Research during COVID-19: VR Exergames for Older Adults Living with Dementia, ft. John Muñoz

Wednesday, December 9, 2020
by Marisa Benjamin

The COVID-19 pandemic has greatly impacted the research landscape. In this series, we explore how our community is navigating their daily lives and innovating to adapt their research and collaboration techniques.

John Muñoz is a Postdoctoral fellow with the Intelligent Technologies for Wellness and Independent Living (ITWIL) Lab. His research involves developing virtual reality (VR) exercise games (Exergames) for people living with dementia. Their design approach is user-centred, which means that John and the research team work directly with end-users and stakeholders to incorporate feedback and improve the VR experience. Thus, when the COVID-19 pandemic began, John faced many challenges to advancing this work, so he and his team had to adapt.

Marisa Benjamin: The circumstances surrounding COVID-19 introduced many obstacles for researchers. What are some of the challenges you faced that are unique to your research?

John Muñoz: Our end-users are people in long-term care facilities, which is likely the most vulnerable population in the pandemic. Before COVID-19, we managed to do a few playtests, but when the lockdowns started, accessing people became very challenging since there are a lot of risk factors associated with going into facilities and working directly with participants. We are also collaborating with an independent VR development company, VR Vision, that was suddenly facing a lot of uncertainty. They did not know how they would be able to adapt to COVID, so there was also the fear that they would not be able to stay with the project. When you need to find a way to survive, research isn’t your top priority. We had to find strategies for both progressing the research with participants and maintaining the collaboration with the company.

Benjamin: How did you pivot your research so you could continue with participant studies? 

Muñoz: Accessing people has been the ultimate challenge but we came up with a way to still involve participants. Instead of doing studies in long-term care facilities, we started moving to at-home programs. We have adapted the population, too, toward older adults in community living. People who can take the headset at home and follow the instructions on their own, connected through internet to follow instructions and use the system. We developed kits for at-home VR studies using Oculus Quests, including all the accessories our participants will need. Everything is there, ready to go, in the VR system so all the participants have to do is charge it and follow the routine, 2-3 times per week. It’s great that we’re able to do this; VR technology right now is ready. It’s never been this ready before.

VR technology right now is ready. It’s never been this ready before.

Benjamin: If the participants are doing this at home, how do you and your team collect your data?

Muñoz: We have a system that records the data automatically. For example, when participants are doing the rowing exercise, our system records exactly what distance they’re rowing at and what interactions they are having in the virtual environment. This is a strategy we came up with since we knew we weren’t able to deploy the solution face-to-face, as we intended. The type of data we will collect in the study also had to change, since the information when you’re observing a person is different than what the system collects. For example, we previously were measuring improvements in participants’ functional fitness – which is, essentially, improvements to their physical fitness. To do this, we would have to be able to with the person to conduct tests of their performance in certain activities to assess their physical fitness, establishing a baseline in the beginning and comparing their results after using the system. Collecting this information now isn’t possible since the facilities don’t have time to run these tests for us. So, we’re changing what we had previously established as outcome measures and being cognizant of the limitations.

Benjamin: How have you adapted your outcome measures?

Muñoz: Our new outcome measures look at how people are integrating these systems into their homes and lives. How much are participants using it? What barriers are they having to using it? Can participants establish and maintain a routine, such as using it 2-3 times a week?

Benjamin: Tell me more about the study itself. Are there any additional precautions you’ve had to take to launch your VR study?

Muñoz: We’ll be recruiting participants for the study in early 2021, hoping to launch afterwards for 8-10 weeks in participant homes, asking each person to do 3, 20-minute sessions per week for the duration of the study. We’ll conduct interviews online to talk about their experience and analyze this along with the data we collect through the system itself. Based on our research, we developed a protocol for sanitizing VR equipment and actually had this approved by the research ethics board. The protocol ensures the equipment won’t be a spread of the virus as it outlines proper sanitization of non-critical medical devices in facilities. Allowing people to have the Oculus headsets and kits at home is a huge component of the study so that they wouldn’t have to go through our sanitization protocol every time they use the system. Otherwise, you can imagine, that could affect their willingness to use it often, which would confound our data.

Benjamin: You mentioned you’re working closely with a partner company. Who are they and what is their role on the project?

Muñoz: We’ve been working with a small development team from VR vision, a VR development studio based out of Toronto. I connected with them to see if they would be interested in supporting this research and they agreed because they were enthusiastic about what we are trying to do and believed in the importance of the partnership. I play the role of lead game designer, and they bring the ideas to life. That being said, they have also brought in their own ideas and participate in the design process, too.

Benjamin: Since the lockdowns started in March, have you been able to continue with your user-centred design approaches even though you haven’t had access to work directly with your intended end-users?

Muñoz: We are still using user-centered design, but we had to pivot by asking ourselves “who else can give us rich feedback?” We considered bringing in family members or other stakeholders related to seniors in long-term care facilities. However, we discovered that the best people to bring into the project were exercise therapists who work with participants living with dementia. This introduced another challenge since these therapists are very busy dealing with the pandemic.

Rowing with dolphin
Asking them to take some time to talk about the game sometimes sounded like a joke. However, when they did have the motivation to engage in the project, they were resourceful and imaginative. This makes sense given they have a lot of day-to-day experience with figuring out creative ways to encourage people to exercise.

We couldn’t go into the facilities and get therapists to try out the system, so I had to work around this by conducting sessions remotely. I would wear the headset on and mirror what I was seeing in a virtual meeting with 4 therapists who were watching and making these suggestions for what to incorporate to improve the exergames. For example, we asked for feedback about improving our rowing exercise to encourage people to row on a specific path and keep a consistent intensity. One therapist suggested incorporating a dolphin for participants to follow as they row, which, thanks to the development team at VR Vision, is now an actual feature in the game.

Remote video URL