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Lettre J, Routhier F, Giesbrecht EM, Choukou MA, Miller WC, Archambault PS. Clinical stakeholders' perspective for the integration of an immersive wheelchair simulator as a clinical tool for powered wheelchair training. Assist Technol 2023; 35:497-505. [PMID: 36701417 DOI: 10.1080/10400435.2022.2161669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/27/2023] Open
Abstract
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.
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Affiliation(s)
- Josiane Lettre
- Center for interdisciplinary research in rehabilitation and social integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - François Routhier
- Center for interdisciplinary research in rehabilitation and social integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada
| | - Edward M Giesbrecht
- Department of Occupational Therapy, University of Manitoba, Winnipeg, MB, Canada
| | | | - William C Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Program and GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Philippe S Archambault
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Center for interdisciplinary research in rehabilitation of the greater Montreal, Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
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Chaar F, Archambault PS. Usability of a virtual reality manual wheelchair simulator. Disabil Rehabil Assist Technol 2023; 18:1489-1499. [PMID: 35175178 DOI: 10.1080/17483107.2022.2039307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Individuals with impaired mobility often require assistance for getting around. The skilled use of a manual wheelchair (MW) is required in order to gain independence while preventing injuries. Training in a virtual reality (VR) setting allows for safe practice of MW skills in a wide range of environments. We developed a low-cost MW simulator which includes visual and haptic feedback. Our objectives were to assess the usability and fidelity of the VR simulator, by clinicians and expert MW users, and to determine whether the addition of haptic feedback would positively improve the user's experience. MATERIALS AND METHODS This mixed method study investigated the sense of presence, overall experience and ease of use of the experience in six MW users, as well as five clinicians (wheeled mobility experts) who practiced in the simulator. RESULTS Participants reported a positive perception of usefulness, sense of presence, and immersion during the MiWe simulator experience. The addition of haptic feedback to the simulator significantly enhanced fidelity of the overall experience, compared to the no-feedback condition. CONCLUSION Our low-cost simulator was well perceived by clinicians and MW users and was considered as a potentially useful tool to complement MW skill training.IMPLICATIONS FOR REHABILITATIONWe developed a low-cost, virtual reality simulator with visual and haptic feedback, for the practice of manual wheelchair skills.Expert clinicians and wheelchair users reported a positive experience after practicing in the wheelchair simulator, in terms of presence, realism and usability.Participants highlighted the potential usefulness of our low-cost simulator in the training of manual wheelchair skills.
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Affiliation(s)
- Fadi Chaar
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada
- Interdisciplinary Research Center in Rehabilitation (CRIR), Quebec, Canada
| | - Philippe S Archambault
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada
- Interdisciplinary Research Center in Rehabilitation (CRIR), Quebec, Canada
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Zorzi C, Tabbaa L, Covaci A, Sirlantzis K, Marcelli G. Train vs. Play: Evaluating the Effects of Gamified and Non-Gamified Wheelchair Skills Training Using Virtual Reality. Bioengineering (Basel) 2023; 10:1269. [PMID: 38002393 PMCID: PMC10669445 DOI: 10.3390/bioengineering10111269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/28/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
This study compares the influence of a gamified and a non-gamified virtual reality (VR) environment on wheelchair skills training. In specific, the study explores the integration of gamification elements and their influence on wheelchair driving performance in VR-based training. Twenty-two non-disabled participants volunteered for the study, of whom eleven undertook the gamified VR training, and eleven engaged in the non-gamified VR training. To measure the efficacy of the VR-based wheelchair skills training, we captured the heart rate (HR), number of joystick movements, completion time, and number of collisions. In addition, an adapted version of the Wheelchair Skills Training Program Questionnaire (WSTP-Q), the Igroup Presence Questionnaire (IPQ), and the Simulator Sickness Questionnaire (SSQ) questionnaires were administered after the VR training. The results showed no differences in wheelchair driving performance, the level of involvement, or the ratings of presence between the two environments. In contrast, the perceived cybersickness was statistically higher for the group of participants who trained in the non-gamified VR environment. Remarkably, heightened cybersickness symptoms aligned with increased HR, suggesting physiological connections. As such, while direct gamification effects on the efficacy of VR-based wheelchair skills training were not statistically significant, its potential to amplify user engagement and reduce cybersickness is evident.
