Powered wheelchair simulator development: implementing combined navigation-reaching tasks with a 3D hand motion controller

Clinical stakeholders' perspective for the integration of an immersive wheelchair simulator as a clinical tool for powered wheelchair training

This study aimed to investigate clinical stakeholders' acceptance of an immersive wheelchair simulator as a potential powered wheelchair skills training tool. Focus groups, conducted in four rehabilitation centers, were used to obtain a rich understanding of participants' experiences and beliefs. Then, a cross-sectional survey of the simulator acceptability for clinical practice was created. Twenty-three rehabilitation therapists and clinical program directors participated in the focus groups and thirty-three responded to the survey. Participants generally expressed that use of the simulator would be complementary to training in an actual powered wheelchair, and that it could be useful for challenging situations in rehabilitation centers (e.g. anxious clients; when there is uncertainty around their potential to drive a powered wheelchair; tasks that cannot be assessed in a real-life environment). They also provided suggestions to improve the simulator (e.g. more feedback during tasks; possibility of adjusting control settings such as speed and sensitivity; possibility of adding varied control interfaces). Feedback received from key stakeholders clearly indicated that the wheelchair simulator would be complementary to training provided in a real context of use. However, some important limitations must be addressed to improve the simulator and promote its adoption by clinical programs, therapists and clients.

Pediatric powered mobility training: powered wheelchair versus simulator-based practice

METHOD

Participants included 30 children and adolescents (23 males, 13 females) with cerebral palsy and other neuromuscular diseases, aged 6-18. Data were collected and compared at baseline and after 12 weeks of home-based practice via a powered wheelchair or a simulator. Powered mobility ability was determined by the Powered Mobility Program (PMP), the Israel Ministry of Health's Powered Mobility Proficiency Test (PM-PT) and the Assessment of Learning Powered Mobility (ALP).

RESULTS

All participants practiced for the required amount of time and both groups reported a similar user experience. Both groups achieved significant improvement following the practice period as assessed by the PMP and PM-PT assessments, with no significant differences between them. A significant improvement was found in the ALP assessment outcomes for the powered wheelchair group only.

CONCLUSIONS

This is the first study, to our knowledge, that compares two different wheelchair training methods. Simulator-based practice is an effective training option for powered mobility for children with physical disabilities aged 6-18 years old, demonstrating that it is possible to provide driving skill practice opportunities safe, controlled environments.

The More, the Better? Improving VR Firefighting Training System with Realistic Firefighter Tools as Controllers

A virtual reality (VR) controller plays a key role in supporting interactions between users and the virtual environment. This paper investigates the relationship between the user experience and VR control device modality. We developed a VR firefighting training system integrated with four control devices adapted from real firefighting tools. We iteratively improved the controllers and VR system through a pilot study with six participants and conducted a user study with 30 participants to assess two salient human factor constructs—perceived presence and cognitive load—with three device modality conditions (two standard VR controllers, four real tools, and a hybrid of one real tool and one standard VR controller). We found that having more realistic devices that simulate real tools does not necessarily guarantee a higher level of user experience, highlighting a strategic approach to the development and utilization of VR control devices. Our study gives empirical insights on establishing appropriate combinations of VR control device modality in the context of field-based VR simulation and training.

Immersive virtual reality health games: a narrative review of game design

BACKGROUND

High quality head-mounted display based virtual reality (HMD-VR) has become widely available, spurring greater development of HMD-VR health games. As a behavior change approach, these applications use HMD-VR and game-based formats to support long-term engagement with therapeutic interventions. While the bulk of research to date has primarily focused on the therapeutic efficacy of particular HMD-VR health games, how developers and researchers incorporate best-practices in game design to achieve engaging experiences remains underexplored. This paper presents the findings of a narrative review exploring the trends and future directions of game design for HMD-VR health games.

METHODS

We searched the literature on the intersection between HMD-VR, games, and health in databases including MEDLINE, Embase, CINAHL, PsycINFO, and Compendex. We identified articles describing HMD-VR games designed specifically as health applications from 2015 onwards in English. HMD-VR health games were charted and tabulated according to technology, health context, outcomes, and user engagement in game design.

FINDINGS

We identified 29 HMD-VR health games from 2015 to 2020, with the majority addressing health contexts related to physical exercise, motor rehabilitation, and pain. These games typically involved obstacle-based challenges and extrinsic reward systems to engage clients in interventions related to physical functioning and pain. Less common were games emphasizing narrative experiences and non-physical exercise interventions. However, discourse regarding game design was diverse and often lacked sufficient detail. Game experience was evaluated using primarily ad-hoc questionnaires. User engagement in the development of HMD-VR health games primarily manifested as user studies.

CONCLUSION

HMD-VR health games are promising tools for engaging clients in highly immersive experiences designed to address diverse health contexts. However, more in-depth and structured attention to how HMD-VR health games are designed as game experiences is needed. Future development of HMD-VR health games may also benefit from greater involvement of end-users in participatory approaches.

Simulation System of Electric-Powered Wheelchairs for Training Purposes

For some people with severe physical disabilities, the main assistive device to improve their independence and to enhance overall well-being is an electric-powered wheelchair (EPW). However, there is a necessity to offer users EPW training. In this work, the Simcadrom is introduced, which is a virtual reality simulator for EPW driving learning purposes, testing of driving skills and performance, and testing of input interfaces. This simulator uses a joystick as the main input interface, and a virtual reality head-mounted display. However, it can also be used with an eye-tracker device as an alternative input interface and a projector to display the virtual environment (VE). Sense of presence, and user experience questionnaires were implemented to evaluate this version of the Simcadrom in addition to some statistical tests for performance parameters like: total elapsed time, path following error, and total number of commands. A test protocol was proposed and, considering the overall results, the system proved to simulate, very realistically, the usability, kinematics, and dynamics of a real EPW in a VE. Most subjects were able to improve their EPW driving performance in the training session. Furthermore, all skills learned are feasible to be transferred to a real EPW.

Virtual Reality to Foster Social Integration by Allowing Wheelchair Users to Tour Complex Archaeological Sites Realistically

People with disabilities encounter numerous barriers when dealing with the simplest and most usual things in their daily lives. This is even more remarkable when they are faced with archaeological heritage buildings or environments. People with reduced mobility come too often upon architectural barriers that stop them from enjoying their visits to sites and monuments. This paper introduces a virtual reality (VR) experience developed to provide people in wheelchairs with the most realistic sensations while virtually touring some archaeological sites. To this end, the remote sensing of the site enables the production of a realistic 3D model leading to the creation of a virtual world that the user will explore. This VR application has been developed to traverse one of the most important monumental buildings in Spanish Protohistory, the site of Cancho Roano (Zalamea de la Serena, Spain).

Eye-controlled, power wheelchair performs well for ALS patients

BACKGROUND

Our pilot study tested the feasibility and performance of an eye-controlled power wheelchair for amyotrophic lateral sclerosis (ALS) patients.

METHODS

In this prospective pilot study, participants drove the wheelchair three times around an indoor course. We assessed the time to complete the course; starting and stopping on command; turning 90, 135, and 180 degrees; time to backup; and obstacle negotiation. Following their use of the wheelchair, subjects were given a questionnaire to assess user experience.

RESULTS

Twelve patients participated, and all were able to complete three trials without difficulty. Eight participants completed all of the individual tasks (eg, turning, stopping, etc.) without any errors. Overall performance ratings were high across all participants (4.6/5-excellent).

CONCLUSIONS

Our eye-controlled power wheelchair prototype is feasible and has a very favorable user experience. This system has the potential to improve the mobility and independence of ALS patients, and other groups with motor impairments.

