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2012 Full Papers ~ Abstracts and Papers

Abstracts are listed in alphabetical order, based on first author. Click links below each paper to view publication.


Link to Short Papers

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Development of an augmented treadmill for the rehabilitation of children with cerebral palsy: pilot perspectives from young healthy adult users, M Al-Amri, D Abásolo, S Ghoussayni, D Ewins, University of Surrey, Guildford/ Queen Mary’s Hospital, Roehampton, London, UK

A Real-time Treadmill Speed Control Algorithm (RTSCA) has been developed for gait rehabilitation of children with cerebral palsy (CP). The objective of the work described in this paper was to investigate the feasibility of the RTSCA prior to use by children with CP. Thirteen healthy subjects aged between 19 and 25 were recruited to walk on the treadmill using conventional speed buttons without the virtual reality (VR) environment, and the RTSCA with and without VR. The participants were asked to undertake three treadmill tests and to complete a questionnaire to provide feedback on the control of the treadmill. The descriptive results show that for 10 participants changing walking speed from stationary when using the RTSCA was similar or more comfortable to using conventional treadmill speed control buttons. For those who found it less comfortable the core issue was insufficient time to practise with the system. All the participants were satisfied with the safety and the performance of the RTSCA when incorporated into the VR scenario. A Wilcoxon test was conducted to examine whether there was a significant difference between walking speeds on the treadmill when using the conventional speed buttons and the RTSCA. The results showed that participants walked at significantly higher speeds when using the RTSCA. This may suggest that they walked more naturally or confidently on the treadmill when using the RTSCA as compared to the use of conventional treadmill speed control buttons.

M Al-Amri, D Abásolo, S Ghoussayni, D Ewins, Development of an augmented treadmill for the rehabilitation of children with cerebral palsy: pilot perspectives from young healthy adult users, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 77-85, Laval, France, 10 - 12 Sept. 2012.


Augmented reality improves myoelectric prosthesis training, F Anderson, W F Bischof, University of Alberta, CANADA

This paper presents the ARM Trainer, a new augmented reality-based system that can be used to train amputees in the use of myoelectric prostheses. The ARM Trainer provides users with a natural and intuitive method to develop the muscles used to control a myoelectric prosthetic. In addition to improving the training process, the new interface has the potential to mitigate psychological issues arising from amputation that are not addressed by existing approaches (e.g., self-image, phantom limb pain). We conducted an empirical study comparing our system to an existing commercial solution (Myoboy) and found the ARM Trainer to be superior along a number of subjective dimensions (enjoyment, perceived effort, competency, and pressure). We also found no significant difference in terms of muscle control development between the two systems. This study shows the potential of augmented reality-based training systems for myoelectric prostheses.

F Anderson, W F Bischof, Augmented reality improves myoelectric prosthesis training, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 69-76, Laval, France, 10 - 12 Sept. 2012.


User perspectives on multi-touch tabletop therapy, M Annett, F Anderson, W F Bischof, University of Alberta, CANADA

Technology-based activities are becoming increasingly popular in therapy programs. In particular, multi-touch tabletops seem to be well suited for many therapy activities. To better understand the benefits of using multi-touch tabletops during rehabilitation, we examined users’ attitudes towards rehabilitation activities on a multi-touch tabletop and on a non-interactive surface. Using a standardized questionnaire and semi-structured interviews, we identified many advantages and limitations of using multi-touch tabletops in rehabilitation. We discuss the implications of user expectations and experiences on the design of future activities.

M Annett, F Anderson, W F Bischof, User perspectives on multi-touch tabletop therapy, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 255-260, Laval, France, 10 - 12 Sept. 2012.


Combining virtual reality and a myo-electric limb orthosis to restore active movement after stroke: a pilot study, S Bermúdez i Badia, E Lewis, S Bleakley, Universidade da Madeira, Funchal, PORTUGAL/Myomo Inc., Cambridge, MA/University of Pittsburgh, PA, USA

We introduce a novel rehabilitation technology for upper limb rehabilitation after stroke that combines a virtual reality training paradigm with a myo-electric robotic limb orthosis. Our rehabilitation system is based on clinical guidelines and is designed to recruit specific motor networks to promote neuronal reorganization. The main hypothesis is that the restoration of active movement facilitates the full engagement of motor control networks during motor training. By using a robotic limb orthosis, we are able to restore active arm movement in severely affected stroke patients. In a pilot study, we have successfully deployed and evaluated our system with 3 chronic stroke patients by means of behavioral data and self-report questionnaires. The results show that our system is able to restore up to 60% of the active movement capacity of patients. Further, we show that we can assess the specific contribution of the biceps/triceps movement of the paretic arm to the virtual reality bilateral training task. Questionnaire data show enjoyment and acceptance of the proposed rehabilitation system and its VR training task.

S Bermúdez i Badia, E Lewis, S Bleakley, Combining virtual reality and a myo-electric limb orthosis to restore active movement after stroke: a pilot study, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 187-193, Laval, France, 10 - 12 Sept. 2012.


What are the current limits of the Kinect™ sensor?, B Bonnechère, B Jansen, P Salvia, H Bouzahouene, L Omelina, J Cornelis, M Rooze, S Van Sint Jan, Université Libre de Bruxelles/Vrije Universiteit Brussel/ Interdisciplinary Institute for Broadband Technology, Ghent, BELGIUM

The Kinect sensor offers new perspectives for the development and application of affordable, portable and easy-to-use markerless motion capture (MMC) technology. However, at the moment, accuracy of this device is still not known. In this study we compare results from Kinect (MMC) with those of a stereophotogrammetric system (marker based system [MBS]). 27 subjects performed a deep squatting motion. Parameters studied were segments lengths and joint angles. Results varied significantly depending on the joint or segment analysed. For segment length MMC shows poor results when subjects were performing movement. Differences were also found concerning joint angles, but regression equations were computed for each joint that produced the same results for MMC and MBS after correction.

B Bonnechère, B Jansen, P Salvia, H Bouzahouene, L Omelina, J Cornelis, M Rooze, S Van Sint Jan, What are the current limits of the Kinect™ sensor?, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 287-294, Laval, France, 10 - 12 Sept. 2012.


When sighted people are in the skin of visually impaired ones: perception and actions in virtual reality situation, Y Boumenir, A Kadri, N Suire, C Mury, E Klinger, Arts et Métiers ParisTech, Angers-Laval/Institut pour malvoyants des Hauts Thébaudières, Vertou, FRANCE

Most of us do not know how a visually impaired person perceives and acts within the environment in everyday life. In this context, an experimental study was conducted using a virtual reality simulation in which sighted people were immersed in low vision situations: Blurred vision, Tunnel vision, central Scotoma. After a brief familiarization procedure with a virtual reality tool called “SENSIVISE” which includes a virtual apartment, 24 adults had to explore two rooms through low vision simulation or full vision (as control group) to identify their location, and then were instructed to find particular targets. Perception and actions performances were measured in terms of time needed to answer questions related to visual perception, and distances between the participants’ body and the screen. The results show that low vision simulation impairs perception among sighted people. It was expressed by a statistically significant effect of lower times needed to execute tasks compared to the control condition. Consequently, the sighted individuals realized how it is difficult to perceive and move when vision is limited.

Y Boumenir, A Kadri, N Suire, C Mury, E Klinger, When sighted people are in the skin of visually impaired ones: perception and actions in virtual reality situation, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 111-119, Laval, France, 10 - 12 Sept. 2012.


Information and communication technology – a person-centered approach to stroke care, J Broeren, J Jalminger, L-Å Johansson, A Parmerud, L Pareto, M Rydmark, Sahlgrenska University Hospital, Västra Götaland County/ Alkit Communications, Mölndal/University West, Trollhättan/University University of Gothenburg, SWEDEN

This report describes the possibilities of information and communication technology (ICT) in stroke care, addressing a person-centered care (PCC) approach. Attention is paid to user involvement, design, videogames, and communication between health care professionals mutually as well as with patients, and how to share performance data with an electronic health record. This is the first step towards a supportive ICT system that facilitates interoperability, making healthcare information and services available to citizen’s across organizational boundaries. 