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Affiliation(s)
- Chantal Zorzi
- School of Engineering, University of Kent, Canterbury CT1 7NT, UK; (C.Z.); (L.T.); (A.C.)
| | - Luma Tabbaa
- School of Engineering, University of Kent, Canterbury CT1 7NT, UK; (C.Z.); (L.T.); (A.C.)
| | - Alexandra Covaci
- School of Engineering, University of Kent, Canterbury CT1 7NT, UK; (C.Z.); (L.T.); (A.C.)
| | - Konstantinos Sirlantzis
- School of Engineering, Technology and Design, Canterbury Christ Church University (CCCU), Canterbury CT1 1QU, UK;
| | - Gianluca Marcelli
- School of Engineering, University of Kent, Canterbury CT1 7NT, UK; (C.Z.); (L.T.); (A.C.)
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Gefen N, Archambault PS, Rigbi A, Weiss PL. Pediatric powered mobility training: powered wheelchair versus simulator-based practice. Assist Technol 2023; 35:389-398. [PMID: 35737961 DOI: 10.1080/10400435.2022.2084183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 10/17/2022] Open
Abstract
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.
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Affiliation(s)
- Naomi Gefen
- Deputy Director General, ALYN Hospital, Jerusalem, Israel
| | - Philippe S Archambault
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- McGill, University of Montreal, University of Quebec in Montreal
| | - Amihai Rigbi
- Faculty of Education, Beit Berl College, Kfar-Saba, Israel
| | - Patrice L Weiss
- Department of Occupational Therapy, University of Haifa, Haifa, Israel
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Faure C, Routhier F, Lettre J, Choukou MA, Archambault PS. Effectiveness of the miWe Simulator Training on Powered Wheelchair-driving Skills: A Randomized Controlled Trial. Arch Phys Med Rehabil 2023; 104:1371-1377. [PMID: 37209934 DOI: 10.1016/j.apmr.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of a home-based simulator training, in comparison with a videogame-based training, in terms of powered wheelchair driving skills, skills use in a real-world setting, and driving confidence. DESIGN Single-blinded randomized controlled trial. SETTING Community. PARTICIPANTS New powered wheelchair users (N=47) randomly allocated to simulator group (n=24, 2 drop-out) and control group (n=23, 3 drop-out). INTERVENTIONS The miWe wheelchair simulator (simulator group) or a kart driving videogame (control group) was setted-up at participants' homes (computer + joystick). They were instructed to use it at least 20 minutes every 2 days, during a period of 2 weeks. PRIMARY OUTCOME MEASURE(S) Assessments were done at baseline (T1) and post-training (T2) using the Wheelchair Skills Test Questionnaire (WST-Q, version 4.1), Wheelchair Confidence Scale (WheelCon), Assistive Technology Outcomes Profile for Mobility, and Life-Space Assessment (LSA). The time necessary to complete 6 WST tasks was measured with a stopwatch. RESULTS Participants of the simulator group significantly increased their WST-Q capacity score at T2 by 7.5% (P<.05), whereas the control group remained at the same score (P=.218). Participants of both groups rolled backward and went through a door significantly faster at T2 (P=.007; P=.016), but their speed did not change for the other skills. The WheelCon score significantly increased after training (+4% for the control group and +3.5% for the simulator group, P=.001). There was no T1-T2 difference between groups for the WST-Q performance scores (P=.119), the ATOP-Activity (P=.686), the ATOP-Participation scores (P=.814), and the LSA score (P=.335). No adverse events or side effects were reported during data collection or training. CONCLUSIONS Participants of both groups improved some skills and their wheelchair driving confidence. The simulator training group also demonstrated a modest post-training gain in their WST-Q capacity, but more studies would be needed to explore the long-term effects of the McGill immersive wheelchair simulator (miWe) simulator on driving skills.
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Affiliation(s)
- Céline Faure
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale du Québec, Quebec City, Canada
| | - François Routhier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale du Québec, Quebec City, Canada; Department of Rehabilitation, Université Laval, Quebec City, Canada
| | - Josiane Lettre
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale du Québec, Quebec City, Canada
| | - Mohamed-Amine Choukou
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale du Québec, Quebec City, Canada
| | - Philippe S Archambault
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada.
