Virtual environments for the transfer of navigation skills in the blind: a comparison of directed instruction vs. video game based learning approaches

The Design Space of the Auditory Representation of Objects and Their Behaviours in Virtual Reality for Blind People

As virtual reality (VR) is typically designed in terms of visual experience, it poses major challenges for blind people to understand and interact with the environment. To address this, we propose a design space to explore how to augment objects and their behaviours in VR with a nonvisual audio representation. It intends to support designers in creating accessible experiences by explicitly considering alternative representations to visual feedback. To demonstrate its potential, we recruited 16 blind users and explored the design space under two scenarios in the context of boxing: understanding the location of objects (the opponent's defensive stance) and their movement (opponent's punches). We found that the design space enables the exploration of multiple engaging approaches for the auditory representation of virtual objects. Our fndings depicted shared preferences but no one-size-fts-all solution, suggesting the need to understand the consequences of each design choice and their impact on the individual user experience.

VR for Cognition and Memory

This chapter will provide a review of research into human cognition through the lens of VR-based paradigms for studying memory. Emphasis is placed on why VR increases the ecological validity of memory research and the implications of such enhancements.

A Training Smartphone Application for the Simulation of Outdoor Blind Pedestrian Navigation: Usability, UX Evaluation, Sentiment Analysis

Training blind and visually impaired individuals is an important but often neglected aspect of Assistive Technology solutions (ATs) that can benefit from systems utilizing multiple sensors and hardware devices. Training serves a dual purpose as it not only enables the target group to effectively utilize the ATs but, also, helps in improving their low acceptance rate. In this paper, we present the design, implementation, and validation of a smartphone-based training application. It is a form of immersive system that enables users to learn the features of an outdoor blind pedestrian navigation application and, simultaneously, to help them develop long-term Orientation and Mobility (O&M) skills. The system consists of an Android application leveraging, as data sources, an external high-accuracy GPS sensor for real-time pedestrian mobility tracking, a second custom-made device attached to traffic lights for identifying their status, and an ultra-sonic sensor for detecting near-field obstacles on the navigation path of the users. The training version running as an Android application employs route simulation with audio and haptic feedback, is functionally equivalent to the main application, and was used in the context of specially designed user-centered training sessions. A Usability and User Experience (UX) evaluation revealed the positive attitude of the users towards the training version as well as their satisfaction with the skills acquired during their training sessions (SUS = 69.1, UEQ+ = 1.53). Further confirming the positive attitude was the conduct of a Recursive Neural Network (RNN)-based sentiment analysis on user responses with a score of 3 on a scale from 0 to 4. Finally, we conclude with the lessons learned and the proposal of general design guidelines concerning the observed lack of accessibility and non-universal interfaces.

Neural substrates of spatial processing and navigation in blindness: An activation likelihood estimation meta-analysis

Even though vision is considered the best suited sensory modality to acquire spatial information, blind individuals can form spatial representations to navigate and orient themselves efficiently in space. Consequently, many studies support the amodality hypothesis of spatial representations since sensory modalities other than vision contribute to the formation of spatial representations, independently of visual experience and imagery. However, given the high variability in abilities and deficits observed in blind populations, a clear consensus about the neural representations of space has yet to be established. To this end, we performed a meta-analysis of the literature on the neural correlates of spatial processing and navigation via sensory modalities other than vision, like touch and audition, in individuals with early and late onset blindness. An activation likelihood estimation (ALE) analysis of the neuroimaging literature revealed that early blind individuals and sighted controls activate the same neural networks in the processing of non-visual spatial information and navigation, including the posterior parietal cortex, frontal eye fields, insula, and the hippocampal complex. Furthermore, blind individuals also recruit primary and associative occipital areas involved in visuo-spatial processing via cross-modal plasticity mechanisms. The scarcity of studies involving late blind individuals did not allow us to establish a clear consensus about the neural substrates of spatial representations in this specific population. In conclusion, the results of our analysis on neuroimaging studies involving early blind individuals support the amodality hypothesis of spatial representations.

