Cyber Therapy & Rehabilitation Magazine (1, 2008)

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CyberTherapy & Rehabilitation - Issue 1 / 2008
Issue 1 / 2008 The Official Voice of IACR
FEATURES:
Facing Your Fears:
Virtually
p 12
+ JCR - Volume 1 - Issue 3 / Fall 2008
My Heart’s “Neurological
Rehabilitation” Concept
p 17
Using Mobile Phones as

Behavioral Technologies
p 20
The Emergence of
CyberFashion
p 22
COVER STORY:
Virtual
Reality
in
p6
Healthcare
PRODUCT
COMPARISON:
Head-Mounted
Displays
p 10
COUNTRY FOCUS:
Spain
p 28
ISSN 2031 - 278
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C&R_approval:Layout 1 9/01/09 15:34 Page 1
Letter from the Publisher

Professor Dr. Brenda K. Wiederhold
“This publication will serve as a c atalyst whereby

society may rapidly benefit from the remarkable
technological revolution...”
C&R Editorial Board Dear Reader, treatment. As well, in the United States,
forward-thinking organizations such as
Professor Brenda K. Wiederhold, Welcome to the inaugural issue of Cyber- the National Institute on Drug Abuse
Ph.D., MBA, BCIA Therapy & Rehabilitation Magazine (C&R), (NIDA), National Institutes of Health
Editor-in-Chief, C&R Magazine
Belgium
the official voice of the International As- (NIH), the National Science Foundation
sociation of CyberTherapy & Rehabilita- (NSF) and the Department of Defense
Professor Rosa M. Baños, Ph.D. tion (IACR). IACR is an international as- (DoD) continue to support simulation
University of Valencia
sociation that has been created with the for training, education, and therapeutic
Spain
goal of disseminating knowledge about interventions.
Professor Cristina Botella, Ph.D. exciting new f indings b eing made to
Universitat Jaume I
transform healthcare through the addi- IACR believes there is an urgent need to
Spain
tion of cutting edge technologies. develop a set of standar ds and a
Professor Stéphane Bouchard, Ph.D. “roadmap” for future directions. Since
Université du Québec en Outaouais An exciting body of research regarding this is a rapidly growing field with signif-
Canada
the utilization of advanced technologies icant implications to change healthcare
Professor Tony Brooks
Aalborg University
in the areas of training, therapy, educa- as we know it, it is critical that there be 1
tion, prevention, and rehabilitation has a unified voice which brings together
Denmark
emerged over the past fifteen years, re- thought leaders and provides a forum to
Professor Paul M.G. Emmelkamp, Ph.D. vealing developments and discoveries speak with policymakers, decision mak-
University of Amsterdam made by over 450 clinicians and r e- ers, and funding agencies to voice our
The Netherlands
searchers. Advanced technologies—such needs and help shape research agendas.
Professor Luciano Gamberini, Ph.D. as virtual reality (VR), robotics, non-inva- There is also a critical necessity to provide
University of Padova sive physiological monitoring, e-health, a central repository of information for
Italy
and adaptive displays—are now being those in both the general public as well
Professor Sun I. Kim, Ph.D. applied to several areas of healthcare, in- as the scientific community who are ea-
Hanyang University cluding physical and cognitive rehabili- ger to learn more about how technology
Korea
tation, anxiety disorders, eating disorders can enhance healthcare.
Professor Dragica Kozaric-Kovacic, and obesity, addictions, stress manage-
M.D., Ph.D. ment, and as a distraction mechanism This publication will serve as a catalyst
University Hospital Dubrava during painful or anxiety-provoking med- whereby society may rapidly benefit from
Croatia
ical or dental procedures. These tech- the remarkable technological revolution
Professor Paul Pauli, Ph.D. nologies are also providing for improved that is occurring, with the ultimate aim
University of Würzburg quality of life for populations such as the of impr oving the quality of to day’s
Germany
elderly and the disabled. healthcare, helping to quickly dissemi-
Professor Simon Richir, P.h.D nate research results, and ultimately el-
Arts et Metiers ParisTech An increasing number of agencies are evating the level of care available for each
France
recognizing the huge potential of tech- citizen. Currently a considerable knowl-
Professor Giuseppe Riva, Ph.D., M.S., M.A. nology to dramatically improve 21st cen- edge base exists; however, there is no uni-
Istituto Auxologico Italiano tury healthcare. The European Commis- fied plan for the future of best practices
Italy sion, in its last three frameworks, has for adding advanced technologies to ex-
Professor Paul F.M.J. Verschure, Ph.D. invested heavily in research support of isting clinical protocols. IACR aims to be
Universitat Pompeu Fabra e-health and simulation technologies ap- the organization that brings ideas and
Spain plied to healthcare and e-inclusion. The decision makers together.
Professor Mark D. Wiederhold,
European Union, as well as individual Topics C&R intends to address include:
M.D., Ph.D., FACP governments within Europe, has recog-
Virtual Reality Medical Center nized the critical role that advanced tech- • Large-scale display technologies includ-
USA
nologies can play in both prevention and ing 3-wall CAVES.
GENERAL INFORMATION
CyberTherapy & Rehabilitation Magazine

ISSN: 2031-278
Letter from the Publisher
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 in collaboration with EMC Con- • Low-cost videogame-based simulations in- • What type of interface needs to be creat-
sulting Group. The magazine explores the uses of advanced
cluding inexpensive handheld devices, ported so that a continuum from the therapist’s
technologies for therapy, training, education, prevention,
and rehabilitation. Areas of interest include, but are not lim-
able consumer products, and other low-cost office to the patient’s home and place of
ited to, psychiatry, psychology, physical medicine and reha- mobile, wireless, and patient-friendly inter- employment (etc.) exists?
bilitation, neurology, occupational therapy, physical thera- faces.
py, cognitive rehabilitation, neurorehabilitation, oncology, • How can technologies be specifically fo-
obesity, eating disorders, and autism, among many others. • Next-generation immersive head-mount- cused to meet the needs of varied patient
ed displays (HMDs) which might include populations, their families, and caregivers?
PUBLISHING HOUSE
retinal displays.
Virtual Reality Medical Institute BVBA
in collaboration with EMC Consulting Group BVBA In this first issue, we begin our process of
28/7 Rue de la Loi, • Low-cost, interactive haptic devices that discovery by exploring both currently avail-
B-1040 Brussels, Belgium can be used in the home for education, able technologies as well as some of their
Telephone: +32 2 286 8505 training, and healthcare delivery. present applications. We begin with an in-
PUBLISHERS troduction to “VR in healthcare” in our fea-
Brenda K. Wiederhold, Ph.D., MBA, BCIA
• Easy-to-use software that allows for real- tures section. Since many of today’s appli-
Christian Marolt
time creation of any environment from dig- cations employ HMDs, you will f ind
Fax: +32/2/286 8508 ital photographs. information on some of the currently avail-
E-mail: office@vrphobia.eu able HMDs in our product comparison chart
Website: http://www.vrphobia.eu • Object-oriented software for the creation and surrounding pages. This issue’s coun-
of digital avatars that can rapidly be made try focus is on Spain. Take a moment to read
ADVERTISING to perform any type of movement, action, what cutting-edge researchers are doing
For advertising information, rates, and specifications please
or complex series of commands. throughout the country.
contact Virtual Reality Medical Institute, 28/7 Rue de la Loi,
2 B-1040 Brussels, Belgium, Telephone: +32 2 286 8505; Fax:

+32/2/286 8508; E-mail: office@vrphobia.eu Other thought-provoking questions that I hope you will enjoy reading our publication
C&R hopes to explore are: and find it informative and beneficial for you.
REPRINTS Always striving to meet the needs of our read-
Individual article reprints are available from corresponding • How can simulation tools become both ers, your suggestions and contributions are
authors. Please contact the publisher for rates on special or-
doctor and patient-friendly? always welcome. Please contact me, or Daniel
ders of 100 or more.
Stevens, Managing Editor, at office@vrpho-
MANUSCRIPTS • How can virtual environments and inter- bia.eu with your comments, which we be-
Submissions should be addressed to the JCR Managing Edi- net-based therapies be created so that they lieve are vital to our continued growth.
tor, Virtual Reality Medical Institute, 28/7 Rue de la Loi, B- automatically respond and morph based
1040 Brussels, Belgium, Telephone +32 2 286 8505, Fax: +32 upon a predetermined set of criteria estab- Create your own reality!
285 8508; E-mail: office@vrphobia.eu. lished by the therapist? Brenda Wiederhold
COPYRIGHT
Copyright © 2008 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 and EMC Consult-
ing Group BVBA. Printed in Hungary.
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TABLE OF CONTENTS
EDITORIAL
p1
COVER STORY
Virtual Reality in Healthcare:
An Introduction
G. Riva
p6
VR in Healthcare
PRODUCT COMPARISON CHART Virtual Reality, a term used for the first time
Head-Mounted Displays
in the 1980s to describ e a computer simu-
p 10 lated environment within and with which an
individual can interact, has been utilized for
FEATURES almost two decades to aid in therapy and re-
habilitation. Amongst the latest develop-
Facing Your Fears: Virtually ments are networked virtual environments
B. K. Wiederhold and 3-D interfaces to the Internet.
p 12
My Heart’s “Neurological Rehabilitation” 3

Concept: Technologies for Post-Stroke Treatment
T. Giorgino, P. Tormene, G. Maggioni,
B.Cattani, C. Pistarini, S.Quaglini
p 17
Opportunities and Challenges in Using

Mobile Phones as Behavioral Technologies
G. Jacucci
p 20
The Emergence of CyberFashion

D. Stevens
p 22
C&R IN BRIEF
North America
The Emergence of CyberFashion
C. Pockrandt
p 27 Medical experts have begun to realize the in-
credible opportunity provided by wearable
technologies, allowing citizens to benefit from
COUNTRY FOCUS a continuum of care. Prevention, assessment,
Spain diagnosis, and treatment can all benefit, al-
lowing citizens mor e available acc ess to
D. Stevens
healthcare.
p 28
International Association of CyberTherapy & Rehabilitation (IACR)

Conference Participation Report Fall/Winter 2008
PRESENCE 2008: The World of Health IT’08