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Siribunyaphat N, Punsawad Y. Brain-Computer Interface Based on Steady-State Visual Evoked Potential Using Quick-Response Code Pattern for Wheelchair Control. SENSORS (BASEL, SWITZERLAND) 2023; 23:2069. [PMID: 36850667 PMCID: PMC9964090 DOI: 10.3390/s23042069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
Brain-computer interfaces (BCIs) are widely utilized in control applications for people with severe physical disabilities. Several researchers have aimed to develop practical brain-controlled wheelchairs. An existing electroencephalogram (EEG)-based BCI based on steady-state visually evoked potential (SSVEP) was developed for device control. This study utilized a quick-response (QR) code visual stimulus pattern for a robust existing system. Four commands were generated using the proposed visual stimulation pattern with four flickering frequencies. Moreover, we employed a relative power spectrum density (PSD) method for the SSVEP feature extraction and compared it with an absolute PSD method. We designed experiments to verify the efficiency of the proposed system. The results revealed that the proposed SSVEP method and algorithm yielded an average classification accuracy of approximately 92% in real-time processing. For the wheelchair simulated via independent-based control, the proposed BCI control required approximately five-fold more time than the keyboard control for real-time control. The proposed SSVEP method using a QR code pattern can be used for BCI-based wheelchair control. However, it suffers from visual fatigue owing to long-time continuous control. We will verify and enhance the proposed system for wheelchair control in people with severe physical disabilities.
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Affiliation(s)
| | - Yunyong Punsawad
- School of Informatics, Walailak University, Nakhon Si Thammarat 80160, Thailand
- Informatics Innovative Center of Excellence, Walailak University, Nakhon Si Thammarat 80160, Thailand
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Guo JL, Chang YC, Lin FH, Fan CC, Lai TM, Huang CM. User experience evaluation of a 3D virtual reality educational program for illegal drug use prevention among high school students: Applying the decomposed theory of planned behavior. Digit Health 2023; 9:20552076231171237. [PMID: 37152240 PMCID: PMC10159246 DOI: 10.1177/20552076231171237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Objective To evaluate user acceptability of an immersive three-dimensional virtual reality program for preventing illegal drug use and identify factors associated with continuous usage intention of three-dimensional virtual reality learning among high school students based on the decomposed theory of planned behavior. Methods In this cross-sectional observational study, we developed five educational modules and serious games based on three-dimensional virtual reality technology. Ninety student-participants' experiences were assessed by a structured questionnaire based on the decomposed theory of planned behavior variables. We applied partial least squares structural equation modeling to examine the correlates of continuous usage intention. Results The proposed model demonstrated an acceptable fit to the observed data. Eight of the 11 hypotheses based on the decomposed theory of planned behavior were supported. Continuous usage intention was significantly associated with attitudes, subjective norms, and perceived behavioral control; these variables explained 55.4% of the variance in continuous usage intention. Perceived usefulness and compatibility were significant antecedents of attitude. The significant antecedent of subjective norms was support from school staff. Self-efficacy and resource-facilitating conditions were significant antecedents of perceived behavioral control. Conclusions Our findings support the applicability of the decomposed theory of planned behavior as a framework for evaluating a three-dimensional virtual reality program for illegal drug use. We recommend that the program be included as teaching material for illegal drug prevention education in senior high schools.
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Affiliation(s)
- Jong-Long Guo
- Department of Health Promotion and
Health Education, College of Education, National Taiwan Normal University, Taipei,
Taiwan
| | | | - Fen-He Lin
- Institute of Clinical Nursing, College
of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Chih Fan
- Department of Community Medicine, En Chu Kong Hospital, Taipei, Taiwan
| | | | - Chiu-Mieh Huang
- Institute of Clinical Nursing, College
of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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de Sá AAR, Morère Y, Naves ELM. Skills assessment metrics of electric powered wheelchair driving in a virtual environment: a survey. Med Biol Eng Comput 2022; 60:323-335. [PMID: 35013870 DOI: 10.1007/s11517-022-02500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/28/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this review is to present studies on the parameters for assessing the skills of users of electric wheelchair driving simulators in a virtual environment. In addition, this study also aims to identify the most widely used and validated parameters for the quantification of electric wheelchair driving ability in a virtual environment and to suggest challenges for future research. To carry out this research, the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were adopted. Literature searches in English, French, and Portuguese were conducted up to December 2020 in the PubMed, SciELO, Science Direct, World Wide Science, and Scopus databases. The keywords used were electric wheelchair, simulator, performance indicators, performance skills, driving skills, training platform, virtual environment, and virtual reality. We excluded studies involving "real" wheelchairs without a simulator in a virtual environment. We have selected a total of 42 items. In these studies, we identified 32 parameters (3 qualitative and 29 quantitative) that are used as parameters for the evaluation of the ability to control a powered wheelchair in a virtual environment. Although the amount of research in this area has increased significantly in recent years, additional studies are still needed to provide a more accurate and objective assessment of skills among the target population. A challenge for future work is the increasing application of artificial intelligence techniques and the exploration of biomedical data measurements, which may be a promising alternative to improve the quantification of user competencies.
