Recently, while watching the surfers on the beaches of sunny California, I was reminded of the similarities between those of us working in the field of disabilities. After more than 25 years, we are still trying to find the 'perfect wave' to ride. But, unlike the surfers who must wait for nature to take its course, the perfect wave for working with disabilities is almost ready to crest. Putting Virtual Reality (VR) to work as an assistive teaching tool and an environmental enhancement for people with disabilities has the potential for becoming one of the 'perfect waves' in the history of disabilities.
The Virtual Reality and Person With Disabilities Conference was held this summer in San Francisco and I must admit to being in total awe of the applications and research going on in this field of technology. Never before have I been so charged up by the new things I learned. As a special educator, my mind was constantly on zoom lens, fast-forwarding to other applications in teaching, rehabilitation, and independent living training.
Having followed only the written literature up to this point, I was amazed to find that the field has gone beyond cyberspace battles and games to new levels of application. We are definitely beyond the telecommunication era and into the Age of "Telepresence". Previously, this business term has been used to refer to a VR tool that allows an operator located in one part of the world to manipulate equipment that may be located somewhere else (Hamilton & Smith, 1992). In the future, however, this term may be used synonymously with training people with disabilities to live, work, and play in a VR simulated environment that is oblivious to their handicap and enhances their capabilities. Remember, folks, you read it here, first Telepresence Training for people with disabilities!
A key underpinning of VR is the assumption that the brain can process information more effectively when it is presented through combining sight, sound, and touch (Hamilton & Smith, 1992). This is one of the main characteristics that makes VR different from other computer generated graphics. At the core of the VR system is a database that has specifications to create almost anything in the world. Using this data in combination with sophisticated computer generated graphics, a "world" can be created to the exact specifications the data describe. Although the graphics displayed may vary a great deal, images may appear in 3-D on the computer monitor or projected onto several screens, theater style. At the conference, a variety of computer generated displays and stereoscopic lenses that were mounted inside helmets were demonstrated.
The other key element of VR is that it is interactive. A specially designed glove with sensors may be worn in some VR worlds to assist in manipulating objects and movements within that environment. In other images viewed on the computer or screen, using a mouse or joystick may be the means of interaction. By experiencing the sensations of sight, sound, and touch, there is definitely an internalized 'feeling' that you are actually experiencing the 'presence' of being in that reality as an interactive participant.
In analyzing the two basic ingredients for VR, there are striking parallels in teaching people with disabilities. Many studies are in strong support for utilizing multi-sensory teaching techniques and creating interactive teaching situations to assist in the generalization of skills from one setting to another. This makes VR an extremely viable tool for expanding into new outcomes for learning, vocational, and independent living training via Telepresence Training. If children can interact at a young age with new learning experiences in an alternative environment that responds to their limitations and style of learning, then the potential for increased language development becomes much more viable. Since interactive language is at the core of our developing into people who learn, live, socialize, and work independently, this presents exciting new possibilities.
Several ways of interacting with VR are currently under investigation. During the conference, neuroscientist and physicist, Dr. Dave Warner, demonstrated some of the powerful applications being developed at Loma Linda University Medical Center and Loma Linda University Children's Hospital in California. Through the Institute for Interventional Information in Loma Linda, many people with various physical, mental, and/or health disabilities are taking part in research Warner refers to as "Wellness Technology." The researcher begins with asking what can the person do? Then, the focus is placed on the physiological basis of information processing and culminates with customizing technology to the needs of the whole person. In viewing that "a spinal cord injury looks different than a muscle injury...looks different than a cognitive injury"..., this information is then utilized as a mechanism for healing. Warner is studying the "neurological system as an information processing network, a link between the mind and the outside world."
In some of Warner's first work, the VLP DataGlove was used in medical applications to measure the frequency, duration, and intensity of Parkinson's tremors. The tool soon became an efficient way for neurologists to measure a patient's response to therapy and time. The DataGlove uses fiber optics in the fingers. Through bending the fingers, the fiber optics sense the movement and the movement is translated into numerical values and stored in the computer.
