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Study provides starting point for development of VR therapies


An engaging, attractive and colourful interface, an element of challenge plus continual feedback have been identified as key features of a virtual reality experience for people with dementia, according to new research.

Findings from independent research on Alzheimer’s Australia’s forest-themed virtual reality program, which shows residents with dementia experience greater pleasure but also more fear, can be applied to other virtual reality applications, said the study’s lead author.

Alzheimer’s Australia Vic began development on the sensor therapy application in 2014 ahead of launching the Virtual Forest for use at Lifeview Residential Care in Victoria in September 2015 where it continues to be used as part of a successful sundowning program aimed at reducing agitation and the use of antipsychotic medications.

Leading dementia care researcher Professor Wendy Moyle undertook a small exploratory study – the first to describe the impact of a virtual reality activity on people with dementia – involving 10 aged care residents with dementia, 10 family members and 9 care staff at two Lifeview facilities.

Overall, the forest was perceived by residents, family members and staff to have a positive effect and the study suggests virtual reality may have the potential to improve quality of life and outcomes for people with dementia, according to the findings published this month in The Gerontologist.

The research assessed how a 15-minute virtual reality forest experience affected the person with dementia’s engagement, apathy and mood.

It found that residents experienced more pleasure and a greater level of alertness, but also a greater level of fear or anxiety than normal for this cohort. No participants showed signs of anger or sadness.

Specifically, four residents displayed 1–5 minutes of pleasure, nine displayed alertness for more than 5 minutes while of the five residents showing anxiety or fear, two did so for 1–5 minutes and three for between 16 seconds and 1 minute.

Wendy Moyle

Professor Moyle said the results around fear and anxiety were not surprising considering the participants.

She said they believed the finding related to the unfamiliarity of the situation and wanted to highlight it because it was relevant to staff education.

“To me it wasn’t surprising but it is something that we need to consider in the use and also in any redevelopment in any areas of virtual reality,” Professor Moyle told Australian Ageing Agenda.

Other findings included general agreement among participants that 5–10 minutes was enough time in one sitting to use the forest while many family members indicated the scenery and objects were well designed but would like additional scenes.

Staff feedback suggested the program was best suited to people with mid-stage dementia as people with early stage dementia could get bored and those with later stage might become confused, according to the findings.

Professor Moyle said while only a small exploratory study, the findings were relevant to other virtual reality programs for people with dementia in aged care.

“The next stage is about taking the learnings and putting them into the redevelopment or the new development of other technology,” she said.

The paper outlined the following steps to consider in the future development and use of virtual technology including:

  1. An engaging, attractive, and colourful interface that promises enjoyment
  2. It is always obvious what to do next, either because of the way the interface behaves or because of a specific prompt
  3. An element of challenge and skill mastery to the experience, such as a point to the activity even for people with little working memory
  4. Continual feedback provided on the user’s performance.

Feedback informs development

A scene from Alzheimer’s Australia Vic’s Virtual Forest.

Alzheimer’s Australia Vic business development manager Tanya Petrovich said the independent evaluation was an important part of the continuous improvement process of the virtual forest and the findings have informed the support materials accompanying the technology.

In particular she said they have created e-learning materials that explain how to use the forest most effectively in response to the evaluation finding some people could be anxious when they first came to the forest.

“The e-learning explains to people that when they introduce it, these are the precautions you need to take and we explain how they support people to use the forest,” said Dr Petrovich, who co-authored the study.

She said from their experience including during a six-month trial at Lifeview, participants might have a bit of apprehension and prefer to watch other people doing it at first but then their anxiety lessened.

“That is just a momentary reaction. It is not ongoing,” she said.

Dr Petrovich said the findings helped them understand what people liked and provided ideas on what they could do next.

She said they would look at including more scenes and different scenes in future developments.

Dr Petrovich and Professor Moyle agreed it was very early days for virtual reality therapy programs and more research was needed to understand the impact.

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