International Conference Series on Disability, Virtual Reality and Associated Technologies The University of Reading

2016 Full Papers ∼ Abstracts and Papers

Abstracts are listed in alphabetical order, based on first author. 

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Applying Bayesian modelling for inclusive design under health and situational induced impairments, B I Ahmad, P M Langdon, S J Godsill, University of Cambridge, UK

Predictive pointing enables realising smart interfaces, which are capable of inferring the user intent, early in the pointing task, and accordingly assisting the on-display target acquisition (pointing and selection). It adopts a Bayesian framework to effectively model the user pointing behaviour and incorporate the present perturbations induced by situational impairments as well as inaccuracies in the utilised sensing technology. The objective of the predictive pointing system is to minimise the cognitive, visual and physical effort associated with acquiring an interface component when the user input is perturbed due to a situational impairment, for example, to aid drivers select icons on a display in a moving car via free hand pointing gestures. In this paper, we discuss the ability of the predictive pointing or display solution to simplify and expedite human computer interaction when the user input is perturbed due to health induced impairments and disability, rather than a situational impairment. Examples include users with tremors, spasms, or other motor impairments. Given the flexibilities acceded by the Bayesian formulation, the applicability of the predictive pointing to inclusive design in general is addressed. Its intent prediction functionality can be adapted to the user’s physical capabilities and pointing characteristics or style, thereby, catering for wide ranges of health induced impairments, such as those arising from ageing. It is concluded that predictive displays can significantly facilitate and reduce the effort required to accomplish selection tasks on an interactive display when the user input is perturbed due to health or physical impairments, especially when pointing in 3D with free hand pointing gestures.

Ahmad, BI, Langdon, PM, and Godsill, SJ (2016), Applying Bayesian modelling for inclusive design under health and situational induced impairments, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 113–121, Los Angeles, California, USA, 20-22 Sept. 2016


Study of stressful gestural interactions: an approach for assessing their negative physical impacts, S Ahmed, L Leroy, A Bouaniche, Université Paris, FRANCE

Despite the advantages of gestural interactions, they involve several drawbacks. One major drawback is their negative physical impacts. To reduce them, it is important to go through a process of assessing risk factors to determine the interactions’ level of acceptability and comfort so as to make them more ergonomic and less tiring. We propose a method for assessing the risk factors of gestures based on the methods of posture assessment in the workplace and the instructions given by various standards. The goal is to improve interaction in virtual environments and make it less stressful and more effortless.

Ahmed, S, Leroy, L, and Bouaniche, A (2016), Study of stressful gestural interactions: an approach for assessing their negative physical impacts, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 83–91, Los Angeles, California, USA, 20-22 Sept. 2016


Augmented feedback approach to double-leg squat training for patients with knee osteoarthritis: a preliminary study, M Al-Amri, J L Davies, P Adamson, K Button, P Roos, R van Deursen, Cardiff University/Cardiff and Vale UHB, UK/ CFD Research Corporation, Huntsville, AL, USA

The aim of this preliminary study was to explore the effects of two types of augmented feedback on the strategy used by healthy participants and patients with knee osteoarthritis (OA) to perform a double-leg squat. Seven patients with knee OA and seven healthy participants performed three sets of eight double-leg squats: one without feedback, one with real-time kinematic feedback and one with real-time kinetic feedback. Kinematic and kinetic outcome measures (peak knee flexion angle, peak knee extensor moment, and symmetry of the support knee moment between the injured and non-injured knees) demonstrate the potential influence of real-time kinetic feedback on the motor strategy used to perform a double-leg squat in both groups. This feedback could be used to develop more efficient and effective motor strategies for squatting in patients with knee OA and further evaluation is warranted.

Al-Amri, M, Davies, JL, Adamson, P, Button, K, Roos, P, and van Deursen, R (2016), Augmented feedback approach to double-leg squat training for patients with knee osteoarthritis: a preliminary study, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 251–257, Los Angeles, California, USA, 20-22 Sept. 2016


Impact of the visual representation of the input device on driving performance in a power wheelchair simulator, A Alshaer, D O’Hare, S Hoermann, H Regenbrecht, University of Otago, Dunedin, NEW ZEALAND/ University of Sydney, AUSTRALIA

Virtual reality-based power wheelchair simulators can help potential users to be assessed and trained in a safe and controlled environment. Although now widely used and researched for several decades, many properties of virtual environments are still not yet fully understood. In this study, we evaluated the effects of the visual representation of the input device in a virtual power wheelchair simulator. We compared the virtual display of a standard gaming joystick with that of a proprietary power wheelchair joystick while users used either of the real world counterparts, and measured the effects on driving performance and experience. Four experimental conditions comprising of two visual virtual input modalities and their two real counterparts as independent variables have been studied. The results of the study with 48 participants showed that the best performance was obtained for two of three performance indicators when a virtual representation of the PWC joystick was displayed, regardless of what type of joystick (real PWC or gaming joystick) was actually physically used. Despite not explicitly being made aware of by the experimenter, participants reported noticing the change in the visual representation of the joysticks during the experiment. This supports the theory that the effects of virtual reality representations have a significant impact on the user experience or performance, and visual properties need to be carefully selected. This is specifically important for applications where the transfer effects to real world scenarios is sought and ecological valid simulation is aimed for.

