Gaming has been increasingly used in therapy as a tool to improve physical and mental health. It has been found to be effective in treating a wide range of mental health conditions, including depression, anxiety, and post-traumatic stress disorder (PTSD). But it has also proven useful in motivation people to use physical therapy, as can be seen in [1].
[1] Gaming being used as a playful way to motivate patients to actively take part in therapy sessions.
Regarding physiotherapy, video games offer dynamic and interactive exercises that target specific motor skills and promote physical rehabilitation. In this context, the word exergaming gets used. Of special interest is the field of pediatric care/therapy because especially for children, video games transform therapy sessions into engaging adventures, motivating them to actively participate in their treatment.
Impact of video games
Gaming in therapy isn’t just about entertainment; it’s about leveraging interactive digital experiences to promote health and well-being. From physiotherapy to pediatric care, video games are being integrated into treatment protocols to engage patients, enhance rehabilitation outcomes and foster a sense of empowerment. They can also provide an escape for patients, where they are temporarily transported into alternative worlds. Though escapism should always be handled with care, these moments can reduce the pain felt and bring joy to patients.
Benefits
Enhance the experience for the patient Video games provide a new and novel approach to keep patients interested.
Personalized treatment Digital treatment methods such as video games can be highly customizable and easily replicable.
Real-time feedback Patients get instant feedback, e.g. regarding their posture, and then can act accordingly. Also, for some patients visual feedback can be more beneficial than verbal instructions.
Challenges
Accessibility and cost There is a certain amount of investment cost required to set up the hardware. Also, software, especially if it needs to be made completely new, can be quite expensive.
Applicability Treatment methods need to be applicable for a wide range of different age groups and patients.
Balancing gaming and treatment The treatment part should always remain the main focus. Gaming should only help to enhance, not overtake, the therapeutic objectives. Also, it should only be used when there is a specific reason or need to do so. As several studies have shown, the physical impact is very similar to traditional treatment methods. The advantage therefore lies in the novelty, joy and motivation this process can bring.
Technical implementation
From the articles I have gathered, there are many ways how to realize this idea of gaming therapy technically. One method often mentioned is the Wii gaming console which can be controlled by motion gestures via controller or some games can be controlled via balance board. But also head mounted virtual reality displays can provide useful, such as the Meta Quest, Sony PlayStation VR or the HTC Vive (among many others).
Summary & conclusion
Gaming in therapy represents a paradigm shift in patient care, offering novel approaches to rehabilitation and promoting overall well-being. As we continue to explore the therapeutic potential of gaming, it is essential to embrace innovative solutions that enhance patient outcomes and foster a culture of holistic healthcare. Gaming in this sense would not be seen as a replacement of traditional treatment methods, but as an enhancement to existing treatment structures.
Many times during my research, I have come across the importance of ethical considerations for the use of VR (both as a consumer product and a medical instrument) and about the usage of modern technology in healthcare in general. In this blog post, I want to delve deeper into some of the challenges and important lessons regarding ethics in this environment.
Using VR and modern digital technology in treatment settings introduces a host of ethical considerations. One of the primary concerns revolves around patient privacy and data security. With the collection and utilization of sensitive health information through digital platforms, ensuring robust safeguards against data breaches and unauthorized access becomes paramount. Health information is sensitive information. When protection is not set up correctly, many people can be compromised, as can be seen in [1], which is a list of the 14 biggest healthcare data breaches
Another ethical consideration is about informed consent and patient autonomy. As patients engage in VR therapy or digital therapeutics, they must be fully informed about the nature of the treatment, its potential risks and benefits, and any alternatives available. Furthermore, ensuring that patients have the capacity to provide informed consent, especially in cases involving vulnerable populations or individuals with diminished decision-making capacity, is essential. Especially regarding new technologies, patients may not know about potential risks/benefits and may be ill-informed – the goal of the professional has to be to inform the patient about these factors.
Furthermore, the equitable access to VR therapy and digital interventions raises concerns about healthcare disparities. As these technologies become more prevalent in treatment settings, ensuring equitable access across diverse socioeconomic and demographic groups becomes imperative to prevent exacerbating existing healthcare disparities. Another aspect to keep in mind are the biases of the professionals creating these services, as talked about in [2] or written about in [3] and [4]. A diverse team of people with different backgrounds can ensure that all facets are addressed and that no group of people is disadvantaged in any way.
[2] An interesting discussion about the ethics of VR and its usage as a consumer and medical product.
Addressing ethical challenges requires a multifaceted approach that encompasses technological, regulatory, and ethical considerations. Implementing robust data protection measures, such as encryption protocols and secure storage systems, can help safeguard patient privacy and mitigate the risk of data breaches.
Furthermore, integrating informed consent processes into VR therapy and digital treatment platforms empowers patients to make informed decisions about their healthcare journey. This involves providing comprehensive information about the treatment modality, including its potential risks, benefits, and alternatives, in a clear and accessible manner.
