DISABILITY AND REHABILITATION,
6 , 213-220
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1997; VOL. 19, NO.
REVIEW
Virtual reality, disability and rehabilitation
PAUL N. WILSON, NIGEL FOREMAN and DANAE STANTON
Accepted for publication: January 1997
Keywords virtual reality, virtual environments, physical
disability, learning difficulty
Summary
Virtual reality, or virtual environment computer technology,
generates simulated objects and events with which people can
interact. Existing and potential applications for this technology
in the field of disability and rehabilitation are discussed. The
main benefits identified for disabled people are that they can
engage in a range of activities in a simulator relatively free from
the limitations imposed by their disability, and they can do so
in safety. Evidence that the knowledge and skills acquired by
disabled individuals in simulated environments can transfer to
For personal use only.
the real world is presented. In particular, spatial infoimation
and life skills learned in a virtual environment have been shown
to transfer to the real world. Applications for visually impaired
people are discussed, and the potential for medical inter-
ventions and the assessment and treatment of neurological
damage are considered. Finally some current limitations of the
technology, and ethical concerns in relation to disability, are
discussed.
What is virtual reality?
Virtual reality (VR) refers to a range of computing
technologies that present artificially generated sensory
information in a form that people perceive as similar to
real-world objects and events.’. Scientists working in
this field generally prefer the term virtual environment
(VE) to virtual reality, as it is less ambiguous. The basis
of most VE systems is the simulation of a visual three-
dimensional environment presented on a monitor, or
projected on to a large screen, or viewed via one or two
screens inside a helmet-mounted display (HMD). The
computer generates a succession of two-dimensional
images from spatial data sets, allowing the user to view
the environment from any perspective. To make the
subjective experience of exploration and interaction
realistic, the cornputer must generate new images fast
Authors: Dr Paul N. Wilson, (author for correspondence),
Nigel Foreman and Dana& Stanton, Department of Psy-
chology, University of Leicester, Leicester LE1 7RH, UK.
0963-8288/97 $12.00 0 1997 Taylor & Francis Ltd
enough to give the impression of real-time movement
and responsiveness. Importantly, in a VE the simulated
objects and events cannot only be sensed, but the user
can interact with them as though they were real.3 A
remarkable psychological effect of exploring and inter-
acting with a VE is that the user often feels, at least to
some degree, ‘present’ in the simulated world. Arguably,
this feeling of presence is the defining feature of VR
e ~ p e r ie n c e .~
It may be that a sense of presence is
engendered at least as much by the activity that occurs in
the simulated world as its sensory realism. This is
evident, for example, when people enjoy arcade simu-
lators and three-dimensional computer games.
Virtual environments can be experienced in several
ways. In immersion VR the VE is viewed via screens in
a HMD; a tracking system slaves head movements to the
image-generation system so that, for example, when the
head is turned to the left, an appropriate update of the
left-hand view of the environment is displayed. Because
the image is updated in synchrony with the head
movements, the subjective impression is one of looking
around from within the environment. Additional move-
ments may be effected using a joystick or similar device
such as a spaceball (a tennis-sized ball that responds to
hand pressure in any direction), or a three-dimensional
mouse. The simulated visual world may be supplemented
by sounds that appear to remain in particular localities in
the VE independent of changes in head position (see
below).
In desk-top VR the environment is viewed on a
conventional computer monitor (or sometimes projected
onto a larger screen). The impression is similar to
looking at the environment through a vehicle windscreen.
Typically image resolution is much better than for
immersion VR. Sounds are usually presented via external
loudspeakers. Movement may be effected in a variety of
ways as with immersion VR. Although immersion and
desk-top VEs are the main forms of virtual world
presentation, there are others. For example, images may
be projected onto the walls and ceiling of a specially
designed studio, e.g. the CAVE Automatic Virtual
Environment at the University of I l l i n ~ i s Perhaps
.~ the
 P. N . Wilson et al.
best-known alternative is flight simulation, which typi-
cally uses a purpose-built cab that moves in synchrony
with the visual images, providing an additional source of
sensory input to the user. Given current technology,
flight simulation is probably the closest match to its real-
world equivalent, both in the apparent realism of the
simulated world and in the sense of presence experienced
by the user.
In order to interact with simulated objects, a range of
interface technologies have been developed. Some ac-
tivities in a VE, such as turning on a light, can be
achieved by pointing to a switch using a mouse or
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joystick-controlled pointer and pressing a button. More
sophisticated methods include presenting a simulated
hand within the VE that is slaved to the movements of
the user's hand via a glove fitted with position and
stretch sensors. As described below. considerable efforts
are being directed towards refining the ways that people
with physical disability can interact with VEs more
easily.