Cognitive map formation supported by auditory, haptic, and multimodal information in persons with blindness

For efficient navigation, the brain needs to adequately represent the environment in a cognitive map. In this review, we sought to give an overview of literature about cognitive map formation based on non-visual modalities in persons with blindness (PWBs) and sighted persons. The review is focused on the auditory and haptic modalities, including research that combines multiple modalities and real-world navigation. Furthermore, we addressed implications of route and survey representations. Taking together, PWBs as well as sighted persons can build up cognitive maps based on non-visual modalities, although the accuracy sometime somewhat differs between PWBs and sighted persons. We provide some speculations on how to deploy information from different modalities to support cognitive map formation. Furthermore, PWBs and sighted persons seem to be able to construct route as well as survey representations. PWBs can experience difficulties building up a survey representation, but this is not always the case, and research suggests that they can acquire this ability with sufficient spatial information or training. We discuss possible explanations of these inconsistencies.

Cognitive map formation through tactile map navigation in visually impaired and sighted persons

The human brain can form cognitive maps of a spatial environment, which can support wayfinding. In this study, we investigated cognitive map formation of an environment presented in the tactile modality, in visually impaired and sighted persons. In addition, we assessed the acquisition of route and survey knowledge. Ten persons with a visual impairment (PVIs) and ten sighted control participants learned a tactile map of a city-like environment. The map included five marked locations associated with different items. Participants subsequently estimated distances between item pairs, performed a direction pointing task, reproduced routes between items and recalled item locations. In addition, we conducted questionnaires to assess general navigational abilities and the use of route or survey strategies. Overall, participants in both groups performed well on the spatial tasks. Our results did not show differences in performance between PVIs and sighted persons, indicating that both groups formed an equally accurate cognitive map. Furthermore, we found that the groups generally used similar navigational strategies, which correlated with performance on some of the tasks, and acquired similar and accurate route and survey knowledge. We therefore suggest that PVIs are able to employ a route as well as survey strategy if they have the opportunity to access route-like as well as map-like information such as on a tactile map.

Social cognition in the blind brain: A coordinate-based meta-analysis

Social cognition skills are typically acquired on the basis of visual information (e.g., the observation of gaze, facial expressions, gestures). In light of this, a critical issue is whether and how the lack of visual experience affects neurocognitive mechanisms underlying social skills. This issue has been largely neglected in the literature on blindness, despite difficulties in social interactions may be particular salient in the life of blind individuals (especially children). Here we provide a meta-analysis of neuroimaging studies reporting brain activations associated to the representation of self and others' in early blind individuals and in sighted controls. Our results indicate that early blindness does not critically impact on the development of the "social brain," with social tasks performed on the basis of auditory or tactile information driving consistent activations in nodes of the action observation network, typically active during actual observation of others in sighted individuals. Interestingly though, activations along this network appeared more left-lateralized in the blind than in sighted participants. These results may have important implications for the development of specific training programs to improve social skills in blind children and young adults.

Two Decades of Touchable and Walkable Virtual Reality for Blind and Visually Impaired People: A High-Level Taxonomy

Although most readers associate the term virtual reality (VR) with visually appealing entertainment content, this technology also promises to be helpful to disadvantaged people like blind or visually impaired people. While overcoming physical objects’ and spaces’ limitations, virtual objects and environments that can be spatially explored have a particular benefit. To give readers a complete, clear and concise overview of current and past publications on touchable and walkable audio supplemented VR applications for blind and visually impaired users, this survey paper presents a high-level taxonomy to cluster the work done up to now from the perspective of technology, interaction and application. In this respect, we introduced a classification into small-, medium- and large-scale virtual environments to cluster and characterize related work. Our comprehensive table shows that especially grounded force feedback devices for haptic feedback (‘small scale’) were strongly researched in different applications scenarios and mainly from an exocentric perspective, but there are also increasingly physically (‘medium scale’) or avatar-walkable (‘large scale’) egocentric audio-haptic virtual environments. In this respect, novel and widespread interfaces such as smartphones or nowadays consumer grade VR components represent a promising potential for further improvements. Our survey paper provides a database on related work to foster the creation process of new ideas and approaches for both technical and methodological aspects.

X-Road

Orientation and Mobility (O8M) classes teach people with visual impairments how to navigate the world; for instance, how to cross a road. Yet, this training can be difficult and dangerous due to conditions such as traffic and weather. Virtual Reality (VR) can overcome these challenges by providing interactive controlled environments. However, most existing VR tools rely on visual feedback, which limits their use with students with visual impairment. In a collaborative design approach with O8M instructors, we designed an affordable and accessible VR system for O8M classes, called X-Road. Using a smartphone and a Bespoke headmount, X-Road provides both visual and audio feedback and allows users to move in space as in the real world. In a study with 13 students with visual impairments, X-Road proved to be an effective alternative to teaching and learning classical O8M tasks, and both students and instructors were enthusiastic about this technology. We conclude with design recommendations for inclusive VR systems.