J Broeren, J Jalminger, L-Å Johansson, A Parmerud, L Pareto, M Rydmark, Information and communication technology – a person-centered approach to stroke care, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 329-335, Laval, France, 10 - 12 Sept. 2012.


Camera-based software as a significant tool in rehabilitation/therapy intervention, A L Brooks, Aalborg University, Esbjerg, DENMARK

Use of an affordable, easily adaptable, ‘non-specific camera-based software’ that is rarely used in the field of rehabilitation is reported in a study with 91 participants over the duration of six workshop sessions. ‘Non-specific camera-based software’ refers to software that is not dependent on specific hardware. Adaptable means that human tracking and created artefact interaction in the camera field of view is relatively easily changed as one desires via a user-friendly GUI. The significance of having both available for contemporary intervention is argued. Conclusions are that the mature, robust, and accessible software EyeCon is a potent and significant tool in the field of rehabilitation/therapy and warrants wider exploration.

A L Brooks, Camera-based software as a significant tool in rehabilitation/therapy intervention, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 311-316, Laval, France, 10 - 12 Sept. 2012.


Second-hand masculinity: do boys with intellectual disabilities use computer games as part of gender practice?, D Charnock, P J Standen, University of Nottingham, UK

The process of gendered practice in the pursuit of masculine identity is complex with many obstacles and hegemonic forms to negotiate on the journey.  Add to this the multifaceted and diverse nature of intellectual disability (ID) and the opportunity for normalised gendered practice is further complicated.  Focused on the talk of boys with ID, this paper offers an account of the development of ideas about masculinity to show how gaming may offer a space for gendered practice not available in other areas of the boys’ lives.  The paper tentatively argues that gaming may offer an opportunity for the boys and those working with them to explore gendered practice safely to facilitate the construction of their identities as men and to challenge problematic images of the hyper-masculine ideal found in these games.

D Charnock, P J Standen, Second-hand masculinity: do boys with intellectual disabilities use computer games as part of gender practice?, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 337-344, Laval, France, 10 - 12 Sept. 2012.


Study of the impact of added contextual stimuli on the performance in a complex virtual task among patients with brain injury and controls, H Cherni, P-A Joseph, E Klinger, Arts Métiers ParisTech, Angers-Laval/ EA4136, Bordeaux, FRANCE

During the last years, researchers showed the feasibility and the interest of using Virtual Reality (VR) among patients with cognitive impairments for the recovery of capacities. While interacting, the VR system provides various kinds of information for different purposes: display of the virtual environment, understanding of the task, but also highlighting of functionalities or delivery of instructions. Generally, in order to improve the patient performance, additional cues are provided to enhance information saliency, such as arrows, change of colors. We define a “contextual Additional Software Stimulus” (contextual ASS) as any additional information delivered by the virtual system, related to the interaction whose absence in the virtual environment does not have an effect on the unfolding of the task. This work was designed to study the effects of contextual ASS on the performance in a daily living simulated task: purchasing items in the Virtual Action Planning Supermarket (The VAP-S). In this purpose, we started by implementing ASS in the VAP-S then we carried out experiments in which 23 healthy subjects (12 M and 11F) and 12 patients with brain injury (12 M) took part. Results show that the deliverance of contextual ASS during the virtual task improves significantly some parameters describing the performance of healthy subject and patients with brain injury.

H Cherni, P-A Joseph, E Klinger, Study of the impact of added contextual stimuli on the performance in a complex virtual task among patients with brain injury and controls, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 379-384, Laval, France, 10 - 12 Sept. 2012.


So much technology, so little time: factors affecting use of computer-based brain training games for cognitive rehabilitation following stroke, B B Connor, P J Standen, Sierra Nevada Memorial Hospital, Grass Valley, CA, USA/University of Nottingham, UK

Rehabilitation following stroke typically focuses on regaining use of the affected lower and upper limbs. Impairment of cognitive processes, however, is predictive of rehabilitation outcomes. Stroke survivors and their caregivers report difficulty finding time to practice gait and upper limb training at home due to the time demands of routine activities of daily living (ADL), leaving little time for cognitive retraining. Cognitive activities have become more readily accessible to the home user through web-based games that engage brain functions often disrupted by stroke. With neuropsychological testing, it is possible to “prescribe” brain training that targets the specific cognitive functions disrupted by an individual’s acquired brain injury. We asked if computer-based braining training were made available in-home at no cost, would stroke survivors complete the training? Five stroke survivors participated, none completed the recommended 40 training sessions. Interviews with participants and caregivers reveal barriers to training including physical and cognitive limitations, as well as time and fatigue management. Training also showed effects on ADLs and mood.

B B Connor, P J Standen, So much technology, so little time: factors affecting use of computer-based brain training games for cognitive rehabilitation following stroke, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 53-59, Laval, France, 10 - 12 Sept. 2012.


Metabolic response to virtual reality augmented cycling training, J E Deutsch, M J Myslinski, R Ranky, M Sivak, C Mavroidis, J A Lewis, University of Medicine and Dentistry of New Jersey/Northeastern University, Boston, MA/VRehab, USA

A virtual reality (VR) augmented cycling system was developed to address motor control and fitness deficits. In this paper we report on the use of the system to train fitness for individuals (N=4) in the chronic phase post-stroke who were limited community ambulators. Fitness was evaluated using a sub-maximal bicycle ergometer test before and after training. There was a statistically significant 13%  (p = .035) improvement in VO2 (with a range of 6-24.5 %).  For these individuals, VR augmented cycling, using their heartrate to set the avatar’s speed, fostered training of sufficient duration and intensity to promote fitness.

J E Deutsch, M J Myslinski, R Ranky, M Sivak, C Mavroidis, J A Lewis, Metabolic response to virtual reality augmented cycling training, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 97-102, Laval, France, 10 - 12 Sept. 2012.


Robotic/virtual reality intervention program individualized to meet the specific sensorimotor impairments of an individual patient: a case study, G G Fluet, A S Merians,  Q Qiu, S Saleh, V Ruano, A R Delmonico, S V Adamovich, University of Medicine & Dentistry of New Jersey/New Jersey Institute of Technology, NJ, USA

A majority of studies examining repetitive task practice facilitated by robots for the treatment of upper extremity paresis utilize standardized protocols applied to large groups. Others utilize interventions tailored to subjects but don’t describe the clinical decision making process utilized to develop and modify interventions. This study will describe a virtually simulated, robot-based intervention customized to match the goals and clinical presentation of a gentleman with upper extremity hemiparesis secondary to stroke. MP, the subject of this case, is an 85 year-old man with left hemiparesis secondary to an intracerebral hemorrhage five years prior to examination. Outcomes were measured before and after a one month period of home therapy and after a one month virtually simulated, robotic intervention. The intervention was designed to address specific impairments identified during his PT examination. When necessary, activities were modified based on MP’s response to his first week of treatment. MP’s home training program produced a 3 second decline in Wolf Motor Function Test (WMFT) time and a 5 second improvement in Jebsen Test of Hand Function (JTHF) time. He demonstrated an additional 35 second improvement in JTHF and an additional 44 second improvement in WMFT subsequent to the robotic training intervention.  24 hour activity measurement and the Hand and Activities of Daily Living scales of the Stroke Impact Scale improved following the robotic intervention Based on his responses to training we feel that we have established that, a customized program of virtually simulated, robotically facilitated rehabilitation was feasible and resulted in larger improvements than an intensive home training program in several measurements of upper extremity function in our  patient with chronic hemiparesis.

G G Fluet, A S Merians,  Q Qiu, S Saleh, V Ruano, A R Delmonico, S V Adamovich, Robotic/virtual reality intervention program individualized to meet the specific sensorimotor impairments of an individual patient: a case study, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 17-24, Laval, France, 10 - 12 Sept. 2012.


