Ambient Intelligence and Immersive Virtual Telepresence in Health Care

From Technology to Health: How to use advanced technologies to improve the quality of life: Ambient Intelligence and Immersive Virtual Telepresence G. Riva , Ph.D. Istituto Auxologico Italiano E-mail: [email_address] http://www.cybertherapy.info http://www.emergingcommunication.com http://www.e-psychology.net

Goals of this Presentation Outline the actual trends in the use of Virtual Reality and Ambient Intelligence in health care Identifying applicative areas, pros and cons Identify a possible future scenario - the emergence of p-health – based on Immersive Virtual Technologies and Ambient Intelligence Understanding how this scenario can influence future health care provisions Identify a tentative roadmap

Cybertherapy Cybertherapy is an internationally recognised term that covers any method used to promote health, prevent and treat disease and improve rehabilitation or long-term care based on new Information Technologies. “ Cybertherapy" in this context i not confined to pieces of sophisticated equipment , but include: procedures, settings of care and screening programmes.

The problems Even if the potential of Health Technology is huge , its impact on the health-care system is still limited . On one side, clinicians are not aware of the potential of technology and are reluctant to adapt their own procedures to the technological constrains. On the other side developers are not focussed on the specific clinical requirements. In fact, health technologies should not be promoted as an end in themselves. They should only be chosen when they meet an evident need and are cost-effective .

The challenge How is possible to overcome these difficulties? In the presentation we will analyze the vision behind the VEPSY Updated European project, http://www.cybertherapy.info in which technology developers and clinical practicioners worked together to develop advanced application based on VR and 3G phones http://www.thedreamisland.com These applications are now used in the treatment of phobias, stress, eating disorders and obesity.

Our vision: p-health? Is a shared immersive e-therapy in which the presence, simulation, and experience components of virtuality are key factors of the therapeutic process.

VR is the core p-health tool Since the development of methods of electronic communication clinicians have been using information and communication technologies in health care. However, the possible impact of virtual reality (VR) on health care is even higher than the one offered by the new communication technologies In fact, VR is at the same time a technology , a communication interface and an experience .

VR in Health Care 1989 : First VR company (VPL Research) founded 1991: Virtuality Game System 1993: Suggested the use of VR in psychological treatment 1993: Suggested the use of VR in surgical simulation 1995: First research papers on VR in neuro-psychological assessment and treatment 1996: Completed Visible Human (male) 2006 : more than 1200 papers in MedLine

Virtual Reality Technology VR is usually described as a collection of technological devices : a computer capable of interactive 3D visualization, a head-mounted display and data gloves , equipped with one or more position trackers . The trackers sense the position and orientation of the user and report that information to the computer that updates (in real time) the images for display.

Immersive Tools (1) $2,900 $10,000 $20,000 $500-2,000 $900 $24,000 $1,800 Head Mounted Displays “ Near Eye Immersive Display Systems”

Immersive Tools (2) Trackers $1,800 $5,000 $900 $5,000 -15,000

Head Mounted Display with tracker Z800 3D Visor : 600 € Intel Core Duo PC with Nvidia GeForce 7900 GTX graphic card: 2000 € Our Hardware: less than 3000 €

PC based VR For many years one of the main obstacles to the development of VR applications was the price of the equipment : a typical VR system required a costly Silicon Graphic workstation in the range of 250000 US$. The significant advances in PC hardware that have been made over the last five years, are transforming PC-based VR into a reality . A simple immersive VR system now may cost less than 6000 US$.

