Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
FEATURES:
Augmenting Mental Models
p 19
PRODUCT
COMPARISON:
Cognitive Enhancements & Trainers
p 22
COVER STORY:
Brain
Computer
Interface
COUNTRY FOCUS:
Austria
p 44
tial may turn this into a significant niche industry. to increase alertness while using VR in a simulator,
Already, classifications have been proposed – cog- will we choose the airline that advertises that its pi-
niceuticals to improve memory, learning, attention, lots are trained this way?
and decision-making processes, emoticeuticals to
affect awareness, mood, feelings, and motivation, At C&R, we believe in letting efficacy drive the mar-
and sensoceuticals to enhance and restore our sens- ket for neuroceuticals. Some of the most promis-
es. Marketing neuroceuticals for these purposes will ing results are emerging from animal studies, and
likely be successful, as this new group of neuromod- need to be proven in human subjects. To accom-
plish this, government and
industry must earmark ade-
A study conducted by the Virtual Reality quate funds to conduct
Medical Center (VRMC) showed that troops large-scale studies of these
off-label uses of existing
trained via the VRMC simulation cleared a drugs, both as standalone
real-world building four times faster than therapy and when combined
those not receiving simulated training. Using with other technologies such
as VR therapy. In this man-
this VR simulation in combination with a drug ner, we can improve the out-
such as modafinil (Provigil) will increase alert- comes for various diagnoses
and produce attendant cost
ness and may produce an even faster build- savings. For example, we
ing-clearance rate and steeper learning curve. may be able to avert or at
2 least delay the onset of
ulators has negligent side effects and emerging ev- Alzheimer’s and other dementias, which cost Amer-
idence of high efficacy. To learn more about cogni- icans $148 billion per year.
tive enhancement drugs, see our Product
Comparison Chart on page 23. For my part, I think I’ll raid the medicine cabi-
net, pop that pill, and play that VR brain game
Of course, ethical questions remain. For example, tonight.
if drugs can erase horrifying memories, sharpen at-
tention, and enhance physical therapy, should physi-
cians prescribe them? If we know an airline pilot Create your own reality!
will have a better safety record after taking a drug Brenda Wiederhold
Volume 13, Number 1 t Februar y 2010 t 1SSN: 2152-2715
Cyberpsychology,
Behavior, and
Social Networking
Special Issue on
Now Available Online! Posttraumatic Stress Disorder
CyberTherapy & Rehabilitation Magazine Professor Brenda K. Wiederhold Professor Dragica Kozaric-Kovacic,
ISSN: 2031-278 Ph.D., MBA, BCIA M.D., Ph.D.
GTIN-13 (EAN): 9771784993017 Editor-in-Chief University Hospital Dubrava
C&R Magazine Croatia
CyberTherapy & Rehabilitation Magazine is published quar- Belgium
terly by the Virtual Reality Medical Institute (VRMI), 64 Rue
de l'Eglise, Boite 3, 1150 Woluwe-Saint-Pierre, Belgium. The Professor Paul Pauli, Ph.D.
magazine explores the uses of advanced technologies for Professor Rosa M. Baños, Ph.D. University of Würzburg
therapy, training, education, prevention, and rehabilita- University of Valencia Germany
tion. Areas of interest include, but are not limited to, psy- Spain
chiatry, psychology, physical medicine and rehabilitation,
neurology, occupational therapy, physical therapy, cogni- Professor Simon Richir, Ph.D.
Professor Cristina Botella, Ph.D. Arts et Metiers ParisTech
tive rehabilitation, neurorehabilitation, oncology, obesi-
Universitat Jaume I France
ty, eating disorders, and autism, among many others.
Spain
PUBLISHING HOUSE
Professor Giuseppe Riva,
Virtual Reality Medical Institute BVBA
Professor Stéphane Bouchard, Ph.D. Ph.D., M.S., M.A.
64 Rue de l'Eglise, Boite 3 Universite du Quebec Istituto Auxologico Italiano
1150 Woluwe-Saint-Pierre en Outaouais (UQO) Italy
Belgium Canada
Telephone: +32 2 770.93.33
Fax: +32 2 762.93.33 Professor Paul F.M.J. Verschure, Ph.D.
E-mail: office@vrphobia.eu A.L. Brooks Universitat Pompeu Fabra
Website: http://www.vrphobia.eu Aalborg University Spain
Denmark
PUBLISHER
Brenda K. Wiederhold, Ph.D., MBA, BCIA Professor Mark D. Wiederhold, M.D.,
Professor Paul M.G. Emmelkamp, Ph.D. Ph.D., FACP
PRODUCTION AND PRINTING University of Amsterdam Virtual Reality Medical Center
The Netherlands USA
6 Nyomda
ADVERTISING
For advertising information, rates, and specifications please Professor Luciano Gamberini, Ph.D. Professor XiaoXiang Zheng, Ph.D.
contact Virtual Reality Medical Institute, 64 Rue de l'Eglise, University of Padova Zhejiang University
Boite 3, 1150 Woluwe-Saint-Pierre, Belgium, Telephone: +32 Italy P.R. China
2 770.93.33; Fax: +32 2 762.93.33; E-mail: office@vrphobia.eu.
MANUSCRIPTS
Submissions should be addressed to the C&R Managing Ed-
itor, Virtual Reality Medical Institute: office@vrphobia.eu.
COPYRIGHT
Copyright © 2010 by Virtual Reality Medical Institute. All rights
reserved. CyberTherapy & Rehabilitation Magazine is owned
by Virtual Reality Medical Institute BVBA and published by the SUBSCRIBE TO C&R
Virtual Reality Medical Institute BVBA. Printed in Hungary.
Individual Institution
With the exception of fair dealing for the purposes of re-
search or private study, or criticism or review, no part of this Europe Euro 115 Euro 245
publication may be reproduced, stored, or transmitted in 1 Year
International Euro 145 Euro 295
any form or by any means without prior permission in writ-
ing from the copyright holder.
Europe Euro 210 Euro 465
For permission to photocopy an article for internal purpos- 2 Years
es, please request permission and pay the appropriate fee International Euro 270 Euro 575
by contacting office@vrphobia.eu.
Subscriptions begin with the first issue of the current volume. No cancellations
The accuracy of contents in CyberTherapy & Rehabilitation or refunds are available after the volume’s first issue is published. Publisher is
Magazine are the responsibility of the author(s) and do not to be notified of cancellations six weeks before end of subscription. Members
constitute opinions, findings, conclusions, or recommenda- of the International Association of CyberPsychology, Training & Rehabilitation
tions of the Publisher or editorial staff. In addition, the Pub- (iACToR) receive a 20% discount. To subscribe please visit www.vrphobia.eu and
lisher is not responsible for the accuracy of claims or infor- click “Subscribe.”
mation presented in advertising portions of this publication.
TABLE OF CONTENTS
PRESIDENT’S NOTE
B. Wiederhold p 1
COVER STORY
One Pill Makes You Larger: An Overview on the
Field of Cognitive Enhancement
M. Wiederhold, B. Wiederhold p 11
FEATURES
Brain-Computer Interface for Spelling and
Environmental Control
C. Guger p 14
84 tions and an industrial exhibition and networking area, Med-e-Tel 2011 in Luxembourg.
8
of World of Health IT have we experienced such a high number of
eHealth Week delegates and media interest, not to mention the fact that the exhi-
Health IT Conference & Exhibition
Barcelona, Spain/ March 15-18, 2010 bition show floor was sold out weeks before the event took place.
These facts confirm that there is a need for a truly European eHealth
Before March 15th, there was a lot of speculation into how the first conference which offers solutions and demonstrates the conver-
collaboration between the European Commission’s High Level Min- gence of healthcare systems on a local, national and international
isterial Conference and the World of Health IT Conference & Exhibi- level.”
tion would proceed.
On Wednesday, March 17th, the HIMSS Europe eHealth Leadership
On Thursday, March 18th, all skeptics were convinced. The Barcelona award was presented to Niels Rossing, a Danish champion in eHealth.
event was an immense success. Throughout the week, the confer- Mr. Rossing said that he was accepting this on behalf of the entire
ence was hailed as the largest pan-European eHealth conference, European eHealth Community, who have already paved the road to
and by many, the best. eHealth with many significant achievements.
eHealth week 2010 gathered 3,200 delegates and 95 exhibitors, and The event ended with the announcement that eHealth week 2011
was visited by an astounding 150 international journalists. Press ar- will be held in Budapest, during the Hungarian Presidency.
ticles appeared on a daily basis across Europe, and television and ra-
dio stations were broadcasting live from the event. Important atten- The World of Health IT Conference & Exhibition is the leading fo-
dees included the Vice President of the European Commission and rum for the advancement of Health IT in Europe. Addressing the
Commissioner for the Digital Agenda, Neelie Kroes, and Commis- needs of key stakeholders in the European eHealth Community, The
sioner for Health and Consumer Policy, John Dalli. The conference World of Health IT Conference & Exhibition offers professional de-
also hosted Ministers of Health and State Secretaries from the 27 velopment sessions, vendor exhibitions, best practice exchanges,
member states and a number of high level key note speakers. networking sessions, and debates and discussions on the issues that
will shape the future of eHealth information can be found at
Jeremy Bonfini, Senior VP, HIMSS Global said, "Never in the history www.ehealthweek2010.org and www.worldofhealthit.org.
