The use of the Nintendo Wii in motor rehabilitation for virtual reality interventions:a literature review

Several review articles have been published on the use of Virtual Reality (VR) in motor rehabilitation. The majority of these focus on the effectiveness of VR on improving motor function using relatively expensive commercial tools and technologies including robotics, cybergloves, cybergrasps, joysticks, force sensors and motion capture systems. However, we present the case in this chapter that game sensors and VR technologies which can be customized and reconfigured, such as the Nintendo Wii, provide an alternative and affordable VR intervention for rehabilitation. While the performance of many of the Wii based interventions in motor rehabilitation are currently the focus of investigation by researchers, an extensive and holistic discussion on this subject does not yet exist. As such, the purpose of this chapter is to provide readers with an understanding of the advantages and limitations of the Nintendo Wii game sensor device (and its associated accessories) for motor rehabilitation and in addition, to outline the potential for incorporating these into clinical interventions for the benefit of patients and therapists

Clinical Decision Support Systems with Game-based Environments, Monitoring Symptoms of Parkinson’s Disease with Exergames

Parkinson’s Disease (PD) is a malady caused by progressive neuronal degeneration, deriving in several physical and cognitive symptoms that worsen with time. Like many other chronic diseases, it requires constant monitoring to perform medication and therapeutic adjustments. This is due to the significant variability in PD symptomatology and progress between patients. At the moment, this monitoring requires substantial participation from caregivers and numerous clinic visits. Personal diaries and questionnaires are used as data sources for medication and therapeutic adjustments. The subjectivity in these data sources leads to suboptimal clinical decisions. Therefore, more objective data sources are required to better monitor the progress of individual PD patients. A potential contribution towards more objective monitoring of PD is clinical decision support systems. These systems employ sensors and classification techniques to provide caregivers with objective information for their decision-making. This leads to more objective assessments of patient improvement or deterioration, resulting in better adjusted medication and therapeutic plans. Hereby, the need to encourage patients to actively and regularly provide data for remote monitoring remains a significant challenge. To address this challenge, the goal of this thesis is to combine clinical decision support systems with game-based environments. More specifically, serious games in the form of exergames, active video games that involve physical exercise, shall be used to deliver objective data for PD monitoring and therapy. Exergames increase engagement while combining physical and cognitive tasks. This combination, known as dual-tasking, has been proven to improve rehabilitation outcomes in PD: recent randomized clinical trials on exergame-based rehabilitation in PD show improvements in clinical outcomes that are equal or superior to those of traditional rehabilitation. In this thesis, we present an exergame-based clinical decision support system model to monitor symptoms of PD. This model provides both objective information on PD symptoms and an engaging environment for the patients. The model is elaborated, prototypically implemented and validated in the context of two of the most prominent symptoms of PD: (1) balance and gait, as well as (2) hand tremor and slowness of movement (bradykinesia). While balance and gait affections increase the risk of falling, hand tremors and bradykinesia affect hand dexterity. We employ Wii Balance Boards and Leap Motion sensors, and digitalize aspects of current clinical standards used to assess PD symptoms. In addition, we present two dual-tasking exergames: PDDanceCity for balance and gait, and PDPuzzleTable for tremor and bradykinesia. We evaluate the capability of our system for assessing the risk of falling and the severity of tremor in comparison with clinical standards. We also explore the statistical significance and effect size of the data we collect from PD patients and healthy controls. We demonstrate that the presented approach can predict an increased risk of falling and estimate tremor severity. Also, the target population shows a good acceptance of PDDanceCity and PDPuzzleTable. In summary, our results indicate a clear feasibility to implement this system for PD. Nevertheless, long-term randomized clinical trials are required to evaluate the potential of PDDanceCity and PDPuzzleTable for physical and cognitive rehabilitation effects

Evaluation of Detecting Cybersickness via VR HMD Positional Measurements Under Realistic Usage Conditions.

With the resurgence of virtual reality, head-mounted displays (VR HMD) technologies since 2015, VR technology is becoming ever more present in people's day-to-day lives. However, one significant barrier to this progress is a condition called cybersickness, a form of motion sickness induced by the usage of VR HMD’s. It is often debilitating to sufferers, resulting in symptoms anywhere from mild discomfort to full-on vomiting. Much research effort focuses on identifying the cause of and solution to this problem, with many studies reporting various factors that influence cybersickness, such as vection and field of view. However, there is often disagreement in these studies' results and comparing the results is often complicated as stimuli used for the experiments vary wildly. This study theorised that these results' mismatch might partially be down to the different mental loads of these tasks, which may influence cybersickness and stability-based measurement methods such as postural stability captured by the centre of pressure (COP) measurements. One recurring desire in these research projects is the idea of using the HMD device itself to capture the stability of the users head. However, measuring the heads position via the VR HMD is known to have inaccuracies meaning a perfect representation of the heads position cannot be measured. This research took the HTC Vive headset and used it to capture the head position of multiple subjects experiencing two different VR environments under differing levels of cognitive load. The design of these test environments reflected normal VR usage. This research found that the VR HMD measurements in this scenario may be a suitable proxy for recording instability. However, the underlying method was greatly influenced by other factors, with cognitive load (5.4% instability increase between the low and high load conditions) and test order (2.4% instability decrease between first run and second run conditions) having a more significant impact on the instability recorded than the onset of cybersickness (2% instability increase between sick and well participants). Also, separating participants suffering from cybersickness from unaffected participants was not possible based upon the recorded motion alone. Additionally, attempts to capture stability data during actual VR gameplay in specific areas of possible head stability provided mixed results and failed to identify participants exhibiting symptoms of cybersickness successfully. In conclusion, this study finds that while a proxy measurement for head stability is obtainable from an HTC Vive headset, the results recorded in no way indicate cybersickness onset. Additionally, the study proves cognitive load and test order significantly impact stability measurements recorded in this way. As such, this approach would need calibration on a case-by-case basis if used to detect cybersickness