As yet, haptic feedback from activity in VEs is still
very difficult to achieve. Tactile feedback can be
simulated by incorporating vibrating nodules or inflatable
For personal use only.
bubbles into a glove.'j Force feedback can be incor-
porated into a j o y s t i ~ kor
, ~ the steering wheel of a driving
simulator. However, while creating a three-dimensional
visual representation of a table is relatively straight-
forward, it is a very different matter to get it to support
the user's weight ! Although with cumbersome specialist
equipment it is possible to 'feel' the outline of simulated
objects,* force feedback is very difficult to simulate in a
natural way. In a system developed at the University of
North Carolina the researcher attempts to guide simu-
lated molecules into potential receptor sites using
manipulator arms, and a repulsion force is generated in
the arms if the fit of the receptor site is poor (see ref. 1).
Although in principle smell and taste can be incorporated
into a VE, in practice this is not often attempted.
Although the popular media have focused on the
entertainment potential of VR (typically making ludi-
crously exaggerated claims about the current state of the
technology), the past 5 years have seen a rapid growth of
industrial, educational and scientific applications for
VEs. Most of these applications focus on the visualiza-
tion potential of the technology. Applications in the field
of disability represent a natural extension of the long-
standing recognition of the importance of technology for
people with disabilities. In what follows, applications in
the fields of spatial learning, special education and
physical rehabilitation are discussed, along with some of
the many beneficial spin-offs from VE-associated tech-
nologies.
214
Transfer of spatial knowledge from VR to the real
world
The most important question when considering the
potential benefits of VE use for people with disability is:
does skill or knowledge acquired in a VE transfer to the
real world? In able-bodied individuals, VE systems do
appear to have significant potential as aids to learning;
for example, flight simulation and combat simulation
have been used to good effect for many years.g However,
the experimental evidence for transfer of training is not
extensive. Several experiments have reported improve-
ment in skills with exposure to simulation practice.
Lampton et ~ 1 . ' found~ improvement on several
perceptual-motor tasks with practice in a simulated
environment. Similarly, Regian et aZ." have shown the
development of skill acquisition on a spatial procedural
task (learning a sequence of knob or button activations
on a simulated consul). However, Kozak et uL3 failed to
find a positive transfer effect of training in a VE on a very
simple motor task (moving simulated cans to target
locations). They attributed the failure to the simplistic
task and the lack of veracity of their simulation. Below
we discuss two experiments conducted with disabled
individuals that have shown transfer of knowledge and
skill from a simulated to a real equivalent
The first experiment concerns transfer of spatial
learning in physically disabled children. Regian et uZ."
have shown that people can orient themselves in VEs,
and simulations of three-dimensional space have been
used as tools for investigating aspects of spatial cog-
niti~n.l~ Spatial
- ~ ~ awareness is often poorly developed
in physically disabled children." In some individuals this
problem may be a consequence of neurological damage,
but for others it seems likely that the lack of opportunity
for independent exploration is a contributing factor. VEs
offer the potential for exploration experience relatively
free from the limitations imposed by physical disability.
With appropriately designed input devices a physically
disabled individual can explore with similar freedom to
an able-bodied person.
Wilson et ~ 1 . 'have
~ demonstrated that spatial in-
formation acquired by physically disabled children from
exploration of a VE will transfer to a real-world
equivalent environment. After a period spent exploring a
desk-top simulation of a building, which was constructed
to the same relative dimensions as a real building, the
children were tested on their knowledge of the layout of
the real building. From within a room in the real building
they could point in the direction of objects (items of fire
apparatus and fire exits) situated around the building but
not visible from the test site. Their performance was
 Virtual reality, disability and rehabilitation
superior to a group of able-bodied adults who made
reasoned guesses as to the likely position of these items.
Therefore, a VE can provide a useful aid which children
can use to orient themselves to a particular environment
before visiting it for real. Importantly, this exploration
occurs in an environment that is free from real hazards,
social as well as physical. There may be benefits for the
individual’s confidence and, as in Wilson et al.’s19
experiment, important safety information can be con-
veyed in an entertaining way.
Given successful learning of the layout of a real place
from a virtual representation, the possibility exists that
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repeated exploration of VEs may lead to a general
improvement in spatial learning ability. Stanton et a1.16
have investigated this possibility in two experiments. In
the first, physically disabled children were allowed to
explore a series of three VEs. Each environment
comprised three rooms connected by corridors, and
partitions subdivided each room. Around the environ-
ment were six novel objects which served as target items
for a test (e.g. a piano, a computer, a globe). Sub-
sequently, from a position within the environment where
none of the test objects was visible, the children were
For personal use only.
asked to rotate their direction of view (as indicated by a
cross in the centre of the computer screen) to point
towards each object in turn. Although on the first session
they made average errors of approximately 50 degrees,
by the third session these errors were reduced to
approximately 25 degrees, a statistically significant
improvement.