11th Annual International Workshop on Presence Conference & Exhibition
Padova, Italy / October 16-18, 2008 Copenhagen, Denmark / November 4-6, 2008
As part of the PRESENCE 2008 c onference, Dr. Anna Spagnolli The World of Health IT Conference & Exhibition 2008 (WoHIT 2008) has
and Dr. Luciano Gamberini of HTLab, University of Padova, Italy been designed for and by the healthcare ICT community in the Euro-
and Dr. Brenda K. Wiederhold of IACR co-organized the Second pean region including: technology end users, vendors, providers and pol-
European Workshop of Cybertherapy, Rehabilitation and E-Men- icy makers. Addressing the perspectives of clinicians, directors and oth-
tal health. ** JCR Editorial Board Member, Dr. Paul Emmelkamp, er healthcare professionals, WoHIT offered:
University of Amersterdam, chaired the symposium and also
gave an address in the opening session. The speakers represent- - Educational sessions - IHE Interoperability Showcase
ed 6 countries and spoke on a range of topics from virtual real- - Vendor exhibitions - Networking sessions
ity and eating disorders to on-line counseling and the therapeu- - Best practice exchange - Continuing Medical Education (CME)
tic value of videogames. In addition studies dealing with basic
research on presence as well as clinical applications were pre- Speakers included Viviane Reding, the European Commission’s commis-
sented during the pre-conference workshop and as part of the sioner for Information Society and Media; Jakob Axel Nielsen, Denmark’s
regular conference. The International Society for Presence Re- minister for health and prevention; Former Prime Minister of Finland
search also held its first general assembly, chaired by President Esko Aho; and Nicholas Negroponte, Chairman Emeritus of the MIT Me-
Matthew Lombard. dia Lab. Dr. Wiederhold, Secretary General of the IACR and Dr. Giuseppe
Riva, Founding Board Member, held a symposium on Virtual Reality in
** Drs. Spagnolli, Gamberini, and Wiederhold are all Founding Members of IACR.
Training, Therapy, & Rehabilitation. In addition, VR equipment was demon-
For further information, please visit: strated for the audience, and also available in the Exhibit Hall.
4 http://www.presence2008.org/uploads/file/PRESENCE_2008_Second_CfP.pdf
In addition, the European Commission, HIMSS Europe, the Ministry of
Health and Consumption of Spain, and the Government of Catalonia an-
nounced that the next WoHIT conference and exhibition will be held in
Presence: conjunction with the European Union’s annual High Level eHealth Min-
isterial Conference in Barcelona on March 15-18, 2010.
Present and Future Markets,
The Peach Industry Event For further information, please visit: http://www.worldofhealthit.org
Turin, Italy / November 12-13, 2008
The Peach Industry Event “Presence: Present and Future Mar-

kets” was focused on assessing future market trends and op- ICT 2008
portunities for presence technologies and applications, and - Setting the ICT Research Agenda for the Next Decade
addressed both market actors and the research community. Lyon, France / November 25-27, 2008
PEACH is an FP6 funded project. During the event, interna-
tional experts discussed present and future markets, offered The European Commission’s ICT event, held in the Centre de Congrès
examples of commercial applications as well as research and in Lyon, examined how and where Europe can lead the ICT agenda in
development (R&D) outcomes. The event covered topics such the next ten years. The main themes covered topics such as:
as promising application fields, Presence technologies (e.g. vir-
tual agents, brain-computer interface, 3D displays etc.) as well - European Union priorities in ICT research for over ¤2 billion
as training and education. of funding available in 2009-2010;
- The major current technological trends which impact upon
This year’s event was organized in partnership with the VIEW strategic research planning
Conference - Digital Transformations - an international event - Public research policies to stimulate research and innovation.
focusing on Computer Graphics and covering Digital Cinema,
Automotive Design, Virtual Reality, 3D Animation & VFX, Ar- The ICT event also included 180 exhibits showcasing the latest break-
chitecture & Design and Games. Exhibits allowed attendees the throughs of European research projects as well as networking sessions for
opportunity to try many of the new technologies for themselves. researchers and investors to find partners for potential research initiatives.
For further information, please visit: For further information, please visit:
http:// peach.tel.fer.hr/industry/peach_industry_event_home.html http://ec.europa.eu/information_society/events/ict/2008/index_en.htm
COVER STORY
Virtual Reality
in Health Care:
An introduction
For many health care professionals, VR is f irst of all a technology.
However, the analysis of the dif ferent VR applications clearly shows that
the focus on technological devices is not the same in all the ar eas of
medicine and it is related to the specific goals of the health care provider.
6 By Giuseppe Riva
Since 1986, when the computer scientist al (3D) graphical environment from nu- ment, creating the illusion of interacting
and author Jaron Lanier used the term merical data. Using visual, aural or haptic with and thus being immersed within the
for the first time, “virtual reality” (VR) has devices, the human operator can experi- environment. Typically, a VR system is
been usually described as a computer sim- ence the environment as if it were a part composed by:
ulated envir onment with and within of the world. This computer generated
which people can interact. world may be either a mo del of a real- • the output tools (visual, aural and
world object, such as a house; or an ab- haptic), that immerse the user in
The basis for the VR idea is that a com- stract world that does not exist in a real the virtual environment;
puter can synthesize a three-dimension- sense but is understo od by humans,
such as a chemical molecule or a repre- • the input tools (trackers, gloves or
sentation of a set of data; or it might be a mouse) that continually reports the
in a completely imaginary science fic- position and movements of the users;
tion world.
• the graphic rendering system that
Figure 1:
Further, because input devices sense the generates, at 20-30 frames per second,
Typical head-
mounted display operator's reactions and motions, the op- the virtual environment;
worn by VR user. erator can modify the synthetic environ-
the database construction and virtual
object modeling software for building
and maintaining detailed and realistic
models of the virtual world. In particu-
lar, the software handles the geometry,
texture, intelligent behavior, and physi-
cal modeling of hardness, inertia, sur-
face plasticity, of any object included in
the virtual world.
The Official Voice of the International

Figure 2: Addition of haptic device on VR user’ shand to allow for “touch sensation” 7
The computer technology that allows the de-

velopment of three-dimensional virtual en-
vironments consists of both hardware and
software (see Table 1 for VR Hardware). The
computer hardware used ranges from stan-
dard PCs to high-performance workstations
with parallel processors for the rapid compu-
tation of world models, and high-speed com-
puter networks for transferring information
among participants in the virtual world. The
implementation of the virtual world is accom-
plished with software for modeling (geomet-
ric, physical, and behavioral), navigation, in-
teraction, and hypermedia integration.
The most recent development of VR has

been in the area of networking and the Inter-
net. Networked virtual environments and 3-
D interfaces to the Internet are amongst the
latest applications of VR in a growing telecom-
munications market (See Table 2 for a 5-year
forecast of VR in health care).
For many health care professionals, VR is first

of all a technology. However, the analysis of
the different VR applications clearly shows Figure 3 and 4: Examples of VR environnement before and after mapping
A ssociation of CyberTherapy & Rehabilitation

COVER STORY
8 Figure 5: Users interacting with large scale VR environment Figure 6: Example of Character Design software Interface
that the focus on technological devices is described differently. For instance Drs. – the medical avatar. In this sense, an ef-
is not the same in all the areas of med- Brenda and Mark Wiederhold, in their fective VR system should offer real life
icine and it is related to the specific goals book “Virtual Reality Therapy for Anxi- body parts or avatars that interact with
of the health care provider. ety Disorders: Advances in Evaluation and external devices such as surgical instru-
Treatment” define VR as “an advanced ments as near as possible to their real
For instance, former Defense Advanced form of human-computer interface that models. This view also drives the Informa-
Research Projects Agency (DARPA) Pro- allows the user to interact with and be- tion and Communications Technologies
gram Manager and retired Army Colonel come immersed in a computer-generat- (ICT) Work Programme strategic objective
Dr. Richard Satava (M.D., FACS), in his re- ed environment in a naturalistic fashion”. “Virtual Physiological Human” (VPH). The
cent book “Emerging Technologies in VPH lists as its main target outcome patient-
Surgery,” describes VR as: “a collection These two definitions underline two dif- specific computer models for personal-
of technologies that allow people to in- ferent focuses of VR in medicine: VR as ized and predictive healthcare and tools
teract efficiently with 3D computerized simulation tool and VR as interaction tool. for modeling and simulation of human
databases in real time using their natu- physiology and disease-related processes.
ral senses and skills”. This definition lacks For physicians and surgeons, the simula-
any reference to head mounted displays tion focus of VR prevails over the interac- For clinical psychologists and rehabili-
and instrumented clothing such as tion one: the ultimate goal of VR is the tation specialists, the interaction focus
gloves or suits. In fact, less than 20% of presentation of virtual objects to all of the of VR prevails over the simulation one:
VR health care applications in medicine are human senses in a way identical to their they use VR to provide a new human-
actually using any immersive equipment. natural counterpart. As noted by Satava, computer inter action p aradigm in
as more and more of the medical tech- which users are no longer simply exter-
However, if we shift our attention to be- nologies become information-based, it nal observers of images on a computer
havioral scienc es and r ehabilitation, will be possible to represent a patient with screen but are active participants with-
where immersive devices are used by higher fidelity to a point that the image in a computer-generated three-dimen-
more than 50% of the applic ations, VR may become a surrogate for the patient sional virtual world. Within the VE the

Figure 6: Second Life online world 9
Table 1: VR Hardware patient has the possibility of learning to man-