Other applications with the DataGlove were then tried with individuals without speech to help them turn hand gestures into speech. By using sign language, the person could generate a computer-synthesized voice. In further experiments, the DataGlove was used by patients in rehabilitation therapy to move virtual objects around on a computer terminal. This tool allowed the patient to pull virtual levers, turn wheels, and move virtual boxes around on the screen monitor. Because the rehabilitation process can be very rigorous and requires a lot of repetitive exercising, people often lose the will to keep trying. Warner views that one of the most important findings from the investigations has been that eye/hand coordination and fine motor skills can be developed with the patient using very little strength. Thus, VR also becomes a tool to help foster motivation because the person is having fun. Warner notes that it is not the physiological rehabilitation that is the deterrent from improvement, "it's the psychological capacity that blocks them. They don't want to do it. They are depressed. They've lost function." Through various uses of VR, they think they are having fun, while they are actually being rehabilitated.
In working with children receiving cancer treatment, Dr. Warner has investigated VR as an interactive illusion, using the computer to generate the illusion. In one experiment, a computer cartoon character helped generate positive interactions with the children. Using an interface tool called the Bio-Muse that mediates between a person's muscles and a computer, an actor was hooked up to a computer via the facial muscles to help create an animated "3-D talking head" on the computer screen. The actor made expressions with his face and the computer generated animated effects, appearing to the viewer as though they were actually having a conversation with the talking head animation. During these experiments, children who had not smiled in weeks, suddenly began laughing and experiencing joy. In other experiments, VR has been used to create the illusion that the child is swimming and trying to catch sharks with a big net. These experiences help create an "out-of-body" experience for the person whose body may be physically worn out from their medical problems or confined to a hospital room. While working to capture the sharks, the children begin making more body movements and verbally interacting in ways that enhance their feelings of joy through their achievements. When people experience more joy and happiness, this stimulates the brain to promote more brain chemicals which may help in promoting wellness for the body.
Using items that can be purchased at places such as Radio Shack, Dr. Warner created the Bio-Muse to assist the bodies own ability to create electrical activity. Linked with special software that converts electrical impulses and other inputs into computer commands, a combination of information systems and information technology is applied in ways designed to intervene with the individual. This tool acts as an interface between humans and technology. Electronic sensors measure the movement of the eyes and interface between humans and technology. Electronic sensors measure the movement of the eyes and activation of facial muscles. Thus, a severely handicapped person can move a cursor on the computer terminal by moving the eyes and initiate commands through the computer by using jaw muscles or muscles in other areas.
A demonstration of the Warner's equipment and software gave convincing evidence of the ease and usefulness of these VR tools for future applications. Dr. Warner demonstrated how electrodes were snapped onto cables and put over a specific groups of muscles. When the muscle flexes, energy from the muscle contraction gives an electrical signal which is then picked up by the electrodes. Two electrodes are typically used and the voltage is being picked up between the two. The signal is then interpreted by computer chips in the Bio-Muse box. Those numbers are then sent to the computer which gives a smooth, controlled signal. In experiments with people having spinal cord injuries, this type of VR uses bioelectric signals to help the person utilize any muscles which might still be functioning. In one instance, a young child with a spinal cord injury since birth was able to learn to use her facial muscles to help create an interactive environment allowing her to experience such activities as swimming in water and climbing a tree. Warner built Cindy Cyberspace, a mannequin head with two small TV cameras for eyes and two microphones for ears. While Warner carried 'Cindy' into the pool, every sight and sound was experienced by the child while wearing 3-D glasses and stereo headphones. With advanced human-computer interfaces, the investigator believes that people with severe disabilities can achieve goals never before thought possible. Warner refers to this type of VR interaction as an out-of-chair experience! This experience is an escape for people and opens the door for them to be more independent.
One of the greatest features of Dr. Warner's work is its affordability. Several types of economy packages can be purchased at prices that most people can afford. For example, in one of the combination packages, TNG 1 is offered along with electrode and serial cables, one sheet of ten electrodes, and NEAT software, version 3.0 for the price of $150. Not a bad price when you consider someone's freedom to participate more fully in experiences that everyone else takes for granted!