Virtual exercises to promote cognitive recovery in stroke patients: the comparison between head mounted displays versus screen exposure methods, P Gamito, J Oliveira, N Santos, J Pacheco, D Morais, T Saraiva, F Soares, C SottoMayor, A F Barata, CEPCA/ULHT, Lisbon/Alcoitão Hospital, Alcabideche, PORTUGAL

Stroke can be considered as a major cause of death and the consequences are associated with different syndromes of the impaired physical, cognitive, behavioral and emotional domains. The cognitive rehabilitation is often related to improvement on executive functioning through repeated and systematic training in memory and attention exercises, in which virtual reality has proven to be a valid approach. Several devices have been used as visual outputs. Head mounted displays (HMD) and desktop screens displays are amongst them. HMD is usually perceived has being more immersive than screens. However, it presents several shortcomings if a widespread use is the objective. In this way, this study aims at assessing the prospect of opting for screen displays as an alternative to HMD within virtual reality (VR) based applications to rehabilitate memory and attention impairments in stroke patients. A sample of 17 patients with memory and attention deficits resulting from stroke were recruited from the hospital Centro de Medicina da Reabilitação do Alcoitão. The patients were randomly assigned to two different groups: (1) HMD based VR; and (2) desktop screen based VR. The patients in the experimental groups underwent a virtual reality (VR) training programme with 12 sessions regarding memory and attention exercises. These patients were assessed before and after the VR training sessionswith the Wechsler Memory Scale for memory and the Toulouse Pieron for attention functioning. The results showed increased working memory and sustained attention from initial to final assessment regardless of the VR device used. These data may suggest better functional independence following VR-based intervention and support the use of non-expensive displays as an alternative to high-end setups commonly used in VR applications devised for rehabilitation purposes.

P Gamito, J Oliveira, N Santos, J Pacheco, D Morais, T Saraiva, F Soares, C SottoMayor, A F Barata, Virtual exercises to promote cognitive recovery in stroke patients: the comparison between head mounted displays versus screen exposure methods, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 361-367, Laval, France, 10 - 12 Sept. 2012.


Assessing prospective memory in young healthy adults using virtual reality, J Gonneaud, P Piolino, G Lecouvey, S Madeleine, E Orriols, P Fleury, F Eustache, B Desgranges, Université de Caen Basse Normandie/Université Paris Descartes, FRANCE 

Virtual Reality (VR) is a very relevant tool for the study of complex cognitive functions, such as Prospective Memory (PM; remember to execute an intention at an appropriate time in the future). Thirty-five young subjects performed a PM task while immersed in a virtual city. On a theoretical level, we reached a better characterisation of PM functioning, notably regarding the influence of the link between the “when” and “what” components of PM on performance in event- and time-based PM tasks. This work validates utility of VR in PM assessment and opens perspectives in evaluation and rehabilitation of PM deficits.

J Gonneaud, P Piolino, G Lecouvey, S Madeleine, E Orriols, P Fleury, F Eustache, B Desgranges, Assessing prospective memory in young healthy adults using virtual reality, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 211-218, Laval, France, 10 - 12 Sept. 2012.


Rehabilitation tools along the reality continuum: from mock-up to virtual interactive shopping to a living lab, S Y Hadad, J Fung, P L Weiss, C Perez, B Mazer, M F Levin, R Kizony, University of Haifa/Sheba Medical Center, Tel Hashomer, ISRAEL/McGill University, Montreal/Jewish Rehabilitation Hospital, Laval, Quebec, CANADA

The purpose of this study was to compare shopping performance using the 4-item test, between three types of environments; a real environment (small, in-hospital “cafeteria”), a store mock-up (physical simulation) and a virtual environment (Virtual Interactive Shopper-VIS), in a post-stroke group compared to a control group. To date, 5 people with stroke and 6 controls participated in the study. Participants performed the original 4-item test (“buy” 4 items) in the VIS and the store mock-up as well as a modified 4-item test (“buy” 4 items with budget constraints) in all three environments. Results were analyzed descriptively and findings to date, indicate that the post-stroke group performed more slowly than the control group. In addition, in both groups, the time to complete the test within the VIS was longer than in the store mock-up and the cafeteria. Performance in the VIS, the store mock-up and the cafeteria were correlated in the post-stroke group. Finally, participants’ responses to their experience in the VIS were positive. The preliminary results of this small sample show that the test within the VIS is complex and realistic and may be used to assess and train the higher cognitive abilities required for shopping.

S Y Hadad, J Fung, P L Weiss, C Perez, B Mazer, M F Levin, R Kizony, Rehabilitation tools along the reality continuum: from mock-up to virtual interactive shopping to a living lab, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 47-52, Laval, France, 10 - 12 Sept. 2012.


Augmented reflection technology for stroke rehabilitation – a clinical feasibility study, S Hoermann, L Hale, S J Winser, H Regenbrecht, University of Otago, Dunedin, NEW ZEALAND

This paper presents a clinical feasibility study of a novel Augmented Reflection Technology system, called TheraMem. The feasibility of the system for physical rehabilitation of the upper limb and the potential to improve motor impairments following stroke were evaluated. Five patients participated in a total of 20 sessions of upper limb training with the system. Tailored support for patients performing the exercises was provided based on the severity and level of their impairment. Various configurations of the system were evaluated and adjusted to best match the patient’s preferences as well as the therapeutic requirements. We found that all patients were able to successfully participate and complete the TheraMem intervention. Patients’ engagement and motivation was high over the course of the therapy sessions.

S Hoermann, L Hale, S J Winser, H Regenbrecht, Augmented reflection technology for stroke rehabilitation – a clinical feasibility study, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 317-322, Laval, France, 10 - 12 Sept. 2012.


Development of the system for continuous medical rehabilitation for patients with post-stroke and spinal cord injury motor disorders, O A Jafarova, E A Tarasov, R Yu Guk, M B Shtark, Russian Academy of Medical Sciences, Novosibirsk/Siberian Clinical Center FMBA, Krasnoyarsk, RUSSIA

This paper describes an experience of developing a computer system for continuous medical rehabilitation involving patients with post-stroke and spinal cord injury motor disorders. Particular focus is made on the concept of telerehabilitation for this specific group of patients. Telerehabilitation has to be continuous and regular. It is also necessary to provide the possibility of conducting treatment/communication sessions asynchronously. The empirical results of four year implementation of this system in Russia showed high efficiency and revealed some limitations of a distant network rehabilitation program based on electromyographic biofeedback.

O A Jafarova, E A Tarasov, R Yu Guk, M B Shtark, Development of the system for continuous medical rehabilitation for patients with post-stroke and spinal cord injury motor disorders, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 385-392, Laval, France, 10 - 12 Sept. 2012.


Virtual reality for cognitive rehabilitation: from new use of computers to better knowledge of brain black box?, P-A Joseph, J-M Mazaux, E Sorita, University of Bordeaux, FRANCE

Virtual reality based technologies are one of the emerging tools that appear to have great potential for use in cognitive rehabilitation but it stills unclear how brain capacities are involved and what is the best way for such training. At first, virtual reality was mainly used in single user virtual environments, but social interaction should also be addressed using collaborative virtual environments (CVE). In a CVE, multiple users can interact and collaborate with each other, solve complex tasks and learn with each other. Regarding to impact of behavioral disturbances in family burden and social reentry, such tools need to have larger use in next years.

Quantitative aspects are encouraging as some improvement had been shown after few training sessions. Home retraining or telerehabilitation based on VR may bridge the gap between lack of specialized resources and growing number of patients. Qualitative design of VR tools is more questionable. Choice of errorless or errorfull designs may depend of severity of disturbances. Most VR tools emphasize the explicit component of task, even procedural aspects are a main strength of VR retraining programs. VR and augmented reality tools give various stimuli and indicators but their best modalities stay unclear, as most data are coming from educational in normal subjects more than rehabilitation studies in brain injured patients. Specific research studies to explore impact of sensorial transmodal effects and emotional involvement in VR tasks are requested. Rehabilitation protocols utilizing virtual environments are moving from single applications to cognitive impairment (i.e. alert, memory, neglect, language, executive functions) to comprehensive rehabilitation programs with the aim of efficient improvement in autonomy and transfer of benefits in real life conditions. A core issue that presents challenges to rehabilitation is decreased ability of persons with brain injury to transfer learning from one situation or context to another. The multicontext approach to cognitive rehabilitation proposes treatment methods for teaching use of strategies across a wide range of meaningful activities to promote generalization and enhance functional performance.

