VR games , Virtual Reality as healthcare tools for seniors
VR games (virtual reality games) and VR applications are not only fancy gadgets for teenagers’ fun. Today they are more and more employed in the healthcare domain for assessment, training and rehabilitation of different disorders. VR games and applications range from phobias to physical rehabilitation after stroke of brain injury; from healthcare staff training, to patient’s cognitive stimulation. And recently VR games and applications attracted the attention of clinicians and researchers working on elderly people and people affected by Alzheimer’s disease and other related disorders. I know it sounds weird, but VR games for seniors have a good potential of improving significantly the early diagnosis, non-pharmacological treatment and quality of life of seniors with dementia and related disorders.
VR games for seniors: why now?
- Price drop. Till a few years ago, immersive VR systems were extremely expensive, and owned only by research laboratories and specialized centers. Today VR technology is becoming more and more affordable. You can buy online wide 3D screens for no more than 200$, or Smartphone compatible VR headset from 20 to 100$ to get a fully immersive VR experience using your phone. This means that clinician can start using VR games and applications in their everyday practice, and suggest patients to employ VR games and applications at home.
- User-friendly developer kits. While most of the existing VR games and applications are still designed by experts in the domain of graphics using technical software such as Maya and 3Ds Max (Autodesk), the time is close when almost everyone will be able to create a VR environment in a few clicks. Already now developer kits built for the Oculus Rift allow reconstructing a 360° realistic environment from pictures taken from a camera. The environment is still not ‘navigable’, but is a perfect 3D copy of the surrounding environment, much more realistic than any HR picture. This means that clinicians will be soon able to develop themselves basic personalized VR games and applications to be used in their clinical practice.
- Clinical research on VR games. Today more and more laboratories are doing research on how VR can improve assessment, stimulation and motivation of patients with different pathologies. This means that we are starting to better understand the potentials, limitations and side effects of VR games. This is happening also in the domain of Alzheimer’s disease and dementia related disorders. For more information you can read the following paper, which is available online:
García-Betances RI, Arredondo Waldmeyer MT, Fico G and Cabrera-Umpiérrez MF (2015) A succinct overview of virtual reality technology use in Alzheimer’s disease. Front. Aging Neurosci. 7:80. doi: 10.3389/fnagi.2015.00080
VR games and applications for seniors: let’s review the most promising!
VR games for early detection of cognitive impairment
Memory issues are the most commonly reported symptoms at the beginning of pathologies such as Alzheimer’s, and are important to detect to make early diagnoses. However, there are other deficits that appear very early in the disease progression, that are rarely assessed and detected. For instance, problems in the representation of spatial information from different viewpoints are very common in the early stages of Alzheimer’s, because they are linked to the same brain regions affected in Alzheimer, such as the hippocampus. Deficits in spatial navigation and visual representation can be easily detected in navigable VR games, where the player needs to orient himself in complex environments, using self- or other-people viewpoints. This perfect control of the viewpoint cannot be easily obtained in the classical clinical settings.
VR games for ecological tests of autonomy in activities of daily living
When coming to medical consultation, patients with dementia –and their caregivers, when present -are asked to report if they have problems in everyday activities, such as taking medications, making a phone call, or paying a bill. Though important, self-reports of the patients and caregivers may be biased and distorted: patients may report to be more autonomous of what they actually are (because, for instance, they do not realize that they are not taking medications regularly); or less autonomous of what they could be (they may be afraid to mess things up, and as a result they stopped preparing their own meals even if could still do that safely). Medical doctors cannot spend the day at the patient’s home to observe more objectively what is going on, and recreating a typical everyday situation in a hospital is challenging. But not with VR games. We can easily imagine asking patients to wear VR headsets, and preparing their pillbox for the day, or cooking a meal. Thanks to the VR games, evaluation of the patient’s autonomy can be ecological, fast and objective.
VR games for reminiscence therapy.
Autobiographical memories contribute to the development of a coherent sense of ourselves, our emotions, and our future plans, and play a major role in motivating behavior and in daily life. Episodic autobiographical memory, in particular the richness of detail, is impaired early in the course of pathologies such as Alzheimer’s disease. Reminiscence therapy aims at stimulating autobiographical memory, and consists of discussion of past activities, events, and experiences with another person or group of people, usually with the aid of tangible prompts, such as photographs, household and other familiar items from the past, and music or sound recordings. VR games and applications are promising tools in reminiscence therapy because of their visual realism and high degree of immersion. Imagine your 80y old uncle that explores the city where he was born thanks to a VR headset, as it was in the 50s, with the old café that closed 30 years ago, and the old bridge that was rebuilt in the 80s. This has the potential to be much more effective in triggering old memories compared to an old picture with few details, and has the advantage that the VR game environment can be navigated, thus increasing the feeling of “being there”.
