17645684 cybertherapy rehabilitation magazine 1 2009

The focus of this conference is on the increasing use of interactive media intraining, education, rehabilitation, and therapeutic interventions.Technologies include virtual reality simulations, video games, telehealth,videoconferencing, the Internet, robotics, and noninvasive physiological monitoring devices.

Giuseppe Riva, Ph.D., Conference Co-Chair

Brenda K. Wiederhold, Ph.D., MBA, BCIA, Conference Co-Chair

CT14 Goes Green! To be environmentallyfriendly,the use of paperat CT14 will be limited. Conference documents will be available in electronic format. Instead of the usual conference bag, participants will receive a free USB stick.

Issue 1 / 2009

FEATURES:The Eldergame s Project

p 9

Transforming VR into a Reality:The NeuroVR Project

p 12

Internet Environment to Curb Teen Smoking

p 14

Intelligent Clothing Calls for the Doctor

p 17

Visualizing Voicep 21

The SpiderGlovep 24

PRODUCT COMPARISON:Wearables

p 20

COUNTRY FOCUS:Italy

p 28

COVER STORY:

The Evolution of

Wearables

T h e O f f i c i a l V o i c e o f I - A C To R

ISSN 2031 - 278

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cover_C&R_no_spine:Layout 1 9/07/09 11:10 Page 3

Dear Reader,

Welcome to Issue 1 of the 2009 CyberThera-py and Rehabilitation Magazine (C&R), the of-ficial voice of the International Association ofCyberPsychology, Training and Rehabilitation(I-ACToR). I-ACToR, formerly known as the In-ternational Association of CyberTherapy andRehabilitation (IACR), is an international asso-ciation dedicated to the promotion of virtualreality and advanced technologies as an ad-junct to more traditional forms of healthcare.It also, in its new form, will deal with issuesconcerning how technology is changing be-havior and society.

As you know, 2008 was C&R’s inaugural year.In 2009, C&R will continue to work to bringyou news of cutting-edge technologies, inno-vations and new research in this domain. Iwould like to take this opportunity to thankyou, our readers, for your encouragement andsupport in the founding of C&R. Specialthanks also go to the Editorial Board mem-bers for their dedication in bringing this ideainto reality. I would like to as well thank theManagement Board and Founding Membersof I-ACToR. We are excited to announce thatwe have already formed affiliations with sev-eral other associations, conferences, publica-tions and institutional partners to furtherstrengthen the goals of the association andunite this heretofore-fragmented field. Weplan to build upon the momentum begun in2007 and 2008 through the hard work anddetermination of my colleagues.

In the inaugural issue of C&R, we began ourvoyage of discovery by looking at currentlyavailable technologies and their benefits forhealth. We introduced the concept of virtu-al reality in healthcare, and focused on head-mounted displays. In this, the second issueof C&R, we take a closer look at the applica-tions of advanced technologies. Our lead ar-

ticle considers the evolution of wearables andtheir uses in the field of healthcare. The wear-ables theme is continued with articles onclothing which calls for the doctor and the“SpiderGlove”. Our product comparison chartallows you to compare existing innovationsin wearable technology – these range fromgarments that monitor health problems to apatch used for transdermal drug delivery.Other articles look at technological solutionsto curb teen smoking and improve the cog-nitive functioning and increase the social par-ticipation of the elderly. A further study alsolooks at how human computer interactioncan improve the social skills of children withAspergers Syndrome. And finally, an open-source platform is discussed for virtual envi-ronments. I would like to thank the authorsof these articles for the time and effort thatthey put into getting these thought-provok-ing articles ready for print.

Looking to the future, coming issues of C&Rwill discuss topics such as E-habilitation, videogames for health, implantables and muchmore. There is a wealth of advanced technol-ogy for healthcare, and C&R will continue todedicate itself to bringing you news of excit-ing developments in this field.

I hope you enjoy reading our publication andthat it sparks your desire to increase yourknowledge in this exciting new domain. Weare always striving to meet (and surpass!) theneeds and expectations of our readers, and sowe very much welcome your input. Please con-tact me, or the C&R Managing Director, at [email protected], with your comments andsuggestions. We would be delighted to hearfrom you. Indeed, your contributions are vitalto our continued growth.

Create your own reality!Brenda Wiederhold

1

“We began our voyage of discovery by looking at currently available technologies and their benefits for health. Now we take a closer look at the applications of advanced technologies…”

Letter from the PublisherProfessor Dr. Brenda K. Wiederhold

C&R_Issue_2_Mess_around:Layout 1 8/07/09 18:19 Page 1

2

GENERAL INFORMATION

CyberTherapy & Rehabilitation Magazine

ISSN: 1784-9934

GTIN-13 (EAN): 9771784993017

CyberTherapy & Rehabilitation Magazine is published quar-

terly by the Virtual Reality Medical Institute, 28/7 Rue de la

Loi, B-1040 Brussels, Belgium. The magazine explores the

uses of advanced technologies for therapy, training, educa-

tion, prevention, and rehabilitation. Areas of interest in-

clude, but are not limited to, psychiatry, psychology, phys-

ical medicine and rehabilitation, neurology, occupational

therapy, physical therapy, cognitive rehabilitation, neurore-

habilitation, oncology, obesity, eating disorders, and autism,

among many others.

PUBLISHING HOUSEVirtual Reality Medical Institute BVBA

28/7 Rue de la Loi,

B-1040 Brussels, Belgium

PUBLISHER

Brenda K. Wiederhold, Ph.D., MBA, BCIA

Fax: +32/2/286 8508

E-mail: [email protected]

Website: http://www.vrphobia.eu

Telephone: +32 2 286 8505

ADVERTISING For advertising information, rates, and specifications please

contact Virtual Reality Medical Institute, 28/7 Rue de la Loi,

B-1040 Brussels, Belgium, Telephone: +32 2 286 8505; Fax:

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REPRINTSIndividual article reprints are available from corresponding

authors. Please contact the publisher for rates on special or-

ders of 100 or more.

MANUSCRIPTSSubmissions should be addressed to the C&R Managing Ed-

itor, Virtual Reality Medical Institute, 28/7 Rue de la Loi, B-

1040 Brussels, Belgium, Telephone +32 2 286 8505, Fax: +32

285 8508; E-mail: [email protected].

COPYRIGHTCopyright © 2009 by Virtual Reality Medical Institute. All rights

reserved. CyberTherapy & Rehabilitation Magazine is owned

by Virtual Reality Medical Institute BVBA and published by the

Virtual Reality Medical Institute BVBA. Printed in Hungary.

With the exception of fair dealing for the purposes of re-

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For permission to photocopy an article for internal purpos-

es, please request permission and pay the appropriate fee

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The accuracy of contents in CyberTherapy & Rehabilitation

Magazine are the responsibility of the author(s) and do not

constitute opinions, findings, conclusions, or recommenda-

tions of the Publisher or editorial staff. In addition, the Pub-

lisher is not responsible for the accuracy of claims or infor-

mation presented in advertising portions of this publication.

SUBSCRIBE TO C&R

Subscriptions begin with the first issue of the current volume. No cancellations or

refunds are available after the volume’s first issue is published. Publisher is to be no-

tified of cancellations six weeks before end of subscription. Members of the Inter-

national Association of CyberPsychology, Training & Rehabilitation (I-ACToR) receive

a 20% discount. To subscribe please visit http://www.vrphobia.eu and click “Subscribe”.

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Professor Brenda K. Wiederhold, Ph.D., MBA, BCIAEditor-in-ChiefC&R MagazineBelgium

Professor Rosa M. Baños, Ph.D.University of ValenciaSpain

Professor Cristina Botella, Ph.D.Universitat Jaume ISpain

Professor Stephane Bouchard, Ph.D.Université du Québec en Outaouais (UQO) Canada

Professor Tony Brooks, Ph.D.Aalborg UniversityDenmark

Professor Paul M.G. Emmelkamp, Ph.D. University of AmsterdamThe Netherlands

Professor Luciano Gamberini, Ph.D.University of PadovaItaly

Professor Sun I. Kim, Ph.D.Hanyang UniversityKorea

Professor Dragica Kozaric-Kovacic,M.D., Ph.D.University Hospital DubravaCroatia

Professor Paul Pauli, Ph.D.University of WürzburgGermany

Professor Simon Richir, Ph.D.Arts et Métiers ParisTechFrance

Professor Giuseppe Riva,Ph.D., M.S., M.A.Istituto Auxologico ItalianoItaly

Professor Paul F.M.J. Verschure, Ph.D.Universitat Pompeu FabraSpain

Professor Mark D. Wiederhold,M.D., Ph.D., FACPVirtual Reality Medical CenterU.S.A.

C&R Editorial Board


EDITORIALp 1

COVER STORYThe Evolution of WearablesD. Stevens

p 6

PRODUCT COMPARISON CHARTWearables

p 20

FEATURESThe Eldergames ProjectL. Gamberini, F. Martino, B. Seraglia, A. Spagnolli,M. Fabregat, F. Ibanez, M. Alcaniz, J. Montesa Andrés

p 9

Transforming VR into a Reality: The NeuroVR ProjectG. Riva, A. Gaggioli, A. Gorini

p 12

An Internet Environment to Curb Teen SmokingN. Ahmann

p 14

Intelligent Clothing Calls for the Doctor M. Lawo

p 17

Visualizing VoiceK. Karahalios

p 21

The SpiderGloveP. Pyk, L. Holper, D. Mochancki, D. Kiper and K. Eng

p 24

COUNTRY FOCUSItalyD. Stevens

p 28

TABLE OF CONTENTS

3

The Evolution of Wearables

Daniel Stevens documents the evolution ofwearables in the lead article on p6. He takesus on a journey through time, from the ori-gins of wearables - the invention of the pock-et watch in the 1500s - to the high-tech wear-ables of today, which are now being used inhealthcare. Take a look at this interesting ar-ticle to learn more about the pros and consof current wearable technology.