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Affiliation(s)
- Angela A R de Sá
- Faculty of Electrical Engineering, Federal University of Uberlândia, Assistive Technologies Group, Av Joao Naves de Avila, 2160 - Bloco 3N, Uberlandia, Brazil.
| | - Yann Morère
- LCOMS - Laboratoire de Conception, Optimisation Et Modélisation Des Systèmes, Université de Lorraine, 7 rue Marconi, 57070, Metz, France
| | - Eduardo L M Naves
- Faculty of Electrical Engineering, Federal University of Uberlândia, Assistive Technologies Group, Av Joao Naves de Avila, 2160 - Bloco 3N, Uberlandia, Brazil
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Guo JL, Hsu HP, Lai TM, Lin ML, Chung CM, Huang CM. Acceptability Evaluation of the Use of Virtual Reality Games in Smoking-Prevention Education for High School Students: Prospective Observational Study. J Med Internet Res 2021; 23:e28037. [PMID: 34581679 PMCID: PMC8512192 DOI: 10.2196/28037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/30/2021] [Accepted: 06/14/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Alternative forms of cigarettes, such as electronic cigarettes (e-cigarettes), are becoming increasingly common among adolescents. Many high schools now provide smoking-prevention education in an attempt to minimize the potential negative health effects and illness burdens e-cigarettes may induce in adolescents. However, it is often difficult to motivate young students to engage with traditional education regarding the harmful effects of tobacco; thus, the development of alternative approaches may be required. OBJECTIVE In this study, we aimed to conduct an acceptability evaluation of educational virtual reality games designed to support smoking-prevention measures. We based the acceptability evaluation on the following two experience types: game-playing and content-learning experiences. The paths by which these experience types affect the intention to abstain from smoking were also examined. METHODS We applied a prospective observational study design. We developed educational games based on three-dimensional virtual reality technology, in which participants operated joysticks to complete challenge tasks. To increase the possibility of the games fostering motivation to abstain from smoking, the ARCS motivational model (comprising attention, relevance, confidence, and satisfaction) was used as a framework during the games' design. We measured the participants' game-playing experiences by inquiring about the strength of the ARCS elements; content-learning experiences were measured using overall knowledge improvement and the perceived persuasiveness of the content. A total of 130 students participated in the program. Study hypotheses for this evaluation were derived from a literature review. We used partial least squares structural equation modeling to examine the proposed hypotheses. RESULTS Based on the responses of the students to questionnaire items concerning attention, relevance, confidence, and satisfaction in the context of the games, most students agreed or strongly agreed that the educational games were motivational, and that their game-playing experiences were positive. Regarding content-learning experiences, there was a significant improvement in knowledge (t129=25.67, P<.001), and most students perceived themselves as being persuaded to abstain from smoking. Attention, relevance, and satisfaction significantly influenced perceived persuasiveness (t=3.19, P<.001; t=4.28, P<.001; and t=3.49, P<.001, respectively); however, confidence did not (t=0.42, P=.67). Perceived persuasiveness, relevance, and satisfaction significantly influenced the intention to abstain from smoking (t=3.57, P<.001). In addition to directly affecting the intention to abstain from smoking, indirect effects were observed from both relevance and satisfaction to intention via perceived persuasiveness (t=2.87, P=.004 and t=2.11, P=.04, respectively). However, intention was not significantly influenced by knowledge improvement. CONCLUSIONS Our findings revealed that the educational games were positively accepted by the participating students. This indicates that the integration of the ARCS framework and persuasive strategies is applicable for smoking-prevention education. We recommend that the games be included as teaching materials for smoking-prevention education.
