Virtual reality for rehabilitation: enhancing the transition to wheelchair use

Whether arising from neurological or orthopaedic conditions acquired at birth, in infancy, or later in life, the use of a wheelchair becomes a necessity for some. The journey of transitioning from non-disabled to relying on a wheelchair can be disheartening, requiring adaptation to new physical, practical, and emotional needs in order to navigate the challenges of everyday life. To facilitate this transition, support and training programs play an important role. In recent years, Virtual Reality (VR) has gained widespread popularity in rehabilitation. For wheelchair adaption programs, VR is able to address challenges found in real-life programs such as resource constraints and time limitations. Consequently, for new wheelchair users, VR can serve as a valuable environment for acclimating to newfound physical restrictions and learning to navigate daily life. This thesis investigates the opportunities VR can offer to support the transition to wheelchair use, with a particular focus on improving wheelchair driving skills training. The work presented in the thesis is built upon a review of the literature, to identify the gaps in existing research and contribute to the knowledge of the field. In particular, the following gaps are identified: lack of VR applications for wheelchair rehabilitation beyond driving skills training, lack of a standard framework and cost-effective system for VR driving skills training programs, and lack of insights about the effects of VR driving skills training programs on the participants’ physiological well-being. Consequently, this thesis presents three main contributions: general suggestions of how VR could assist the transition to wheelchair use after an exploration into the daily life of wheelchair users; general and technological suggestions on how VR wheelchair skills training programs can be maximised for powered wheelchair users; technological suggestions on how to monitor a user’s physiological well-being during VR training. Specifically, experienced wheelchair users were individually interviewed about the challenges they face in daily life, with the findings used to suggest different potential VR applications that can mitigate them. For wheelchair driving skills training, a framework is proposed for the standardisation of these applications within VR, with suggestions about the environment design, tasks to be performed, and the assessment of skills acquisitions. A controller was developed and used for the navigation in VR, which allows participants to use the joystick of a real wheelchair to perform the tests in VR. This controller was developed with the consideration of the need for cost-efficient and ergonomic technology for a successful VR driving skills training program. Further, the physiological signals of the participants, specifically the heart rate (HR), were monitored throughout the two studies to analyse the effect VR has on the user’s well-being. The results underscore the necessity for VR applications to aid new wheelchair users across various aspects of their transition, extending beyond physical assistance. Regarding driving skills training, the vi results indicate that VR programs can be optimised through: the implementation of a standardised framework for the assessment of skill acquisition; the use of cost-effective technology; and the thoughtful consideration of environmental design choices. Addition ally, the results highlight that monitoring participants’ HR provides an implicit measure of their well-being. Hence, this thesis contributes to the research community’s enhanced comprehension of the effective application of VR as a rehabilitation tool for individuals transitioning to wheelchair use. It incorporates the valuable lived experiences of wheelchair users. It proposes and develops a system aimed to maximise the effectiveness of VR wheelchair driving training programs. Additionally, it monitors the well-being of participants through out their VR experiences.