VR and accessibility - literature analysis and categories for consideration

To the RQTF

Following up on the action item from two weeks ago, I've completed assessing the literature and finding a few more which are relevant so that we're in a position to draw together some broad points. I've put the new references in the right format to go on the wiki.

Building on what we've already covered, here's some thoughts on the primary categories with a bit more detail fleshed out.

Category 1 - Use of virtual reality by people with disabilities

1.1 The need to support people with disabilities in VR  through the use of assistive technologies (AT) in a similar way to how the interaction of AT and the mobile web or apps works now.

This requires the provision of accessible APIs to support AT, the provision of AT and the VR environment designed to work with the provided framework.  papers that discuss this generally look at VR as an extension of mobile apps (e.g Google Cardboard). As such the primary access discussion relates to the way in which AT built into the mobile devices works with the VR app and the implementation WCAG.

1.2 VR environment specifically set up for people with disabilities: This generally focuses on how VR can be used to help with learning outcomes for people with particular disabilities such as autism or intellectual disabilities whereby a customised VR environment is created to provide a comfortable and immersive environment with a particular focus on education. In most instances the environment is customised with the gamification of VR in mind to make education fun. This differs from 1.1 above in that the focus is on making the visual and audio elements accessible along with an instructional focus to support people with disabilities rather than an AT focus.

Category 2 - addition or removal of simulated real-world aids to support people with disabilities in VR

2.1 Using VR to remove the need for real-world aids

Papers that focused on Second Life and other more recent examples highlight the benefits to people with disabilities in being able to interact in a virtual environment without the need to use disability-related aids, such as the ability for a person that uses a wheelchair in the real world can walk effectively in the virtual one. The main requirement relates to the adjustment of the viewpoint whereby it would be lower for a person in a wheelchair, higher for a person standing or even higher if they wanted to fly or something completely unrestricted.

2.2 Using a virtual equivalent of a real-world aid in VR

Several papers discuss how real-world aids such as a sonic cane or wheelchair should be available in VR as users who rely on these aids in the real-world will be most comfortable in navigating virtual spaces with the same aids. While the user would have the option to leave the aids as noted in 2.1, the literature suggest at people with disabilities that use aids in the real-world are more comfortable and able to navigate more effectively, e.g. walking in the middle of a pathway if using a sonic cane rather than bumping into things, if such aids are available.

Category 3 - Simulation of disability in VR

3.1 Simulation of disability for learning

Several papers discuss how people that work in the disability sector and medical professionals can develop a better sense of understanding as to the needs of people with disabilities through VR simulations. Examples include the simulation of low vision or navigating a VR environment at the height level of a person in a wheelchair.

3.2 Simulation for the purposes of rehabilitation and training

This point looks at how people with disabilities can be supported in VR through the use of a simulation. For example, a person who has recently acquired a disability can use VR to test out interactions with everyday tasks and familiar environments in preparation for the equivalent real-world tasks.

Will be good to chat on the call as to what questions can be drawn out of this and the findings of others.

Incidentally the paper titled 'Rubber ball to cloud rehabilitation musing on the future of therapy
' listed below looks across pretty much all three categories so found this one particularly interesting.

Thanks everyone,

Scott.


Year: 2014
Title: Program that Prepares Students Who are Blind or Visually Impaired for College Highlights Opportunity, Teaches Independence
Place Published: Washington, D.C.
Short Title: Program that Prepares Students Who are Blind or Visually Impaired for College Highlights Opportunity, Teaches Independence


Year: 2017
Title: Information and Communication Technology (ICT) Standards and Guidelines
Place Published: Lanham
Volume: 82
Pages: 5790



Author: Amarasinghe, Akarshani and Wimalaratne, Prasad
Year: 2017
Title: An Assistive Technology Framework for Communication with Hearing Impaired Persons
Journal: GSTF Journal on Computing (JoC)
Volume: 5
Issue: 2
Pages: 1-7
DOI: 10.5176/2251-3043_5.2.362
Abstract:  This paper presents a novel assistive technology framework which provides an interface to support communication between hearing impaired person and ordinary person over the mobile phone. It converts the ordinary person's voice to text and afterward text to tactile feedback at the hearing impaired person's end. The Morse Code tactile feedback have been identified as the most appropriate method for providing the tactile feedback at the hearing impaired person's end, since it is a standard code which helps persons with impairments. The work addresses the challenge of using a set of Morse Code shorthand vibration patterns to translate the whole text message to tactile feedback to provide a simple, efficient and synchronous communication, rather than vibrating each and every character in text using Morse Code characters. The user evaluation found that, most hearing impaired persons' preferred method of conversation is the Morse Code shorthand forms with two or three character length rather than reading the entire text message. Due to less perspicuity of a hearing impaired person's voice, the study comes up with the conversion of the hearing impaired persons' voice to text and sends it to the ordinary person synchronously as a voice reply. The results of the evaluation experiment shows that the assistive technology framework facilitates by improving the quality of communication of hearing impaired persons over a mobile device.


Author: Burdea, Grigore C.
Year: 2009
Title: Rubber ball to cloud rehabilitation musing on the future of therapy
Pages: 50-50
DOI: 10.1109/ICVR.2009.5174204
Abstract: We can trace the origins of virtual rehabilitation to the late 80s when sensing gloves were used to determine the degree of hand tremor in patients with Parkinson, and virtual environments were investigated as a medium to train wheelchair navigation. At the first Medicine Meets Virtual Reality conference in San Diego in 1992, we proposed a unified system where sensing gloves were used to diagnose and train patients post hand surgery. Other researchers pioneered the use of virtual environments in phobias, attention deficit, post-traumatic stress and other conditions. In 1996 researchers interested primarily in VR phobia treatment started the CyberTherapy conference series, and VR-based physical therapy, occupational therapy, therapy for learning deficits, and amnesia were reported at the first International Conference on Disability, Virtual Reality and Associated Technologies. By 1997 the National Science Foundation funded a study of rehabilitation at a distance between Rutgers and Stanford universities, located on either side of the United States. These beginnings used color-coded virtual rubber balls and haptic gloves to program the mechanical work done by the patient's affected hand. An artificial separation existed in the clinical practice between physical or occupational rehabilitation and cognitive therapy, due in part to separate education tracks. Nonetheless virtual reality researchers realized that the same hardware could be used in either physical or cognitive rehabilitation, and all that needed changing was the simulation software used. We thus coined the term “virtual rehabilitation” to encompass the continuum of therapy. In 2002 the associated conference started in Switzerland as the International Workshop on Virtual Rehabilitation. This later became the Virtual Rehabilitation International Conference series which you are attending today. While “virtual rehabilitation” was initially met with some skepticism by therapists who were concerned patients will misunderstand it, nowadays the term is better understood. To help further recognition for this emerging field, a new society was formed in 2008, the International Society for Virtual Rehabilitation (www.isvr.org), which is a co-sponsor of this conference. The merging of physical/occupational therapy and cognitive therapy is not due solely to the modularity offered by the hardware and software used in virtual environments. Another cause is the fact that patients affected by certain neurologic and motor deficits often have psychological and other cognitive co-morbidities. A well known example is depression associated with some types of stroke or with societal isolation that often follows the inability to have regular employment. The same tele-rehabilitation systems that are projected for large scale use to train patients in their home, may also be used to reduce the sense of isolation. Video games that are now being investigated as a way to reinvigorate therapeutic interventions could also be used in future game “tournaments” among teams of people with disabilities, or among people with disabilities and their families and friends. Virtual environments could then be used to customize the games and allow a patient to succeed, greatly boosting morale. An extreme example is the use of virtual hand avatars controlled by people with amputated arms, an application which we pioneered back in 2003. Popular awareness of and demand for virtual rehabilitation is expected to grow, which in turn will trigger changes in the way therapists are educated and accredited. A new field of study will emerge, as will the way therapists and psychologists will be recertified. Certainly the way licensing, insurance, even liability clauses follow local geography is archaic, and a more global certification program is expected to emerge. The one-to-one paradigm of therapy will also change, with one therapist performing “multiplexed” tele-rehabilitation. This is expected to reduce treatment cost while also increasing access to therapeutic care worldwide. Certain technologies will need to advance to act as force multipliers and to help therapists handle the expected workload increase. One supporting technology will be home-based robots which will not only clean, cook and guard, but extend their use to provision of therapy, especially physical therapy. Advances in technology will provide the ability to take therapy anywhere, anytime, addressing current limitation due to geographical location, lack of transportation, limited therapist availability or endurance. This will be facilitated by the proliferation of portable computing/communication terminals coupled to powerful mega-servers, in what is called today “cloud computing.” We predict that cloud computing will be extended to “cloud rehabilitation” by transforming these portable devices into rehabilitation systems. In cloud rehabilitation the library of disability-specific software simulations or games will reside on a third-party “cloud” of web servers. This is where clinicians will log on to set up rehabilitation regimens, follow up patient progress, insure compliance and monitor safety. By concentrating software maintenance and licensing to a unified web structure, the current information technology problems that plague healthcare institutions will be alleviated, the portability of medical data improved and the defense against unauthorized access to medical data boosted. The way to cloud rehabilitation seems straightforward - new types of input devices to measure the patient's input, games that allow clinically meaningful variables to be stored and therapeutic regimens set and monitored, distributed databases storing medical data securely, reliable and encoded communication, and of course, more computer savvy patient and therapist populations.