The SpiderGlove

The SpiderGlove is a new data glove, which hasbeen developed to address the need for low-cost, easily adjustable and user-friendly datagloves. The SpiderGlove can not only be usedfor a variety of hand sizes, but it requires littleor no recalibration when it is transferred be-tween patients with different hand sizes. Findout more about this new data glove on p24.


International Association of CyberPshycology, Training & Rehabilitation (I-ACToR)

Conference Participation Report Winter/Spring 2009

4

EUROPE 20095th Annual World Health Care CongressBrussels, Belgium / May 13-14, 2009

This year, the World Health Care Congress brought to-gether international healthcare providers, payers andsuppliers with European policy-makers, health min-isters and health officials in Brussels, the center ofthe European Union. The congress, which has beenunder the patronage of the European Commissionsince 2005, comprised two days of workshops andseminars on subjects ranging from financing andfunding solutions for healthcare to innovations inhealthcare technology. During the congress, over 90international experts discussed telemedicine, newapproaches to eHealth, computer games for healthand the need to demystify technology. Speakers in-cluded Marina Geli, the Spanish Minister of Healthand Social Security, Dr Francisca Garcia-Lizana, thePolicy Officer, ICT for Health at the European Com-mission and Tove Sorensen, Head of the WHO Col-laboration Centre for Telemedicine.

NextMedMedicine Meets Virtual Reality (MMVR) 17 Long Beach, California, U.S.A. / January 19-22, 2009

Medicine Meets Virtual Reality (MMVR) is the premierconference on emerging data-centered technologiesfor medical care and education. It brings together aninterdisciplinary, vanguard community of computer sci-entists and engineers, physicians and surgeons, med-ical educators and students, military medicine special-ists, and biomedical futurists. The CyberTherapy andCyberPsychology conference has its origins in this an-nual conference.

MMVR presentations this year at Long Beach, Califor-nia, offered a critical review of current progress: frominitial vision and prototypes, through assessment andvalidation, to clinical and academic utilization and com-mercialization. Members of both the JCR and I-ACToRboard were asked to take part in the Behavioral Healthportion of the conference. Complimentary copies ofJCR and C&R were given to all members in attendance.

e-Health 2009 ConferenceeHealth for Individuals, Society and Economy Prague, Czech Republic / February 18-20, 2009

The ministerial conference, eHealth for Individuals,Society and Economy took place in Prague this Febru-ary, during the Czech presidency of the EuropeanUnion. Members of I-ACToR were invited to attend,along with the editiorial boards of the Journal of Cy-berTherapy and Rehabilitation (JCR) and the Cy-berTherapy and Rehabilitation Magazine (C&R). Thechallenges and benefits of eHealth were discussedfrom an individual, societal and economic perspec-tive. The conference ended with the adoption of thePrague eHealth Conference Declaration. This declara-tion summarizes the way in which ICT in healthcareis currently used in Europe, including its benefits forpatients and for the economic efficiency of the healthsector. It goes on to define future steps to be taken onboth a national and a European level. Finally, it callsfor a common European eHealth area to facilitate pan-European communication about eHealth strategies.

Science beyond FictionThe European Future Technologies Conference (FET) 2009Prague, Czech Republic / April 21-23 2009

The new European Future Technologies Conference andExhibition is dedicated to frontier research in future andemerging information technologies. It was organizedby the European Commission, in conjunction with theAcademy of Sciences of the Czech Republic and theCzech Technical University in Prague. This multi-disci-plinary conference attracted over 750 participants, whowere able to listen to 6 keynote speeches, attend 29 sci-entific sessions and see over 80 posters and exhibits. Itwas an opportunity for scientists, policy makers, indus-try representatives and science journalists to see howcutting-edge technologies can be used in a wide vari-ety of disciplines. Exhibits included gaze-contingentdisplays and gaze-based interaction, cognitive robotcompanions, rehabilitation gaming and activity moni-toring systems, a wireless wearable EEG recording sys-tem and much more.


6

COVER STORY

By Daniel Stevens

When the word “wearable” is mentioned,mixed notions of its meaning ariseamongst the general population. It is fair-ly safe to say that the term wearable is nota commonly used expression outside ofthe CyberTherapy community. However,few understand that a very high percent-age of the world’s population use wear-able technology everyday. In fact, wear-ables have been in use since the 1500swhen a familiar and well-known device -the pocket watch - was invented. Sincethen, technology has expanded with theinvention of the wristwatch, blood sugarmonitors, intelligent textiles, health mon-itoring systems - and the list goes on. Astechnology has been revolutionized, wear-ables and their many uses have sprungup, reflecting improved ways of reinvent-ing healthcare and well-being.

The term “wearables”, in its most basic form,denotes a computer worn on the exteriorof the body. However, the meaning of theterm has broadened to technology worn onthe body, which is generally focused onhealth and healthcare issues amongst themedical community. What was once just amatter of attaching a watch to a wrist has

blossomed into a welcomed new applica-tion for the medical and technologicalworlds, and this modern innovation can beused in areas such as behavioral health,monitoring, media development, and oth-er information technology. Also referred toas “wearable computing”, researchers havemade headway in areas of study such asaugmented reality, pattern recognition, bodytemperature control, applications for dis-abilities, applications for the elderly, user in-terface design, electronic textiles, as well aseven fashion design. With a constant inter-action between the user and the comput-er, an “on/off” switch does not exist, allow-ing for continuous monitoring for researchwith little to no interruption of the user’severyday lifestyle.

A History

The first wearable was invented in the1500s with the invention of the pocketwatch. However, modern wearables haveonly come into existence in the last cen-tury, with vast improvements even in thelast decade. Though some attempts tocreate wearable technology occurred inthe 1960s, the most notable wearable

computing began in the 1980s with all-purpose wearables. The First Internation-al Symposium on Wearable Computers:Digest of Papers, IEEE Society credits SteveMann with the first general-purpose wear-able technology – he invented the back-pack-mounted CMOS 6502 microproces-sor-based computer that controlledcameras and flash bulbs. Mann would lat-er invent the Wearable Wireless Webcamin 1994, which greatly influenced wear-ables and wearable research.

A head-mounted display by Private Eye in-stigated further research and improve-ments for head-mounted displays (HMDs)in 1989; however, universities such as MIT(“Tin Lizzy” wearable computer design),Columbia University (KARMA: Knowledge-based Augmented Reality for MaintenanceAssistance), and the University of Toron-to (the “wrist-computer”) made drastic im-provements and additions to the wearableworld in the early 1990s. DARPA (DefenseAdvanced Research Projects Agency), aU.S. agency responsible for the develop-ment of military technology, began theSmart Modules Program to develop wear-able technology for commercial use.

The Evolution of Wearables“The medical world has taken wearables to a new level: it has takenadvantage of the possibilities of this technology to monitor human action and body temperature, and even administer medication…”

T h e O f f i c i a l V o i c e o f t h e I n t e r n a t i o n a l


7Today, the latest research and moderntechnology is being developed and show-cased at international technology andhealthcare conferences such as IEEE, SIG-GRAPH, and CyberTherapy & CyberPsychol-ogy conferences. Commercial technologycompanies have realized the possibilitiesof these wearables and have attempted tocommercialize different wearable comput-ers for the masses. Though some attemptsdid not popularize, the wristwatch with aGPS system wearable, probably the mostpopular and commercialized wearable, hasbecome mainstream for campers, runners,and travelers.

Wise Wearables

Current projects that have risen on thewearable community radar are focusing onreinventing different and innovative usesfor wearable technology. These projectsare among some of the most groundbreak-ing uses of wearables on the market today.

Fabrican has created a spray-on, non-wo-ven garment to create unique clothingthat attaches itself to the body or the gar-ments beneath, creating a one-of-a-kind

technology-based clothing that can be cre-ated to fit the user’s mood and creativity.The company has also begun exploringmedical possibilities with the “fabric’s” po-tential as an adhesive for new types ofpatches, wound healing products, dress-ings, and slow release systems, among oth-ers. Dr. Manel Torres, who bases his oper-ations out of Imperial College London,describes his products as “novel concepts[that] enlighten major worldwide manufac-turers as to the huge potential which ex-ists, through the successful branding of aproduct range.” Fabrican states that their“underlying ethos is to produce conceptproducts, which are market leaders, throughscientific research and development for afuturistic market” (www.fabricanltd.com).

An MIT-based team of scientists has creat-ed “Graspables,” which are built around theidea that technology and wearables shouldnot be complicated or user-unfriendly.“Graspables” have achieved a technologythat is considered smart enough to under-stand what the user expects “based on themany physical cues that people automati-cally give when they simply pick up a de-vice” (Boston.com). The “wearable” can

achieve this adaption by sensing the typeof grasp of the device itself by the user. Witha familiar “bar of soap” appearance, “Gras-pables” are able to predict the user’s intentand automatically morph into predictedmodes such as a cell phone, camera, or re-mote control. This product is able to reactand even predict the user’s actions and thushas an incredible potential for the commer-cial world. The technology reacts to theuser’s fingers and their grip on the surfaceof the product. Graspable technology is al-ready finding its way into the sports andmedicinal realms, considering its capabili-ty to enhance and mold itself to fit the userinstead or vice versa.

