S Y Hadad J Fung P L Weiss C Perez B Mazer M F Levin and R Kizony Rehabilitation Tools along the Reality Continuum: From Mock-up to Virtual Interactive Shopping to Living Lab

In collaboration with  1. Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel  2. Department of Occupational Therapy, Sheba Medical Center, Tel Hashomer, Israel.  3. School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.  4. Feil/Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada

Why Shopping? Meaningful IADL Significant

 Many new motor and cognitive difficulties after neurological injury  Difficult to return to similar function, especially the elderly  Only small percentage of post-stroke population continues to participate in complex life tasks.  During rehabilitation, difficult to assess and practice shopping tasks at a real supermarket Importance of Practicing Shopping Task After Stroke Why Shopping?

VR Desktop Based Virtual Supermarkets Therefore we have many virtual supermarkets Castelnuovo, et al., 2003; Josman et al., 2008; Klinger et al., 2004; Lee et al., 2003 IREX- VMall: Video Capture VR System Rand, et al., 2007; 2009; 2010

Virtual supermarkets limited options of changing task complexity More complex set-up needed for operation integrating & assessing motor and cognitive aspects IREX - VMall: Video Capture VR System (Rand, et al., 2007)

Budget Management integrating & assessing motor and cognitive aspects different stores that can be changed & adapted Virtual Interactive Shopper SeeMe VIS Video Capture is used without the need of chroma key background

Virtual Supermarket ? A Real Environment The continuum between the Environments

Virtual Supermarket: Physical MockUp Store: A Real Environment: The continuum between the Environments VIS “SuperModel” “In-hospital Cafeteria”

Virtual Interactive Shopper

Virtual Supermarket: Physical MockUp Store: A Real Environment: The continuum between the Environments VIS “SuperModel” “In-hospital Cafeteria”

Mock-up

Virtual Supermarket: Physical MockUp Store: A Real Environment: The continuum between the Environments VIS “SuperModel” “In-hospital Cafeteria”

Cafeteria

 To explore the performance of shopping tasks in three different environments: a real environment, a physical mock-up and a virtual environment of post –stroke subjects as compared to healthy controls  To examine the relationship between performance of shopping tasks in the 3 environments Objectives

Rationale  The three environments (Virtual, MockUp, Real) complement one another for the purposes of assessment and treatment of performance of complex IADL tasks during the rehabilitation process  The findings will lead to better understanding of how to use VEs in clinical settings for training skills needed for participation in everyday activities

Population: 6 Healthy Adults 5 female 1 male Age (years) range: mean ± SD: 63.5 ± Inpatients After Stroke 2 female, 3 male Age (years) range: mean ± SD: 74.8 ± 6.6 Time since stroke (months): FIM: 88.4 ± 19.5 MMSE: 26.4 ± 4.8

Experimental Task Original Task: (Rand et al., 2007) List is visible during test Performed in VIS and MockUp Outcome measures Time to complete test Number of errors (wrong item, not buying an item) Does not involve budget management. Modified Task: Performed in all 3 environments (VIS, MockUp & Cafeteria) Involved budget handling (Type of error if incorrect) control subject.avi post stroke subject.AVI control subject.avipost stroke subject.AVI “4 Items”

Time to complete both versions of the 4-item tests in all environments, for two groups Results

Modified test in the Cafeteria and VIS Modified test in the Mock-up and VIS Performance of individuals

Post-stroke Control Locations visited by one subject with stroke and one control within the virtual supermarket during the modified 4-item test Trajectory

Total Number of Errors Number of Errors EnvironmentTaskPost stroke (n=5) Control (n=6) VISOriginal12 (5 subjects) 8 (6 subjects) Modified4 (1 subject) 2 (2 subjects) MockUpOriginal10 Modified5 (3 subjects) 3 (2 subjects) CafeteriaModified1 (1 subject) 4 (2 subjects) Total 2317

Conclusions  VIS appears to be well suited for the assessment and training of the higher cognitive abilities needed for shopping  Shopping tasks may be adapted and graded  Requires motor and cognitive aspects  VIS Performance results suggest that it is sensitive to differences between post-stroke subjects and healthy controls  Performance ability in 3 environments related  For the post-stroke group, times to complete the modified 4-item test in the VIS appear to correlate with both the times of the store mock-up and the cafeteria

Conclusions (Con’t)  Positive responses of all participants to VIS (n=11) according to Short Feedback Questionnaire -SFQ (Kizony et al., 2006) :  enjoyed the task (mean ± SD = 4.2 ± 0.9)  reported that it appeared to be realistic (mean ± SD = 4.2 ± 0.9)  Further analysis needed to discern types of errors and ability of participants to self-correct.

Give a hand to shopping

Acknowledgements Supported by : Fonds de Recherche du Québec - Santé awarded to the Montreal Centre of Interdisciplinary Research in Rehabilitation (CRIR) to the "Living Lab“strategic innovative project: Jewish Rehabilitation Hospital Foundation Many thanks to: Mr. Arie Burstin and Mrs. Riki Brown My Supervisors: Dr Racheli Kizony and Prof Tamar Weiss

Bibliography G Castelnuovo, C Lo Priore, D Liccione, G Cioffi (2003), Virtual reality based tools for the rehabilitation of cognitive and executive functions: The V- STORE, PsychNology, 1,3, pp N Josman, E Klinger and R Kizony (2008), Performance within the virtual action planning supermarket (VAP-S): an executive function profile of three different populations suffering from deficits in the central nervous system, Proc. of 7th ICDVRAT with ArtAbilitation, pp R Kizony, N Katz, D Rand and P L Weiss (2006), A Short Feedback Questionnaire (SFQ) to enhance client-centered participation in virtual environments, Proc. of 11 th Annual Cybertherapy Conf. Virtual Healing: Designing Reality, Gatineau, Canada. E Klinger, I Chemin, S Lebreton and R. M Marié (2004), A Virtual Supermarket to Assess Cognitive Planning, Cyberpsychol. Behav, 7, 3, pp

J H Lee, J Ku, W Cho, W Y Hahn, I Y Kim, S Lee, Y M Kang, D Young-Kim, T Yu, B K Wiederhold, M D Wiederhold and S I Kim (2003), A virtual reality system for the assessment and rehabilitation of the activities of daily living, Cyberpsychol. Behav., 6, 4, pp Mitchell The Living Lab D Rand, N Katz and P L Weiss (2007), Evaluation of virtual shopping in the VMall: Comparison of post-stroke participants to healthy control groups, Disabil. Rehabil., 29,22, pp Virtual Reality Rehabilitation, SeeMe System. Retrieved September 4th, 2012 from: rehabilitation.com/products/seeme/what- is-seemehttp:// rehabilitation.com/products/seeme/what- is-seeme Bibliography