VR Workstation Tracking system age a problematic situation related to his/her
Nvidia Quadro Plex 2000 D2 Polhemus Fastrak disturbance. The key characteristics of virtu-
Nvidia Quadro Plex 1000 Model 4 Ascension PC Flock of Birds al environments for these professionals are
Professional graphic cards Intersense Intertrax 2
both the high level of control of the interac-
Quadro FX 5800 2048 Mbyte PCI Express 3D Shutter Glasses
ATI FirePro 8700 2048 Mbyte PCI Express StereoEyes Wireless tion with the tool without the constraints
Quadro FX 4600 768 Mbyte PCI Express Elsa 3D Revelator IR usually found in computer systems, and the
Consumer graphic cards VRex Cordless enriched experience provided to the patient.
Nvidia GeForce 8800 Ultra 768 Mbyte PCI Express Head Mounted Display
ATI Radeon HD 4870 X2 2048 Mbyte PCI Express PiSight (2400x1720 resolution - 3D display) In the following C&R papers we discuss in
VR 1280 (1280x1024 resolution – 3D)
more detail these two visions, describing more
VR Gloves Visette 45 (1280x1024 resolution – 3D)
CyberTouch with tactile feedback 3-Scope (800x600 resolution – 2D) in detail different areas of health care in which
5DT Data Glove 5 Ultra Wireless Z800 eMagin (800x600 resolution – 3D) the use of VR is actually investigated.
Pinch Glove I Glassess PC/SVGA (800x600 resolution – 3D)
P5 Glove Vuzix iWear VR920 (640x480 resolution – 3D) Both areas of VR are equally important, and
*Prices available upon request at office@vrphobia.eu. equally useful, as we move towards the in-
tegration of technology into existing clini-
cal and teaching paradigms. Technology works
Table 2: Five Year Forecast to assist and enhance existing clinical skills
and training tools, not to replace them.
[ ]
- Health Care VR systems for less than 5000 Euros
- Clinical/Well Being VR experiences on the web and on high-end cellular phones Giuseppe Riva, Ph.D., M.S., M.A.
- Large scale randomized controlled trials Istituto Auxologico Italiano
- Integration of VR systems with biosensors: the features of the VR world are adapted according www.auxologico.it/
to the biological responses of the patients info@auxologico.it

PRODUCT COMPARISON
Product Comparison Chart:

Head-Mounted Displays
Head-Mounted Displays (HMDs) are crit- actions, and memories that can trigger has compiled a list of the most com-
ical tools for medical therapies that in- a patient’s anxiety. HMDs can also be mon HMD models and their details in
corporate virtual reality as a basis for applied for entertainment purposes, order to compare the quality, affordabil-
treatment. Therapists use HMDs as while some c ompanies design their ity, weight, and other information to
tools to aid in stimulating emotions, re- models for military purposes only. C&R best suit the consumer.
MODEL MANUFACTURER RESOLUTION DISPLAY TYPE FIELD OF VIEW DEVICE WEIGHT

i-Theatre XT i-O Display Systems 320 x 240 LCD 32° 2.1 oz.
i-glasses VIDEO 3D PRO i-O Display Systems 800 x 600 LCD 26° < 8 oz.
DV920 Vuzix 640 x 480 LCD 26° 3.5 oz.
VR920 Vuzix 640 x 480 LCD 32° 3 oz.
LV920 Vuzix 640 x 480 LCD 32° 12 oz.
hi-Res800 Cybermind NL 800 X 600 LCOS 26° 21.2 oz
hi-ResSVGA+ Cybermind NL 800 x 600 OLED 42° 17.6 oz
10 Dual input version.
Visette45 SXGA Cybermind NL 1280 x 1024 FLCOS 45° 24.7 oz.
i-visor FX601 Daeyang 800 x 600 OLED 42° 4.23 oz.
i-visor DH4400VP Daeyang 800 x 600 LCOS 31° 11.3 oz.
i-visor FX605 Daeyang 800 x 600 OLED 42° 4.23 oz.
Z800 3D visor eMagin 800 x 600 OLED 40° < 8 oz.
i-Theater Digital Vision 320 x 240 LCD 25° 2.1oz.
nVisor ST NVIS 1280 X 1024 LCOS 60° 45.9 oz.
nVisor SX NVIS 1280 x 1024 LCOS 60° 35.3 oz.
piSight Sensics 2400 x 1720 MICRO 82°-188° < 35.3 oz.
ARvision 3D HMD Trivisio 800 x 600 LCOS 40° 8.1 oz.
3scope HMD Trivisio 800 x 600 LCOS 40° 4.2 oz.
M3 Trivisio 800 x 600 LCOS 32° 3.9 oz.
VR1280 Virtual Research 1280 x 1024 FLCOS 60° 28 oz.
Ruggedized i-visor Virtual Research 800 x 600 LCD 42° 16 oz.
Cyberface Leep VR 120 x *1 LCD 120° 18 oz.
Cyberface2 Leep VR 385 x 119 LCD 145° 2 oz.
Cyberface3 Leep VR 720 x 240 LCD 80° 3 oz.
AddVisor 150 SaabTech 1280 x 1024 FLCOS 46° 35.3 oz.
5DT HMD 800-26-3D Inition 800 X 600 LCOS 26° 21.2 oz.
ProView XL35 Rockwell Collins 1024 x 768 XGA 35° 35.3 oz.
ProView XL40 STm Rockwell Collins 1024 x 768 AMLCD 44° 28.2 oz.
ProView XL50 Rockwell Collins 1024 x 768 XGA 50° 35.3 oz.
Sim Eye XL100A Rockwell Collins 1024 x 768 XGA 112° 88.2 oz.
Register by Friday 31 December 2008 and

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FEATURES
Facing Your
Fears: Virtually
With over 200 recognized anxiety disorders affecting one-fourth
of the world’s population, the need for continued improvement
of treatment availability is critical. With advanced technologies,
psychology has the opportunity to rise to a new level, moving
towards unprecedented heights to offer more affordable, more
available healthcare to a larger portion of our society.
12 By Brenda K. Wiederhold
What if the thought of entering the en- phobias, social phobia, and agoraphobia), VR exposure therapy immerses an indi-
closed space of an elevator terrified you panic disorder, obsessive-compulsive dis- vidual in a c omputer-generated world
so badly that you decided to climb the order, posttraumatic stress disorder and where various stimuli related to the pho-
seven flights of stairs to your do ctor’s generalized anxiety disorder under the bia may be "experienced" three-dimen-
office? Or imagine having to send re- broad category heading of Anxiety Disor- sionally. The client wears a head-mount-
grets to your b est friend’s wedding b e- ders. This group of disorders does not ed display with small TV monitors and
cause you could not stand the idea of distinguish between age, sex, or race, af- stereo earphones to receive both visual
mingling at the reception. Though fear flicting those from all walks of life. Not and auditory cues. In careful, controlled
and anxiety are a normal part of the hu- only adults, but also children and adoles- stages, the client is exposed to experi-
man experience, for some these feelings cents can develop anxiety disorders. ences that elicit higher levels of anxiety.
are so intense that they can severely im- Each stage c an b e r epeated until the
pact everyday life. For these people, there Most people experience feelings of anxi- client is comfortable with the experience
are various treatments that can offer ety before an important event such as a and satisfied with the response.
hope, some with traditions stretching for business presentation, big exam, or first
hundreds of years, and others newly ar- date. Anxiety disorders, however, are ill- Specific Phobias
rived, seemingly from the realm of sci- nesses that fill people's lives with over-
ence fiction. whelming anxiety and fear that are chron- Phobias are the most common psychi-
ic, unremitting, and can grow progressively atric disorder, more common than alco-
Anxiety disorders, as a group, are the most worse. Tormented by obsessive thoughts, hol abuse, alcohol dependence, or major
common mental illnesses in the world. flashbacks of traumatic events, panic at- depression. A specific phobia is defined
According to a 2007 study by the Anxiety tacks, nightmares, or countless frighten- as an intense and p ersistent fear that is
Disorder Resource Center, anxiety disor- ing physical symptoms, some people with considered excessive or unreasonable in
ders affect approximately 1 in 4 people anxiety disor ders may even b ecome response to a situation. Specific phobias
worldwide at some point in their lives. housebound. Groups around the world include fear of flying, spiders, heights,
The Diagnostic and Statistical Manual of are, however, advancing the treatment of thunderstorms, public speaking, blood,
Mental Disorders, Fourth Edition, Text Re- these conditions through the use of vir- etc. Exposure to the phobic stimulus con-
vision (DSM-IV-TR) lists phobias (specific tual reality (VR) therapy. sistently provokes an anxious reaction,

VR environment for
treating aviophobia
The Client wears a headmounted display with small monitors

to receive both visual and auditory cues
VR environment for treating
posttraumatic stress disorder 13
which may take the form of a situational- Situational Type, which includes fear of in a secure, controlled environment. Stud-
ly predisposed panic attack. Adults recog- flying, bridges, elevators, driving, or en- ies around the globe have shown that VR
nize that their fear is excessive and unrea- closed places. The age of onset is either for specific phobias has approximately a
sonable, but ar e unable to c ontrol it. during childhood or in the mid-20s. This 92% success rate in just 8-12 one-hour ses-
Children may or may not have any insight is the most fr equent subtyp e seen in sions. In addition, by adding physiological
into the fact that their fear is excessive. In adults. monitoring and feedback to the VR proto-
both adults and children, the feared object Other Type, which includes fear of falling col, relapse rate and both short and long-
or situation is usually avoided or anticipat- down when away from walls, fear of vom- term treatment gains may be further im-
ed with dread. The phobia is diagnosed iting or choking, fear of contracting an ill- proved.
when one’s fear, or evasive actions to avoid ness, fear of loud sounds, and fear of cos-
the feared situation, interferes with daily tumed characters. Social Phobia
routine, employment, or social life.
The most common treatment for specific Social phobia, or social anxiety, is a disor-
Over 200 phobias have been identified and phobias is exposure therapy. This exposure der characterized by excessive self-con-
named, falling into five different subtypes: was typically done either in real-life (in vivo) sciousness and overwhelming anxiety in
or imaginally (in vivo) prior to VR. Howev- everyday social situations. People with so-
Animal Type, which generally has a child- er, in vivo exposure is not always conven- cial phobia have a persistent, intense, and
hood onset and includes fear of insects ient, safe, or cost-effective (e.g. fear of fly- chronic fear of being watched and judged
or other animals. ing, fear of driving), and in vitro is often by others and of being humiliated or em-
Natural Environment Type, which inclu- difficult as only 15% of individuals are able barrassed by their own actions. Their fear
des fear of heights, water, and storms to imagine the f eared situation vividly may be so severe that it interferes with
and generally has a childhood onset. enough to evoke the anxiety response nec- work, school, and other ordinary activities.
Blood-Injection-Injury Type, including fear essary f or succ essful tr eatment. That ’s While many people with social phobia rec-
of invasive medical or dental procedures where virtual reality (VR) steps in. In Virtuo ognize their fear is excessive or unreason-
such as receiving an injection, giving blood exposure provides all of the stimuli need- able, they are unable to overcome it. They
or seeing blood or an injury. This phobia ed for successful treatment while at the often worry for days or weeks in advanc e
subtype is often characterized by fainting. same time allowing therapy to take place of the dreaded situation.