Promoting transparency and accountability within the healthcare ecosystem also plays a crucial role in addressing ethical concerns. Healthcare providers and technology developers must adhere to ethical guidelines and standards of practice, ensuring that patient interests are prioritized throughout the treatment process.
Summary & conclusion
As we navigate the evolving landscape of healthcare technology, the ethical considerations surrounding VR therapy and digital interventions will continue to shape the future of patient care. As designers, embracing a culture of ethical reflection and continuous improvement is essential to foster trust and integrity within the broader community.
Looking ahead, advancements in artificial intelligence, machine learning, and immersive technologies are most likely about to revolutionize healthcare delivery and patient outcomes. However, as we embrace these innovations, it is imperative to remain vigilant in safeguarding patient rights, promoting equitable access, and upholding ethical standards. In conclusion, navigating the ethical considerations associated with VR therapy and modern digital technology in healthcare requires a collaborative effort grounded in principles of transparency, accountability, and patient-centered care.
References used in this article and for research
The notes under the links are mostly for myself, in order to have an organised overview over the content of each source.
This blog post is a continuation of the previous post #05, where I talked about the definition and explanation of various terms surrounding the topic of immersion therapy. In this second part, I want to go deeper into the advantages and disadvantages and specific use cases for these treatment methods. This will hopefully deepen my understanding of this subject and which elements are or are not important.
Advantages and disadvantages of this treatment method
As mentioned in previous blog posts, this type of therapy can be used to treat both physical and mental health problems. As a side note, I found that the internet provides many resources when it comes to the treatment of mental health problems but less so for physical problems. In the upcoming section, I will talk about advantages and disadvantages for both mental and physical problems, as these often times overlap and apply to both.
Let us discuss briefly what the distinct advantages of this digitized approach of therapy is, over more traditional ways.
It is a very safe and controlled environment. People can be gradually exposed to their fears/problems/anxieties. The therapist can fully control the level of exposure and also monitoring devices, e.g. for the heart rate, may be utilized to gather information. Furthermore, the patient can rest assured that they can end or pause the treatment whenever they feel overwhelmed.
Be more engaging and interactive experience. For example, compared to traditional talking treatments, the patient feel more immersed and connected to the experience. This helps with the efficiency of the treatment and can also be useful when dealing with patients with a low attention span or motivation, such as with children. Furthermore, VR is shown to be able to reduce the pain levels experienced by patients. It can help to break or alleviate a negative feedback loop caused by pain, dizziness and fatigue.
It can be time- and cost-efficient. A VR setup can be quite inexpensive and certain scenarios may be reused multiple times. Also, the treatment can easily be done in a simple room. Comparing this to e.g. treating the fear of flying where one would need to somehow simulate a flight or go flying, the ease of use becomes apparent.
The results produced by this method seem to be long-lasting and very positive according to several studies done. However, even though this sound positive, more research is needed. Most research done thus far is on phobias and PTSD, its use for other problems still needs to be thoroughly researched.
Treatment may be administered remotely. Some patients may not be able to leave their homes. VR therapy could be used to deliver training/therapy materials to patients anywhere.
Of course this type of treatment method also has disadvantages and problems, such as:
Technical aspects can prove difficult. Such as the initial setup cost, bugs, hardware problems and also the need to create programs/levels/scenarios for the specific treatment. This takes time and money.
Therapists need to be trained to utilize this tool. The adoption of VR technology as a therapy method is slow, and many mental health professionals are also not trained to work with it. This is also a problem here in Austria, where very few places (hospitals, etc.) actually work with and support it.
Patients may not feel open to this treatment approach and not accept it. Instead seeing it a simple gimmick with no real usage.
Let us talk very quickly about why exposure therapy works. There are several ways how it functions and creates positive effects:
Habituation – meaning that through exposure, people can become accustomed to their fears and decrease their reaction to the object/situations which create the fear.
Extinction – similar to habituation. Previous (negative) associations with objects/situations can be weakened or even replaced with positive emotions through exposure.
Self-efficacy – patients learn that they are strong enough to handle their fears on their own and confront them forthright.
Emotional processing – describes the process in which patients change their beliefs about objects/situations/activities/… and attach new, more realistic beliefs and emotions to them.
VR can be used to target areas in the brain responsible for pain processing and help regulate them and reduce the pain felt. For this reason, it can be used to treat several forms of chronic pains.
Summary & conclusion
Again, since this blog post is getting kind of long, I will continue and finish this subject in blog post 7 – part 3. There I will go into further detail regarding specific use cases for immersion therapy.
In this blog post, advantages and disadvantages were discussed. It is important to look at both sides and have a realistic view about this new form of therapy to be able to best use it. Furthermore, a brief overview over why this form of therapy works has been given.
References used in this article and for research
The notes under the links are mostly for myself, in order to have an organised overview over the content of each source.
In this blog post I want to explore some other topics related to VR or immersion therapy but from a bit of a different angle and with a more distant view on the core themes discussed thus far. So let us get rigth into it.
