Panagiotis E. Antoniou

Design, Implementation, and Wide Pilot Deployment of FitForAll: An Easy to use Exergaming Platform Improving Physical Fitness and Life Quality of Senior Citizens

Many platforms have emerged as response to the call for technology supporting active and healthy aging. Key requirements for any such e-health systems and any subsequent business exploitation are tailor-made design and proper evaluation. This paper presents the design, implementation, wide deployment, and evaluation of the low cost, physical exercise, and gaming (exergaming) FitForAll (FFA) platform system usability, user adherence to exercise, and efficacy are explored. The design of FFA is tailored to elderly populations, distilling literature guidelines and recommendations. The FFA architecture introduces standard physical exercise protocols in exergaming software engineering, as well as, standard physical assessment tests for augmented adaptability through adjustable exercise intensity. This opens up the way to next generation exergaming software, which may be more automatically/smartly adaptive. 116 elderly users piloted FFA five times/week, during an eight-week controlled intervention. Usability evaluation was formally conducted (SUS, SUMI questionnaires). Control group consisted of a size-matched elderly group following cognitive training. Efficacy was assessed objectively through the senior fitness (Fullerton) test, and subjectively, through WHOQoL-BREF comparisons of pre-postintervention between groups. Adherence to schedule was measured by attendance logs. The global SUMI score was 68.33±5.85%, while SUS was 77.7. Good usability perception is reflected in relatively high adherence of 82% for a daily two months pilot schedule. Compared to control group, elderly using FFA improved significantly strength, flexibility, endurance, and balance while presenting a significant trend in quality of life improvements. This is the first elderly focused exergaming platform intensively evaluated with more than 100 participants. The use of formal tools makes the findings comparable to other studies and forms an elderly exergaming corpus.

Exploring Design Requirements for Repurposing Dental Virtual Patients From the Web to Second Life: A Focus Group Study

Background Since their inception, virtual patients have provided health care educators with a way to engage learners in an experience simulating the clinician’s environment without danger to learners and patients. This has led this learning modality to be accepted as an essential component of medical education. With the advent of the visually and audio-rich 3-dimensional multi-user virtual environment (MUVE), a new deployment platform has emerged for educational content. Immersive, highly interactive, multimedia-rich, MUVEs that seamlessly foster collaboration provide a new hotbed for the deployment of medical education content. Objective This work aims to assess the suitability of the Second Life MUVE as a virtual patient deployment platform for undergraduate dental education, and to explore the requirements and specifications needed to meaningfully repurpose Web-based virtual patients in MUVEs. Methods Through the scripting capabilities and available art assets in Second Life, we repurposed an existing Web-based periodontology virtual patient into Second Life. Through a series of point-and-click interactions and multiple-choice queries, the user experienced a specific periodontology case and was asked to provide the optimal responses for each of the challenges of the case. A focus group of 9 undergraduate dentistry students experienced both the Web-based and the Second Life version of this virtual patient. The group convened 3 times and discussed relevant issues such as the group’s computer literacy, the assessment of Second Life as a virtual patient deployment platform, and compared the Web-based and MUVE-deployed virtual patients. Results A comparison between the Web-based and the Second Life virtual patient revealed the inherent advantages of the more experiential and immersive Second Life virtual environment. However, several challenges for the successful repurposing of virtual patients from the Web to the MUVE were identified. The identified challenges for repurposing of Web virtual patients to the MUVE platform from the focus group study were (1) increased case complexity to facilitate the user’s gaming preconception in a MUVE, (2) necessity to decrease textual narration and provide the pertinent information in a more immersive sensory way, and (3) requirement to allow the user to actuate the solutions of problems instead of describing them through narration. Conclusions For a successful systematic repurposing effort of virtual patients to MUVEs such as Second Life, the best practices of experiential and immersive game design should be organically incorporated in the repurposing workflow (automated or not). These findings are pivotal in an era in which open educational content is transferred to and shared among users, learners, and educators of various open repositories/environments.

Leveraging Web Technologies to Expose Multiple Contemporary Controller Input in Smart TV Rich Internet Applications Utilized in Elderly Assisted Living Environments

This work describes a lightweight framework allowing internet applications to access controllers such as the Wii remote, Wii balance board and MS Kinect irrespective of proximity or configuration. This is achieved by utilizing predetermined schemas for encapsulating the controller information and transferring this data through standard internet communication technologies RESTFUL services and Web Sockets in platform independent, device naive ways. These features of the framework provide Rich Internet Applications RIAs with ubiquitous access to sophisticated human computer interaction schemes for diverse uses. The proliferation of Smart TVs as central information hubs in elderly assisted living environments, along with the need for simple gesture control schemes for these demographics, provides one application of this framework. Thus, we demonstrate how this service can be incorporated for developing internet applications and how it can be utilized for providing intuitive interaction methods for RIAs deployed through Smart TVs in elderly assisted living environments.