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
15th Annual CyberPsychology Seoul, Korea
& CyberTherapy Conference June 13 – 15, 2010
The 15th Annual CyberPsychology and CyberTherapy Confer-
ence (CT15), the official conference of the International Asso-
ciation of CyberPsychology, Training & Rehabilitation (iACToR)
was co-organized by Brenda K. Wiederhold, Ph.D., MBA, BCIA of
the Interactive Media Institute and Sun I. Kim, Ph.D. of Hanyang
University. CT15 was hosted at the President Hotel in downtown
Seoul, Korea, and attracted researchers, experts, and students
from 23 countries around the world. CT15 was truly an interna-
tional success setting directions for advancements in the grow-
ing disciplines of cyberpsychology, cybertherapy, training, and
rehabilitation.
CT15’s theme was two fold: First, CT15 explored technologies as Attendees at CT15 listened to welcoming remarks during a dinner
enabling tools. This included the use of advanced technologies at the President Hotel in downtown Seoul, Korea.
such as virtual reality simulations, videogames, telehealth, video-
conferencing, the Internet, robotics, brain computer interfaces,
wearable computing, non-invasive physiological monitoring de-
“Virtual Reality Cognitive and Physical Rehabilitation” tutorial. 9
Sunday concluded with a welcome reception with a perform-
vices, in diagnosis, assessment, and prevention of mental and ance by the Chung-Ang University Gayastra.
physical disorders. In addition, interactive media in training, ed-
ucation, rehabilitation, and therapeutic interventions were dis- The conference officially began on Monday, the 14th of June,
cussed. Second, CT15 explored the impact of new technologies. with welcome remarks from the Conference Co-Chairs, Profes-
sor Brenda K. Wiederhold and Professor Sun I.
Kim. This year’s scientific chairs were Professors
The quality and significance of the work presented at Stéphane Bouchard, José Gutiérrez Maldonado,
CT15 reaffirms that Virtual Reality is already playing a sig- and Giuseppe Riva.
nificant role in health care. CT15 further strengthened Along with their invaluable help, we would also
and advanced efforts to improve health care through like to thank our sponsors including: Bionet, Eu-
ropean Commission, DGINFSO, Hanyang Uni-
technology, and explored ways to take advantage of versity and Hanyang University’s Institute of Ag-
remarkable transformations that are occurring. ing Society Silver & u-Health Research Center,
International Association of CyberPsychology,
CT15 investigated how new technologies are influencing behav- Training, & Rehabilitation (iACToR), Istituto Auxologico Italiano,
ior and society through cyberadvertising, cyberfashion, and cy- Interactive Media Institute (IMI), Mary Ann Liebert, Inc., Nation-
berstalking to name a few. The conference also explored how so- al Institute on Drug Abuse, Osteosys, Université du Québec en
cial networking tools such as Twitter and Facebook are influencing Outaouais, Canada, Virtual Reality Medical Center (VRMC), Vir-
individual behavior and personal relationships. tual Reality Medical Institute (VRMI), Chung-Ang University, and
the National Research Foundation of Korea (NRF).
Under the direction of Tutorial Chairs, Prof. Luciano Gamberi-
ni and Dr. Alessandra Gorini, CT15 kicked off with pre-confer- Monday’s program included two plenary sessions and two par-
ence workshops on Sunday, the 13th of June, which focused on allel sessions on the use of advanced technologies in anxiety
multiple aspects of cybertherapy. Professor Stéphane Bouchard disorders, eating disorders, and addictions as well as an online
led an important tutorial titled “Virtual Reality and Psychother- interaction symposium. Two attractive and innovative events of
apy,” while Dr. Xialoing Hu and Professor Andrea Gaggioli led the the conference took place during lunch on Monday. The poster
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
session and Cyberarium gave opportunities for developers and
scientists to demonstrate their work and converse, one-on-one,
with interested spectators and colleagues. Monday was closed
by the 2nd Annual General Assembly of the International Asso-
ciation of CyberPsychology, Training, & Rehabilitation (iACToR),
which was coordinated by Secretary General Brenda K. Wieder-
hold and led by newly elected President Professor Giuseppe
Riva. The General Assembly invited members from over 20 coun-
tries to convene to review relationships made with other asso-
ciations, conferences and publications. The General Assembly
then discussed how to bring about more rapid innovation in
the advanced technologies and healthcare arenas.
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
COVER STORY
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
COVER STORY
and donepezil (Aricept®) aimed at slowing aroused participants receiving naltrexone, tools would no doubt benefit from the use
the progression of Alzheimer's disease, are an opioid receptor antagonist, recognized of one of the cognitive enhancers discussed
proven to increase alertness and boost incidental material from a presented story in this section.
learning. The effects of modanafil in healthy better than did participants receiving place-
people are increases in concentration, alert- bo, at no expense to memory for thematic Controversies Surrounding Cognitive
ness, short-term memory and focus. material. As a result, naltrexone improved Enhancers
Donepezil improves cognition and slows overall recognition memory.
the decline of overall function. Adaptogens Safety is a primary concern, as the long-term
can increase tolerance to mental exhaus- Piracetam, originally designed as an effects of these drugs for the purpose of
tion and may enhance attention in fatigue. antiepileptic drug, was one of the first drugs cognitive enhancement are unknown, even
Beneficial effects are primarily associated to be used off label for cognitive enhance- if no adverse events are apparent in the
with the hypothalamic-pituitary-adrenal ment. Results from animal studies are prom- short term. However, there is medical prece-
axis, a part of the stress-system that is be- ising. However, results from studies in which dent for accepting risk for the purpose of
lieved to play a primary role in the reac- it was used to treat children with Down syn- enhancement, as in the case of cosmetic
tions of the body to repeated stress and drome were equivocal, with only certain surgery. The patient may decide that the
adaptation. Single doses of ginseng extract populations showing improved function. benefits outweigh the risks.
can affect cognitive performance and ex-
ert a direct effect on central nervous sys- One study of 24 healthy young adults Fairness in competition is another issue:
tem (CNS) functioning, as seen in the mod- showed that administration of S. lavandu- Could athletes or other competitors gain
ulation of cerebroelectrical activity. laefolia (sage) resulted in a consistent im- unfair advantage by “brain doping” before
Adaptogens, donepezil, ginseng, and provement for both the 25- and 50-μl dose a match? The Olympic Games have banned
modanafil could enhance VR combat train- on the “speed of memory” factor. There was the use of stimulants during competition,
ing by increasing alertness and enhancing also an improvement on the “secondary but other sports such as poker have yet to
mental acuity and performance for com- memory” factor for the 25-μl dose. The data adopt the World Anti-Doping Code. In ad-
bat training. suggest that previous reports of memory dition, such drugs may be used prior to com-
enhancement by Salvia may be due to petition in practice sessions.
Varenicline, an alpha(4)beta(2) nicotinic more efficient retrieval of target material.
acetylcholine receptor partial agonist, pro- Further, unauthorized users of certain drugs
motes smoking cessation. Use of the drug A soya diet containing high levels of may face fines or even imprisonment. For ex-
could increase the effectiveness of a VR-as- isoflavone phytoestrogens significantly im- ample, Adderall and Ritalin are Schedule II
sisted cognitive-behavioral therapy smok- proved memory and frontal lobe function controlled substances, and Provigil® is a
12 ing cessation program. in young healthy male and female volun- Schedule IV substance due to its lower poten-
teers compared with volunteers receiving tial for dependence and misuse. Students with
Drugs for Cognitive Rehabilitation a soya-free diet for 10 weeks. Soya phytoe- attention-deficit hyperactive disorder (ADHD),
strogens have been shown to act like estro- who have a legitimate reason for taking a drug
Ampakines, under development by phar- gen in the brain, which has a number of di- such as Adderall, complain about their healthy
maceutical laboratories, amplify memory rect and indirect receptor-mediated friends who take it, saying that it gives their
by increasing the activity of brain chemi- genomic effects that could affect cognition. friends an unfair advantage while they need
cals such as the neurotransmitter gluta- In addition, estrogen potentiates glutamate- the drug to be “normal.”If schools begin test-
mate, which is important for memory for- induced calcium signaling. Although it is ing students for such drugs in the days be-
mation. Upon repeated exposure to unlikely that phytoestrogens will mimic all fore an exam, will legal stimulants such as caf-
glutamate within a short period of time, the CNS effects of estrogens, there are suf- feine be banned as well?
one receptor triggers another, and calcium ficient potential mechanisms that could
molecules enter the brain cell. This causes mediate cognitive improvement. Future Directions
the synaptic connection to change, and is
believed to be the basis of memory forma- VR has been used as a way to assist pa- Substances that promote cognitive enhance-
tion and consolidation. tients with brain damage and intellectual ment have the potential to benefit a vari-
disabilities. For example, VR has been used ety of VR therapy protocols. For example,
In animal studies, acute administration be- to train cognitive tasks in brain-damaged VRMC may use its fMRI-safe VR device to
fore a training session of two different 5- and intellectually disabled patients by train- study the brain’s activity when, for exam-
HT6 receptor antagonists improved mem- ing them in the performance of activities ple, a smoking virtual environment is used
ory formation. Effective doses of both of daily living, such as grocery shopping, in combination with a cognitive enhancer
antagonists ranged from 1 to 30 mg/kg. One food preparation, orientation, road cross- to treat addiction. As another example, the
of the formulations elicited a 7-fold increase ing, and vocational training. At The Virtu- Virtual Reality Medical Institute eventually
relative to the control saline group. al Reality Medical Center (VRMC), re- may experiment with propranolol to aug-
searchers plan to create VR cognitive ment the Interreality in the Management
Studies have shown that brain opioid sys- training tools that specifically target and and Treatment of Stress-Related Disorders
tems can modify memory and learning train working memory, selective attention, (INTERSTRESS) device under development
processes. In one study, physiologically and sustained attention processes. Such by its partners.