Mobile/PDA based VR Gizmondo from Tiger: 390 Euro Windows Mobile OS Bluetooth, GPS and GPRS Graphic Power similar to a Playstation 1, MP3, MP4 904SH from Sharp: 500 Euro Symbian OS Bluetooth and GPS VGA screen and video-out Graphic Power similar to a Playstation 1, MP3, video

VR: Beyond the technology There are two visions of VR: Simulation technology : a collection of technologies that allow people to interact efficiently with 3D models in real time using their natural senses and skills Communicative interface : a advanced form of human-computer interface that allows the user to interact with and become immersed in a computer-generated environment in a naturalistic fashion In synthesis: a synthetic experience providing the feeling of “ presence ”

VR in Health Care The concept of presence clarifies the possible role of VR in medicine: a communication interface based on interactive 3D visualization, able to collect and integrate different inputs and data sets in a single real-like experience . It is up to the health care provider to decide if the VR application will be more focused on the integration of different data sets or on the realism of the virtual experience .

VR applications in Medicine Medical Education Through 3-D visualization of massive volumes of information and databases, clinicians and students can understand important physiological principles or basic anatomy => For instance, VR can be used to explore the organs by "flying" around, behind, or even inside them. A significant step towards the creation of VR anatomy textbooks was the acquisition of the Visible Human male and female data made in August of 1991 by the University of Colorado School of Medicine

VR applications in Medicine Surgical simulation and planning Surgeons know well that in training there is no alternative to hands-on practice => since early 1990s different research teams has been trying to develop VE simulators . Another application is the planning of surgical and neuro-surgical procedures . It usually relies on the studies of series of two-dimensional Magnetic Resonance and/or Computer Tomography images, which have to be mentally integrated by surgeons into a three-dimensional concept => A VR-based system can incorporate different scanning modalities in a 3D view .

VR applications in Medicine Neuropsychological assessment and rehabilitation VR is a highly flexible tool, providing a large amount of controlled stimuli and, simultaneously, monitoring the possible responses generated by the user of the virtual world. The patient can manage successfully the problematic situation or rehabilitation task: the patient is more likely not only to gain an awareness of his/her need to do something to change but also to experience a greater sense of personal efficacy.

Possible killer apps (1) REHABILITATION Through its capacity to allow the creation and control of dynamic 3-dimensional, remote, ecologically valid stimulus environments within which behavioral responding can be recorded and measured, offers clinical assessment and rehabilitation options that are not available with traditional methods. Specific clinical areas : memory, motor abilities, executive functions and spatial representation .

Possible killer apps (2) EATING PATHOLOGIES Through its capacity to: modify the perceptual/cognitive bodily distortions , a major reason patients want to lose weight . support the empowerment process . VR has the right features to support empowerment process, since it is a special, sheltered setting where patients can start to explore and act without feeling threatened p-health offers new options that are not available with traditional methods. Specific clinical areas : anorexia, obesity, binge eating disorders, bulimia - Addictions (smoking, drug, etc.)

Possible killer apps (3) PHOBIAS Through its simulation and mobility power has: the ability to expose the client to a range of conditions that would be impractical or unsafe in the real world; the potential to precisely control what is presented; the ability to tailor treatment environments to the needs of each individual; the ability to improve confidentiality by substituting for group treatment or in vivo desensitization. Specific clinical areas : panic disorders, generic phobias (fear of driving, flying, etc.)

Actual weakness of VR in medicine “ Perceived” and Actual Costs “ Perceived” and Actual Complexity Platform Compatibility Wires!: The Interface Challenge Display Hardware Side Effects Front End Flexibility Back End Data Extraction, Management, Analysis, Visualization

No Moore’s Law Operating in the area of HMDs and other quality peripherals Need Cost/Benefit Proofs! Aftereffects Lawsuit Potential Ethical Challenges The Perception that VR Tools will eliminate the need for the Therapist Limited Awareness/Unrealistic Expectations No reimbursement from health care systems Key issues to solve

Immersive Virtual Telepresence

ITV in Telemedicine Augmented Telemedicine : a user can see the avatar of another user coming into the scene and a 3D video conference is carried on. It is also possible to embed additional info.