A scoping review of powered wheelchair driving tasks and performance-based outcomes

Introduction: Wheelchairs and scooters promote participation and have positive effects on quality of life. However, powered wheelchairs (PW) use can be challenging and can pose safety concerns. Adequate PW assessment and training is important. There is a wide variety of tasks and PW driving assessment measures used for training and assessing PW driving ability in the literature and little consensus as to which tasks and outcomes are the most relevant. A scoping review of the literature was performed in order to characterize this extensive variety of tasks and performance-based outcomes used for training and assessing PW skills.Methods: A search of the literature was conducted in January 2017. Four databases were searched: CINAHL, Embase, PsycInfo and Medline. Articles were included if they contained at least one PW driving task.Results: 827 articles were screened and 48 articles were retained. PW driving tasks from each article were identified and categorized in terms of the environment in which they were performed: Driving in a controlled environment, ecological driving tasks, 2D virtual environment (VE) tasks, 3D VE tasks. The assessment measures formed a separate category. Subjective and objective performance-based outcomes related to PW driving were also identified and grouped into outcomes assessing speed and outcomes assessing accuracy.Conclusion: This scoping review provides an overview of tasks and performance outcomes used in the literature when training and assessing PW skills. The results of this review could guide future research when choosing appropriate tasks and performance outcomes for PW driving ability.Implications for rehabilitationThere is wide variety of tasks and performance-based outcomes for PW driving.Results showed that available assessment measures are not commonly used in research and that tasks used often lacked consistency across studies.New methods to measure the interaction of speed and accuracy are needed.The contents of this review could be used by researchers as a starting point when designing a PW task and selecting appropriate performance-based outcomes.

Investigating the Reliability and Validity of Three Novel Virtual Reality Environments With Different Approaches to Simulate Wheelchair Maneuvers

Wheelchair manoeuvring has received little attention in the literature despite its importance in mobility and performing activities of daily living and its role in developing secondary injuries for wheelchair users. The focus in this paper was technology development with iterative and proof-of-concept testing. Three versions of a wheelchair simulator that were designed and developed for simulating curvilinear wheelchair propulsion in virtual reality were tested for their validity and reliability. The wheelchair simulators comprise a sophisticated wheelchair ergometer in an immersive virtual reality environment and are developed for manual wheelchair propulsion. These simulators all replicate inertia in translation, in addition to taking three approaches for simulating turning. The three systems were then tested and compared with the real world to see how reliable and valid they are; 15 healthy participants were recruited to perform the Illinois Agility Test (IAT) in two sessions that were at least one week apart. The intraclass correlation coefficient and the Pearson correlation coefficient were found for 16 variables to find the test-retest reliability and convergent construct validity of the systems, respectively. Overall, the three systems showed good validity and reliability with the VR_system 2 (mechanical compensation for rotational inertia) having the best scores and the VR_system 3 (software compensation for rotational inertia) having the lowest scores. Also, it was observed that performing IAT in the real world needed fewer pushes and often accompanied more negative pushes. Participants also used longer strokes in the real world compared to virtual reality environment.

Virtual reality-based wheelchair simulators: A scoping review

Sense of presence (SoP) has recently emerged as one of the key elements promoting the effectiveness of virtual reality-based training programs. In the context of wheelchair simulators (WSs), the effectiveness of the simulation has been sought using different perception and interaction devices, providing the end-users with different levels of SoP. We performed a scoping review searching scientific and grey literature databases with the aim of assessing the extent of published research dealing with SoP and effectiveness of WSs. Sixty-two articles, describing 29 WSs, were included in the review. In spite of promising results, the high heterogeneity of the employed technological solutions, of the training programs and of their outcomes precluded drawing definitive conclusions about the optimal solution for the enhancement of SoP and thus of WSs' effectiveness. Future research should focus on controlled trials in order to help researchers in assessing the most suitable technologies and methodologies for the application of WSs in clinical practice.