Redefining Healthcare in the Digital Age
In the fast-paced realm of modern healthcare, two terms have been gaining momentum: telehealth and digital therapeutics. As we navigate through a modern, digital landcape where technology intertwines with every aspect of our lives, it is very important to understand how these innovations are reshaping the landscape of healthcare delivery and patient treatment.
Understanding Telehealth and Digital Therapeutics
Let us start by dissecting these concepts. Telehealth encompasses a broad spectrum of healthcare services delivered remotely through telecommunications technology, i.e. remotely. From virtual doctor visits to remote patient monitoring, telehealth leverages digital platforms to bridge the gap between patients and healthcare providers, fostering accessibility and convenience.
On the other hand, digital therapeutics (often shortened to DTx) represent a distinct category of healthcare treatments that utilize digital technologies to treat medical conditions or enhance clinical outcomes. Unlike traditional pharmaceuticals, digital therapeutics deliver evidence-based interventions through software programs or devices, often targeting behavioral changes or managing chronic diseases (which are also often times treated using immersion therapy).
Differentiating Between Telehealth and Digital Therapeutics
While both telehealth and digital therapeutics operate within the digital realm, they serve distinct purposes in the healthcare ecosystem. Telehealth primarily focuses on delivering clinical services remotely, facilitating consultations, diagnoses, and monitoring of patients‘ health status. In contrast, digital therapeutics delve deeper into the realm of treatment, offering interactive interventions tailored to manage specific health conditions or modify patient behaviors. In short Telehealth can be seen as virtual doctors visits whereas digital therapeutics simply means the ultilization of digital tools for therapeutic measures.
There are also the terms digital health and digital medicine floating around. For the sake of clarity I will mention a definition provided by [1] as seen in Figure 1.
Figure 1. The difference between Digital Health, Digital Medicine and DTx
Exploring Use Cases and Applications
The applications of telehealth and digital therapeutics are as diverse as the healthcare landscape itself. From remote consultations for routine check-ups to virtual sessions for mental health counseling, telehealth offers a huge variety of solutions to enhance patient access and streamline healthcare delivery. Patients can now seek medical advice from the comfort of their homes, minimizing travel time and reducing exposure to contagious illnesses. Furthermore, as previously mentioned in other blog posts, travel may not be enjoyable or even feasable for some patients. Receiving healthcare instructions remotely provides an important form of healthcare accessability. In Austria measures regarding telehealth have already been taken with ELGA (Elektronische Gesundheitsakte) which is a system that allows medical professionals and patients to view their medical files digitally.
Digital therapeutics, on the other hand, are chaning the treatment methods across various medical domains. From managing diabetes and cardiovascular diseases to addressing mental health disorders and addiction, digital therapeutics present new and novel approaches to enhance traditional treatments or serve as standalone interventions. One further positive aspect is that it can lead to increased patient engagement (improved frequency and regularity of treatments) due to the level of comfort and ease of use.
Bridging the Gap with Virtual Reality Therapy
As we delve deeper into the realm of digital therapeutics and telehealth solutions, the parallels with virtual reality (VR) therapy become apparent. Virtual reality therapy utilizes immersive technology to create therapeutic environments that simulate real-world scenarios and facilitate exposure-based treatments for mental health disorders, phobias, and PTSD (and many more). Patients can engage in virtual reality sessions guided by healthcare professionals, addressing psychological challenges and overcoming barriers to treatment through immersive simulations.
Summary & conclusion
In conclusion, telehealth and digital therapeutics represent a modern shift regarding the topic of healthcare. How and when we receive healthcare is being changed by these processes. By embracing digital innovations and leveraging the power of technology, we can enhance patient outcomes, improve accessibility, and revolutionize the healthcare experience for generations to come. Steps have and are being taken, but it will surely be a long and ongoing process until new technologies are fully utilized.
This is part 3 of my research into the topic of immersion therapy. In this blog post, I want to explore specific use cases for this type of digital therapy.
Use cases for immersion therapy
Uses cases for VR therapy are varied. In general, a distinction between physical and psychological health problems may be considered, as these may require distinctly different treatment methods. However, it should also be noted, that physical and mental problems are often interlinked (i.e. one may develop mental health problems because of existing physical problems) and overlap frequently. Until now, I have talked a lot about exposure therapy, which is used to treat mental health issues. However, physical problems, or the mental health problems which may arise from said health issues, may also be treated using CBT based methods. In an interview with Liana Fraenkel (MD, MPH), it was stated that Cognitive Behavioral Therapy (CBT) is as effective as other non-pharmacologic approaches such as exercise. CBT can be used to address many mental health problems, which often occur due to physical problems. Therefore, its value in physical therapy must not be understated. CBT can help treat depression, insomnia, fatigue management, and self-management, which are all symptoms of physical problems. Additionally, the techniques learned during therapy sessions can be utilized at any time, making them useful beyond the therapy sessions.