The medical world has indeed taken wear-ables to a new level: instead of just usingtechnology for creative or commercial pur-poses, it has taken advantage of the possi-bilities of this technology to monitor hu-man action, body temperature, and evenadminister medication when needed. TheU.S.-based IsisBiopolymer has created a“wearable” technology called the Isis Patch,that is a “personalized, single-use, flexible,ultra-thin, transdermal drug delivery (“TDD”)patch…which will allow medical profession-als, for the first time, to accurately controltransdermal drug delivery” (isisbio -polymer.com). This product has the abilityto ensure drug administration that is bothreliable and effective over an extended pe-riod of time without a nurse or doctor hav-ing to physically be with the patient. Thefounders of the Isis Patch describe theirbreak-through technology as expanding thepossibilities for similar products (much likenicotine or hormone-based patches) to ap-plications for pain management, cancertreatments, neurology, chronic and acuteillnesses, as well as diabetic medications.Design News describes the technology asa “Band-Aid like” patch, which is .002 inch-es thick. Prominent researchers are con-vinced that the Isis Patch will revolutionizethe way medicine is delivered.

The “Flip Side”

After researching and discovering the mul-titude of wearable computing innovations,

A s s o c i a t i o n o f C y b e r P s y c h o l o g y , T r a i n i n g & R e h a b i l i t a t i o n

The first wearable, the pocket watch, was invented in the 1500s.


one can’t help but wonder if wearablescan be completely positive, practical,beneficial, and hold the potential to rev-olutionize medicinal and technologicalapplications. Despite these incredibleapplications, when in use, can they prac-tically aid the user, whether it is medi-cinally or for general purposes, or willwearables become an added burden?Objectively, I’ve put together some keypoints, on the possible “downsides” ofwearable to determine their practicaluses for the general population.

Practicality and Affordability

Are wearables practical? Designers wouldargue that this is the purpose of havingcomputer technology attached to the user,so that s/he will have access to the tech-nology at any point at which the user de-cides. This argument is quite true andwearable technology serves its purposewell - but at what cost? How affordablecan a mobile medication reminder or ad-vanced multi-media watch be for the gen-eral public? Can smell-technology incor-porated into garments become affordable?

Obviously, new technology will initiallycome at a high price. However, onceperfected and commercialized, theproduct has the ability to become moreaffordable for the general public. GPSwatches, which are probably one of themost commercialized modern wear-ables, are currently being sold for $250- $400 per watch, which is expensive,but you can certainly spend more on atraditional top-of-the-line watch. It is afact that with most new technologies,the price will remain higher than an av-erage product due to their connectionto other technologies. Take, for exam-ple, the same GPS watch as previouslymentioned. In order for the technolo-gy to function, the wearable relies on asatellite circling the globe, tracking thesystem to inform the user of their loca-tion. The company who produces thesewatches must have satellite-launchingcapabilities or must partner with a com-pany who has them. The same process

coincides with medicinal wearables aswell, as monitoring technology mustrely on third-party technology to relaymessages back and forth between thetwo users. Products that rely on third-party technology will consistently re-main at a higher price than other tech-nology-based products.

“Wear-Ability”

As the GPS watch example shows, somewearables can be used without effort,effectively appearing to be a part ofclothing or even a simpler wearable.However, when certain technology be-comes larger, odd-shaped, or even serv-ing as an adhesive to the body, it maycause difficulty in the practicality of ac-tually wearing the wearable. Fabrican’sspray-on technology is incredibly inven-tive, but is it completely “wearable”?Would you feel comfortable spraying onyour clothes while performing activitiesthat might induce perspiration like jog-ging, cleaning your house, or helping afriend move? The sheer possibility thatan object could easily rip would hindermy decision in a similar situation. Ob-viously, this spray-on technology ismeant for a higher fashion realm andto be used with other traditional gar-ments as well, but, for all intents andpurposes, these are clothing substitutesand must be treated as such. On theother hand, Fabrican’s technology holdsa high probability of success in medic-inal treatments for pain management,etc. as well as finding applications inthe automotive, design, and hygienefields of study.

Other technology such as the “No Con-tact Jacket” from No Contact, whichuses a highly electric-stimulated ma-terial to shock an uninvited attackerto the point of losing muscle control,has been designed with a woman’s pro-tection in mind. The idea behind thisparticular wearable is to protect theuser, yet such a jacket has the poten-tial to do more harm than good. In-deed, this is effectively a wearable

taser-gun that could just as easily in-jure an innocent bystander as it couldan actual attacker. With such a design,the question of “wear-ability” arises aswell as whether or not a wearable hasa plausible possibility of success in aneveryday environment.

Future Applications

Although there are a few downsides towearable technology, in most cases, itseems to be a very relevant, practical, af-fordable, and “wearable” concept. Manywearables have been commercialized:they are quickly becoming more afford-able and improvements are being madeto original models. In the next decade,I predict that wearables will become acommon and well-used household prod-uct amongst the general population, andthis will only enhance our daily and me-dicinal lives.

So where would you go to find thenewest wearables and wearable researchstudies? International conferences suchas SIGGRAPH, IEEE, and the CyberTher-apy & CyberPsychology conferenceswould be at the top of your list. Corpo-rations and medical technology business-es are watching closely for the neweststudy to be unfolded at these confer-ences. This groundbreaking addition tothe technological and medical field hasalready been able to enhance the user’slife and will continue to support im-proved quality of life. Wearables havebeen introduced to us, providing a tech-nology to better our lives, and time willtell the magnitude of the effect that thisconcept will have on the future of tech-nology - a future that no doubt will bebeyond our imaginations.

Photos courtesy of Matt Isgro www.mattisgro.com

8

Daniel Stevens, LL.MC&R [email protected]


COVER STORY The Evolution of Wearables


FEATURES


9

The Eldergames Project“Eldergames is an EU-funded international project that in three yearscompleted the design, testing and production of an entertainmentplatform for elderly people to train memory, attention and reasoning.”

By Luciano Gamberini et al

A longer life expectancy and decreasingbirth rates in developed countries repre-sent the main factors contributing to arapid growth of the aging population.Even in the case of normal aging, elderlypeople risk a gradual exclusion from so-cial life and a worsening of their generalwell-being because of a decrease in somecognitive functions (e.g. memory) and be-cause of changes in their social roles (e.g.retirement). Joined solutions exploitingthe advances in medicine, psychology andtechnology are sought in order to supporta dignified continuation of life character-ized by independence and by satisfacto-ry social participation. Information andCommunication Technologies (ICTs) al-low the implementation of solutions toimprove cognitive and social activity forthe elderly as well as the monitoring oftheir general conditions. In the form ofcomputerized exercise programs, ICTs cancomplement the intervention already pro-vided by hospitals, health care centersand leisure centers, supporting psycho-logical and neuropsychological treatmentand rehabilitation through cognitive stim-ulation and training. In particular,videogames can be used to stimulate thecognitive abilities of both young and oldusers alike.

Eldergames (“Development of High Ther-apeutic Value IST-based Games for Mon-itoring and Improving the Quality of Lifeof Elderly People”, ref. n. 034552) is an EU-

funded international project that in threeyears completed the design, testing andproduction of an entertainment platformfor elderly people to train memory, atten-tion and reasoning. The game is dividedinto two main modules: Memogame andMinigame. Minigames are individualgames randomly selected by the systemto train a specific cognitive ability (mem-ory, attention, reasoning and categoriza-tion). The Memogame is a social gamerequiring a player to pair his/her cards -representing images, sounds, or calcula-tions - with the matching cards amongthose positioned in the central panel. Cor-rect or incorrect pairing leads to receiv-ing a bonus (extra time or extra turns) orto taking a Minigame, whose successfulcompletion waives the assignment of apenalty respectively. Bonuses can be spenton a final multiplayer game offered at theend of the Memogame.

The scores of all players are shown dur-ing the game and are permanently storedin an archive along with several indicesof the players’ performance over time.Experts can access this archive to mon-itor the development or decrease in theusers’ abilities. In fact, a comparison be-tween the performances of 59 elderlyparticipants in the Minigames for mem-ory, reasoning, selective attention, divid-ed attention, and categorization, and thescores obtained on the WASI (WechslerAbbreviated Scale of Intelligence) test was

carried out. No significant differenceswere found between the scores, showingthat Eldergames can be used as a mon-itoring tool for cognitive functions.

The specific needs of elderly users weretaken into account both in the concep-tion and in the development of the pro-totype. Regarding the concept, the riskthat users could perceive the tool as toochallenging and complex was considered.A mixed-reality tabletop solution was thenchosen, in order to make the prototypeappear as an elegant, ergonomic yet fa-miliar object. The entire hardware systemconsists of five main elements: a cus-tomized table, a screen (a normal 47” LCDTV), 4 webcams, 4 pen-objects and a nor-mal PC for running the software (Fig. 1).The users are comfortably sitting aroundthe table, handling one pen each. By de-tecting the position of the pens with re-spect to the virtual objects appearing onthe screen, the system allows the usersto interact with the game. In this way, theelderly can take advantage of an advancedICT without having to learn commandsor to use unfamiliar input modalities. Inthe development of the interface, thestarting point was the identification of aseries of requirements that took into ac-count specific usability needs connectedto aging impairments in perception,memory and attention. From the first pro-totype to the last one, an extensive us-ability evaluation was carried out, where


the fulfillment of the requirements wasiteratively tested through methods suchas checklists, cognitive walkthrough andvideo analysis.

