Cristina Menchaca 2007-49018

Technology has been developing soquickly that the purpose of computers has extended far beyond typing up documents, making graphs, computing math equations, and anything connected to being online. Virtual realityhas been used as a method for cognitive rehabilitation, computers and machines are being developed to help paralyzed people carry out actions, and a lot more. Five years ago, 2D virtual reality programs were tested to see if they could train people with intellectual disabilities and helpthem with their shopping skills.

Almost all of us are familiar with the concept of virtual reality. Taking it from its name, virtua, reality or VR simulates real life situations while creating the illusion that one is in and is interacting with that world, artificial may it be. Studies have actually found that VR can enhance the learning and transfer of skills to everyday circumstances. In other words, there is a clear, positive transfer effect from virtual to real training. These have been proven through activity in the nervous system, neuroplastic changes in the cerebral cortex, and neuroimaging and psychophysiological studies. Thus, aside from being used in entertainment or in analyzing consumers’ attitudes and behaviors regarding a certain product, VR has been applied in functional and vocational training. Recently, there has been interest in studying whether people with learning disabilities would 1) be motivated to use a virtual environment, 2) be capable of using it, and 3) benefit from such a method of training. This is exactly what Tam et al sought to find: how effective a non-immersive, flat-screen VR method would be compared to a conventional psychoeducational method in training people with intellectual disabilities to shop in a local supermarket.

A convenience sample was used to obtain 16 participants (from four different organizations) who had a Stanford-Binet IQ test score from 40 to 54. All of them were trainees of a vocational skills training center. Selection of participants included the following requirements: at least 16 years old, emotionally and medically stable, no history of psychiatric problems or autism, independent in basic self-care activities, able to follow simple verbal instructions, able to grasp simple concepts about money, have real shopping needs, and have given consent in participating in the study. Four males and four females were randomly assigned into a group: intervention group (the VR method) and control group (the conventional method). All participants were introduced to the training objectives, training on supermarket skills, practice of shopping skills, and revision of the shopping skills. Before and after the assigned programs were carried out, a checklist for supermarket shopping skills was used in assessment, and the participants’ behavior throughout the program was also observed and noted.

What made the two set-ups so different? The control group made use of psychoeducational training: a teaching-learning process that included demonstration, role-play, and verbal feedback. VR on the other hand is interactive in nature, enabling the user to exercise direct control over a video-based virtual environment. Users are allowed to navigate, explore, and interact with videos that make up a virtual supermarket environment. The shopping process is divided into a series of tasks that required participants use to their judgment. Choices are provided at crucial points, and participants can proceed and get immediate visual and auditory reinforcement if they choose the right way to proceed. You may be thinking, why wasn’t a typical 3D method used instead of this non-immersive 2D program that makes use of a touch screen? A fully immersive display that includes a head mount 1) might not be feasible (or even necessary) for people with cognitive deficits, and 2) in general, may cause side effects like vertigo, nausea, eyestrain, disorientation, etc. because of a conflict between perceptions in different sense modalities.

There’s more to the methods. For each set-up, two sessions per person were held, each lasting 30 minutes. In the VR method, a trainer demonstrated options first. Participants received help in familiarizing themselves with navigating in the virtual environment. Retraining occurred on an individual basis, involving two trainers who gave instructions to the participants. Trainers physically collaborated with the trainees, interacting and communicating in nonverbal ways to help them. Trainers also tracked the trainees’ visual attention and physical movements in interacting with the environment (hands). In the conventional group, each participant took part in a two-part psychoeducational tutorial and role-play. Participants received consistent instructions from a trainer that were complemented with audiovisual demonstrations. Using information-based and simulated methods, the trainer introduced concepts and skills required, then the participants role-played.

Between groups and within groups differences were assessed. Participants in both groups showed improvement after the training, and the difference is significant. Training effect was more consistent for the VR group (scores 6 to 11) compared to the other group (scores 1 to 11), but the difference was not significant, meaning that VR can achieve the same level of improvement in conventional intervention. It suggests though that the VR program has a slightly greater effect, but a larger sample would be needed to confirm so. Participants who went through conventional training actually showed more varied learning outcomes because the VR method focused on consistency and motivation for certain tasks. Still, this study supported the finding that learning in a virtual training environment can be extended to reality. The VR program was a more realistic environment, while the conventional program made use of instructions and role-play only. There was also effective feedback (that facilitated learning) in the VR set-up because of the program’s design. In the conventional set-up, feedback from trainers as the participants role-played may not have been considered objective and consistent by the participants.

