virtual reality quick start guide hh vr quick start guide_0.pdf · ! 7! game!recommendations!!!!...
TRANSCRIPT
RESNA 2018
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Table of Contents
v Choose your VR platform – 3 v Clinical Set-‐Up – 5 v Precautions and Contraindications – 5 v Limitations of VR – 6 v Self-‐teaching/training – 6 v Game Recommendations – 7 v Clinical Justification -‐10 v Documentation – 11 v Other Measurement Examples – 12 v Grading – 12 v Recent Evidence – 13
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Choose your VR platform
v Oculus Rift Ø Cost: $399 for Oculus Rift headset, Oculus Touch motion controllers, two
room sensors, and the Oculus Remote. Ø Bottom Line: Powerful, PC-‐tethered VR headset that comes with Oculus
Touch motion controllers. 1 lb. Keep an eye out for Oculus Go that launched May 1st for $199—it’s an all-‐in-‐one wireless VR headset.
Ø Pros: Immersive VR experience with a simple setup. Uses a desk-‐mounted camera that functions very well close up. Touch controllers are curved to fit comfortably in the hand and “feel better” than other controllers. Oculus offers a free downloadable program that scans your computer and tells you whether or not it meets the required specs. Comes with built-‐in on-‐ear headphones that are adjustable. Can wear glasses underneath, but will be a tight fit.
Ø Cons: Requires a powerful gaming computer to run—recommended specs for a PC include having at least a Nvidia GeForce GTX 970 or Radeon R9 GPU graphics card, an Intel i5-‐4590 processor or greater, 8GB or more of RAM, an HDMI 1.4 or DisplayPort 1.2 video output, a USB 2.0 port, and a Windows 7 SP1 64-‐bit operating system or above. A system that meets these requirements would likely run $1,700 or above. Does not have whole-‐room VR.
v HTC Vive
Ø Cost: $499 Ø Bottom Line: Comprehensive PC-‐tethered
VR system that supports both motion controls and whole-‐room VR. All games/experiences are through Steam VR, which has a very strong selection. Keep an eye out for the Vive Pro which came out on April 5th for $799—it has increased resolution and a second external camera.
Ø Pros: Immersive VR. Can wear glasses underneath the Vive and headset facemask is easy to remove for cleaning. Only device that offers whole-‐room
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VR. Comes with “The Lab”—a multi-‐situation VR demo that is a collection of neat mini games and experiences.
Ø Cons: Tons of cables and kind of a complicated setup. Having a tethered headset can make whole-‐room VR tricky. Like the Oculus, requires a computer with a lot of power, which will therefore be pretty costly. Earphones that come with it pop out easily—can also use your own earphones or headphones. Need a space of at least 6.5 by 5 ft for whole-‐room VR; can still set up for “standing” VR if you don’t have the space, but will limit what you can do. Only works with SteamVR platform.
v Samsung Gear VR Ø Cost: $129 Ø Bottom Line: Inexpensive headset that uses
compatible phones (Samsung phones from last two years) to offer a VR experience.
Ø Pros: Good if you want to try VR without investing much money.
Ø Cons: Smartphone-‐based—inferior graphical capabilities and motion-‐tracking.
v Sony PlayStation VR Ø Cost: $399 for PS VR + PlayStation Camera; $449 for PS VR PlayStation
Camera and two Move controllers Ø Bottom Line: Sony’s tethered VR system—designed for use with PS4 or PS4
Pro. As of September 2017 is sold in one of two bundles mentioned above. Move controllers are optional, but enable motion controls.
Ø Pros: Top selling points are the price and ease of use. The PS4 platform can run non-‐VR apps and games—will display as a giant screen floating in front of your face. Cost of a PS4 is much less than the gaming PCs required to run Vive and Rift. Has a 120Hz refresh rate which gives it the capability of
smoother motion than 90Hz Rift and Vive. Ø Cons: Slightly less powerful specs
than main competitors (Vive and Rift). Picture is slightly grainier than Vive and Rift. Difficulty with motion-‐tracking in bright lighting as it relies on visual tracking with colored lights rather than infrared tracking. Fairly direct process to set up, but has a ton of cables. Since the Move controllers depend on the PlayStation Camera, you can’t turn completely around like you can with other systems. Move controller shape is a wand with glowing bulb at end and included wrist strap and isn’t as easy to grasp as other controllers. Doesn’t support whole-‐room
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motion tracking. Have to have a fair amount of space to set up—won’t work well in a cramped area.
v Google Daydream View Ø Cost: $99 Ø Bottom Line: Inexpensive headset
that uses compatible phones to offer a VR experience.
Ø Pros: Good if you want to try VR without investing much money.
Ø Cons: Limited functionality as it is smart-‐phone based.