In a personal interview, Michelle Johnson, working with the Rehabilitation Research & Development Center in Palo Alto, provided a slightly different focus in research which will be of benefit to people who have experienced neuromuscular changes due to a stroke. Using robot and control-assist theory, the goal is to quantify the disability to provide improved range of motion and functioning for greater, overall rehabilitative functioning. Currently, two different machines are under investigation. The MIMI (Mirror Image Movement Enabler) is a robot assistive device designed to help the functioning of an individual who has right Hemiplegia. The paralyzed left robot assists the right side and mirrors the movement to improve the person's range of motion.
Another tool known as the Driver's Seat is an interactive computer controlled driving simulation. People with neurological damage will gain a new tool to assist in their rehabilitation. A unique feature of this equipment is its "split-steering wheel" to assist the person who is paralyzed on one side or the other. The researchers view that if one arm is damaged and the other is normal, then a phenomenon known as "learned disuse" can develop. To avoid this, tasks are done via the machine which use both sides of the body. Sensors placed on the steering wheel measure the tangential force being used. For example, if 30 pounds of tangential force is needed to make the car move and the person is only registering 3 pounds via the sensors, then the person will have to work harder to involve the non-paralyzed limb. The new split-steering and force indicator offer a tremendous boost in giving more immediate feedback to the user and a better mechanism for predicting the level of improvement being made.
Other environmental VR applications are being investigated by Kenneth Nemire and Rebecca Crane with Interface Technologies, in Capitola, California. The researchers designed a means for interacting in virtual worlds that can utilize the motor capabilities of people with cerebral palsy (CP).
People with CP may have speech dysfunction(s), involuntary movements, difficulty processing information regarding arm or head position, spasticity, poor upper extremity coordination and minimal force control, making it almost impossible to operate some types of physical controls. Previously, the Virtual Environment Science Laboratory (VESL (TM) was created as an enhancement in science education for use with non-disabled students and to assist in making accommodations for people with spinal cord injuries or other types of paralysis. By providing access to educational and science experiences, the doorway to job opportunities in science careers has been opened.
Although the researchers have investigated a variety of experiments, the one presented at the Conference utilized spatial tracking technology and special prediction software to help students with CP select targets in a virtual world. It was determined that two different kinds of prediction software enabled the students to reach targets faster than they could without software enhancements. This was also accomplished with no increase in the number of misses. Thus, the performance of the user's interactions in a 3-D virtual world were viewed as successful improvements by the authors. The authors are utilizing these results to refine further predictive software, and provide a more firm foundation for testing with a wider range of conditions and wider range of users (Nemire & Crane, 1995).
Since computers have become integrated into all parts of our lives, a growing number of applications will be extended into virtual interface technologies to provide a virtual environment which features a highly adaptable mechanism for interacting with computers rather than constraints. Two applications that extend more complex use of virtual interface technology were presented by Walter Greenleaf, Ph.D. with Greenleaf Medical Systems in Palo Alto and Maria Tovar with Stanford University. The Virtual Receptionist is a system that allows people with speech or motor impairments to perform the duties of a receptionist. This technology requires fiber-optic flexion sensors for detecting movement, a sound digitizer for recording and playing back the voice, a PBX for managing the telephone, and an Apple Macintosh computer which controls inputs, outputs, and maintains records. Software being utilized for this interactive technology are the Gesture-Control System and the GloveTalker. A limitation of the current system is in trying to quantify upper-extremity motion to allow for better analysis of the data. At the present time a "real-time measurement" device for the hand is used with the DataGlove. The Movement Analysis System (MAS) functions as a link between the DataGlove's fiber-optic sensor data and a software tool to help quantify upper extremity function. However, in the future, the integration of a more "fully configured glove" is planned by the investigators. The goal is to create a system which would allow therapists to design virtual worlds with objects traditionally associated with living, working, and playing independently. The motions, location, and trajectory of the hand movements required to perform a task could be recorded as data to analyze for better interpretation and rehabilitation planning. Standard software is used to assist in analyzing statistical data for interpretation. This approach would allow the therapist the use of animation to "play back" the motions to allow more time to analyze critical movements. In addition, because the person's virtual body is modeled in the spatial sense, the therapist would also be able to change the viewing angle, thus allowing for a totally different spatial perspective to be analyzed (Greenleaf & Tovar, 1994).
