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ICDVRAT logo
  An International Society for Virtual Rehabilitation Sponsored Conference

7th ICDVRAT with ArtAbilitation 2008

The Seventh International Conference on Disability, Virtual Reality and Associated Technologies
with ArtAbilitation 2008

8th to 11th September 2008 - Maia & Porto, Portugal

Abstracts are listed in alphabetical order, based on first author. Full paper links will be available from 1 March 2009.


SOUND=SPACE opera, A P Almeida, L M Girão, R Gehlhaar, P M Rodrigues, P Neto and M Mónica, Fundação Casa da Música/Universidade Nova de Lisboa/Artshare Lda., Aveiro, PORTUGAL and University of Plymouth/Coventry University, UK

Over a period of three and a half months an artistic project using Rolf Gehlhaar’s SOUND=SPACE, was held at Casa da Música, Porto, Portugal, in the context of the meeting «Ao Alcance de Todos», with a group of young people with special needs. Two final performances were the public surface of a very rewarding process that improved the quality of life of those who participated.

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Functional Magnetic Resonance Imaging (fMRI) and virtual reality: adding brain imaging to your virtual reality repertoire, R S Astur, Hartford Hospital/Yale University, USA

Investigating the neural bases of human behavior is a remarkably complex process. In the 20th century, the traditional tools available to researchers have typically involved studying behavioral changes following a brain injury or lesion, as well as a number of physiology measures such as recording and stimulating brain areas (either inter-operatively or chronically during medical telemetry, often implemented to localize epileptic foci). Each of these has made unique contributions in providing insights into brain and behavior relations. However, such studies are invasive, and are not ideal for most purposes. This paper is designed for the VR researcher who has interest in using functional brain mapping during VR research, but who is unsure of the various issues that are involved in such a venture. Included are some of the main factors that one should consider in starting VR/fMRI experiments, and common solutions to problems that arise are provided. This primer can be used by anybody, ranging from the new graduate student with no research funds available to a full professor with generous available funds and unlimited staff.

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Visual eye disease simulator, D Banks and R J McCrindle, University of Reading, UK

Visually impaired people have a very different view of the world such that a seemingly simple environment as viewed by a normal sighted person can be difficult for with those with visual impairment to access and move around. This is a problem that can be hard to fully comprehend by people with ‘normal vision’ even when guidelines for inclusive design are available. This paper investigates ways in which image processing techniques can be used to simulate the characteristics of a number of common visual impairments in order to provide, planners, designers and architects, with a visual representation of how people with visual impairments view their environment, thereby promoting greater understanding of the issues, the creation of more accessible buildings and public spaces and increased accessibility for visually impaired people in everyday situations.

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Collaborative puzzle game - an interface for studying collaboration and social interaction for children who are typically developed or who have Autistic Spectrum Disorder, A Battocchi, E Gal, A Ben Sasson, F Pianesi, P Venuti, M Zancanaro and P L Weiss, University of Trento/Fondazione Bruno Kessler, ITALY and University of Haifa, ISRAEL

In this paper we present the design and some initial observations of the Collaborative Puzzle Game, an interactive play system designed with two main purposes: 1) to study social interactions and collaboration in boys with Autistic Spectrum Disorders and with typical development, and 2) to test the feasibility of the system as an instrument for the rehabilitation of social abilities of boys with ASD. Designed to run on the DiamondTouch, an interactive table supporting multi-user interaction, the CPG allows to implement “enforced collaboration”, an interaction paradigm where actions on digital objects that can be performed only through the simultaneous touch of two or more users.

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Exploration of computer games in rehabilitation for brain damage, J Broeren, A-L Bellner, M Fogelberg, O Göransson, D Goude, B Johansson, P A Larsson, K Pettersson and M Rydmark, Sahlgrenska University Hospital/Göteborg University/Primary Care and Municipality Uddevalla/Fyrbodal Research Institute/ Uddevalla Hospital, SWEDEN

Cognitive and physical deficits are consequences of stroke/traumatic brain injuries (TBI). Without rehabilitation activity problems persist i.e. limitations to handle personal care, the work situation, and recreational activities. The aim of this study is to test an application of Virtual Reality (VR) technology with 3D computer games as an occupational therapy assessment/treatment method in rehabilitation for patients with cognitive and physical deficits. We also wanted to investigate if playing computer games resulted in improved cognitive function. An easy-to-use semi-immersive workbench with haptic game selection menu was located at an activity centre. The training activities were 3D computer games. Every time an activity was run, data about the hand movements were collected and analyzed. Quantitative variables were time (s) to perform the test, average velocity (m/s) and, tremor or uncertainty in movements HPR). Executive functioning was examined by utilizing Trial Making Test. The intervention involved five patients. Results provide evidence to support the use of 3D computer games in cognitive rehabilitation. As an implementation tool within the occupational therapy area, this technology seems to be well adapted to the technological and economical development of society in Sweden.