Alshaer, A, O’Hare, D, Hoermann, S, and Regenbrecht, H (2016), Impact of the visual representation of the input device on driving performance in a power wheelchair simulator, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 65–72, Los Angeles, California, USA, 20-22 Sept. 2016


Open rehabilitation initiative: design and formative evaluation, S Bermúdez i Badia, J E Deustch, R Llorens, Universidade da Madeira, Funchal, PORTUGAL/ Rutgers University, Newark, NJ, USA/Universitat Politècnica de València/Fundación Hospitales NISA, Valencia, SPAIN

Development and testing of virtual environments for rehabilitation is a lengthy process which involves conceptualization, design, validation, proof concept testing and ultimately, if appropriate, randomized controlled trials. Ironically, once vetted, many of these VEs are not available to clinicians or their patients. To address the challenge of transferring research grade technology from the lab to the clinic the authors have created the Open Rehabilitation Initiative. It is an international independent online portal that aims to help clinicians, scientists, engineers, game developers and end-users to interact with and share virtual rehabilitation tools. In this paper, the conceptualization, development and formative evaluation testing are described. Three groups of developers of VEs (n=3), roboticists who use VEs for robot interactivity (n=10) and physical therapists (n=6) who are the clinicians end-users participated in the study. Interviews, focus groups and administration of the SUS were used to assess acceptability. Data were collected on three aspects, 1) discussion of what a resource might look like, 2) interaction with the site, and 3) reaction to the proposed site and completion of the SUS. Interviews and focus groups were recorded and transcribed. Data from the SUS was analyzed using a One-way ANOVA. There was no significant difference by groups. However, the clinicians’ mean score of 68 on the SUS was just at the acceptable level, while the developers and roboticists scored above 80. While all users agreed that the site was a tool that could promote collaboration and interaction between developers and users, each had different requirements for the design and use. Iterative development and discussion of scaling and sustaining the site is ongoing.

Bermúdez i Badia, S, Deustch, JE, and Llorens, R (2016), Open rehabilitation initiative: design and formative evaluation, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 93–100, Los Angeles, California, USA, 20-22 Sept. 2016


Face to face: an interactive facial exercise system for stroke patients with facial weakness, P Breedon, P Logan, D Pearce, J Edmans, B Childs, R O’Brien, Nottingham Trent University/University of Nottingham/Barker Brettell LLP, Birmingham/Maddison Product Design Ltd, Fittleworth, UK

Each year 152,000 people in the UK have a stroke. Almost all have an initial facial weakness. Many resolve in the first few days but it is estimated that 26,000 people experience some kind of long-term paralysis in their face. This may impact on their eating, drinking, speaking, facial expression, saliva management, self-image and confidence. A survey of 107 UK based clinicians found that routine treatment of facial weakness was provision of exercises with a written instruction sheet. The UK National Stroke Clinical Guidelines recommend that patients undertake 45 minutes of therapy per day, but anecdotal evidence suggests that patients have poor adherence to the exercises because they find them boring and there is no feedback to help them see a difference. A multidisciplinary team, which includes patients, researchers and therapists have produced a working prototype system to improve facial weakness. It is called Face to Face and includes a Kinect sensor, a small form PC and a monitor. Patients follow exercises given by a therapist on the screen; the system records and simultaneously gives feedback, with a facial recognition algorithm providing tracking data for each captured frame of the user's face. Results from our small clinical trial indicate that the system is more successful at getting patients to complete their exercises than using a mirror, patients liked it, and they said it had helped improve their facial symmetry. Therapists said Face to Face encouraged patients to exercise daily, they liked the fact that it could be individually programmed and could record how much the patient had exercised. Based on the initial project work and positive outcomes Face to Face aims to help patients practice their facial muscle exercises to speed their recovery, providing direct benefits in terms of costs and time, and offering patients significant improvements.

Breedon, P, Logan, P, Pearce, D, Edmans, J, Childs, B, and O’Brien, R (2016), Face to face: an interactive facial exercise system for stroke patients with facial weakness, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 233–240, Los Angeles, California, USA, 20-22 Sept. 2016


Using virtual interactive training agents with adults with autism and other developmental disabilities, T Bresnahan, A A Rizzo, S L Burke, M Partin, R M Ahlness, M Trimmer, The Dan Marino Foundation, Fort Lauderdale/ University of Southern California - Institute for Creative Technologies, Los Angeles/Florida International University, Miami, USA

Conversational Virtual Human (VH) agents are increasingly being used to support role-play experiential learning across a range of use-cases and populations. This project examined whether use of the Virtual Interactive Training Agent (VITA) system would improve job interviewing skills in a sample of persons with autism or other developmental disability. The study examined performance differences between baseline and final interviews in face-to-face and virtual reality conditions, and whether statistically significant increases were demonstrated between interviewing conditions. Paired samples t-tests were utilized to examine mean changes in performance by interview stage and in the overall difference between baseline and final interview stages. The preliminary results indicated that VITA is a positive factor when preparing young adults with autism or other developmental disability for employment interviews.  Statistically significant results were demonstrated across all pilot conditions and in all but one post-assessment condition.