Emphasizing the social dimension of thegame is important to keep the players in-volved and is a goal in itself given the riskof isolation for the elderly population. Upto four players can be involved in theMemogame at the same time, includingplayers connected from different coun-tries via the Internet. A communicationsystem implemented in the platformmakes interaction possible betweenspeakers of different languages.

The project involves engineers and us-ability experts from the academy, lead-ing European toy manufacturers andtesters, and elderly care centers. Being agame, fulfilling several usability require-ments tailored to the elderly populationand involving the participation of sever-

al players at the same time, the projectconsortium aimed at creating a tool tosustain the users’ motivation to engagein continuous cognitive training. The lev-el of acceptance of the prototype, meas-ured through specific questionnaires ad-ministered to 128 elderly people andexperts in three different countries(Spain, Norway and the UK), showed thatthe platform was received very favorably.The hands-on experience gained at thevarious trial sites around Europe con-firms that Eldergames provides userswith an enticing ICT solution, that whileappearing like an ordinary piece of fur-niture within a recreation center, con-tains all the tools necessary to connect,train and monitor the users.

This project is supported by the EuropeanCommission under the 6th FWP (SixthFramework Programme), Project Refer-ence n° 034552; Start Date: 2006-09-01- End Date: 2009-02-28.

Luciano Gamberini, Ph.D.Francesco Martino, Ph.D.Bruno Seraglia, M.S.Anna Spagnolli, Ph.D.HTLab, Department of General Psychology, University of Padova, ItalyMalena Fabregat, M.S.AIJU, Toy Research Institute,SpainFrancisco Ibanez, Ph.D.Brainstorm Multimedia,SpainMariano Alcaniz, Ph.D.Javier Montesa Andrés, Ph.DInstituto en Bioingeniería yTecnología Orientada al SerHumano, UniversidadPolitécnica de Valencia,Spain

[email protected]

The Eldergame consortium is composed of:

AIJU (Spain)

Labhuman (Spain)

Lappset (Finland)

Gaia (Spain)

Generalitat Valenciana (Spain)

Brainstorm Multimedia (Spain)

Trondheim Kommune (Norway)

Kent Council County (UK)

Università di Padova (Italy)

Infowerk (Austria)

FEATURES The Eldergames Project

10These pictures show users gathering around the game table to play with Eldergames. This picture contains extra cameras for the purpose of videorecording of the session.


Join the International Association of CyberPsychology, Training & Rehabilitation (I-ACToR)

MissionOur mission is to bring together top researchers, policy makers,funders, decision-makers and clinicians, pooling collective knowl-edge to improve the quality, affordability, and availability of exist-ing healthcare.

Ultimately, through international collaboration with the mosteminent experts in the field, we are working to overcome obstaclesand increase access to top-quality healthcare for all citizens. Byenhancing public awareness of the possibilities that technologyoffers, we move toward changing and improving healthcare as itcurrently exists.

I-ACToR is the official voice and resource for the internationalcommunity using advanced technologies in therapy, training, edu-cation, prevention, and rehabilitation.

MembershipAs the only international association dedicated toCyberPychology, Training and Rehabilitation, I-ACToR offers itsmembers unique opportunities to:- Network with other experts and industry leaders in

CyberPsychology, Training and Rehabilitation- Be the first to know about important events, funding

opportunities and other news- Share knowledge with industry peers- Learn industry best practices and standards- Attend the international CyberTherapy & CyberPsychology

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For more information on how to join I-ACToR, please visit www.myiacr.comContact Email: [email protected]


12

FEATURES

Although frequent papers show that Vir-tual Reality (VR) has come of age for clin-ical and research applications, the major-ity of projects are still in the laboratoryor investigation stage. In fact, accordingto the data that will be presented by Prof.Giuseppe Riva, Ph.D., Istituto AuxologicoItaliano, Milan, Italy at the forthcomingCyberTherapy 2009 conference in Verba-nia, Italy – http://www.e-therapy.info - thereal impact of VR in European behavioralhealth is still low:

The penetration of VR in behavioral health care/research centers is minimal: around 0.5/1%The penetration of VR between

behavioral health professionals is even lower: less than 0.001%

Why is VR more virtual than real for manyhealth care practitioners? From the ex-perience of the current researchers in-volved in this area it is possible to iden-tify four major issues that are limitingthe use of VR in psychotherapy and be-havioral neuroscience:

the lack of standardization in VR hardware and software, and the limited possibility of tailoring the virtual environments (VEs) to the specific requirements of the clinical or the experimental setting;

the low availability of standardized protocols that can be shared by the community of researchers; the high costs (up to 100.000 ¤) required for designing and testing a clinical VR application; most VEs in use today are not user-friendly; expensive technical support or continual maintenance are often required.

To address these challenges, the ItalianFIRB research project IVT2010 is devel-oping NeuroVR (http://www.neurovr.org),a cost-free virtual reality platform basedon open-source software, that allows non-expert users to easily modify a virtual en-vironment (VE) and to visualize it usingeither an immersive or non-immersivesystem. Now at its version 1.5, the origi-nal NeuroVR 1.0 received the 2007 LavalVirtual Science Award (http://www.laval-virtual.org/) for the best Virtual Realityscience application worldwide.

The majority of existing VEs for healthcare are proprietary and have closedsource, meaning they cannot be tailoredfrom the ground up to fit the specificneeds of different clinical applications.NeuroVR addresses these issues by pro-viding the clinical professional with acost-free VE editor, which allows non-ex-pert users to easily modify a virtual

Transforming VR into a Realityfor Behavioral Health Care:The NeuroVR Project The Italian FIRB research project IVT2010 is developing NeuroVR, a cost-free virtual reality platform based on open-source software, that allows non-expert users to easilymodify a virtual environment (VE) and to visualize it using either an immersive or non-immersive system.

By Giuseppe Riva et al

Figure 1: Ascreenshotof the Neu-roVR Editor



13

scene, to best suit the needs of the clini-cal setting.

Using the NeuroVR Editor (see Figure 1),the psychological stimuli/stressors appro-priate for any given scenario can be cho-sen from a rich database of 2D and 3D ob-jects, and easily placed into thepre-designed virtual scenario by using anicon-based interface (no programmingskills are required). In addition to static ob-jects, the NeuroVR Editor allows an over-lay on the 3D scene of video compositedwith a transparent alpha channel. The ed-iting of the scene is performed in realtime, and effects of changes can bechecked from different views (frontal, lat-eral and top).

Currently, the NeuroVR library includes dif-ferent pre-designed virtual scenes, repre-senting typical real-life situations, i.e., thesupermarket, the apartment, the park.These VEs have been designed, developedand assessed in the past ten years by a mul-tidisciplinary research team in several clin-ical trials, which have involved over 400 pa-tients. On the basis of this experience, onlythe most effective VEs have been selectedfor inclusion in the NeuroVR library.

An interesting feature of the NeuroVR Ed-itor is the possibility of adding new ob-jects to the database. This feature allowsthe therapist to enhance the patient’s feel-ing of familiarity and intimacy with thevirtual scene, i.e., by using photos of ob-jects/ people that are part of the patient’sdaily life, thereby improving the efficacyof the exposure.

The second main component of NeuroVRis the Player, which allows the user to nav-igate and interact with the VEs created us-ing the NeuroVR Editor. The player offersa set of standard features that contributeto increasing the realism of the simulat-ed scene. These include collision detec-tion to control movements in the environ-ment, realistic walk-style motion, advancedlighting techniques for enhanced imagequality, and streaming of video texturesusing an alpha channel for transparency.

The player can be configured for two ba-sic visualization modalities: immersive andnon-immersive. The immersive modalityallows the scene to be visualized using ahead-mounted display, either in stereo-scopic or in mono-mode; compatibilitywith a head-tracking sensor is also provid-ed. In the non-immersive modality, the vir-tual environment can be displayed usinga desktop monitor or a wall projector. Theuser can interact with the virtual environ-ment using either keyboard commands, amouse or a joypad, depending on the hard-ware configuration chosen. A future goalof the developers is also to provide soft-ware compatibility with instruments thatallow collection and analysis of behavioraldata, such as eye-tracking devices and sen-sors for psychophysiological monitoring.

The current NeuroVR library includes a lim-ited number of VEs addressing specificphobias (i.e. fear of public speaking, ago-raphobia) and eating disorders. However,new pre-designed environments will be de-veloped in the coming years: it is envi-sioned that the 250,000 people in the

worldwide Blender user community willcontribute to extend the NeuroVR library,developing new VEs which can be tailoredby clinical professionals for a range of clin-ical and experimental needs.

A final critical issue related to the use ofVR in health care is the lack of availabilityof a VR system in the real life context ofthe patient: both the cost and the settingof the system limit its use to the healthcare center/hospital/therapist’s office. Toovercome this issue, a VRML/X3D exporterfor experiencing the environments on theWeb and a player for PDAs and smart-phones are planned features. The final goalis the development of a phone-based VRsystem able (see Figure 2):

To present and structure emotionally relevant contents in a home setting; To verify the compliance of the patient and eventually alert the patient/therapist;To track in real-time the emotional level of the patient and record this for later assessment by the therapist;To provide feedback to the patient to enable him to cope with the environment’s contents;To automatically contact the therapist if the emotional level of the patient is higher than a preset cut-off value defined by the therapist.