Author: Chen, Min, Ma, Yujun, Song, Jeungeun, Lai, Chin-Feng and Hu, Bin
Year: 2016
Title: Smart Clothing: Connecting Human with Clouds and Big Data for Sustainable Health Monitoring
Journal: Mobile Networks and Applications
Volume: 21
Issue: 5
Pages: 825-845
DOI: 10.1007/s11036-016-0745-1
Abstract:  Traditional wearable devices have various shortcomings, such as uncomfortableness for long-term wearing, and insufficient accuracy, etc. Thus, health monitoring through traditional wearable devices is hard to be sustainable. In order to obtain healthcare big data by sustainable health monitoring, we design "Smart Clothing", facilitating unobtrusive collection of various physiological indicators of human body. To provide pervasive intelligence for smart clothing system, mobile healthcare cloud platform is constructed by the use of mobile internet, cloud computing and big data analytics. This paper introduces design details, key technologies and practical implementation methods of smart clothing system. Typical applications powered by smart clothing and big data clouds are presented, such as medical emergency response, emotion care, disease diagnosis, and real-time tactile interaction. Especially, electrocardiograph signals collected by smart clothing are used for mood monitoring and emotion detection. Finally, we highlight some of the design challenges and open issues that still need to be addressed to make smart clothing ubiquitous for a wide range of applications.


Author: Courbalay, Anne, Deroche, Thomas and Descarreaux, Martin
Year: 2017
Title: Estimating Pain and Disability in Virtual Patients with Low Back Pain: The Contribution of Nonverbal Behaviors
Journal: Journal of Nonverbal Behavior
Volume: 41
Issue: 3
Pages: 289-304
DOI: 10.1007/s10919-017-0254-3
Abstract: It is well recognized that chronic low back pain (cLBP) can be estimated from nonverbal pain behaviors. However, only a few studies examined how clinicians rely on those when estimating specific outcomes, such as pain intensity and pain disability. Therefore, the present study examines (1) if facial expressions and guarding behaviors (including speed of the movement and lifting strategy) contribute to the prediction of pain intensity and disability in patients with cLBP; and (2) if these pain behaviors have been given the same importance according to the outcome. Twenty-five experienced clinicians and thirty-one novice clinicians were asked to estimate low back pain intensity and disability from a realistic virtual character performing a lifting lowering task. The studied pain behaviors were manipulated across different conditions. Pain intensity and disability were judged higher when the character moved more slowly and displayed painful facial expression. Speed of the movement and facial expressions explained a greater portion of variance when related to pain intensity assessment than to pain disability assessment. Results also showed a significant interaction between the lifting strategy, the speed of the movement and facial expressions, but only when estimating the character's pain-related intensity. Novice clinicians rated pain disability higher than experienced clinicians did. Although pain-related concepts, pain intensity and related disability are not estimated through the same pain behaviors by clinicians. Clinical experience does not contribute to clinical judgments through the use of nonverbal pain behaviors when estimating pain outcomes but contributes to pain disability rating overall.