In the second experiment Stanton et al.“ compared
two groups of physically disabled children on their
ability to orient in a simulated environment before and
after a series of four sessions of computer use. Between
the test sessions one group explored additional three-
dimensional environments, while the other group played
on non-violent two-dimensional platform games. The
three-dimensional group showed a reduction in orien-
tation errors from the first test to the last, but the two-
dimensional group did not. The improvement in orien-
tation in this experiment can unambiguously be attri-
buted to the three-dimensional properties of the virtual
environments, rather than to any general practice effects
or familiarity with the computer or experimenter.
Transfer of life skills from VR to the real world in
students with learning disability
A second important demonstration of transfer of skills
from a virtual to a real environment was conducted with
teenagers who have severe learning diffi~u1ties.l~ An
experimental group of students were given extended
experience of shopping in a virtual supermarket. A
matched control group were allowed equivalent ex-
perience exploring other VEs, such as a city, a house and
a ski-slope. The control group were also given additional
experience of a game with a shopping list theme to
control for the effects of familiarity with test items. On a
pretest in a real supermarket the groups did not differ on
their ability to find four items on a list. However,
following training in the virtual supermarket the ex-
perimental group completed a real shopping trip faster
than the control group, and they selected more correct
items.
Cromby er al.’l describe several features of VEs that
make them especially promising as learning aids for
individuals with severe learning difficulties. First, they
encourage self-directed activity, which is especially
important for people with disabilities who typically have
little control over their circumstances, and who often
show a tendency to passivity. Second, individuals with
learning difficulties can be provided with the opportunity
to learn by making mistakes but without suffering the
real consequences. Third, in VEs it is possible to convey
rules, concepts and relationships without the use of
language or other symbolic systems. As Cromby et al.
point out, ‘objects in a virtual environment have their
own “natural semantics ” :” their qualities can be
discovered by direct interaction and experience. No
pictures, symbols, formulae, graphs, diagrams, tables or
even any words are necessary elements in a virtual
environment which can help students to grasp a concept
or rule.’ Fourth, with carefully designed interface devices,
VEs can minimize the problems associated with physical
disabilities.
VEs have been used to teach children with learning
difficulties to use Makaton symbol~,’~ and Standen and
Lowz4have shown that during the learning process the
students made more self-initiated actions as sessions
progressed. The ‘Virtual Environment Science Lab-
oratory’, a learning aid designed to help students to
understand the laws of physics, has been modified in an
attempt to accommodate the needs of students with
cerebral palsy.25
Learning and safety
VEs, such as flight simulators, provide the opportunity
to practise real-world tasks free from real hazards. With
increasing dangers on the roads there is a great deal of
interest in the development of driving simulators.
Learning to drive in a simulator would be a valuable
resource for able-bodied individuals, but more so for
disabled people,26particularly as the disabled driver may
215
 P. N . Wilson et al.
have to use specially modified vehicle controls. Also, it
would be preferable to assess a person's ability to drive
safely on a virtual road where hazardous situations can
be simulated. A related life skill is teaching children with
learning disabilities to cross the road ~afely.~' Inman et
d Zhave8 used VEs as a safe method for young children
to learn how to drive a motorized wheelchair. Gundersen
et have designed a system for remotely controlling a
wheelchair using a virtual presence interface. The remote
controller observes the view from the wheelchair via
cameras, and can also hear the sounds around the
wheelchair via microphones. They suggest that this kind
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of system might be useful for training new or unskilled
users, or could be used to help someone (e.g. a sufferer in
the early stages of Alzheimer's disease) who had become
lost or confused.
Disabled children can also be taught how to use a bus
in a virtual environment. Mowafy30 has created a
simulated bus ride that illustrates important landmarks
along the route. Children can practise travelling and
learn to look out for appropriate points to change buses
and recognize when they have reached their school. Pilot
research is under way to use a VE to teach health
For personal use only.
education to students with moderate learning diffi-
c ~ l t i e sAs
.~~Brown and Stewart31suggest, a child could
be taught an appropriate response to an approach from
a stranger in a virtual city. A related use of VEs has been
reported for people who suffer from a disabling irrational
fear of heights.32Phobic individuals can be exposed to a
simulated height and allowed to habituate to their
anxiety.