Bresnahan, T, Rizzo, AA, Burke, SL, Partin, M, Ahlness, RM, and Trimmer, M (2016), Using virtual interactive training agents with adults with autism and other developmental disabilities, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 49–56, Los Angeles, California, USA, 20-22 Sept. 2016


Insights from 10 years of stroke virtual rehabilitation – a personal perspective, M Cameirão, University of Madeira/Madeira Interactive Technologies Institute, PORTUGAL

During the last decade, the use of virtual reality (VR) for the rehabilitation of motor and cognitive deficits after stroke has became increasingly popular. This trend can be appreciated by the exponential growth over the years of the number of publications that evaluate, propose or review novel stroke rehabilitation and/or assessment paradigms based on the use of VR based technology. In 2006, we started the development of the Rehabilitation Gaming System (RGS), a pioneer VR based system in multiple aspects at that time. Besides some technical innovations – such as a non-invasive low-cost webcam-based motion capture system years before MS Kinect was developed – RGS had very specific mechanistic neuroscientific hypothesis on how VR could be further exploited to maximize stroke recovery. RGS exploited the embodiment of virtual agents, the effect of first-person perspective and Mirror Neuron activation as mechanisms for potentiating neuroreorganization. In addition, RGS was one of the first pushing forward the concept of a build-in adaptability engine to maximize training outcomes through an automated difficulty adjustment that individualized training parameters to patients (Cameirão, Badia, Oller, & Verschure, 2010). The impact of this system in comparison to standard rehabilitation was evaluated by a number longitudinal studies. In the most ambitious and demanding study that I ran, RGS was used in a 3-month intervention (plus 3 months follow-up) in acute stroke patients (Cameirão, Bermúdez i Badia, Duarte, & Verschure, 2011). The results of this study showed that VR based rehabilitation can have an acceleration effect in stroke recovery in the acute phase of stroke. Still nowadays there are not many studies of this kind because the implementation of such a protocol is very challenging and demanding. Nevertheless, controlled studies of this kind were (and are still) needed, and to date this is still one of my most important contributions to the field of virtual rehabilitation. In a later study with RGS, we compared the effect of using 3 different interface technologies (natural user interface, passive exoskeleton, and haptics) with 44 chronic stroke survivors on the same VR task (Cameirão, i Badia, Duarte, Frisoli, & Verschure, 2012). Results showed that the main contributor for the positive results were the VR scenario irrespective of interface technology. Further, retention of improvements on follow up was higher when a haptics interface was used, allegedly because of increased ecological validity in the interaction with the VR scenario.

Cameirão, M S (2016), Insights from 10 years of stroke virtual rehabilitation – a personal perspective, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 9–10, Los Angeles, California, USA, 20-22 Sept. 2016 (extended abstract only)


Tele-guidance based orientation and mobility system for visually impaired and blind persons, B Chaudary, P Pulli, I Paajala, E Keino, University of Oulu,  FINLAND

The design and development of tele-assistance services have taken a great consideration in the domain of healthcare lately. Telecare solutions are seen as a potential means of addressing the future care needs of ageing societies. With the growing proportion of dependent people (ageing, disabled users), tele-assistance and tele-monitoring platforms will play a significant role to provide an efficient and less-costly remote care and support. It will allow aged and disabled persons to maintain their independence and lessen the burden and cost of caregiving. In the case of visually impaired persons (VIP) and blind persons, guide dog and white cane provide them a fair degree of independence. However, those are very limited in guiding the user towards a specific desired location, especially in an unknown environment. The assistance of other people presents a feasible solution, though it does not improve the idea of autonomous guidance and privacy. The concept of proposed tele-guidance system is based on the idea that a blind pedestrian can be assisted by spoken instructions from a remote caregiver who receives a live video stream from a camera carried by her. The assistive tools have reportedly acceptance issues by VIP. The paper also presents a qualitative study using a modified version of UTAUT-2 (Unified Theory of Acceptance and Use of Technology) to find out causes for acceptance issues in navigation tools for visually impaired. Another goal of the study was to validate the UTAUT2-model is suitable for researching acceptance issues of navigation assistance tools of VIP.

Chaudary, B, Pulli, P, Paajala, I, and Keino, E (2016), Tele-guidance based orientation and mobility system for visually impaired and blind persons, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 123–132, Los Angeles, California, USA, 20-22 Sept. 2016


Expanded sense of possibilities: qualitative findings from a virtual self-management training for amputees, R Cooper, S L Winkler, M Schlesinger, A Krueger, A Ludwig, Nova Southeastern University, Fort Lauderdale, FL/ James A Haley VA Hospital, Tampa, FL/Virtual Ability, Inc., Aurora, CO, USA

This paper presents the procedures and results of a qualitative study that was part of a larger study comparing two methods of accessing a self-management training for amputees: e-learning and a virtual world.  Interviews were conducted in Second Life with ten subjects who completed the training in the virtual world and seven subjects who completed e-learning training. Interpretative Phenomenological Analysis (IPA) was used for qualitative data analysis, leading to the identification of 14 themes within five major categories.  An overarching theme of the SL experience resulting from analysis was that of an expanded sense of possibilities.

Cooper, R, Winkler, SL, Schlesinger, M, Krueger, A, and Ludwig, A (2016), Expanded sense of possibilities: qualitative findings from a virtual self-management training for amputees, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 227–232, Los Angeles, California, USA, 20-22 Sept. 2016


Experimental pain reduction in two different virtual reality environments: a crossover study in healthy subjects, N Demeter, D Pud, N Josman, University of Haifa, ISRAEL

The literature on unique virtual reality (VR) attributes impacting pain reduction is scarce. This study investigated the effect of two VR environments, with differing cognitive load (CL) demands, on experimental pain levels. Sixty-two students underwent psychophysical thermal pain tests, followed by exposure to tonic heat stimulation under one of three conditions: low CLVR (LCL), high CLVR (HCL), and a control. Significantly greater pain reduction occurred during VR compared to the control condition. Cognitive components predicted pain reduction during HCL only. Cognitive load involved in VR may influence the extent of pain decrease, a finding that may improve treatment protocols and promote future research.