Clinical Set-‐Up
v Safe place free of obstacles (space for virtual workspace)
v Minimum space requirements-‐ 6.5 by 5 ft for whole-‐room VR
v Pairing with other equipment, such as activity-‐based, bedrest
v Safe seating v Heavy static chair with wide base of
support v For clients deemed safe, swiveling
office chair on castors (recline featured locked)
Precautions and Contraindications
v Precautions: Ø Vertigo/vestibular problems Ø Prone to motion sickness Ø Seizure history
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Ø Easily agitated/overstimulated Ø Poor dynamic trunk control Ø Double vision Ø Incomplete eyelid closure
v Relative Contraindications: Ø Unstable C spine Ø Craniotomy
Limitations of VR
v Space requirements v Limited portability v Weight and comfort of the headset v Fine motor requirements v Cords v Cybersickness – similar to motion sickness v Occluded vision
Self-‐teaching and Training
v Use this guide! v Start with included user instructions v Play!
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Game Recommendations
VISION Game Description Platforms Available
on Paid or Free
Vision Therapy
Visual guidance on completing five vision therapy exercises.
Samsung GearVR, Oculus Rift, and Steam VR
Paid
Vivid Vision
A variety of games that address amblyopia, strabismus,
suppression, acuity, stereo acuity, fusion, and convergence insufficiency.
Oculus Rift, HTC Vive, Samsung GearVR, and will support Google Daydream in the
future
Paid
BALANCE Game Description Platforms Available
on Paid or Free
Oculus Rift Dreamdeck
Highly-‐rated demo by Oculus that allows the user to stand or walk through
Oculus Rift Free
Fruit Ninja
Cut flying fruit with one or two ninja swords while
working on weight shifting, head turns, reaction time. No fine motor required
Oculus Rift, PlayStation VR, and
HTC Vive Paid
Ballanced Weight shifting and postural sway
Oculus Rift Paid
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FINE MOTOR Game Description Platforms Available on Paid or Free
Rec Room – Paintball
Players use many of the Oculus Touch
controller buttons to shoot paintball guns, capture the other
teams flag, etc. Many other games besides paintball are included
with Rec Room.
Oculus Rift and PlayStation VR Free
Spider-‐man: Homecoming –Virtual Reality Experience
Players assume the role of Spiderman to
complete a variety of tasks that require
Oculus Rift and HTC Vive Free
Blocks Create a variety of
creations with different shapes
Oculus Rift and HTC Vive Free
Lucky’s Tale
Use the controller buttons to journey
through a course while collecting coins and avoiding obstacles.
Oculus Rift Free
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COGNITION Game Description Platforms Available
on Paid or Free
Job Simulator
Funny and engaging, simulates hands-‐on task performance of several virtual jobs. Forces user to divide attention, sequence.
Oculus, HTC Vive, and PlayStation VR Paid
Fantastic Contraption
Use creativity and problem solving skills
to build “contraptions” in order to complete
challenges
Oculus Rift, HTC Vive, and PlayStation
VR Paid
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PSYCH Game Description Platforms Available on Fee or Free
Guided Meditation VR
Provides guided sessions in
meditation and has the ability to measure heart
rate.
Oculus, HTC Vive, and Gear VR Free
AppliedVR
Subscription-‐based, clinically validated VR platform being used at Cedars-‐Sinai hospital that was designed specifically for healthcare use. Provides a “VR Pharmacy” with a
suite of experiences for pain management and anxiety.
GearVR (purchase the headset and app exclusively from
https://appliedvr.io/pricing/; cannot buy AppliedVR separately)
Paid
Clinical Justification
v Dynamic v Balance conflict v Proprioceptive emphasis v Dual tasking v Repetitions v Simultaneous core stabilization and distal mobility focus v Inherently motivating
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v Appeal to younger clients v Easy to grade v Functional planes of movement for ADLs (i.e. Plate to mouth, brushing hair,
dressing, etc). v Increased Repetitions v Grasp patterns focus for games not requiring hand controllers
Documentation (examples)
v Standing/PT: Ø Documentation-‐ While engaged in a virtual task using an Oculus Rift
Platform targeting dynamic standing balance and endurance, Erin stood for 20 minutes with contact guard assistance. This was an improvement compared to her previous performance of 5 minutes with minimal assistance.
Ø STG-‐ Erin will stand for at least 10 minutes with close stand by assistance while engaged in a virtual task targeting dynamic standing balance and endurance.
v Occupational therapy/hand use: Ø Documentation-‐With initial minimal assistance followed by minimal verbal
cues for technique, Erin demonstrated thumb flexion and adduction for 5 minutes on an oculus rift controller while engaged in a virtual task from seat d level aimed at eliciting functional grasp patterns of the hand. Previously, she had only been able to do so with visual feedback. Gains are evidence of improvements in proprioception and coordination.
Ø STG-‐ Erin will sustain at least 10 minutes of thumb flexion, extension, adduction, and abduction from standing level while engaging in a virtual task using leap motion software with an Oculus Rift Platform. This will be performed without the use of hand controllers.
v Cognitive: Erin was able to engage in a virtual activity using an Oculus Rift platform for 25 minutes with close supervision and moderate verbal cues to attend to visual cues on a screen to maintain attention. *This was an improvement in terms of attention to task, as no other previous activities held her attention for longer than 10 minutes due to severe frontal lobe dysfunction causing distractibility in many environments.