This study is a clear example of taking action because it allows participants to scan their environment and make decisions and actions based on the important cues they see. The checklist for the abilities for the participants is as follows, each being rated as 1 for dependent, 2 for needs assistance, and 3 for independent:

1. Can recognize the sign of the supermarket

2. Can enter in the right entrance

3. Can recall the target item

4. Can decide whether or not to use the food cart

5. Can get into aisles and identify whether or not the target item is there

6. Can decide which aisle to enter given more than one choice

7. Can locate items on shelves, displays, or bins

8. Can locate items similar to the target item

9. Can locate the target item

10. Can choose the correct amount of the target

11. Can check food expiration dates when suspected

12. Can avoid purchasing products that are dented, opened or appear spoiled

13. Can pick up the target item

14. Knows the need to pay for the item

15. Can search for the cashier after picking up the item

16. Can locate the cashier

17. Can find a cashier in service

18. Can queue at the cashier

19. Can put the item on the counter

20. Can pay using Hong Kong money

21. Can communicate appropriately with the cashier when needed

22. Can get the change

23. Can pick up the bought item

24. Can find the correct exit

VR creates an “artificial” multisensory experience of an environment, including space and events, and thus may be more effective for participants than simple role-play, where participants may have difficulty generalizing their actions when in the real environment. However, it was also observed by the trainers that impaired learning ability of participants limits their ability to navigate within the virtual environment and even in participating in such training. Cognitive issues when designing the VR system should thus be considered. I suppose this was difficult for the researchers. On one hand, there’s the importance of making sure participants are comparable, but on the other hand, there’s a compromise for that when the sample is very specific- in this case, people with intellectual disabilities, and people with such have different levels of intelligence, capability, etc.

I liked that the very essence of this study was something ‘life promoting’. People with disabilities already have less advantage than other people, so it’s heartwarming to know that technology is being put into good use, so that maybe, their lives can be less difficult and they can depend less on others. I appreciated the checklist actually, because the items were so specific. The items made me realize how we take for granted the things we don’t even think we think of, when there are people who actually have difficulty doing them. Speaking in terms of technicality, I liked that choosing participants was very specific, so that comparison among participants and evaluation of results would not be ‘nullified’. I also liked that the study ensured an equal number of males and females per set-up, to account for gender differences. One may think that having such numerous criteria to be a participant is unfair in the sense that the study is still biased because it cannot speak for those with less capability. I think otherwise, because this is just the starting study. For now, it would be best to have a specific sample, to see if the method even works. When it can be improved, then can we worry about having the method be one that could suit anyone. I appreciate that VR was considered as an option in such training. After all, it makes sense to practice in a condition that is almost life-like, so that it is not hard to apply it in real life. It makes extra sense for the intellectually disabled, not because they are any less, but because being disabled, not being able to practice in a more real setting (as in role-play) might be harder to apply. Finally, I also have Asian pride because of this experiment, since the study was done in Hong Kong, and made use of Hong Kong dollars. I like that the study made things as ‘real life’ as possible, through the use of real money for example, no matter what set-up.

My only suggestion for this study is that a bigger sample be used so that the effectiveness of the method can be verified and its comparison with the conventional method be established. It’s really from here that the technology can then be developed so that it could reach more people. This study had important knowledge that the participants could learn from. Speaking short term, participants would think of questions like where am I in the environment, what do I see, where do I go, how do I get there? Speaking long term, participants could ask themselves questions like what can and do I learn as I see and explore the environment? Perhaps in the future, technology can extend further and train people in various skills of community survival: transport skills, road safety, wheelchair accessibility, etc. Whatever happens, I’m sure we can all agree even from this study alone that the virtual reality environment can be a very powerful tool in rehabilitation and improvement of life, not just in entertainment and whatnot.

Source:

Tam, S., Man, D., Chan, Y., Sze, P., & Wong, C. (2005). Evaluation of a computer-assisted, 2-D virtual reality system for training people with intellectual disabilities on how to shop. Rehabilitation Psychology, 50(3), 285-291.