Author: Hakim, Renée M., Tunis, Brandon G. and Ross, Michael D.
Year: 2017
Title: Rehabilitation robotics for the upper extremity: review with new directions for orthopaedic disorders
Publisher: Taylor & Francis
Volume: 12
Pages: 765-771
DOI: 10.1080/17483107.2016.1269211
Abstract: AbstractImplications for RehabilitationThere is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders.The most promising approaches using rehabilitation robotics are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity.Based on the evidence in neurologic populations, virtual reality-enhanced robotics may be integrated with current concepts in orthopaedic rehabilitation shifting from an impairment-based focus to inclusion of more intense, task-specific training for patients with UE disorders, specifically emphasizing the wrist and hand.Clinical application of a task-oriented approach may be accomplished using commercially available haptic robotic device to focus on training of grasp and manipulation tasks. The focus of research using technological innovations such as robotic devices has been on interventions to improve upper extremity function in neurologic populations, particularly patients with stroke. There is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders. The most promising approaches are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity. Based on this evidence, we describe application and feasibility of virtual reality-enhanced robotics integrated with current concepts in orthopaedic rehabilitation shifting from an impairment-based focus to inclusion of more intense, task-specific training for patients with upper extremity disorders, specifically emphasizing the wrist and hand. The purpose of this paper is to describe virtual reality-enhanced rehabilitation robotic devices, review evidence of application in patients with upper extremity deficits related to neurologic disorders, and suggest how this technology and task-oriented rehabilitation approach can also benefit patients with orthopaedic disorders of the wrist and hand. We will also discuss areas for further research and development using a task-oriented approach and a commercially available haptic robotic device to focus on training of grasp and manipulation tasks. Implications for Rehabilitation There is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders. The most promising approaches using rehabilitation robotics are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity. Based on the evidence in neurologic populations, virtual reality-enhanced robotics may be integrated with current concepts in orthopaedic rehabilitation shifting from an impairment-based focus to inclusion of more intense, task-specific training for patients with UE disorders, specifically emphasizing the wrist and hand. Clinical application of a task-oriented approach may be accomplished using commercially available haptic robotic device to focus on training of grasp and manipulation tasks.


Author: Smart, Eric, Aulakh, Adeeta, McDougall, Carolyn, Rigby, Patty and King, Gillian
Year: 2017
Title: Optimizing engagement in goal pursuit with youth with physical disabilities attending life skills and transition programs: an exploratory study
Journal: Disability and Rehabilitation
Volume: 39
Issue: 20
Pages: 2029-2038
DOI: 10.1080/09638288.2016.1215558
Abstract: AbstractPurpose: Purpose: Identify strategies youth perceive will optimize their engagement in goal pursuit in life skills and transition programs using an engagement framework involving affective, cognitive, and behavioral components. Methods: Methods: A qualitative descriptive design was used. Two semi-structured interviews were conducted with seven youth. The first was informed by a prior observation session, and the second occurred after the program ended and explored youths' perceptions of whether and how their engagement changed. Data were analyzed using thematic analysis. Results: Results: The analysis generated eight strategies youth considered effective. These were categorized under the three components of engagement. Affective strategies: (1) building a relationship on familiarity and reciprocity; and (2) guiding the program using youths' preferences and strengths. Cognitive strategies: (3) assisting youth to envision meaningful change; (4) utilizing youths' learning styles; and (5) promoting awareness of goal progress. Behavioral strategies: (6) ensuring youth access to a resource network; (7) providing youth multiple decision opportunities; and (8) enabling youth to showcase capabilities. Conclusions:Implications for RehabilitationService providers are encouraged to be aware of the nature of engagement strategies identified by youth.Comprehensive frameworks of engagement are essential to generate knowledge on the range of strategies service providers can use to engage clients in rehabilitation services.Strategies perceived by youth to optimize their engagement in goal pursuit in life skills and transition programs have subtle yet significant differences with strategies used in other rehabilitation settings like mental health and adult healthcare services.Self-determination theory shows potential in guiding further research on exploring the role of engagement in maximizing rehabilitation outcomes. Conclusions: Service providers together with youth are encouraged to consider the role of context and self-determination needs in order to optimize youth engagement in goal pursuit. Systematic approaches to studying engagement are necessary to learn how to maximize rehabilitation potential. Implications for Rehabilitation Service providers are encouraged to be aware of the nature of engagement strategies identified by youth. Comprehensive frameworks of engagement are essential to generate knowledge on the range of strategies service providers can use to engage clients in rehabilitation services. Strategies perceived by youth to optimize their engagement in goal pursuit in life skills and transition programs have subtle yet significant differences with strategies used in other rehabilitation settings like mental health and adult healthcare services. Self-determination theory shows potential in guiding further research on exploring the role of engagement in maximizing rehabilitation outcomes.


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