VR offers a very promising and exciting support for cognitive rehabilitation but we have to move from mimicking “in room” or desk rehabilitation practice to specific VR programs to maximize benefits and to get optimal improvement in cognitive and behavioral autonomy of patients.

P-A Joseph, J-M Mazaux, E Sorita,Virtual reality for cognitive rehabilitation: from new use of computers to better knowledge of brain black box?, Keynote Address, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 1-8, Laval, France, 10 - 12 Sept. 2012.


Dynamic spatial positioning system based on sounds and augmented reality for visually impaired people, C Kirner, C S Cerqueira, T G Kirner, Federal University of Itajubá/National Institute for Space Research, São Paulo, BRAZIL

This paper presents an application which intends to exercise spatial association of a three dimensional stimulus with its corresponding motor feedback, inspired on the Ping Pong Game. The application uses a low cost and easily built artifact, enhanced with an augmented reality layer provided by a free authoring tool. The augmented reality resources empower the artifact with sound feedback, so visually impaired people can use it. Besides, the visual feedback can be useful for non-visually impaired people and also for therapists, who can prepare exercises, promoting a therapeutic application and involving social inclusion capabilities.

C Kirner, C S Cerqueira, T G Kirner, Dynamic spatial positioning system based on sounds and augmented reality for visually impaired people, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 121-129, Laval, France, 10 - 12 Sept. 2012.


Measuring the effect of affective stimuli on autonomic responses and task performance in a virtual environment by children with and without cerebral palsy, S Kirshner, P L Weiss, E Tirosh, University of Haifa/Technion- Israel Institute of Technology/The Child Development Center, Bnai-Zion Medical Center, Haifa, ISRAEL

This study examined whether a functional virtual environment (VE) may be used to provide affective stimuli (AS) that lead to changes in the emotional responses and task performance of children with and without cerebral palsy (CP). Fifteen children with CP and 19 typically developing (TD) peers (6 to 12 years) prepared seven virtual meals in a predefined order within a virtual meal-making VE, referred to as the Emotional Meal-Maker (EMM), run on a 2D video capture VR platform. During each of six meals either a negative, positive, or neutral visual stimulus, selected from the International Affective Picture System (IAPS), was displayed. Heart rate (HR) and skin conductance (SCR) were recorded online in synchrony with stimulus onset. These variables were also recorded when the children passively viewed the same sequence of affective pictures displayed onscreen while rating their valence and arousal levels. Autonomic responses were calculated as the amount of change in the autonomic variables compared to baseline. Correlations between behavioural characteristics (i.e., trait and state anxiety) with both autonomic responses and task performance were also calculated. Significant differences were found between groups in task performance and heart rate variability (HRV) components, i.e., a higher “low frequency” (LF) to “high frequency” (HF) ratio in the children with CP during the meals in which a negative stimulus was displayed (U= 59.00, p= 0.011) and during the passive visual display, regardless of type of stimulus. For children with CP, the amplitude of skin conductance response during the passive pictures display was significantly higher for negative stimuli (0.80 ± 0.46 µS) than for positive stimuli (0.52 ± 0.28; Z= -2.38, p= 0.017), but there were no significant changes in autonomic responses as a function of stimuli during meal-making. Positive correlations were found in the CP group between trait anxiety and the LF:HF ratio during virtual meal-making with positive (p< 0.05) and negative stimuli (p<0.01) but not during meals when stimuli were neutral. The implications of these results are discussed. 

S Kirshner, P L Weiss, E Tirosh, Measuring the effect of affective stimuli on autonomic responses and task performance in a virtual environment by children with and without cerebral palsy, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 219-228, Laval, France, 10 - 12 Sept. 2012.


Using a virtual supermarket as a tool for training executive functions in people with mild cognitive impairment, R Kizony, M Korman, G Sinoff, E Klinger, N Josman, University of Haifa/Sheba Medical Center, Tel Hashomer/School for Special Education, Tzohar Le’Tohar, Rechasim/Carmel Medical Center, Haifa, ISRAEL/Arts et Métiers ParisTech, Angers-Laval, FRANCE

Cognitive and executive functions (EF) intervention programs for people with mild cognitive impairment (MCI) has not been studied enough, especially with the use of virtual reality. The purpose of the current study was to examine the effectiveness of using the Virtual Action Planning – Supermarket (VAP-S) to improve performance of a shopping task and EF among people with MCI. Seven participants with non-amnestic or multi-domain amnestic MCI completed the study protocol which followed an ABA single subject design. The outcome measures included the Multiple Errands Test (MET) to assess EF while performing a shopping task and the WebNeuro to assess EF impairments. Results showed that 4 participants improved their EF as assessed by the WebNeuro and 4 improved their performance of the shopping task in the MET. It seems that in some cases a learning effect occurred which explains why some of the participants did not improve. The results point to the potential of using the VAP-S as an intervention tool for training EF in people with MCI.    

R Kizony, M Korman, G Sinoff, E Klinger, N Josman, Using a virtual supermarket as a tool for training executive functions in people with mild cognitive impairment, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 41-46, Laval, France, 10 - 12 Sept. 2012.


Design of virtual reality based physical and cognitive stimulation exercises for elderly people, E Klinger, E Martinet, A L Lucas, D Perret, Arts et Métiers ParisTech/CIGMA, CIDEVIM, Laval, FRANCE

Elderly people are the most growing part of the population in developed countries (Europe, North America and Japan). This population is getting more and more alone and isolating this part of the population is the big issue of this century. This isolation can lead to a lack in physical and cognitive activity. Because virtual reality has given good results in health domain, we decided to design an application that combines physical activities and cognitive stimulation. The “Balade à l’EHPAD” application was then tested on different kind of population. Then, the expectations and needs of elderly people were collected and analyzed. The results clearly indicate that preconceived ideas exist in every people and also in professional caregivers who generally have a better knowledge of this population. Elderly people would like to have raw colors and virtually practice more violent sports (e. g., skiing, rugby). The overall study clearly indicates that more than for younger adults, the involvement of elderly people into the application design process is a prerequisite for the appropriation by this population.

E Klinger, E Martinet, A L Lucas, D Perret, Design of virtual reality based physical and cognitive stimulation exercises for elderly people, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 369-377, Laval, France, 10 - 12 Sept. 2012.


User-centered development of a virtual reality cognitive assessment, S T Koenig, D Krch, N Chiaravalloti, J Lengenfelder, O Nikelshpur, B S Lange, J DeLuca, A A Rizzo, Institute for Creative Technologies, University of Southern California, Playa Vista, CA/Kessler Foundation Research Center, NJ, USA

In recent years user-centered design, participatory design and agile development have seen much popularity in the field of software development. More specifically, applying these methods to user groups with cognitive and motor disabilities has been the topic of numerous publications. However, neuropsychological assessment and training require special consideration to include therapists and brain-injured patients into the development cycle. Application goals, development tools and communication between all stakeholders are interdependent and outlined in a framework that promotes elements of agile development. The framework is introduced by example of a virtual reality cognitive assessment for patients with traumatic brain injuries. The assessment has seen a total of 20 iterations over the course of nine months including changes in task content, task difficulty, user interaction and data collection. The framework and development of the cognitive assessment are discussed.

S T Koenig, D Krch, N Chiaravalloti, J Lengenfelder, O Nikelshpur, B S Lange, J DeLuca, A A Rizzo, User-centered development of a virtual reality cognitive assessment, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 247-253, Laval, France, 10 - 12 Sept. 2012.