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Affiliation(s)
- Jong-Long Guo
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hsiao-Pei Hsu
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Mei-Ling Lin
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Ming Chung
- Department of Applied Information Technology, Hsing Wu University, New Taipei, Taiwan
| | - Chiu-Mieh Huang
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Yan H, Archambault PS. Augmented feedback for manual wheelchair propulsion technique training in a virtual reality simulator. J Neuroeng Rehabil 2021; 18:142. [PMID: 34548085 PMCID: PMC8456569 DOI: 10.1186/s12984-021-00936-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Motor learning of appropriate manual wheelchair propulsion is critical, as incorrect technique elevates risk for upper extremity pain. Virtual reality simulators allow users to practice this complex task in a safe and realistic environment. Additionally, augmented feedback (AF) may be provided in order to optimize learning. The purpose of this study was to investigate the effects of providing AF with various delivery schedules on motor learning and transfer of this skill to over-ground propulsion. METHODS Thirty healthy young adults were randomly assigned to three groups. During a virtual reality propulsion training session, the high-frequency AF group received AF in the form of knowledge of performance throughout all propulsion training; the faded AF group received this AF in a faded schedule (high relative frequency of AF early in practice, with relative frequency of AF provision diminishing throughout practice); and the control group underwent training with no AF. Propulsion assessments were performed at baseline and 48 h after practice in both virtual and real environments to measure retention and transfer, respectively. RESULTS Compared to the control group, both feedback groups exhibited significant improvements in contact angle and push frequency in both environments after training. Small, non-significant between-group differences were also found between the high-frequency and faded feedback groups. CONCLUSION Virtual reality training is an effective learning intervention for acquisition, retention, and transfer of appropriate manual wheelchair propulsion technique when such training includes AF regarding propulsion biomechanics.
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Affiliation(s)
- Hui Yan
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
- Center of Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - Philippe S. Archambault
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
- Center of Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Assessment of Wheelchair Propulsion Performance in an Immersive Virtual Reality Simulator. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158016. [PMID: 34360309 PMCID: PMC8345396 DOI: 10.3390/ijerph18158016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/20/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
Maneuvering a wheelchair is an important necessity for the everyday life and social activities of people with a range of physical disabilities. However, in real life, wheelchair users face several common challenges: articulate steering, spatial relationships, and negotiating obstacles. Therefore, our research group has developed a head-mounted display (HMD)-based intuitive virtual reality (VR) stimulator for wheelchair propulsion. The aim of this study was to investigate the feasibility and efficacy of this VR stimulator for wheelchair propulsion performance. Twenty manual wheelchair users (16 men and 4 women) with spinal cord injuries ranging from T8 to L2 participated in this study. The differences in wheelchair propulsion kinematics between immersive and non-immersive VR environments were assessed using a 3D motion analysis system. Subjective data of the HMD-based intuitive VR stimulator were collected with a Presence Questionnaire and individual semi-structured interview at the end of the trial. Results indicated that propulsion performance was very similar in terms of start angle (p = 0.34), end angle (p = 0.46), stroke angle (p = 0.76), and shoulder movement (p = 0.66) between immersive and non-immersive VR environments. In the VR episode featuring an uphill journey, an increase in propulsion speed (p < 0.01) and cadence (p < 0.01) were found, as well as a greater trunk forward inclination (p = 0.01). Qualitative interviews showed that this VR simulator made an attractive, novel impression and therefore demonstrated the potential as a tool for stimulating training motivation. This HMD-based intuitive VR stimulator can be an effective resource to enhance wheelchair maneuverability experiences.
