementia continuously, and discusses clinical, technological, ethical, regulatory, and user-centered requirements for collecting real-world evidence in future randomized controlled trials. Challenges of data safety, quality, and privacy and regulatory requirements need to be addressed by future smart sensor technologies. When these requirements are satisfied, these technologies will provide access to truly user relevant outcomes and broader cohorts of participants than currently sampled in clinical trials

Design and Evaluation of Virtual Reality Exergames for People Living with Dementia

Dementias such as Alzheimer’s disease are a progressive neurodegenerative disorder with consequences such as cognitive impairment and memory problems. While exercise is important to improve physical health and quality of life for people living with dementia (PWD), symptom-induced challenges, such as language processing and physical limitations, can make it more difficult for PWD to engage in exercise. In this study, exercise games (exergames) to promote exercise for PWD were designed in two virtual environments: a farm and a gym. To design the activities and interfaces of the games, a participatory design approach was followed with exercise therapists, kinesiologists, and PWD from Schlegel Villages long-term care facility. Five upper-body motions were selected and five corresponding activities developed for each game. The games were built for the Oculus Rift CV1 head mounted display virtual reality (HMD-VR) as this platform uses a fully immersive three-dimensional display with high frame rate display. The touch controllers of Oculus were used to provide hand-motion interactions in virtual reality (VR). A three-week evaluation experiment was conducted with six PWD to evaluate the designed exercise games. A mixed-methods approach was used to qualitatively and quantitatively investigate the impact of using designed HMD-VR exergames in engaging PWD in exercise. Questionnaires for participants recorded participants’ feelings of enjoyment, engagement, interest, easiness, comfort, and level of effort. Clinical measurements of fitness parameters and recorded motion parameters from sensors in Oculus Rift provided quantifiable metrics such as range of motion (ROM), distance traversed, speed, grip strength, and shoulder circumduction for evaluation. All the participants successfully completed the exercise using the exergames, demonstrating the promising potential of using HMD-VR for PWD. The analysis of the participants’ answers to the questionnaires shows subjective metrics for human-guided exercise is comparable to VR games conditions, which is a noteworthy result considering the novelty of using VR for PWD. Overall, the analysis of motion parameters showed no differences between environments, which indicates the participants’ level of movment in VR environments was as good as with human-lead exercise. This thesis research demonstrates the potential of HMD-VR as an engaging way to support exercise of PWD

Include 2011 : The role of inclusive design in making social innovation happen.

Include is the biennial conference held at the RCA and hosted by the Helen Hamlyn Centre for Design. The event is directed by Jo-Anne Bichard and attracts an international delegation

Proceedings of Designing Self-care for Everyday Life. Workshop in conjunction with NordiCHI 2014, 27th October.

Managing chronic conditions can be challenging. People in such conditions, and the people around them, have to, for example: deal with symptoms, adapt to the resulting disability, manage emotions, and change habits to keep the condition under control. Self-care technologies have the potential to support self-care, however they often disregard the complexity of the settings in which they are used and fail to become integrated in everyday life.The present collection of papers forms the Proceedings of the Workshop “Designing Selfcare for Everyday Life” conducted last October 27th, 2014 in Helsinki, where 14 participants from 7 different countries spent the day discussing how to design self-care technologies that are in harmony with people’s everyday life. During the morning, discussions were driven by poster presentations focused on the participants’ work. In the afternoon, we engaged in aparticipatory design exercise focused on the self-care of Parkinson’s disease. Our discussions were driven by the experience of two people living with Parkinson’s that participated in our workshop. At the end of the exercise, each group presented the different insights, concepts and problems that each patient experiences in their everyday life with the disease. Last, we all engaged in a broader discussion with a mapping exercise of issues and challenges in relation to self-care.The contributions featured in the proceedings have been peer-reviewed by the members of the Workshop Program Committee and selected on the basis of their quality, alignment with the workshop theme, and the extent (and diversity) of their backgrounds in design. They express points of view of researchers from both Academia and Industry and provide relevant insights in the design and development use of technologies for self-care.We want to thank all the participants and co-authors for contributing to the Workshop. We are particularly grateful to the two patients, members of the Finnish Parkinson’s Association, who accepted to participate in the workshop and enabled researchers to get aperspective on the challenges of their lives. We also want to thank all the Programme Committee members for all their work during the reviewing process as well as the organisers of NordiCHI 2014 for providing useful facilities