Giuseppe Riva, Ph.DAndrea Gaggioli, Ph.D. Alessandra Gorini Ph.D. CandidateIstituto Auxlogico ItalianoItaly

[email protected]

THERAPIST PATIENT

CONTROL SYSTEM

Simulation andPatient State Log

Biosensor Monitoring & Analysis

Visual SimulationControl

SafetyOverride

Figure 2: Main featuresof a future mobileVRET system



Smoking kills 440,000 Americans eachyear. Despite this grim statistic, 2,000teens start smoking every day. It is esti-mated that at least 4.5 million adoles-cents in the U.S. are still cigarette smok-ers, despite anti-smoking advertising.

Among the many serious concernsabout teen smoking is this statistic cit-ed by the American Lung Association:“of adolescents who have smoked atleast 100 cigarettes in their lifetime,most report that they would like to quit,

but are not able to do so.” In otherwords, it takes only five packs beforethese kids’ smoking “choices” begin turn-ing into an addiction.

In 1998, the tobacco industry agreed tolaunch its own anti-smoking campaigns,including magazine and television ads.However, these campaigns appear to bedoing more harm than good. Philip Mor-ris International, one of the world’s largesttobacco companies, request that vendorsplace an anti-underage-smoking sign(“Help stop underage smoking – don’tbuy cigarettes for kids”) in point of sale lo-cations. What message, though, will teenstake away from this sign? They have justbeen called “kids,” and it has been impliedto them that smoking is okay as long asthey’re grown-up enough. The message isgetting across, but it is not the messagesupposedly intended.

Given the poor record of previous tac-tics to curb teen smoking and the fail-ure of the tobacco industry to provideeffective teen smoking countermeasures,

By Nancy Ahmann 14

Given the poor record of previous tactics to curb teen smoking, and the failure of the tobacco industry to provide effective teen smoking counter-measures, a new approach is clearly needed. This article reports on the Internet-based VR environment developed and tested by VRMC to help teens quit smoking.

Teens Help Researchers Create Internet EnvironmentTo Curb Teen Smoking


FEATURES

Figure 1. The Virtual Reality Medical Center’s Internet-based environment to curb teen smoking.


15

a new approach is clearly needed. It is wide-ly recognized that the initial act of smok-ing has much to do with a manufacturedimage of what smoking means and the psy-chological state of the teenager (see Table1). In a study launched in 2006, The Virtu-al Reality Medical Center (VRMC) set outto shatter the media-manufactured imageaimed at teens. VRMC theorized that amore effective way to curb teen smokingwould be to allow the teen audience todraw its own conclusions about tobacco.To this end, VRMC researchers solicitedteens to participate in creating a new mes-sage. With funding from the National In-stitute on Drug Abuse (NIDA) and with theinput of teen volunteers, VRMC developedand tested an Internet-based VR environ-ment to curb teen smoking.

The Internet site is made up of two parts:1) an introductory page that displays de-ceptive media messages to make the pointwithout being explicit or condescendingand 2) a link to a game that teaches youngsmokers how to recognize and overcome

smoking cues. The inclusion of media mes-sages is an important aspect of this ap-proach. Other groups, such as Campaignfor Tobacco Free Kids (www.tobac-cofreekids.org/) post tobacco advertise-ments on their Website with informationabout how much the industry spends onadvertising. They also solicit users of theWebsite to send ads to them. Acknowledg-ing the ability of young people to think for

themselves demonstrates respect for theircommon sense and makes for a more ef-fective communication strategy.

The overall goal of VRMC’s Internet anti-smoking environment is to help teens quitsmoking for good. VRMC worked with agroup of students from a local Californiahigh school to help design an effectiveanti-smoking message. The high school

Smoking is good because:

Controls your weight / makes you thinner

Improves mood, distracts from depression

Makes you look older / “cool”

Relaxes you when stressed

Makes you resemble cultural icons (Britney Spears)

Smoking is bad because:

Parents get angry if you are caught

Shortens your life

Makes hair and clothes smell bad

Gives you ashtray breath

Annoys friends who don’t smoke

Table 1. Smoking as Viewed by Adolescents

Figure 2. Software designers at The Virtual Reality Medical Center in San Diego, California get feedback from local high school students on the development of a Website to curb teen smoking. Input from teen participants was an important part of this NIDA-funded study.



FEATURES Teens Help Researchers Create Internet Environment To Curb Teen Smoking

students helped create images and text forthe Website. They also assisted with betatesting and review. When the initial versionof the Website was tested on another groupof teens, results showed that the Websitedramatically increased their knowledge ofthe effects of smoking and techniques forsmoking cessation.

Virtual reality (VR) has been used successful-ly by VRMC in a variety of therapeutic andtraining applications. Because VR is a height-ened experience of computer gaming, it is par-ticularly well-suited to deliver education to theteenage demographic. Speaking to teensthrough VR gets their attention due to thenovel and interactive qualities of the medi-um. VR also uses mechanisms with whichteens have familiarity, skill, and interestthrough their experiences in computer gam-ing. With its online capability, the program iseasily accessed almost anywhere in the worldwith minimum system requirements. In itslatest development, the application has beenimported onto a cell phone platform, whichis very desirable among mobile-savvy and par-ticipative teenagers.

16


Figure 3.

The environment is

based on the daily rou-

tine of a typical teenag-

er and contains com-

mon smoking cues.

Figure 4. Icons on the

lower screen indicate

decision to smoke/not

smoke (lungs), number of

activities performed (sta-

mina) and presence of

smoking cues (craving).

Figure 5. Icons on the upper screen indicate time of day and number of smoke-

free days, which helps teens monitor their cravings and provides motivation.


FEATURES

VRMC has conducted several previous in-vestigations in collaboration with Korea’sHanyang and Chung-Ang Universities us-ing VR to study smoking cues. In a studyfor nicotine craving, virtual environments(VE) were set up for smokers to virtually nav-igate. The rooms contained different smok-ing cues, such as an ashtray and an openpack of cigarettes on a bar. Overall, the studywas determined to have helped reduce crav-ings in those who are nicotine dependent.Dr. Brenda Wiederhold was also involved ina study using functional magnetic reso-nance imaging (fMRI) to study smokingcravings in VEs. This study tested whethersmokers could experience cue-inducedsmoking craving inside an MRI scanner by

using the VR system, and, if so, whether themagnitude of the craving differed betweenthe classical device (2D pictures) and theVE scenario. The study concluded thatsmoking cues in the 3D virtual world werestronger than in the 2D world.

Researchers at VRMC hope that by usingthe distinctive attributes of VR, they cancreate effective counter messages to thetobacco industry’s media campaign, whichhas been ongoing for more than 50 years.VRMC’s expertise in combining VR withtherapeutic applications provides a uniqueunderstanding of how VR can be an effec-tive response to the tobacco industry’s con-struction of the meaning of smoking. Sev-

eral Ministries of Health in Europe have ex-pressed interest in VRMC’s Internet-basedprogram originally developed in the U.S. tocurb teen smoking. Sensitivity and atten-tion to cross-cultural cues will be importantin successful acceptance and implementa-tion of the anti-smoking message. For moreinformation, visit The Virtual Reality Med-ical Center Website at www.vrphobia.com.

Nancy AhmannThe Virtual Reality Medical Center [email protected]

Intelligent ClothingCalls for the Doctor Wearable Computing Assistants will allow people with chronic diseases to have a safe and secure life in their own home.

By Michael Lawo

Among the initiatives aiming to improvehealth status monitoring technologies,the European Commission promotesCHRONIOUS, a 42-month project, start-ed in February 2008 and involving 19partners from several countries. The proj-ect (www.chronious.eu) works on an in-novative, open and adaptive platform thatincludes overall a mobile and wearablesystem with intelligent sensors and deci-sion support system for patients andhealthcare professionals in the area ofchronic diseases. It is a system to moni-tor patients’ vital body parameters, con-

text, environmental variables, patient mo-tion and other activities such as drug in-take and dietary habits. Furthermore it isdesigned to detect patient’s abnormalhealth status, generating possible alert-ing information for the management ofemergency situations critical for patientsand health professionals. The system willassist health care experts and patients byproviding tools for health status monitor-ing and decision support. The projectaims to evaluate the platform on two spe-cific chronic diseases: Chronic Obstruc-tive Pulmonary Diseases (COPD) and Kid-

ney Diseases. This paper describes thegoal of the project and its background,the system architecture and a first proto-type with preliminary results and the ex-pected impact. The focus will be on theevaluation of the system prototype byuser tests.

CHRONIOUS suggests the implementa-tion of generic system architecture to beeasily adapted to any chronic diseasemanagement program. For testing pur-poses, it focuses on two major chronicconditions, but the aim is to create an

17



18

easily adapted system for other chronic dis-eases requirements.

With such an approach, quality of life canbe improved and highly qualified and effi-cient healthcare services for citizens can beprovided (e.g. through disease prevention,ubiquitous and seamless to the user mon-itoring, adaptive interaction based on usercharacteristics and context of activity, reduc-tion of unnecessary visits to hospitals andcomplexity of selfcare especially for patientswith chronic diseases). Advanced diseaseprediction and diagnosis tools, and the ex-ploitation of the vast pool of monitored pa-rameters are provided (e.g. vital signs arerecorded for various users groups under di-verse contexts and conditions) for the pro-duction of new diagnostic models and pro-tocols. Thus the formal care burdens arereduced, and formal care improved (e.g.through the reduction of patient visits forroutine examinations, the prevention, diag-nosis and in some cases prognosis of dis-eases, and immediate intervention in emer-gency or time-critical situations).