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Go Virtual to Get Real: Virtual Reality as a Resource for Spinal Cord Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041819. [PMID: 33668438 PMCID: PMC7918193 DOI: 10.3390/ijerph18041819] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 02/05/2023]
Abstract
Increasingly, refined virtual reality (VR) techniques allow for the simultaneous and coherent stimulation of multiple sensory and motor domains. In some clinical interventions, such as those related to spinal cord injuries (SCIs), the impact of VR on people's multisensory perception, movements, attitudes, and even modulations of socio-cognitive aspects of their behavior may influence every phase of their rehabilitation treatment, from the acute to chronic stages. This work describes the potential advantages of using first-person-perspective VR to treat SCIs and its implications for manipulating sensory-motor feedback to alter body signals. By situating a patient with SCI in a virtual environment, sensorial perceptions and motor intention can be enriched into a more coherent bodily experience that also promotes processes of neural regeneration and plasticity. In addition to the great potential of research, the most significant areas of interest concern is managing neuropathic pain, motor rehabilitation, and psychological well-being.
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Meyer RT, Sergeeva Y. Mixed-reality assistive robotic power chair simulator for Parkinson's tremor testing. Med Eng Phys 2020; 83:142-147. [PMID: 32507417 DOI: 10.1016/j.medengphy.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 03/10/2020] [Accepted: 05/13/2020] [Indexed: 11/28/2022]
Abstract
This note describes the development of a mixed-reality assistive robotic wheel chair simulator for testing of Parkinson's tremor mitigation and operator assistance. It consists of a power chair (PCh), roller dynamometer, head mounted virtual reality (VR) display, computer with VR game engine, and microcontroller to interface the PCh and computer. Unlike past VR PCh simulators, both a tremor notch filter and basic collision avoidance is implemented. Further, the simulator identifies the Parkinson's tremor frequency. Operator performance is assessed using deviations from a given route and velocity profile. To demonstrate the simulator's operation, an operator with Parkinson's tremor drove the PCh down two 20 m long hallways connected by a 90∘ turn while operating data was collected. Results show less variation in velocity tracking with use of the notch filter than without it; route tracking was nearly the same. Advantages of the simulator compared to a wholly physical approach are low cost, improved safety, portability, small footprint, and environments and robotic features are virtual.
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Affiliation(s)
- Richard T Meyer
- Department of Mechanical and Aerospace Engineering, Western Michigan University, 1903 Kalamazoo, MI 49008 USA.
| | - Yuliia Sergeeva
- Department of Mechanical and Aerospace Engineering, Western Michigan University, 1903 Kalamazoo, MI 49008 USA
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Gefen N, Rigbi A, Archambault PS, Weiss PL. Comparing children's driving abilities in physical and virtual environments. Disabil Rehabil Assist Technol 2019; 16:653-660. [PMID: 31805790 DOI: 10.1080/17483107.2019.1693644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare children's driving abilities in a physical and virtual environment and to validate the McGill Immersive Wheelchair Simulator (MiWe-C) for the use of children with disabilities. MATERIALS AND METHODS Participants included 30 children (17 males, 13 females; mean age 14 y 1 mo, [SD 3 y 6 mo]; range: 5-18 y) with cerebral palsy, neuromuscular disease and spinal cord injury. All children were proficient drivers with more than 3 months' experience, who had their own powered wheelchairs. Participants drove a 15-minute physical route and high-fidelity simulation of that route in a counterbalanced order. Performance of the two routes was compared using the 32 item Powered Mobility Programme (PMP). Differences between the driving modes were analyzed with the non-parametric Wilcoxon signed-rank test. Significance was set at α = 0.05. RESULTS The scores for the total PMP score as rated during both simulator wheelchair driving and during physical driving were very high (M = 4.90, SD = 0.20; M = 4.96, SD = 0.12, respectively) with no significant difference between them (z= -1.69, p = .09). Five out of the 32 PMP tasks showed significant differences between driving modes (narrow corridors, crowded corridors, doorway, sidewalks), with higher scores for the physical driving mode. CONCLUSIONS Having a validated powered mobility simulator for children provides a viable option for an additional practice mode. The MiWe-C simulator is affordable and a user-friendly simulator that can be used anywhere including at home and in school. Children can be independent when practicing even if they are not yet proficient drivers since continual adult assistance is not needed.Implications for rehabilitationHaving a validated powered mobility simulator for children provides a viable option for an additional practice mode.The MiWe-C is now validated to be used with children 5-18 years with physical disabilities.The MiWe-C is one of the few options for children to practice outside of a research environment.