Web-based home rehabilitation gaming system for balance training, V I Kozyavkin, O O Kachmar, V E Markelov, V V Melnychuk, B O Kachmar, International Clinic of Rehabilitation, UKRAINE

Currently, most systems for virtual rehabilitation and motor training require quite complex and expensive hardware and can be used only in clinical settings. Now, a low-cost rehabilitation game training system has been developed for patients with movement disorders; it is suitable for home use under the distant supervision of a therapist. It consists of a patient-side application installed on a home computer and the virtual rehabilitation Game Server in the Internet. System can work with different input gaming devices connected through USB or Bluetooth, such as a Nintendo Wii balance board, a Nintendo Wii remote, a MS Kinect sensor, and custom-made rehabilitation gaming devices based on a joystick. The same games can be used with all training devices. Assessment of the Home Rehabilitation Gaming System for balance training was performed on six patients with Cerebral Palsy, who went through daily training sessions for two weeks. Preliminary results showed balance improvement in patients with Cerebral Palsy after they had completed home training courses. Further studies are needed to establish medical requirements and evidence.

V I Kozyavkin, O O Kachmar, V E Markelov, V V Melnychuk, B O Kachmar, Web-based home rehabilitation gaming system for balance training, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 167-173, Laval, France, 10 - 12 Sept. 2012.


Improving orientation and mobility skills through virtual environment for people who are blind:  past research and future potential, O Lahav, Tel-Aviv University, ISRAEL

This presented paper describes and examines 21 virtual environments developed specifically to support people who are blind in collecting spatial information before arrival at a new location and to help people who are newly blind practice orientation and mobility skills during rehabilitation. The paper highlights weaknesses and strengths of virtual environments that have been developed in the past 15 years as orientation and mobility aids for people who are blind. These results have potential to influence future research and development of a new orientation and mobility aid that could enhance navigation abilities.

O Lahav, Improving orientation and mobility skills through virtual environment for people who are blind:  past research and future potential, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 393-398, Laval, France, 10 - 12 Sept. 2012.


Development of a visual impairment simulator using the Microsoft XNA Framework, J Lewis, L Shires, D J Brown, Nottingham Trent University, UK

This paper describes the development of a visual impairment simulator based upon a virtual environment developed using Microsoft's XNA framework and High Level Shader Language. Shaders were developed to simulate the effects of cataracts, macular degeneration, glaucoma, myopia and hyperopia. These were then used to impair the real time display of an explorable 3D virtual environment. The simulator was evaluated by a qualified optician and trialled with a group of students. The paper concludes that further development is required to fully and accurately represent the impairments, however the simulator remains effective in improving participants level of understanding of visual impairments.

J Lewis, L Shires, D J Brown, Development of a visual impairment simulator using the Microsoft XNA Framework, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 399-407, Laval, France, 10 - 12 Sept. 2012.


Balance rehabilitation using custom-made Wii Balance Board exercises: clinical effectiveness and maintenance of gains in acquired brain injury population, R Lloréns, S Albiol, J A Gil-Gómez, M Alcañiz, C Colomer, E Noé, Universitat Politècnica de València/Univesity of Jaume I, Castellón/Servicio de Neurorrehabilitación de los Hospitales NISA Valencia al Mar y Sevilla/Aljarafe, SPAIN

Balance disorders are a common impairment of some of the pathologies with the highest incidence and prevalence rates. Conventional physical therapy treatment focuses on the rehabilitation of balance skills in order to enhance patients’ self-dependency. In the last years, some studies have reported the clinical benefits of virtual reality systems in the balance recovery. The force platform Wii Balance Board has been adopted with rehabilitative purposes by many services due to its low cost and widespread battery of exercises. However, this entertainment system is oriented to healthy people and cannot adapt to the patient’s motor (and possible cognitive) deficits. In previous studies we have developed custom-made adaptive exercises that use the Wii Balance Board with promising results in acquired brain injury population. In this contribution, we present some conclusions derived from the past and undergoing clinical studies.   

R Lloréns, S Albiol, J A Gil-Gómez, M Alcañiz, C Colomer, E Noé, Balance rehabilitation using custom-made Wii Balance Board exercises: clinical effectiveness and maintenance of gains in acquired brain injury population, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 175-180, Laval, France, 10 - 12 Sept. 2012.


Virtual reality learning software for individuals with intellectual disabilities: comparison between touchscreen and mouse interactions, E Loup-Escande, O Christmann, R Damiano, F Hernoux, S Richir, Arts et Métiers ParisTech, Laval, France

The aim of this article is to analyze the impact of two user interfaces - a tactile interface and a computer mouse - on a virtual environment allowing self-learning tasks as dishwashing by workers with mental deficiencies. We carried out an experiment within the context of a design project named “Apticap”. The methods used were an experiment, an identification questionnaire and a post-experimentation interview, with six disabled workers. The results of this study demonstrate the interest of a virtual reality tool associated with a tactile interaction for learning of real tasks by workers with mental deficiencies.

E Loup-Escande, O Christmann, R Damiano, F Hernoux, S Richir, Virtual reality learning software for individuals with intellectual disabilities: comparison between touchscreen and mouse interactions, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 295-303, Laval, France, 10 - 12 Sept. 2012.


Movement rehabilitation in virtual reality from then to now: how are we doing?, A S Merians, G Fluet, E Tunik, Q Qiu, S Saleh, S Adamovich, University of Medicine and Dentistry of New Jersey/New Jersey Institute of Technology, NJ, USA

During the past decade there has been a continuous exploration of how virtual environments can be used to facilitate motor recovery and relearning after neurological impairment. The goals for using virtual environments have been to either improve patients’ rehabilitation outcomes beyond our current capabilities, or to supplement labor intensive and time consuming therapies with technology based interventions.  After over a decade of investigation it seems appropriate to determine whether we are succeeding in meeting our goals.

A S Merians, G Fluet, E Tunik, Q Qiu, S Saleh, S Adamovich, Movement rehabilitation in virtual reality from then to now: how are we doing?, Keynote Address, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 9-15, Laval, France, 10 - 12 Sept. 2012.


Collaborative virtual environment for conducting design sessions with students with autism spectrum conditions, L Millen, S V G Cobb, H Patel, T Glover, University of Nottingham, UK

Young students with autism spectrum conditions (ASC) often find it difficult to communicate with others face-to-face. Virtual reality offers a platform in which students can communicate in a safe and predictable environment where face-to-face communication is not necessary. Participatory design with end-users is an important part of developing successful, usable and enjoyable technology. As designers of technology for young students with ASC, we seek to involve these end-users in the design of software. Therefore, we have developed the Island of Ideas: a collaborative virtual environment (CVE) designed to facilitate participatory design activities with students with ASC. In this paper we report an experimental trial of the Island of Ideas CVE as a meeting space in which a researcher talks with students to find out their views on computer game design and their ideas for new game levels. 

L Millen, S V G Cobb, H Patel, T Glover, Collaborative virtual environment for conducting design sessions with students with autism spectrum conditions, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 269-278, Laval, France, 10 - 12 Sept. 2012.


Helping deaf and hard-of-hearing people by combining augmented reality and speech technologies, M R Mirzaei, S Ghorshi, M Mortazavi, Sharif University of Technology, Kish Island, IRAN

Recently, many studies have shown that the Augmented Reality (AR), Automatic Speech Recognition (ASR) and Text-to-Speech Synthesis (TTS) can be used to help people with disabilities. In this paper, we combine these technologies to make a new system, called "ASRAR", for helping deaf people. This system can take a narrator's speech and convert it into a readable text, and show the text directly on AR displays. Since most deaf people are unable to make meaningful sounds, we use a TTS system to make the system more usable for them. The results of testing the system show that its accuracy is over 85 percent, using different ASR engines, in different places. The results of testing TTS engines show that the processing time is less than three seconds and the spelling of correct words is 90 percent. Moreover, the result of a survey shows that more than 80 percent of deaf people are very interested in using the ASRAR system for communication.