Virtual reality and visual impairment
Although the basis of most VE systems is the
simulation of a visual three-dimensional environment
which might be supplemented by other sensory in-
formation, for someone with a visual impairment a
three-dimensional sound system may form the hub of a
VE. Several sound sources may be generated, each of
which appears to remain in a particular locality in-
dependent of changes in the user's body p ~ s i t i o n . ~ , ~ ~ of
Hollander and Furness3' have shown that people can
recognize geometric shapes and alphanumeric characters
presented through a ' virtual speaker array ' as sequential
arrays of sound. Lumbreras et al.36 describe a system
under development which generates sound sources such
as voices that appear to remain in particular localities
around the user. These ' audicons ' have functionality,
and can be used in a similar fashion to icons in a visual
graphical user interface to control a hypermedia system.
Using a glove interface the user can perform an operation
216
similar to the drag-and-drop operation of the visually
based system to position the sounds in particular places.
Associated VE technologies
VE technology is being used in a variety of ways to
help disabled individuals without necessarily aiming to
induce a sense of presence in a synthetic world.
Applications can be found in telerobotic systems, sign-
language recognition devices, aids for the visually
impaired, and intelligent home systems. The idea of
using telerobotics to help, and extend the functions of,
people with neurological injury is not new (e.g. ref. 37).
Typically such devices use head and mouth sticks to
allow users to extend their existing proprioceptive skills
to the tip of a device such as a prosthetic limb. With the
aim of providing increased power and range of move-
ment for those with physical disabilities such as spinal
cord damage and muscular dystrophy, Harwin and
Rachman3' have developed a head-operated telerobotic
system. Using a head-mounted sensor device the user can
direct the movements of a robot arm or a power-assisted
arm orthosis (a device which supports and moves the
person's arm).
In advanced VEs it is possible for the user to give
verbal instructions to the computer to control events. A
less sophisticated method of exercising control is to use
hand gestures via a glove fitted with sensors. Glove-
based input devices have been used to recognize hand
gestures and convert the hand signs into ~ p e e c h . ' - ~ ~ - ~ ~
These can be particularly useful for allowing non-vocal
deaf people to communicate with the wider community.
Because the output from the hardware is in the form of
synthesized speech, the deaf person can 'talk' to people
who are unable to understand sign language directly.
Currently under development is a system for recognizing
hand gestures which can be transmitted across a
telecommunications network to be replicated by an
animated model of a human signer.42
Attempts are being made to develop ultrasound
devices that can provide information, about the position
, ~ 'objects in the immediate surroundings, to blind
people.43When the ultrasound device detects the pres-
ence of objects, a tactile interface which vibrates against
the body conveys the information to the user. A tactile
rather than an auditory interface has the advantage that
it does not obscure other important auditory information
on which the blind person relies.
Some visually impaired users who have sufficient
vision to use a conventional computer screen can do so
only by using software that enlarges part of the material.
The problem with this solution is that it is extremely
 Virtual reality, disability and rehabilitation
difficult to keep track of where, on the unmagnified page,
the magnified portion relates. Using a VR headset the
problem can be ameliorated by presenting a greatly
enlarged version of the page which appears to be at a
distance.44Users look at only part of the screen at a time,
but their head position orients them to the position of the
information on the page. Interaction with the computer
screen is achieved by looking in the required direction
and clicking a mouse button.
Related to the above, Istance et describe an eye- ability to perform everyday functions, such as making a
tracker system for motor-impaired users that enables
eye-gaze interaction with a standard graphical user
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interface (see also ref. 46). Further, in the future,
controlling movement around a VE using only bio-
electrical signals may be pos~ible.~’ Augmented reality
systems overlay computer-generated information onto a
user’s natural senses. When the information is visual it is
superimposed on the user’s view of the world via a head-
mounted screen. W ’ e g h o r ~hast ~ ~described an augmented
reality system that helps people who are suffering from
Parkinson’s disease. One of the prominent symptoms of
this illness is an awkward and poorly coordinated gait
during normal walking. The problem is attenuated when
For personal use only.
walking up stairs or across a square-patterned floor.
Weghorst’s system superimposes a grid pattern over the
victim’s view of the ground that remains stable despite
changes in the position of the head. The result is a
significant improvement in the sufferer’s gait.
Augmented reality technology to help control inte-
grated home systems is currently under d e v e l ~ p m e n t . ~ ~ and cost of therapy apply to other patients, such as those
Integrated home systems provide a network of links
between electrical devices in the disabled individual’s
home which they can control remotely. By overlaying an
outline of important objects over the actual position of
those objects, the user may eventually be able to operate
such things as doors, windows, light switches, and alarm
systems simply by looking at them and activating an
infrared control.