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
Drugs and Supplements with Potential to Enhance Virtual Reality Therapy
Substance Performance-enhancing properties VR therapy potential
Adaptogens (herbal preparation) Improves attention, speed, and accuracy Combat training, Driving
Ampakine, glutamate booster
Improves memory Cognitive rehabilitation
(still in development)
Promotes neuroplasticity; improves con-
Amphetamine and dextroamphetamine
centration, alertness, motor skills, and lan- Combat training, Driving, Public speaking
(Adderall, Dexedrine)
guage learning skills
Anisomycin (ANISO) injections (protein Affects fear memory consolidation when in
Phobias, PTSD
synthesis inhibitor tested in animals only) the presence of direct memory activation
Calcium channel agonist BayK8644, L-type
Facilitates extinction learning Phobias
voltage-gated
Cannabinoid CB1 receptor antagonist AM- Blocks neuronal emotional associative
Prevention of PTSD
251 (at a dose of 1.0 mg/kg or higher) learning
Cortisol/cortisone Reduces/inhibits retrieval of fear memory Phobias
CREB (transcription factor cAMP-response-
Has selective effect on negatively charged
element-binding protein) inhibitors PTSD
memories
(still being researched)
Reduces fear learning and increases
D-cycloserine (DCS) Phobias
extinction
Donepezil (Aricept) Boosts learning Combat training
Endogenous cannabinoid (eCB) break-
down and reuptake inhibitor AM404 and Enhances extinction of conditional fear Phobias
other eCB modulators
Ephedra/ephedrine Increases concentration Combat training, Public speaking
5-HT6 receptor antagonists
Improves memory consolidation Cognitive rehabilitation
(tested in animals only)
Ginseng Can modulate stress, fatigue, and learning Combat training, Cognitive rehabilitation
Increases concentration, boosts spatial
13
Methylphenidate (Ritalin) Combat training, Public speaking
working memory
Modafinil (Provigil®) Improves alertness Combat training
Opioid peptides mediate alterations in
Naltrexone specific aspects of human memory during Cognitive rehabilitation
heightened emotional states
Piracetam (significant results in animal Enhances memory, improves spatial learn-
Combat training, Cognitive rehabilitation
studies only) ing, increases attention and cognition
Prevents strong emotions from making
Propranolol hydrochloride PTSD
strong memories
Sage (Salvia) Improves speed of memory retrieval Cognitive rehabilitation
Improves memory and
Soya isoflavones (supplement) Cognitive rehabilitation
frontal lobe function
Sulpiride, a dopamine D2-like receptor
Facilitates extinction of conditional fear PTSD, Phobias
antagonist (animals tested only)
Selective alpha4beta2 nicotinic acetyl-
Varenicline Smoking
choline receptor partial agonist
Yohimbine Facilitates extinction of conditional fear Phobias
[ ]
Cognitive enhancers may have important consequences for
society, and perhaps even profound implications for the fu- Mark D. Wiederhold, M.D., Brenda K. Wiederhold, Ph.D.,
ture of all people. It is exciting to be involved in neuroscience Ph.D., FACP MBA, BCIA
research in the so-called Age of the Brain, helping patients Virtual Reality Medical Center Virtual Reality Medical Institute
create achievements that indeed make them feel as if they’re San Diego, California Belgium
10 feet tall. mwiederhold@vrphobia.com office@vrphobia.eu
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES
Brain-computer Interface
for Spelling and
Environmental Control
With work becoming more and more “futuristic,” the field of Brain-comput-
er Interface allows users to operate external devices simply using their
thoughts. Whether operating a wheelchair or prosthetic device, or spelling
on a screen, as is discussed in the following article, exciting possibilities will
soon be available for paralyzed and disabled patients.
By Christoph Guger
14
A brain-computer interface (BCI) is a The Spelling System fore, the characters of the English alpha-
communication channel between the bet, Arabic numbers and icons were
human brain and external devices Such a system was developed recently. arranged in a matrix on a computer
based on the Electroencephalogram The Intendix BCI system was designed to screen (see Figure 2). Then the characters
(EEG). Such a system allows a person be operated by caregivers or the patient’s are highlighted in a random order and the
to operate different applications just family at home. It consists of active EEG person has the task to concentrate on the
by thinking. Two of the most important electrodes to avoid abrasion of the skin, specific character he/she wants to spell.
applications are spelling and environ- a portable biosignal amplifier and a lap- At the beginning the BCI system is trained
mental control for totally paralyzed pa- top or netbook running the software un- based on the P300 response of several
tients. der Windows (see Figure 1). The electrodes characters with multiple flashes per char-
are integrated into acter to adapt to the specific person.
the cap to allow a
fast and easy mon- If the system is started up for the first
tage of the equip- time, a user training session has to be per-
ment. The system formed. Therefore, usually five to ten train-
allows viewing the ing characters are entered and the user
raw EEG to inspect has to copy and spell the characters. The
data quality, but in- EEG data is used to calculate the user spe-
dicates automati- cific weight vector which is stored for lat-
cally to the unex- er usage. Then the software switches au-
perienced user if tomatically into the spelling mode and
the data quality on the user can spell as many characters as
a specific channel wanted. The system was tested with 100
is good or bad. subjects who had to spell the word LU-
CAS. After five minutes of training 72 %
This control can were able to spell it correctly without any
be realized by ex- mistakes.
tracting the P300 The user can perform different actions
evoked potential such as copy the spelled text into an Ed-
from the EEG data itor, copy the text into an e-mail, send the
Figure 1: Intendix running on the laptop and user wearing the in real-time. There- text via text-to-speech facilities to the loud
active electrodes.
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
[ ]
time experiments and a special BCI com- by looking first at the TV symbol. Then,
munication interface must be developed the station and the volume can be regu-
to have enough degrees of freedom avail- lated. A special go to mask consisted of a Christoph Guger, Ph.D.
able to control the VR system. plan of the smart home and of letters in- g.tec medical engineering
dicating the different accessible spots in Austria
Figure 3 illustrates the components in de- the smart home. The letters flash during guger@gtec.at
tail. A 3-D projector is located behind a pro- the experiment.Inside the mask, there are www.gtec.at
jection wall for back projections. The subject letters indicating the different accessible
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
lost weight in accordance with the physical aged doppelgänger. Those who saw an aged ciated with successful phobia management,
actions of a participant in the lab caused doppelgänger became more future-orient- which may serve as an additional incentive
real changes in physical behavior. Compared ed and demarcated more funds for retire- to work towards managing the phobia.
to various control conditions, watching one’s ment than those who saw a current doppel-
doppelgänger lose weight as a reward for gänger. These same aging models could be Physical rehabilitation VEs present another
activity or gain weight as a punishment for used to promote long-term health goals, use for doppelgängers. Although many em-
inactivity caused more exercise. This change such as quitting smoking or staying physi- body a first-person perspective, some phys-
in health behavior was observed immedi- cally active, to promote positive outcomes ical movements may be better learned from
ately after the treatment in the lab as well rather than negative consequences in the a third-person perspective. In these cases, in-
as twenty-four hours afterwards. future. corporating a doppelgänger as a model may
promote more self-efficacy and learning.
A similar technique can be used to change Future Directions
eating habits. We had participants observe Doppelgängers have shown great potential
their doppelgängers eating, and afterwards Given our success in modifying exercise, for changing physical behaviors. Much work
they responded to survey questions while diet, and financial behaviors, we feel that in cybertherapy successfully implements a
seated at a desk with a large bowl of candy. doppelgängers should be explored more first person, real-time controlled avatar view
We observed a replication of social facilita- widely within the fields of therapy and re- during therapy. These researchers should
tion effects on eating, wherein men con- habilitation. consider the potential of incorporating au-
sumed more candy and women suppressed tonomously behaving doppelgängers in
their appetites, eating no candy after the vir- Bandura originally used social modeling as their treatments.
[ ]
tual treatment. These studies suggest that a method of phobia desensitization, and vir-
doppelgängers may be used for the treat- tual reality exposure therapy has been suc-
ment of obesity, compulsive eating, or eat- cessfully used for this purpose. Doppel- Jesse Fox, Ph. D
ing disorders and could be incorporated in gängers could be incorporated in VEs for Ohio State University
existing diet-based virtual environments (VEs). acrophobia (the fear of heights), agorapho- Jeremy N. Bailenson, Ph. D
bia (fear of open spaces), aviophobia (fear Virtual Human Interaction Lab,
In a third line of work, conducted with Hal of flying), or social phobia. Participants could Stanford University
Ersner-Hershfield and Laura Carstensen, we see their doppelgängers coping with stress- U.S.A.
used doppelgängers to influence future fi- ful environments, thus bolstering their sense 17
nancial decision-making. Participants em- of self-efficacy. They may also observe their fox.775@osu.edu
bodied either a current doppelgänger or an virtual self experiencing the rewards asso- bailenson@gmail.com
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES Deep Brain Stimulation
Indeed, besides being used to diminish versus enhancement is neither necessary apeutic benefit when in fact what is on of-
Parkinson’s symptoms, DBS procedures nor helpful in order to find the appropriate fer is not proven, but simply a tool being
have also been used to treat severe depres- ethical framework for the use of DBS in tested as a function of research? 4. How
sion, obsessive-compulsive disorder, obe- healthy, informed and consenting subjects. should DBS be regulated in such a way to
sity, epilepsy and Tourette syndrome, DBS will only be ethically approved for assure first and foremost patient safety, with-
among countless other applications. More- healthy subjects if these subjects make un- out stopping the research altogether in this
over, in some cases, DBS has been found solicited and informed decisions; only this field? These questions require detailed eth-
to be correlated with cognitive (e.g. mem- approach to conditions for access to DBS ical analysis and should receive answers
based on the bioethical principles of benef-
“Is there something intrinsically unethical about using DBS for icence—promoting well-being or benefit—
and Non-maleficence—refraining from
enhancement purposes with perfectly healthy, fully informed, harm. These questions must be thought
through and given serious ethical attention,
free, consenting subjects? Is there a risk that these novel tech- before applications for DBS can be approved
nologies may even transform the personal identity, or even the for use in healthy human subjects.