Demeter, N, Pud, D, and Josman, N (2016), Experimental pain reduction in two different virtual reality environments: A crossover study in healthy subjects, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 157–172, Los Angeles, California, USA, 20-22 Sept. 2016


Impact of combined cognitive and motor rehabilitation in a virtual reality task: an on-going longitudinal study in the chronic phase of stroke, A L Faria, J Couras, M S Cameirão, T Paulino, G M Costa, S Bermúdez i Badia, Universidade de Coimbra/Madeira Interactive Technologies Institute, Funchal/Centro Médico da Murtosa, Aveiro/Universidade da Madeira, Funchal, PORTUGAL

Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients' capability to live independently. Virtual Reality (VR) based methods for stroke rehabilitation have mainly focused on motor rehabilitation but there is increasing interest towards the integration of cognitive training for providing more effective solutions. In this work we present a VR cognitive and motor training task - the Reh@Task - and the preliminary results from an ongoing one-month longitudinal intervention. We show the results from twelve patients divided in two groups: experimental and control. Both groups were enrolled in conventional occupational therapy, which mostly involves motor training. Additionally, the experimental group performed a specific attention and memory training with the Reh@Task and the control group performed time-matched conventional occupational therapy. This VR-based task consists in performing adapted arm reaching movements and has difficulty progression levels implemented with guidelines from a participatory design study. We assessed the impact of both interventions post-treatment (4-5 weeks) and at 4 weeks follow-up through the Montreal Cognitive Assessment, Single Letter Cancellation, Digit Cancellation, Bells Test, Fugl-Meyer, Chedoke Arm and Hand Activity Inventory, Modified Ashworth Scale and Barthel Index. A within groups analysis revealed significant improvements with respect to baseline in the global cognitive functioning in both groups, but only the patients who used the Reh@Task improved significantly in attention and memory. With respect to the motor domain, the control group showed greater improvements. Nevertheless, both groups improved significantly in the functional recovery of the hand and arm scores, revealing that both interventions had an impact in the use of the hand and arm in the activities of daily living. Overall, results are supportive of the viability of tools that combine motor and cognitive training, such as the Reh@Task.

Faria, AL, Couras, J, Cameirão, MS, Paulino, T, Costa, GM, and Bermúdez i Badia, S (2016), Impact of combined cognitive and motor rehabilitation in a virtual reality task: an on-going longitudinal study in the chronic phase of stroke, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 11–19, Los Angeles, California, USA, 20-22 Sept. 2016


Current issues and challenges in research on virtual reality therapy for children with neurodisability, W J Farr, I Male, D Green, C Morris, H Gage, S Bailey, S Speller, V Colville, M Jackson, S Bremner, A Memon, Sussex Community NHS Foundation Trust, Brighton/Oxford Brookes University/University of Exeter/Sussex Community NHS Foundation Trust, Brighton/University of Surrey/Brighton and Sussex Medical School, Brighton, ENGLAND

issues and challenges in virtual reality therapy research in community health settings. Widespread variation within and between populations, e.g. co-morbid conditions, complicates treatment fidelity and applicability. Interventions require flexible dose and frequency to fit into children’s family circumstances, with clearly employed specialist paediatric research staff. Comparisons require adaptation to digital technology, and keep pace with development. Outcomes may overstate the impact of virtual reality therapy and technological novelty, while not fully unpacking hidden digital effects. A wide set of agreed, flexible, and patient-centred outcome measures are required to establish positive clinical baseline.

Farr, WJ, Male, I, Green, D, Morris, C, Gage, H, Bailey, S, Speller, S, Colville, V, Jackson, M, Bremner, S, and Memon, A (2016), Current issues and challenges in research on virtual reality therapy for children with neurodisability, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 41–48, Los Angeles, California, USA, 20-22 Sept. 2016


Computer model based audio and its influence on blind students’ learning about gas particle behavior, N Hagab, O Lahav, V Talis, Tel Aviv University, ISRAEL

This paper focuses on the need of students who are blind to access science curriculum learning materials. Net Logo is a widely used computational agent-based modelling language that enables exploring and constructing models of complex systems. The Listen-to-Complexity environment is based on the Net Logo and involves sonified feedback that was adapted to users who are blind. This study examines the scientific conceptual knowledge, systems reasoning, and Kinetic Molecular Theory of gas in chemistry that were learned as a result of interaction with the Listen-to-Complexity environment by people who are blind as shown in their answers to a pre- and post-test. Five participants who are blind volunteered to participate in this research. The preliminary findings are encouraging with regard to the sonified model’s efficacy in providing access to central and difficult scientific concepts, even when the target phenomenon is complex. The benefits of this longitudinal research are likely to have an impact on science education for students who are blind, supporting their inclusion in the K-12 academic curriculum on an equal basis with sighted users.