Finally, it is worth noting that telepresence techniques
are being developed which will aid in remote medical
treatment. For example, the US Army is investigdting
the possibility that, using remote television cameras and
robotics, paramedics dealing with an injury victim could
communicate with a surgeon at a remote site, who could
carry out a surgical i n t e r v e n t i ~ n . ~ ~
Potential for rehabilitation following traumatic brain
injury
An important potential field of application for virtual
environments is the diagnosis and rehabilitation of
traumatic brain injury. Rose” points out that, while
there are well-developed measures of the sensory and
motor capabilities of brain injury victims, there is a
continuing debate about how best to assess cognitive
functions such as attention, memory and reasoning. Of
particular relevance is the issue of ‘ecological validity ’,
or how measures of these cognitive functions relate to
practical skills in real-life settings. A possible approach
to this problem would be to assess these functions in a
VE. This would allow the researcher to assess a patient’s
cup of tea in a simulated kitchen, without endangering
the patient and without sacrificing strict control over the
test situation. As the experimenter has complete control
over the VE, accurate and detailed information can be
gathered on the subject’s activities. Where a patient’s
mobility is restricted it would be possible to measure
cognitive function in a wider variety of situations than
would be possible in the real world. For the patient with
sensory impairment, enhancing certain aspects of the
sensory array would be po~sible.~’ An extreme example
of current interest concerns patients suffering from a
persistent vegetative VE technology could allow
these patients to be exposed to a much wider range of
sensory stimuli, and over much longer periods, than is
otherwise possible in a hospital setting. Further, this
technology would increase the chances of selecting
meaningful responses in such a patient.51 For example,
recording nervous system changes as correlates of VR
experience is possible.53Similar benefits in terms of time
suffering from strokes, who typically spend only
3&60 min per day in formal therapy.54 A VE increases
the possibility of stimulation and interaction with the
world without increasing demands on staff time. It can
provide interesting and engaging tasks that are more
motivating than formal repetitive therapy.
Drawbacks and ethical considerations
There are two broad areas of concern related to VE
use: first, there are practical problems to do with the
technology itself, and second, ethical worries, particu-
larly where vulnerable individuals are involved. One
drawback to HMDs is that a delay inevitably occurs
between movements of the user’s head and the updating
of the screen image.’ This is in part due to the tracking
system. If the delay is great enough the user may
experience discomfort. It is known that some users of
simulation technology, particularly flight simulators,
suffer from symptoms similar to motion Users
of HMDs have been reported to suffer from related forms
of discomfort. For example, Ruddle et a1.56reported that
217
 P. N . Wilson et al.
all 12 participants in their study complained of at least
two ‘slight’ side-effects, and three participants withdrew
due to severe nausea and dizziness. It should be noted
that no such problems have been reported following
desk-top VR use.
An area of ethical concern, particularly for children
who have difficulty in negotiating real environments,
such as children with physical disabilities, is that they
may find VEs too attractive. A few children appear to
find standard computer games addictive, and the
particularly engaging nature of VEs may enhance this
effect. There is always the possibility that a few children
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may become addicted to VR experience and withdraw
from real-world interactions. However, the converse
possibility exists that it may soon be possible to interact
socially with virtual people, and this might be used to
provide an intermediate stage in the training of social
skills for those who have difficulty with social inter-
actions. Moreover, with the increased use of shared VEs
over the Internet and World Wide Web, social com-
munication and interaction may be promoted in indivi-
duals who might otherwise be restricted in their ability to
socialize. The Defence Simulation Internet (DSI), de-
For personal use only.
veloped by the American Advanced Research Projects
Administration, is an advanced prototype of such a
system. It comprises a network of simulators which allow
tactical training between simulated tanks, helicopters,
and fixed-wing aircraft, all engaged on the same
simulated battlefield, despite their actual location in real
space. It is a simple matter to create a very basic version
of such a common VE by networking two or more PCs
so that many game players can interact in the same three-
dimensional environment. Such systems offer the possi-
bility for disabled individuals to engage in shared
activities which their disability might otherwise preclude.
A related worry is that the content of VEs may
promote undesirable learning and behaviour. Several
violent VR games of the DOOM format are currently
available, and these are very popular with teenagers.
Cromby et ~ 1 . ’point
~ out that the evidence for simple
causal links between real-world violence and its media
representation is lender.^' Further, the existence of
violent desk-top VE games does not prevent their non-
violent educational development. However, it is clearly
incumbent on the designer of a virtual world to bear in
mind the potential dangers inherent in their use. This is
particularly important when conducting research with
people with mental incapacity, when applied to the
assessment and treatment of fears and stress, and in
prosthetic use of computer interfaces in the care of
people with brain Particular care must be taken
when presenting simulated events that have a dangerous
218
real-world equivalent. For example, children who are
trained to cross the road in a simulator may conceivably
become desensitized to the danger of traffic if they make
errors that have no consequences.