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Interpretations: inter-sensory stimulation concept targeting inclusive access offering appreciation of classical music for all ages, standing, & disability, A L Brooks, Aalborg University Esbjerg, DENMARK

‘SoundScapes’ is a body of empirical research that for almost two decades has focused upon investigating non-invasive gesture control of multisensory stimuli and potential uses. Especially targeted are disabled people of all ages, and a special focus on the profoundly impaired who have limited opportunities for creative self-articulation and playful interaction. The concept has been explored in various situations including: live stage performances; interactive room installations for museums, workshops, and festivals; and in healthcare sessions at hospitals, institutes and special schools. Multifaceted aspects continuously cross-inform in a systemic manner, and, in line with Eaglestone & Bamidis (2008), each situation where the motion-sensitive environment is applied is considered as a hybrid system. The presented preliminary work exemplifies the motion-sensitive environment and how it is used to elicit dynamic performance data from a situation that features the Orquestra Nacional do Porto. A goal is to complement the music by offering an experience of inter-sensory stimulation. Inclusive access is planned in order that all may have an opportunity to appreciate classical music. This paper reports on the background, the targeted experience, and future plans of the concept.

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Towards a platform of alternative and adaptive interactive systems for idiosyncratic special needs, A L Brooks, Aalborg University Esbjerg, DENMARK

Eight participatory workshops were created as a hybrid situation wherein physical and virtual environments were designed to investigate responses of attendees when empowered by non-invasive sensor technology to interactively control responsive multimedia through motion. 144 disabled children and adults attended with caregivers and helpers. Targeted were fun experiences, social interactions, and recognised achievements. Evident was that the majority of disabled attendees joyfully, freely and creatively self-articulated and playfully interacted. However, traditional caregiver role in such situations is questioned following observations from the workshops. Specific design issues, targeted effect-goals, and attendee responses are reported in the paper. Conclusions reflect how such hybrid situations can offer opportunities to assess the dynamic relationships between technical set-ups and related human responses. Strategies are proposed towards future inter/multidisciplinary open research platforms to more fully examine potentials of motion-sensitive environments for this segment of society.

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Remote mobility and navigation aid for the visually disabled, M Bujacz, P Baranski, M Moranski, P Strumillo and M Materka, Technical University of Lódz, POLAND

Outdoor tests of a system for remote guidance of the blind are reported in the paper. The main idea of the system is to transmit a video stream from a camera carried by a visually impaired user to a remote assistant that navigates the blind by short spoken instructions. The communication link is established over the GSM network within the High-Speed Downlink Packet Access (HSDPA) communication protocol. Mobility trials of the system were carried out with a mobile prototype and three blind volunteers in the university campus. The aim of the study was to test the overall tele-assistance concept including: communication link efficiency and reliability, influence on mobility and safety, and the improvement of operator-user interaction. Tests, albeit performed on a small group of volunteers, clearly show an objective performance increase when traveling with the remote guide. This is evident primarily in increased travel speeds and decreased occurrences of missteps and collisions.

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An infrared sound and music controller for users with specific needs, B P Challis and K Challis, University of Glamorgan, UK/Education Bradford, UK

The design and rationale behind a novel music and sound controller (“The Benemin”) is described. Using an array of eight low-cost infrared distance measuring sensors, the system enables users to trigger and manipulate sounds using MIDI messages. Although the controller can facilitate complex musical interaction, providing eight note polyphony and expressive control, the central theme of the project has been one of accessibility. The controller is designed to be used in a variety of settings by users with special needs and has been designed to be both intuitive to play and easy to set up. An ongoing programme of user testing is described and discussed alongside preliminary results.

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Virtual reality system for upper extremity rehabilitation of chronic stroke patients living in the community, A Chortis, P J Standen and M Walker, University of Nottingham, UK

For stroke patients with residual motor impairment, access to sufficient rehabilitation after discharge is often difficult to achieve due to cost, distance and availability of rehabilitative services. Virtual Reality (VR) rehabilitation is a promising method for maximizing the intensity and convenience of task specific rehabilitation training. However, many of the systems that have been developed are expensive, heavy and require frequent technical support. This feasibility study was the first phase in the evaluation of a commercially available game controller for leisure-based therapy at home. Eight people at least six months post stroke took part in a two group randomised control trial. Participants completed a range of measures of upper limb functioning before half spent three sessions a week playing computer games using the game controller while the other half spent the same amount of time in a progressive muscle relaxation program. The study is still underway so data are presented on the performance of the participants in the games group. Their results so far suggest that participants have the potential to improve their performance on the games available using this device.

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Aphasic theatre or theatre boosting self-esteem, I Côté, L Getty and R Gaulin, Théâtre Aphasique Montréal/Université de Montréal, CANADA

Aphasia is an acquired communication disorder caused by a brain damage that can affect the ability to speak and understand, as well as to read and write. Aphasia is most commonly caused by a stroke, but it can also result from a traumatic brain injury or a tumor. Having lost normal communication skills, an aphasic victim will often hide and isolate him or herself. This can also occur as a result of a reduced level of activity following rehabilitation. To help cope with this condition and in order to help victims regain their self-esteem, the Aphasic Theatre was created in 1992. The objective was to involve interested victims in drama and theatre as a way to rehabilitating their communication skills and self-esteem. The Aphasic Theatre is today a recognized theater company which has put on plays in Quebec as well as elsewhere in Canada and Europe. There is now an accumulation of recorded evidence, from specialists, aphasic participants and their relatives, audience attending Aphasic Theatre performances as well as a study completed by ESPACE group of University of Montreal, to confirm the validity of this innovative social rehabilitation method.