In the following section, I want to give an overview over possible uses cases. The list is roughly based from mental health problems to physical health problems:
Depression
Anxiety disorders e.g. social anxiety
Borderline personality disorder
Eating disorders
Obsessive compulsive disorder (OCD)
Panic disorder
Various different kinds of phobias e.g. fear of flying, animals, insects, heights, … Patients can be gradually exposed to stronger, more realistic depictions of their phobia
Post-traumatic stress disorder (PTSD) It is commonly used for the treatment of war veterans who suffer from PTSD. VR therapy allows them to immerse themselves in their memories and experiences in a controlled way. This can help them cope with their emotions and memories. The treatment of PTSD is an important way of helping people and preventing suicides.
Psychosis
Schizophrenia
Sleep problems such as insomnia
Alcoholism
Irritable bowel syndrome (IBS)
Chronic fatigue syndrome (CFS)
Fibromyalgia
(Partial) paralysis This one I know of from personal experience. As previously mentioned, my brother is partly paralyzed in his left side, especially when it comes to vision. One exercise was a car driving simulator using a VR headset. He had to simultaneously perform the driving actions, keep an overview over the traffic, and also deal with his trauma from his car accident. In another exercise, the goal was to find certain objects which were hidden in a virtual room and connect two objects with a wire. The goal of another training exercise was to dodge and block incoming balls which were coming toward the player.
Pain relief therapy / Chronic pain (such as arthritis) One example I came across described using VR to deal with phantom pains after the patient had lost a limb. Through the sensory information and the (movement) input, the brain is triggered and sends and receives signals to/from the still existing extremities. The setup may look like as follows: The patient see a virtual avatar of themselves with all limbs still attached. Over certain signals/impulses, the patients can move their amputated limbs again. This can be a highly emotional experience, but it helps over 50 % of patients to reduce pains in their daily lives.
Stroke
Cerebral Palsy
Parkinson’s disease
Multiple Sclerosis
Especially for children, it can help them deal with ADHD, autism or developmental delays by supporting them in a fun and gamified way.
and many more…
Summary & conclusion
In this blog post, we took a look at specific use cases for both mental and physical health problems and how the treatment may look like. Physical and mental health problems/conditions are often interlinked and occur together – therefore, a holistic approach should be considered to increase the effectiveness of the treatment method.
References used in this article and for research
The notes under the links are mostly for myself, in order to have an organised overview over the content of each source.
In my last blog post I came across some articles talking about „Immersion Therapy“. I found this topic interesting and even though I know the basics I have yet to delve deeper into this field of therapy. So let us do just that!
Definition of terms
Firstly, let us begin with a brief definition, which will be further expanded on in more detail in the next section. There are a bunch of terms and definitions floating around this topic. The most commonly used terms in this discourse are:
Cognitive behavioural therapy (CBT)
Exposure therapy
Virtual reality exposure therapy (VRET)
Immersion therapy
Exposure therapy describes a specific form of cognitive behavioral therapy. Immersion therapy is a more intense form of exposure therapy, where the patient is especially immersed. This can be achieved through various methods. Virtual reality exposure therapy simply describes exposure therapy which utilizes some sort of VR setup. VRET can be a part of immersion therapy, but doesn’t have to be.
In the context of this blog post, I will use the terms immersion therapy and VRET interchangeably, always meaning a form of exposure therapy which uses a VR setup to immerse the patient.
Deeper research into this topic
Next up I want to explain the four terms from above further and in more detail. The use cases for these methods will be assessed in the section „Use cases for immersion therapy“ in the next blog post #06. I believe a strict destination between these segments helps with clarity and readability regarding this vast topic.
Firstly, let us start with cognitive behavioral therapy, since this is the building block on which all further methods are based upon. As seen in graphic 1. CBT is based on the assumption that one’s thoughts, behaviors and emotions are interlinked and can thus create a positive but also negative cycle / feedback loop. The goal of CBT is to deal with negative emotions by breaking them down into smaller parts. These can then be more easily understood and techniques can be learned how to deal with them, i.e. see them one’s problems and emotions in a new light. At the end, the patient should have a better quality of life by learning how to deal with their negative emotions. CBT is a talking treatment where patients talk to their therapist, who then can give advice on how to tackle their problems. In general, it can be said, that different from other talking methods, CBT focuses on current problems rather than searching for problems in one’s past.
1. Cognitive Behavioural Therapy
Exposure therapy then builds on CBT. The goal is to help people overcome their fears and anxieties, or rather to reduce the negative reactions of people to fears and specific situations. This is done through exposure, therefore the name exposure therapy. The idea, it is predicated upon, is that people can grow stronger against their fears by willingly confronting them. In exposure therapy, patients learn how to address, process and confront their fears. Together with their therapist, patients walk through their problems, then (in a very controlled manner) expose themselves to these problems and then once again talk about their experience. This is repeated as many times necessary.
Virtual reality exposure therapy, as the name implies, is the same treatment form as exposure therapy. The only difference being, that in VRET a virtual reality setup of some kind is used. This brings some unique challenges but also advantages with it. Patients can feel way more immersed and the level of exposure can be easily controlled by the therapist. Also, patients know that they can rely on the medical specialist to turn off the VR program, should they uncomfortable or not yet ready to deal with this level of exposure.