Conclusions
Much of the research and development discussed in
this review is still in progress. It is too early to say which
of the applications will prove the most beneficial for
disabled individuals. What is important is that, despite
the current technological limitations, information gained
from experience in a VE can transfer to the real world.
The advantages of using simulations are that activities
can be carried out in safety, and the effects of specific
disabilities can be minimized. The entertainment market
drives much of the development of VE technology, and
it is important to remember that this field may be of
particular importance to disabled people. In a simulated
world disabled people can enjoy experiences that would
otherwise be denied to them. That is not to suggest that
experience of virtual activities will or should come to
replace real activities, but rather that they can provide
useful supplements to real-world experience. Nor does
the use of simulated worlds necessarily imply social
isolation. Great efforts are being made to develop multi-
user VEs in which people can share activities as well as
words.
References
1 Kalawsky RS. The Science of Virtual Reality and Virtual Environ-
ments. Wokingham: Addison-Wesley, 1993.
2 Rheingold, H. Virtual Reality. London: Secker & Warburg, 1991.
3 Kozak JJ, Hancock PA, Arthur EJ, Chrysler ST. Transfer of
training from virtual reality. Ergonomics 1993; 36: 777-784.
4 Steuer J. Defining virtual reality: dimensions determining tele-
presence. Journal of Communication 1992; 2 : 17-27.
5 Cruz-Neira C, Sandin DJ, Defanti TA, Kenyon RV, Hart JC. The
Cave : audio-visual experience; automatic virtual environment.
Communications ofthe ACM 1993; 35: 65-12.
6 Stone RJ. Applications focus : telepresence. Proceedings, Virtual
Reality (Impact and Applications) : Real World Applications of
Virtual Reality (Day Z), June 1991.
7 Ouy-Young M, Stelle Minsky M. Feeling and seeing: issues in force
display. Symposium on Interactive 3 0 Computer Graphics 1991 ;
235-244.
8 Fritz JP, Barner KE. Design of a haptic graphing system. In
Proceedings ofthe RESNA 1996 Annual Conference. Salt Lake City,
Utah, 1996.
9 Theasby PJ. The virtues of virtual reality. GEC Review 1992; 7 :
131-145.
10 Lampton DR, Knerr BW, Goldberg SL, Bliss JP, Moshell JM, Blau
BS. The virtual environment performance assessment battery
(VEPAB): development and evaluation. Presence 1994; 3 : 145-157.
11 Regian JW. Shebilske WL, Monk JM, Virtual reality: an
instructional medium for visual spatial tasks. Journal of Com-
munication 1992: 42: 136149.
 Virtual realit-v, disability and rehabilitation
12 Wilson PN, Foreman N, Tlauka M. Transfer of spatial information
from a virtual to a real environment in physically disabled children.
Disability and Rehrrbilitation 1996; 18: 633-637.
13 Cromby JJ, Standen PJ, Newman J, Tasker H. Successful transfer
to the real world of skills practised in a virtual environment by
students with severe learning disabilities. In: Sharkey Phi (ed.)
Proceedings of the 1st European Conference on Disability, Virtual
Reality and Associuted Technologies. Maidenhead, UK, July 1996;
103-107.
14 May M, Ptruch P, Savoyant A. Navigating in a virtual environment
with map acquired knowledge : encoding and alignment effects.
Ecological Psychology 1995; 7 : 21-36.
15 Peruch P, Vercher J, Gauthier GM. Acquisition of spatial
knowledge through visual exploration of simulated environments.
Ecological Psychology 1995; 7 : 1-20.
16 Stanton D, Wilson PN, Foreman N. Using virtual reality
Disabil Rehabil Downloaded from informahealthcare.com by University of Ulster at Jordanstown on 04/04/15
environments to aid spatial awareness in disabled children. In:
Sharkey PM (ed.) Proceedings of the 1st European Conference on
Disability, Virtual Reality and Associated Technologies. Maid-
enhead, UK, July 1996; 93-101.
17 Tlauka M, Wilson PN. The effect of landmarks on route-learning in
a computer-simulated environment. Journal of Environmental
Psychology 1994; 14: 305-313.
18 Tlauka M, Wilson PN. Orientation-free representations from
navigation through a computer-simulated environment. Environ-
ment and Behavior 1996; 28: 647464.