FEATURES Facing Your Fears: Virtually
Social phobia may involve only one type advantages. First, therapy is carried out ilar to those where they have experienced
of situation (such as a fear of speaking in in the privacy of the therapist’s office. panic attacks) or to reproductions (inte-
formal or informal situations, or eating Second, the therapist can more carefully roceptive exposure) of the physical symp-
or drinking in front of others) or, in its control the reactions of the people with toms of panic attacks (e.g., shortness of
most severe form, it may be so broad that which the patient is interacting. And most breath, vertigo, and tunnel vision). These
a person experiences symptoms almost importantly, treatment can progress at the symptoms can be recreated in virtual en-
any time they are around other people. user’s own pace. It allows each session to vironments with sound (pounding heart,
Social phobia can be very debilitating and be customized to the individual receiving fast br eathing) or with visual ef fects
can even prevent an individual from go- treatment. (blurred or stretched images). Each of
ing to work or school. Many people with these exposures is accompanied by ther-
this illness have a hard time making and Panic Disorder apist-facilitated cognitive restructuring
keeping friends. and coping skills.
Panic disorder is characterized by unex-
Physical symptoms often accompany the pected and repeated episodes of intense Most patients show significant progress
intense anxiety of social phobia and may fear (called panic attacks) accompanied af ter approximately ten tr eatment
include symptoms of anxiety such as by physical symptoms that may include sessions. Relapses may occur, but they
profuse sweating, trembling, blushing, dif- shortness of breath, dizziness, chest pain, can often be effectively treated with
ficulty talking and nausea or other stom- heart palpitations, or abdominal distress. “booster sessions” or a short “refresher”
ach discomfort. These visible symptoms These sensations often mimic symptoms course.
heighten the fear of disapproval and the of a heart attack or other life-threaten-
symptoms themselves can become an ing medical condition. As a result, the di- Obsessive-Compulsive Disorder
additional focus of fear. Fear of symptoms agnosis of panic disorder is unfortunate-
can create a vicious cycle: as people with ly often not given until extensive and There are two sides to obsessive-compul-
social phobia worry about experiencing costly medical procedures fail to provide sive disorder (OCD): obsessions and com-
14 the symptoms, the chances of develop- an alternate diagnosis or relief. pulsions. Obsessions are thoughts, and
ing the symptoms increase. Social pho- compulsions are actions. The obsessions
bia often runs in families and may be ac- Many people with panic disorder devel- in OCD are repetitive and persistent, in-
companied by co-morbid disorders such op intense anxiety between episodes. It appropriate and intrusive, and are impos-
as depression or alcohol dependence. is not unusual for a person with panic sible to suppress. These cause the suf-
disorder to develop phobias about places ferer signif icant distr ess and anxiety .
Research has shown two main f orms of or situations where panic attacks have Compulsions are repetitive behaviors or
effective treatment: medication and cog- occurred, such as in supermarkets or mental acts that the person applies based
nitive-behavioral therapy (CBT). A main other everyday situations. As the fre- on rigid rules that they follow. The goal
component of CBT is exposure therapy, quency of panic attacks increases, the of these actions is to pr event a dreaded
which involves helping patients gradual- person often begins to avoid situations event or to lessen distress. They are, how-
ly become more comfortable with situa- where they fear another attack may oc- ever, not really connected in a logical way
tions that frighten them. The exposure cur or where help would not be imme- to these events. Once the person com-
process often involves three stages. The diately available. This avoidance may pletes a compulsive behavior, a sense of
first is introducing the individual to the eventually develop into agoraphobia, relief is felt. It is easy to imagine how
feared situation. The second level is to in- an inability to go b eyond known and these unwanted thoughts and disruptive
crease the risk for disapproval in that sit- safe surroundings because of intense behaviors cause disturbances and impair
uation so the patient builds confidence fear and anxiety. the sufferer from living everyday life. Not
and can handle rejection or criticism. The only are these rituals time consuming,
third stage involves teaching the patient Appropriate treatment by an experienced but it is quite difficult to function social-
techniques to cope with disapproval. In professional can help reduce or prevent ly while experiencing them.
this stage, the individual is asked to imag- panic attacks in 70% to 90% of p eople
ine his/her worst fear and is encouraged with panic disorder. Treatment for panic OCD is most often treated with a combi-
to develop constructive responses to this disorder often includes medications and nation of medication and exposure ther-
fear and any perceived disapproval. CBT. CBT teaches people how to view pan- apy with ritual prevention. Some medica-
ic attacks differently and demonstrates tions have b een f ound to have a
All three stages of exposure can be ac- ways to reduce anxiety. VR environments significant effect on symptoms, but re-
complished in vivo, in vitro, or in virtuo used to treat panic disorder involve ex- lapse rates upon medication cessation
(VR). However, using VR provides certain posing patients to feared situations (sim- are extremely high if coping skills are not
FEATURES Facing Your Fears: Virtually
also learned prior to discontinuing med- tients f ail to impr ove. It is gener ally ceived funding from various military and
ication. Research has revealed that VR is thought that this is due to lack of activa- government organizations to develop vir-
effective at inducing the anxiety response tion of the brain’s fear structure, where tual reality software and clinical proto-
necessary for effective treatment to take the trauma memories are stored. Since cols, and to provide treatment to both
place. The benefit of conducting expo- the structure is not activated, it is thought U.S.-based active duty and veteran pop-
sure therapy with VR is that situations that the information stored is therefore ulations as well as NATO coalition troops
that trigger obsessions and compulsions not available to receiving “disconfirming” and continuing clinical education and
can be experienced repeatedly, a neces- information (e.g., “there is no longer dan- training to psychologists and psychiatrists.
sary element of overcoming the repeti- ger here”). Currently in use at over thirty installa-
tion of OCD. In addition, this treatment tions in the U.S., systems are also now
can take place in the privacy of a ther a- Virtual reality (VR) can solve the problem available in both Warsaw, Poland and Za-
pist’s office, ensuring patient confiden- of avoidance and lack of good imagery greb, Croatia. Psychologists and psychia-
tiality. Though VR exposure therapy for abilities that plague some patients and trists trained on the clinical protocols are
OCD can take longer than for specific prohibits successful alleviation of symp- now able to provide this innovative treat-
phobias, many patients experience some toms. By providing the patient with stim- ment to patients.
relief within the first few sessions. uli that engage multiple senses (audio,
visual, tactile, and olfactory), the therapist The VR programs recently established in
Posttraumatic Stress Disorder does not have to rely on the imagination Croatia and Poland will not only help pa-
and willingness of the patient to create tients, but will allow for the clinical investi-
Many have heard the term “shell shock” anxiety, but rather can provide stimuli di- gation of determining the system’s cross-
in the context of soldiers returning from rectly to the patient at the touch of a but- cultural relevance. Some parts of the system
war. The condition’s technical name is ton. In addition, because the virtual en- may be shown to be transferable across cul-
Posttraumatic Stress Disorder (PTSD). vironment allows the ther apist and tures whereas other portions may need to
16 PTSD can affect anyone who has experi- patient complete control over the pace be re-configured to allow for cultural
enced a traumatic event such as a motor and duration of treatment sessions, the differences.
vehicle accident, an assault, or anything danger of overwhelming the patient with
that threatens a person’s life or physical anxiety can be avoided, alleviating the pa- Conclusion
integrity. Symptoms may range from in- tient’s anxiety at beginning treatment. In
creased anxiety or arousal to dissociation addition, many clinicians combine phys- Virtual reality has made a significant im-
and flashbacks of the event, though the iological monitoring and feedback with pact on the way anxiety disorders are able
disorder may manifest differently in each VR exposure. This has the added advan- to be treated. With increasing advance-
individual. tage of providing continuous monitoring ments in technology, and with the avail-
of the patient’s heart rate, breathing rate ability now to port many VR experiences
Because PTSD has such varied symptoms, and other physiological signals, allowing over the Internet, the potential for im-
a combination of treatments is often nec- for an objective, real-time measurement proved psychological treatment of men-
essary. Anxiety-reducing medications, an- of the patient’s condition to occur. This tal disorders is seemingly endless. With
tidepressants, support from friends and also can be used to teach the patient to over 200 recognized anxiety disorders af-
family, and CBT involving exposure can visually understand when relaxation has fecting one-fourth of the world’s popula-
help with recovery. A recent Institute of been achieved. With this addition, the tion, the need for continued improve-
Medicine study maintains that exposure therapy can be further individualized to ment of treatment availability is critical.
is an important component to be includ- progress according to each individual pa- With advanced technologies, psychology
ed in treatment regimens. One type of tient’s needs. has the opportunity to rise to a new lev-
exposure therapy that has often been el, moving towar ds unpr ecedented
used is imaginal exp osure therapy, in VR exposure treatment has b een per- heights to offer more affordable, more
which patients are asked to repeatedly formed for survivors of earthquakes, mo- available healthcare to a larger portion
imagine and retell their traumatic expe- tor vehicle accidents, terror attacks and of our society.
[ ]
rience to their therapist. However, because other various traumatic events. One of
one of the hallmarks of PTSD is an avoid- the most recent developments has been
Brenda K. Wiederhold,
ance of reminders of the trauma, this is to use this treatment for those returning
Ph.D., MBA, BCIA
often difficult for some patients. Those from Iraq and Afghanistan who are diag-
Virtual Reality Medical Center
who ar e unable to engage with their nosed with PTSD (www.vrphobia.com).
www.vrphobia.com
memories do not evoke an anxiety re- The Virtual Reality Medical Center and frontoffice@vrphobia.com
sponse during exposure, and these pa- Interactive Media Institute, have both re-

