Targeting Technology for Autistic Spectrum Disorder Patrice L. (Tamar) Weiss, Ph.D, OT Dept. of Occupational Therapy Faculty of Social Welfare & Health.

Targeting Technology for Autistic Spectrum Disorder

 Patrice L. (Tamar) Weiss, Ph.D, OTDept. of Occupational Therapy

Faculty of Social Welfare & Health Sciences

University of Haifa

[email protected]

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Virtual Reality

Applying interactive simulations created with computer hardware and software to present users with

opportunities to engage in environments that appear and feel similar to real world objects and events

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Virtual Reality Continuum

Presence Cost Complexity

HighTech

LowTech

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User – Location Plane

Examples

StreetCrossing for ASD

Virtual Classroom for ADHD

IREX Meal-Maker for CP

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• 6 children, 9-16 years, low functioning ASD used desktop VR street crossing intervention program (ten 30 min sessions); 6 children with ASD as controls.

• All children in VR group improved in task while operating the VE.

• all succeeded in advancing from initial baseline performance to their final baseline significantly

• number of accidents decreased significantly

• transfer of skills: 3/6 children achieved greater proficiency in the protected real street environment occurred

Josman, N., Milika Ben-Chaim, H., Friedrich, S. and Weiss, P.L. Effectiveness of virtual reality for teaching street-crossing skills to children and adolescents with autism. International Journal of Disability and Human Development. 7: 49-56, 2008.

Bart, O., Katz, N., Weiss P.L., & Josman, N. Street crossing by typically developed children in real and virtual environments. OTJR: Occupation, Participation and Health, 28: 89-97, 2008. New VE

Functional Virtual EnvironmentsDesktop System: Street crossing

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Functional Virtual EnvironmentsVideo Capture Systems: IREX vs EyeToy

Virtual Meal Maker: IREX

clip

7 years, mainstream school in the first grade, has mild right hemiparesis

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Functional Virtual EnvironmentsVideo Capture Systems: IREX vs EyeToy

Using EyeToy with and without adaptation

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Functional Virtual EnvironmentsVirtual Classroom using a Head Mounted Display

Heads

Virtual classroom

Rizzo et al., University of Southern California

Pollak, Y. Weiss, P. L., Rizzo, A.A., Gross-Tsur, V., Shalev, R. The utility of a continuous performance test embedded in virtual reality in measuring ADHD-related deficits. Journal of Developmental and Behavioral Pediatrics, in press.

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Virtual RealityAssets for Rehabilitation

and Special EducationEcological validity

Grade cognitive & motor demands

Convenient times & locations

Performance can be documented

Easy to test & change

Safe for user

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User – Location Plane

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User – Location Plane

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DiamondTouch Interactive Table• Mitsubishi Electronic Research

Lab (MERL)• Large horizontal interactive

surface• Table-top interaction modality• Operated through PC using

Flash programming• Images are top projected Gal, E., Bauminger, N., Goren-Bar, D., Pianesi, F., Stock,O., Zancanaro, M. and Weiss, P.L. Enhancing social communication of children with high functioning autism through a co-located interface. Artificial Intelligence & Society, 24:75–84, 2009.

Kupersmitt, J., Yifat, R., Gal, E., Bauminger, N., Stock, O., Zancanaro, M., Pianesi, F. and Weiss, P.L. Joint construction of stories by high functioning children with autism: Using a technological setting. Int J Child Adolesc Health 3: 00-00, 2010.