O&M Indoor Virtual Environments for People Who Are Blind

BACKGROUND: Knowing their current position in the surroundings constitutes one of the biggest challenges faced by people with visual disabilities when they move around. For them, it is difficult to be aware of the direction in which they are going, and the location of nearby objects and obstacles. In this context, obtaining relevant spatial information is always very significant to these individuals. Hence, the research in the development of assistive technologies for needs and perspectives of people who are blind has been a promising area in terms of the orientation and mobility (O&M) challenges.

OBJECTIVE: The purpose of this study is to systematically examine the literature on &M virtual environments designed to support indoor navigation to identify techniques for both developing and evaluating the usability and cognitive impact of these applications.

METHODS: A systematic literature review (SLR) was performed, considering population, intervention, outcomes, and study design as eligibility criteria. After a filtering process from 987 works retrieved from six databases, we extracted data from 51 papers, which meet the study selection criteria.

RESULTS: The analysis of the 51 papers describing 31 O&M indoor virtual environments, indicated that O&M virtual environments to support indoor navigation are usually designed for desktop, adopt spatial audio as way to support orientation, and use joystick as primary interaction device. Regarding evaluation techniques, questionnaires, interviews, user observation, and performance logs are commonly used to evaluate usability in this context. In tests involving users, the participants are usually adults aged 21–59 years, who individually spend about 90 minutes split in usually two evaluation sessions. Most papers do not report any strategies to evaluate the cognitive impact of O&M virtual environments on users’ navigational and wayfinding skills. Thirteen papers (25.49%) reported the conduction of experiments or quasi-experiments and demonstrated pieces of evidence associated with a positive cognitive impact resultant from O&M indoor virtual environments usage. Finally, only four papers (7.84%) reported the development of indoor maps editors for O&M virtual environments.

CONCLUSION: Our SLR summarizes the characteristics of 32 O&M virtual environments. It compiles state-of-the-art for indoor simulations in this domain and highlights their challenges and impacts in O&M training. Also, the absence of clear guidelines to design and evaluate O&M virtual environments and the few available computer editors of indoor maps appear as research opportunities.

Physical exploration of a virtual reality environment: Effects on spatiotemporal associative recognition of episodic memory

Associative memory has been increasingly investigated in immersive virtual reality (VR) environments, but conditions that enable physical exploration remain heavily under-investigated. To address this issue, we designed two museum rooms in VR throughout which participants could physically walk (i.e., high immersive and interactive fidelity). Participants were instructed to memorize all room details, which each contained nine paintings and two stone sculptures. On a subsequent old/new recognition task, we examined to what extent shared associated context (i.e., spatial boundaries, ordinal proximity) and physically travelled distance between paintings facilitated recognition of paintings from the museum rooms. Participants more often correctly recognized a sequentially probed old painting when the directly preceding painting was encoded within the same room or in a proximal position, relative to those encoded across rooms or in a distal position. A novel finding was that sequentially probed paintings from the same room were also recognized better when the physically travelled spatial or temporal distance between the probed paintings was shorter, as compared with longer distances. Taken together, our results in highly immersive VR support the notion that spatiotemporal context facilitates recognition of associated event content.

Spotlights and Soundscapes

For persons with visual impairment, forming cognitive maps of unfamiliar interior spaces can be challenging. Various technical developments have converged to make it feasible, without specialized equipment, to represent a variety of useful landmark objects via spatial audio, rather than solely dispensing route information. Although such systems could be key to facilitating cognitive map formation, high-density auditory environments must be crafted carefully to avoid overloading the listener. This article recounts a set of research exercises with potential users, in which the optimization of such systems was explored. In Experiment 1, a virtual reality environment was used to rapidly prototype and adjust the auditory environment in response to participant comments. In Experiment 2, three variants of the system were evaluated in terms of their effectiveness in a real-world building. This methodology revealed a variety of optimization approaches and recommendations for designing dense mixed-reality auditory environments aimed at supporting cognitive map formation by visually impaired persons.

Low vision rehabilitation for better quality of life in visually impaired adults

BACKGROUND

Low vision rehabilitation aims to optimise the use of residual vision after severe vision loss, but also aims to teach skills in order to improve visual functioning in daily life. Other aims include helping people to adapt to permanent vision loss and improving psychosocial functioning. These skills promote independence and active participation in society. Low vision rehabilitation should ultimately improve quality of life (QOL) for people who have visual impairment.

