Patrice L. Weiss

Textbook of Neural Repair and Rehabilitation: Virtual reality in neurorehabilitation

This chapter provides an overview of applications of virtual reality (VR) to rehabilitation. A key concept related to VR is immersion. Immersion relates to the extent to which the VR system succeeds in delivering an environment which refocuses a users sensations from the real world to a virtual world. Virtual environments are usually experienced with the aid of special hardware and software for input and output. Visual information is commonly displayed by head mounted displays (HMDs), projection systems or flat screens of varying size. VR applications in rehabilitation are expanding at a rapid pace and a large variety of platforms and programs are currently being used and developed. It has been used as a medium for the assessment and rehabilitation of cognitive processes. The ultimate goal of VR-based intervention is to enable clients to become more able to participate in their own real environments in an independent manner.

PEBBLES: A Personal Technology for Meeting Educational, Social and Emotional Needs of Hospitalised Children

Abstract: Wayne Gretzky’s PEBBLESTM (Providing Education By Bringing Learning Environments to Students) is a unique example of a personal technology, one in which PC-based video-conferencing is used to make a real-time link between a hospitalised child and his or her regular classroom. The system provides an opportunity for children who are in isolated situations, such as hospitals, to maintain a meaningful link with their regular educational and social environments, thereby minimising many of the secondary problems that may develop as a result of long-term illness and hospitalisation. The objective of this paper is to illustrate the impact that PEBBLES had on one child who directly benefited from the system and on the people with whom she interacted (classmates, parents, teachers and hospital staff). These results were used to explore how exposure to this personal technology influenced the behaviours and attitudes of those involved in this study. The results indicate that, overall, PEBBLES has a very positive effect on both the young and adult participants; the most dramatic effect of all was on the ill child who used PEBBLES to attend school.

Virtual Environments in the Diagnosis, Prevention, and Intervention of Age-Related Diseases: A Review of VR Scenarios Proposed in the EC VETERAN Project

A group of worldwide virtual reality and health-care researchers have decided to combine their efforts in a multidisciplinary project titled VETERAN-virtual environments in the diagnosis, prevention and intervention of age-related diseases. The main goal of the VETERAN project is the tuning and testing of different virtual environments, designed to address the cognitive/functional impairments that may occur due to the aging process and age-related disorders. In particular the developed modules will address the problems commonly found in the following pathologies that have a strong impact on the elderly health care policy: Alzheimers disease and other senile dementias; stroke and unilateral spatial neglect; mobility-related accidents within specific environments (e.g., falls, shocks). The project will focus on research into clinical aspects of age-related diseases and disorders of high morbidity and specifically target goals of prevention, treatment, or delay in onset. Another goal of the VETERAN project is to define and develop new protocols and tools to be used for general rehabilitation purposes. These tools will aim to provide systematic restorative training within the context of functionally relevant, ecologically valid simulated environments. This approach is hoped to optimise the degree of transfer of training and/or generalisation of learning to the persons real world environment.

Performance within a virtual supermarket and its relationship to executive functions in post-stroke patients

Executive functions are defined as higher-order functions that are needed for performing complex or non-routine tasks. People who have had a stroke often suffer from impairments in executive functions which have implications for their ability to return to full participation in their everyday activities and occupations. During the rehabilitation process clinicians seek opportunities, which will not be time consuming or expensive, to engage patients in complex functional activities, in order to train and improve deficits in executive functions. One solution for this is using functional virtual environments. The objectives of this study were to examine the feasibility of using a virtual supermarket to assess and treat executive function deficits for people who have had a stroke, and to explore the relationships between performance within the virtual supermarket and executive functions. The virtual supermarket used in this study runs on a desktop computer and is easy to operate in typical clinical settings. Twenty-six people, aged 31 to 65 years, who had a stroke participated in the study. Participants were tested with the virtual supermarket where they were asked to buy seven products from a prepared list. Each participant was also tested with the behavioral assessment of the dysexecutive syndrome. The results showed a large variance of performance within the virtual supermarket. In addition, moderate relationships were found between performance within the virtual supermarket and executive functions. The results point to the potential of the virtual supermarket to be used as an assessment and training tool for executive functions of people who have had a stroke

Video-mediated communication in the classroom to support sick children: a case study

Abstract Video mediated communication is a valuable educational resource because it provides access to otherwise unreachable learning materials, it motivates students, and helps them improve their communication skills. Over the last four years we have developed a unique application of video mediated communication known as Wayne Gretzkys Providing Education By Bringing Learning Environments to Students (PEBBLES). This is a video-mediated communication system that has been designed to link a child in the hospital with his/her regular classroom. Analysis of video tape data from a six-week case study documenting the frequency of interactions and usage behaviors indicates that the student was able to spend most of her in-class time focussing on the academic tasks assigned to the class despite some technical difficulties and distractions in her local environment. Audio difficulties persisted throughout the study and must be improved in future design iterations of the system. Relevance to industry Successful use of videoconferencing in the classroom has not been well documented. A communication system that combines videoconferencing technologies and a physical avatar has been designed for use by sick children to attend school. An evaluation methodology and a case study presenting the results are beneficial to learning technology industries and users as well as videoconferencing industries.