Ambient Intelligence ( AmI ) refers to electronic environments that are sensitive and responsive to the presence of people A better future…

Ambient Intelligence AMBIENT INTELLIGENCE : The convergence of Electronics Engineering, Computer Science and Telecommunications

Embedded Personalized Adaptive Anticipatory Many invisible distributed devices throughout the environment, that can be tailored towards your needs and can recognize you, that can change in response to you and your environment, and that anticipate your desires as far as possible without conscious mediation Ambient Intelligence (2)

 Key technologies Ubiquitous Computing Ubiquitous Communication Intelligent user social/friendly Interfaces Purpose Deliver seamless applications and services to citizens User-driven approach Better integration of technology into our environment  Understand how people interact with technology Indispensable component: user context Characteristics to be achieved Ubiquity, awareness, transparency, intelligent, sensitive, adaptive and responsive AmI Features

AmI from an user’s viewpoint (1) AmI is the effective and transparent support to the activity of the subject/s through the use of information and communication technologies- the definition focuses on the activity of the subject as the main object of analysis Further, identifies “ effectiveness ” (the activity reaches its objective) and “ transparency ” (the activity is experienced without breakdowns) as the main characteristics of an AmI system.

Specifically, an effective AmI system has to support: User awareness : the interface should be capable of user-adapted behavior by automatically selecting an interaction patterns appropriate to the particular end-user ; Activity awareness : the interface should be capable of activity-adapted behavior by selecting an interaction patterns appropriate to the particular level of activity , its related objective and its status; Situation awareness : the interface should be capable of situation-adapted behavior by automatically selecting interaction patterns appropriate to the particular physical, social and cultural environment . AmI from an user’s viewpoint (2)

AmI integrates different complementary areas : health care information provision, administrative and clinical data collection, therapy and assessment provision. In particular, new and emerging technologies will provide personalized, intelligent, assistive technology that can promote recovery and sustain independence and quality of life. AmI in Health Care

How to apply p-health vision in health care? Provision of therapeutical contents using 3G portable phones; Advanced telemedicine settings based on mobile mixed reality; Biofeedback like VR: interaction based on biosensors’ data; Integration of patients data in wide networks for behavior analysis and better therapy planning.

Advantages of p-health (1) Complete naturalistic performance record Safe testing and training environment which minimizes risks due to errors Graduated, systematic exposure Distraction Gaming factors to enhance motivation Low cost functional environments that can be duplicated and distributed No location boundaries

Advantages of p-health (2) Ecological validity Stimulus/Response control and consistency Repetitive and hierarchical stimulus delivery possible Cueing stimuli for “errorless learning” Real time performance feedback Self-guided exploration and independent practice Stimulus and response modification contingent on user’s impairments Remote collection of clinical data

Processing Power/Graphics/Video Integration Integration with mobile communication Academic and Professional Acceptance Well-Matched VR Rehab/Clinical apps also have widespread intuitive appeal to the public: phobias, eating disorders, Alzheimer, etc. Close Knit VR Community Gaming and Entertainment Industry Drivers Integration with Imaging and Psychophysiological Approaches TeleRehabilitation Virtual Humans p-health supporting issues

Thank you for your attention http://www.cybertherapy.info http://www.emergingcommunication.com http://www.e-psychology.net Giuseppe Riva Istituto Auxologico Italiano E-mail: [email_address]

The Phenom Project (Philips) PHENOM is a long-term research project, which aims at creating an homr environment that is aware of the identity, location and intention of its users , and that eventually is capable of butler-like behavior. An intelligent Memory Browser system has been designed as carrier application: the system recognizes multiple users, devices and objects, and learns from their behavior. Interaction with the system is very natural: users can e.g. select photos using souvenirs. The project generates concepts and builds capabilities, particularly in system integration.

TouchWall – A picture wall allowing bidirectional interaction (voice – text)

MoveWall A picture wall allowing movement tracking and recognition

MirrorMe – A touch-screen mirror allowing bidirectional interaction

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