As mentioned above, immersion therapy is a derivative of exposure therapy, which is more intense and immersive than regular exposure therapy. The patient is immersed in their traumatic experience or thought process. This is done for an extended period of time. The goal is to once again strengthen patients by providing a safe space to face their fears and problems – which ultimately leads to a better quality of life. This immersion can be done through various methods such as:
In vivo exposure … facing the source of fear/anxiety in real life.
imaginal exposure … trying to actively and vividly imagine the source of fear/anxiety.
Virtual reality exposure … using a virtual reality device and setup of some kind.
Introceptive exposure … exposing oneself to similar physical sensations which are similar to these which happen when facing the fear/anxiety. E.g. running in place to increase heart rate, similar to the sensation one with panic disorder might have, therefore training the mind to see this sensation as harmless.
Summary & conclusion
Since this topic is too big for the scope of one blog post, the advantages and disadvantages, as well as the specific use cases for this treatment method will be covered in the next upcoming blog post #06.
In this blog post I delved into the four topics of cognitive behavioral therapy (CBT), exposure therapy, immersion therapy and virtual reality exposure therapy (VRET). Both a definition and explanation of these terms were provided. Since I am not a health student, this was an unfamiliar topic and a new experience. These are hugely important fields of research and fascinating but also vast and daunting. However, I look forward to researching this topic further in the upcoming blog posts.
As I was thinking about what to write the next blog post about and in which direction to take my research, my attention got caught by a simple word: immersion. We hear and use it all the time. Every company wants to create immersive experiences with their marketing, and we say „that video game is immersive“. But what does it mean really? Why are some things considered immersive, and why aren’t others? And is it important when you think about therapy? Does it have to be immersive to produce therapeutic results?
When you ask google for a definition about immersion, the first result explains it like this:
the action of immersing someone or something in a liquid. „his back was still raw from immersion in the icy Atlantic sea“
deep mental involvement in something. „a week’s immersion in the culinary heritage of Puglia“
Oxford Languages Disctionary
For our case, the second definition is the far more interesting one. When we think of immersive experiences and what are also the first search results to come up are modern digital experiences. For example, light projection mappings in museums, VR/AR/XR experiences, video games, etc. What I found interesting is that the definition characterizes it as „deep mental involvement in something“ and that something may be anything. We can find ourselves immersed in a book, for example, where there is no other external stimulus other than the words on the page. However, the images we create in our head, our imagination, can immerse us in these stories. We are solely focused on the story told, and we do not notice how much time passes. This „flow state“ may also be the reason why we can get immersed in work as well.
In the modern media landscape, immersion is also often used to describe interactive media. Media forms where the viewer also becomes a participant and can influence the media in some way, i.e. the viewer has some level of autonomy in what is created. I mentioned some types like these above. For example, video games, light mapping installations, virtual reality applications, etc.
One concrete example would be the ARTE museum in Gangneung, South Korea. Here visitors find themselves in environments made up of huge displays and light mappings where they can get lost in otherworldly surroundings. Through both visual and auditive stimulation the visitor can feel completely involved i.e. immersed.
When it comes to therapy, the term „immersion therapy“ crops up. This describes a more intense form of exposure therapy. Depending on the devices used it may also be called „virtual reality exposure therapy“. The patient is put into a virtual environment which can be used to, in a very controlled way, expose him*her to their fears. Because the patient is more stimulated/immersed than via more traditional methods, this form of therapy seems to prove quite effective. This immersion is especially useful when treating mental problems such as PTSD or phobias, but may be less necessary when dealing with physical ailments. This topic of „immersion therapy“ is a vast and very interesting topic and this has just been a short overview (but it might be an interesting topic for further exploration. Maybe in an upcoming blog post…).
To summarize, immersion is something that happens when we are deeply mentally involved in something. This can be when we are stimulated by our own thoughts (e.g. reading a book) or from exterior stimuli (e.g. video game: visuals, audio, touch of input device, …). For therapy, it can help to make these processes more intense but also controllable.
In this blog post i want to close off the topics I have had researched a bit before, before starting with completely new research. As the title says, this week’s theme is input methods for people with disabilities., meaning how they are able to use and interact with digital devices such as a PC or smartphone. Since this is a vast and deep topic, I want to focus on an area in which I already have some experience in – gaming. Since I went into the relevance of this particular use case in my first blog post I will not go into it further here. So let’s get right into it!
Depending on the disability, players may not need specialized equipment at all. As is the case with Street Fighter player BrolyLegs, who uses a normal controller to play the fast-paced, fighting game Street Fighter V. Instead of using the controller with his hands, he uses the controller with his mouth. Using this technique, he can go toe to toe with other pro players.
However, sometimes more specialized equipment may be needed. One option to help disabled gamers play their favorite games is to redesign the controller they are using. Both Sony and Microsoft have done just that and developed controllers for their respective consoles which are designed with disabled gamers in mind. In Sony’s case, they have developed the Access-Controller, as they call it. It features big, customizable buttons and a big joystick. Button remapping is supported in the PlayStation software, allowing players to customize as they see fit. It will release this December at a retail price of 89,99€. On the other hand, Microsoft developed the Xbox adaptive controller. It features two large pads which can receive input as well as a d-pad. Its strength lies in its customizability and ability to work with other devices, such as joy sticks or buttons, which is supported in the software. It is also sold for 89,99€.
Xbox Adaptive ControllerSony Access Controller
One thing I came across in my research which I found interesting was eye tracking. As for a specific use case, I found EyeMine, a piece of software which can be used to control the popular video game Minecraft with your eyes. However, this software only supports specific devices such as the „Tobii Eye Tracker 5“ which, even on sale, is listed at 223€. This investment cost may serve as a potential barrier of entry for low income households. However, basic eye tracking is achievable at very low cost. Any webcam may be turned into an eye tracker using software like the open source software „Opentrack“. The problem then stems from the available software to utilize cameras. However, there already exist many (free) options and as these open source projects grow, it will become more and more easyily for end users to utilize such technology.
While I was doing my research I also stumbled upon this video by Great Big Story who interviewed streamer and psychologist Perrikaryal (her internet handle). Though not disabled herself, she found an input method which may be useful for disabled people. Using an EEG (ElectroEncephaloGram) she was able to pick up brain signals and translate them into usable input. This means that when thinking of an action, e.g. attack or jump, the input can be mapped so that the game character responds accordingly. However, this is not as easy as it may seem. It took her many hours of deliberate imagination practice for the EEG to be able to pick up the signals. Nevertheless, combining this brain tracking technology with eye tracking, she was able to beat Elden Ring, a game commonly known for its high difficulty. This input method may prove a valid option for people with disabilities.
Another form of input are voice commands. Utilizing any microphone and software, which in many cases is open source or even built into the operating system directly (as is the case with Microsoft’s Speech Recognition) users are able to use their voice to input commands or generate text. This may be very useful for slower paced games, such as turn based games, where the speed in which an input must be made is not that decisive. Speech commands may take longer to perform or take a while to be recognized, and may therefore hinder faster paced games. This does not mean that voice commands cannot be used for such games, but it is a problem to keep in mind.
In summary, there exist various input methods which may provide suitable solutions for disabled gamers. These input methods are not only applicable in the field of gaming, however. They may be used as input methods for digital devices in general. But even just in the field of gaming, the possibility for people to play games and connect to each other, regardless of disability, is of incredible value.
Like I said in the first blog post, I want to use these posts as a means to delve into different topics. I look forward to widening the scope of this topic. But before that, I want to note down a specific topic I have in mind. Virtual reality therapy. I will try to keep this as concise as possible. Therefore, without further ado, let us jump right into it.
What is Virtual Reality?
Before delving into the subject matter, it is essential to establish a shared understanding of the term Virtual Reality (VR). The Oxford English Language dictionary defines it as such:
The computer-generated simulation of a three-dimensional image or environment that can be interacted with in a seemingly real or physical way by a person using special electronic equipment, such as a helmet with a screen inside or gloves fitted with sensors.
This is a very technical description, but it defines VR quite clearly. A VR setups is compromised of three parts: there is a computational machine which performs the calculations needed, in other words, a computer. This can be a simple image, video or entire 3D generated worlds. These 3D worlds are often created using a game engine which allows for interactive real time environments. Two notable examples which support VR would be Unity and Unreal. Then there is an output device which displays the generated images. Traditionally this would be a screen, in this case, it is a VR headset, also referred to as a Head Mounted Display (HMD). Finally, though strictly not mandatory, the inclusion of an input system may be necessary. This spans from conventional controllers to VR hand-tracked controllers. Or, as we just recently saw with Matt Corall’s presentations about Ultraleap, there is also the possibility of tracking the hands and using them for input without any controller. Haptic feedback, the simulation of touch, is also a notable component which can drastically increase the immersion and the effectiveness of VR.
However futuristic it may seem, the roots of VR extend significantly into the past. In 1838 the concept of stereopsis, the fact that the brain overlays two images to create a 3D image with depth, was first described. In the 1950s Morton Heilig created Sensorama, a device with the goal of fully immersing the user by using a stereoscopic 3D image, sound, smell, vibrations and simulated wind.
Sensorama
In 1960, Morton Heilig, the innovator behind Sensorama also patented the Telesphere Mask, which can be considered the first HMD. Skipping ahead, in 1997 Georgia Tech and Emory University collaborated to utilize VR as a therapy method for the treatment of Post-Traumatic Stress Disorder (PTSD) in war veterans.
With this short history overview, I wanted to shake the notion that VR is something entirely new. While I provided a brief glimpse, I glossed over many other captivating inventions. If you are interested, I recommend having a read of the full articles – they really are fascinating. The links can be accessed in the Sources section below.
Use cases in therapy?