FEATURES
My Heart’s “ Neurological
Rehabilitation ” Concept:
Technologies for Post-Stroke Treatment
MyHeart’s Neurological Rehabilitation (NR) Concept is especially devoted to supporting post-stroke
treatment. This paper describes how the concept is structured and how technologies are leveraged to
support both motor rehabilitation and speech/cognitive training. The architecture permits assisted
training both at the clinic and at home, after discharge from the in-tensive care unit. Both promis-
ing results and issues, collected during the first evaluation phase, will be discussed.
By Toni Giorgino et al.
Recovery from a stroke begins in the acute er cognitive impairment that could impact In this paper, the service built within Con-
unit and it is articulated into a series of in- on the system's use. cept NR will be described, in terms of its
tensive and extensive rehabilitation proto- architecture, technology used and first ex-
cols. Despite the protocols variability, there Liability constraints of Italian hospitals perimental results. 17
is nowadays a common trend, in clinical impose that IT-based rehabilitation does
medicine, to shorten hospitalization and not replace conventional therapy. There- The system architecture
foster homecare. The reason is both to cut fore, at the hospital, exercise performed
costs and improve quality of life. The aim with the system is added to the conven- Figure 1 shows a simplified view of the sys-
of My Heart’s Product Concept NR is to sup- tional one, resulting in a more intensive, tem technical architecture.
port patients in the performance of speech hopefully more effective, program. This
and motor therapy, both when they are still could lead to an earlier discharge. After The infrastructure is based on EvoCare, a
hospitalized, and after discharge, at home. discharge, patients could bring the reha- solution developed by Dr Hein GmbH. The
Patients eligible for the service must be in bilitation device to a long stay ward or at main components are one server, and a
stable clinical condition and show mild mo- home, and continue exercises with the number of users’ workstations, connected
tor impairment and/or aphasia with no oth- help of their caregivers. by a secure network.
Figure 1:
Concept NR’s
telemedicine UI Technologies
Therapy Patient Patient
platform Modules Touch Screen Station Station
Sensorized Garment
Speech
Patient’s Homes or Hospital Therapy
Gymnasia Station
Motor Patient Patient
Therapy Station Therapist
Station Station
VPN Secured Network VPN Secured Network

Connection Connection
Remote Administration Site

FEATURES My Heart’s “ Neurological Rehabilitation ” Concept
Figure 2:
The sensor printing design, the prototype and the final
version of the garment. No wir e is visible and the
portable electronics are hidden in the pocket
18
Medical personnel use the therapists’ stations an extensive set of exercises, each promot- (Lycra in our case) and they are stable and non-
to administer their assigned patients, pre- ing one ability: to r ecognize words, pho - toxic. The same material can be used to re-
scribe exercises, and review their performance. nemes, graphemes, and pictures. Semantic alize connection wires between sensors and
and orthographic information is considered the readout electronics (fig. 2).
Patients use the patients’ stations which sup- in order to build exercises with an adapting
port the rehabilitation exercises. Patients’ iden- degree of difficulty. Movement recognition
tities are recognized via per-sonal “check-in
cards.” Once inserted, the exercise protocol Motor therapy is an innovative component When signals from body movement are ac-
(prepared by physicians) and messages are of the system. When sitting at their station, quired, they are processed in order to verify
downloaded automatically at the patient’s site. patients wear a special sensorized garment, the correct execution of the rehabilitation
plugged into a portable electronics box (fig. 2). exercise. Since there is no direct correspon-
The server acts as the repository for exercise After a brief calibration phase, the motion dence between the fabric stretch values at
prescriptions, results, and messages. recognition software is started; it provides various points of the garment and biome-
real-time feedback on the progress and ac- chanical parameters or like angles between
Specific exercises, including speech therapy curacy of exercises by means of clear sym- limb segments, posture classification was
and motor therapy, are realized by a “plug- bols such as c olored b ars and a smi l- tackled via machine -learning based algo-
in” mechanism. Each plug-in implements all ing/frowning face. The movements have to rithms. Therefore, every repetition is classi-
activities required by the specific type of ex- be repeated until the assigned number of fied evaluating the similarity with a known
ercise: it is responsible for providing config- repetitions are performed, or a timeout ex- “correct” or reference path. Some reference
uration screens, supports the execution of pires. A traffic light icon shows when to start paths correspond to well-known, deficit-
the actual exercise, provides appropriate feed- a new repetition (fig. 3, left). related exercises, like adduction, abduction,
back to the patient, and stores the results. It rotation, extension, etc. But other exercises may
also supports browsing and summarization Motion recognition is based on strain sensor be tailored to the specific patients, in partic-
of the results for the therapist to review. technology, directly printed on garments. ular functional movements like combing, eat-
Conductive elastomers are polymer-based ing, brushing, etc. A short “calibration session”
The technology materials which exhibit electrical conductiv- allows the system to learn such move ments
ity. Sensing stripes are thin and can be print- and store the corresponding reference paths.
Speech therapy is based on the EvoLing soft- ed by cheap industrial processes; they do not
ware developed by Dr. Hein GmbH. It includes alter the mechanical properties of the fabric The machine learning approach to move-

the pictures, icons and words that could

make the patient confused.
Conclusion
The integrated nature of the NR system is

intended to support a multidisciplinary,
telemedicine-based approach to rehabilita-
tion. The benefits of this (and similar) IT-
based aids are supported by current beliefs
on rehabilitation, e.g. those expressed in the
SPREAD guidelines (www.spread.it). First of
Figure 3: all, long term rehabilitation programmes are
Two patients mak- considered b eneficial f or the r ecovery
ing motor rehabil- process, but cost is very high. IT technolo-
itation (lef t) and gies are a promising solution for pro-viding
speech therapy re- long-term rehabilitation at lower costs. At
habilitation (right)
exercise using the
the same time, early discharge is recom-
N-concept work- mended for patients with less severe dis-
stations ability. The system allows for early discharge
while still being monitored remotely.
Finally, the concept addresses a frequently-

reported issue, i.e. lack of quantitative meas-
ures on the progress of rehabilitation. The
19
ment recognition is an important research nical problems, comfort e.g. possible prob- diffusion of computerized monitored reha-
topic by itself, because strain sensors are af- lems with the garment) and the users' sat- bilitation aids may increase the objectivity
fected by various sources of uncertainty, isfaction (perceived usefulness from the pa- of practice and allow for quantitative progress
which make the recovery of limb positions tients' and therapists’ point of view). evaluation and therapy comparisons.
from sensor readings less than straightfor-
ward. The accuracy of classification is af- Preliminary qualitative and quantitative re- Acknowledgments
fected by the dynamic nature of the task. sults for speech therapy were obtained from
Smeared sensors produce velocity-depend- the first ten patients enrolled. Most of the The authors thank F. Lorussi and D. De Rossi
ent artifacts; therefore, the recognition ac- enrolled patients enjoy using the system, and (University of Pisa); R. Mauri (Fondazione
curacy is impaired when limbs are moving. use it about three times a day, in addition to Maugeri, Pavia); M. Stefanelli (University of
In addi-tion, patients wear the garment their traditional face-to-face encounter with Pavia); D. Tietze and R. Setz (Dr . Hein
each time in a different way, and also with- the speech therapist. GmbH) for essential contributions to the
[ ]
in the same session the garment may project. The work was partly funded by EU
slightly move. Also, one is interested in the Motor therapy support, while representing a project “MyHeart” no. IST-2002-507816.
closeness of a movement p ath to a refer- very promising technology, is a more chal-
ence, not just to detect a limited set of ba- lenging task. The preliminary laboratory eval-
Toni Giorgino, Ph.D.
sic positions. uation with voluntary subjects showed an Paolo Tormene, M.S.
overall efficiency on movement recognition Silvana Quaglini, Ph.D.
Results of 91%. However, we can not report at the Laboratory for Biomedical
moment quantitative results on patients, since Informatics, Dipartimento di
The NR system is currently undergoing a the first months of the evaluation phase have Informatica e Sistemistica,
small-scale study to assess user satisfaction been spent in gathering feedback from pa- Università di Pavia, Italy
and gather initial measures and feedback. It tients (six subjects) and therapists in order to
Giorgio Maggioni, M.D.
includes, in its last phase, 10 months of ex- improve the system usability. The garment Barbara Cattani, M.S.
perience in the field, with real healthcare design has been improved adding a zip to fa- Caterina Pistarini, M.D.
operators and at least 20 patients exploiting cilitate wearing and markers to facilitate wear- IRCCS Fondazione
the different system functionalities. Results ing the garment always in the same way. Also Salvatore Maugeri, Pavia, Italy
of the study will deal with the usability of the interfaces have been made more and silvana.quaglini@gmail.com
the system (user-friendliness, lack of tech- more simple and immediate, leaving out all

FEATURES
Using Mobile Phones as

Behavioral Technologies
Opportunities and Challenges
Technology should be easy to weave into the f abric of our everyday life; recent research in Human-
Computer Interaction shows that this integration is made easier if the technology supp orts situated
use, exploiting user actions and the envir onment as a resource- rather than requiring explicit
commands or data entry by users.
Giulio Jacucci
20
Behavioral technology should ideally be always munication logs, profile of the phone in silent, experience by creating novel expression prac-
with users, should not burden them with addi- usage data of the phone or its applications. tices in a group of subjects.
tional devices or force them to learn new in- All these features are even more powerful when In a series of studies on spectators at large-scale
terfaces, and should be flexibly applicable to used in concert rather than separately and ini- events we have shown how mobile pictures
different tasks and activities. In short, the tech- tial naturalistic studies show that such novel can affect group experience and action. In a
nology should be easy to weave into the fabric mobile applications can have a great impact on first study by just utilizing simple c amera
of our everyday life. Recent research in Human- activities and experiences of users in particular phones with just the built in applic ations, we
Computer Interaction shows that this integra- leveraging social interaction. Let’s review some witnessed rich forms of multimedia-mediated
tion is made easier if the technology supports examples starting with studies of collective sto- expression such as staging, competition, story-
situated use, exploiting user actions and the ry creation using mobiles, then studies of mo- telling, joking, communicating presence, and
environment as a resource rather than requir- bile awareness cues and their integration, and portraying others. These expressions were al-
ing explicit commands or data entry by users. finally sensing and augmented reality and their ways connected to group practices and were
There is a candidate platform that can accom- potential for novel applications. motivated by how they featured in socially en-
modate these requirements, and that is “what gaging, processual, and shared nature of expe-
used to be called the mobile phone.” Collective Creation and Sense riences. The analysis pointed to how mobile
Making of Mobile Media media was not only imp ortant to mediate or
Mobile phones have evolved to the extent that document experiences but in how it partici-
manufacturers do not call them phones any- With Comeks on the phone, users create com- pated in the very construction of experience
more. Features include cameras with ever in- ic strips by augmenting and annotating their by providing opportunities for action.
creasing resolution for picture and video cap- own mobile pictures with speech bubbles and
ture, internet connectivity (based on operators other comic-related accessories. Messages are In a subsequent study, we equipped groups of
network or WLAN), near field communication put in a sequence creating stories that can be spectators with an application that implement-
as RFID (Radio Frequency Identification), a va- sent to friends. In a longitudinal field study ed mobile media messaging in collective stories
riety of sensors like accelerators, and GPS (Glob- messages featured performative acts where (group messaging spaces) that became archived
al Positioning System). Through the bluetooth members play-acted together or turned ob- group media albums. We have used the term
interface virtually any sensor can be used in jects into characters. Collage was frequent, re- “collective” to refer to the experiential compo-
applications and the bluetooth itself can be a using, for example, pictures from the mem- nent in joint media creation and sense-making.
sensor that is able to scan and sense the pres- bers of the group or other printed material Collective use appears to be rewarding because
ence of other devices. More importantly, the (Salovaara 2007). The study shows how a mo- it not only provides new forms of interpersonal
mobile phone contains rich and diverse infor- bile phone that supports producing and send- and inter-group communication, but also ways
mation about the user and his or her actions ing comic strips out of mobile pictures (figure to re-enact and re-use group’s conventions and
that can be used by applications: calendar, com- 1, left) can impact group communication and shared memories in novel inspiring ways. In