OBJECTIVES

To assess the effectiveness of low vision rehabilitation interventions on health-related QOL (HRQOL), vision-related QOL (VRQOL) or visual functioning and other closely related patient-reported outcomes in visually impaired adults.

SEARCH METHODS

We searched relevant electronic databases and trials registers up to 18 September 2019.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) investigating HRQOL, VRQOL and related outcomes of adults, with an irreversible visual impairment (World Health Organization criteria). We included studies that compared rehabilitation interventions with active or inactive control.

DATA COLLECTION AND ANALYSIS

We used standard methods expected by Cochrane. We assessed the certainty of the evidence using the GRADE approach.

MAIN RESULTS

We included 44 studies (73 reports) conducted in North America, Australia, Europe and Asia. Considering the clinical diversity of low vision rehabilitation interventions, the studies were categorised into four groups of related intervention types (and by comparator): (1) psychological therapies and/or group programmes, (2) methods of enhancing vision, (3) multidisciplinary rehabilitation programmes, (4) other programmes. Comparators were no care or waiting list as an inactive control group, usual care or other active control group. Participants included in the reported studies were mainly older adults with visual impairment or blindness, often as a result of age-related macular degeneration (AMD). Study settings were often hospitals or low vision rehabilitation services. Effects were measured at the short-term (six months or less) in most studies. Not all studies reported on funding, but those who did were supported by public or non-profit funders (N = 31), except for two studies. Compared to inactive comparators, we found very low-certainty evidence of no beneficial effects on HRQOL that was imprecisely estimated for psychological therapies and/or group programmes (SMD 0.26, 95% CI -0.28 to 0.80; participants = 183; studies = 1) and an imprecise estimate suggesting little or no effect of multidisciplinary rehabilitation programmes (SMD -0.08, 95% CI -0.37 to 0.21; participants = 183; studies = 2; I2 = 0%); no data were available for methods of enhancing vision or other programmes. Regarding VRQOL, we found low- or very low-certainty evidence of imprecisely estimated benefit with psychological therapies and/or group programmes (SMD -0.23, 95% CI -0.53 to 0.08; studies = 2; I2 = 24%) and methods of enhancing vision (SMD -0.19, 95% CI -0.54 to 0.15; participants = 262; studies = 5; I2 = 34%). Two studies using multidisciplinary rehabilitation programmes showed beneficial but inconsistent results, of which one study, which was at low risk of bias and used intensive rehabilitation, recorded a very large and significant effect (SMD: -1.64, 95% CI -2.05 to -1.24), and the other a small and uncertain effect (SMD -0.42, 95%: -0.90 to 0.07). Compared to active comparators, we found very low-certainty evidence of small or no beneficial effects on HRQOL that were imprecisely estimated with psychological therapies and/or group programmes including no difference (SMD -0.09, 95% CI -0.39 to 0.20; participants = 600; studies = 4; I2 = 67%). We also found very low-certainty evidence of small or no beneficial effects with methods of enhancing vision, that were imprecisely estimated (SMD -0.09, 95% CI -0.28 to 0.09; participants = 443; studies = 2; I2 = 0%) and multidisciplinary rehabilitation programmes (SMD -0.10, 95% CI -0.31 to 0.12; participants = 375; studies = 2; I2 = 0%). Concerning VRQOL, low-certainty evidence of small or no beneficial effects that were imprecisely estimated, was found with psychological therapies and/or group programmes (SMD -0.11, 95% CI -0.24 to 0.01; participants = 1245; studies = 7; I2 = 19%) and moderate-certainty evidence of small effects with methods of enhancing vision (SMD -0.24, 95% CI -0.40 to -0.08; participants = 660; studies = 7; I2 = 16%). No additional benefit was found with multidisciplinary rehabilitation programmes (SMD 0.01, 95% CI -0.18 to 0.20; participants = 464; studies = 3; I2 = 0%; low-certainty evidence). Among secondary outcomes, very low-certainty evidence of a significant and large, but imprecisely estimated benefit on self-efficacy or self-esteem was found for psychological therapies and/or group programmes versus waiting list or no care (SMD -0.85, 95% CI -1.48 to -0.22; participants = 456; studies = 5; I2 = 91%). In addition, very low-certainty evidence of a significant and large estimated benefit on depression was found for psychological therapies and/or group programmes versus waiting list or no care (SMD -1.23, 95% CI -2.18 to -0.28; participants = 456; studies = 5; I2 = 94%), and moderate-certainty evidence of a small benefit versus usual care (SMD -0.14, 95% CI -0.25 to -0.04; participants = 1334; studies = 9; I2 = 0%). ln the few studies in which (serious) adverse events were reported, these seemed unrelated to low vision rehabilitation.