Effect of seated posture on interface pressure in children who are able-bodied and who have myelomeningocele

Purpose : The objective of this study was to investigate the relationship between sitting position and interface pressure distribution in seated children. Method : Fifteen able-bodied children and 15 children with myelomeningocele complete paraplegia, aged 7 to 18 years were included in the study. The body-seat interface pressure was measured with the QA pressure measurement system. Four sitting positions typically used to reduce body-seat interface pressure position (recline, tilt, combined and lean forward) were compared to a neutral position. Results : Test/re-test Pearson correlation coefficients were greater than 0.94 for maximum pressure and greater than 0.88 for mean pressure at all test positions ( p < 0.0001) and, for the risk area (defined as the percentage of sensors which recorded pressures greater than 40 mm Hg.) varied from 0.62 to 0.85 ( p < 0.0005). Maximum pressures for the myelomeningocele group were significantly higher than those recorded for ablebodied subjects in the neutral, combined and lean forward positions ( p < 0.001). For the able-bodied subjects, maximum pressures at the combined ( p < 0.001), tilt ( p < 0.05) and lean forward ( p < 0.0001) positions were significantly lower than those measured at the neutral position. For the myelomeningocele subjects, maximum pressure at all tested positions was significantly lower than at the neutral position ( p < 0.05). Conclusions : The results point to the importance of measuring body-seat interface pressure for each wheelchair user and of using the information to customize wheelchair utilization.

Recovery of Patients with a Combined Motor and Proprioception Deficit During the First Six Weeks of Post Stroke Rehabilitation

The objective of this study was to characterize (1) the severity of the proprioception deficit in the affected upper extremity on admission to rehabilitation and (2) the motor and functional recovery during the first six weeks of rehabilitation. Twenty patients who had sustained a hemispheric cerebral vascular accident (CVA) and had a proprioception deficit in addition to a motor deficit of their upper extremity participated in the study. Subjects were assessed for propriocep-tion loss and motor ability of the upper extremity four times (weeks 0, 2, 4, and 6) and for functional ability of the upper extremity and BADL (Basic Activities of Daily Living) on admission and after six weeks. On admission, eight of the patients suffered from a severe deficit, eight patients suffered from a moderate deficit, and four suffered from a mild deficit. By week 6, five patients had improved to the point where no deficit was discerned. Only two patients retained a severe deficit, whereas the remaining 13 patients retained moderate or mild deficits. In addition a significant improvement in the motor and functional ability of the upper extremity was found. Familiarity with these facts should help the clinician to establish more realistic therapeutic goals and to anticipate with greater accuracy the eventual treatment outcome.

Street Crossing by Typically Developed Children in Real and Virtual Environments

Pedestrian injury is the second leading cause of death and serious injury among children between the ages of 5 and 14. The existing methods for teaching children how to cross the street safely are difficult to transfer to real life situations. The objective of this study was to evaluate the effectiveness of a virtual reality (VR) environment in teaching children how to cross a street safely. Eighty-six children (55 girls and 31 boys), aged 7-12 years, participated in the study. The children were observed while crossing a real street and tested on a test in the virtual environment (VE) prior to and following VR training. The children in the training group significantly improved their street crossing abilities in the VR simulation as well as in the real street crossing in comparison to the control group. Street crossing became safer with age however, no differences were found between boys and girls. This low-cost and readily available street crossing simulation had a positive effect on childrens street crossing behavior and on their self-reported satisfaction

A Case Study of Videoconferencing in the Classroom: A Methodology for Measuring Interactions, Behaviors and Attitudes

Videoconferencing is a valuable educational resource because it provides access to otherwise unreachable learning materials, it motivates students, and helps them improve their communication skills. Over the last four years we have developed a unique application of videoconferencing known as Wayne Gretzkys PEBBLES (Providing Education By Bringing Learning Environments to Students). This is a video-mediated communication system that has been designed to link a child in the hospital with his/her regular classroom. Analysis of video tape data from a six-week case study documenting the frequency of interactions and usage behaviors indicate that the student was able to spend most of her in-class time focussing on the academic tasks assigned to the class despite some technical difficulties and distractions in her local environments. Audio difficulties persisted throughout the study and must be improved in future design iterations of the system.