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Virtual reality in the rehabilitation of the upper limb after hemiplegic stroke: a randomised pilot study, J H Crosbie, S Lennon, M C McGoldrick, M D J McNeill, J W Burke and S M McDonough, University of Ulster, N. IRELAND

The aim of this study was to assess the feasibility of an RCT to investigate VR mediated therapy in comparison to standard physiotherapy alone in the motor rehabilitation of the upper limb following stroke, and to provide data to inform a power analysis to determine numbers for a future trial. A single blinded randomised controlled trial was conducted. Participants were recruited from two hospital stroke units and members of local Northern Ireland Chest, Heart and Stroke Association clubs. The Upper Limb Motricity Index, Action Research Arm Test were completed at baseline, post-intervention and 6 weeks follow-up. 18 participants were randomised to either a VR mediated upper limb therapy group or a standard therapy group. No significant between group differences were noted. Both groups reported some small changes to their upper limb activity levels. Both interventions seemed to have been acceptable to participants. This study demonstrated the feasibility of a randomised controlled trial of virtual reality mediated therapy for the upper limb compared to standard therapy. Forty-eight participants (24 per group) would be needed to complete an adequately powered study.

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Accessible virtual environments for people who are blind – creating an intelligent virtual cane using the Nintendo Wii controller, L Evett, D J Brown, S Battersby, A Ridley and P Smith, Nottingham Trent University, UK

People who are blind tend to adopt sequential, route-based strategies for moving around the world. Common strategies take the self as the main frame of reference, but those who perform better in navigational tasks use more spatial, map-based strategies. Training in such strategies can improve performance. Virtual Environments have great potential, both for allowing people who are blind to explore new spaces, reducing their reliance on guides, and aiding development of more efficient spatial maps and strategies. Importantly, Lahav and Mioduser have demonstrated that, when exploring virtual spaces, people who are blind use more and different strategies than when exploring real physical spaces, and develop relatively accurate spatial representations of them. The present paper describes the design, development and evaluation of a system in which a virtual environment may be explored by people who are blind using Nintendo Wii devices, with auditory and haptic feedback. Using this technology has many advantages, not least of which are that it is mainstream, readily available and cheap. The utility of the system for exploration and navigation is demonstrated. Results strongly suggest that it allows and supports the development of spatial maps and strategies. Intelligent support is discussed.

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Virtual reality rehabilitation – what do users with disabilities want?, S M Flynn, B S Lange, S C Yeh and A A Rizzo, University of Southern California, USA

This paper will discuss preliminary findings of user preferences regarding video game and VR game-based motor rehabilitation systems within a physical therapy clinic for patients with SCI, TBI and amputation. The video game and VR systems chosen for this research were the Sony PlayStation® 2 EyeToy™, Nintendo® Wii™, and Novint® Falcon™ and an optical tracking system developed at the Institute for Creative Technologies at the University of Southern California. The overall goals of the current project were to 1) identify and define user preferences regarding the VR games and interactive systems; 2) develop new games, or manipulate the current USC-ICT games to address these user-defined characteristics that were most enjoyable and motivating to use; and 3) develop and pilot test a training protocol aimed to improve function in each of the three groups (TBI, SCI and amputation). The first goal of this research will be discussed in this paper.

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Robotic assisted rehabilitation in virtual reality with the L-EXOS, A Frisoli, M Bergamasco, L Borelli, A Montagner, C Procopio, M C Carboncini and B Rossi, Scuola Superiore Sant’Anna/University of Pisa, ITALY

This paper presents the results of a clinical trial employing the PERCRO L-Exos (Light-Exoskeleton) system, which is a 5-DoF force-feedback exoskeleton for the right arm, for robotic-assisted rehabilitation. The device has demonstrated itself suitable for robotic arm rehabilitation therapy when integrated with a Virtual Reality (VR) system. Three different schemes of therapy in VR have been tested in the clinical evaluation trial, which was conducted at the Santa Chiara Hospital in Pisa with nine chronic stroke patients. The results of this clinical trial, both in terms of patients performance improvements in the proposed exercises and in terms of improvements in the standard clinical scales which have been used to monitor patients progresses will be reported and discussed throughout the paper. The evaluation both pre and post-therapy was carried out with both clinical and quantitative measurements with EMG and motion data; the latter ones measured in terms of different kinetic parameters estimated through the online data logged during the repeated sessions of exercise. It is to be noted that statistically significant improvements have been demonstrated in terms of Fugl-Meyer scores, Ashworth scale, increments of active and passive ranges of motion on shoulder, elbow and wrist joints of the impaired limb, active and passive, and quantitative indexes, such as task time and error, synergies and smoothness of movement.

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CaDaReMi: an educational interactive music game, R Gehlhaar, P M Rodrigues and L M Girão, Coventry University/University of Plymouth, UK and Artshare Lda., Aveiro/Fundação Casa da Música, PORTUGAL

This new multi-user interactive sound installation (= 8 persons simultaneously) implements proprietary glob-recognition and tracking software in order to allow visitors to a large empty space (~5m × 7m) to move an avatar - projected on a screen at the end of the space – simply by moving about the space, with the objective of taking it to specific, recognizable locations. Success in this endeavour causes sounds to be triggered.

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Passages - a 3D artistic interface for child rehabilitation and special needs, F Ghedini, H Faste, M Carrozzino and M Bergamasco, Scuola Superiore Sant’Anna/IMT Institute for Advanced Studies, ITALY

Passages is an immersive, multimodal, user-controlled artistic interface. It consists of a three-dimensional interactive Virtual Environment that can be created, explored and interacted with in real-time. The installation has been exhibited in Grenoble, France, during the ENACTION_in_Arts conference (November 19-24, 2007) and in Pisa, Italy, during the Beyond Movement workshop (December 17-21, 2007). This paper outlines the design of the artistic installation Passages, and its potential in the field of rehabilitation.

