Joan McComas

Barriers and Facilitators to Inclusive Education

To examine how inclusive our schools are after 25 years of educational reform, students with disabilities and their parents were asked to identify current barriers and provide suggestions for removing those barriers. Based on a series of focus group meetings, 15 students with mobility limitations (9–15 years) and 12 parents identified four categories of barriers at their schools: (a) the physical environment (e.g., narrow doorways, ramps); (b) intentional attitudinal barriers (e.g., isolation, bullying); (c) unintentional attitudinal barriers (e.g., lack of knowledge, understanding, or awareness); and (d) physical limitations (e.g., difficulty with manual dexterity). Recommendations for promoting accessibility and full participation are provided and discussed in relation to inclusive education efforts.

Experimental Studies of Virtual Reality-Delivered Compared to Conventional Exercise Programs for Rehabilitation

This paper presents preliminary data from two clinical trials currently underway using flat screen virtual reality (VR) technology for physical rehabilitation. In the first study, we are comparing a VR-delivered exercise program to a conventional exercise program for the rehabilitation of shoulder joint range-of-motion in patients with chronic frozen shoulder. In the second study, we are comparing two exercise programs, VR and conventional, for balance retraining in subjects post-traumatic brain injury. Effective VR-based rehabilitation that is easily adapted for individuals to use both in inpatient, outpatient and home-based care could be used as a supplement or alternative to conventional therapy. If this new treatment approach is found to be effective, it could provide a way to encourage exercise and treatment compliance, provide safe and motivating therapy and could lead to the ability to provide exercises to clients in distant locations through telehealth applications of VR treatment. VR is a new technology and the possibilities for rehabilitation are only just beginning to be assessed.

Benefits of activity and virtual reality based balance exercise programmes for adults with traumatic brain injury: perceptions of participants and their caregivers.

Objective: To explore multi-dimensional benefits of exercise participation perceived by adults with traumatic brain injury (TBI) and their caregivers. Methods: Adults (n = 27, aged 18–66) with moderate or severe TBI 6 months or more earlier participated in focus groups following 6 weeks of an activity-based (ABE) or a virtual reality (VR) delivered balance exercise programme. Family members and care providers participated in separate focus groups. Perceptions related to programme participation as well as balance confidence and lower extremity function were extracted from focus group verbatim and quantitative scales, respectively. Outcomes: Benefits in three domains, psychosocial, physical and programme, were identified from transcription and analyses of focus group verbatim. Improvements were noted in balance confidence and function in both groups. Substantially greater enthusiasm and knowledge was expressed by participants in the VR group and their caregivers. Conclusions: Both exercise programmes offered benefits in addition to improved balance. The VR participants had greater improvements on quantitative measures and provided more comments expressing enjoyment and improved confidence. Applications in terms of community reintegration and quality of life are discussed.

Effectiveness of Virtual Reality for Teaching Pedestrian Safety

Sixty percent to 70% of pedestrian injuries in children under the age of 10 years are the result of the child either improperly crossing intersections or dashing out in the street between intersections. The purpose of this injury prevention research study was to evaluate a desktop virtual reality (VR) program that was designed to educate and train children to safely cross intersections. Specifically, the objectives were to determine whether children can learn pedestrian safety skills while working in a virtual environment and whether pedestrian safety learning in VR transfers to real world behavior. Following focus groups with a number of key experts, a virtual city with eight interactive intersections was developed. Ninety-five children participated in a community trial from two schools (urban and suburban). Approximately half were assigned to a control group who received an unrelated VR program, and half received the pedestrian safety VR intervention. Children were identified by group and grade by colored tags on their backpacks, and actual street crossing behavior of all children was observed 1 week before and 1 week after the interventions. There was a significant change in performance after three trials with the VR intervention. Children learned safe street crossing within the virtual environment. Learning, identified as improved street-crossing behavior, transferred to real world behavior in the suburban school children but not in the urban school. The results are discussed in relation to possibilities for future VR interventions for injury prevention.

Children's Transfer of Spatial Learning from Virtual Reality to Real Environments

Spatial abilities in children have been shown to be related to activity in the environment, particularly to walking and other forms of active locomotion. The objective of this study is to investigate whether virtual reality (VR) can assist children in transferring spatial learning to a real environment. Children (six and seven-yr-old participants) were asked to find ten objects hidden around a room and to try not to visit the same location more than once. Examination of the percentage of correct choices and the visit of first error showed improvement as a result of training. There were initial differences between children trained on the computer compared to those trained in the real environment. However, after three practice trials, children with the VR training were comparable to children trained in the real space. The implications for utilizing a VR environment for enhancing spatial abilities for children with mobility difficulties is discussed.

The Effect of Two Types of Virtual Reality on Voluntary Center of Pressure Displacement

Voluntary movements result in internal perturbations of balance and equilibrium. One variable regulated during movement is the position of the center of pressure (COP). Sensory information from the visual, vestibular and somatosensory systems is used in establishing relevant frames of reference for postural control. In this study, we were interested in determining whether different limitations of COP movement occur when different approaches to delivering virtual environments are used and when visual information incoherent with vestibular and somatosensory information is provided. Eighteen healthy adults completed voluntary lateral reaches under three conditions: continuous lateral reach (CLR), flatscreen virtual reality (FS), and head-mounted display virtual reality (HMD). Reaching behavior was indexed by force plate measures of maximum anterior-posterior and lateral displacement of the COP. The COP movement decreased in the lateral direction in the HMD condition relative to the FS. The maximum range of COP movement in the anterior-posterior direction increased as a function of reaching task with HMD realizing the greatest amount of movement. The lack of an exocentric frame of reference in HMD coherent with information from other sensory systems results in limiting COP movement within the base of support (BOS) in order to decrease the challenge to the postural control system.

Children's Memory for Locations Visited: Importance of Movement and Choice

In 2 experiments, the effect of active or passive mobility and active or passive choice experiences on childrens memory for locations visited while retrieving puzzle pieces hidden in a large room were examined. In the first experiment, fifty-two 6- and 7-year-old children were randomly assigned to 1 of 4 training conditions: active choice-active movement, active choice-passive movement, passive choice-active movement, and passive choice-passive movement. After 3 training trials, all children were tested in the active choice-active movement condition. A 2 (movement) x 2 (choice) factorial multivariate analysis of variance revealed a significant main effect for movement. Children who had moved actively to find the puzzle pieces in the training trials had (a) a greater percentage correct, (b) more correct visits between errors, and (c) a later visit of first error than children who had been passively pushed in a wheelchair. Making active choices in training did not significantly affect performance. A second experiment used identical procedures but tested 32 children with mobility difficulties who regularly used a wheelchair because of either cerebral palsy or spina bifida. Children from this group who moved actively during training to retrieve the puzzle pieces also performed better on testing. Implications of the results for children with disabilities and for developmental theory are discussed.