[ ]
3. Are patients who might be interested in
Given that every type of medical treatment DBS desperate, and in this state are they Frederic Gilbert, Ph.D.
aims to enhance or improve a patient’s likely to succumb to what is termed the Dalhousie University
quality of living, it follows that every treat- "therapeutic misconception" – the mis- Canada
ment is a form of enhancement. To speak conception that a treatment holds real fredericgilbertt@gmail.com
about the distinction between treatments promise of either a cure or substantial ther- www.noveltechethics.ca
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
Augmenting Mental
Models
By Egon L. van den Broek et al.
The complexity of conceptualizing mental models has made Virtual Reality
an interesting way to enhance communication and understanding between
individuals working together on a project or idea. Here, the authors discuss
practical applications of using VR for this purpose.
With recent technological developments, port education, improve training of skills, sions with other users. However, despite
Virtual Reality (VR) has become more and or enhance human communication. It is all technological developments, creating
more accessible for various application generally acknowledged that the interac- VR remains a complex and expensive
fields such as medicine, military, educa- tive characteristic and vivid imagery of business. For many companies the prac-
tion, and product design. The possibility VR improves the user’s subjective expe- tical implications of VR outweigh the
to interactively explore virtual worlds has rience, not only increasing learning per- practical benefits. Therefore, after decen-
become an important concept to sup- formance but also encouraging discus- nia of VR research, the question remains:
19
Figure 1: The application of VR to product design, using visual, auditory, and haptic modalities. Users can interactively test virtual
products (e.g., prototypes and concepts), even in the earliest stage of the design process. Moreover, multiple distinct scenarios can be
explored using the same VR setup.
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES Augmenting Mental Models
What benefits does VR provide that is are 3.memory processing via increased per- Team Work
not provided by other, less advanced tech- ceptual and motor processing in VR,
nologies? which facilitates the information storage When starting a project in which a new
in memory in a more accurate and com- team is formed, the members might have
To understand the benefits of low-fideli- plete manner than in other computer-me- different backgrounds, use their own jar-
ty VR for its users (e.g., see Figure 1), we diated environments. Thus, VR aids the gon, and adopt their own mental models,
must first understand the effect VR has generation of ideas or mental models. see Figures. 2 and 3. Communication
on human cognition. The main effect of might be difficult and miscommunication
VR on human cognitive processing is A mental model is a complex concept for and misunderstanding lie in wait. Having
three folded, as VR can augment users’: which a broad range of definitions have a shared mental model might prevent
been used. We define a mental model as these problems as it contains the under-
1. (multimodal) perceptual information the (partial) mental representation of the standing and/or the commonality of indi-
processing by presenting information via, dynamics of the external world. As such, vidual mental models (at least by a part
multimodal displays; e.g., large immer- mental models aid understanding, pro- of the group). Shared mental models are
sive visual displays that surround the vide explanations, and help predicting fu- created by shared experiences or shared
users. Moreover, unlike other computer- ture situations; see Figure 1 and 4. familiarization and/or by communication
mediated environments, VR provides the and negotiation. VR fully supports these
users with auditory, haptic, tactual, or In many application fields such as med- processes and is, therefore, considered an
even olfactory feedback, stimulating oth- icine, VR can improve mental models. important means in problem-solving and
er perceptual processes as well. However, people have mental models of decision-making processes.
almost everything in their environment
2. motor processing by facilitating the ranging from simple to complex items. Describing Abstract Concepts
users to perform natural interactions. Not Without aiming to present an exhaustive
only can users practice specific skills in list, we present three characteristics that VR is useful when abstract concepts are
VR, but also they can learn about the indicate the potentially added value of involved. It is easier to outline a mental
functionality of complex objects. VR in generating mental models: model of something when different chan-
nels of information can be used; i.e., the
20 principle of triangulation. Using solely
words to explain an abstract concept might
lead to different interpretations, as the in-
Figure 2: VR's vi- terpretation of these words depends on
sualization tech- individuals’ mental models. Using VR can
niques improves help avoiding these different interpreta-
the users' mental tions.
model of a prod-
uct in develop- Complex Environments
ment, improving
their understand- As already was denoted and is long known
ing of potential de- in psychology, people benefit from multi-
sign problems and modal information as opposed to uni-
solutions. modal information; see Figure 1. VR is per
definition multimodal and, as such, is par
excellence suitable in presenting informa-
tion, in particular complex information.
However, multimodal presentation of in-
formation has its downside. Humans are
Figure 3: Team mem-
very sensitive to asynchrone presentation
bers with different
of modalities. A latency of even 50 msec.
backgrounds and dif-
can cause a disturbance with the user, pos-
ferent mental models
sibly without that the user is consciously
can use VR to create
aware of it.
a shared mental mod-
el, which can be ben-
eficial when trying to In practice, these three characteristics are
make a decision. often intertwined. An example of an area
where these characteristics often come
together is risk management; i.e., the log-
ical and systematic identification, analy-
sis, treatment, and monitoring of the risks
involved in an activity. In short, risk man-
agement is providing decision support. In
general, crisis management involves i)
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
[ ]
relevant, mental models are hardly ever ap- tion in this article.
plied explicitly in VR studies and remain an
umbrella concept. Although touching upon
the essence of VR, for the time being, the
concept of mental models is bound to re- Egon L. van den Broek, Ph.D.
search and not applications. Par excellence, Frank Meijer, M.A.
Figure 4: Placing virtual products in a realis- University of Twente
VR can be utilized to explore people’s men-
tic context can further improve the users' Renske B. Landman, M.Sc.
tal models further as it facilitates multi-
mental model. ErgoS Engineering and Ergonomics
modal interaction; see Figures 1 and 4. Ex-
teamwork as various stakeholders partici- ploration of concepts and thoughts as well The Netherlands
pate; e.g., police, firemen, and healthcare as the communication of them with other
personal; ii) abstract concepts; e.g., people’s people is all supported by VR technology. vandenbroek@acm.org
experience with events; and iii) complex en- As such, VR is deemed to bring science a frankmeij@gmail.com
vironments; a crisis takes place under high- significant step further in understanding r.b.landman@alumnus.utwente.nl
ly dynamic, often hectic circumstances. and applying mental models in practice.
21
Put to the Test:
By Madeleine Grealy
“Brain Training”
Cognitive enhancers marketed in the form of “brain games” have
become increasingly popular in recent years. But the question
remains: Do they really work?
Earlier this year 11,430 healthy adults took or people who are experiencing age-relat- of recovery will occur during the first year
part in an experiment to test whether "brain ed cognitive decline are two likely groups or so after the injury has occurred. Howev-
training" using computerized games could of individuals who might benefit greatly er, during these early weeks and months fol-
improve reasoning, memory, planning, spa- from using VR to enhance, or prevent the lowing the injury, the patient is most likely
tial skills and attention. After six weeks of decline of, their cognitive powers. to experience high levels of fatigue, low lev-
training the results showed no evidence My own interest in this area is in helping els of concentration and low levels of acti-
that this type of "brain training" resulted in people with brain injuries to reach their op- vation. The last thing they feel like doing is
cognitive enhancement. This suggests that timum level of recovery. Following a brain engaging in cognitive rehabilitation tasks
using Virtual Reality (VR) to improve the injury there is a critical time during which such as trying to remember lists of words,
cognitive abilities of fit young adults is not the brain undergoes some regenerative plan a journey using a map or solve com-
likely to be successful, however, there are growth and reorganization. Whilst this crit- plex puzzles. Attention grabbing and engag-
many people in society for whom this may ical period will differ for each individual, it
not be the case. People with brain injuries is generally accepted that the greatest rates Continued on page 24
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
PRODUCT COMPARISON
MindFit interactive software program of exercises that boost cognitive skills: CogniFit Mind Fitness
short-term and location memory, attention, dual tasking, visual search, Solutions Ltd
time estimation, spatial orientation, planning and more
Brain Age: Train Your puzzle game for the handheld Nintendo DS system that presents quick Nintendo
Brain in Minutes a Day mental activities to stimulate your brain – "acts like a treadmill for
the mind" and "measures your brain's mental age"
Brain Fitness Program computer program consisting of six program mental exercises that Posit Science
trains your brain over a forty sessions
BrainBuilder PC Game "neurobic" computer-based training program that is designed to as- Advanced Brain
sess and develop auditory and visual sequential processing abilities Technologies
Captain's Log 33-program set of computerized exercises designed to improve atten- BrainTrain
22 tion skills, visual motor skills, conceptual skills, numeric concept with
memory skills, and higher level cognitive skills
Brain Fitness PC game 28 different exercises designed to improve logic, language, and at- Scientific Brain Training
tention skills
Buzz! Entertaining 16 fast-paced mini games designed for all ages within the four cate- Playstation
brain games for a cog- gories of analysis, operation, memory, and calculation, can include
nitive workout up to six players
MyBrainTrainer.com online Web site with paid membership login to access 10 different MyBrainTrainer, LLC
brain exercise games
The Listening Program eight 60-minute CDs with “psychoacoustically modified classical mu- Advanced Brain
sic” designed to improve listening, learning, and communication abil- Technologies
ities through plasticity
IQ Academy game for IQ Academy gauges the player’s performance in various tasks of recog- Upstart Games
mobile phone nition, logical prediction, and spatial resolution with puzzles. Multi-
ple choice game for the mobile phone
Mind WorkOut personal coaching kits on mental workouts for businesses designed Behavioral Coaching
Coaching kit to improve mental acuity Institute
BrainFit book book of games/brain teaser/mental exercises, weekly exercise plan- BrainFit
ners, lifestyle planner, anti-aging health tips and risk assessment
Games and brain online membership gives you access to over 20 games within the cat- Luminosity
assesment egories of speed, problem solving, attention, memory, and flexibili-
ty, offers feedback and tracking of improvement
PRODUCT COMPARISON
ing virtual environments on the other viewed journals and all of these reported all patients and specifically tailoring the
hand can be both motivational, enjoyable positive results for the use of VR interven- virtual environments to meet the individ-
and provide the required therapy in a man- tions. However, like Rose et al,. the authors ual needs of each patient seems the best
ner that is accessible to the patient. The noted a series of issues with many of these way to produce the most gains. The oth-
environments virtual nature means that studies which led them to be somewhat er big issue is in trying to have matched
it can be tailored to meet the individual’s cautious in drawing definitive conclusions. control groups for the purposes of com-
needs, and changed parison. Matching
as their rehabilitation “... VR holds great potential to enhance the cognitive capabili- for type of injury,
progresses. time since injury,
ties of people with brain injuries and hopefully as it becomes other aspects of
So is there compelling treatment, hospi-
evidence that VR can
easier for non-specialists to create and use VR technology, the tal/clinic experi-
assist in brain injury evidence base for its effectiveness will increase as will its avail- ence, age, gender
rehabilitation process- etc. is by no
es? Whilst the existing ability to all who could benefit from it.” means an easy
research studies sug- task, and those re-
gest that it might, it is still too early to tell Many studies suffer from small sample searchers who have tried to do this should
which executive functions can be im- sizes and not all have been able to adopt be commended for their efforts.