M R Mirzaei, S Ghorshi, M Mortazavi, Helping deaf and hard-of-hearing people by combining augmented reality and speech technologies, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 149-158, Laval, France, 10 - 12 Sept. 2012.


Haptic presentation of 3D objects in virtual reality for the visually disabled, M Moranski, A Materka, Technical University of Lodz, POLAND

The paper presents an initial research on haptic perception of 3D objects in a virtual reality environment for aiding the visually disabled persons in learning new routes and obstacle identification. The study spans a number of fields, from the very technical, such as scene segmentation and obstacle detection algorithms to psychological aspects such as the effectiveness in utilizing haptic information. The authors constructed a prototype system for the tactile presentation of real objects in a virtual reality.

M Moranski, A Materka, Haptic presentation of 3D objects in virtual reality for the visually disabled, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 103-109, Laval, France, 10 - 12 Sept. 2012.


Using virtual environments to teach coping skills in addiction treatment, L North, C Robinson, A Haffegee, P M Sharkey, F Hwang, Swanswell, Rugby/University of Reading, UK

This paper presents a novel application of virtual environments to assist in encouraging behaviour change in individuals who misuse drugs or alcohol. We discuss the background and development, through user-led design, of a series of scenes to engage users around the identification of triggers and encourage discussion about relevant coping skills. We then lay out the results of some initial testing of this application that show some positive reaction to the scenes and some positive learning outcomes and discuss the conclusions drawn from these.

L North, C Robinson, A Haffegee, P M Sharkey, F Hwang, Using virtual environments to teach coping skills in addiction treatment, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 345-353, Laval, France, 10 - 12 Sept. 2012.


Virtual reality exposure therapy for post-traumatic stress disorder patients controlled by a fuzzy logic system, F M de Oliveira, R S Lanzillotti, R M E M da Costa, R Gonçalves, P Ventura, L A V de Carvalho, Universidade do Estado do Rio de Janeiro, BRAZIL

This paper describes the main characteristics of two integrated systems that explore Virtual Reality technology and Fuzzy Logic to support and to control the assessment of people with Post-Traumatic Stress Disorder during the Virtual Reality Exposure Therapy. The integration of different technologies, the development methodology and the test procedures are described throughout the paper.

F M de Oliveira, R S Lanzillotti, R M E M da Costa, R Gonçalves, P Ventura, L A V de Carvalho, Virtual reality exposure therapy for post-traumatic stress disorder patients controlled by a fuzzy logic system, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 355-360, Laval, France, 10 - 12 Sept. 2012.


Serious games for physical rehabilitation: designing highly configurable and adaptable games, L Omelina, B Jansen, B Bonnechère, S Van Sint Jan, J Cornelis, Vrije Universiteit Brussel/Interdisciplinary Institute for Broadband Technology, Ghent/Université Libre de Bruxelles, BELGIUM

Computer games have been recognized as a motivational tool in rehabilitation for a decade. Traditional rehabilitation includes exercises which are often considered as repetitive, boring and requires supervision by the therapist. New opportunities in rehabilitation have risen with the emerging popularity of computer games and novel input sensors like 3D cameras, balance boards or accelerometers. Despite active research in this area, there is still lack of available games for rehabilitation mainly due to many different requirements that have to be met for each type of therapy. In this paper we propose a specialized configurable architecture for revalidation games, focusing on neuro-muscular rehabilitation. The proposed architecture enables a therapist to define game controls depending on the patient needs and without any programing skills. We have also implemented a system meeting this architecture and four games using the system in order to verify correctness and functionality of the proposed architecture.

L Omelina, B Jansen, B Bonnechère, S Van Sint Jan, J Cornelis, Serious games for physical rehabilitation: designing highly configurable and adaptable games, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 195-201, Laval, France, 10 - 12 Sept. 2012.


Mathematical literacy for everyone using arithmetic games, L Pareto, University West, Trollhättan, SWEDEN

An innovative mathematics game shown to be effective for low-achieving mainstream students is tested in special education for learners with intellectual disabilities. The game relies on a graphical, intuitive representation for numbers and arithmetic operations to foster conceptual understanding and numbers sense, and provides a set of 2-player games to develop strategic thinking and reasoning skills.  The game runs on computers and interactive white boards, and as an augmented reality application at a science centre. We compare its use in special education and mainstream education with respect to usage, performance levels and learning gain. The game has been used by teachers in special educations, with gains in mathematical understanding, strategic thinking and communication skills as effects.

L Pareto, Mathematical literacy for everyone using arithmetic games, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 87-96, Laval, France, 10 - 12 Sept. 2012.


3D augmented reality applied to the treatment of neuropathic pain, B Penelle, D Mouraux, E Brassinne, T Tuna, A Nonclercq, N Warzée, Université Libre de Bruxelles/Erasme Hospital, Brussels, BELGIUM

Neuropathic pain is characterized by a permanent or recurrent background pain including stinging, tingling, allodynia, burning, shock or stabbing sensations. It significantly alters the patient quality of life. Such painful conditions are observed in the case of phantom limb pain (PLP) and complex regional pain syndrome (CRPS), and are difficult to treat effectively. Recent studies show the crucial role of the central nervous system in these pathologies and suggest a link to the plasticity of the latter. Mirror visual feedback (MVF) is often used in case of amputation, CRPS or stroke to restore normal cortical organization and to lower pain intensity. We have conceived an augmented reality (AR) system that applies the principle of MVF without requiring the use of a physical mirror. The system strengthens the patient’s immersion and concentration by using realistic, natural looking 3D images that are acquired, processed and displayed in 3D, in real time. Our system is based on standard inexpensive hardware and is easy to install and to use. This makes it perfectly suitable for use in a therapist's practice or at home. The preliminary results of clinical tests show that the system can significantly reduce the pain, after only a few training sessions.

B Penelle, D Mouraux, E Brassinne, T Tuna, A Nonclercq, N Warzée, 3D augmented reality applied to the treatment of neuropathic pain, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 61-68, Laval, France, 10 - 12 Sept. 2012.


Stress resilience in virtual environments: training combat relevant emotional coping skills using virtual reality, A A Rizzo, B John, J Williams, B Newman, S T Koenig, B S Lange, J G Buckwalter, Institute for Creative Technologies, University of Southern California, Playa Vista, CA, USA

The incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel has created a significant behavioral healthcare challenge. This has served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. One emerging form of treatment for combat-related PTSD that has shown promise involves the delivery of exposure therapy using immersive Virtual Reality (VR). Initial outcomes from open clinical trials have been positive and fully randomized controlled trials are currently in progress to further investigate the efficacy of this approach. Inspired by the initial success of this research using VR to emotionally engage and successfully treat persons undergoing exposure therapy for PTSD, our group has begun developing a similar VR-based approach to deliver stress resilience training with military service members prior to their initial deployment. The STress Resilience In Virtual Environments (STRIVE) project aims to create a set of combat simulations (derived from our existing Virtual Iraq/Afghanistan PTSD exposure therapy system) that are part of a multi-episode interactive narrative experience. Users can be immersed within challenging combat contexts and interact with virtual characters within these episodes as part of an experiential learning approach for delivering psychoeducational material, stress management techniques and cognitive-behavioral emotional coping strategies believed to enhance stress resilience. The STRIVE project aims to present this approach to service members prior to deployment as part of a program designed to better prepare military personnel for the types of emotional challenges that are inherent in the combat environment.  During these virtual training experiences users are monitored physiologically as part of a larger investigation into the biomarkers of the stress response. One such construct, Allostatic Load, is being directly investigated via physiological and neuro-hormonal analysis from specimen collections taken immediately before and after engagement in the STRIVE virtual experience. This paper describes the development and evaluation of the Virtual Iraq/Afghanistan Exposure Therapy system and then details its current transition into the STRIVE tool for pre-deployment stress resilience training. We hypothesize that VR stress resilience training with service members in this format will better prepare them for the emotional stress of a combat deployment and could subsequently reduce the later incidence of PTSD and other psychosocial health conditions.