AUTHORS' CONCLUSIONS

In this Cochrane Review, no evidence of benefit was found of diverse types of low vision rehabilitation interventions on HRQOL. We found low- and moderate-certainty evidence, respectively, of a small benefit on VRQOL in studies comparing psychological therapies or methods for enhancing vision with active comparators. The type of rehabilitation varied among studies, even within intervention groups, but benefits were detected even if compared to active control groups. Studies were conducted on adults with visual impairment mainly of older age, living in high-income countries and often having AMD. Most of the included studies on low vision rehabilitation had a short follow-up, Despite these limitations, the consistent direction of the effects in this review towards benefit justifies further research activities of better methodological quality including longer maintenance effects and costs of several types of low vision rehabilitation. Research on the working mechanisms of components of rehabilitation interventions in different settings, including low-income countries, is also needed.

Navigation and perception of spatial layout in virtual echo-acoustic space

Successful navigation involves finding the way, planning routes, and avoiding collisions. Whilst previous research has shown that people can navigate using non-visual cues, it is not clear to what degree learned non-visual navigational abilities generalise to 'new' environments. Furthermore, the ability to successfully avoid collisions has not been investigated separately from the ability to perceive spatial layout or to orient oneself in space. Here, we address these important questions using a virtual echolocation paradigm in sighted people. Fourteen sighted blindfolded participants completed 20 virtual navigation training sessions over the course of 10 weeks. In separate sessions, before and after training, we also tested their ability to perceive the spatial layout of virtual echo-acoustic space. Furthermore, three blind echolocation experts completed the tasks without training, thus validating our virtual echo-acoustic paradigm. We found that over the course of 10 weeks sighted people became better at navigating, i.e. they reduced collisions and time needed to complete the route, and increased success rates. This also generalised to 'new' (i.e. untrained) virtual spaces. In addition, after training, their ability to judge spatial layout was better than before training. The data suggest that participants acquired a 'true' sensory driven navigational ability using echo-acoustics. In addition, we show that people not only developed navigational skills related to avoidance of collisions and finding safe passage, but also processes related to spatial perception and orienting. In sum, our results provide strong support for the idea that navigation is a skill which people can achieve via various modalities, here: echolocation.

Virtual reality in episodic memory research: A review

Although virtual reality (VR) is a promising tool for the investigation of episodic memory phenomena, to date there has been relatively little examination of how learning mechanisms operate in VR and how these processes might compare (or contrast) with learning that occurs in real life. Moreover, the existing literature on this topic is spread across several disciplines and uses various distinct apparatuses, thus obscuring whether the differences that exist between studies might be due to genuine theoretical discrepancies or may be more simply explained by accounting for methodological variations. The current review is designed to address and elucidate several issues relevant to psychological researchers interested in understanding and/or using this technological approach to study episodic memory phenomena. The principle objectives of the review are as follows: (a) defining and discussing the various VR systems currently used for research purposes, (b) compiling research of episodic memory effects in VR as they have been studied across several disciplines, and (c) surveying major topics in this body of literature (e.g., how virtual immersion has an impact on memory; transfer effects from VR to the real world). The content of this review is designed to serve as a resource for psychologists interested in learning more about the current state of research in this field and is intended to highlight the capabilities (and constraints) associated with using this technological approach in episodic memory research.

Role of Rehabilitation in Neural Plasticity

AIM

Verifying if physical therapy, neurostimulation techniques, aerobic fitness and video games can induce neural plasticity making it possible for cortical reorganisation, motor recovery in patients, improvement of cognitive functions and transfer of spatial knowledge in the everyday living environment.

METHODS

There have been revised scientific articles respectively focused on the role of pain, the role of physical therapy, neurostimulation techniques and video games in cortical reorganisation. Articles related to the role of pain have taken in the study subjects with pain, to observe its role in cortical reorganisation. Studies related to physical therapy and neurostimulation techniques after cerebrovascular accident consisted of the involvement of these subjects which exposed to different neurostimulations. Also, related to cognition and video games subjects exposed to these interventions for cognitive benefits.

