Sara Arlati

Virtual Environments for Cognitive and Physical Training in Elderly with Mild Cognitive Impairment: A Pilot Study

This work aims at providing an evaluation of the acceptability and the usability of a virtual reality-based intervention developed for the physical and cognitive training of mild cognitive impaired elderlies. To perform this evaluation, participants enrolled in the intervention group (n = 4) of a randomized controlled trial to test the system were interviewed, and their adherence and their performances in the virtual environments for cognitive training were evaluated. In spite of the small sample, the active participation and the unanimous positive judgement of all the participants led to the conclusion that the training program was well accepted and enjoyable. Participants also claimed reduced level of anxiety in their ADL. On the basis of these encouraging results, a second trial, with enlarged sample and with a system implementing the improvements required to overcome the limitations and the problems highlighted with this pilot study, will be performed in the next future.

A virtual reality system for strengthening awareness and participation in rehabilitation for post-stroke patients

This paper presents a system called REAPP, a virtual environment aiming at supporting upper-limb robotic neurorehabilitation for post-stroke patients. In the last few years different systems using either or both virtual environments and robots have been developed. However, such advanced systems often lack attention on the physical and psychological conditions perceived by the patient, who should be the key focus in therapies. In this context, REAPP aims not to be just an entertaining interface but also a means to investigate patients’ feelings toward the therapy and to enhance their self-perception while performing the rehabilitation exercises. Before and after the rehabilitation session the patients are inquired about their emotional state, their physical condition and a self-evaluation of the performance is done. While performing the exercises patients look at a 2D/3D interface which has the aim of enhancing their self-awareness by showing them, through an avatar, the movements they are doing. Widgets and a virtual assistant provide additional feedback about the quality of the movements which is computed through a specifically developed arm model that can be customized on the residual capabilities of each patient.

Enhancing awareness and personification by virtual reality and multimedia means in post-stroke patients during rehabilitation

The use of mechanical/robotic devices and of IT based applications in the post-stroke rehabilitation is one of the main challenges in applied research in health sector. Among the wide spectrum of systems, it seems that the focus is still much on the system itself, as a technological whole, and less on the key actor, that is the patient. In this paper a supporting system for post-stroke rehabilitation, based on a 2D/3D real time interface, is presented. It aims at enhancing the point of view of the patients by showing them the movements they are performing through an avatar and by presenting some qualitative aspects of the exercises that can help the patients to be more aware of, and eventually improve, their performance.

Quantitative EEG and Virtual Reality to Support Post-stroke Rehabilitation at Home

Post-stroke rehabilitation has an enormous impact on health services worldwide because of the high prevalence of stroke, in continuous growth due to the progressive population aging. Systems for neuro-motor rehabilitation at home can help reduce the economic burden of long lasting treatment in chronic post-stroke patients; however the efficacy of these systems in providing a correct and effective rehabilitation should be established. From this point of view, coupling home rehabilitation systems with quantitative EEG methodologies for objectively characterizing patients’ cerebral activity could be useful for the clinician to optimize the rehabilitation protocol and assess its efficacy. Moreover, the use of virtual/augmented reality technologies could assist the patients during unsupervised rehabilitation by providing an empathic feedback to improve their adherence to the treatment. These two aspects were studied and implemented in RIPRENDO@home, a multidisciplinary project, aimed to develop an integrated technological platform oriented to home neurorehabilitation for stroke patients.

Characteristics, Usability, and Users Experience of a System Combining Cognitive and Physical Therapy in a Virtual Environment: Positive Bike

We present the architecture and usability evaluation of virtual reality system—“Positive Bike”—designed for improving cognitive and motor conditions in frail elderly patients. The system consists of a cycle-ergometer integrated in an immersive virtual reality system (CAVE) which allows combining motor and cognitive exercises according to a “dual-task” paradigm. We tested the usability and user’s experience of the prototype in a pilot evaluation study that involved five elderly patients. The prototype was tested in one-session training to understand the limitations and areas for improvement of our system. The evaluation consisted in (i) usability assessment using the system usability scale; (ii) evaluation of user’s engagement using the flow state scale; and (iii) expert evaluation involving interviews with domain experts. Results showed a good usability, both for system usability scale and the semi-structured interview. The level of flow (i.e., enjoyment with the task at hand) measured using the short flow state scale, was also high. Analysis of semi-structured interview carried out with domain experts provided further indications to improve the system. Overall, these findings show that, despite some limitations, the system is usable and provides an enjoyable user’s experience.

VirtualCruiseTour: An AR/VR Application to Promote Shore Excursions on Cruise Ships

This work presents VirtualCruiseTour, an AR/VR-based application dedicated to ship cruises’ guests for the promotion of organized shore excursions. It can be exploited also in travel agencies to showcase future customers the sites of interest that can be visited during the cruise. The AR module allows augmenting a map showing the cruise route, the ship current position and the ports in which the liner will stop. Tapping one of the port (or the ship), the user is shown more details about the shore excursions organized for that stop (or the ship facilities) and has the chance to experience the site of interests watching 360° pictures or videos either in an immersive (VR) or non-immersive mode. A pilot study to validate the application as a marketing tool is foreseen. The experiment evaluates the customers’ purchase intentions and their knowledge of the product in comparison to traditional marketing media (web sites and brochures). Preliminary results of the study conducted enrolling nine participants are presented and discussed.