Development of a model based on virtual reality for the evaluation of behavioral compliance with warnings and wayfinding contexts

Virtual Reality (VR) when framed in adequate methodologies, has an ample field of application for Ergonomics and for Design, since it allows to analyze and understand how people interaction with simulated situations in Virtual Environments (VEs). As such, it is of extreme importance for research and the practice of Ergonomics, to understand how it is possible to optimize, create, implement and evaluate solutions based in VEs in different contexts, including dangerous one, in particular those that can place in risk the physical integrity of people. These VEs can be used to study the Human behavior in critical situations, which is important when projecting products and systems that involve dangers to the users that would be difficult to study otherwise. In this context, this project has as its general objective the study of the factors that influence the development of VEs for VR and in the implementation of solutions (with a focus on the software and hardware) that better can correspond to the development of this type of studies, namely in studies of behavioral compliance with warnings and in studies of wayfinding. The methodological proposal described in this document focuses in a User-Centered Design (UCD) perspective, which involved the participation of the users, in the different phases of development of the project. As a result, it was developed and evaluated software and hardware solutions for the understanding and evaluation of the factors associated to the study of Human behavior, namely in behavioral compliance with warnings and in wayfinding contexts. It was also studied the best solutions for interaction and navigation in VEs, that correspond to high levels of presence, which is a fundamental aspect in behavioral compliance with warnings and wayfinding studies that use VR as a support tool. With this purpose, two navigational interfaces were developed (i.e., Balance Board and Walk-in-Place), also in a UCD perspective, to guarantee a constant cycle of tests and improvement of the implementations among the users. A comparative study was made between these two navigational interfaces and another that is commonly used in studies with VR (i.e., a Joystick). This comparative study was conducted in a context of evaluation of behavioral compliance with warnings and performance variables were analyzed, as well as the levels of presence in the different navigational interfaces. There were no statistically significant differences in the levels of presence or in the behavioral compliance between the three navigational interfaces. However, statistically significant differences were found in several performance variables (e.g., average speed, total distance). Future directions for the research are also discussed.A Realidade Virtual (RV) quando enquadrada em metodologias adequadas, tem um campo de aplicação alargado para a Ergonomia e o Design, visto permitir analisar e compreender como as pessoas interagem com situações simuladas em Ambientes Virtuais (AVs). Desta forma, é de extrema importância para a investigação ou prática da Ergonomia, perceber como se pode optimizar, construir, implementar e avaliar soluções baseadas em AVs em diferentes contextos, incluindo contextos perigosos, particularmente aqueles que podem colocar em risco a integridade física das pessoas. Estes AVs podem ser usados para estudar o comportamento Humano em situações críticas, o que é importante quando se projecta produtos e sistemas que envolvam perigos para os utilizadores que de outra forma seria muito difícil avaliar. Neste contexto, este projecto tem como objectivo geral o estudo dos factores que influenciam o desenvolvimento de ambientes para Realidade Virtual e na implementação de soluções (com um foco maior no software e hardware) que melhor possam corresponder ao desenvolvimento deste tipo de estudos, nomeadamente em estudos de consonância comportamental com avisos de segurança e estudos de wayfinding. A proposta metodológica descrita neste documento foca-se numa perspectiva de Design Centrado no Utilizador (DCU), que envolveu a participação dos utilizadores, nas várias fases de desenvolvimento do projecto. Como resultado, desenvolveu-se e avaliou-se soluções de software e hardware para a compreensão e avaliação dos factores associados ao estudo do comportamento Humano, nomeadamente para a consonância comportamental com avisos de segurança e para situações de wayfinding. Foram também estudadas as melhores soluções para interacção e navegação em AVs, que correspondam a níveis de presença elevados, aspecto fundamental em estudos de consonância comportamental com avisos de segurança e em estudos de wayfinding que usam RV. Com este intuito, foram desenvolvidas duas interfaces de navegação para Realidade Virtual (i.e., Balance Board e Walk-in-Place), também numa perspectiva de DCU, para garantir um constante ciclo de testes e aperfeiçoamento das implementações junto dos utilizadores. Foi realizado um estudo comparativo entre estas duas interfaces de navegação e uma outra que é utilizada mais frequentemente em estudos com RV (i.e., um Joystick). Este estudo comparativo realizou-se num contexto de avaliação da consonância comportamental com avisos de segurança e foram analisadas variáveis de desempenho, assim como os níveis de presença das diferentes interfaces de navegação. Não se observaram diferenças estatisticamente significativas em relação aos níveis de presença nem em relação à consonância comportamental entre as três interfaces de navegação. No entanto, foram encontradas diferenças estatisticamente significativas em várias variáveis de desempenho (e.g., velocidade média, distância percorrida). Também são discutidas as possíveis linhas de investigação de continuação ao trabalho