Hagab, N, Lahav, O, and Talis, V (2016), Computer model based audio and its influence on blind students’ learning about gas particle behavior, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 133–138, Los Angeles, California, USA, 20-22 Sept. 2016


Usability and performance of Leap Motion and Oculus Rift for upper arm virtual reality stroke rehabilitation, D E Holmes, D K Charles, P J Morrow, S McClean, S M McDonough, Ulster University, Coleraine/Jordanstown, UK

Intensified rehabilitation is important for stroke survivors but difficult to achieve due to limited access to physiotherapy. We present a virtual reality rehabilitation system, Target Acquiring Exercise (TAGER), designed to supplement center-based physiotherapy by providing engaging and personalized exercises. TAGER uses natural user interface devices, the Microsoft Kinect, Leap Motion and Myo armband, to track upper arm and body motion. Linear regression was applied to 3D user motion data using four popular forms of Fitts’s law and each approach evaluated. While all four forms of Fitt’s Law produced similar results and could model users effectively, it may be argued that a 3D tailored form provided the best fit. However, we propose that Fitts’s Law may be more suitable as the basis of a more complex model to profile user performance. Evaluated by healthy users TAGER proved effective, with important lessons learned which will inform future design.

Holmes, DE, Charles, DK, Morrow, PJ, McClean, S, and McDonough, SM (2016), Usability and performance of Leap Motion and Oculus Rift for upper arm virtual reality stroke rehabilitation, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 217–226, Los Angeles, California, USA, 20-22 Sept. 2016


Designing a location-aware augmented and alternative communication system to support people with language and speech disorders, M S Hossain, M Takanokura, K Nakashima, Kanagawa University, Yokohama, JAPAN

Working with those who have speech and language disorders can be a great challenge for researchers. Language difficulties can significantly affect a user’s ability to communicate with others. Our aim is to design an Augmentative and Alternative Communication (AAC) system based on current location for people with language disorders in order to support communication in their everyday life.  In this paper, we design a location based AAC system that provides a list of images that is able to assist in communication.

Hossain, MS, Takanokura, M, and Nakashima, K (2016), Designing a location-aware augmented and alternative communication system to support people with language and speech disorders, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 193–199, Los Angeles, California, USA, 20-22 Sept. 2016


Integrative virtual reality therapy produces lasting benefits for a young woman suffering from chronic pain and depression post cancer surgery: a case study, G House, G Burdea, N Grampurohit, K Polistico, D Roll, F Damiani, J Hundal, D Demesmin, Bright Cloud International Corp, Highland Park, NJ/Roosevelt Care Center, Edison, NJ/Hundal Neuropsychology Group, Watchung, NJ/University Pain Medicine Center, Summerset, NJ, USA

This case study was part of an evaluation of the BrightArm Duo Rehabilitation System for treating the effects of chronic upper body pain following breast cancer surgery.  The subject was a 22-year old woman with burning and stabbing pain in the right upper arm. Training consisted of playing custom bimanual 3D games while seated at the gravity-modulating robotic table for 16 sessions over 8 weeks.  Standardized assessments demonstrated a meaningful improvement in motor, cognitive and emotive domains with a statistically significant reduction in pain. Gains transferred to daily activities enabling the subject to resume full time employment, driving and socializing.

House, G, Burdea, G, Grampurohit, N, Polistico, K, Roll, D, Damiani, F, Hundal, J, and Demesmin, D (2016), Integrative virtual reality therapy produces lasting benefits for a young woman suffering from chronic pain and depression post cancer surgery: a case study, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 173–182, Los Angeles, California, USA, 20-22 Sept. 2016


Longitudinal study of integrative virtual rehabilitation for the maintenance of skilled nursing facility residents with chronic stroke, G House, G Burdea, N Grampurohit, K Polistico, D Roll, F Damiani, S Keeler, J Hundal, S Pollack, Bright Cloud International Corp, Highland Park, NJ/Roosevelt Care Center, Edison, NJ/JFK Hartwyck at Edison Estates, Edison, NJ/Hundal Neuropsychology Group, Watchung, NJ/Data Driven Innovation, Westhampton, NY, USA

The objective of this 45-week longitudinal controlled study was to examine the effects of integrative virtual rehabilitation with BrightArm Duo System for the maintenance of elderly skilled nursing facility residents with chronic stroke. The experimental group trained intensely for 8-weeks followed by 3 booster periods at 8-week intervals. The sessions were supervised by an occupational therapist. The control (n=3) and experimental (n=7) groups both received standard-of-care maintenance. The improvement for the experimental group was significantly better than the controls in standardized assessments of UE range of motion (p=0.04), strength, and function (p=0.035), and for cognition and emotion (p=0.0006)

House, G, Burdea, G, Grampurohit, N, Polistico, K, Roll, D, Damiani, F, Keeler, S, Hundal, J, and Pollack, S (2016), Longitudinal study of integrative virtual rehabilitation for the maintenance of skilled nursing facility residents with chronic stroke, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 21–29, Los Angeles, California, USA, 20-22 Sept. 2016


Choosing virtual and augmented reality hardware for virtual rehabilitation: process and considerations, S T Koenig, B S Lange, Katana Simulations Pty Ltd, Henley Beach South/Flinders University, Adelaide, AUSTRALIA

Virtual and Augmented Reality hardware has become much more affordable in the past three years, largely due to the availability of affordable sensors and smartphone displays as well as financial investments and buy-in through the entertainment industry. Many new consumer devices are becoming available to researchers, clinicians and software developers. With so many options available, planning a Virtual Rehabilitation project and selecting appropriate hardware components can be a challenge. This paper presents a stepwise selection process for Virtual and Augmented Reality hardware. The process is described through an example project and clinical and technical implications of each hardware choice are discussed.