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Affiliation(s)
- Naomi Gefen
- Department of Occupational Therapy, ALYN Hospital, Jerusalem, Israel.,Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | | | - Phillipe S Archambault
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation, Jewish Rehabilitation Hospital, Laval, Canada
| | - Patrice L Weiss
- Department of Occupational Therapy, University of Haifa, Haifa, Israel
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Lin HT, Li YI, Hu WP, Huang CC, Du YC. A Scoping Review of The Efficacy of Virtual Reality and Exergaming on Patients of Musculoskeletal System Disorder. J Clin Med 2019; 8:jcm8060791. [PMID: 31167435 PMCID: PMC6616618 DOI: 10.3390/jcm8060791] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/26/2022] Open
Abstract
To assess the effects of virtual reality on patients with musculoskeletal disorders by means of a scoping review of randomized controlled trials (RCTs). The databases included PubMed, IEEE, and the MEDLINE database. Articles involving RCTs with higher than five points on the Physiotherapy Evidence Database (PEDro) scale were reviewed for suitability and inclusion. The methodological quality of the included RCT was evaluated using the PEDro scale. The three reviewers extracted relevant information from the included studies. Fourteen RCT articles were included. When compared with simple usual care or other forms of treatment, there was significant pain relief, increased functional capacity, reduced symptoms of the disorder, and increased joint angles for the virtual reality treatment of chronic musculoskeletal disorders. Furthermore, burn patients with acute pain were able to experience a significant therapeutic effect on pain relief. However, virtual reality treatment of patients with non-chronic pain such as total knee replacement, ankle sprains, as well as those who went through very short virtual reality treatments, did not show a significant difference in parameters, as compared with simple usual care and other forms of treatment. Current evidence supports VR treatment as having a significant effect on pain relief, increased joint mobility, or motor function of patients with chronic musculoskeletal disorders. VR seems quite effective in relieving the pain of patients with acute burns as well.
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Affiliation(s)
- Hui-Ting Lin
- Department of Physical Therapy, I-Shou University No. 8, Yida Road, Yan-chao District, Kaohsiung 82445, Taiwan.
| | - Yen-I Li
- Department of Physical Therapy, I-Shou University No. 8, Yida Road, Yan-chao District, Kaohsiung 82445, Taiwan.
| | - Wen-Pin Hu
- Department of Bioinformatics and Medical Engineering, Asia University. 500, Lioufeng Road, Wufeng, Taichung 41354, Taiwan.
| | - Chun-Cheng Huang
- Department of Rehabilitation, E-DA Hospital, No.1, Yida Road, Yan-chao District, Kaohsiung 82445, Taiwan.
| | - Yi-Chun Du
- Department of Electrical Engineering, Southern Taiwan University of Science and Technology, No. 1, Nan-Tai Street, Yungkang District, Tainan 71005, Taiwan.
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Vailland G, Grzeskowiak F, Devigne L, Gaffary Y, Fraudet B, Leblong E, Nouviale F, Pasteau F, Breton RL, Guegan S, Gouranton V, Arnaldi B, Babel M. User-centered design of a multisensory power wheelchair simulator: towards training and rehabilitation applications. IEEE Int Conf Rehabil Robot 2019; 2019:77-82. [PMID: 31374610 DOI: 10.1109/icorr.2019.8779496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Autonomy and social inclusion can reveal themselves everyday challenges for people experiencing mobility impairments. These people can benefit from technical aids such as power wheelchairs to access mobility and overcome social exclusion. However, power wheelchair driving is a challenging task which requires good visual, cognitive and visuo-spatial abilities. Besides, a power wheelchair can cause material damage or represent a danger of injury for others or oneself if not operated safely. Therefore, training and repeated practice are mandatory to acquire safe driving skills to obtain power wheelchair prescription from therapists. However, conventional training programs may reveal themselves insufficient for some people with severe impairments. In this context, Virtual Reality offers the opportunity to design innovative learning and training programs while providing realistic wheelchair driving experience within a virtual environment. In line with this, we propose a user-centered design of a multisensory power wheelchair simulator. This simulator addresses classical virtual experience drawbacks such as cybersickness and sense of presence by combining 3D visual rendering, haptic feedback and motion cues. It relies on a modular and versatile workflow enabling not only easy interfacing with any virtual display, but also with any user interface such as wheelchair controllers or feedback devices. This paper presents the design of the first implementation as well as its first commissioning through pretests. The first setup achieves consistent and realistic behavior.
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