Abstract Background Visuospatial neglect (VSN) is a cognitive disorder after stroke in which patients fail to consciously process and interact with contralesional stimuli. Visual Scanning Training (VST) is the recommended treatment in clinical guidelines. At the moment, several mixed reality versions of Visual Scanning Training (VST) are being developed. The aim of this study was to explore the opinions of end-users (i.e., therapists) on the use of Virtual Reality (VR) and Augmented Reality (AR) in VSN treatment. Methods Therapists played one VR and two AR Serious Games, and subsequently flled out a questionnaire on User Experience, Usability, and Implementation. Results Sixteen therapists (psychologists, occupational, speech, and physiotherapists) played the games, thirteen of them evaluated the games. Therapists saw great potential in all three games, yet there was room for improvement on the level of usability, especially for tailoring the games to the patient’s needs. Therapists’ opinions were comparable between VR and AR Serious Games. For implementation, therapists stressed the urgency of clear guidelines and instructions. Discussion Even though VR/AR technology is promising for VSN treatment, there is no one-size-fts-all applicability. It may thus be crucial to move towards a plethora of training environments rather than a single standardized mixed reality neglect treatment. Conclusion As therapists see the potential value of mixed reality, it remains important to investigate the efcacy of AR and VR training tools.
Introduction: Visuospatial neglect (VSN) is common after stroke and can seriously hamper everyday life. One of the most commonly used and highly recommended rehabilitation methods is Visual Scanning Training (VST) which requires a lot of repetition which makes the treatment intensive and less appealing for the patient. The use of eHealth in healthcare can increase options regarding improved treatment in the areas of patient satisfaction, treatment efficacy and effectiveness. One solution to motivational issues might be Augmented Reality (AR), which offers new opportunities for increasing natural interactions with the environment during treatment of VSN. Aim: The development of an AR-based scanning training program that will improve visuospatial search strategies in individuals affected by VSN. Method: We used a Design Research approach, which is characterized by the iterative and incremental use of prototypes as research instruments together with a strong human-centered focus. Several design thinking methods were used to explore which design elements the AR game should comply with. Seven patients with visuospatial neglect, eight occupational therapists, a game design professional and seven other healthcare professionals participated in this research by means of co-creation based on their own perspectives. Results: Fundamental design choices for an AR game for VSN patients included the factors extrinsic motivation, nostalgia, metaphors, direct feedback, independent movement, object contrast, search elements and competition. Designing for extrinsic motivation was considered the most important design choice, because due to less self-awareness the target group often does not fully understand and accept the consequences of VSN. Conclusion: This study produced a prototype AR game for people with VSN after stroke. The AR game and method used illustrate the promising role of AR tools in geriatric rehabilitation, specifically those aimed at increasing the independence of patients with VSN after stroke. 2020 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
This paper presents how the application of the STPA method might support the evaluation of fighter pilots training programs and trigger procedural and technological changes. We applied the STPA method by considering the safety constraints documented in the Standard Operating Procedures (SOPs) of a South European Air Force and regard a flight of a two F-16 aircraft formation. In this context, we derived the control actions and feedback mechanisms that are available to the leader pilot during an Aircraft Combat Maneuver (ACM) mission, and we developed the control flow diagram based on the aircraft manuals. We compared the results of each analysis step with the respective flight training program, which is based on a mixed skill and rule-based decision-making, and we examined the role of the feedback mechanisms during multiple safety constraints violations. The analysis showed that: the flight training program under study does not structurally include cases of infringement of multiple safety constraints; the maintenance of some safety constraints are not supported by alerts, or rely on only one human sense; the existing procedures do not refer to the prioritization of pilot actions in cases of violation of multiple safety constraints; operation manuals do not address the cases of possible human performance deterioration when simultaneous information from feedback mechanisms is received. The results demonstrated the benefits of the STPA method, the application of which uncovered various inadequacies in the flight training program studied, some of them related to the F-16 cockpit ergonomics. The analysis lead to recommendations in regard to the amendment of the corresponding fighter pilots training program, and the conduction of further research regarding the aircraft – pilot interaction when multiple safety constraints are violated. The approach presented in this paper can be also followed for the (re)evaluation of flight training schemes in military, civil and general aviation, as well by any human-machine interface intensive domain.