these collective albums awareness and social for this called ContextPhone. Also 3D graph-
presence are actively constructed achievements. ics are developing quickly, enabling complex
Our work points to how users can actively en- visualization that could be useful in rehabili-
gage in constructing the cues by contributing tation scenarios.
to build up the medium for presence.
Recent developments make Augmented Re-
Awareness Cues ality visualizations possible to be played on
and Their Integration mobile phones which means enabling the abil-
ity to register 3D virtual objects in a real scene
Another example is how mobile awareness using computer vision tracking optical mark-
cues on other’s context impact coordination ers (Figure 1, right). This creates engaging and
and communication. ContextCues augments rich mediation to the physical environment
the contact list of the mobile phone by juxta- and has been shown to activate users in nav-
posing to each name and number context in- igating and using space in a different way for
formation on that person. These cues can in- example in educational games in museums.
clude: the location, nearby members, time
elapsed since phone used, and other activity A Call for Balance and Artful Integration
cues. Longitudinal intervention studies showed Figure 1. pictures from two different comic
impact to coordination whereby cues were The mobile phone is therefore a surprisingly stories created by subjects with a mobile
used to infer information, align, and optimise powerful tool compared to desktop applications phone using Comeks Salovaara (2007).
mobility and communication. More impor- for its ability to provide continuous and ubiqui-
tantly, cues were used in the pursuit of con- tous use, meaning also interaction with the en-
nectedness, companionship, and a sense of vironment, which can be useful in physically ac-
belonging with peers and significant others. tivating subjects. Mor e imp ortantly, it c an
function as a powerful tool for expression and
In further experiments we have also combined social interaction, deeply affecting action and 21
awareness cues and collective media stories experience in a variety of activities. Our exam-
as shown in Figure 2. Our system combined ples show that to make best use of the rich fea-
a group media space with event information tures provided by mobile phones, an artful in-
and integrated awareness cues throughout. In tegration is required to create applications that
two field trials we found that the system sup- can truly be woven in users’everyday practices.
ported what we call active spectatorship facil-
itating onsite reporting to offsite members, There are several issues and open questions
coordination of group action, keeping up to connected to the mobile phone as a b ehav-
date with others, spectating remotely, and jok- ioral technology. On a technical level, develop-
ing. In these activities, media, awareness cues, ing applications for phones is difficult given
and event information were often used in con- the portability problems, as there are several
cert, albeit assuming differing roles. programming languages and operating sys-
Figure 2: awareness cues about
tems on phones. Finally, although phone
other members
Sensing and Augmented Reality screens are getting bigger and their inter face
Also sensor information, for example a heart easier (see iPhone), a phone application can
rate sensor, can be used in mobile applications be perceived to be difficult and complex to
as the one in Kurvinen et al. 2007 that was ex- use. More importantly, in some of the studies
perimented with sharing real-time perform- mentioned before, the use was so intensive,it
ance information of football teenage players raised concerns of negative effects in the longer
to their parents and coaches during training term. Some users even reported having felt so-
and competition. This exemplifies how easy cial uneasiness in public spaces when other
it is to integrate sensorial information even at people noticed them staring so long at their
a physiological level and also how the sensed mobile phone. Therefore as with any technol-
information can be used not just for the indi- ogy, the design should aim for achieving a bal-
vidual user but in a social application. anced impact.
Technologically there are some solutions on
[ ]
mobile phones that start to be interesting as
ways to tag the environment like RFID tags, and Giulio Jacucci, Ph.D.
optical markers. The mobile phone increa- Helsinki Institute for Information Figure 3. recent developments allow
www.hiit.fi/uix Augmented Reality visualizations
singly can interface with a variety of sensors.
giulio.jacucci@hiit.fi (by Schamlstieg and Wagner 2007)
We have developed at our institute a platform

FEATURES
The Emergence
of CyberFashion
There is no doubt that wearable technology is on the rise.
The future cannot be foreseen, but the possibilities are bright;
cyberfashion will most undoubtedly change the way we wear
our clothes…
22
By Daniel Stevens
When most think of fashion, we tend to panies such as Philips, known throughout able to control your own body heat at all
think of chic models, latest trends, beau- the world for their technologies and elec- times, never too cold and never too hot.
tiful garments, and innovative designs. tronics, have begun producing technolo- Envision the possibilities if a material can
The clothing industry has generated bil- gy that can be fused with textiles to give determine if an infant has a fever or is too
lions in revenue by creating enticing de- your clothing that “extra something,” the cold when it cannot speak to its parents.
signs for the general population. Fashion new wave of the future.
designers are always searching for the next Futuristic Fusion
fashion trend for innovative products. I would Wearable Technologies
like to declare that I have discovered that Mobile phones and telehealth have made
new trend; that new, exciting, and innova- Medical technology has begun to realize headway in the medical field, bringing
tive fad that will change the fashion world the incredible market for wearable tech- wireless communication for better health
forever: the new trend is here, it is “now,” nology. Wearable health companies have and wellbeing to the user. Companies
it is….technology. surfaced in North America, Europe, and have even created clothing that actually
Asia as innovators to the new “trends” in acts as a mobile phone, catching much
Recently, technology has begun to emerge healthcare. Intelligent textile companies media attention worldwide. CNN.com has
onto the fashion scene, creating unique use their textiles for the wearer’s wellbe- recently described this phenomenon, stat-
additions incorporated within fashion de- ing, using temperature-changing materi- ing, “Futuristic fusion of fashion and tech-
signs. Products such as mobile phone als to change color in reaction to body nology is b ecoming more common as
technology, kinetic energy, and sunlight heat, fabrics that have their own c ooling [clothing] designers are increasingly incor-
reactors have begun to intertwine with system in reaction to the wearer’s envi- porating electronics into their garments.”
well-known fashion designers, introduc- ronment, and even clothing that has its The article featured fashion companies
ing technology to runways worldwide. own personal heating system. that have added creative technology in
However, interestingly enough, technolo- their garments. Products featured include
gy companies have begun to “dip their With materials and technology like these, swimwear that changes colors in reaction
toes” in the pool of fashion as well. Com- the future is electrifying. Imagine being to sunlight, a dress that measures air qual-

Mamagoose technology for SIDS

detection. Photos courtesy VERHAERT
Bruce Damer models his

iDoublet designs. Photo
courtesy of CyberWearz.
www.cyberwearz.com
tigious conferences and shows including

the Second Skin Show in San Francisco,
the 11th Annual Presence Conference in
Padova, and at the Virtual Worlds Sum-
mit in London. “I see a merger between
the two fields with textiles becoming high
tech and manufacturing of garments be-
coming driven by CAD/CAM (Computer 23
Aided Design/Manufacturing),” Damer
states, “The apparel business is one of the
ity, garments that show moving video im- ty to change the color of a garment at will last holdouts of old fashioned 18th Cen-
ages and a self-heating vest, among others. or trendy mobile phone accessories, are tury hand construction.” A pioneer in ear-
CyberFashion has progressed into the ensure to become more than a passing craze. ly virtual worlds and avatars now turned
tertainment industry, with products such Investigating these new garments is dif- designer, Bruce foresees fashion moving
as the “air guitar t-shirt,” a shirt that allows ficult, as most are not currently commer- towards the medic al realm. “Medic al
the user to play an objectless musical in- cializing their pr oducts f or the main- health monitoring [and] cyber-garments
strument by Dr. Richard Helmer of the stream market. Philips, who has created will bring real breakthroughs such as heart
Commonwealth Scientific and Industrial the LumaLive technology, a material that monitoring, galvanic skin response, and
Research Organisation (CSIRO), and Cute- can change colors, shapes, and designs communication of health status.”
Circuit’s “Hug Shirt,” which enables mobile controlled by the user, rents out their tech-
phones to give someone a “virtual hug.” nology for shows, but are still in the “cus- Other pioneering developments in cloth-
tomizing phase,” working to make their ing have made headway in this field. The
But why are these companies moving to- product more flexible. Other designers Mamagoose pajamas, created by the Eu-
wards technology instead of using, should such as Hussein Chalayan and Vega Za- ropean Space Agency, embody built-in
we call them, “unintelligent” textiles? Is ishi Wang use technology to create visual sensors and electronic monitoring to de-
this a passing fad or has this sparked the effects on a runway, but do not necessar- tect Sudden Inf ant Death Syndr ome
new wave of modern clothing? There is ily infuse the ef fects in the c ommer- (SIDS), more commonly called “cot death.”
no doubt that wearable technology is on cialized version. When symptoms or characteristics of SIDS
the rise. The future cannot be foreseen, arise, an alarm sounds to prevent death.
but the possibilities are so bright; this will Bruce Damer of CyberWearz has created The World Health Organization (WHO) has
most undoubtedly change the way we the iDoublet, in which he designs cloth- conducted many studies on using wear-
wear our clothes. Once these products being that incorporates an Apple iPod di- able monitoring systems for the preven-
come affordable and commercialized, the rectly into the garment. The iDoublet was tion of the relapse of depression, moni-
trend will take off and continue to pros- debuted at MacWorld. In addition, Damer toring and c orrelating r esponses to
per. Even the “simplest” things, the abili- has presented his research at many pres- antidepressant drugs, detecting drug mis-