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Making music with images: interactive audiovisual performance systems for the deaf, M Grierson, Goldsmiths College, UK

This paper describes the technical and aesthetic approach utilised for the development of an interactive audiovisual performance system designed specifically for use by children with multiple learning difficulties, including deafness and autism. Sound is transformed in real-time through the implementation of a Fast Fourier Transform (FFT) and translated into a moving image. This image is adapted so that relevant information can be understood and manipulated visually in real-time. Finally, the image is turned back into sound with only minimal delay. The translation process is based on research in computer music, neuroscience, perception and abstract film studies, supported by the Arts and Humanities Research Council. The system has been developed through collaboration with the Sonic Arts Network, Whitefields Special Needs School, and the South Bank Centre, specifically for a project led by Duncan Chapman with the London Philharmonic Orchestra. The system has now been made available for free by the Sonic Arts Network.

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The effect of game speed and surface perturbations on postural control in a virtual environment, P J R Hawkins, M B Hawken and G J Barton, Liverpool John Moores University, UK

The aim of this study was to describe the relationship between performance and difficulty set by altering game velocity and surface perturbations in a virtual game environment. Performance deteriorates as game difficulty increases when changing game velocity and surface perturbations. Adjustment of both game velocity and the introduction of surface perturbations independently appear to be simple and effective methods of customising task difficulty as a function of patients’ motor ability during rehabilitation.

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Tele-evaluation and intervention among adolescents with handwriting difficulties – Computerized Penmanship Evaluation Tool (ComPET) implementation, L Hen, N Josman and S Rosenblum, University of Haifa, ISRAEL

Writing is a complex and essential human activity. During adolescence, there is an increase in the complexity and quantity of writing required for communication, self-expression, and for demonstrating academic ability. Deficits in handwriting performance limit the writing abilities, and hence the participation of adolescents in many areas of life. Computer-based tele-rehabilitation has the potential to address handwriting assessment and treatment. The goal of the present study is to examine the potential of the ComPET as a tool to assess and treat adolescents with handwriting difficulties. A case report is presented.

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Customization of gaming technology and prototyping of rehabilitation applications, B Herbelin, J Ciger and A L Brooks, Aalborg University Esbjerg, DENMARK

The field of rehabilitation has recently seen various experimentations with games using interfaces that require physical activity. In order to establish the basis for developments and experimentations with those interactive systems, we propose a rapid prototyping approach using various commercial devices and open source software. To demonstrate this idea, we first show how a simple free game can be adapted to specific needs—for training or use by disabled people— by using different sensors and control modes. Similarly, we show that an open on-line virtual world such as Second Life, although not perfect, offers sufficient conditions for quickly building custom content and testing with usual interactive devices. When presented to these prototyping possibilities, people from the target group (health care professionals, patients, handicapped, families) are able to relate to their needs and to elaborate on the use of such systems. In other words, the availability of a simple prototyping platform with free games and new interfaces already opens the discussion on the design of original rehabilitation applications.

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Performance within the virtual action planning supermarket (VAP-S): an executive function profile of three different populations suffering from deficits in the central nervous system, N Josman, E Klinger and R Kizony, University of Haifa, ISRAEL and Arts et Métiers ParisTech, Angers-Laval, FRANCE

Executive functions are those higher-order functions required for performing complex or non-routine tasks. People exhibiting Central Nervous System (CNS) deficits often manifest impaired executive functions, compromising return to full everyday activity and occupation. Such individuals have difficulty performing mundane daily living activities, and especially complex activities – termed Instrumental Activities of Daily Living (IADL). The use of ecologically valid, functional virtual environments constitutes a novel solution to evaluation. The Virtual Action Planning Supermarket (VAP-S) allowed us to compare performance among 3 groups of clients: post-stroke, Minimal Cognitive Impaired, and schizophrenics, and to analyze predictive group membership of the clients (N=83). Results supported study objectives, revealing distinctive performance profiles per group.

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Interactive training of speech articulation for hearing impaired using a talking robot, M Kitani, Y Hayashi and H Sawada, Kagawa University, JAPAN

This paper introduces a speech training system for auditory impaired people employing a talking robot. The talking robot consists of mechanically-designed vocal organs such as a vocal tract, a nasal cavity, artificial vocal cords, an air pump and a sound analyzer with a microphone system, and the mechanical parts are controlled by 10 servomotors in total for generating human-like voices. The robot autonomously learns the relation between motor control parameters and the generated vocal sounds by an auditory feedback control, in which a Self-organizing Neural Network (SONN) is employed for the adaptive learning. By employing the robot and its properties, we have constructed an interactive training system. The training is divided into two approaches; one is to use the talking robot for showing the shape and the motion of the vocal organs, and the other is to use a topological map for presenting the difference of phonetic features of a trainee’s voices. While referring to the vocal tract motions and the phonetic characteristics, a trainee is able to interactively practice vocalization for acquiring clear speech with an appropriate speech articulation. To assess the validity of the training system, a practical experiment was conducted in a school for the deaf children. Nineteen subjects took part in the interactive training with the robotic system, and significant results were obtained. The talking robot is expected to intensively teach an auditory impaired the vocalization skill by directing the difference between clear speech and the speech with low clarity.