A A Rizzo, B John, J Williams, B Newman, S T Koenig, B S Lange, J G Buckwalter, Stress resilience in virtual environments: training combat relevant emotional coping skills using virtual reality, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 229-237, Laval, France, 10 - 12 Sept. 2012.


Appreciating speech through gaming, S T Sadural, M T Carreon, Code8 Technology Solutions/University of the Philippines Diliman, PHILIPPINES

This paper discusses the Speech and Phoneme Recognition as an Educational Aid for the Deaf and Hearing Impaired (SPREAD) application and the ongoing research on its deployment as a tool for motivating deaf and hearing impaired students to learn and appreciate speech. This application uses the Sphinx-4 voice recognition system to analyze the vocalization of the student and provide prompt feedback on their pronunciation. The packaging of the application as an interactive game aims to provide additional motivation for the deaf and hearing impaired student through visual motivation for them to learn and appreciate speech.

S T Sadural, M T Carreon, Appreciating speech through gaming, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 141-148, Laval, France, 10 - 12 Sept. 2012.


Chilean higher education entrance examination for learners who are blind, J Sánchez, M Espinoza, University of Chile, Santiago, CHILE

In the context of the admissions process for Chilean state universities, there is a knowledge-measuring instrument called the University Selection Test (PSU, for its Spanish acronym). This instrument of evaluation is designed to measure the level of knowledge in various learning sub-sectors such as Language and Communication, Mathematics, History and Social Sciences, and finally Science. For each learning sub-sector, students use a paper facsimile with questions that each have 5 possible answer choices, which are recorded on a separate answer sheet. Based on a contextual analysis of the problems that people who are blind have with participating in the regular admissions process for Chilean universities, the purpose of this study was to design, implement and evaluate a digital pilot system that adapts the Chilean university entrance system, PSU, in the area of Language in Communication for people with disabilities based on audio and haptics. This pilot allowed for the inclusive, equitable and autonomous participation of people with visual disabilities in the university admissions processes. The results demonstrate the creation of a system called AudioPSU, which provides the necessary autonomy and respects the working time that each user needs to respond to the questions in the PSU. In addition, the system is shown to help users to map the structure of the PSU facsimile for Language and Communication. Finally, initial results show that AudioPSU allows for the integration of people with visual disabilities in the admissions process for Chilean universities.

J Sánchez, M Espinoza, Chilean higher education entrance examination for learners who are blind, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 409-418, Laval, France, 10 - 12 Sept. 2012.


Videogaming for wayfinding skills in children who are blind, J Sánchez, M Espinoza, J M Garrido, University of Chile, Santiago/Pontifical Catholic University of Valparaíso, Viña del Mar, CHILE

There are several problems faced by people who are blind when navigating through unfamiliar spaces, and especially open spaces. One way to mitigate these problems is by getting to know the spaces prior to actual navigation, through the use of virtual environments represented through audio and haptic interfaces. In exploring the possibilities for further improving navigation through such spaces; it was especially interesting to study the option of simulating the real body movement of a learner who is n during his interaction with a virtual environment. To achieve this the design, implementation and impact evaluation of an audio and haptic-based videogame called MovaWii is proposed, in which a real physical space is represented virtually, where learners who are blind interact through their own body movements and use of the Wiimote controllers of the Nintendo Wii console in order to navigate through unknown virtual spaces. The results demonstrated a videogame that allows for the development of orientation and mobility skills in learners who are blind, as it serves as a supporting tool for the construction of a mental map of the virtual space navigated through the integration of its audio and haptic components. In addition, learners could transfer the information obtained from virtual to the real world physical space, through which they were then able to navigate autonomously and efficiently.

J Sánchez, M Espinoza, J M Garrido, Videogaming for wayfinding skills in children who are blind, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 131-140, Laval, France, 10 - 12 Sept. 2012.


Development of a complex ecological virtual environment, S Sangani, P L Weiss, R Kizony, S T Koenig, M F Levin, J Fung, McGill University, Montreal/Jewish Rehabilitation Hospital, Laval, Quebec, CANADA/University of Haifa/Sheba Medical Center, Tel Hashomer, ISRAEL/Institute for Creative Technologies, University of Southern California, Playa Vista, CA, USA

Virtual environments (VEs) provide clinicians and researchers an opportunity to develop and implement an engaging, ecologically valid, complex, life-like interactive 3D simulation, which can be tailored dynamically to characterize and precisely measure functional behaviour in response to different multisensory stimuli. Complex ecological VEs that are based on familiar real-world environments enable participants to relate to the training environment which in turn, may promote translation of functional improvements to real-world tasks. This study describes the development of a systematic and context-specific complex VE using simple computer graphics and modelling tools.

S Sangani, P L Weiss, R Kizony, S T Koenig, M F Levin, J Fung, Development of a complex ecological virtual environment, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 261-268, Laval, France, 10 - 12 Sept. 2012.


Evaluation of the prototype mobile phone app Pugh: a 3D cartoon character designed to help deaf children to speech read, D M Shaw, M Patera, E Paparidou, R Wolff, University of Salford, UK/German Aerospace Center, Brunswick, GERMANY

Pugh, a 3D cartoon character, is a prototype smartphone application developed at the University of Salford. Its purpose is to provide speech-reading exercises for hard of hearing and deaf children. This paper discusses the design of the application, the test process and acknowledges that the technological limitations of the platform and the character’s non-human characteristics provide some interesting challenges. A preliminary test was conducted to evaluate speech perception and lipreading from Pugh. The findings proved that Pugh is not an accurate speaker. Further development of the lip movement and facial expressions is required in order to achieve accuracy.

D M Shaw, M Patera, E Paparidou, R Wolff, Evaluation of the prototype mobile phone app Pugh: a 3D cartoon character designed to help deaf children to speech read, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 159-165, Laval, France, 10 - 12 Sept. 2012.


Development of a low-cost virtual reality-based smart glove for rehabilitation, M Sivak, D Murray, L Dick, C Mavroidis, M K Holden, Northeastern University, Boston, MA, USA

Presented is the third version of a low-cost bimanual rehabilitation system designed for in-home use by post stroke patients to improve hand and upper extremity function. Companion virtual reality software is still in development. The mechanical characterization and healthy subject (n=24) testing of the system sensors is described. These sensors include potentiometer bend sensors for finger motions and inertial measurement units (IMUs) for hand/arm position and orientation. The system accurately measures larger finger angles and all functional ranges of hand orientation (yaw, pitch, roll). Measurement of small finger angles and position of the hand in space requires further refinement.

M Sivak, D Murray, L Dick, C Mavroidis, M K Holden, Development of a low-cost virtual reality-based smart glove for rehabilitation, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 279-286, Laval, France, 10 - 12 Sept. 2012.


Can a home based virtual reality system improve the opportunity for rehabilitation of the upper limb following stroke?, P J Standen, K Threapleton, L Connell, A Richardson, D J Brown, S Battersby, F Platts, University of Nottingham/University of Central Lancashire/Erewash Community Occupational Therapy Service, Derbyshire/Nottingham Trent University/ Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK

Many stroke survivors fail to regain functional use of their impaired upper limb yet access to the rehabilitation required is limited. One route through which this may be achieved is through the adoption of virtual reality and interactive video gaming. We have been developing a home based system that employs infra red capture to translate the position of the hand, fingers and thumb into game play but do the patients actually use it to the recommended level and if not, why not? Performance data collected by the software from three participants allocated to the intervention group in a feasibility RCT indicate that the pattern of play is variable and can fall far short of the recommendations participants were given. Interviews with participants at the end of the intervention and observations by the research team indicate the barriers to recommended use but also some of the characteristics of the intervention that demonstrate its potential for improving the opportunity for rehabilitation of the upper limb following stroke.