Ø STG-‐ Erin will be able to engage in a virtual task using an Oculus Rift platform for at least 30 minutes with close supervision and minimal verbal cues to sustain attention.
v Psych-‐ Following education related to the use of mindfulness meditation for severe chronic depression and chronic low back pain, Erin engaged in a therapeutic virtual reality environment aimed at coaching mindfulness meditation as a pain management strategy for 30 minutes with verbal instructions provided by the psychologist.
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Ø STG: Erin will self report the ability to maintain attention on simple perceptual stimuli presented in the virtual reality environment for at least 30 minutes without judgment or interferences of pain perceptions.
Ø LTG: Erin will generalize mindfulness meditation strategies of accepting emotions and thoughts without judgment in everyday experiences. Erin will specifically experience bodily sensations of movements of the low back without judgment while attending to outside of the body sights and sounds.
v Vision: With tactile cuing, Erin was able to track visual stimuli in an immersive virtual environment as evidenced by 25 rotational head movements to the left from her wheelchair during a 5-‐minute virtual task. *This was indicative of improved left sided visual spatial attention. Erin has severe left sided visual in attention as a result of her Cerebral Vascular Accident.
Ø STG: Erin will demonstrate at least 25 rotational head movements to the left side with verbal cues while engaged in a 5-‐minute virtual task.
Ø LTG: Erin will demonstrate transfer of skills to a non-‐VR environment as evidenced by at least 25 rotational movements of the head to the left side while ambulating down a hallway during a therapeutic task.
Other Measurement Examples
v Level of physical assistance from seated or standing level (contact guard, minimal assistance, etc.)
v Position and seated surface v Length of time attending to virtual task, sustained upper extremity movements,
standing while engaged in virtual task v Balance-‐ base of support, number of balance corrections v Approximate goniometric measures of AROM at shoulder or elbow v Number/type of grasp patterns exhibited during virtual task v Game scores v Number of discrete active UE movements recorded v Rating Scales
Ø Balance Ø Psych
Grading
v Sitting in wheelchair, sitting on stationary chair >swiveling office chair > static standing with physical assistance> standing without assistance
v Use of one controller (one handed use) > use of two controllers (bilateral upper extremity use)
v Short duration > long duration v Without distractors > with distractors
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v With verbal cues> without verbal cues v With hands on assistance > without hands on assist v Within game setting adjustments > increased difficulty with game levels v Without controllers > with controllers
Recent Evidence
v The use of commercial video games in rehabilitation: a systematic review (2016) Ø Video gaming offered similar results as conventional physical rehabilitation
in most cases. Ø Bonnechere B, Jansen B, Omelina L, Van Sint Jan S. Int. J. Rehabil. Res. 2016;
39(4): 277-‐290. v Virtual reality gaming in the rehabilitation of the upper extremities post-‐stroke.
Ø Literature review of 15 articles found that virtual reality gaming rehab is equal to traditional therapies or successful augmentation to those therapies.
Ø Yates M, Kelemen A, Sik Lanyi C. Virtual reality gaming in the rehabilitation of the upper extremities post-‐stroke. Brain Inj. 2016;30(7):855-‐63. doi: 10.3109/02699052.2016.1144146. Epub 2016 Mar 30. Review. PubMed PMID: 27029647.
v Does a Combination of Virtual Reality, Neuromodulation and Neuroimaging Provide a Comprehensive Platform for Neurorehabilitation? – A Narrative Review of the Literature
Ø Found supporting evidence for the safety and efficacy of the combination of VR and conventional therapy. Likely that the combination of VR and conventional therapy is more efficatious.
Ø Teo, W.-‐P., Muthalib, M., Yamin, S., Hendy, A. M., Bramstedt, K., Kotsopoulos, E., … Ayaz, H. (2016). Does a Combination of Virtual Reality, Neuromodulation and Neuroimaging Provide a Comprehensive Platform for Neurorehabilitation? – A Narrative Review of the Literature. Frontiers in Human Neuroscience, 10, 284. http://doi.org/10.3389/fnhum.2016.00284
v What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-‐analysis of upper-‐limb and cognitive outcomes
Ø Looked at 33 studies and 971 participants. VR produced significant gains for Body Structure/Function and Activity level outcomes. Supporting evidence for the use of VR as an adjunct to conventional stroke rehab.
Ø Aminov, A., Rogers, J. M., Middleton, S., Caeyenberghs, K., & Wilson, P. H. (2018). What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-‐analysis of upper-‐limb and cognitive outcomes. Journal of NeuroEngineering and Rehabilitation, 15, 29. http://doi.org/10.1186/s12984-‐018-‐0370-‐2
v Clinical Utility of Virtual Reality in Pain Management: A Comprehensive Research Review from 2009 to 2016
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Ø Review of 29 studies. Most of the studies were short term, but provided evidence that VR is a useful tool for pain management.
v A meta-‐analysis and systemaitic literature review of virtual reality Ø Looked at 27 sources for meta-‐analysis and 128 sources in literature reiview.
Metaanalysis found that VRR programs are more effective overall than comparable rehab programs. VRR programs are effective but why that are effective is still unkown.
Ø Matt C. Howard. 2017. A meta