FEATURES The Emergence of CyberFashion
use, and to warn or obtain feedback in or- ics have the tendency to break or go “hay- porate advanced technology with high
der to prevent self-injury and suicide. The wire.” Mobile phone companies, small elec- fashion at the first CyberFashion for Well-
most incredible benefit for using intelli- tronic producers, and handheld music de- being Show.
gent textiles is the ability for the user to vice companies have support staff, reliable
live a “normal life,” while wearing a med- store outlets for repair, and can easily ex- Fashion students have already begun to
ical disorder preventative aid. Such antic- change the item f or one similar. With construct designs focusing on medical well-
ipatory garments can be worn underneath these added hassles, mainstream clothing being for the show. Conference organiz-
other clothing which still appear to be “un- companies may avoid selling such mate- ers are engaging with fashion designers
intelligent” textiles, giving the user the feel- rials, despite their ability to appeal to the and wearable companies to participate in
ing of normalcy. Even “wearable comput- consumer. this innovative fashion show. Taking place
ing,” a wearable computer that monitors in Lago Maggiore, Italy, the venue is beau-
behavior and health, can appear to be a Positive Attributes tifully set on the gorgeous Italian lake, near
common wristwatch. Milan, the fashion capital of the world.
Despite the above complications, cyber-
Downsides fashion has many positive attributes while New and emerging technologies will inter-
the complications previously mentioned twine with the clothing, textile, and fash-
On the other hand, as critics may suggest, have the ability to be fixed. Looking at ion industry. Women’s apparel seems to
there are a few downsides to technology medical purposes alone, the positives out- be the “up and coming” sector of fashion
in clothing: weigh the negatives. Many c ompanies to first feature technology. Look for the
have solved the waterproofing issue; af- latest trends to materialize in accessories
Practicality. Clothes become dirty and fordability will c ome with time, while such as purses, bags, and shoes before
therefore must be washed. Modern tech- longevity and reliability can be perfected evolving to garments. There is no doubt
nology must be made waterproof to be in the coming future. in my mind that cyberfashion will become
24 completely integrated into clothing. the new craze and even revolutionize the
CyberFashion for Wellbeing clothing industry. It just goes to show that
Affordability. Incorporating expensive tech- within the exciting and innovative field of
nology into new designs will b e pricey. CyberFashion has initially emerged at tech- technology, there is always something fresh
Most consumers are not willing to part nology conventions and conferences. The and captivating, delighting the user in a
with hundreds to thousands of dollars for upcoming CyberTherapy & CyberPsychol- multitude of capacities.
[ ]
an article of clothing. ogy (CT14) conference will celebrate cyber-
fashion this June near Milan, Italy. The an- Daniel Stevens, LL.M.
Paranoia. For those conspiracy theorists, nual Cyberarium, which provides a forum Managing Editor, C&R Magazine
www.vrphobia.eu
one could make the argument that incor- for new and emer ging technology, r e-
d.s@vrphobia.eu
porating technology into clothing is one search, and wearable products, will incor-
more way for an individual to be moni-
tored, given the possibility that electron-
ics capable of tracking devices could be at-
tached to the garment. However, mobile
phones already have such tracking capa-
bilities; a concerned parent would not have
to worry about their child losing a phone
if the monitoring chip was built into the
child’s clothing.
Longevity. Clothing featuring battery-pow-

ered electronics must either be charged
or will most likely have a short life span.
If such an expensive garment were pur-
chased, the consumer would not look too
Designs made of a jogging suit that lights up from kinetic energy during evening runs for safe-
kindly on its inability to last. ty and visibility by fashion students at the University College Ghent for the CyberFashion for
Wellbeing Show. Designs created by 1. Julie Migneau, 2. Lieve Martens, 3. Saskia Dobbelaere,
Reliability. Micro-technology and electron- 4. Bertien Boon. Jean Luc Dejaeghere is also involved in the design team.
Corporate Presentation
Cybermind,
creation of tools
for Cybertherapy.
About Cybermind:
Cybermind Interactive Nederland is a young and dynamic company,

founded in April 1997, and has grown to become the leading European
distributor/manufacturer of Head Mounted Displays (HMDs). Using
HMDs (Goggles, wearable monitors, personal displays) has a lot of ad-
vantages and creates an experience that cannot be realized with any
other form of presenting images, data, or other information to the par-
ticipant. Cybermind Interactive Nederland is a technology-based com-
pany that seeks to excel in producing affordable, high- end, HMDs that
are durable, comfortable, and versatile. These tools are produced for
professionals, can be customized according to the requirements of the
application, and enable effective treatments. Future expectations:
The use of HMDs, and understanding their effectiveness, is widely ac- With the steps taken by Cybermind to create a technol-
26 cepted compared to instance monitors, projection surfaces, and Cave- ogy platform and its optical system, future developments
like projection environments. Scientific research over the last few years will follow at a faster pace. The last three years have
confirms the usage and the increased effectiveness and efficiency of been focused on the creation of a versatile platform and
procedures and treatments. a transparent optical system. Creating larger Field of
Views will be the most important achievement for the
Virtual Reality (VR) and Augmented Reality (AR) technology within Cy- standard Visette range, but the possibilities for creat-
bertherapy in 2008: ing mobile set-ups, and lighter and more attractive de-
signs etc. are plentiful. The focus on Field of View is im-
The unique design features of HMDs include the following: complete portant, although, using motion capture (tracking the
immersive design, lightweight, comfortable, functional, and flexible person/object within the virtual environment) creates
(seamless integration of microphones, cameras, sensors etc). The im- the experience of 360° Field of View. In certain cases,
mersive design is also highly effective in combination with AR appli- mainly in the clinical area, having sight in the periphery
cations. The treatments of various phobias, including the fear of heights, of the eyesight is important.
claustrophobia, and the fear of flying, have proven successful. In ad-
dition, other medical applications, such as pain relief during treatment Cybermind will proceed with creating non-invasive de-
of burn wounds, are done with “traditional” VR equipment as well. signs with specifications (Field of View, resolutions com-
fort etc.) that create near-life experiences, which will
Cybermind has created their own technology and optics in order to of- increase the already impressive effectiveness of HMDs.
fer high-end equipment at an affordable price to make VR and AR ac-
cessible for a wider audience. Not only can the equipment be used with Contact:
many different sources (PC, cameras, DVD players etc.), but the unique
technology also supports content with various resolutions and is com- Cybermind Interactive Nederland
patible with older VGA animations combined with video segments and "Supporting Tomorrow's Technology Today"
SXGA animated content. This is all made possible with the HMD Visette
series. Forum 55 (MECC)
6229 GV MAASTRICHT
The Visette 45, a top range model, complemented with Optical See- The Netherlands
through, or combined with one of the headsets c ontaining a camera, Tel: +31.(0)43 3618 300
can open the world of AR to any user. Adding virtual objects (like spi- Fax: +31.(0)43 3618 394
ders or fire) to real life scenery has great potential. AR can, for a vari- GSM: +31 651409752
ety of treatments, be more effective than the complete virtual environ- Website: www.cybermindnl.com - www.hi-res800.com
ments that are utilized by VR. E-mail: mark@cybermindnl.com
C&R IN BRIEF
Across North America…