proved and the best way to do this. Pro- rigorous enough experimental designs to
fessor David Rose’s group at the Universi- be able to make comparisons between At present, we can only really speculate on
ty of East London have been very those who have received a VR interven- how VR rehabilitation programs influence
influential in this field, and in a review pa- tion and a control group who have not. the structure and function of the human
per in 2005 they described 101 studies These are fair criticisms but in defense of brain, but as brain scanning technologies
that have been concerned with using VR many of the researchers working in this improve we are moving towards more so-
to assist in the assessment and rehabilita- area, it is worth noting that this is still a phisticated ways of determining this. Un-
tion of brain injured patients abilities to new field of research and conducting large doubtedly though, VR holds great poten-
plan, form strategies, memorize and per- robust studies is not at all easy. There are tial to enhance the cognitive capabilities
24 form spatial orientation tests. They con- many things to consider. First, there is the of people with brain injuries and hopeful-
cluded that there are many promising type of VR experience that the patient ly as it becomes easier for non-specialists
signs that VR can enhance cognition dur- should receive. The use of immersive dis- to create and use VR technology, the evi-
ing brain injury rehabilitation, but there plays seems favorable but this has to be dence base for its effectiveness will in-
are still many challenges that have to be counteracted by the potential adverse ef- crease as will its availability to all who could
overcome before "VR rehab" becomes fects of using immersive VR, particularly benefit from it.
widely available. By far the most common head-mounted displays. The second issue
[ ]
brain injury is caused by stroke and in 2007 concerns the content of the VR task, that
Dr. Jacqui Crosbie and colleagues from the is what the person is asked to do. For the
University of Ulster also published a re- purposes of designing a research study it Madeleine Grealy, Ph.D.
view which looked at the VR intervention is better that every participant receives the University of Strathclyde
studies that have been conducted for same type of intervention, but in reality it U.K.
stroke rehabilitation. They found 11 stud- is unlikely that one VR memory task or m.grealy@strath.ac.uk
ies which had been published in peer-re- one VR planning task will be suitable for
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES
importance of physical exercise, social in- forum for real time social interaction (e.g. it is high time to make serious in-roads
[ ]
teraction and multi-sensory information Second life). into this area of research.
on the recovery of both motor and cogni-
tive functions in addition to cerebral reor- Using VR to enrich the environments of
ganization. As a brief glance through any people with brain damage is a topic far Paul Penn, Ph.D.
VR related publication will attest, the char- too large to entertain fully in this article. David Rose, Ph.D.
acteristics of VR are amenable to creating However, it is fair to say that enriched vir- University of East London
a diverse range of virtual environments tual environments in neuropsychological U.K.
highly relevant to patients’ daily lives. The rehabilitation hold the promise of enhanc-
characteristics can be orientated to sup- ing recovery from brain damage at very p.r.penn@uel.ac.uk
port exercise programs, utilize several sen- little financial cost and with minimal risk. f.d.rose@uel.ac.uk
sory modalities, provide automated rudi- This idea was originally proposed over a www.uel.ac.uk/psychology/re-
mentary social interaction, or serve as a decade ago - the authors would argue that search
were found to have a larger cortex, more ulation, socialization and brain health Neural Energies for Health of the Human
synaptic connections, and even new brain in humans. This parallels the same find- Brain
cells (neurogenesis) in their hippocampus ing in animal brains. In addition, hu-
as measured at autopsy. This was in com- mans who reduce stress and eat brain As the human brain is the single greatest
parison to rodents raised in unenriched en- healthy foods derive additional benefit and most complicated system ever de-
vironments. These scientists, including Mar- to the function and even structure of signed it is safe to presume we do not yet
ion Diamond, defined the enriched their brains. I have put together a proac- understand its full potential. The brain is
environment as having other animals to in- tive and comprehensive brain health a chemical and electrical source of ener-
teract with, having a running wheel to exer- lifestyle ™ that has been published for gy that can be tapped. Neural Energies
cise, and having toys to play with. These the general public. Our approach to refers to the energy of the human brain
three factors were not present in the unen- health needs to be proactive and this is being used to affect matter within and ex-
riched environment. I have characterized particularly true for the human brain. ternal to the human body. This is perhaps
these three factors as “socialization, physi- As we are now fully engaged in a tech- the most salient example of “CyberTher-
apy” as it does not entail any external or
“Our brains are shaped by technology and internal human-based instrumentation.
It reflects a more advanced process that
indeed, our brains shape the latest technologi- uses the brain’s energy to shape a partic-
ular condition towards health and to or-
cal trends. Too much stimulation can be dam- chestrate the implementation of the
aging while proper use of technology with prop- body’s natural defenses against disease.
The same sources of energy should also
er content can be health promoting. This is the be able to shape outcomes outside of the
body.
fine balance that is not yet a science and is
28 most likely subjective or idiosyncratic.” Current therapies that utilize primitive
examples of neural energy include neu-
rofeedback to help create internal home-
cal activity, and mental stimulation” respec- nology-based environment we need to ostasis, EMDR that helps with anxiety and
tively. This work helped to reinforce the idea pay attention to the types and utiliza- posttraumatic stress disorder, visualiza-
that environment shapes the structure and tion of technology as one part of the en- tion, and even using the electrical ener-
function of the animal brain and can help vironmental-brain shaping process. This gy of thought to transmit to computers
the animal brain generate new brain cells is true within and outside of the med- for purposes of communication in pa-
in a region critical to learning and memory. ical field. tients who are paralyzed. This represents
an entirely new arena for study and ap-
Neurogenesis in the animal brain is a given Our brains are shaped by technology and plication that relies on harnessing the
with substantial research to support the sen- indeed, our brains shape the latest tech- power of the human brain. Mental focus,
sitivity of the hippocampus for new brain nological trends. Too much stimulation visualization, telepathy, and control of in-
cell development. Support for human neu- can be damaging while proper use of ternal body function represent a most ad-
rogenesis was lacking until Eriksson and col- technology with proper content can be vanced use of technology to health. In
leagues reported similar sensitivity in the health promoting. This is the fine bal- this case, however, the technology is the
human hippocampus in 1998. This finding ance that is not yet a science and is most two to four pound miracle that is com-
revolutionized thinking on the human brain likely subjective or idiosyncratic. Chil- prised of nearly 60% fat and demands
and directly challenged the traditional ideas dren text as a primary means of commu- 25% of the blood from each heartbeat,
about human brain function and its limita- nication and this behavior will likely the human brain.
tions. Neurogenesis is one product of a brain shape their brains in different ways than
[ ]
that has plasticity and prompts the ques- their parents and grandparents who did
tion “does environment shape the human not use such technology for such pur-
brain and can the human brain be shaped poses. Negative and violent imagery can Paul D. Nussbaum, Ph.D.
for health?” affect the emotional and sometimes the University of Pittsburgh School
behavioral status of the human brain. of Medicine
Brain Health Promotion The critical issue for medicine and for U.S.A.
health is “what are the types of environ-
drnuss@zoominternet.net
Research has demonstrated robust sup- mental shaping that can best promote www.paulnussbaum.com
port for physical exercise, mental stim- the health of the human brain?”
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
Seniors Cybercycling
for Enhanced Cognitive
Performance
By Cay Anderson-Hanley & Paul Arciero
“... one of the most widely recognized and cost-effective strategies for
preserving quality of life into old age is exercise, but this is often neg-
lected or underutilized as a strategy ... exercise is linked to cognitive
enhancement, brain health, and even neurogenesis.”
The graying of America will lead to an explosion
of the older adult population as the baby boomers
Figures:
29
begin to reach retirement age in 2011. This
Year 2 –
changing demographic will bring increased chal-
Expresso
lenges for this segment of the population and
integrated and
society as a whole, as the number of persons with
interactive re-
cognitive compromise will begin to increase dra-
cumbent bike
matically. While cognitive decline is not automat-
system
ic with aging, the rate of dementia increases sig-
nificantly around retirement age, and rises
exponentially after age 80.