Koenig, ST, and Lange, BS (2016), Choosing virtual and augmented reality hardware for virtual rehabilitation: process and considerations, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 209–215, Los Angeles, California, USA, 20-22 Sept. 2016


Does mixed reality influence texting while walking among younger and older adults?, T Krasovsky, P L Weiss, R Kizony, University of Haifa/Sheba Medical Center, Tel Hashomer, ISRAEL

Young and older adults have difficulties in performance of an additional task while walking (dual task). This feasibility study investigates the dual task costs of texting on a mobile phone and walking among young and older adults, as well as the potential of a mixed reality app, which projects the real world onto the background of the mobile display, to modify these costs. Seven young (age 26.4±4.5 years) and 7 older (age 69.9±3.9 years) adults were asked to walk while texting on a custom-written mobile android app (with and without mixed reality display), as well as to perform each task (walking, texting) separately. Preliminary results show that dual task interference of both tasks is similar in both groups. Using a mixed reality display does not modify these costs, but does affect the subjective experience of the groups differently. This may be due to different levels of familiarity with mobile phone use in the two groups. Additional data is currently being collected.

Krasovsky, T, Weiss, PL, and Kizony, R (2016), Does mixed reality influence texting while walking among younger and older adults?, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 183–191, Los Angeles, California, USA, 20-22 Sept. 2016


Competition improves attention and motivation after stroke, R Llorens, MD Navarro, E Noé, M Alcañiz, Universitat Politècnica de València/ Fundación Hospitales NISA, Valencia/Univesity of Jaume I, Castellón, SPAIN

Cognitive deficits are a common sequelae after stroke. Among them, attention impairments have the highest incidence and limit functional recovery and quality of life. Different strategies to improve attention have been presented through the years, even though its effectiveness is still unclear. Basing on the human competitive nature, competitive strategies have been proposed to increase motivation and intensity. However, this approach has been never applied to train attention after stroke. In this paper, we present a randomized controlled trial that evidences the important role of competition in cognitive functioning. Our results support that competitive strategies combining virtual reality-based and paper and pencil tasks can improve attention and motivation after stroke to a greater extent than non-competitive paper and pencil tasks.

Llorens, R, Navarro, MD, Noé, E, and Alcañiz, M (2016), Competition improves attention and motivation after stroke, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 31–39, Los Angeles, California, USA, 20-22 Sept. 2016


Differential effect of neutral and fear-stimulus virtual reality exposure on physiological indicators of anxiety in acrophobia, P Maron, V Powell, W Powell, University of Portsmouth, UK

This paper presents a study which explores the physiological and behavioural indicators of anxiety during exposure to a virtual reality environment. Using 10 participants (5 with acrophobia and 5 control) the study aimed to determine whether an increase in heart rate (HR) from baseline to VR exposure is a sufficient measure for effectiveness of a virtual reality exposure therapy (VRET) stimulus, or whether there is a mediating effect of neutral VR exposure which should be taken into account. The participants all explored an immersive cityscape at ground level and at height, and both subjective and objective measures of physiological arousal were recorded.   It was found that the VRET was successful in inducing an anxiety response in the participants with acrophobia, and moreover demonstrated that an increase in HR from baseline to VRET on its own should not be considered a reliable indicator of VRET efficacy, but that there should be an adjustment for the effect of neutral VR exposure on physiological arousal.

Maron, P, Powell, V, and Powell, W (2016), Differential effect of neutral and fear-stimulus virtual reality exposure on physiological indicators of anxiety in acrophobia, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 149–155, Los Angeles, California, USA, 20-22 Sept. 2016


Authenticating the subjective: a naturalistic case study of a high-usability electronic health record for virtual reality therapeutics, H J Moller, L Saynor, University of Toronto/OCAD University, Toronto/PRAXIS Holistic Health, Toronto, CANADA

Using data from our established Technology-Enhanced Multimodal Meditation (TEMM) stress-reduction program employing the electronic health record system Wellpad, we illustrate the value of developing a qualitative data-analysis approach to inform clinical practice in the rapidly emerging field of immersive therapeutics. In examining “rich data” of a naturalistic 50-patient TEMM cohort, point out that as with design of VR therapeutics, there is a highly salient role for immersive diagnostics, which ultimately relates to consumer satisfaction, both for patient and health-care practitioner.

Moller, HJ, and Saynor, L (2016), Authenticating the subjective: a naturalistic case study of a high-usability electronic health record for virtual reality therapeutics, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 107–112, Los Angeles, California, USA, 20-22 Sept. 2016


Laval Virtual Vision 2025 – blurring the lines between digital and physical worlds, M Pallot, S Richir, Arts et Metiers ParisTech/Laval Virtual, FRANCE

The recent evolution of immersive technologies, such as Virtual Reality (VR) and Augmented Reality (AR) as well as Mixed Reality (MR), leads to the emergence of new immersive experiences occurring in blended spaces constituted of both digital and physical worlds. This paper, based on the outcomes of the first edition of the Laval Virtual Seminar on Vision 2025, explores Immersive Virtual Environments (IVE), its related technologies, and more particularly addresses the potential increase of the immersion quality. It also discusses the main IVE elements and tries to foresee their key challenges and needs towards envisioned future developments.