Analysis for the design of a novel integrated framework for the return to work of wheelchair users

BACKGROUND

Return to work represents an important milestone for workers who were injured during a workplace accident, especially if the injury results in needing a wheelchair for locomotion.

OBJECTIVE

The aim of the study was to design a framework for training novice wheelchair users in regaining autonomy in activities of daily living and in the workplace and for providing medical personnel with objective data on users' health and work-related capabilities.

METHODS

The framework design was accomplished following the "Usability Engineering Life Cycle" model. According to it, three subsequent steps defined as "Know your User", "Competitive Analysis" and "Participatory Design" have been carried out to devise the described framework.

RESULTS

The needs of the end-users of the framework were identified during the first phase; the Competitive Analysis phase addressed standard care solutions, Virtual Reality-based wheelchair simulators, the current methodologies for the assessment of the health condition of people with disability and the use of semantic technologies in human resources. The Participatory Design phase led to the definition of an integrated user-centred framework supporting the return to work of wheelchair users.

CONCLUSION

The results of this work consists in the design of an innovative training process based on virtual reality scenarios and supported by semantic web technologies. In the near future, the design process will proceed in collaboration with the Italian National Institute for Insurance against Accidents at Work (INAIL). The whole framework will be then implemented to support the current vocational rehabilitation process within INAIL premises.

Virtual reality for activities of daily living training in neurorehabilitation: a usability and feasibility study in healthy participants

After severe injury or neurodegenerative disorders patients often experience long-term functional deficits, resulting in a reduction o performance in activities of daily living (ADL). Given their direct relevance to everyday functioning and quality of life, neurorehabilitative programs using simulated ADL's have seen increased interest recently. One of the core elements in simulated ADL's is the interface between the user and the virtual environment, which has a high impact on the therapeutic outcome. The aim of this study was to nalyze the feasibility of a simple virtual ADL (tea preparation task) using two different input devices. The tea preparation task setup consisted of a computer rendering the virtual environment, a head-mounted display (HMD) to visually present the ADL, and two input devices (mouse and handheld controller) to guide virtual hands in the virtual environment. A total of 24 healthyyoung adults performed the tea preparation task after which workload, usability, immersion and presence was rated. The handheld controller was rated significantly lower workload and higher usability than the mouse input device. Also, the sense of being there (immersion) and spatial presence ratings for the task and setup were close to the maximum score of 5. Thus, the handheld controller outperformed the mouse, suggesting that user interaction in the virtual environment with the handheld controller is similar to the real world and intuitive to use. Overall, the simulated ADL implemented with VR technology is feasible for diagnostic and rehabilitative purposes in patients experiencing long-term functional deficits.

Development of Three Versions of a Wheelchair Ergometer for Curvilinear Manual Wheelchair Propulsion Using Virtual Reality

Although wheelchair ergometers provide a safe and controlled environment for studying or training wheelchair users, until recently they had a major disadvantage in only being capable of simulating straight-line wheelchair propulsion. Virtual reality has helped overcome this problem and broaden the usability of wheelchair ergometers. However, for a wheelchair ergometer to be validly used in research studies, it needs to be able to simulate the biomechanics of real world wheelchair propulsion. In this paper, three versions of a wheelchair simulator were developed. They provide a sophisticated wheelchair ergometer in an immersive virtual reality environment. They are intended for manual wheelchair propulsion and all are able to simulate simple translational inertia. In addition, each of the systems reported uses a different approach to simulate wheelchair rotation and accommodate rotational inertial effects. The first system does not provide extra resistance against rotation and relies on merely linear inertia, hypothesizing that it can provide acceptable replication of biomechanics of wheelchair maneuvers. The second and third systems, however, are designed to simulate rotational inertia. System II uses mechanical compensation, and System III uses visual compensation simulating the influence that rotational inertia has on the visual perception of wheelchair movement in response to rotation at different speeds.