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You are who you know: user authentication by face recognition, M Klíma, A J Sporka and J Franc, Czech Technical University in Prague/Sun Microsystems, Inc, CZECH REPUBLIC and University of Trento, ITALY

In this paper, a novel method of authentication based on user-performed identification of known and unknown faces is described. The target group of the method is the elderly users for which the use of traditional techniques, such as passwords, personal identification numbers (PIN), or biometrics is not without problems. The performance of this method and authentication by PIN has been compared in a two-pass usability study. Our method performed significantly better than PIN. The method is suitable for low-security applications in hospitals and senior houses.

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Changes in electroencephalographic spike activity of patients with focal epilepsy through modulation of the sensory motor rhythm in a brain-computer interface, R J Lopes, P S Gamito, J A Oliveira, L H Miranda, J C Sousa and A J Leal, Universidade Lusófona de Humanidades e Tecnologias/Universidade Nova de Lisboa/Hospital Júlio de Matos/Hospital Dona Estefânia, PORTUGAL

In epilepsy persistence of seizures, despite appropriate pharmacological therapy, motivates referral to surgery of epilepsy, currently the most effective treatment. Because surgery is not indicated for all patients, search for alternative therapies is ongoing. Preliminary data suggests the potential benefit of sensory-motor rhythm modulation on the epileptic activity. However, no controlled studies have been performed. Our study evaluates the benefits of sensory-motor rhythm training to reduce spike activity in Rolandic epilepsy patients with frequent spike activity. Using a Brain-Computer Interface, we obtained a statistically significant modulation of the Mu rhythm and variation of interictal spike activity.

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Virtual reality and associated technologies in disability research and intervention, P Lopes-dos-Santos, M Maia, A Tavares, M Santos and M Sanches-Ferreira, University of Porto/Porto Polytechnic School of Education, PORTUGAL

This paper concerns the application of virtual reality and associated technologies (VRAT) in the disability research and intervention field. By reviewing 144 studies presented at the International Conference Series on Disability, Virtual Reality and Associated Technologies (1996-2006), our analytic work examine the underlying conceptual frameworks of disability and methodological rationales used in selected papers. In the last 15 years, there was a paradigmatic shift from the medical to the biopsychosocial model of disability. Yet, our analyses indicate that such shift is not clearly reflected in the way VRAT have been addressing disability issues. The present manuscript offers recommendations regarding definition of goals, methodological procedures, and assessment rationales in order to stimulate discussions on how the use of VRAT can be improved in the field of disability research and practice.

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Using immersion in a musical virtual space environment to enhance quality of body movement in young adults with hemiparesis, P Lopes-dos-Santos, A Nanim, H Fernandes and J Levi, University of Porto/UADIP/Balleteatro, Portugal

This paper focuses on the application of musical virtual space environments in the rehabilitation of individuals with motor disabilities. It is contended that the use of such environments has the potential of enhancing performance through engagement of the person in meaningful and functional activities. Our study describes and evaluates the use of a musical virtual space to increase the quality of movement and improve gross motor functioning in four young adults with hemiparesis. Results showed that immersion episodes in the musical virtual environment provided highly engaging experiences that fostered body movement and social interaction. After twenty immersive sessions, participants revealed gains in the aesthetic quality of gestures performed in dancing responses to music. There were also significant improvements regarding gross motor functions, namely in parameters such as stability, coordination, flow, effort, and mobility.

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Virtual reality and neuropsychology: a cognitive rehabilitation approach for people with psychiatric disabilities, A Marques, C Queirós and N Rocha, Oporto Polytechnic Institute/University of Porto, PORTUGAL

This pilot-study evaluated the feasibility of a 9 month Cognitive Rehabilitation Program – using Virtual Reality and the Integrated Psychological Therapy (IPT) – to improve cognitive functioning in people with schizophrenia. In order to assess the program it was applied (pre and post) the WCST, WAIS-III sub-tests, Stroop Test, and The Subjective Scale to Investigate Cognition in Schizophrenia. Results identified significant differences (p<0.05) between pre and post tests in the subjective and objective assessed cognitive dimensions. The results point out that virtual reality technology and IPT may be a significant resource and intervention methodology in the cognitive remediation of people with psychiatric disabilities.

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Mix-it-yourself with a brain-computer music interface, E R Miranda and V Soucaret, University of Plymouth, UK

This paper is a follow up from the work presented at the ICDVRAT 2006 conference in Esbjerg, where the first author introduced a Brain-Computer Music Interface (BCMI) to control a generative music system. Here we introduce a new musical application for the BCMI (an EEG-controlled music mixer) and report on efforts to make our BCMI system cheaper to implement, more portable and easier for users to operate. We also comment on a new method that we are developing to generate melodies from the topological behaviour of the EEG.

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Low-cost optical tracking for immersive collaboration in the CAVE using the Wii Remote, A Murgia, R Wolff, P M Sharkey and B Clark, University of Reading/University of Salford, UK

We present a novel way of interacting with an immersive virtual environment which involves inexpensive motion-capture using the Wii Remote. A software framework is also presented to visualize and share this information across two remote CAVE-like environments. The resulting applications can be used to assist rehabilitation by sending motion information across remote sites. The application’s software and hardware components are scalable enough to be used on desktop computer when home-based rehabilitation is preferred.

