Richard M. Eastgate

Applied virtual environments to support learning of social interaction skills in users with Asperger's Syndrome

Aspergers Syndrome (AS) is an autistic spectrum disorder characterised by normal to high IQ but with marked impairment in social skills. Successful social skills training appears to be best achieved either in situ or in role-play situations where users can explore different outcomes resulting from their social behaviour. Single user virtual environments (SVEs) provide an opportunity for users with AS to learn social interaction skills in a safe environment which they can visit as many times as they like.The use of game-like tasks can provide an incentive and can also be used to guide the user through progressive learning stages. Collaborative virtual environments (CVEs) allow several users to interact simultaneously within the virtual environment, each taking different perspectives or role-play characters. Within the AS interactive project a series of SVEs and CVEs have been developed in collaboration with users and professional groups with an overall aim of supporting social skills learning. Initial evaluation studies have been carried out which have been used to both inform and refine the design of these virtual environments (VEs) as well as giving an insight into the understanding and interpretation of these technologies by users with AS.

Preliminary results from the use of the novel interactive binocular treatment (I-BiT) system, in the treatment of strabismic and anisometropic amblyopia

BackgroundWe have developed a novel application of adapted virtual reality (VR) technology, for the binocular treatment of amblyopia. We describe the use of the system in six children.MethodsSubjects consisted of three conventional treatment ‘failures’ and three conventional treatment ‘refusers’, with a mean age of 6.25 years (5.42–7.75 years). Treatment consisted of watching video clips and playing interactive games with specifically designed software to allow streamed binocular image presentation.ResultsInitial vision in the amblyopic eye ranged from 6/12 to 6/120 and post-treatment 6/7.5 to 6/24-1. Total treatment time was a mean of 4.4 h. Five out of six children have shown an improvement in their vision (average increase of 10 letters), including those who had previously failed to comply with conventional occlusion.ConclusionsImprovements in vision were demonstrable within a short period of time, in some children after 1 h of treatment. This system is an exciting and promising application of VR technology as a new treatment for amblyopia.

Modified virtual reality technology for treatment of amblyopia

PurposeThe conventional patching/occlusion treatment for amblyopia sometimes gives disappointing results for a number of reasons: it is unpopular, prolonged, frequently resulting in poor or noncompliance, and also disrupts fusion. The aim of this research was to develop a novel virtual-reality (VR)-based display system that facilitates the treatment of amblyopia with both eyes stimulated simultaneously.MethodsWe have adopted a multidisciplinary approach, combining VR expertise with a team of ophthalmologists and orthoptists to develop the Interactive Binocular Treatment (I-BiT™) system. This system incorporates adapted VR technology and specially written software providing interactive 2D and 3D games and videos to the patient via a stereo (binocular) display, and a control screen for the clinician.ResultsWe developed a prototype research system designed for treatment of amblyopia in children.ConclusionsThe result is a novel way to treat amblyopia, which allows binocular treatment. It is interactive, and as it is partially software based, can be adapted to suit the age/ability, and needs of the patient. This means that the treatment can be made captivating and enjoyable. Further research is on-going to determine the efficacy of this new modality in the treatment of amblyopia.

Mixed reality environments in stroke rehabilitation: Interfaces across the real/virtual divide

Previous studies have examined the use of virtual environments (VEs) for stroke and similar rehabilitation. To be of real benefit it is essential that skills (re-)learned within a VE transfer to corresponding real-world situations. Many tasks have been developed in VEs, but few have shown effective transfer of training. We believe that, by softening the real/virtual divide, mixed reality technology has the potential to ease the transfer of rehabilitation activities into everyday life. We present two mixed reality systems, designed to support rehabilitation of activities of daily living and providing different mixtures of digital and physical information. Functional testing of these systems is described. System development and user evaluation continues, some of which is described in a sister paper (Edmans et al 2004) in this volume.

Manufacturing operations in virtual environments move

During the past 2 years, the way in which industry views virtual reality (VR) has changed. Previously, only a few large companies were assessing virtual environments either as internal marketing exercises or through demonstration worlds built for them by outside consultants or universities; most other industrialists may have seen VR as only having entertainment applications. Now there is some evidence that parts of industry, and manufacturing industry in particular, see VR as an increasingly affordable technology with potentially wide-ranging applications. This paper briefly describes a recent U.K. research program MOVE (Manufacturing Operations in Virtual Environments) consisting of an industrial VR user survey and demonstration applications built to allow potential users to make informed assessments of virtual environments. Two particular applications—training for maintenance and rapid prototyping for product design—are described in greater detail as examples of industrially relevant environments, before an assessment is provided of potential VR application in manufacturing.

Interactive binocular treatment (I-BiT) for amblyopia: results of a pilot study of 3D shutter glasses system.