Sense of Presence and Cybersickness While Cycling in Virtual Environments: Their Contribution to Subjective Experience

Head mounted displays (HMDs) are visualization devices that provide high levels of immersion in virtual environments (VEs), which have been recently used to enhance the experience of subjects performing a physical exercise. However, the use of these devices in rehabilitation is discussed as it could cause cybersickness and other physical drawbacks. In this context, we conducted a preliminary study investigating the experiences of navigating in the same VEs using a cycle-ergometer and either a projected screen (PS) or a HMD, considering whether the “the Sense of Presence” influenced the device’s preference. Thirty-three healthy young adults were enrolled and randomized in four groups to counterbalance the two conditions and to investigate the effects of 5-days washout. Most of the subjects (n = 26) preferred the HMD with respect to PS; sense of presence was higher using HMD than using projector (t = −11.47, p < 0.001), but the difference between conditions was higher for those who preferred the HMD (t = −14.64, p < 0.001), compared to those who chose projector (t = −2.70, p < 0.05). The correlation of presence with cybersickness revealed that, despite higher levels of sickness, sense of presence probably counts more in choosing the HMD as the preferred device.

Effects of Combined Physical and Cognitive Virtual Reality-Based Training on Cognitive Impairment and Oxidative Stress in MCI Patients: A Pilot Study

The growing elderly population and the increased incidence of mild cognitive impairment (MCI) and Alzheimer’s disease (AD) call for the improvement of the quality and the efficacy of the healthcare and social support services. Exercise and cognitive stimulation have been demonstrated to mitigate cognitive impairment and oxidative stress (OxS) has been recognized as a factor that contributes to the advancement of neurodegenerative diseases. Taking these aspects into account, the impact of a novel virtual reality (VR)-based program combining aerobic exercise and cognitive training has been evaluated in the pilot study proposed here. Ten patients (aged 73.3 ± 5.7 years) with MCI (Mini-Mental State Examination, MMSE: 23.0 ± 3.4) were randomly assigned to either 6 weeks physical and cognitive training (EXP) or control (CTR) group. Evaluations of cognitive profile, by a neuropsychological tests battery, and OxS, by collection of blood and urine samples, were performed before and at the end of the experimental period. The assessment of the patients’ opinions toward the intervention was investigated through questionnaires. EXP group showed a tendency towards improvements in the MMSE, in visual-constructive test and visuo-spatial tests of attention, while CTR worsened. EXP group showed a greater improvement than CTR in the executive test, memory functions and verbal fluency. No statistical significance was obtained when comparing within and between both the groups, probably due to small number of subjects examined, which amplifies the effect of the slight heterogeneity in scores recorded. Despite a greater worsening of Daily Living Activities tests, all participants reported a better performance in real life, thanks to the elicited self-perceived improvement. After training intervention OxS (i.e., reactive oxygen species (ROS) production, oxidative damage of lipids and DNA) decreased resulting in significantly (range p < 0.05–0.001) lower in EXP vs. CTR group. Although not conclusive, the recorded effects in the present study are promising and suggest that this proposal would be a useful tool in support of cognitive training reducing OxS too. However, further studies on larger scale samples of patients are needed.

A Virtual Reality-Based Physical and Cognitive Training System Aimed at Preventing Symptoms of Dementia

This work presents a physical and cognitive training program, based on virtual reality technologies, designed with the aim of preventing the occurrence of symptoms of dementia in elderly with Mild Cognitive Impairment (MCI). The system foresees a physical task to be performed on a cycle-ergometer and two virtual environments for cognitive stimulation. In this paper, results of different validation phases conducted on both healthy and MCI subjects are described. The presented validation path allowed to implement, in parallel, the two current versions of the setup: the former, optimized to assess the efficacy of the intervention in a randomized clinical trial, which will take place in the next future, and the latter, more experimental, which foresees the employment of immersive environments to increase subjects’ engagement and motivation.

Semantic and Virtual Reality-Enhanced Configuration of Domestic Environments: The Smart Home Simulator

This paper introduces the Smart Home Simulator, one of the main outcomes of the D4All project. This application takes into account the variety of issues involved in the development of Ambient Assisted Living (AAL) solutions, such as the peculiarity of each end-users, appliances, and technologies with their deployment and data-sharing issues. The Smart Home Simulator—a mixed reality application able to support the configuration and customization of domestic environments in AAL systems—leverages on integration capabilities of Semantic Web technologies and the possibility to model relevant knowledge (about both the dwellers and the domestic environment) into formal models. It also exploits Virtual Reality technologies as an efficient means to simplify the configuration of customized AAL environments. The application and the underlying framework will be validated through two different use cases, each one foreseeing the customized configuration of a domestic environment for specific segments of users.