The approach mainly addresses two cate-gories of users:(1) patients, the real final users, who have

to wear and interact with the system(2) care providers, who have to use the

system to remotely monitor the healthconditions of the patients.

Therefore it is important to understandand collect data about what these differ-ent subjects are expecting from the sys-tem, and the most suitable way to complywith their expectations: a successful sys-tem and products must begin with an un-derstanding of the needs and requirementsof users and must also satisfy compliancewith ethical principles.

With regard to local health institutions, pro-fessionals and hospitals, expected devel-opments are the reduction of acute eventsand related hospitalization costs by up to20-30%, by emergency cases alert, ration-alization of medical prescriptions for diag-nostic routine examinations, decision andeducation support services for profession-als involved, stronger integration withhome care service providers both in termsof shared clinical pathways and technolog-ical interoperability, quick and efficientmedical information’s access through alogical, structured and certified pathwaysimilar to human logic, sensible growth incooperation and multiactor approach tochronic diseases and an enhancement inICT investments.

The expected impact on patients’ lives ishigh because wearable monitoring will benon-invasive, allow them to reduce routinevisits to hospitals for diagnostic purposes,provide them with more tranquillity be-

cause of a reduction of time of interven-tion when occurring in time-critical situa-tions, integrate a reminding and alertingservice linked to particular behaviors suchas drug intake, eating and activities per-formed, require an active participation ofpatients both in monitoring and in deci-sion-making, and need availability of ade-quate ICT equipment at home and a friend-ly approach to new technologies by patientsand their families.

CHRONIOUS is multidisciplinary researchproject. In the ubiquitous health andlifestyle-monitoring domain it investigatesand experiments with future visions andemerging technologies. The framework’s ar-chitecture and structure is generic and thusenables expansion to the support of themanagement of further chronic diseases.CHRONIOUS, in its very final form, will bea universal solution to healthcare facilitiesand professionals for managing all varioustypes of chronic diseases, increasing thequality of patients’ lives and reducing healthassistance costs.

FEATURES Intelligent Clothing Calls for the Doctor

Michael Lawo, Ph.D. Center for Computing Technologies(TZI) Universitaet [email protected]

Intelligent Clothing

Bluetooth SMS

Home monitor CHRONIOUS Server

Mobile Internet

Figure 1.

CHRONIOUS

platform moni-

tors patients

with chronic dis-

eases for a

longer and saver

stay at home. It

provides contin-

uous supervision

by virtual and

real caretakers

and physicians.


20

CREATOR

AlphaMicronFabricanCenTex BelASU Center for AppliedNanoBioScienceOfSeth

No-ContactLifeWear

Fluid Interfaces Group

Columbia CGUI LabePI LabDepartment of Computer Science University of IoanninaCLUTCH

Charmed Technology, Inc.

Science Fashion Lab

The Banff New Media InstituteEurotech Ltd.

Angel Chang

Triage WirelessIsis BiopolymerSalpavaara et al.

Pill PhoneAnthroTronix & ICT,SMARTlabSiemens

CyberwearzCuteCircuitVehaert, Mamagoose

WEARABLE

Liquid crystal technologySpray-on garmentIntelligent TextileSensory chameleon bodysuitTextile for healthcare monitoringNo-contact jacketWearable Computing MIT Media Lab Human dynamicsInvisible Media

MARSWearCamIntelligent Information Systems

Medulla-Intimata

Badge-electronic

Smart Second skin

"Health Watch", "Company Keeper"Zypad

Glow-in-the-Dark Bob Ross DressRapid Response Monitor, ViSiIsis Biopolymer PatchCapacitive insole sensor forhip surgery rehabilitationThe Pill PhoneScent Collar

A Wearable EMG augmentationsystem for robust behavioralunderstandingiDoubletSkirteleonSpace Pajamas

FUNCTION

Film laminated into a plastic curveInstant, sprayable, non-woven fabricPara-medical devicesGarment that responds to wearer’s environmental and vital signsOptical fiber sensors embedded into textiles for healthcare monitoringExo-electric preventative armorBody-worn computation, sensing, and networking in a clothing-integrated design Garments with the ability to respond to people’s needs and actionsMobile, augmented reality systemsPersonal Imaging A Wearable platform for the monitoring of health conditions and sport performance and the real-time prevention of sport injuriesSensors that monitor the wearer's emotions to guide real-time video-generation that evokes a sense of seeing beneath the surface of the skinBadges that record the contact information of other CharmBadge users as they come into rangeImplanting smell technology into multi-sensorial clothingResponsive communicative health data analysis technologyAdvanced multimedia tourist guide application wrist watch softwareGlow-in-the-dark fabric infused with music

Wireless vital sign monitoringTransdermal drug deliverySensor that guides a hip surgery patient to train the operated leg with a suitable forceMobile medication reminderAugmentation of emotional connections in immersive environmentsRecognizes the emotional state of its users in real time

Fusion of music technology and fashionPhoto & thermochromatic ink/UV threadInfant clothing designed to detect signs of SIDS

LOCATION

Alphamicron.comFabricanltd.comCentexbel.bebiodesign.asu.edu

ofseth.org

No-contact.comMedia.mit.edu

Ambient.media.mit.edu

Graphics.cs.columbia.edueyetap.orgMedlab.cs.uoi.gr

Tinagonsalves.com

Charmed.com

smartsecondskin.com

banffcentre.ca

Eurotech-ltd.co.uk

angelchang.com

triagewireless.comisisbiopolymer.comPervasive Health 2008

pillphone.comSIGGRAPH 2004

IST Project

cyberwearz.comCutecircuit.comverhaert.com

YEAR

2009200020092004

2007

20062005

2009

199619972005

2004

2001

2005

1998

2009

2008

200920072008

20092004

2008

200820092008

Wearable technology is one of the fore-most fusions of science and technolo-gy with every-day life. With a combina-tion of fashion and technology, thosein the medical field as well as commonnon-medical technology companies arediscovering the possibilities of thisunique blend. “Wearables” as they are

commonly called, can fulfill a range offunctions. They can monitor the healthof the wearer, change color or shape toreflect the environment surroundingthe garment, react to the user’s bodytemperature and mood, or even havetelecommunication and music systemsinstalled within their material. Up and

coming innovations in wearable tech-nologies are being unveiled at technol-ogy conferences, such as IEEE, SIG-GRAPH, and the CyberTherapy &CyberPsychology (CT14) conferences.For more information concerning wear-able technologies and how to get in-volved, contact [email protected].

Product Comparison Chart: Wearables

PRODUCT COMPARISON



Visualizing VoiceThis article explores how human computer interaction can be used forvoice recognition and to show audio patterns. The “Conversation Clock”creates a graphical language for visualizing communication.

By Karrie Karahalios

In the area of Human Computer Interac-tion (HCI), research in audio is minimalcompared to textual and graphical do-mains. For example, there are many tex-tual and image search engines, yet veryfew voice browsers for public use. Onereason is that a voice or audio browserrelies heavily on speech recognition andaudio classification that is not very accu-rate in general use scenarios. Given dif-ferent speakers and different speaking en-vironments, the problem becomesincreasingly difficult. Another reason isthat audio is ephemeral; it is difficult to“see”, and, hence, to compare as onewould two photographs.

We have decided to take a step back andlook at voice from a simpler perspective.Perfect speech recognition is currentlyout of technical reach. Yet there is stillso much that can be learned by lookingback at some of the basic parameters:volume, pitch, rate of speech, pausepoints, and history. Our approach is tocomputationally visualize voice to pro-vide social cues and feedback that maynot be easily perceived in traditional

face-to-face interaction. For example, wecan see mimicry - the state of mirroringanother’s volume and tone to signal al-legiance, turn taking, status roles suchas leaders and followers in group inter-action, etc.

By starting from the beginning and look-ing at simple vocal features augmentedwith simple graphics, we create the build-ing blocks for a new visualization tool.This first graphical language resemblesmusical notation in the sense that it char-acterizes pitch, volume, and prosody. Inour early experiments, we have found thatcombining these simple parameters hascreated more intuitive and powerful vi-sualization tools for reflecting on one’saudio than existing state of the art toolsthat cater to the research elite. As timeprogresses and users adapt to the exist-ing vocabulary, the building blocks willbecome more complex.

The goal is to combine the ease of voicewith the visual feedback of graphics to cre-ate a new communication medium. In asense we are creating a graphical language

for visualizing communication. Below, Idescribe one example of this approachwith the project Conversation Clock.

The Conversation Clock visualizes auralparticipation of up to four people arounda circular table. The participants at thetable wear lapel microphones. Their re-spective audio is captured by the micro-phones, transformed into an abstractform, and rendered onto the table via anoverhead projector. A snapshot of a Con-versation Clock rendering can be seenin Figure 1.

Each person in this visualization is repre-sented by a different color. As a personspeaks, his or her audio is visualized as aseries of rectangular bars along the pe-riphery of the tabletop. The length of therectangular bar is proportional to the par-ticipant’s spoken volume. That is, thelonger the rectangular bar, the louder theaudio. If no one is speaking, dots are ren-dered along the circumference of the ringto indicate that the table is active andcapturing audio from the microphones.The most recent conversation is rendered

FEATURES


21


22

on the outermost ring. Each ring repre-sents one minute of time. As each graph-ical ring is completed, it animates towardthe center of the table and a new ring be-gins at the outermost edge.