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Virtual reality, haptics and post-stroke rehabilitation in practical therapy, L Pareto, J Broeren, D Goude and M Rydmark, University West, Trollhättan/Curictus AB, Kista/Göteborg University/Sahlgrenska University Hospital, SWEDEN

We address the question of usefulness of virtual reality based rehabilitation equipment in practical therapy, by letting experienced therapists explore one such equipment during six months in their regular practice under natural circumstances. By protocols, questionnaires and focus group interviews we collect data regarding which activities they considered useful, why these are useful and what might improve usefulness of such activities, based on the therapists’ professional judgement and experiences. This resulted in a set of purposeful activities, identified values for therapeutic work, and design guidelines. The conclusion is that such equipment has benefits beyond real life training, that variation in content and difficulty levels is a key quality for wide suitability and that the combination of challenging cognitive activities which encourage motor training was considered particularly useful.

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Virtual human patients for training of clinical interview and communication skills, T D Parsons, P Kenny and A A Rizzo, University of Southern California, USA

Although schools commonly make use of standardized patients to teach interview skills, the diversity of the scenarios standardized patients can characterize is limited by availability of human actors. Virtual Human Agent technology has evolved to a point where researchers may begin developing mental health applications that make use of virtual reality patients. The work presented here is a preliminary attempt at what we believe to be a large application area. Herein we describe an ongoing study of our virtual patients. We present an approach that allows novice mental health clinicians to conduct an interview with virtual character that emulates 1) an adolescent male with conduct disorder; and 2) an adolescent female who has recently been physically traumatized.

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Neuropsychological assessment using the virtual reality cognitive performance assessment test, T D Parsons and A A Rizzo, University of Southern California, USA

The traditional approach to assessing neurocognitive performance makes use of paper and pencil neuropsychological assessments. This received approach has been criticized as limited in the area of ecological validity. The newly developed Virtual Reality Cognitive Performance Assessment Test (VRCPAT) focuses upon enhanced ecological validity using virtual environment scenarios to assess neurocognitive processing. The VRCPAT battery and a neuropsychological assessment were conducted with a sample of healthy adults. Findings suggest 1) good construct validity for the Memory Module; and 2) that increase in stimulus complexity and stimulus intensity can manipulate attention performance within the Attention Module.

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HARMiS – hand and arm rehabilitation system, J Podobnik, M Munih and J Cinkelj, University of Ljubljana, SLOVENIA

This paper presents the HARMiS device (Hand and arm rehabilitation system), which is primarily intended for use in robot-aided neurorehabilitation and for training of reaching, grasping and transporting virtual objects in haptic environments. System combines haptic interface and module for grasping, which is mounted on the top of the haptic interface. This allows combined training of the upper extremity movements and grasping. High level of reality is achieved with use of the graphic and haptic visual environments, which is beneficial for the motivation of the patients.

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Examination of users’ routes in virtual environments, C Rigó and C Sik Lányi, University of Pannonia, HUNGARY

We developed three virtual environments (VEs): a VR gallery, a VR store and a VR labyrinth for the investigation of the users’ routes in these VEs. In this article we examine the matching of these tours with two developed utilities. From the results we want to draw the inference to the practical development of the virtual environments for defined groups of users. We examined left-handed, right-handed persons and people who play often with VR games as well as people who play with VR games rarely or never. The VE and the developed testing frame software are adaptable for every disabled group’s route examination.

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Virtual reality in psychology and rehabilitation: the last ten years and the next!, A A Rizzo, Institute for Creative Technologies, University of Southern California, USA

Virtual reality (VR) has undergone a transition in the past 10 years that has taken it from the realm of expensive toy and into that of functional technology. Revolutionary advances in the underlying VR enabling technologies (i.e., computation speed and power, graphics and image rendering technology, display systems, interface devices, immersive audio, haptics tools, tracking, intelligent agents, and authoring software) have supported development resulting in more powerful, low-cost PC-driven VR systems. Such advances in technological “prowess” and accessibility have provided the hardware platforms needed for the conduct of human research and treatment within more usable, useful and lower cost VR systems. At the same time, there has been a growing awareness of the potential value of VR by scientists and clinicians, in addition to the general public. While much of this recognition may be due to the high visibility of digital games and massive shared internet-based virtual worlds (World of Warcraft, Halo and 2nd Life), clinical research applications routinely come into the public consciousness via the popular media. Whether this can be considered as “hype” or “help” to a field that has a storied history of alternating periods of public enchantment and disregard, still remains to be seen. Regardless, growing public awareness coupled with solid scientific results delivered from VR clinical and research applications have brought the field past the point where sceptics can be taken seriously when they characterize VR as a “fad technology”. It is not 1998 anymore! This paper charts the past 10 years of progress and anticipates development in the field over the next decade.

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Virtual reality Post Traumatic Stress Disorder (PTSD) exposure therapy results with active duty Iraq war combatants, A A Rizzo, G Reger, K Perlman, B Rothbaum, J Difede, R McLay, K Graap, G Gahm, S Johnson, R Deal, J Pair, T D Parsons, M Roy, R Shilling and P M Sharkey, University of Southern California/Naval Medical Center – San Diego/Emory University School of Medicine/Weill Medical College of Cornell University/Madigan Army Medical Center – Ft. Lewis/Virtually Better, Inc/Walter Reed Army Medical Center/Office of Naval Research, USA and University of Reading, UK

Post Traumatic Stress Disorder (PTSD) is reported to be caused by traumatic events that are outside the range of usual human experience including (but not limited to) military combat, violent personal assault, being kidnapped or taken hostage and terrorist attacks. Initial data suggests that at least 1 out of 6 Iraq War veterans are exhibiting symptoms of depression, anxiety and PTSD. Virtual Reality (VR) delivered exposure therapy for PTSD has been used with reports of positive outcomes. The aim of the current paper is to present the rationale and brief description of a Virtual Iraq PTSD VR therapy application and present initial findings from its use with PTSD patients. Thus far, Virtual Iraq consists of a series of customizable virtual scenarios designed to represent relevant Middle Eastern VR contexts for exposure therapy, including a city and desert road convoy environment. User-centered design feedback needed to iteratively evolve the system was gathered from returning Iraq War veterans in the USA and from a system deployed in Iraq and tested by an Army Combat Stress Control Team. Results from an open clinical trial at San Diego Naval Medical Center of the first 18 treatment completers indicate that 14 no longer meet PTSD diagnostic criteria at post-treatment, with only one not maintaining treatment gains at 3 month follow-up. Clinical tests are also currently underway at Ft. Lewis, Emory University, Weill Cornell Medical College, Walter Reed Army Medical Center and 10 other sites. Other sites are preparing to use the application for a variety of PTSD and VR research purposes.

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Mobile audio assistance in bus transportation for the blind, J H Sánchez and C A Oyarzún, University of Chile, CHILE

People with visual disabilities have serious difficulties when mobilizing through the city on the public transportation system. We introduce AudioTransantiago, a handheld application that allows users to plan trips and provide contextual information during the journey through the use of synthesized voices. The usability and cognitive evaluation of AudioTransantiago was performed using a prototype evaluation in order to identify and solve usability issues, ending up with an intuitive and simple interface. Finally, a cognitive impact evaluation administered during bus trips taken with the assistance of AudioTransantiago demonstrated that the software provides more autonomy and effectiveness for users’ trips, improving their orientation and mobility.

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Effects of different virtual reality environments on experimental pain threshold in individuals with pain following stroke, M J Simmonds and S Shahrbanian, McGill University, CANADA

The objectives of this study were to determine whether different virtual reality environments (VR) had a differential effect on pain threshold (PT) in stroke patients with pain, and whether the patient’s level of interest in the VR influenced PT. Ten stroke individuals with pain participated. PT to hot and cold stimuli was determined using Quantitative sensory testing within four different VEs; Hot, Cold, Neutral and no VR. After the VR exposure, subjects rated each VR condition based on their engagement. The results suggest that VR is more effective than no VR and all VR conditions were more engaging than no VR.

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Providing disabled persons in developing countries access to computer games through a novel gaming input device, A C Smith and C Krause, African Advanced Institute for Information & Communications Technology, SOUTH AFRICA

A novel input device for use with a personal computer by persons with physical disabilities who would otherwise not be able to enjoy computer gaming is presented. This device is simple to manufacture and low cost. We describe the constituent parts of this device. A collaboration gaming application especially designed for this input device is given in brief.

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Effect of playing computer games on decision making in people with intellectual disabilities, P J Standen, F Rees and D J Brown, University of Nottingham/Nottingham Trent University, UK

People with intellectual disabilities have difficulty making decisions and this may hinder their independence and inclusion in society. Interactive computer software may give them the opportunity to practice the underlying components of this skill. A previous study indicated that playing a computer game improved choice reaction time. This study aimed to discover if repeated sessions playing a computer game involving aspects of decision making, such as collecting relevant information and controlling impulsivity, would improve performance in two non-computer based tests of decision making. 12 adults with intellectual disabilities were randomly assigned to either an intervention group or control group. They were all exposed to 10 twice weekly sessions, playing either the intervention game or the control game, which involved simple reaction time only. All participants completed two non-computer based tests of decision making at baseline and post-intervention. After repeated sessions, the intervention group showed a significant improvement in game score, with researcher assistance significantly decreasing. At follow up, the intervention group showed a significant decrease from baseline in the number of guesses made before guessing correctly on both of the decision making tests. The decrease observed in the control group failed to reach significance.

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Finger spelling recognition using distinctive features of hand shape, Y Tabata and T Kuroda, Kyoto College of Medical Science/Osaka University, JAPAN

The authors have been developing a glove based input device, called “Stringlove”, recognizing finger shapes by adapting for several shapes pointing an angle of each finger joint. A research group reports on the sign language linguistics features to distinguish finger shapes, and advance to make it practicable to engineering. This paper mentions that the method of recognition of finger shapes was examined by using the developing equipment. According to a preliminary experiment, it has been suggested that the present method has a good possibility to improve a rate of recognition of finger shapes.

