In a research project in collaboration with the Swiss Children’s Rehab of the University Children’s Hospital Zurich, we were able to prove that children accept a VR experience as a motivating tool and therapists evaluate it as a useful addition to existing therapies (Virtual Reality in Pediatric Neurorehabilitation). With this knowledge as a basis, the project entered the next phase.
An important aspect of rehab with children is the promotion of activities of daily living that are important to the child and the family. Currently, these therapies usually take place in therapy rooms or in the safe environment of the rehabilitation center. Many activities of daily living are difficult to train in this setting. It is also difficult to maintain the children’s motivation over a longer period of time, as a monotonous and colorless room offers far too little variety.
It was important to find a solution that is accepted by the children and therapists and can be used as an additional therapy option to train various everyday activities in a safe environment. Thanks to the use of VR, the children can solve tasks in a playful way. They are much more engaged and therefore move longer and more persistently. This allows children to perform, without realizing it, a higher number of movement repetitions, which are necessary for learning and improving an activity.
Initial results already show a positive influence – this is now being further scientifically evaluated.
After an evaluation of the devices, the Oculus Quest 2 was chosen. It is best accepted by the children and allows the most intensive immersion in new worlds.
The therapist accompanies the child and therefore needs to know where the child is in the game. Oculus offers the option of mirroring the screen, but the data shouldn’t be put on the Internet. In addition, the therapists want to control the app and the scenes in a simple way. Therefore, a dedicated companion app was developed, which allows the therapist to interact with the scene and provide live support, as well as view tracking and statistics.
There are different game modes and a scene selection to choose a world that suits the child.
The companion app, including self-developed streaming, allows the supervisor to view the situation at any time and to influence the game, e.g. by adjusting the difficulty level.
Another innovation on the Quest 2 that is new to rehab is accurate foot tracking. This was realized with trackers that indicate the position in space. Thanks to the use of 3 trackers per foot, it’s position and orientation in space can be recreated in the VR scene in real time. This allows the child to see the movements and placement of his feet in the virtual world at any time. In addition, the child can be alerted via auditory feedback, for example, if he or she has bumped into an obstacle with the foot. Especially for children with neurological diseases, visual and auditory feedbacks are very important and valuable, as these children often have a reduced body perception.
Hand tracking is used for intuitive player interaction. Thus, picking fruits, opening doors or touching magic mushrooms feels as natural as possible and can be used as another motivation option.
The goals were achieved very well. The acceptance of the children is very high and they enjoy it. When choosing between the virtual or the conventional form of therapy, they always opt for VR because there is much more to discover and their actions trigger a reward, be it in the form of a visual effect, an animal movement or acoustic feedback.
Therapists also rate it as a good addition to existing therapies. It is much easier to motivate the children to do exercises, and the recorded movement and behavior data enable a systematic and verifiable evaluation of the progress the child is making.
This was evaluated using a trial with 21 participants: