Research Publications

Two interdisciplinary immersive performances were organised within the framework of ReInHerit, funded by Horizon 2020 (https://www.reinherit.eu), which is an international project focused on promoting a digital ecosystem connecting cultural heritage collections and sites, in order to present Europe’s tangible and intangible heritage to citizens and tourists in its wider historical and geographical contexts. The immersive performances will provide a template for collaborations for developing similar projects, which are shaped by cultural heritage sites and will in turn help to attract wider audiences to them. These were planned, developed and realised in parallel to the setup of a digital platform, in which all key stakeholders (museums, cultural heritage sites, policy makers, professionals and communities) have an open and collaborative space to experiment, share, co-create and innovate. A diverse group of professionals joined forces to create this project, resulting in two interdisciplinary performances that invited audiences to take initiative in shaping their experience of them.

With the rapid advancement of technology, children’s museums have integrated interactive installations to engage young visitors in immersive and educational experiences. The advantages of interactive installations lie in their ability to cater to different learning styles and enhance children’s engagement with educational content. However, it is important to acknowledge the limitations and challenges that such interactive technologies can have in these settings. This chapter explores the design of two interactive installations in a children’s museum, examining the advantages that can be achieved and also the challenges and limitations that can be addressed through a well-thought-out design process. By focusing on fairy tale museums, and through a real case example, the chapter explores how interactive technologies can foster fantasy, imagination and allow children to be transported in magic worlds. The chapter explores and analyses specific design considerations and principles that can be applied in order to harness the advantages of interactive installations while addressing their limitations and explains how these were applied in a fairy tale museum in Cyprus.

• Non-pharmacological interventions for people with dementia are of great importance. • Virtual Reality found to enhance symptom management in people with dementia. • Virtual Reality found to improve the quality of life of people with dementia. • Virtual Reality was found to be a possible solution for pain management. Emerging research supports that institutionalisation may contribute to the development of the behavioural and psychological symptoms of dementia. Many studies have documented that Virtual Reality can enhance symptom management in people diagnosed with dementia. We design a Virtual Reality system to improve the symptom management of people diagnosed with dementia residing in long-term care services. Twenty people with dementia were enrolled in the study to evaluate the developed solution. Following semi-structured interviews and observations, a thematic analysis was conducted to analyse the results of the system. Heart Rate and Eye-tracking data were recorded to enhance the reliability of the findings. Our findings indicate that Virtual Reality might be able to improve the quality of life of people diagnosed with dementia, as it is highly effective in reducing behavioral and psychological symptoms associated with dementia, including aggression, agitation, anxiety, apathy, and depression. Additionally, Virtual Reality was found to be a possible solution for pain management, reminiscence therapy, and dementia diagnosis.

BACKGROUND: The development of wearable solutions for tracking upper limb motion has gained research interest over the past decade. This paper provides a systematic review of related research on the type, feasibility, signal processing techniques, and feedback of wearable systems for tracking upper limb motion, mostly in rehabilitation applications, to understand and monitor human movement. OBJECTIVE: The aim of this article is to investigate how wearables are used to capture upper limb functions, especially related to clinical and rehabilitation applications. METHODS: A systematic literature search identified 27 relevant studies published in English from 2011 to 2023, across 4 databases: ACM Digital Library, IEEE Xplore, PubMed, and ScienceDirect. We included papers focusing on motion or posture tracking for the upper limbs, wearable devices, feedback given to end users, and systems having clinical or rehabilitation purposes. We excluded papers focusing on exoskeletons, robotics, prosthetics, orthoses, or activity recognition systems; reviews; and books. RESULTS: The results from this research focus on wearable devices that are designed to monitor upper limb movement. More specifically, studies were divided into 2 distinct categories: clinical motion tracking (15/27, 56%) and rehabilitation (12/27, 44%), involving healthy individuals and patients, with a total of 439 participants. Among the 27 studies, the majority (19/27) used inertial measurement units to track upper limb movement or smart textiles embedded with sensors. These devices were attached to the body with straps (mostly Velcro), providing flexibility and stability. The developed wearable devices positively influenced user motivation through the provided feedback, with visual feedback being the most common owing to the high level of independence provided. Moreover, a variety of signal processing techniques, such as Kalman and Butterworth filters, were applied to ensure data accuracy. However, limitations persist and include sensor positioning, calibration, and battery life, as well as a lack of clinical data on the effectiveness of these systems. The sampling rate of the data collection ranged from 50 Hz to 2000 Hz, which notably affected data quality and battery life. In addition, several findings were inconclusive, and thus, further future research is needed to understand and improve upper limb posture to develop progressive wearable systems. CONCLUSIONS: This paper offers a comprehensive overview of wearable monitoring systems, with a focus on upper limb motion tracking and rehabilitation. It emphasizes the various types of available solutions; their efficacy, wearability, and feasibility; and proposed processing techniques. Finally, it presents robust findings regarding feedback accuracy derived from experiments and outlines potential future research directions.