Over the past two decades, researchers have been busy designing, developing, testing, and
implementing advanced technologies to successfully help those with disorders, spanning
from anxiety to addiction to phantom limb p ain. Scientists throughout the world are realizing
the potential for technology to enhance the medical “continuum of care” beginning with
prevention, training, and education and continuing through treatment and rehabilitation.
In this issue, we highlight some of the advanc es being made in North America.
Canada medicine and therapy protocols. The com- using VR to reduce the distress and pain
bination of VR, MR, and in some cases hap- associated with invasive procedures. Led
Universities across Canada are currently tics, provides for the assessment and treat- by f orward-thinking physician Jose L.
conducting exciting research projects us- ment of a variety of disorders ranging from Mosso-Vázquez, clinicians ar e using a
ing virtual reality (VR) to assess, under- anxiety to traumatic brain injury to pain Head Mounted Display (HMD) system in
stand, and treat mental disorders, includ- distraction. Protocols may include physi- order to display VR scenarios to their pa-
ing anxiety disorders and eating disorders. ological monitoring and feedback for fur- tients during procedures. To date, almost
These studies have resulted in the pro- ther training of patients or participants 500 patients have participated in the stud-
duction of effective clinical protocols, en- and objectification of results. American
psychologists have developed successful
ies, with the conclusions showing that pos-
itive results are being received, through
27
abling affected individuals within Canada
to undergo enhanced treatment meth- protocols for the treatment of specific pho- both reduced patient discomfort and re-
ods. The principal investigators of these bias (flying, driving, public speaking, claus- duced cost of certain procedures, since
various projects use a variety of technolo- trophobia, heights, and spiders), panic dis- the need for pain medication and anes-
gies, such as high quality Head-Mounted order, agoraphobia, posttraumatic stress thesia is greatly reduced.
Displays (HMDs), eye-tracking systems, disorder due to motor vehicle accidents,
physiological measures, and precision mo- and social phobia through conducting con- VR has been shown by many groups to
tion tracking. trolled studies with VR-CBT. Telehealth is successfully reduce pain or discomfort in
also being explored for treatment through a variety of less invasive procedures, such
The CyberPsychology Lab of the Univer- use of avatars and Internet-based worlds. as dentistry, wound care and physical ther-
site du Quebec en Outaouais, headed by apy. The use of VR during these proce-
Stéphane Bouchard, recently unveiled its In addition to therapy and rehabilitation, dures has led to the exploration of the
addition of a CAVE system; one of the few the area of stress inoculation training (SIT) potential for VR to be used during pro-
in use in the world. The University’s CAVE, for first responders and military person- cedures of higher complexity. This is the
a 6-wall immersive room, is referred to as nel is being augmented by VR simulations first study to document the use of VR for
“Psyche” and devoted to research on VR, and more realistic wound creation through complex and invasive medical procedures.
presence and mental disorders. Other re- scientific advancements. One small com-
searchers study eye-gaze patterns to assess pany, Virtual Reality Medical Center, head- In the upcoming issues of C&R Magazine,
sexual preferences among pedophiles, use ed by Dr. Mark Wiederhold, is working with we will continue to showcase the advances
a virtual bicycle to increase obese children’s areas as diverse as posttraumatic stress being made in other parts of the world.
motivation to exercise, and validate the VR disorder, chronic and acute pain, cogni- In the next issue, cybertherapy and ad-
environment to test executive functioning. tive and physical rehabilitation, and SIT. vanced technologies in mental health will
The technology is proving to be an impor- be examined in Asian countries.
[ ]
United States tant adjunct to established methods.
Carrin Pockrandt
Across the United States, small companies Mexico Staff Writer, C&R Magazine
and university research labs are incorpo- www.vrphobia.eu
rating Virtual Reality (VR) and Mixed Real- In Mexico City, five public health hospi- office@vrphobia.eu
ity (MR) technology into more traditional tals have participated in VR research by
> COUNTRY FOCUS
C&R in S pain
[ ]
Many Spanish universities and clinics have b egun
AUTHOR:
Daniel Stevens, LL.M. using cybertherapy to treat mental disorders, joining an
Managing Editor, international community of researchers and clinicians.
C&R Magazine
Specifically, over the past few years, the connections
www.vrphobia.eu
d.s@vrphobia.eu between Spain and the rest of the world have improved
dramatically.
28
W
With the national motto of “Plus ized European neighbors. Since then, mental disorders, joining an international commu-
Ultra,” meaning “Further Beyond,” health care has significantly improved, includ- nity of researchers and clinicians. Specifical-
it only seems fitting that cyberther- ing the birth of advanced technologies to aid ly, over the past few years, the connections
apy found its way into the Mediterranean- in the treatment of mental disorders. between Spain and the rest of the world has
based country of Spain. With over 40 million improved dramatically. Nonetheless, Spain
inhabitants, Spain shares the highest preva- Many agree that cybertherapy was first for- lacks the same budget for research and de-
lence for mental disorders in Europe with the mally introduced to the world in 1992 at the velopment to comparatively remain at the
United Kingdom. Thus, a heightened need first Medicine Meets Virtual Reality Confer- same level as its surrounding countries. Many
for increasingly effective treatment for men- ence; however, the use of vir tual reality for researchers use international journals to dis-
tal disorders has become evident in the Reino the treatment of mental disorders has been seminate their findings in an effort to glob-
de España. Many laboratories and clinics in distinct in Spain for just over 10 years. The alize their studies.
Spanish universities have developed virtual Spanish Ministry of Education and Science,
reality and advanced technology-based ther- the Government of Catalonia, along with oth- The European Framework Programmes have
apy treatments in order to better treat the er regional and national agencies currently decisively contributed to the connection of
increasingly large population of individuals fund projects for research teams towards the the research groups in Spain with the rest of
who suffer from mental disorders. application of new ICTs in clinical psycholo- Europe. Currently, Spanish teams are partic-
gy and rehabilitation. Many award-winning ipating in some of the most imp ortant Eu-
History of Mental Health in Spain projects and innovative research have risen ropean projects in mental health, allowing
out of Spanish laboratories and universities, Spanish laboratories to connect and collab-
The Proclamation of the Health Reform Law placing Spain in an impressive position in orate with other European institutions. Se-
in 1985, which introduced modernity into the the world of cybertherapy. lect labs have ongoing collaborations with
Spanish health care system, came with a hu- universities and research centers in Italy, the
manitarian concern for large amounts of International Collaborations United States, the United Kingdom, Germany,
prevalent mental disorders in the population, The Netherlands, Portugal, Sweden, Ireland,
ideally bringing the general care for the men- Many Spanish universities and clinics have Canada, Mexico, Colombia, Argentina, and
tally ill to the same level of their industrial- begun using cybertherapy to treat mental South Africa, among others. It is not uncom-

Population (Million) 40,5 2008

Percentage of Urban Population 0,77 2006
Unemployment Rate 8,30% 2007
Life Expectancy (years) 79,9 2008
Psychiatrists 6 2008
(per 100,000 Inhabitants)
Number of Universities Of fering 35 2008
Psychology Programs
Population Median Age (years) 39 2001
Population Self-Assessing 61.72 - 77% 2002
Health as Good 3,2 2005
Suicide Rate (per 100,000)
Psychiatric Hospital Beds 45.77 - 46% 2005
(per 100,000)
Fertility Rate 1.22 - 1.34% 2004
Extrapolated Prevalence to 740.455 2004
Eating Disorders (total)
Extrapolated Prevalence 325.800 2004
to Schizophrenia (total)
Extrapolated Prevalence 592.364 2004
to Anxiety Disorders (total)
29
mon for Spanish clinics and universities to trackers, and eye tracking displays. knowledge and research is of the highest pri-
solicit foreign researchers as well as visit lab- Universities work hand-in-hand with clini- ority. However, some groups hesitate to take
oratories in other countries. cians, realizing the support needed for ICT advantage of EU funded projects because of
projects. Cooperation and mutual enrich- the complexity and time needed to set up a
Research Facilities in Spain ment make Spanish laboratories’ research consortium, a proposal, and finally manage
improve and become more enjoyable. In the administrative tasks associated with the
The ability to raise funds for research has general there is a very good relationship be- projects, preparation of reports, etc.
grown dramatically in Spain in recent years. tween the universities and the research labs
Both the central government and many of that operate within them. Collaboration be- Research Areas
the regional administrations are now aware tween well-connected Spanish colleagues has
that the investment in research and devel- also been beneficial for most Spanish uni- Many distinguished studies are being ex-
opment is vital to ensure the welfare of the versities with projects such as CONSOLIDER, plored in Spain, promising future exempli-
population. Private companies of a certain which includes seven participating universi- fied results. Areas of current study include:
size, as well, are investing in basic and ap- ties as well as CENIT, which links Spanish uni-
plied research. Spain is in a relatively good versities and enterprises. • Theoretical and methodological
position in Europe, with the possibility of topics including:
FEDER funds, which have been a notable help EU Funded Projects > Reality judgment and sense of presence
towards the development and up date in in virtual environments
many domains, including research. Nation- EU funded projects and funding is one of the > Learning in virtual environments
al agencies normally fund equipment and best ways to obtain adequate resources that and learning transfer
personnel for furthering research. Nonethe- will enable Spain to reach levels of scientif- > Design and development of psychological
less, constant funds are needed due to the ic output of high quality. The possibility of assessment tools based on ICT
high-speed evolution of the cutting edge sys- collaborating with first line researchers and > Development of mood induction and
tems and platforms as well as other essen- to participate in the joint effort of develop- mood change experimental procedures
tial equipment such as HMDs, projectors, ing scientific knowledge is key for Spanish > Experimental procedures for subliminal
sound systems, informatics, head position laboratories. Extending and disseminating perception in virtual environments.

> COUNTRY FOCUS
• Advances in the utility of technological

developments in clinical psychology
including:
> Environmental Intelligence
> Augmented reality without traces
> Autonomous agents
> D systems in real time on ICT mobiles
> RFID sensors
• Psychological disorders and other
psychological problems including:
> Development and consolidation of Spanish Projects in the Spotlight livery of psychological treatments in com-
technological applications for the plex mental disorders. This display has
assessment and treatment of anxiety, Some significant projects to come out from been effective in the treatment of post-
30 eating disorders, child mental disorders, Spain are: “Development and Application traumatic stress disorder, complicated grief,
adjustment disorders and grief, and of Technologically Advanced Methods Ba- and adjustment disorders.
problems related to violence and sed on Virtual Reality for Attention-Diver-
aggressiveness sion, Visualization and Body Image Modi- The Future of ICT Research
• Physical and health problems including: fication, and Adjunct Analgesic Techniques in Spain
> Development consolidations of techno- Against Chronic Pain”, and the EU funded
logical applications for the assessment EMMA Project (Engaging Media for Men- It is agreed that the future is limitless in
and treatment of pain management tal Health Applications). Spain due to its efficiency and future col-
> Palliative treatment for restricted laboration possibilities. Physical and men-
mobility people The first project consists of 19 researchers, tal health, health in the workplace, leisure,
> Palliative treatment of cancer deriving from the University of Barcelona, and general wellbeing are among several
> Cognitive rehabilitation in cognitive the University Jaume I, the Hospital Provin- possibilities for the future. CyberTherapy
disorders cial de Castellón, the University of Valencia, in Spain has left its mark on the world and
• Quality of life and wellbeing in the the Polytechnical University of Catalonia, the world looks back with interest as fu-
elderly enhancing e-inclusion solutions and the University Miguel Hernández of Al- ture research emerges. With future collab-
• Advances in psychopathology and icante for a three-year collaboration. The orations with European and international
psychological treatment of several gathering of these groups to carry out this partners, advances in cybertherapy will con-
mental disorders including: project has given birth to one of the most tinue to flourish in la España soleada.
> Anxiety disorders efficient teams in the field of virtual reality
> Mood disorders applied to health disorders and disease. Sources:
> Somatoform disorders
> Adjustment disorders World Health Organization,
The latter of the two projects, EMMA, de-
> Substance-related disorders European Commission,
veloped a mood induction procedure that
> Impulse control disorders Medical News Today,
effectively changes the users’ mood and
• Kansei engineering and product personal communication with
has been proven to be useful in basic and
evaluation Dr. Cristina Botella
clinical research. An adaptive display was
• Basic perceptual processes and Dr. José Gutiérrez Maldonado
developed during this project for the de-

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cover_C&R_spine:Layout 1 12/01/09 14:59 Page 1

CyberTherapy & Rehabilitation - Issue 1 / 2008

Issue 1 / 2008 The Official Voice of IACR

Using Mobile Phones as

Letter from the Publisher

“This publication will serve as a c atalyst whereby