Exergames for Assessment in Active and Healthy Aging - Emerging Trends and Potentialities

This paper articulated the position, based on literature research findings as well as experiences and considerations, of the authors regarding the role of exergames in stealth cognitive assessment. The conclusions presented therein are based on a long and lasting experience of design, implementation and piloting trials with seniors over the last six years. They are also supported by literature findings concerning exergames’ engagement, acceptance, perceived usefulness and ease of use. The authors express a positive outlook regarding the role of daily exergaming programs regarding their capacities in stealth assessment. Furthermore, it is postulated that additional research efforts should focus on providing even more concrete, evidence based arguments for convincing researchers and clinicians of the potential clinical value of exergames in terms of cognitive assessment.

Virtual Patients on the Semantic Web: A Proof-of-Application Study

Background Virtual patients are interactive computer simulations that are increasingly used as learning activities in modern health care education, especially in teaching clinical decision making. A key challenge is how to retrieve and repurpose virtual patients as unique types of educational resources between different platforms because of the lack of standardized content-retrieving and repurposing mechanisms. Semantic Web technologies provide the capability, through structured information, for easy retrieval, reuse, repurposing, and exchange of virtual patients between different systems. Objective An attempt to address this challenge has been made through the mEducator Best Practice Network, which provisioned frameworks for the discovery, retrieval, sharing, and reuse of medical educational resources. We have extended the OpenLabyrinth virtual patient authoring and deployment platform to facilitate the repurposing and retrieval of existing virtual patient material. Methods A standalone Web distribution and Web interface, which contains an extension for the OpenLabyrinth virtual patient authoring system, was implemented. This extension was designed to semantically annotate virtual patients to facilitate intelligent searches, complex queries, and easy exchange between institutions. The OpenLabyrinth extension enables OpenLabyrinth authors to integrate and share virtual patient case metadata within the mEducator3.0 network. Evaluation included 3 successive steps: (1) expert reviews; (2) evaluation of the ability of health care professionals and medical students to create, share, and exchange virtual patients through specific scenarios in extended OpenLabyrinth (OLabX); and (3) evaluation of the repurposed learning objects that emerged from the procedure. Results We evaluated 30 repurposed virtual patient cases. The evaluation, with a total of 98 participants, demonstrated the system’s main strength: the core repurposing capacity. The extensive metadata schema presentation facilitated user exploration and filtering of resources. Usability weaknesses were primarily related to standard computer applications’ ease of use provisions. Most evaluators provided positive feedback regarding educational experiences on both content and system usability. Evaluation results replicated across several independent evaluation events. Conclusions The OpenLabyrinth extension, as part of the semantic mEducator3.0 approach, is a virtual patient sharing approach that builds on a collection of Semantic Web services and federates existing sources of clinical and educational data. It is an effective sharing tool for virtual patients and has been merged into the next version of the app (OpenLabyrinth 3.3). Such tool extensions may enhance the medical education arsenal with capacities of creating simulation/game-based learning episodes, massive open online courses, curricular transformations, and a future robust infrastructure for enabling mobile learning.

Integrating the USEFIL Assisted Living Platform; Observation from the Field

Ambient assisted living (AAL) platforms are seen as a viable way for managing healthcare costs in an ever aging first world population. One of the most crucial parts of AAL development is the integration of the different developed components to a functional cohesive platform. Integration strategies are many and varied catering to different system needs. The USEFIL AAL system was conceived as a platform utilizing low cost “off-the-shelf” technology and providing an independent and healthy lifestyle to elderly people. This platform like several AAL platforms reached its system integration stage consisting of relatively few components. In that context technological hurdles have been resolved in the development process of each component. For that reason in the present work the focus is on relatively simple but crucial “observations from the field” taken during the USEFIL AAL platform’s integration effort. The resulting guidelines for integration of AAL platforms are: A) Managerial clarity: Clearly defined roles both cross and within teams, robust avenues of interpersonal communication, detailed and flexible fiscal planning. B) Testing diligence: No assumptions should be made about the robustness of components or the triviality of tests. Component interconnection may lead to unexpected loss of functionality. C) Iterative functional testing: In the case of AAL systems with complex AI components the introduction of additional infrastructure may lead to significant differentiation in functionality a thing that needs to be tested and corrected if detected. D) Pre-pilot testing objectivity: Pre pilot users testing the AAL platform should be provided with minimal training in order to interact with the system as an ordinary user. Only that way they can provide genuinely original feedback. These guidelines while non-technical proved essential for the integration of USEFIL and could serve as a primer for avoiding pitfalls in the integration of similar AAL systems.