Though there is often an overlap I would differenciate between two different use cases:
physical
mental
Let us begin by considering the physical use case,. For example, partial paralysis of a body part or side. While conventional treatment methods exist, Virtual Reality (VR) presents distinctive advantages. The therapy experience can be tailored to exact use cases, which would be hard to train reliably in real life scenarios, such as relearning how to drive. A driving simulator setup, i.e. a chair with a steering wheel and shift lever should not be used instead of VR, but they should work in tandem to increase immersion and effectiveness. Furthermore, the experience may easily be gamified, meaning turning the process of therapy into a fun game. This may especially help when dealing with children who may not have the discipline or motivation to push through rigorous training programs.
VR is also especially useful in the treatment of mental problems. A notable use case involves the treatment of specific phobias, including but not limited to the fear of flying, arachnophobia, elevator anxiety, or social anxiety. Treating a fear like flying is difficult with more traditional treatment methods. Arranging a plane, traveling to a specific location, and repeating such processes multiple times can be logistically difficult and time-consuming. Using VR, a 3D scene can be comparably easily created and the treatment can be done in a very controlled fashion. Furthermore, as previously mentioned, VR has been employed by the military for the treatment of war veterans grappling with Post-Traumatic Stress Disorder (PTSD).
BraveMind – a VR treatment method for war veterans struggling with PTSD
In this context it is used to allow soldiers to relive the traumatic experiences and work through them with a specialist, in a carefully designed and controllable manner. Soldiers who may not be able to cope with their experiences may decide to commit suicide as a result. Therefore application of VR in trauma-focused therapy provides a crucial and potentially life-saving intervention for individuals dealing with the profound impact of their military service.
Personal experience
In my previous blog post, I delved into my personal motivations surrounding this topic. Since then, I have talked with my brother and the kind of experiences he had using VR therapy. In his particular case, VR served as a tool for training the left side of his body, which experienced partial paralysis, resulting in reduced speed. Additionally, VR was employed to address issues related to his partially impaired field of vision.
He recounted three different programs which were used in his treatment. Firstly, a car driving simulator, which was used to train both his motor function and his ability to perceive traffic. A virtual room in which he needed to search for objects and, on occasion, connect different objects using wire. And lastly, a game in which balls were being thrown at him, and he had to deflect them using his hands. He expressed a strong preference for the visual feedback of seeinghis hands in the VR environment. He also noted that he talked quite a lot with his therapist and at least in Austria, the options of VR treatment programs is very limited. Few programs exist and they can not really be customized to the needs of the user. In the last example, my brother wanted to train his left side more but have the objects be slower and the therapist said that this cannot be changed, unfortunately. This seems to be a common problem with these programs – the customization options for individual patients is limited.
Summary
In summary, VR has a long history, yet its potential as a treatment method remains underutilized, presenting a lot of potential for innovation and research in this area. The versatility of VR spans both physical and mental health topics. VR therapy proves useful because it can be individualised and is both time- and cost-effective. As we continue to
, offering the distinct advantage of tailoring experiences to individual users while proving to be time- and cost-effective. As we continue to uncover the multifaceted applications of VR in the realm of therapy, its transformative impact on healthcare interventions is poised for further realization and advancement.
On my research journey thus far, I have had many different ideas on very diverse topics. But the one idea that was most fleshed out and that resonated most with Fabry and me was on the topic of disability. More specifically, I had two ideas of where this topic could lead:
Input methods (in the context of gaming) for disabled people
Virtual-Reality therapy for disabled people (or people with disorders)
Both of them touch on the same topic, disability, but each one is distinct and offers a different direction for exploration. Currently, I tend to favor the second idea of doing my thesis on the topic of VR treatment and therapy.
Input methods
Individuals with physical disabilities may face challenges when using electronic devices and digital services that rely on standard input methods. One area of focus within this vast domain of interaction is the gaming landscape. In recent years, there have been numerous innovations in the field of accessibility. For instance, Xbox and PlayStation have created their own unique controllers for disabled people. However, designing for people with disabilities presents several difficult problems that need to be addressed. One of the biggest factors is the availability of customization options. The list of requirements is vast and unique for everybody. Nobody should be unable to enjoy their favorite game just because of a physical limitation of their body. For these people, gaming can often be more than just a simple way to pass the time – it can transport them into different worlds and has the opportunity to change their lives.
VR therapy
Virtual reality therapy is a therapeutic approach which utilizes a virtual reality headset to simulate real time environments in an immersive and controlled way. It can be a great training method for physically impaired people. However, VR therapy may not just be an interesting prospect for dealing with physical problems. VR is also being used in the treatment of psychological and mental problems and disorders. Prominently in the treatment of phobias. The fear of flying, spiders or social anxiety can be treated by VR exposure therapy. One significant advantage VR has over more traditional treatment methods is time and cost efficiency. It is inexpensive to set up and can be adapted to many different use cases with relatively low time and financial investments. Furthermore, the US military uses VR to treat war veterans with PTSD. We are just beginning to tap into the value of VR as a training and therapy method.