The role of virtual reality in improving health outcomes for community-dwelling older adults : systematic review

Background: Virtual reality (VR) delivered through immersive headsets creates an opportunity to deliver interventions to improve physical, mental, and psychosocial health outcomes. VR app studies with older adults have primarily focused on rehabilitation and physical function including gait, balance, fall prevention, pain management, and cognition. Several systematic reviews have previously been conducted, but much of the extant literature is focused on rehabilitation or other institutional settings, and little is known about the effectiveness of VR apps using immersive headsets to target health outcomes among community-dwelling older adults. Objective: The objective of this review was to evaluate the effectiveness of VR apps delivered using commercially available immersive headsets to improve physical, mental, or psychosocial health outcomes in community-dwelling older adults. Methods: Peer-reviewed publications that included community-dwelling older adults aged ≥60 years residing in residential aged care settings and nursing homes were included. This systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness evidence. The title of this review was registered with JBI, and the systematic review protocol was registered with the International Prospective Register of Systematic Reviews. Results: In total, 7 studies that specifically included community-dwelling older adults were included in this review. VR apps using a head-mounted display led to improvements in a number of health outcomes, including pain management, posture, cognitive functioning specifically related to Alzheimer disease, and a decreased risk of falls. A total of 6 studies reported a statistically significant difference post VR intervention, and 1 study reported an improvement in cognitive function to reduce navigational errors. Only one study reported on the usability and acceptability of the interventions delivered through VR. While one study used a distraction mechanism for pain management, none of the studies used gaming technology to promote enjoyment. Conclusions: Interventions to improve health outcomes through VR have demonstrated potential; however, the ability to synthesize findings by primary outcome for the older adult population is not possible. A number of factors, especially related to frailty, usability, and acceptability, also need to be explored before more substantial recommendations on the effectiveness of VR interventions for older adults can be made

Efficacy of adaptive cognitive training through desktop virtual reality and paper-and-pencil in the treatment of mental and behavioral disorders

Cognitive defcits are a core feature of mental and behavioral disorders, leading to poor treatment adherence and functional ity. Virtual reality (VR) methodologies are promising solutions for cognitive interventions in psychiatry once they provide greater ecological validity. This study assessed and compared two content-equivalent cognitive training (CT) interventions, delivered in desktop VR (Reh@City v2.0) and paper-and-pencil (Task Generator (TG)) formats, in patients with mental and behavioral disorders. 30 patients were randomly assigned to the Reh@City v2.0 group and the TG group. Both groups of patients underwent a time-matched 24-sessions intervention. Neuropsychological assessments were performed at baseline, post-intervention, and follow-up. A within-groups analysis revealed signifcant improvements in visual memory and depres sive symptomatology after the Reh@City intervention. The TG group improved in processing speed, verbal memory, and quality of life (social relationships and environmental domains). Between groups, Reh@City led to a greater reduction in depressive symptomatology, whereas the TG group showed higher improvements in social relationships aspects of quality of life. At follow-up, previous gains were maintained and new improvements found in the Reh@City (global cognitive func tion, language, visuospatial and executive functions) and the TG groups (attention). The Reh@City signifcantly reduced depressive symptomatology, and the TG led to greater improvements in processing speed, abstraction, and social relationships domain of quality of life at follow-up. Both interventions were associated with important cognitive, emotional, and quality of life benefts, which were maintained after two months. Reh@City and TG should be considered as complementary CT methods for patients with mental and behavioral disorders. Trial registration The trial is registered at ClinicalTrials.gov, number NCT04291586.info:eu-repo/semantics/publishedVersio