VR games for motivational physical and cognitive trainings
Physical and cognitive trainings are important to prevent and delay the progression of dementia related conditions (http://flexaging.com/dementia-risk-assessment/). But as we all know, doing physical exercise and cognitive exercise can be boring, tiring and not very motivating. So why not embedding the training is a game, making it a playful experience? This is the principle behind Serious Games – video-games with purpose different than entertaining (http://flexaging.com/video-games-for-elderly/). Today there are starting to design VR games to motivate people with dementia to make cognitive exercise, for instance to train their attention. The first results are very encouraging, and suggest that VR games are considered as more interesting by seniors with cognitive impairment compared classical tasks performed on paper-pencil version. For more information see the following paper, that can be freely downloaded:
Manera V, Chapoulie E, Bourgeois J, Guerchouche R, David R, Ondrej J, et al. (2016) A Feasibility Study with Image-Based Rendered Virtual Reality in Patients with Mild Cognitive Impairment and Dementia. PLoS ONE 11(3): e0151487. doi:10.1371/journal.pone.0151487
VR games potential side effects
Although the promising applications, VR games may have side effects. For instance cybersickness is a form of motion sickness with symptoms including nausea, vomiting, disorientation and vertigo. After effects may also include disturbed locomotion, changes in postural control, perceptual-motor disturbances, flashbacks, drowsiness, and fatigue. In order to obtain usable and safe VR games for fragile people, it is necessary to adapt them to the specific patients’ deficits and problems. For instance, it is wise to design VR games in which people can sit, to avoid falls. Similarly, most of the VR games and applications designed so far employ 3D screens with 3D eyeglasses instead of VR headsets. This way people can keep fix reference points in the room, and do not risk to be disoriented.
Virtual Reality and Augmented Reality
VR is a computer-simulated environment that can provide the sensation of physical presence in places representing real or imagined worlds. Contrary to VR, that brings us to a simulated world, Augmented reality (AR) is a live direct or indirect view of our real-world environment whose elements are augmented by computer-generated sensory input such as sound, video, graphics or GPS data. When we watch the Super Bowl and we see scores, game times and additional information written on the screen, we are experiencing a form of AR, in which the technology is enhancing our current perception of reality. In other words, AR improves our experience of the world by providing us with information that our senses cannot (easily) collect.
Augmented Reality for seniors
AG has a number of very potentially interesting applications for seniors. In particular, AR can compensate for:
- Sensory deficits. Elderly people often suffer from sensory deficits, such as vision and hearing issues, which are often not properly detected, and thus untreated. And even when seniors employ hearing and vision aids, they may not bring them back to a perfect sensory acuity. This means that they may be less reactive when driving, more at risk of accidents even when just walking along the street (they may not hear a car approaching), and less reactive in everyday situations (e.g., it may take them more time to locate their favorite butter at the grocery store). Olfactory deficits are also very common in elderly people with dementia. This means that people may fail to detect a smoke smell coming from the kitchen, or the smell of rotten milk. AR could help to compensate for sensory deficits by highlighting the important information in the surrounding environment. A voice could read aloud road signs, alert people when a car is approaching too fast and too close to the crossroad, or when a potentially dangerous smell is detected. Visual recognition tools may help people to easily locate objects on the shelves, and so on. Unfortunately these tools are still not available on the market, but they may be ready soon, at least some prototypes.
- Cognitive impairment. Elderly people suffering from dementia or other age related conditions often have some form of cognitive impairment, including problems of memory, attention, and executive functions (the ability to plan action sequences, or to monitor ongoing actions), or orientation. AR headsets could support people with cognitive impairments in different ways. For instance, headsets may remind the shopping list when people arrive at the grocery store; GPS applications may bring people where they need to go without they get lost; algorithms for face recognition may help people remember who they need to meet by detecting the person in a crowd; people may be reminded step by step what they need to do to cook their meal, and where to find the ingredients in their kitchen. Small things like these may drastically improve the quality of life of people with dementia and their caregivers, because they help people to remain at least partially autonomous in certain activities of daily living, increasing self-confidence and wellbeing.
- Motor impairment. As we grow old, we have more and more probabilities to become frail and have some motor impairments, such as slower walking speed, lower ability to overcome obstacles, and higher chances to fall. And as the physical decline is often slow, we are not necessarily completely aware of that: many falls could be prevented by just being aware that we are walking too fast for our legs, or by recognizing that a step is too high to jump on it without holding the railing. AR could help us by telling us when a stair that we are going to climb in the city hall is too high for us, or by telling us that we should wait crossing the street because the car which is approaching is too fast compared to our walking speed.
Clinical assessment and training of people with dementia is changing thanks to the help of new information and communication technologies. And AR and VR games and applications represent promising instruments in this respect. This doesn’t mean that VR solutions will substitute the classical instruments, or that they are adapted to everyone: I bet that many seniors won’t find VR games entertaining. However, they will become soon valuable and relatively cheap therapeutic option, possibly adding some fun to the clinical process. Personally, I stopped to be critical when I saw with my eyes how much fun can have seniors with these applications!