P J Standen, K Threapleton, L Connell, A Richardson, D J Brown, S Battersby, F Platts, Can a home based virtual reality system improve the opportunity for rehabilitation of the upper limb following stroke?, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 25-32, Laval, France, 10 - 12 Sept. 2012.


Towards a real-time, configurable, and affordable system for inducing sensory conflicts in a virtual environment for post-stroke mobility rehabilitation: vision-based categorization of motion impairments, B Taati, J Campos, J Griffiths, M Gridseth, A Mihailidis, University of Toronto/Toronto Rehabilitation Institute, CANADA

Upper body motion impairment is a common after-effect of a stroke. A virtual reality system is under development that will augment an existing intervention (Mirror Box therapy) with a method of inducing a body illusion (Rubber Hand) in order to enhance rehabilitation outcomes. The first phase of the project involved developing algorithms to automatically differentiate between normal and impaired upper body motions. Validation experiments with seven healthy subjects simulating two common types of impaired motions confirm the effectiveness of the proposed methods in detecting impaired motions (accuracy >95%).

B Taati, J Campos, J Griffiths, M Gridseth, A Mihailidis, Towards a real-time, configurable, and affordable system for inducing sensory conflicts in a virtual environment for post-stroke mobility rehabilitation: vision-based categorization of motion impairments, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 239-244, Laval, France, 10 - 12 Sept. 2012.


Development of a glove-type input device with the minimum number of sensors for Japanese finger spelling, Y Tabata, T Kuroda, K Okamoto, Kyoto College of Medical Science, Nantan/Kyoto University Hospital, JAPAN

A glove-type input device, which can measure hand postures of human beings directly, is one of essential device to develop Virtual Reality environment. The authors have been developing a data-glove which would be able to capture hand postures according to user’s demand with the minimum number of sensors. Our previous research estimated the data-glove with six sensors could measure all hand postures for Japanese Finger spellings. Thus, this paper proposes a prototype with six sensors and evaluate whether the prototype glove sensor can distinguish all hand postures of Japanese Finger spellings. This evaluation indicated that data-glove with fewer sensors than conventional number of sensors could distinguish hand postures exactly.

Y Tabata, T Kuroda, K Okamoto, Development of a glove-type input device with the minimum number of sensors for Japanese finger spelling, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 305-310, Laval, France, 10 - 12 Sept. 2012.


Telerehabilitation for stroke patients: an overview of reviews, A Turolla, L Piron, T Gasparetto, M Agostini, H R Jorgensen, P Tonin, T Larsen, I.R.C.C.S. Fondazione Ospedale San Camillo, Venice/Social and Health Programs, Regione Veneto, Venice, ITALY/Sygheus Vendsyssel Brønderslev Neurorehabiliteringscenter, Brønderslev/Southern Denmark University, Odense, DENMARK

The increasing number of survivors following stroke events are enlightening new needs to guarantee appropriate care and quality of life support at home. A potential application of telemedicine is to exploit home care and rehabilitation. Within the framework of an EU FP7 project called Integrated Home Care (IHC) we performed an overview of reviews on the telefacilites for the homecare in stroke patients, in order to plan a clinical trial. A broad literature research was conducted in PUBMED, Web of Science® and The Cochrane Library databases. We included and graded all the reviews matching the following criteria: published in English in peer-reviewed journals, targeting stroke as adult patients (age>18yr.) and considering a homecare setting in the intervention. 6 full-text reviews were included: 1 systematic review with meta-analysis and 5 non-systematic reviews. Despite the absence of adverse effects, no conclusions can be stated on the effectiveness of telerehabilitation compared to other home treatment, due to the insufficient data available, nevertheless strong indications emerged for the inclusion of “all cause mortality” and “hospital admission” as primary outcomes. Besides “QoL”, “cost”, “adherence” and “patient acceptability” should be included as secondary outcomes, for a complete evaluation of the tele-intervention. This indications should be considered as relevant in planning a telerehabilitation trial, in order to observe the expected effectiveness from a multidimensional point of view in the clinical, financial and social perspectives.

A Turolla, L Piron, T Gasparetto, M Agostini, H R Jorgensen, P Tonin, T Larsen, Telerehabilitation for stroke patients: an overview of reviews, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 323-328, Laval, France, 10 - 12 Sept. 2012.


Development and validation of tele-health system for stroke rehabilitation, P L Weiss, R Kizony, O Elion,  S Harel, I Baum-Cohen, T Krasovsky, Y Feldman, M Shani, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer/University of Haifa/Sheba Medical Center, Tel Hashomer, ISRAEL/McGill University, Montreal, CANADA

Tele-rehabilitation refers to the use of information and communication technologies to provide rehabilitation services to people in their homes or other environments.  The objective of this paper is to present the development, validation and usability testing of a low-cost, markerless full body tracking virtual reality system designed to provide remote rehabilitation of the upper extremity in patients who have had a stroke. The Methods and Results sections present the progress of our work on system development, system validations and a feasibility/usability study.  We conclude with a brief summary of the initial stages of an intervention study and a discussion of our findings in the context of the next steps.  The validation study demonstrated considerable accuracy for some outcomes (i.e., shoulder “pitch” angle, elbow flexion, trunk forward and side-to-side deviation). In addition positive responses were received from the clients who participated in the feasibility study. We are currently at the process of improving the accuracy of the system as well as conducting a randomized clinical trial to assess the effectiveness of the system to improve upper extremity function post-stroke.  

P L Weiss, R Kizony, O Elion,  S Harel, I Baum-Cohen, T Krasovsky, Y Feldman, M Shani, Development and validation of tele-health system for stroke rehabilitation, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 33-40, Laval, France, 10 - 12 Sept. 2012.


Developmental cognitive neuroscience perspective on motor rehabilitation: the case for virtual reality-augmented therapy, P H Wilson, Australian Catholic University, Melbourne, AUSTRALIA

Developmental disorders and disabilities affecting movement can have far reaching, longer-term consequences for the child and their family, and present a great challenge for intervention.  In the case of upper-limb function, in particular, poor compliance and use of repetitive training routines can restrict progress.  In this paper we consider how an understanding of the neurocognitive bases of disorders like cerebral palsy and Developmental Coordination Disorder (DCD) can inform the choice of therapeutic techniques. Using a cognitive neuroscience approach, I explore the hypothesis that motor prediction is a common, underlying issue in these disorders. I then discuss the role that feedback-based and predictive control plays during the course of normal development and highlight recent applications of augmented feedback (AF) in motor therapy. Critically, VR-based technologies afford many options for the provision of multisensory AF.  I describe recent examples of this principled approach to treatment, and conclude by suggesting avenues for future development in VR-assisted therapy.

P H Wilson, Developmental cognitive neuroscience perspective on motor rehabilitation: the case for virtual reality-augmented therapy, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 203-210, Laval, France, 10 - 12 Sept. 2012.


Upper-body interactive rehabilitation system for children with cerebral palsy: the effect of control/display ratios, T Yamaguchi, P Richard, F Veaux, M Dinomais, S Nguyen, Université d’Angers/Centre les Capucins, Département de Médecine Physique et de Rééducation Pédiatrique, Angers, France

We have developed a virtual reality rehabilitation system using upper-body interaction with Microsoft KinectTM. With the use of KinectTM , the system enables a patient a full-range of avatar movements to adapt the Control/Display (C/D) ratio of a limb’s position in 3D space. In this paper, we have explored the effectiveness of C/D ratios in our prototype application to analyze user performance, work load, and user enjoyment with university students without motor impairments. Our findings suggest that the C/D ratio is related to task difficulty, movement strategy, and user motivation.

T Yamaguchi, P Richard, F Veaux, M Dinomais, S Nguyen, Upper-body interactive rehabilitation system for children with cerebral palsy: the effect of control/display ratios, Proc. 9th Intl Conf. on Disability, Virtual Reality and Assoc. Technologies, P M Sharkey, E Klinger (Eds), pp. 181-186, Laval, France, 10 - 12 Sept. 2012.

 

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