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Story Table

• Interface to support pairs of children in the activity of collaborative storytelling

• Implements “Enforced Collaboration” paradigm

Alternate story backgrounds

Story characters

Voice recording

Lady bugs to hold audio snippets

Story sequence

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Story Table

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SAMPLE

3 pairs of boy with high functioning ASD, 8-11 years

OUTCOME MEASURES

1. Behavioral Checklist

(based on Bauminger, Aviezer & Rogers, 2004)

• positive social interactions (e.g., look at peer with positive

affect)• negative social interactions

(e.g., ignoring action of peer)• autistic behaviors (e.g., perseveration)

2. Analysis of language usage in the interactions and in the narrations

Story Table: Initial Study

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MarbleWorks Free structure play construction game

Pre- and Post-tests

Low-Tech ST scenarios with cardboard figures

Story Table: Initial Study

Link to 1 min video clip

Link to ST intervention video clip

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Comparison of Pre and Post outcomes

•increase in key positive social interactions

• decrease in negative interactions

• increase in narrative and play ability

Story Table: Initial Study

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Collaborative Puzzle Game: Options for non verbal children

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PlayCubes: Individual or Collaboration - DCD

Bi-directional Interface

Real-time 3DModeling

Real-time Interaction

PlayCubes: Individual or Collaboration - DCD

PlayCubes: Individual or Collaboration - DCD

Quantitative tracking of the similarity scores during the construction process

Airplane - Typically Developed

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20

40

60

80

100

0 15 30 45 60 75 90 105 120 135 150

Time (s)

Sim

ilarit

y (%

)

Similarity versus time during the construction of the airplane and slide apparatus

Pyramid - Typically Developed

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20

40

60

80

100

0 15 30 45 60 75 90 105 120 135 150

Time (s)

Sim

ilarit

y (%

)

Airplane Slide

PlayCubes: Individual or Collaboration - DCD

TSU.MI.KI

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User – Location Plane

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Remote User

Home / School / Community

Central System(phase II)

Central DB

(phase II)

Central Unit

Therapist /

Educator / Psychologist

From Avatars to Virtual Humans)Tele-Health(

Autism tele-consult

From Avatars to Virtual Humans

Autism : Justine Cassel’s virtual peers

Eye tracking

Autism : virtual mall

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User – Location Plane

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Second Life an Internet-based virtual world launched in 2003 by Linden’s Lab http://lindenlab.com).

“Residents” inhabit virtual worlds and interact via avatars

Users participate in individual and group activities, and to create and trade items and services using Linden dollars

By the end of March 2008, 13 million registered accounts. About 38,000 residents are logged on to Second Life at any particular moment. number of medical & health educational projects:

Nutrition Game Occupational Therapy at the Virtual Neurological Education

Centre Brigadoon designed for people with Asperger’s syndrome.

Brigadoon - a controlled environment where users are encouraged to feel comfortable and learn socialization skills at their own pace.

Link

http://www.youtube.com/watch?v=pmTXGQ2BhUA&feature=PlayList&p=E048D6F190577DED&index=0&playnext=1

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Balancing Collaboration Technologies: Assets and Limitations for ASD

• technical complexity• cost • non-real context• Isolation

Bane ?

• Motivation / enjoyment• Initiative / independence• self actualization• Challenge for caregiver

Boon?

Bottom Line• effectiveness?• transfer?

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Studies using Virtual Reality and Shared Active Surfaces for Autism:

Table of Evidence - AACPDM LevelStrength of

Evidence for Intervention

Type of study designVR studies (N=18)

SAS studies (N=19)

IGoodMeta-analysis of randomized controlled trials (RCT)

IILarge-sample RCTIIIGood to fairSmall-sample RCTIVNonrandomized controlled

prospective trials 3

VNonrandomized controlled retrospective trials

VIFairCohort studies7VIICase-control studies23VIIIPoorNon-controlled clinical series:

descriptive studies84

IXAnecdotes or case reports55

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Caesarea-Rothschild InstituteFondation Ida et Avrohom Baruch

Israeli Ministry of HealthIsraeli Ministry of Defense

Yad Hanadiv-Keren RothschildIsraeli Foundation for Spinal Cord Injured due to Gunshot

Israel Science FoundationKeren Shalem

Koniver FoundationRayne Foundation

Autism SpeaksEuropean Union FP7 ICT

Acknowledgements

Laboratory for Innovations in Rehabilitation Technology

University of Haifa, Haifa, Israel