RESULTS

From all articles reviewed there have been effective results of neurostimulation techniques, aerobic fitness and video games in cortical reorganisation inducing neural plasticity (p < 0.05) toward motor recovery, improvement of executive functions and transfer of spatial knowledge.

CONCLUSION

Rehabilitation through locomotor training and neurostimulation techniques, improves mobility in subjects after a cerebrovascular accident due to cortical reorganisation. Also, through aerobic fitness and video games, there have been improvements in cognitive functions. This way, rehabilitation dedicated to the promotion of well-being and health urges beneficial neuroplastic changes in brain corresponding in functional improvement.

Orientation and mobility aids for individuals with blindness: Verbal description vs. audio-tactile map

Individuals with visual impairment face significant challenges traveling in the physical environment. Independent movement is directly connected to the quality of someone's life, and thus, orientation and mobility issues are always listed among the top priorities of research in the field. The aim of the present research was to examine the level of accuracy of the cognitive map developed through the use of a verbal description versus the cognitive map developed using an audio-tactile map. A comparison of the effectiveness of the two mobility aids in detecting specific points of interest in the physical environment was an objective of the research. The procedure involved the study of a map using the two mobility aids, and an assessment through the transfer to the corresponding physical environment. The results suggest that an individual with visual impairment can acquire and use a functional cognitive map through the use of an audio-tactile map, while relying on a verbal description entails greater difficulty in detecting specific points of interest when he/she comes into the physical environment.

Individuals with severely impaired vision can learn useful orientation and mobility skills in virtual streets and can use them to improve real street safety

Virtual reality has great potential in training road safety skills to individuals with low vision but the feasibility of such training has not been demonstrated. We tested the hypotheses that low vision individuals could learn useful skills in virtual streets and could apply them to improve real street safety. Twelve participants, whose vision was too poor to use the pedestrian signals were taught by a certified orientation and mobility specialist to determine the safest time to cross the street using the visual and auditory signals made by the start of previously stopped cars at a traffic-light controlled street intersection. Four participants were trained in real streets and eight in virtual streets presented on 3 projection screens. The crossing timing of all participants was evaluated in real streets before and after training. The participants were instructed to say “GO” at the time when they felt the safest to cross the street. A safety score was derived to quantify the GO calls based on its occurrence in the pedestrian phase (when the pedestrian sign did not show DON’T WALK). Before training, > 50% of the GO calls from all participants fell in the DON’T WALK phase of the traffic cycle and thus were totally unsafe. 20% of the GO calls fell in the latter half of the pedestrian phase. These calls were unsafe because one initiated crossing this late might not have sufficient time to walk across the street. After training, 90% of the GO calls fell in the early half of the pedestrian phase. These calls were safer because one initiated crossing in the pedestrian phase and had at least half of the pedestrian phase for walking across. Similar safety changes occurred in both virtual street and real street trained participants. An ANOVA showed a significant increase of the safety scores after training and there was no difference in this safety improvement between the virtual street and real street trained participants. This study demonstrated that virtual reality-based orientation and mobility training could be as efficient as real street training in improving street safety in individuals with severely impaired vision.

Wayfinding in healthcare facilities: contributions from environmental psychology

The ability to successfully navigate in healthcare facilities is an important goal for patients, visitors, and staff. Despite the fundamental nature of such behavior, it is not infrequent for planners to consider wayfinding only after the fact, once the building or building complex is complete. This review argues that more recognition is needed for the pivotal role of wayfinding in healthcare facilities. First, to provide context, the review presents a brief overview of the relationship between environmental psychology and healthcare facility design. Then, the core of the article covers advances in wayfinding research with an emphasis on healthcare environments, including the roles of plan configuration and manifest cues, technology, and user characteristics. Plan configuration and manifest cues, which appeared early on in wayfinding research, continue to play a role in wayfinding success and should inform design decisions. Such considerations are joined by emerging technologies (e.g., mobile applications, virtual reality, and computational models of wayfinding) as a way to both enhance our theoretical knowledge of wayfinding and advance its applications for users. Among the users discussed here are those with cognitive and/or visual challenges (e.g., Down syndrome, age-related decrements such as dementia, and limitations of vision). In addition, research on the role of cross-cultural comprehension and the effort to develop a system of universal healthcare symbols is included. The article concludes with a summary of the status of these advances and directions for future research.