Our initial studies show that the Conver-sation Clock visualization encouraged bal-anced participation between the partic-ipants. In this study, the participants weregraduate students. Specifically, when par-ticipants were divided into two cate-gories, above-average speakers and be-low-average speakers, we found thatalthough above-average speakers tookapproximately the same number of turnsspeaking with and without the Conver-sation Clock visualization, the turns tak-en using the Conversation Clock were no-ticeably shorter in length. Below-average

speakers took more turns using the Con-versation Clock with no noticeable dif-ference in turn-length.

We are not arguing that balanced conver-sation is ideal conversation. In fact, thatis probably not the ideal scenario. We arearguing that “social mirrors” such as theConversation Clock have an intrinsic pow-er to influence group behavior. This sug-gests that they should be carefully de-signed to produce a desired situation.

We are currently running a new series ofstudies using the Conversation Clock in asocial skills club for teenagers diagnosedwith Asperger’s Syndrome.

Children with Asperger’s Syndrome (AS),High-Functioning Autism (HFA), non-ver-

bal learning disorder (NVLD), or PervasiveDevelopmental Delay – Not OtherwiseSpecified (PDD-NOS) have difficulty withthe conversational aspects of social inter-action, including turn-taking, interrupting,conversational dominance, length of turnand use of vocal volume for emphasis.Conventional speech and language ther-apy intervention has focused on remedi-ation by teaching rules for conversation-al skills, practicing the skills and observingthe use of these skills.

Interventions that occur during the con-versation allowing for the child to modi-fy a behavior are few. Using the Conver-sation Clock, children who struggle withsocial interaction receive real-time feed-back and can make immediate adjust-ments during the conversation.

Figure 1. The Conversation Clock visualization. Each participant in the conversation is rendered in a different color. The length of each rectangle is proportional to the volume captured at that point in time. Dots about the circumference of each ring imply the table is active, but no one is speaking. Each ring represents one minute of conversation.

FEATURES Visualizing Voice



23

Social skills such as turn-tak-ing are subtle social negotia-tions. Traditional turn-takingas rendered on the Conversa-tion Clock can be seen in Fig-ure 2c. One speaker rampsdown his or her volume to al-low entry for another speaker.In our longitudinal studies, weare comparing social skills suchas turn-taking, interruption,and volume modulation usingthe Conversation Clock visual-ization and using traditionalsocial skills therapy. The ap-proach using ConversationClock and some of our other“social mirrors” for encourag-ing syllable production andword production in lower func-

tioning children so far appearpromising. Parents are enthu-siastic about the tools and thechildren find them engaging.Our future work includes mi-grating the interfaces toiPhones and toy-like devices sothat they can be used in every-day settings.

Figure 2. Snapshot of Conversation Clock depicting con versational dominance.

Figure 3. Common Conversation Clock patters: (a) concurrent speaking; (b) delayed turn-taking; (c) traditional turn-taking; (d) agreement;(e) agreement.

Karrie KarahaliosPh.D., University of Illinois [email protected]



Data gloves are a part of many virtual re-ality systems for both healthy users andpatients. Currently available data glovessuffer from two major disadvantages: theirlimited adjustability for different handsizes and their unsuitability for use withpatients suffering from hand paralysis orspasticity. For a clinic, the inability to ad-just data gloves increases costs as it re-quires multiple sets to be kept on handeven if not all are in continuous use. Ifthe clinic deals with hand motor rehabil-itation, e.g. after cerebral or spinal cord in-jury, normal gloves can be difficult or im-possible for patients to put on or removedue to swollen or cramped hands, evenwith assistance from therapists.

We have developed the SpiderGlove (Fig-ure 1) to address the need for low-cost,highly adjustable gloves that are easy tohandle for patients and therapists. Its mod-ular design separates the most costly partof the device – the electronics – from theunderlying fabric. To put on the Spider-Glove, the user (patient or therapist) firstselects one of the fabric units. These are

Data gloves are currently used as part of a variety of virtual reality systems. Thisarticle introduces the SpiderGlove, which will soon be available for use in researchand other applications. This data glove addresses the need for low-cost, easily adjustable and user-friendly gloves.

The SpiderGlove: Patient-Optimized Modular Data Glovesfor Pediatric and Adult Rehabilitation

By Pawel Pyk et al24

Cylindrical Power Grip - Index

Cylindrical diameter [mm]

550500450400350300

0 20 40 60 80 100

small handsmedium handslarge hands

Precision Pinch Grip - Index

Cylinder diameter [mm]

Ben

d se

nsor

mea

n []

550500450400350300

0 20 40 60 80 100small handsmedium handslarge hands

Ben

d se

nsor

mea

n []

small handsmedium handslarge hands

FEATURES


Figure 2. SpiderGlove index finger bend sensor readings, averaged across three groups of subjects with small, medium and large hands (5 subjects per group) and three trials per subject and object size. Top: power grip. Bottom: precision pinch grip.


25

made of a mix of fleece and Lycra, combin-ing flexibility and comfort with a firm hold.They are available in four different sizes, cov-ering the range from children of about 8years to large male adults. The machine-washable fabric unit is designed as an elas-tic tube through which the user insertshis/her hand, with a single hole for thethumb. There are no separate finger holes,allowing the tube to be put on quickly andeasily. The electronics, consisting of bendsensors and a wrist unit with accelerometersand digital compass, are then attached tothe fabric units. One bend sensor each isused for the thumb, index and middle fin-gers. Only three digits are used to balancecost and usability against fidelity of fingertracking – approximately 70% of humangrasping function is achieved using thesefingers alone. Velcro is used to attach theelectronics, allowing for precise adjustmentfor each patient. Finally, finger rings (avail-able in three sizes) are attached to each bendsensor. The wrist unit on each hand is at-tached via a flexible cable to a small baseunit which is connected to the host PC viaa USB cable providing both data and power.

In addition, vibration feedback is available inthe box connecting the bend sensors be-tween the index and middle fingers.

With its high adjustability, the question ofglove sensor calibration arises for Spider-Glove users with different hand sizes. Weconducted an experiment with fifteenhealthy volunteers, with hand sizes rangingfrom children (8 years old) to large adults.Each subject grasped a series of objects ofdifferent sizes and the bend sensor valueswere recorded. Surprisingly, the recordedsensor values were virtually the same inde-pendent of hand size (Figure 2). The reso-lution achieved was approximately 1.5 bendsensor units per mm of diameter for a cylin-drical power grip and 0.6 units/mm for aprecision pinch grip. These results meanthat not only can the SpiderGlove be phys-ically fitted to a wide range of hand sizes,but that little or no recalibration should benecessary when transferring between userswith different hand sizes.

We have tested the SpiderGlove on over thir-ty acute and chronic stroke patients, ten chil-

dren and dozens more healthy volunteersof all ages and sizes. In all cases the gloveshave been easily fitted in less than oneminute. Individual patients have workedwith the gloves continuously for an hour ata time over a month, performing over 300reach-and grasp actions during each sessionwith no-discomfort issues.

The SpiderGlove will shortly be made avail-able for use in research and other applica-tions. Future work will focus on obtainingmore detailed hand pose information andautomated decoding of grip type.

Pawel Pyk, Ph.D.Lisa Holper, M.D.Dariusz Mochancki, M.Sc.Daniel Kiper, Ph.D.Kynan Eng, Ph.D.Institute of NeuroinformaticsUniversity of Zurich and ETH ZurichSwitzerland

[email protected]://rehab.ini.ethz.ch/


Figure 1. Overview of the SpiderGlove. Bottom right: fabric unit. Main: Electronics attached with velcro and finger rings.


28

AUTHOR:

Daniel Stevens, LL.M.

Managing Editor, C&R Magazine

[email protected]

> COUNTRY FOCUS

Italy - the nation that birthed Michelangelo, Julius Cesar,Leonardo da Vinci, the Latin language, world-renownedcuisine, incredible art, and the European Renaissance –has become one of the foremost countries at the pinnacle of cybertherapy research and advanced technology-based rehabilitation. [ ]

CyberTherapy in Italy

ith nearly 60 million inhabitants,close to 70 percent of its popula-tion living in urban environ-

ments, and home to one of the highest lev-els of psychological distress in Europe, Italyhas the need for improved mental healthtreatments. Italian institutes, private compa-nies, and universities, with the aid of the Ital-ian Ministry of Health, have seen the possi-bilities that cybertherapy possesses and havejoined in efforts to promote the use of ad-vanced technologies in the treatment andrehabilitation of Italy’s mental well-being.

The Birth of CyberTherapy in Italy

The use of advanced technologies for psy-chological treatment and rehabilitation wasbrought to the scene in the mid-1990s andhas since continued to vastly grow in thelast decade. The Applied Technology forNeuro-Pschology Lab, held at the IstitutoAuxologico Italiano, began in 1996, pioneer-ing many of the applications that enabledthe diffusion of virtual reality and Internet

in the field of healthcare often referred toas “cybertherapy”. At this time, its main fo-cus was integrating innovative research rang-ing from clinical psychology and cognition,to mobile devices and simulation appara-tus. As described by the ISI Web of Science,this lab is currently within the top three lab-oratories worldwide in numbers of publica-tions available on Virtual Reality and Ambi-ent Intelligence.