Pallot, M, and Richir, S (2016), Laval Virtual Vision 2025: blurring the lines between digital and physical worlds, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 1–8, Los Angeles, California, USA, 20-22 Sept. 2016


Evaluating automated real time feedback and instructions during computerized mirror therapy for upper limb rehabilitation using augmented reflection technology, J Pinches, S Hoermann, University of Otago, Dunedin, NEW ZEALAND/University of Sydney, AUSTRALIA

The use of Virtual and Augmented Reality (VR/AR) in physical rehabilitation can provide better control, improved user motivation, and flexibility in how therapy is offered. Mirror therapy is a therapeutic intervention that has been shown to be beneficial for upper limb stroke rehabilitation. However it requires, in its clinical application, the constant presence and attention of a skilled therapist who provides instructions. This paper presents an AR mirror therapy system that provides automatic instructions and feedback. A within-subjects design user study with healthy volunteers was conducted to evaluate the usability (System Usability Scale), perceived suitability (Suitability Evaluation Questionnaire for Virtual Rehabilitation Systems), satisfaction (subset of Usability Satisfaction Questionnaire), general experience (Mixed Reality Experience Questionnaire) and participants’ performance and preference. We compared two conditions where the system automatically instructed the participants and (i) where the system additionally provided feedback, or (ii) the system did not provide feedback. All participants were able to complete the automated mirror therapy intervention. Participants significantly rated the usability and suitability of the automated intervention as positive. The comparisons between the two conditions on user experience and satisfaction indicated preferences for the feedback condition; however it was not statistically significant. In the direct comparison between systems, participants showed a strong and significant preference for the feedback condition. A few participants reported a mild level of discomfort attributed to the sitting position, exercises and placement of their hands on the table. With this study, further progress towards an automated system for the provision of mirror therapy was achieved and successfully evaluated with healthy participants. Preparations for clinical evaluations using this automated system with patients suffering from motor impairments after stroke can now commence.

Pinches, J, and Hoermann, S (2016), Evaluating automated real time feedback and instructions during computerized mirror therapy for upper limb rehabilitation using augmented reflection technology, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 241–249, Los Angeles, California, USA, 20-22 Sept. 2016


Influence of navigation interaction technique on perception and behaviour in mobile virtual reality, W Powell, V Powell, P Brown, M Cook, J Uddin, University of Portsmouth, UK

In recent years the development of affordable virtual reality has opened up enormous possibilities for virtual rehabilitation, and the introduction of ultra-low cost mobile VR such as Google Cardboard has real potential to put virtual rehabilitation right into patient's homes. However, the limited interaction possibilities when a mobile phone is mounted into a headset mean that these devices are generally used for little more than passive viewing. In this paper we present an evaluation of three approaches to supporting navigation in mobile VR, and discuss some of the potential hazards and limitations.

Powell, W, Powell, V, Brown, P, Cook, M, and Uddin, J (2016), Influence of navigation interaction technique on perception and behaviour in mobile virtual reality, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 73–81, Los Angeles, California, USA, 20-22 Sept. 2016


Home based virtual rehabilitation for upper extremity functional recovery post-stroke, Q Qiu, A Cronce, G Fluet, J Patel, A Merians, S Adamovich, Rutgers University/New Jersey Institute of Technology, University Heights, Newark, NJ, USA

After stroke, sustained hand rehabilitation training is required for continuous improvement and maintenance of distal function. An ideal home-based telerehabilitation system has to be low cost, easy to set up, effective in motivating the user to use it every day, generate progress reports to the user for self-tracking, and provide daily monitoring to remote clinicians. In this paper, we present a system designed and implemented in our lab; the NJIT Home-based Virtual Rehabilitation System (NJIT HoVRS).  A single subject proof of concept study was conducted and demonstrated that this system is easy to access and effective in motivating subjects to train at home.

Qiu, Q, Cronce, A, Fluet, G, Patel, J, Merians, A, and Adamovich, S (2016), Home based virtual rehabilitation for upper extremity functional recovery post-stroke, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 259–265, Los Angeles, California, USA, 20-22 Sept. 2016


Clinical interviewing by a virtual human agent with automatic behavior analysis, A A Rizzo, G Lucas, J Gratch, G Stratou, L-P Morency, R Shilling, A Hartholt, S Scherer, Institute for Creative Technologies, University of Southern California, USA

SimSensei is a Virtual Human (VH) interviewing platform that uses off-the-shelf sensors (i.e., webcams, Microsoft Kinect and a microphone) to capture and interpret real-time audiovisual behavioral signals from users interacting with the VH system. The system was specifically designed for clinical interviewing and health care support by providing a face-to-face interaction between a user and a VH that can automatically react to the inferred state of the user through analysis of behavioral signals gleaned from the user’s facial expressions, body gestures and vocal parameters. Akin to how non-verbal behavioral signals have an impact on human-to-human interaction and communication, SimSensei aims to capture and infer user state from signals generated from user non-verbal communication to improve engagement between a VH and a user and to quantify user state from the data captured across a 20 minute interview. As well, previous research with SimSensei indicates that users engaging with this automated system, have less fear of evaluation and self-disclose more personal information compare to when they believe the VH agent is actually an avatar being operated by a “wizard of oz” human-in-the-loop (Lucas et al., 2014). The current study presents results from a sample of military service members (SMs) who were interviewed within the SimSensei system before and after a deployment to Afghanistan. Results indicate that SMs reveal more PTSD symptoms to the SimSensei VH agent than they self-report on the Post Deployment Health Assessment. Pre/Post deployment facial expression analysis indicated more sad expressions and fewer happy expressions at post deployment.