19 Wilson PN, Foreman N, Tlauka M. Transfer of spatial information
from a virtual to a real environment. (Submitted).
20 Foreman N, Orencas C, Nicholas E, Morton P, Gel1 M. Spatial
awareness in seven to 11-year-old physically handicapped children
in mainstream schools. European Journal of Special Needs Education
1989;4: 171-178.
For personal use only.
21 Cromby JJ, Standen PJ, Brown DJ. The potentials of virtual
environments in the education and training of people with learning
es. Journal of Intellectual Disability Research (In press).
22 Bricken W. Training in virtual reality. In Proceedings of the 1st
International Confirenre on Virtual Reality. London : Meckler
International, 1991,
23 Brown D. Close encounters. Special Children 1993; 68: 31-33.
24 Standen PJ, Low HL. Do virtual environments promote self
directed activity? A study of students with severe learning difficulties
learning Makaton sign language. In Sharkey PM (ed.) Proceedings
of the 1st European Conference on Disability, Virtual Reality and
Associared Technologies. Maidenhead, UK, July 1996; 123-127.
25 Nemire K, Crane R. Designing a virtual science laboratory to
accommodate the needs of students with cerebral palsy. In: Murphy
HJ (ed.) Proceedin>:s of the 3rd International Conference ‘Virtual
reality and Persons with Disability’. California State University
Centre on Disabilities, Northridge, 1995.
26 Turner LA. The role of a virtual reality simulator in the assessment
and rehabilitation of the disabled driver. Paper presented at the
Second Annual International Conference on Virtual Realil y and
Persons with Disability, San Francisco, 1994.
27 Strickland D, Marcus L, Hogan K, Mesibov G, McAllister D.
Using virtual reality as a learning aid for autistic children. Autism
France : 3rd International Conference on Autism and Computer
Applications. Nice, January 1995, pp. 113-132.
28 lnman D, Peaks J , Loge K, Chen V. Teaching orthopedically
impaired children to drive motorized wheelchairs in virtual reality.
Proceedings of the 2nd Annual International Conference on Virtual
Reality and Persons with Disabilities. San Francisco, CA, 1994.
29 Gunderson RW, Smith SJ, Abbott BA. Applications of virtual
reality technology to wheelchair remote steering systems. In:
Sharkey PM (ed.) Proceedings of the 1st European Conference on
Disability, Virtual Reality and Associated Technologies. Maid-
enhead, UK, July 1996; 47-56.
30 Mowafy L. Train to travel: the virtual bus to independent living
skills. Paper presented at the conference on Technology and
Persons with Disabilities, Los Angeles, March 1995.
31 Brown DJ, Stewart DS. An emergent methodology for the
development of virtual learning environments. In : Sharkey PM
(ed.) Proceedings of the 1st European Conference on Disability,
Virtual Reality and Associated Technologies. Maidenhead, UK, July
1996; 75-84.
32 Lamson RJ. The effects of virtual reality immersion in the treatment
of anxiety, panic and phobia of heights. Paper presented at the
Second Annual, International Conference on Virtual Reality and
Persons with Disability, San Francisco, 1994.
33 Gigante MA. Virtual reality: definitions, history and applications.
In Earnshaw RA, Gigante MA & Jones H (eds) Virtual Reality
Systems. London: Academic Press, 1993; 3-14.
34 Keating DA. The generation of virtual acoustic environments for
blind people. In: Sharkey PM (ed.) Proceedings of the 1st European
Conference on Disability, Virtual Reality and Associated Tech-
nologies. Maidenhead, UK, July 1996; 201-208.
35 Hollander AJ, Furness TA. Perception of virtual auditory shapes.
HTML document available from the Human Interface Technology
Laboratory, University of Washington, 1995 (http://www.hitl.
washington.edu/publications/conferences/icad/hollander. html).
36 Lumbreras M, Barcia M, Sanchez J. A 3D sound hypermedia1
system for the blind. In: Sharkey PM (ed.) Proceedings of the 1st
European Conference on Disability, Virtual Reality and Associated
Technologies. Maidenhead, UK, July 1996; 187-192.
37 Simpson DC, Smith JG. An externally powered controlled complete
arm prosthesis. Journal of Medical Engineering and Technology
1977; 275-277.
38 Harwin W, Rachman T. Analysis of force-reflecting telerobotic
systems for rehabilitation applications. In: Sharkey PM (ed.)
Proceedings of the 1st European Conference on Disability, Virtual
Reality and Associated Technologies. Maidenhead, UK, July 1996;
171-178.
39 Kramer J, Leifer L. The talking glove: a speaking aid for nonvocal
deaf and deaf-blind individuals. RESNA 12th Annual Conference,
New Orleans, Louisiana, 1989.