In recent decades, the Human TechnologyLaboratory (HTLab), among others, has beenat the forefront of the investigation in hu-man-computer interaction, particularly incognitive, communicative, social, and cul-tural aspects of the human relationshipwith new and emerging technologies. Lo-cated at the University of Padova, this labis devoted to virtual environments, the useof videogames for healthcare (known oftenas “serious games”) and simulators for safe-ty training.

Many other technology-based healthcarelabs exist in Italy, including wearable tech-

nology companies, virtual reality-based treat-ment clinics, and the topmost cyberthera-py research facilities on the continent. De-spite Italy’s small stature, its healthcareresearch has kept Italy as a leader in tech-nology-based mental healthcare. Compa-nies such as FIAT, Telecom Italia, ST Micro-electronics, and Motorola have joined withresearch facilities and the Italian Ministryof Health, focusing on prevention, treat-ment, and rehabilitation to further improveits citizens’ mental wellbeing.

International Collaborations

As a founding member of the EuropeanUnion and a country with a passion for trav-eling, Italy has a multitude of research linksto all corners of the globe. Limited researchfunds have pushed many researchers tomove abroad, creating permanent partner-ships with at least 15 research centers in Asia,Europe, Australia, and North America.

The European Union has a strong connec-tion with Italy’s laboratories and universi-

W



58,1

4,47

5,51

34,21

7,61

0,88

59,34

57,54

0,74

13,02

24,03

2009

2006

2006

1994

2003

2006

2003

1995

1995

2006

2006

Population (Million)

Mental Disorders,

prevalence in % per 100.000

SDR, suicide and self-inflicted injury, 0-64

SDR, suicide and self-inflicted

injury, all ages

Number of mental patients staying

in hospitals 365+ days

Pure alcohol consumption,

litres per capita

SDR, homicide and intentional injury, 0-64

First admissions to drug

treatment centers

Mental disorders incidence

Alcoholic psychosis incidence

Psychiatric hospital beds

SDR, mental disorder & disease of

nervous system & sense organ, all ages

29

ties. The EU supports political, cultural, andeconomic research in Health and FutureEmerging Technologies (FET), granting thepossibility for Italy and other EU countriesto research top-level projects by way of anunbiased evaluation. Acting as a guaranteeof quality, the EU funds the “best of thebest,” often awarding Italian researchers thenecessary funding to supplement the lackof domestic funding opportunities. The useof outside funding has aided many labora-tories to continue research as well as to pro-vide a dissemination process for the labora-tories. The unique possibility to collaboratewith international scientists and researchgroups in the FP7 (EU research frameworkprogram), FP6, and FP5 has offered concretesupport for future advancement in scientif-ic investigation into technology and manyvaried conditions.

EU-Funded Projects in Italy

Some of the top Italian projects have beenfunded by the European Union. Two of thetop current Italian-based projects sponsored

by the EU are the INTREPID and EL-DERGAMES research projects. INTREPID isa project commissioned to design a biofeed-back enhanced Virtual Reality treatment forgeneralized anxiety disorder (GAD). GAD isa psychiatric disorder characterized by a con-stant and nonspecific anxiety that interfereswith daily-life activities. INTREPID uses itsbiofeedback bio-monitoring system to teachthe patient to control his or her physiolog-ical parameters, using the feedback provid-ed by the virtual environment to evaluatehis or her success.

ELDERGAMES has developed a tabletop so-lution for mixed reality environments. Usersare offered the possibility to play with realand virtual objects and to engage in a seriesof more than 40 videogames specifically de-signed to test and monitor elderly cognitiveconditions without mandatory and frequentperiodic psychological check-ups. With theELDERGAMES project, the elderly can social-ize with old and new friends, challenge oth-er players online, try to improve their per-sonal cognitive performance, and provide

data that enables the ability to evaluate andmonitor cognitive conditions – all while thesubjects feel they are playing a game.

The Future of CyberTherapy in Italy

As cybertherapy in Italy continues to grow ata rapid rate, the future will undoubtedly re-main bright for this pioneering country. Fu-ture areas of research appear to be in theconcept of “presence,” an experience elicit-ed by technology, as well as in new forms ofHuman-Computer Confluence (HCC) and ICTstudies as shown by trends in research andby future EU calls for proposals.

Presence is a concept that was described ina journal by Sheridan and Furness, early re-searchers in cybertherapy, as the effect feltwhen controlling real world objects remote-ly as well as the effect felt when individualsinteract with and immerse themselves invirtual environments. Despite the above def-inition, many researchers have argued aboutvarying classifications for the term. Futureand emerging research has indicated a clar-

YearValue



30

> COUNTRY FOCUS

Sources:

World Health Organization, EuropeanCommission, and personal communi-cation with Prof. Giuseppe Riva andProf. Luciano Gamberini

ification of the definition of “presence,”which has a simple, but critical role ineveryday experiences, defining the con-trol of agency and social interactionthrough the unconscious separation ofboth “internal” and “external” and “self”and “other.”

HCC signifies a priority on the EU re-search agenda for the most advancedforms of theorization and empirical in-vestigation on neural, psycho-physiolog-ical, and behavioral correlates of humanrelations with technology, specifically withnew interfaces. This, along with the fast-growing phenomena of new emergingforms of ICT based on interpersonal andsocial networked activities, has been aninterest of the EU. The EU has shown

trends to pursue projects and quickly in-troduce these phenomena into masscommunication, the economy, culture,and education.

Il Futuro è Qui

Italy will be the host of the 14th annual Cy-berTherapy & CyberPsychology conferencethis June, located at the beautiful LagoMaggiore in Verbania-Intra. This confer-ence will explore emerging applications,design, and effects of new media, featur-ing a multitude of top international re-searchers from around the globe. ManyItalian researchers will be in attendance,capitalizing on the international confer-ence’s magnitude and reputation as a front-runner of cybertherapy and advanced tech-

nology-based rehabilitation as well as a keyforum for dissemination.

Italy has proven to be a notable leader incybertherapy and, this June, will host oneof the world’s foremost leading forums foradvanced technologies for healthcare. Italywill continue to hold its place amongst in-fluential researchers in this field and willsurely flourish in the years to come. As Sol-era once said, “You may have the universeif I may have Italy”.


ManagingBoard

Brenda K. Wiederhold, Ph.D., MBA, BCIAVirtual Reality Medical InstituteSecretary GeneralBelgium

Cristina Botella, Ph.D. Universitat Jaume IPresidentSpain

Stephane Bouchard, Ph.D.Université du Québec en Outaouais (UQO)Vice PresidentCanada

Mark D. Wiederhold, M.D., Ph.D., FACP

Virtual Reality Medical CenterTreasurerUSA

Marcel Delahaye, Dipl - PsychUniversity of BaselSecretarySwitzerland

Giuseppe Riva, Ph.D., M.S., M.A.Istituto Auxologico ItalianoPublications DirectorItaly

Luciano Gamberini, Ph.D.University of PadovaSpecial Interest Groups DirectorItaly

Sun I. Kim, Ph.D.

Hanyang UniversityWebsite DirectorKorea

Georgina Cárdenas-López, Ph.D.Universidad Nacional Autónoma de México Membership DirectorMexico

Anna Spagnolli, Ph.D.Università degli Studi di PadovaCommunications Director Italy

Founding Members

Rosa M. Baños, Ph.D.

University of ValenciaSpain

Tony Brooks, Ph.D.

Aalborg UniversityDenmark

Paul M.G. Emmelkamp,Ph.D.

Royal Academy of Arts and Sciences (KNAW),

University of AmsterdamNetherlands

Tom Furness, Ph.D.

University of Washington USA

Hunter Hoffman, Ph.D.

University of WashingtonUSA

Dragica Kozaric-Kovacic, M.D., Ph.D.

University Hospital DubravaCroatia

Paul Pauli, Ph.D.University of WürzbergGermany

Simon Richir, Ph.D.

Arts et Metiers ParisTechFrance

Richard M. Satava, M.D., F.A.C.S.

University of WashingtonUSA

Paul F.M.J. Verschure, Ph.D.Universitat Pompeu FabraSpain

I-ACToR Advisory Board

32


The focus of this conference is on the increasing use of interactive media intraining, education, rehabilitation, and therapeutic interventions.Technologies include virtual reality simulations, video games, telehealth,videoconferencing, the Internet, robotics, and noninvasive physiological monitoring devices.

Giuseppe Riva, Ph.D., Conference Co-Chair

Brenda K. Wiederhold, Ph.D., MBA, BCIA, Conference Co-Chair

CT14 Goes Green! To be environmentallyfriendly,the use of paperat CT14 will be limited. Conference documents will be available in electronic format. Instead of the usual conference bag, participants will receive a free USB stick.

Issue 1 / 2009

FEATURES:The Eldergame s Project

p 9

Transforming VR into a Reality:The NeuroVR Project

p 12

Internet Environment to Curb Teen Smoking

p 14

Intelligent Clothing Calls for the Doctor

p 17

Visualizing Voicep 21

The SpiderGlovep 24

PRODUCT COMPARISON:Wearables

p 20

COUNTRY FOCUS:Italy

p 28

COVER STORY:

The Evolution of

Wearables

T h e O f f i c i a l V o i c e o f I - A C To R

ISSN 2031 - 278


17645684 cybertherapy rehabilitation magazine 1 2009

Documents

inaugural issue of cr

advanced technologies

issueof cr

v o i c e o f

rehabilitation magazine

conference documents

conference cochairbrenda

conference cochair ct14