Versatile mixed reality medical educational spaces; requirement analysis from expert users

Education has tapped into gaming to increase engagement and facilitate knowledge retention through experiential modalities. There have been several high technological intensity digital laboratories where learners are engaged with the subject matter through various activities. There are also several low intensity web-based solutions that familiarize learners with curriculum material but in less experientially intensive manners. A ubiquitous approach to highly impactful, low cost, high reusability gamified educational approach is a versatile mixed reality educational environment. Using prolific technologies such as inexpensive augmented reality (AR) headsets and a versatile low maintenance database (DB) back-ends, a real-world environment can be transformed with 3D graphics and audio to various educational spaces of highly impactful content. Such a simple implementation is presented here for virtual patients in medicine. A simple DB back-end supports a presentation front-end developed in Unity, utilizing the “vuforia”-mixed reality platform. Based on this implementation, future directions are explored.

Design of Novel Teaching Episodes in Medical Education Using Emerging Experiential Digital Assets: Technology Enabled Medical Education Beyond the Gimmicky

Medical education has always been about experiential hands on training to prepare future doctors to create the necessary skillset to deal with the sensitive and immediate nature of their work. Contemporary experiential technologies such as Virtual and Augmented reality offer a realistic but consequence free test-bed in which to interact safely and cope with emotional challenges pertaining to the realistic tasks simulated through these media. This work describes the design guidelines and workflow for incorporating these novel virtual assets in medical education through serious role play learning episodes. This approach consists of the case selection, the identification of roles, information flow and narrative requirements, implementation of technological narrative tools and implementation of the learning episode. Using a specific example of case transfer through this model we describe the process, outline implementation, assessment and technological considerations. Finally rationale for this work as a counterweight to technological hype fluctuations and integration of these media into the mainstream curricula is discussed.

Towards Evidence Based M-Health Application Design in Cancer Patient Healthy Lifestyle Interventions

Cancer is one of the most prevalent diseases in Europe and the world. Significant correlations between dietary habits and cancer incidence and mortality have been confirmed by the literature. Physical activity habits are also directly implicated in the incidence of cancer. Lifestyle behaviour change may be benefited by using mobile technology to deliver health behaviour interventions. M-Health offers a promising cost-efficient approach to deliver en-masse interventions. Smartphone apps with constructs such as gamification and personalized have shown potential for helping individuals lose weight and maintain healthy lifestyle habits. However, evidence-based content and theory-based strategies have not been incorporated by those apps systematically yet. The aim of the current work is to put the foundations for a methodologically rigorous exploration of wellness/health intervention literature/app landscape towards detailed design specifications for connected health m-apps. In this context, both the overall work plan is described as well as the details for the significant steps of application space and literature space review. Both strategies for research and initial outcomes of it are presented. The expected evidence based design process for patient centered health and wellness interventions is going to be the primary input in the implementation process of upcoming patient centered health/wellness m-health interventions.

Virtual Scenarios for Stealth Assessment of the Elderly: Perceptions and Acceptance of Technology-Based Health and Wellness Interventions

As adults get older, the risks are increasing on their health, such as chronic diseases, functional decline and geriatric syndromes which threaten their well-being. Technology has many features to support aging wellness enabling older people maintaining healthy and sociable as they grow. However, the needs of the elderly of the population are not always the same. Stealth assessment, coming from the educational domain, can assess such needs. Virtual scenarios, interactive simulation technologies that recreate realistic scenarios combined with novel and effective interaction modalities such as dialogue integrations are contemporary means for such endeavors. Thus, coalescing all these axes and disciplines this work aims to explore the applicability of a dialogue based virtual scenario stealth assessment approach for evaluating the perceptions of elderly towards technology based health interventions. Utilizing a simple dialogue based authoring and deployment platform a simple scenario was devised. 21 elderly, aged 60-80 (6 males, 15 females) run the scenario and filled out a validator questionnaire for their perceptions towards technology. Correlation was discovered between the devised instrument and the elderlys desire to use technology in everyday life. These results provide the necessary foundations for refining future iteration of such stealth assessment instruments with Evidence Centered Design Principles.