Rizzo, AA, Lucas, G, Gratch, J, Stratou, G, Morency, L-P, Shilling, R, Hartholt, A, and Scherer, S (2016), Clinical interviewing by a virtual human agent with automatic behavior analysis, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 57–63, Los Angeles, California, USA, 20-22 Sept. 2016


Bringing the client and therapist together in virtual reality telepresence exposure therapy, D J Roberts, A J Fairchild, S Campion, A S Garcia, R Wolff, University of Salford, Salford, UK

We present a technology demonstrator of the potential utility of our telepresence approach to supporting tele-therapy, in which client and remote therapist are immersed together. The aim is to demonstrate an approach in which a wide range of non-verbal communication between client and therapist can be contextualised within a shared simulation, even when the therapist is in the clinic and the client at home. The ultimate goal of the approach is to help the therapist to encourage the client to face a simulated threat while keeping them grounded in the safety of the present. The approach is to allow them to use non-verbal communication grounded in both the experience of the exposure and the current surroundings. While this is not new to exposure therapy, the challenges are: 1) to do this not only when the threat is simulated; and 2) when the client and therapist are apart. The technology approach combines immersive collaborative visualisation with free viewpoint 3D video based telepresence. The potential impact is to reduce dropout rate of exposure therapy for resistant clients.

Roberts, DJ, Fairchild, AJ, Campion, S, Garcia, AS, and Wolff, R (2016), Bringing the client and therapist together in virtual reality telepresence exposure therapy, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 157–163, Los Angeles, California, USA, 20-22 Sept. 2016


Remote communication, examination and training in stroke, Parkinson´s and COPD care: work in progress testing 3D camera and movement recognition technologies together with new patient centered ICT services, M Rydmark, J Broeren, J Jalminger, L-Å Johansson, M Johanson, A Ridderstolpe, The Sahlgrenska Academy, University of Gothenburg/Alkit Communications, Mölndal, SWEDEN

This paper describes strategy and work in progress. The combination of patient centered care where many care and nursing units are collaborating with focus on, and in concordance with the patient, the ability to project information focused on the patient total situation and needs independent where the information was created, the ability to use sensor technology to collect a wide range of aspects of the individuals health situation, the ability to use sensor technology to assess movements both for assessment and intervention purposes, to keep the care and nursing process together through module based information services and a structured care plan containing goals, sub goals, defined activity types and a wide range of health status data involve great opportunities for patients having chronic diseases. This group of patients causes extensive resource consumption for society. Well-structured data and semantic definition of data is a key for the ability to communication between different types of multi-professionals actors with different background. New technology like a wide range of sensor types allows the possibly to catch large amounts of data both for assessment and intervention purposes in a continuous way over time. One example is how each planned patient activity has been performed and resulting health status aspects. This research group has worked on these issues for several years and some important milestones have been reached. From a chronic point of view three groups of patients are focused: stroke patients, COPD patients and patients with Parkinson’s disease. Collaboration approaches, communication technology and adapted information services allow new ways to perform home based care. Integrated monitoring services of planned activities like motion activities using 3D sensors allows professionals and patient to in an exact way follow planned and executed motion activities which is of great importance to many patient needs.

Rydmark, M Broeren, J, Jalminger, J, Johansson, L-Å, Johanson, M, and Ridderstolpe, A (2016), Remote communication, examination and training in stroke, Parkinson´s and COPD care: work in progress testing 3D camera and movement recognition technologies together with new patient centered ICT services, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 101–106, Los Angeles, California, USA, 20-22 Sept. 2016


Visual impairment simulator for auditing and design, G Stewart, R J McCrindle, University of Reading, UK

Individuals within the visually impaired community often have difficulty navigating environments due to the different ways in which they view the world, with even apparently simplistic locations frequently being challenging to traverse. It is therefore important when designing architecture or environments, to take into account the perspectives of people with visual impairments in order to ensure that design outcomes are inclusive and accessible for all. Although there is documentation regarding guidance and procedures for design of inclusive spaces; architects, designers, and accessibility auditors often find it hard to empathize with visually impaired people. This project aims to make the process of inclusive design easier through the development of a mobile app, VISAD (Visual Impairment Simulator for Auditing and Design), which enables users to capture images or import CAD designs and apply image distortion techniques in order to replicate different visual impairments.

Stewart, G, and McCrindle, RJ (2016), Visual impairment simulator for auditing and design, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 139–148, Los Angeles, California, USA, 20-22 Sept. 2016


Comparison of functional benefits of self-management training for amputees under virtual world and e-learning conditions, S L Winkler, J A Kairalla, R Cooper, I Gaunaurd, M Schlesinger, A Krueger, A Ludwig, James A Haley VA Hospital, Tampa, FL/University of Florida, Gainesville/Nova Southeastern University, Fort Lauderdale, FL/Miami VA Medical Center, FL/Virtual Ability, Inc., Aurora, CO, USA

Amputation is a life-long condition. Throughout their lifespan, amputees will need health, wellness and prosthetic-related information. This project used a randomized design to compare two methods of disseminating an evidence-based self-management intervention: avatar-based virtual world and e-learning environments. Of the 57 subjects randomized, 37 (65%) completed the study.  The virtual world group had a significantly higher drop-out rate than the e-learning group. Both groups marginally improved on self-efficacy, perceived social support, pain interference, and functional status outcomes with no significant results found between the groups.

Winkler, SL, Kairalla, JA, Cooper, R, Gaunaurd, I, Schlesinger, M, Krueger, A, and Ludwig, A (2016), Comparison of functional benefits of self-management training for amputees under virtual world and e-learning conditions, Proc. 11th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, PM Sharkey, AA Rizzo (Eds), pp. 201–208, Los Angeles, California, USA, 20-22 Sept. 2016

 

 

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