VR Therapy for Dementia Symptoms Management

• This paper explores the use of VR technology to manage dementia symptoms and enhance the quality of life for individuals in long-term care.
• The study examines the effectiveness of VR in reducing behavioral and psychological symptoms associated with dementia (BPSD).
• It investigates how VR experiences can be designed for personalization, social interaction, accessibility and acceptance in dementia care.
• The research correlates VR interactions with physiological responses like heart rate (HR) and eye-tracking to understand the emotional states of PwD
• It aims to address diagnostic challenges, mitigate loneliness, and facilitate reminiscence therapy through VR applications.

Dementia and BPSD

• Dementia is an umbrella term for conditions causing cognitive and social decline, affecting memory, thinking, orientation, language, etc.
• BPSD, including mood disturbances and emotional control issues, are common in dementia, impacting the quality of life for both patients and caregivers.
• BPSD symptoms range from aggression and restlessness to depression and apathy.
• WHO estimates over 55 million people worldwide have dementia, with projections of increasing numbers.
• A Global Action Plan prioritizes improving the Health-Related Quality of Life (HRQOL) for People with Dementia (PwD).

Traditional Interventions for PwD

• Most interventions for dementia focus on overprescribed medications and physical restraints, which can accelerate decline.
• Non-pharmacological interventions, such as sensory stimulation, social engagement, and therapies like reminiscence and art, are preferred for treating BPSD.
• These interventions align with a patient-centric care philosophy and individualized approaches.

VR as a Therapeutic Tool

• VR offers opportunities to support non-pharmacological interventions by immersing users in diverse environments.
• Its beneficial for PwD as it transcends physical limitations, reducing isolation and stimulating positive responses.
• VR can evoke emotions and amplify reactions through calming and familiar environments.
• Studies show PwD respond positively to VR, finding the experience enjoyable and stimulating.
• VR has the potential to engage patients, reduce isolation, and enhance cognitive stimulation, improving the quality of life.

Digital Therapeutics (DTx)

• DTx offers technology-driven methods for personalized care, remote delivery, and online monitoring.
• The DTx market is growing, emphasizing mental and behavioral health management.
• Technology-based interventions include chatbots and cognitive games. Replika offers personalized interactions, while games like Sea Hero Quest support spatial navigation,
• Lumosity uses gamified exercises to improve cognitive functions and can be part of modern dementia care.

VR in Healthcare Applications

• VR is becoming an accessible and low-cost solution in healthcare, used for mental health disorders, eating disorders, phobias, psychosis, and schizophrenia.
• It can provide multisensory interactions and positive experiences for PwD, promoting engagement.
• Special effort should be put on customizing VR experiences to the preferences and skill levels of each user.
• VR has been applied to improve capabilities like cognition, memory, spatial navigation, executive functions, attention, and motor control.
• Recent studies have shown successful VR deployments for PwD but require further evaluation.
• In line with previous research, this study explores the potential benefits of VR for PwD with BPSD in locked hospital units.

Research Questions

• What therapeutic benefits does VR provide in managing BPSD and improving the overall HRQOL for PwD?
• How can VR systems be designed to incorporate personalization, social interaction, and accessibility to enhance acceptance and effectiveness in dementia care?
• What insights do physiological responses, such as heart rate and eye-tracking data, offer about the emotional and behavioral impacts of VR interventions on PwD?
• How can VR applications in dementia care address diagnostic challenges, mitigate loneliness, and facilitate reminiscence therapy through innovative and immersive experiences?

Methods

• People with dementia were recruited, and the study was approved by the National Bioethics Committee with a signed consent form
• Twenty participants with varying dementia severity (MMSE scores 3-24) and had no prior VR experience, participated in this study, all of which had normal or corrected vision and no severe motion sickness.
• Heart rate was measure to provide a measure of emotional arousal.
• The technology of Eye-tracking was implemented for behavioral studies to monitor the opportunities of PwD's experience.
• Observations were recorded during the session noting the interaction with the VR, traits and physical interactions.
• Semi-structured were conducted by researchers for usability and practicality including headset comfort ability and the emotional effects during VR.

Study Design

• Conducted in a familiar hospital room and explained by a researchers with and HCI with PwD.
• A menu of virtual environment options were described with A3 paper illustrations, in instances where the PwD did not promptly choose a specific environment.
• They can chose from up to 3 environments and with a max of 15 minutes to prevent adverse effects like Dizziness.
• If necessary the allotted time would be indicated by the researcher for envirornment transitions
• Patients that were deeply engaged during the experience were permitted with five more minutes including encouragement to withdraw.
• Equipment operations by an engineer researcher for managing the equipment during the VR session including documentation from tracking notes.
• Lastly was the semi structured interview by researches to ensure psychology, HAI and technical insights were recorded lasting 40 mins
• By reviewing the systematic feasibility of using VR for with neurological disorders. Using reflections of 51 healthcare professionals and 24 PwD. The system sense of presence and usability was assessed by 16 HCPs, who used the system as both users and administers based on the HCPs feedback.
• The system has mild cognitive impairment by older adults over 20 and a pilot study was conducted to guide the system design based on MCI data from evaluations and measurements. The effective ness of the system was quantified by PwD

VR System

• The VR system developed using the Unity game engine, deployed on a VIVE Pro Eye VR system with 3D models from the Unity Asset Store
• Display mirrored on laptops showing visual rays with embedded trackers HMD visualizes what's going on where they are looking within. A Samsung Galaxy Active 2 tracks participants HR, used the HeartRateOBS streamed over Bluetooth every second. Using Python store data.

Findings and Discussion

• It is essential to assess the potential VRs must understand the VR. Unique, advantages and limitations. Through a data thematic evaluation the key was interviewed which highlighted and recorded.
• Coded by the doctors, The two researchers identified patterns coded to improve the theme to ensure the presence with the theme
• therapeutic benefits- Emotional expression after BPSD
• Blend real with the unreal- Feasibility as the material aspects were the importance including interactive materials.

Therapeutic Benefits

• Provides various healing benefits to PwD.
• Improved HRQoL for PwD

Affective and reduced BPSD

• Collected data shown severe BPSD anxious or depressed responses
• Shown the lack of apathy or low motivation levels after aggressive behavior to objects or himself
• Decreased aggression and agitation during VR session showing low HR to the individuals
• PwD shown to improve at aggressive activities during VR Sessions improving for couple ours after
• Time in which VR helped with the reduced aggressions in longer levels shows drops were due to immersion in VR environment during transit times.
• The researcher can explain the experiment to PwD

###Pain Alleviation

• Causes significant improvements with Al during VRE in daily routine ###Reminiscence therapy
• Significant memory improvements during Reminiscences with VR