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES Cycling for Enhanced Cognition
ety of barriers to exercise behaviors, rang- the equipment, riders may also be able to their physical and mental state, including
ing from costs and location, to lack of self- compete in real time with another live rid- tests of muscle, bone, and blood, as well as
efficacy, discomfort and boredom. With the er or team of riders. Initially, we piloted the neuropsychological tests of thinking
advent of virtual reality technologies, inno- FitClub interactive system, but our older processes such as executive functions,
vative equipment has been developed that adult sample required a walk-through bike, memory, and attention. Preliminary results
has the potential to address some of these where they would not have to lift a leg over from year 1 were presented in 2009 at the
barriers. In particular, being able to explore a center bar. In year 1 of the study, we uti- annual meeting of the Society of Behav-
a variety of 3D terrains while exercising can lized Netathalon's interactive riding soft- ioral Medicine in Montreal, and suggest sig-
address boredom, and competing with ware on a laptop connected to a recum- nificant cognitive, behavioral and physio-
avatars on the screen can distract one from bent bike. Due to challenges mousing and logical changes. We are awaiting results
the discomforts of exercise. navigating on the laptop for some novice from the complete sample to confirm the
computer users, in year 2 of the study we apparent cognitive benefits of cybercycling
In 2008, with a grant from the Pioneer Port- switched to Expresso’s fully integrated re- over and above standard static cycling. The
folio of the Robert Wood Johnson Founda- cumbent bike. implications of this line of research are ex-
tion, through the Health Games Research citing, since the potential is there for cy-
national program, the Neuropsychology We are in the process of completing the bercycling to increase exercise among the
Lab at Union College teamed up with the second year of the randomized clinical tri- aging population and lead to cognitive en-
Exercise Science Lab at Skidmore College al, examining the cognitive, physiological, hancement along with many other known
to investigate the effectiveness of “cyber- and behavioral effects of cybercycling for benefits of exercise.
cycling” for seniors. The cybercycle con- seniors. Participants exercised three to five
[ ]
sists of a stationary bike, paired with a com- times week for three months, and were ran-
puter such that videogame features domly assigned to either ride the cybercy-
become interactive with the pedaling and cle or a traditional stationary bike. Approx- Anderson-Hanley, Ph.D.
Union College
30 steering components of the bike. Riders imately 100 independent living seniors
Paul Arciero, D.P.E.
can experience virtual 3D tours of various were enrolled in the study over two years,
Skidmore College
landscapes including oceanside bikeways, and approximately 60 participants com- U.S.A.
forested trails, and desert pathways; and pleted the three-month exercise interven-
riders can also compete (or not) with oth- tion and pre- and post-evaluations. Partic- andersoc@union.edu
er avatars on the screen. Depending upon ipants completed full day evaluations of
Integrative Rehabilitation
through Gaming By Kanav Kahol et al.
Integrative Therapy: Combining of patients, and train the patients to per- link some of the complex activities, severe-
Different Modalities to Offer Com- form these individual activities. This ap- ly impedes patients’ motivation and may
prehensive Rehabilitation proach has been very successful in the past be an important reason for a decline in
few decades and has been supported by compliance.
Traditionally, rehabilitation therapy has third party payers. However, there is a lack
been based on a deconstructionist ap- of therapy that trains patients to combine Studies have consistently shown that most
proach wherein complex activities in dai- these individual modular activities into patients do not complete their therapy due
ly life have been divided into simpler units complex activities. Patients are expected to a lack of engagement and feedback [Task
of activities. This division process allows to naturally achieve this combination Force Traumatic Brain Injury 2007]. Re-
therapists to focus on individual move- through self-practice. Yet lack of actual feed- search has shown that technology - such
ments and activities, measure the progress back on completed skills and the ability to as Virtual Reality (VR) and imaging systems
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES Interactive Rehab through Gaming
[ ]
and then move in a counter clockwise or a single unit. This system is analogous to and rehabilitation.
clockwise manner through the different ex- circuit training, but with persuasive ele-
ercises. LCD screens (46 inches full HD) give ments to encourage exercises and meas-
users visual feedback on their performance ure cross-platform and cross-therapy profi- Kanav Kahol, Ph.D.
by providing a persuasive game scenario. ciency of the patient. Camilla Nørgaard Jensen
Arizona State University
In this prototype, every exercise can be vi-
Marshall L. Smith
sualized as a stage of a game where the sto- Conclusions
Suzanne Dilli, M.S., P.T.
ry of the game links all the activities in a Kelly Johnson, P.T.
single cohesive unit. Sensors on the patient A user-centered, integrative gaming thera- Banner Good Samaritan
or exercise equipment help record move- py system design is proposed. The system Medical Center
ment and drive the games. An important addresses a void in modern-day therapy by U.S.A.
design choice was that the transitions be- using games and Virtual Reality as a basis Kanav.Kahol@asu.edu
tween exercises would actually provide an to provide a means to offer comprehensive
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
[ ]
One such effective training paradigm in sen- efits of the training. It is also important to have
ior adults has been real-time strategy a more appropriate control group that would Chandramallika Basak, Ph.D.
videogame training. In a recent study by Basak, receive the same hours of training in another Rice University
Boot, Voss and Kramer (2008), we trained old- set of skills, under similar social interaction, so U.S.A.
er adults age 65 or older in a real-time strate- that video game training related changes are
gy video game for about 24 hours. We collect- not merely attributable to interaction with the Chandramallika.Basak@rice.edu
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES
[ ]
hospitalizations due to illness or injury. How- or follow through beyond the rehabilitation
ever, there is minimal infrastructure and period.
personnel to adequately disseminate these Tiffany E. Shubert, Ph.D., P.T.
programs for the greatest impact on the in- In order for older adults to successfully Center for Aging and Health
dividual and community health. Institute on Aging
change behavior, they must have support
UNC Chapel Hill
and guidance for an extended period of
U.S.A.
Gaming may be a viable health promotion time. Studies show that 12 – 24 week in-
dissemination mechanism for older adults. terventions are the most effective for long tiffany@shubertconsulting.net
The unanticipated phenomenon of the pop- term change. Physical therapy rarely lasts
Join
Join tthe
he iiACToR
iACT
ACTo
ToR
Ning
N i n g Network
Network
J o i n t h e i A C To R o n l i n e c o m m u n i t y b y c re a t i n g y o u r p ro f i l e a n d
j o i n i n g t h e d i s c u ss i o n b e t w e e n e m i n e n t ex p e r t s i n t h e f i e l d t o d a y.
P l u s g e t a cce ss to t h e o f f i c i a l j o u r n a l a n d o f f i c i a l vo i ce o f t h e
a ss o c i a t i o n , t h e J o u r n a l o f C y b e r T h e ra p y & R e h a b i l i ta t i o n a n d
CyberTherapy & Rehabilitation Magazine!
http://iactor.ning.com
h t t p : / / i a c t o r. n i n g . c o m
B E C O M E A P R E M I U M M E M B E R O F iACTo R
re c e i v e d i s c o u n t e d m e m b e r s h i p t o a f f i l i a t e d
c o n f e re n c e s , a s s o c i a t i o n s a n d s o c i e t i e s
D I S C U S S , S H A R E A N D C O L L A B O R AT E
fa c i l i t a t e i m p o r t a n t d i a lo g u e a b o u t t r a n s fo r m i n g
h e a l t h c a re t h ro u g h t e c h n o l o g y f o r f re e
R E C E I V E T H E W E E K LY N E W S L E T T E R
be updated on the latest news and events
ACROSS THE POND:
“Don’t Mess With Mother Nature”: Evaluating the
Moral Opposition to Cognitive Enhancement
tive enhancements”—so called because they be made against these activities (i.e., cognitive
By John Banja ramp up one’s “normal” baseline quality of enhancements)…we sense that it may have
cognitive functioning as opposed to improv- something to do with what is natural, or what
Various surveys in- ing an injured or diseased brain’s impaired is humanly dignified, or with the attitude that
dicate that between functioning. The first argument concerns harm is properly respectful of what is naturally and
four to more than – some of these drugs can cause agitation, dignifiedly human.”
35% of American headaches or sleeplessness. After prolonged
college students ad- use, they can flatten one’s affect such that Kass argues that these “artificial”cognitive en-
mit to using drugs some users have described themselves as hancements disrespect the “special gift that is
like Adderall and Ri- “zombies”when coming off them. Some drugs our own given nature;”that they are a form of
talin to improve can also be habit forming such that when users cheating in giving us abilities that are unde-
their concentration, try to quit, they find they can no longer toler- served given how they were acquired; that they
memory, and mental stamina. Jet-lagged sales ate their previous, foggy-headed mental state show disdain for the importance of discipline,
managers who go straight from the airport to or their depressingly uninteresting or with- hard work, and even pain and suffering in
36 their sales meetings might take a drug like drawn selves. achieving superior performance; and that they
Provigil to rid themselves of their mental fog, render us less humble in the presence of the
while the Air Force makes Provigil available to The second argument is fear of coercion. If Creator’s design of human functioning, which
pilots, especially ones flying long missions. A an individual resists taking these drugs but does not contemplate a “brain on steroids.”
