Skyfarer: Design Case Study of a Mixed Reality Rehabilitation Video Game

To identify barriers to physical fitness faced by individuals with spinal cord injury preventing them from participating in a physical fitness program. In this cross-sectional study, a survey of barriers to exercise was administered to 72 individuals with spinal cord injury. Although 73.6% of the participants expressed an interest in an exercise program, less than half (45.8%) were currently active in an exercise program. Less than half (47.2%) reported that their physician had recommended an exercise program for them. The most frequently cited concerns about barriers to exercise fell into three areas: (1) intrapersonal or intrinsic (e.g., lack of motivation, lack of energy, lack of interest), (2) resources (e.g., cost of an exercise program, not knowing where to exercise), and (3) structural or architectural (e.g., accessibility of facilities and knowledgeable instructors). More individuals with tetraplegia reported concerns over exercise being too difficult and that health concerns kept them from exercising. Greater number of concerns was significantly related to higher levels of perceived stress. People with spinal cord injury face multiple barriers to physical fitness in functional, psychological, and architectural domains. Identification of these barriers can facilitate the participation of individuals with spinal cord injury in an exercise program, improving long-term health and wellness.

This paper details a brief history and rationale for the use of virtual reality (VR) technology for clinical research and intervention, and then focuses on game-based VR applications in the area of rehabilitation. An analysis of the match between rehabilitation task requirements and the assets available with VR technology is presented. Low-cost camera-based systems capable of tracking user behavior at sufficient levels for game-based virtual rehabilitation activities are currently available for in-home use. Authoring software is now being developed that aims to provide clinicians with a usable toolkit for leveraging this technology. This will facilitate informed professional input on software design, development and application to ensure safe and effective use in the rehabilitation context. The field of rehabilitation generally stands to benefit from the continual advances in VR technology, concomitant system cost reductions and an expanding clinical research literature and knowledge base. Home-based activity within VR systems that are low-cost, easy to deploy and maintain, and meet the requirements for "good" interactive rehabilitation tasks could radically improve users' access to care, adherence to prescribed training and subsequently enhance functional activity in everyday life in clinical populations.

Background While enhancing physical activity has been an essential goal of public health officials, people with physical impairments such as spinal cord injury (SCI) are more likely to live a sedentary lifestyle. Exercise has been shown to decrease the risk for many of the secondary conditions associated with SCI, including osteoporosis, cardiovascular disease, pressure ulcers, urinary tract infections, diabetes and arthritis, yet this population is rarely a target for health promotion efforts. This paper examines the self-reported exercise experiences of people with SCI using a qualitative-exploratory design. Methods We enrolled 26 individuals with SCI (15 self-described 'exercisers' and 11 'non-exercisers') from a non-random pool of survey responders. Semi-structured phone interviews were conducted to record participants' experiences with exercise pre/post injury, barriers and facilitators to being active and perceived health impact. Results Regardless of exercise status, all participants reported physical activity prior to injury and expressed interest in becoming active or maintaining an active lifestyle. Participants identified a range of both motivational and socio-environmental factors that were either facilitating or constraining of such a lifestyle. Non-exercisers identified barriers to exercise, including a perceived low return on physical investment, lack of accessible facilities, unaffordable equipment, no personal assistance and fear of injury. Exercisers identified facilitators, including personal motivation, independence, availability of accessible facilities and personal assistants, fear of health complications, and weight management. Exercisers associated a greater range of specific health benefits with being active than non-exercisers. Conclusion Despite motivation and interest in being exercise active, people with SCI face many obstacles. Removal of barriers coupled with promotion of facilitating factors, is vital for enhancing opportunities for physical activity and reducing the risk of costly secondary conditions in this population.