One of the greatest things about the VR Conference is being able to learn from people who have traveled from all parts of the world to collectively share information within the field. Researchers from the United Kingdom presented impressive work with people who have cognitive disabilities. Utilizing a VR simulation of shopping in a supermarket, Standen & Cromby (1995) from the University of Nottingham performed a study with secondary students with developmental disabilities. The goal of the research was to determine if students could increase their speed and accuracy in shopping for grocery items. Not only did the students improve their skills in these areas, the information was retained over six months time and generalized from the original setting to the store with new displays which were rearranged for the holiday season. The store also had many more visual and auditory distracters which added to the overall changes of the research setting.
In another experiment, a VR kitchen was used to train students to locate the items and perform the task of making a cup of tea. Similar to the research results above, the students who were trained and practiced the task using the VR simulated kitchen surpassed the control group that did not use the simulated VR.
Although the VR Conference had many types of disabilities represented, none was discussed which had used the interactive technology with people who have autism. However, in the March/April, 1995 issue of CyberEdge Journal, author Ben Delaney reviewed some interesting research which has great potential. Dorothy Strickland, a doctoral student at North Carolina State University had performed experiments with two children, aged 7 and 9, with "classical autism. Working on the theory that people with autism are unable to synthesize input stimuli effectively and efficiently, Strickland feels that they are also frequently unable to retain and generalize learning to other settings. Seeking new teaching tools and methods, Strickland designed a VR world in which the children ventured into a simply defined street scene with texture-mapped buildings and sidewalk. Later in the investigation, a stop sign was added to the scene. Both subjects were described as "minimally verbal, able to recognize short sentences, and two colors. Because earlier work had shown that using hand signals with the VR was too complicated, only one word responses, or ones that the children performed in response to instructions were used. An example might be in having the children turn their heads to find the car. Even though this research is still in the infant stages, the results are exciting. Both children were willing to accept the Head Mounted Display and able to navigate the VR world. In addition, they recognized and identified the moving car, and located and walked toward the stop sign while using the simulation. It appears that continued research in this area will be fertile ground for future applications for VR.
Some predictive thoughts from the Conference guest speaker, Jaron Lanier, were excellent for passing on to future generations who will be trying to manage the current and future waves of technology. In Lanier's view, a core shift has taken place in the ways we interact with language. Kids today are growing up with what he termed post-symbolic communication because of our computer languages. Currently, the agenda is on "finite games" that eventually seem to blow up! Lanier feels that another core shift must take place which is critical to our existence as a society. The shift must be to appreciate the beauty of technology and learn to make positive use of its infinite capabilities and functions.
It has been said that technology is a great equalizer for people with disabilities. This is true in most respects, especially many of the more sophisticated voice recognition and speech synthesis devices. Virtual Reality is a technology for which the wave is beginning to crest. While presently in the infant and unfortunately, still expensive stages, VR will radically change the way some things are currently being taught to people with disabilities. Interactive Telepresence Training will not only assist people to interact in ways never before thought possible, it will allow them to access other technologies which will make it possible for them to independently teach themselves both efficiently and effectively.
* Editor's note: We met Bobbie at ConnSENSE '95 and learned she was going to attend the Virtual Reality and Person With Disabilities Conference in San Francisco later that summer. We've had always wanted to attend this conference and convinced her to write this article about that conference. Since that time the virtual reality conference has been folded into the annual CSUN conference held each March. It's a great conference!
California State University, Northridge: Technology and Persons with Disabilities; Los Angeles Airport Hilton; 818/677-2578; FAX 818/677-4929; Email: LTM@CSUN.EDU; http://www.csun.edu/cod/
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