“transcranial magnetic stimulator,”which looks fears being penalized
like a halo and is placed on one’s scalp to stim- because his or her “...we shouldn’t be wary of [cognitive enhancing
ulate certain brain regions, has been used to performance will interventions and technologies] because they threat-
help persons suffering from depression, Parkin- compare poorly to en human dignity. Indeed, they might ultimately pro-
son’s disease, and auditory hallucinations from competitors who are mote it or at least better clarify what we mean by it.”
schizophrenia. It is also known, however, to using them, he or
improve drawing, proofreading, and memory she might feel enormous pressure to take Because I have no quarrel with the first three
among “normals.” them. This is probably not dissimilar to the arguments above, I want to spend the remain-
problem of steroid use in athletics. der of this essay discussing what we are to make
Many individuals regard drugs like the selec- of this last one. It continues to be a prominent
tive serotonin re-uptake inhibitors as cogni- A third argument is equal access. Even if these argument among “moral conservatives” and
tive enhancers because of their sometimes drugs prove relatively harmless and effective, extends to virtually all kinds of biotechnolo-
remarkable effect on improving mood and re- will only certain individuals have access to gy—involving not just cognitive enhancement
mediating undesirable personality traits like them? Will we have a two-tiered society where- but research on reproduction, stem cell re-
shyness or social awkwardness. Psychiatrist in one group’s members are cognitively ro- search, and other neurotechnologies—that
Peter Kramer tells numerous stories in his mar- bust, vital, and high-performing, while the oth- might tamper with “the special gift that is our
velous book Listening to Prozac about patients er is depressingly average? own given nature.” How seriously, given the
who, once they begin experiencing the bene- democratic, ethically pluralistic values that char-
fits of these mood and personality brighten- Yet a fourth kind of argument that opposes acterize America, should an “argument from
ers, beg him to continue their prescriptions as cognitive enhancement was strongly advanced nature and human dignity” be taken?
they can’t stand the thought of returning to during George W. Bush’s administration by
“being the person I once was.” some members of his President’s Council on Assessing the Argument from Nature and
Bioethics. Leon Kass, the chair of Bush’s first Human Dignity
Now, there are at least three practical reasons bioethics council from 2001-2005, believed
or arguments that should give us pause about that the three arguments above missed what Despite this argument’s appeal and populari-
categorically endorsing these kinds of “cogni- is really at stake and said, “If there is a case to ty, many individuals such as myself find it very
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
ACROSS THE POND
flawed. First of all, “Nature”—understood as ferent conceptions of dignity and its accompa- respecting others’ rights seems much more
a world of unadulterated biological, physical, nying connotations. The idea that there is some normatively concrete and helpful.
geological, meteorological, and cosmological absolute, eternally true or correct representa-
phenomena—presents us with what exists, not tion of dignity that is not the product of some Last, and perhaps most obviously, objecting to
with what should exist. For every item in the culture seems wildly wrong. Indeed, why even cognitive enhancement on the grounds that
natural world at which we marvel and might insist that dignity be the primary principle or someone or some group’s idea of dignity is in-
want to recommend as a morally right and value that morally grounds and restrains cogni- sulted runs afoul of the traditional rights-based
compelling example—animals caring for their tive enhancement research and use? Why not conception of our moral obligations and norms.
young, say—there is another natural phenom- choose human flourishing, creativity, or efficien- I am obliged to respect your liberties and free-
enon that is horrifying and abhorrent—such cy as our primary goal or human purpose? doms; I cannot harm you without compelling
as natural predators looking to feast off those justification; and I should treat everyone I meet
animals and their offspring. Second, while appeals to human dignity might with a reasonable degree of fairness and just-
sound ennobling, “dignity” in and by itself of- ness (although I might be even more obligat-
Proponents of the argument from nature know ten fails to give us explicit moral direction. For ed towards special individuals, such as my fam-
this, and so they focus on a particular manifes- example, does the jet-lagged sales manager im- ily or professional clients). On the other hand,
tation of nature which, they believe, offers up pugn human dignity when he takes a Provigil denying individuals the right to cognitive en-
compelling moral rules and prescriptions: hu- to be at his best (or even better) for his sales hancement because it is “ignoble,” or would
man nature. Thus, philosophers like Kass make meeting? Does the college student who opts make them “less humble,”or that it would “un-
numerous appeals to certain characteristics and for some Adderall rather than multiple help- dermine the highest and richest possibilities”
traits of human beings, especially those bear- ings of espresso during finals similarly violate of their lives sounds hopelessly dogmatic, vague
ing on human dignity,that they believe embody dignity? Invoking “dignity” isn’t necessarily and undemocratic.
undeniable and inviolable moral truths. For ex- morally informative because different people,
ample, Kass fears that the use of cognitive en- each of whom is morally respectable and de- We should be careful about cognitive enhanc-
hancements will replace humility with arrogance cent, can disagree on what dignity demands in ing interventions and technologies because 37
and incline us towards what is “ignoble;” that any given situation. they might turn out to be harmful, or encour-
cognitive enhancement would “undermine the age coercion, or produce unfairness. But we
highest and richest possibilities of human life”— Third and somewhat related to the last point, shouldn’t be wary of them because they threat-
indeed, would undermine “what it means to be some philosophers believe that dignity is a use- en human dignity. Indeed, they might ultimate-
a human being”—and that cognitive enhance- less concept. What does “acting with dignity” ly promote it or at least better clarify what we
ment would dismiss the normal exercise of hard add to the idea that we should respect one an- mean by it.
work, diligence, perseverance, and suffering in other, not harm one another, and treat one an-
[ ]
the pursuit of human excellence. other fairly and with civility? How many of us
walk into our offices thinking, “Today, I must John D. Banja, Ph.D.
For many individuals, this kind of language has respect everyone’s dignity.”? Very few, one sus- Emory University
U.S.A.
enormous intuitive appeal, and that’s the prob- pects, largely because “dignity”sounds too ab-
jbanja@emory.edu
lem. Different cultures might have radically dif- stract and vague, while acting courteously and
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FURTHER AFIELD
netic properties of the oxygen-carrying hemo- ing, Neuroeconomics and Neuroforensics are light up more as a wine's price increases (even
globin in the blood change. The fMRI receives also endless and only the tip of the iceberg has if the taste of the wine stays the same), and the
and interprets this information and transmits been studied. brains of meditating monks show little change,
it into a running map of the areas of strong oxy- since they exercise greater control over their
gen-carrying blood flow and brain activity. So, Neuromarketing: Coke or Pepsi? frontal lobes. Functional MRI has begun to con-
if a person responds to a stimulus in a certain tribute to many psychological areas. For exam-
way, scientists can see which part of the brain Several commercial businesses have been uti- ple, a study on weight loss has shown that those
is firing, thus “reading” his or her mind. lizing the powers of fMRI technology to gauge with greater success in weight loss programs
consumer preferences. Known as “neuromar- can attribute their weight loss to greater inhibito-
Various studies have been undertaken to test keting,”the use of neuroscience and clinical psy- ry control in response to images of food when
the extent of this “mind reading” technology. chology for commercial gains has become a scanned with fMRI. At the other end of the spec-
Neuroscientists in China were able to identify more and more popular application. To gain the trum, fMRI has been used to locate biomark-
seven years ago that the GO game player, a tra- powers of persuasion through advertising, neu- ers in the brains of soldiers with posttraumat-
ditional Chinese strategy board game, indicat- romarketing has proven to be an influential tool. ic stress disorder.
ed a stronger activation in the right parietal area A study of the Brain Sciences Institute propos-
of the brain, which contrasts the heavy use of es that successful advertising does indeed cause fMRI has already proven to be an extraordi-
the left side in similar games such as chess .One consumers to be more emotionally engaged as nary tool that few would have predicted to ar-
study aimed to predict a patient’s intention to well as more likely to remember the product. rive so soon. The prospect of a machine capa-
either add or subtract two numbers. Using fMRI Another study conducted at Baylor College of ble of reading minds, peering into unconscious
scans, they were able to correctly predict his in- Medicine suggests that neuromarketing may thoughts and reading a state of consciousness
tention 71% of the time. Although showing a be part of the reason why people buy Coke when that is hidden even to the people themselves,
percentage notably higher than the fifty-fifty of they prefer the taste of Pepsi. Even though neu- will provide not only countless implementa-
an uneducated guess, this study is a clear inter- romarketing can result in increased sales and tions and applications but many ethical chal-
38 pretation of the early stages of fMRI applica- better product design by matching consumer lenges as well. The technology is still limited
tions of mind reading. Another study published preferences, this interdisciplinary field is still and as it develops, so must society. There
in Nature presented a set of 1,750 images to young and only a few businesses have incorpo- should be no surprise that in the next decade,
patients, measuring the activity in specific ar- rated it into their advertising campaigns. this “mind reader” will be used wildly in East
eas of the visual cortex of the brain. Then, one- Asia. Better tell those fortunetellers to look for
by-one, each image was presented to the pa- Secrets of Weight Loss? new jobs.
tients, and the scientists were able to determine
[ ]
which image was being shown. Other studies In recent years, functional neuroimaging re-
have ventured into emotions and personality, search has yielded a wealth of intriguing fod- Lingjun Kong, PMP
testing patients’ responses to virtual reality sit- der for journalists but few scientific break- Virtual Reality Medical Center
uations that would invoke stress or pleasure. throughs. We've learned, for instance, the U.S.A.