How to tackle this subject & what I learned from the second feedback round
Over the course of my second meeting with Fabry, I was able to glean some valuable insights. For one, I learned that I do not need to have the specific topic nailed down to the last detail yet. Rather, it would be more advantageous to have a broad and open perspective on the topic of disability in general and look into many diverse areas instead of limiting myself right now. For example, instead of focusing on just VR or input methods, I could take a look at the topic of immersive media in general. Furthermore, I realized that this exploration of themes and topics is exactly what these blogs are for. In the upcoming blog posts, I might want to tackle a different topic in each one or discuss an intriguing piece of literature I have come across. I look forward to exploring many ideas in the upcoming blog posts.
Potential research questions
At this stage I do not want to narrow my focus too quickly. Instead I want to explore this diverse field of research further before narrowing it down. With regard to the two topics proposed, some potential research questions could be as follows:
How can VR be used in the treatment of patients (with …)?
Which input methods (regarding gaming) exist for people with disabilites?
Moreover there are many sub-questions which will arise:
How would a VR experience look like?
Why do it like this? Who would use it?
What are hardware requirements?
What are the results? Can it really help?
Relevance for design field & how can design help with this problem?
Accessibility has steadily gained more and more relevance in many different areas and rightfully so. According to the World Health Organization (WHO), approximately 16% of the global population experiences some form of disability. However, progress in this area is slow and disabled people face numerous challenges in their daily lives. VR therapy can be employed to assist people in training their bodies and minds, aiding in their recovery or strengthening their body and mind. When it comes to mental disorders, VR therapy has the possibility of saving lives. As previously mentioned, it is utilized by the US military to treat veterans with PTSD. Despite this, on average, 17 US military veterans commit suicide every day. A grim number, but it is reality. In light of such statistics, the relevance of such treatment methods becomes apparent. VR therapy offers the opportunity to help a variety of patients with different disabilities at a relatively low cost. As for gaming, it has the power to transport people into different worlds, explore wonderful places and alleviate anxiety. Online gaming can help them socialize, and online gaming communities foster a sense of belonging.
As designers, we have the ability to connect many different fields and strive in these multidisciplinary environments. These skills are applicable in numerous domains, such as designing both physical and digital training environments. Designing these therapeutic processes with a holistic approach in conjunction with the medical assistant, the end user and the technology used. Furthermore, medical programs are often only focused on treating the illness but neglect the UX and usability of the people using the product (as I have learned in talking to my brother – more on that further down). These factors ultimately harm the process and the efficiency of the healing method.
Challenges
A research topic like this poses many challenges that need to be overcome. One of which is getting the right contacts and being able to talk and work with them. This necessitates having access to medical professionals and the ability to interact with disabled individuals, possibly conducting tests. Furthermore, getting the right medical information to validate or invalidate potential hypotheses will also be challenging.
Personal motivation
This might be a good point to talk about my personal motivation regarding this topic. On December 4, 2020, the world for my family and me got turned upside down when we got the news that my brother was involved in a big car accident on the highway from Linz to Vienna. We didn’t know whether he would survive, and neither did the doctors. Hearing his voice again after a month in a coma was a huge relief. Still, the struggle was far from over. My brother had to relearn many things. How to properly move his hands, how to walk and much more. However, after every physical rehabilitation period, you could see the progress he made. One of the techniques used in his rehabilitation was virtual reality therapy. I learned about this subject during my bachelor’s as well, but seeing this relatively new form of therapy used in a real setting and the enjoyment my brother had when using it left a lasting impression on me. It’s still sometimes hard and a challenge, but we are glad every day that we still have him.
As for the gaming topic, the story is far less dramatic. I myself enjoy playing games. A lot. Online, I have seen the struggles of disabled gamers and the challenges they face when they try to play games. Accessibility is (fortunately) becoming a bigger topic in the gaming industry and many new games feature extensive accessibility options. However, progress is slow. What interests me especially is the way of controlling the game, how inputs can be made, and how they are handled. I want to help these people gain more self-confidence and freedom. Everybody should be able to enjoy what they love regardless of the physical limitations they migth have.
Possible solutions to the challenges ahead
As mentioned above, my brother has spent a lot of time in hospitals. During that time, he met many doctors and nurses. These contacts may be able to provide support and help with my thesis. Furthermore, my brother can provide many insightful experiences and may be able to assist as a tester for potential applications. Additionally, a relative of mine works as a neurologist. He might also be open to an interview or have useful contacts. These are difficult challenges to overcome, but there are also opportunities open for me. The best case would be a cooperation with a medical institution. But what will be really possible? Only time will tell.
Intended steps / methodology
Currently, I am in the process of researching this topic to acquire as much information and learn as much as possible. Deciding how to sort and order this information will be vital. Simultaneously, I am also thinking about how to conduct my future research and the possible outcomes of a project on this topic. Possible steps and results may include:
Analysis
Prototype (physical, VR environment, etc.)
User Testing
Survey
Guide handbook
Further outlook
As stated above I will continue doing research but with a wider view, being open for any intriguing topics and findings. In the upcoming blog posts, I then want to focus more on specific topics. Also, to note is that I wrote this blog post quite informally and from a very personal point of view. Further blog posts will likely be more „academic“ and „formal“.