The Future of the Internet III

Presents survey results on technology experts' predictions on the Internet's social, political, and economic impact as of 2020, including its effects on integrity and tolerance, intellectual property law, and the division between personal and work lives

A flexible object orientated design approach for the realisation of assistive technology

This thesis contributes to a growing body of research conducted by the Interactive Systems Research Group (ISRG) at Nottingham Trent University within the fields of accessibility and accessible technologies. Core to this research is the exploration of how interactive technologies can be developed and applied as platforms for education, rehabilitation and social inclusion. To this end the group has been actively evolving the User Sensitive and Inclusive Design (USID) methodology for the design, development and evaluation of accessible software and related technologies. This thesis contributes to the further development of the USID method with a focus on its application for the design of assistive technology

An Arm-Mounted Accelerometer and Gyro-Based 3D Control System

This thesis examines the performance of a wearable accelerometer/gyroscope-based system for capturing arm motions in 3D. Two experiments conforming to ISO 9241-9 specifications for non-keyboard input devices were performed. The first, modeled after the Fitts' law paradigm described in ISO 9241-9, utilized the wearable system to control a telemanipulator compared with joystick control and the user's arm. The throughputs were 5.54 bits/s, 0.74 bits/s and 0.80 bits/s, respectively. The second experiment utilized the wearable system to control a cursor in a 3D fish-tank virtual reality setup. The participants performed a 3D Fitts' law task with three selection methods: button clicks, dwell, and a twist gesture. Error rates were 6.82 %, 0.00% and 3.59 % respectively. Throughput ranged from 0.8 to 1.0 bits/s. The thesis includes detailed analyses on lag and other issues that present user interface challenges for systems that employ human-mounted sensor inputs to control a telemanipulator apparatus

The development and evaluation of virtual reality-based training on performance and rehabilitation outcomes

Sports injuries are types of injuries that usually occur during sports, training, or exercise. Sports injuries often result from poor training methods, inappropriate equipment, lack of fitness, insufficient warm-up, and trauma (Salerno, 2009). Knee injuries are considered one of the most common injuries in athletes and include a large part of the cost of medical care for sports injuries (Loes et al., 2000; Sancheti et al., 2010). The ACL is the most common knee ligament injury in rugby, soccer, ski, volleyball, gymnastics, and basketball players due to quick deceleration movements such as landing, pivoting, cutting, and changing direction in these sports. Despite increased knowledge of ACL injury mechanisms, rehabilitation programmes and surgical techniques, the rates of return-to-sport (RTS) and the subsequent ACL re-injury after ACL reconstruction (ACLR) are not optimal (Buckthorpe, 2019). Therefore, rehabilitation plays a significant role in helping athletes return to sports activities, and inappropriate rehabilitation can even devastate a satisfactory ACLR (Wright et al., 2015). This dissertation consists of two studies, including a systematic review in Chapter 2 that explores the research conducted on the application of immersive technologies for improving the outcome of the rehabilitation phases after ACL reconstruction and examines the correlation between virtual reality, rehabilitation, exercise therapy, and sport-related ACL injuries in patients. The second study in Chapter 3 validates the Microsoft Azure Kinect camera for body tracking of dynamic movements against the gold standard Qualisys system. The findings indicated that VR-based systems could be a considerable alternative to real-world training to improve certain aspects of athletic performance because immersive technologies effectively offer a tool to control virtual environmental features. Finally, immersive technologies and VR-based systems are still in their infancy and will need considerable improvements in the future. Therefore, further research needs to be conducted in a theoretical frame to acknowledge the profitability of VR interventions in sports performance and rehabilitation programmes. The triple Azure Kinect system provides a consistent track of the joint centres' displacements with good to excellent agreement in the vertical and AP direction during the squat exercise in all joints except the ankles, particularly in upper joints such elbow and shoulder. However, future investigations must be conducted to acknowledge the Azure Kinect's profitability in the assessment of abnormal clinical conditions and the limits of Kinect's accuracy in various movements and planes of motion. In conclusion, the markerless triple Azure Kinect motion capture system may be a considerable alternative to a gold standard Qualisys marker-based system for specific applications such as human activities in the frontal plane. However, future investigations must be conducted to acknowledge the Azure Kinect's profitability in the assessment of abnormal clinical conditions and the limits of Kinect's accuracy in various movements and planes of motion

Proceedings of the 9th international conference on disability, virtual reality and associated technologies (ICDVRAT 2012)

The proceedings of the conferenc