Abstract Virtual reality has long existed, but its wider adoption in education is recent. Studies informed by theoretical underpinned co-creation frameworks and utilization of theoretical informed evaluations are scarce in literature. Thus, this study internationally evaluated the efficacy of three virtual reality reusable e-resources (VRReRs), co-created based on the ASPIRE framework, for teaching clinical skills to university students. The study followed a mixed-methods approach, combining SUS, SUS Presence Questionnaire, TAM, and UTAUT2 with a focus group discussion. Additionally, for one VRReR, a quantitative pre/post evaluation of knowledge and comparison with lecture notes followed. Results demonstrated moderately to highly usability, effectively facilitated a strong sense of presence, confidence while using them, and willingness to continue using VRReRs in the future, while increased knowledge of the learners, highlighted their effectiveness. Although some usability issues were identified, these were considered easy to address. This work evidence, in an international context, that co-created VR resources are highly acceptable and effective, similar to other types of digital or traditional resources developed through participatory inquiry paradigm. By leveraging the benefits of VR technology, VRReRs have the potential to transform and enhance the learning experience in the field of clinical skills, ultimately advancing the digitalization of higher education.

Recent advancements in Virtual Reality (VR) immersive technologies provide new tools for the development of novel and promising applications for Medical Education courses. This paper presents an evaluation process for teaching the clinical skills course by exploiting the potential of a Virtual Reality application utilizing 360° videos with medical content for an undergraduate level course. We discuss the evaluation process, results and identify the potential role of Virtual Reality reusable e-resources into learning and practicing clinical skills and the concept of embedding these processes to a real assess-educate assess cycle that uses digital tools to optimize outcome. The development of VR technologies in recent years has resulted in more accessible and affordable solutions that can still provide promising results. The results of our analysis validated the effective design of a technologically enhanced learning tool as an addition to the existing methods used in medical education. Ultimately, the CoViRR analysis on the feasibility and acceptability of reusable virtual reality e-resources will serve as an example to other higher education institutions and faculty on techniques and topics for effective resource creation. Concluding, VR and interactive devices resulted in the development of holistic, portable, accessible, and usable systems for medical education.

Background: Research has suggested that institutionalization can increase the behavioral and psychological symptoms of dementia. To date, recent studies have reported a growing number of successful deployments of virtual reality for people with dementia to alleviate behavioral and psychological symptoms of dementia and improve quality of life. However, virtual reality has yet to be rigorously evaluated, since the findings are still in their infancy, with nonstatistically significant and inconclusive results. Objective: Unlike prior works, to overcome limitations in the current literature, our virtual reality system was co-designed with people with dementia and experts in dementia care and was evaluated with a larger population of patients with mild to severe cases of dementia. Methods: Working with 44 patients with dementia and 51 medical experts, we co-designed a virtual reality system to enhance the symptom management of in-patients with dementia residing in long-term care. We evaluated the system with 16 medical experts and 20 people with dementia. Results: This paper explains the screening process and analysis we used to identify which environments patients would like to receive as an intervention. We also present the system's evaluation results by discussing their impact in depth. According to our findings, virtual reality contributes significantly to the reduction of behavioral and psychological symptoms of dementia, especially for aggressive, agitated, anxious, apathetic, depressive, and fearful behaviors. Conclusions: Ultimately, we hope that the results from this study will offer insight into how virtual reality technology can be designed, deployed, and used in dementia care.

Immersive experiential technologies find fertile grounds to grow and support healthcare education. Virtual, Augmented, or Mixed reality (VR/AR/MR) have proven to be impactful in both the educational and the affective state of the healthcare student’s increasing engagement. However, there is a lack of guidance for healthcare stakeholders on developing and integrating virtual reality resources into healthcare training. Thus, the authors applied Bardach’s Eightfold Policy Analysis Framework to critically evaluate existing protocols to determine if they are inconsistent, ineffective, or result in uncertain outcomes, following systematic pathways from concepts to decision-making. Co-creative VR resource development resulted as the preferred method. Best practices for co-creating VR Reusable e-Resources identified co-creation as an effective pathway to the prolific use of immersive media in healthcare education. Co-creation should be considered in conjunction with a training framework to enhance educational quality. Iterative cycles engaging all stakeholders enhance educational quality, while co-creation is central to the quality assurance process both for technical and topical fidelity, and tailoring resources to learners’ needs. Co-creation itself is seen as a bespoke learning modality. This paper provides the first body of evidence for co-creative VR resource development as a valid and strengthening method for healthcare immersive content development. Despite prior research supporting co-creation in immersive resource development, there were no established guidelines for best practices.

Older adults with cognitive impairments may face barriers to accessing experiences beyond their physical premises. Previous research has suggested that missing out on emotional experiences may affect mental health and impact cognitive abilities. In recent years, there has been growing research interest in designing non-pharmacological interventions to improve the health-related quality of life of older adults. With virtual reality offering endless opportunities for health support, we must consider how virtual reality can be sensitively designed to provide comfortable, enriching out-world experiences to older adults to enhance their emotional regulation. Thirty older adults living with mild cognitive impairment or mild dementia participated in the study. Affect and emotional behavior were measured. The usability and the sense of presence were also assessed. Finally, we assessed the virtual reality experiences based on physiological responses and eye-tracking data. The results indicated that virtual reality can positively enhance the mental health of this population by eliciting a positive affective state and enhancing their emotional regulation. Overall, this paper raises awareness of the role of virtual reality in emotion elicitation, regulation, and expression and enhances our understanding of the use of virtual reality by older adults living with mild cognitive impairments or mild dementia.

The use of Virtual Reality in healthcare education is still uncommon. Measuring the feasibility of such resources into formal training is critical for quality, satisfaction, and ultimately improved efficacy over other methods. The Co-creation of Virtual Reality reusable e-Resources for European Healthcare Education (CoViRR) team used a proven development framework to co-create and analyze the feasibility and acceptance of 3 Virtual Reality Reusable e-Resources (VRReRs). The co-created VRReRs have been evaluated on usability, user acceptance and pedagogical acceptability using several formal and ad-hoc instruments. The results demonstrated that co-created VRReRs were on-par with other IT products in terms of usability. Also, users appeared ready to accept reusable VR e-resources as useful skills training instruments. Qualitative evaluation revealed that the user base is ready to accept VRReRs but require high technical fidelity and human-centric interaction schemes, supporting seamless integration of user activities in the virtual world, without technical obstacles. Ultimately, CoViRR analysis on feasibility and acceptance of virtual reality reusable e-resources will act as an example by other higher education institutions and tutors in techniques and topics for effective resource creation.

Public displays are some of the most challenging interfaces to design because of two key characteristics. First, the experience should be engaging, to attract and maintain users' attention. Second, the interaction with the display should be natural, meaning that users should be able to receive the desired output with little or no training. Holographic displays are increasingly popular in public spaces such as museums and concert halls but there is little published research on users' experiences with such displays. Previous research has suggested both tangible and intangible inputs as engaging and natural options for holographic displays, but there is no conclusive evidence on their relative merits. Hence, we run a study to investigate the user experience with a holographic display comparing the level of engagement and feeling of natural experience in the interacting process. We used a mix of surveys, interviews, video recordings, and task-based metrics to measure users' performance on a specific task, the perceived usability, and levels of engagement and satisfaction. Our findings suggest that a tangible input was reported as more natural than the intangible one, however, both tangible and intangible inputs were found to be equally engaging. The latter findings contribute to the efforts of designing intangible public holographic displays and other interactive systems that take into consideration health safety issues, especially during the Covid-19 pandemic era in which contamination can be established with tangible and physical interaction between users and public displays, yet without affecting the level of engagement compared to the tangible experience.

During the past couple of decades, museums resort to using innovative technological solutions in their permanent collections or temporary exhibitions aiming to enhance visitor experience. In the current study, we tested three emerging technologies (i.e., Interactive Book, Interactive Table, Immersive Virtual Reality) that were created to show in a museum exhibition, content related to ‘difficult heritage’ and ‘difficult history’. In a questionnaire administrated at the end of the exhibition, visitors were first asked to evaluate whether the content of the exhibition was better communicated through these interactive technologies than through non-technological (conventional) installations, and then to assess the usability of these technologies. Results revealed that technological installations were as engaging and successful in the presentation and communication of the content of the exhibition as the non-technological installations. Finally, with respect to the usability of the above three technological installations, results were remarkably high (Mdn: 87), with all visitors reporting a clear preference for the immersive virtual reality installation. Studies such as the current one support that interactive technologies should not aim to substitute conventional installations but instead, to complement them to enhance visitor experience and provide alternative ways of engagement and content communication.

Many people with dementia residing in long-term care may face barriers in accessing experiences beyond their physical premises; this may be due to location, mobility constraints, legal act and/or mental health restrictions. Previous research has suggested that institutionalization increases the co-existing symptoms of dementia, such as aggression, depression, apathy, lack of motivation and loss of interest in oneself and others. Despite the importance of supporting the mental well-being of people with dementia, in many cases, it remains undertreated. In recent years, there has been growing research interest in designing non-pharmacological interventions aiming to improve the Health-Related Quality of Life for people with dementia within long-term care. With computer technology and especially Virtual Reality offering endless opportunities for mental support, we must consider how Virtual Reality for people with dementia can be sensitively designed to provide comfortable, enriching out-world experiences. Working closely with 24 dementia patients and 51 medical and paramedical personnel, we co-designed an intelligent and personalized Virtual Reality system to enhance symptom management of dementia patients residing in long-term care. Through this paper, we thoroughly explain the screening process and analysis we run to identify which environments patients would like to receive as a Virtual Reality intervention to minimize the aforementioned co-existing symptoms of dementia, and the development of an intelligent system using the selected environments, that adapts the content of the Virtual Reality experience based on physiological and eye-tracking data from the patients and their personal preferences.

People living with Dementia (PwD) are amongst the most vulnerable populations in society, often depending on caregivers for their quality of life (QoL). Emerging research confirms the need for technological solutions to support non-pharmacological interventions that can enhance the QoL of PwD. This paper posits that Virtual Reality (VR) is a useful technology for boosting the physical training of PwD. In a study with PwD, we compared the conventional physical training PwD receive at a nursing home, against Semi Immersive VR (SIVR) and Fully Immersive VR (FIVR) training paradigms. We recorded the emotional behaviour, task-specific metrics, and level of independence of PwD during the training. The presence and usability of the systefm by both medical staff and PwD was also assessed. Results indicated that FIVR can improve the training of PwD leading to more accurate execution of the exercises while preventing external distractions. Beyond the findings, this article discusses the opportunities, challenges, along with the feasibility and acceptability of VR, to facilitate physical training for PwD who reside in restricted health care environments.

Abstract Emerging research confirms the need for technologically enhanced solutions to support non-pharmacological interventions which can improve the quality of life, the mental and physical health of demented people. Several types of research examined if virtual reality can be an effective solution. This paper aims to present the cyclic process of prototyping, testing, analysing, and refining the VR system in real-world clinical settings. Seven people with moderate to severe dementia were recruited. The experiment required the patients to attend three virtual reality iterations of rapid prototyping with user testing. All three iterations involved training activities with upper body movements similar to their usual physical training. A mixed-methods design measured affect and emotional behaviour using the Observed Emotion Rating Scale and the Visual Analog Scale. Content analysis was conducted following observations and interviews. During each iteration of rapid prototyping with user testing, quantitative measurements of performance, independence and time were recorded. Eye tracking and movement information were captured by the system. Finally, a simplified version of the presence and usability scales evaluated the system. The results of this study provide further evidence that virtual reality can play a significant role in the improvement of people’s with dementia physical training and emotional health when is appropriately designed. The results present the vital factors which should be incorporated in a virtual reality system which are: 1) a simple interactions modality; 2) visible visual targets and continuous feedback; 3) personalized virtual environments; 4) personalized range of movements.

Medical education has become more challenging, with a lack of resources and clinical environments where students can prepare for their clinical practice. New technologies are being used to fill this gap in education, with 360° videos providing a viable and effective solution. However, the creation of such resources has not been well documented, which forces educators to face the same setbacks during this development process. This paper presents technical guidelines for the creation of a Virtual Reality (VR) application using 360° videos with medical content for an undergraduate-level course. The guidelines are presented through the various decisions that were taken during the development process of the application, providing the rationale behind each one and their necessity. The guidelines validate the effective design of a technologically enhanced learning tool as an addition to the existing methods used in medical education.

The World Health Organization promotes healthy living through regular physical activities, such as exercise and sports, as well as access to healthcare and rehabilitation services for people with motor dysfunctions. However, there is a lack of specialized personnel and increased costs associated with such activities. These have led to the increased use of machine learning for the analysis and evaluation of human motion during exercise. To study the latest advancements in this area, a systematic literature review focusing on publications from 2017 to 2021 was performed. As a result, 88 relevant publications were identified, which developed both shallow machine learning and deep learning algorithms. The results indicated that algorithms for human motion assessment should provide personalized and informative assessments, with explainable and interpretable outcomes, that can be computed in real-time or concurrently with the execution of an exercise. Furthermore, they should be easy to adapt based on the needs of applications and should be able to perform with different motion capture systems. This has been challenging because of the usually small amount of collected data, the lack of large open datasets, and the unique characteristics of exercise motions. Based on the above findings, guidelines for the development of such algorithms are proposed and discussed. They relate to the selection of the type of assessment, handling data imbalances, selecting of motion capture technologies, balancing between accuracy and speed, selecting the right algorithm, performing concurrent assessment during an exercise, personalization and scalability, and evaluation.

Chatbots are becoming a trend in many fields such as medical, service industry and more recently in education. Especially in healthcare education, there is a growing interest in integrating chatbots in the learning and teaching processes mostly because of their portability and affordance. In this paper, we seek to explore the primary uses of chatbots in medical education, as well as how they are developed. We elaborate on current chatbot applications and research enacted in the domains of medical and healthcare education, We focus in the areas of virtual patients in medical education, patients’ education related to healthcare matters but also chatbots as course assistance in for enhancing healthcare professionals’ curricula. Additionally, we examine the metrics that have been used to evaluate these chatbots, which include subjective ones like the usability and acceptability by the users, and objectives ones, like their accuracy and users’ skills evaluation. Overall, even though chatbots offer a flexible solution and a vast possibility to improve healthcare education, our literature review suggests that their efficacy has not been thoroughly tested. Also, limited examples of chatbots in European Healthcare curricula have been found. These call of the need for further research towards this direction.

This paper presents a new approach for teaching the clinical skills course by exploiting the potential of a Virtual Reality application utilizing 360° videos with medical content for an undergraduate level course. We discuss the methodology prospects and identify the potential role of Virtual Reality reusable e-resources into learning and practicing clinical skills and the concept of embedding these processes to a real assess-educate-assess cycle that uses digital tools to optimize outcome. Scenarios, were developed in the context of the CoViRR Erasmus+ project, offering new insights for the digital integration in learning and teaching. The initial results of our analysis validated the effective design of a technologically enhanced learning tool as an addition to the existing methods used in medical education. Future work should integrate the application into the classroom and evaluate its effectiveness with real end-users.

Abstract In recent years, there has been growing interest in designing non-pharmacological interventions to improve the quality of life for People with Dementia (PwD) who face motor impairments. This paper investigates the feasibility of using Virtual Reality (VR) technologies for the rehabilitation of 20 patients with moderate to severe dementia residing in a confined psychiatric hospital and discusses the impact of this interactions on motor training. To accomplish this, we present three interrelated studies that refer to: (1) System requirement analysis carried out through a workshop with experts in dementia care; (2) System interaction method assessment by testing two different types of interaction in Virtual Reality, to identify the most suitable for People with Dementia; and (3) A pilot study with patients performing three upper limb physiotherapy tasks in Virtual Reality. The issues encountered during the design, testing and execution of the experimental tasks are discussed and a set of guidelines and recommendations for the future deployment of VR in healthcare services is provided.

This paper outlines a design case study for Skyfarer, a mixed reality rehabilitation application developed for upper body exercise of individuals aging with disability. We describe how experience, experiential and participatory design methodologies were combined to develop a game, which was publicly exhibited at IEEE VR and ACM SIGGRAPH, and formally evaluated in a biomechanical study at Rancho Los Amigos National Rehabilitation Center RLANRC.

Cheating in online games comes with many consequences for both players and companies. Therefore, cheating detection and prevention is an important part of developing a commercial online game. Several anti-cheating solutions have been developed by gaming companies. However, most of these companies use cheating detection measures that may involve breaches to users' privacy. In our paper, we provide a server-side anti-cheating solution that uses only game logs. Our method is based on defining an honest player's behavior and cheaters' behavior first. After that, using machine learning classifiers to train cheating models, then detect cheaters. We presented our results in different organizations to show different options for developers, and our methods' results gave a very high accuracy in most of the cases. Finally, we provided a detailed analysis of our results with some useful suggestions for online games developers.

Skyfarer is a mixed reality shoulder exercise game developed for prevention and treatment of shoulder pain for individuals aging with spinal cord injury. We are adapting a shoulder exercise protocol that has been evaluated in a randomized clinical trial [Mulroy et al. 2011]. This demonstration will showcase a second-generation integrated exercise hardware and software system. The system consists of an adjustable metal rig outfitted with GameTrak sensors that are attached to interchangeable Thera-Bands and free weights. The rig can accommodate individuals with various types of manual wheelchairs and can be adjusted for arm length. The GameTrak sensors provide three-dimensional movement data to the calibration and exercise software application that was developed in Unity Engine 3.5.