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Cognitive effects of videogames on old people, A Torres, University of Porto/ University of Aveiro, PORTUGAL

In these days the percentage of older people in the population is growing worldwide. It is therefore urgent to decrease the morbidity resulting from biopsychosocial losses associated with old age. The preservation and recovery of cognitive functions and of physical, psychological and social autonomy are provided through new mental and physical activities. As have other activities, the use of video games has shown benefits for this ageing population, in particular at the cognitive level. Although there are only few studies which studied this videogames’ application. In this study we studied the cognitive effects of videogames on the elderly people. And we also studied these effects on self-concept and on the quality of life. The instruments used are the Cognitive Sub-scale of Alzheimer's Disease Assessment Scale, the Clinical Inventory of Self-Concept and the WHOQOL-Bref. The study involved the participation of 43 elderly people distributed between 3 experimental conditions (n = 15 used videogames, n = 17 relaxation and n =11 had no intervention). There were two moments of assessment, before the intervention (Pre-test) and after eight weeks of it (Post-Test). Old people shows to be able to use videogames as well as to like to use it. Although they faced some difficulties using key board and mousse. They show to prefer games without time challenge and without fast and exact movements. They also show to prefer videogames with a real story behind the play activity. It was found that the videogames participants showed a decline in cognitive deterioration from the pre to post intervention tests (t (14) = 3,505, p =. 003, r = .68), unlike the control groups. The self-concept deteriorated up significantly under relaxation condition (t (16) = 2.29, p = .036, r = .50) and on passive control group (t(10) = 3.44, p = .006, r = .74). The quality of life did not show any differences from the start to the end of the study. Nor were any correlations found between the time of use of videogames and larger effects. The mediator effect of self-concept on differences obtained in the ADAS-Cog (rS = .57, p = .014) and in the ICAC (rS = -.47, p = .039) was confirmed. In sum, the results show that the use of videogames leads to the improvement of cognitive functioning and to the maintenance of the self-concept and the quality of life of elderly people. They also suggest that the higher the self-concept, the better are the cognitive effects achieved.

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Auditory-visual virtual environments to treat dog phobia, I Viaud-Delmon, F Znaïdi, N Bonneel, D Doukhan, C Suied, O Warusfel, K V N’Guyen and G Drettakis, IRCAM/La Salpetriere Hospital/ REVES INRIA, FRANCE

In this paper we present the design, development, and usability testing of an auditory-visual based interactive environment for investigating virtual reality exposure-based treatment for cynophobia. The application is developed upon a framework that integrates different algorithms of the CROSSMOD project (www.crossmod.org). We discuss the on-going work and preliminary observations, so as to further the development of auditory-visual environment for virtual reality. Traditionally, virtual reality concentrates primarily on the presentation of high fidelity visual experience. We aim at demonstrating that combining adequately the visual and the auditory experience provides a powerful tool to enhance sensory processing and modulate attention.

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Gazing into a Second Life: gaze-driven adventures, control barriers, and the need for disability privacy in an online virtual world, S Vickers, R Bates and H O Istance, De Montfort University, UK

Online virtual worlds such as Second Life and World of Warcraft offer users the chance to participate in potentially limitless virtual worlds, all via a standard desktop pc, mouse and keyboard. This paper addresses some of the interaction barriers and privacy concerns that people with disabilities may encounter when using these worlds, and introduces an avatar Turing test that should be passed for worlds to be accessible for all users. The paper then focuses on the needs of high-level motor disabled users who may use gaze control as an input modality for computer interaction. A taxonomy and survey of interaction are introduced, and an experiment in gaze based interaction is conducted within these virtual worlds. The results of the survey highlight the barriers where people with disabilities cannot interact as efficiently as able-bodied users. Finally, the paper discusses methods for enabling gaze based interaction for high-level motor disabled users and calls for game designers to consider disabled users when designing game interfaces.

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Keeping an eye on the game: eye-gaze interaction with Massively Multiplayer Online Games and virtual communities for motor impaired users, S Vickers, H O Istance, A Hyrskykari, N Ali and R Bates, De Montfort University, UK and University of Tampere, FINLAND

Online virtual communities are becoming increasingly popular both within the able-bodied and disabled user communities. These games assume the use of keyboard and mouse as standard input devices, which in some cases is not appropriate for users with a disability. This paper explores gaze-based interaction methods and highlights the problems associated with gaze control of online virtual worlds. The paper then presents a novel ‘Snap Clutch’ software tool that addresses these problems and enables gaze control. The tool is tested with an experiment showing that effective gaze control is possible although task times are longer. Errors caused by gaze control are identified and potential methods for reducing these are discussed. Finally, the paper demonstrates that gaze driven locomotion can potentially achieve parity with mouse and keyboard driven locomotion, and shows that gaze is a viable modality for game based locomotion both for able-bodied and disabled users alike.

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Virtual reality methodology for eliciting knowledge about public transport accessibility for people with acquired brain injury, M Wallergård, J Eriksson and G Johansson, Lund University, SWEDEN

The aim of this study was to investigate if and how a virtual reality-based methodology can be used to elicit knowledge about public transport accessibility for people with acquired brain injury (ABI). Four subjects with ABI and four occupational therapists made a bus trip in an immersive virtual environment. Their knowledge about public transport accessibility was elicited using the think aloud technique. All subjects managed to handle the VR methodology sufficiently well. The two subject groups tended to focus on different aspects of accessibility in public transport systems. The results suggest that a VR-based methodology can be used to elicit a wide spectrum of knowledge about public transport accessibility for people with ABI.

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Unintentional intrusive participation in multimedia interactive environments, C Williams, Pontnewydd Primary School, WALES

This paper presents data from two independent case studies, a 15 year old female with Cerebral Palsy and related profound and multiple learning difficulties and a 7 year old male with extreme behaviour associated with Autistic Spectrum Disorder. An audiovisual immersive interactive environment was developed to encourage creative interaction and expression from the participants. There were support workers present in both case studies and it is the interventions of these support staff which are the main focus of this paper. Results indicated that profuse but unintentional interventions from the staff may have distorted interaction with, dissuaded or diverted participants from meaningful engagements with the reactive feedback provided by the system.

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