40 Fels S, Hinton G. Glove-talk: a neural network interface between
a data-glove and a speech synthesiser. IEEE Transactions on Neural
Networks, 1993; 4: 2-8.
41 Vamplew P. Recognition of sign language gestures using neural
networks. In: Sharkey PM (ed.) Proceedings of the 1st European
Conference on Disability, Virtual Reality and Associated Tech-
nologies. Maidenhead, UK, July 1996; 27-33.
42 Harwin WS, Foulds R. An overview of rehabilitation engineering
research at the Delaware Applied Science and Engineering
Laboratories. In: Sharkey PM (ed.) Proceedings of the 1st European
Conference on Disability, Virtual Reality and Associated Tech-
nologies. Maidenhead, UK, July 1996; 221-226.
43 Probert PJ, Lee D, Kao G. Interfaces for multisensory systems for
navigation for the blind. In: Proceedings of the 1st European
Conference on Disability, Virtual Reality and Associated Tech-
nologies. Maidenhead, UK, July 1996; 209-21 7.
44 Zwern AL, Goodrich GL. Virtual computer monitor for visually
impaired users. In: Sharkey PM (ed.) Proceedings of the 1st
European Conference on Disability, Virtual Reality and Associated
Technologies. Maidenhead, UK, July 1996; 13-21.
45 Istance, HO, Spinner C, Howarth PA. Providing motor impaired
users with access to standard graphical user interface (GUI)
software viaeye-based interaction. In: Sharkey PM (ed.) Proceedings
of the 1st European Conference on Disability, Virtual Reality and
Associated Technologies. Maidenhead, UK, July 1996; 109-1 16.
46 Bishop JB, Myers GA. Development of an effective computer
interface for persons with mobility impairment. Proceedings of the
Annual Conference on Engineering in Medicine and Biology, 1993;
15: 12661267.
47 Knapp B. The use of bioelectrical signals for navigating a three
dimensional computer environment. In: Murphy HM (ed.) Pro-
ceedings from the 3rd Conference on Virtual Reality and Persons with
Disabilities. San Jose, 1995.
48 Weghorst S. Virtual reality and movement disorders. Paper
219
 P. N . Wilson et al.
presented at the Second Annual, International Conference on
Virtual Reality and Persons with Disability, San Francisco, 1994.
49 Hammond JC, Sharkey PM, Foster GT. Integrating augmented
reality with intelligent home systems. In: Sharkey PM (ed.)
Proceedings of the 1st European Conference on Disability, Virtual
Reality and Associated Technologies. Maidenhead, UK, July 1996:
57-66.
50 Satava RM. Emerging medical applications of virtual reality: a
surgeon’s perspective. Artificial Intelligence in Medicine 1994; 6 :
281-288.
51 Rose FD. Virtual reality in rehabilitation following traumatic brain
injury. In: Sharkey PM (ed.) Proceedings of the 1st European
Conference on Disability, Virtual Reality and Associated Tech-
nologies. Maidenhead, UK, July 1996: 5-12.
52 Murphy L. Cognition and the persistent vegetative state. The
Disabil Rehabil Downloaded from informahealthcare.com by University of Ulster at Jordanstown on 04/04/15
Psychologist 1995; 8: 44-47,
53 Pugnetti L, Mendozzi L, Barberi E, Rose FD, Attree EA. Nervous
system correlates of virtual reality experience. In: Sharkey PM (ed.)
Proceedings of the 1st European Conference on Disability, Virtual
For personal use only.
220
Reality and Associated Technologies. Maidenhead, UK, July 1996 ;
2 39-246.
54 Tinson DJ. How stroke patients spend their days: an observational
study of the treatment regime offered to patients with movement
disorders in hospital following stroke. International Disability
Studies 1989; 11: 4 5 4 9 .
55 Kennedy RS, Lane NE, Lilienthal MG, Berbaum KS, Hettinger LJ.
Profile analysis of simulator sickness symptoms: application to
virtual environment systems. Presence 1992; 1: 295-301.
56 Ruddle RA, Randall SJ, Payne SJ, Jones DM. Navigation and
spatial knowledge acquisition in large-scale virtual buildings: an
experimental comparison of immersive and ‘desk-top’ displays.
(Submitted).
57 Cumberbatch G. Legislating mythology: video violence and
children. Journal of Mental Health U K 1994: 3 : 186196.
58 Whalley LJ. Ethical issues in the application of virtual reality to the
treatment of mental disorders. In: Earnshaw RA, Gigante MA &
Jones H (eds) Virtual Reality Systems. London: Academic Press,
1993; 273-287.