PurposeA computer-based interactive binocular treatment system (I-BiT) for amblyopia has been developed, which utilises commercially available 3D ‘shutter glasses’. The purpose of this pilot study was to report the effect of treatment on visual acuity (VA) in children with amblyopia.MethodsThirty minutes of I-BiT treatment was given once weekly for 6 weeks. Treatment sessions consisted of playing a computer game and watching a DVD through the I-BiT system. VA was assessed at baseline, mid-treatment, at the end of treatment, and at 4 weeks post treatment. Standard summary statistics and an exploratory one-way analysis of variance (ANOVA) were performed.ResultsTen patients were enrolled with strabismic, anisometropic, or mixed amblyopia. The mean age was 5.4 years. Nine patients (90%) completed the full course of I-BiT treatment with a mean improvement of 0.18 (SD=0.143). Six out of nine patients (67%) who completed the treatment showed a clinically significant improvement of 0.125 LogMAR units or more at follow-up. The exploratory one-way ANOVA showed an overall effect over time (F=7.95, P=0.01). No adverse effects were reported.ConclusionThis small, uncontrolled study has shown VA gains with 3 hours of I-BiT treatment. Although it is recognised that this pilot study had significant limitations—it was unblinded, uncontrolled, and too small to permit formal statistical analysis—these results suggest that further investigation of I-BiT treatment is worthwhile.

Evaluation and development of a novel binocular treatment (I-BiT™) system using video clips and interactive games to improve vision in children with amblyopia ('lazy eye'): study protocol for a randomised controlled trial

BackgroundAmblyopia (lazy eye) affects the vision of approximately 2% of all children. Traditional treatment consists of wearing a patch over their ‘good’ eye for a number of hours daily, over several months. This treatment is unpopular and compliance is often low. Therefore results can be poor. A novel binocular treatment which uses 3D technology to present specially developed computer games and video footage (I-BiT™) has been studied in a small group of patients and has shown positive results over a short period of time. The system is therefore now being examined in a randomised clinical trial.Methods/designSeventy-five patients aged between 4 and 8 years with a diagnosis of amblyopia will be randomised to one of three treatments with a ratio of 1:1:1 - I-BiT™ game, non-I-BiT™ game, and I-BiT™ DVD. They will be treated for 30 minutes once weekly for 6 weeks. Their visual acuity will be assessed independently at baseline, mid-treatment (week 3), at the end of treatment (week 6) and 4 weeks after completing treatment (week 10). The primary endpoint will be the change in visual acuity from baseline to the end of treatment. Secondary endpoints will be additional visual acuity measures, patient acceptability, compliance and the incidence of adverse events.DiscussionThis is the first randomised controlled trial using the I-BiT™ system. The results will determine if the I-BiT™ system is effective in the treatment of amblyopia and will also determine the optimal treatment for future development.Trial registrationClinicalTrials.gov identifier: NCT01702727

Randomised controlled trial of video clips and interactive games to improve vision in children with amblyopia using the I-BiT system

Background Traditional treatment of amblyopia involves either wearing a patch or atropine penalisation of the better eye. A new treatment is being developed on the basis of virtual reality technology allowing either DVD footage or computer games which present a common background to both eyes and the foreground, containing the imagery of interest, only to the amblyopic eye. Methods A randomised control trial was performed on patients with amblyopia aged 4–8 years with three arms. All three arms had dichoptic stimulation using shutter glass technology. One arm had DVD footage shown to the amblyopic eye and common background to both, the second used a modified shooter game, Nux, with sprite and targets presented to the amblyopic eye (and background to both) while the third arm had both background and foreground presented to both eyes (non-interactive binocular treatment (non-I-BiT) games). Results Seventy-five patients were randomised; 67 were residual amblyopes and 70 had an associated strabismus. The visual acuity improved in all three arms by approximately 0.07 logMAR in the amblyopic eye at 6 weeks. There was no difference between I-BiT DVD and non-I-BiT games compared with I-BiT games (stated primary outcome) in terms of gain in vision. Conclusions There was a modest vision improvement in all three arms. Treatment was well tolerated and safe. There was no difference between the three treatments in terms of primary stated outcomes but treatment duration was short and the high proportion of previously treated amblyopia and strabismic amblyopia disadvantaged dichoptic stimulation treatment. Trial registration number NCT01702727, results.

User Involvement in Design and Application of Virtual Reality Gamification to Facilitate the Use of Hearing Aids

The 3D Tune-In project aims to create an innovative toolkit based on 3D sound, visuals and gamification techniques to facilitate different target audiences in understanding and using the varied settings of their hearing aid to attain optimum performance in different social contexts. In the early stages of project development, hearing aid (HA) users participated in activities to identify user requirements regarding the difficulties and issues they face in everyday situations due to their hearing loss. The findings from questionnaire and interview studies and identification of current personas and scenarios of use indicate that the project can clearly and distinctly support the requirements of people with hearing loss as well as improve the general publics understanding of hearing loss. Five Future Scenarios of use have been derived to describe how the technologies and games to be developed by the 3D Tune-In project will address these requirements.

Design and Development of a Virtual-Reality Based System for Improving Vision in Children with Amblyopia

Amblyopia, commonly known as ‘lazy eye’, is traditionally treated in children by wearing an adhesive patch over the non-amblyopic eye for several hours a day, over a period of many months. A novel treatment method, involving interactive game-play and watching a movie clip presented within a virtual television, has been used to offer a specially developed binocular stimulus to the child. This is achieved by using adapted virtual reality (VR). Uniquely the child has both eyes open for the treatment; there is no covering of the non-amblyopic eye, as per traditional treatments. Preliminary studies indicate positive vision improvement and adaptation of this technology offers potential for a wider range of applications in vision assessment and treatment. This chapter describes the nature of amblyopia and conventional treatment, presents a rationale for application of VR technology to provide a novel treatment method, describes design and development of the I-BiT® system for treatment of amblyopia, and summarises treatment case studies to date.