Not only in the medical field, the possibilities nucleus accumbens brain regions light up when lkong@vrphobia.com
www.vrphobia.com
of fMRI scanning at the areas of Neuromarket- we fall in love, our reward centers of the brain
Telehealth is the use of telecommunica- intervention, and follow-up programs to opened up a blend of possibilities for this
tions services to deliver healthcare-related ensure maintenance of treatment effects. approach. Medical professionals can now
services and information, including (but In past decades, the increasing diffusion of communicate with patients utilizing chat,
not limited to) consultation, assessment, the Internet and related online tools has e-mail and videoconference systems, in ad-
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES Multiplayer Games in Telehealth
support for this idea. In one such study, tive filtering and contingency manage- skills. They enter the virtual world to
Bente and colleagues investigated the ment systems.” learn to socialize, work as a team, and
experience of "social presence" as a rel- learn essential computer skills. The suc-
evant effect dimension of avatar-medi- Existing Applications of MMOGs in cess of these virtual communities proves
ated net-communication. In this re- Telehealth the potentiality of MMOGs in becom-
search, 142 participants were randomly ing very useful tools for an innovative
assigned to one of five possible com- The Brain Talk Industries have created form of telehealth.
munication settings–text only, audio a number of online communities and
only, audio and video, audio and low fi- forums to support people affected by In addition to these existing mental
delity avatar, audio and high fidelity specific physical and mental disabilities. health programs, we can envision a pos-
avatar. Results revealed a significant dif- An example is the Brigadoon, a private sible therapeutic application scenario
ference between text and all other com- island created in Second Life specifical- of MMOGs consisting of group therapy
munication modes, indicating that au- ly designed for patients with Asperger’s sessions performed in private areas. Af-
dio, video and avatar systems work Syndrome, a form of Autism character- ter a number of face-to-face sessions
similarly and better than text alone in ized by enormous difficulties in social in which the therapist meets the pa-
creating an experience of social pres- interactions. Brigadoon is meant to tient in order to make a diagnosis and
ence. However, according to the au- serve as an ideal place for these patients to analyze his or her needs, the thera-
thors, avatar platforms offer new pos- to develop social abilities and interac- pist can decide if the patient is suitable
sibilities to overcome many restrictions tions with other people dealing with the for on-line group therapy. If this is the
related to audio and video communi- same problems. A similar aim has guid- case, the patient will receive instruc-
cation modes. In particular, they sug- ed the creation of Live2Give, another tions on how to enter into the virtual
gest that, “Virtual worlds and avatars place in Second Life dedicated to peo- space with a personal identification
could be seen more as a means to con- ple affected by cerebral palsy. Like code. In order to guarantee privacy, only
textualize social interaction and to fos- Brigadoon, this virtual world brings peo- persons with a personal code will be
40 ter the salience of nonverbal informa- ple together giving them the possibili- admitted to the therapy rooms. Differ-
tion, rather than just to provide high ties to help each other in their similar ent therapy rooms will be created on
fidelity transmission channels for visu- struggles. Similarly, a British organiza- the basis of the needs of different cat-
al cues. They are in this sense not just tion called ARCI has developed a virtu- egories of patients and the access will
virtual equivalents of a video confer- al environment in Second Life to help be restricted only to those patients with
encing system but a possibility for ac- abused children learn important life a specific diagnosis. Various environ-
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
ments can be created for each category of just theoretical information in a virtual ening aspects of reality in a “safe” environ-
of patients, such as, for example, learning environment in which they have the pos- ment, it also true that if the use of MMOGs
areas, discussion areas and experience- sibility to meet other users, socialize, par- becomes excessive, it could present a risk
oriented areas. Learning areas use moti- ticipate in group activities and practice new of preventing people from forming mean-
vation provided by the virtual worlds to abilities. Since MMOGs are closed worlds ingful relationships in the real world. As ob-
that do not served by Dr. Sara E. Allison, M.D., from the
reflect the Menninger Department of Psychiatry and
real status Behavioral Sciences, Baylor College of Med-
of the users, icine in Houston, TX, an “increased substi-
during their tution of cyberspace-based personas and
presence in relationships at the expense of face-to-face
the virtual interaction may create a developmental
worlds pa- double-edged sword. The Internet may pro-
tients could vide a socially -anxious patient the oppor-
be instruct- tunity for modified peer group interactions,
ed to use yet it does little to foster the development
various bio of genuine intimacy.” When exposing pa-
and activity tients to virtual environments, therapists
sensors in should consider the risk of game addiction
order to ob- and also encourage their patients to par-
tain real- ticipate in real life social interaction as
Figure 4: time moni- much as possible.
The typical
MMOG interaction.
toring of
their health Regarding therapists, as for any other type 41
status and of domain of practice, it is very important
feedback that they first conduct a self-assessment
that can in- and then enhance their knowledge and
teach the users how to manage the criti- fluence their own experience. At the same skills in using these alternative forms of
cal aspects of their experience through time, the use of biosensors allows the ther- therapy, since the provision of telehealth
slides and film presentation, both with apist to monitor, at distance, the outcome services is not simply a click of the mouse
and without teachers (Figure 1). of the virtual experience. This nor is it fraught with pitfalls and malprac-
approach–usually defined "interreality" tice suits. Most MMOGs have open access,
Discussion areas allow patients to talk and actually explored by the European meaning that it may be difficult to create
about their problems and share experi- funded project "Interstress" (http://www.in- safe therapeutic environments in which
ences with others, with or without the su- terstress.eu)–can provide the following ad- patients can interact with therapists with-
pervision of an expert (see Figure 2). vantages–the outcome obtained from the out external interferences and with priva-
virtual experience can be transferred to cy protection.
Finally, experience-oriented areas will serve the real world and vice versa and the so-
to practice both emotional and relational cial links created in the virtual environ- In sum, the possibilities of using MMOGs
reactions, using the feeling of presence pro- ments can be continued in the real world, as an advanced form of telehealth are quite
vided by the virtual experience, as well as even without revealing the user’s identity promising as long as their limitations and
general decision-making and problem-solv- (for example, by using SMS or e-mail to dangers are taken into consideration as
ing skills through the presentation of crit- communicate or ask support from a virtu- well. Further research is needed in order
ical situations related to the different al friend). to understand the real added value of this
pathologies (Figure 3). Free access to an emerging technology.
electronic library with books on specific Some Important Issues in the Use of
[ ]
arguments will also be provided for sub- MMMOGs in Telehealth
jects in order to extend their theoretical Andrea Gaggioli, Ph.D.
knowledge at any time. Although the therapeutic possibilities of Alessandra Gorini, Ph.D.
online games are quite promising, the prob- Giuseppe Riva, Ph.D.
The main advantage of this MMOGs-based lems that could arise with such a kind of Istituto Auxlogico Italiano
therapeutic scenario is to provide patients therapy should not be overlooked. In fact, Italy
andrea.gaggioli@unicatt.it
with live meaningful experiences instead if it is true that people can explore threat-
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
> COUNTRY FOCUS
C&R in Austria
[ ]
AUTHOR: Austria has a long, rich history of innovation in mental
Christina Valenti health, with scientists like Sigmund Freud, Alfred Adler,
Editorial Department
C&R Magazine and Otto Rank laying the foundation for the world of
www.vrphobia.eu psychology. Now, over half a century later, Austria
cvalenti@vrphobia.com
remains one of the top contenders in the world of
mental healthcare.
44
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
> COUNTRY FOCUS
years, and more than 90% were held in- ropsychiatry was also divided into two As a global leader in biotechnology, Aus-
voluntarily. d i f fe re n t s p e c i a l t i e s , n e u ro l o g y a n d tria’s technological advancements and
psychiatry, and new professions such biomedical research have facilitated
The second tier was made up of a few as clinical psychology and psychother- mental health treatment.
dozen “neuropsychiatrists” running solo apy emerged.
practices, treating both neurological and In 1997, Austria’s largest hospital, AKH
psychiatric outpatients. Little commu- These changes addressed issues that of Vienna, purchased a ROBODOC Sur-
nication between the two tiers was only were overlooked by the previous two - gical Assistant System. ROBODOC is a
one problem that this system faced. A tier system. For example, suicide rates robot that is used by orthopedic and
new system was needed in order to keep noticeably decreased since the adoption trauma surgeons to accurately assist
up with the increasing number of peo- of this new system. This was partly due with surgery.
ple affected by mental disorders in the to the improved structure for the early
rapidly changing industrial world. recognition of mental disorders, as well Austria has also built up a strong repu-
as greater attention to problems in the tation of high quality medical care along
Re fo r m s i n a l l n i n e p ro v i n ce s w e re workplace, attempts to anti-stigmatize with excellent patient care. In 2007, the
swif tly underway. Presently, they em- mental disorders and making access to European Health Consumer Index ranked
b ra ce a m o re co m m u n i t y - b a s e d s y s - help more available. Austrian healthcare at number one, and
tem. The prominent large hospitals in 2008, it was listed among the top
were replaced by over 40 smaller psy- Technology as a Tool for Reform three most consumer friendly health-
chiatric in- and day-patient facilities. care systems in Europe. To obtain such
Under the funding of so cial security, Reforming the healthcare system is not a high rank, Austria ensures short wait-
other similar services were established, the only way that Austria has chosen to ing times for doctor consultations and
such as residential facilities, day struc- help improve mental health within their surgery wait lists, as well as direct access
tures, and ambulatory care units. Neu- country and throughout the world. to doctors. Austria’s dedication to pa-
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
> COUNTRY FOCUS
6IR
TUA
L
2EA
LI
TY
AND
!NXI
ETY
$I
SOR
DERS
INCL
UDING
PHOBI
AS
AND
PANI
C
DI
SOR
DER
6IR
TUA
L
2EA
LI
TY
AND
0OS
TTR
AUMATI
C
3T
RESS
$IS
ORDER
6IR
TUA
L
2EA
LI
TY
AND
0AI
N
-A NA
GEMENT
7E
ARE
AL
SO
PLE
ASED
TO
OFF
ER
62
THERAPY
T
RAI
NI
NG F
OR
T
HERAPI
STS
I
NTER
EST
ED I
N L
EAR
NING
T
O
INCOR
PORA
TE
62 I
NTO
THE
IR
EX
IST
ING
PRACT
ICE
S
#ORNERST
ONE
#OUR
T
%AS
T
3UITE
3AN
$IEGO
#!
F
RONTOF
FI
CEV R
PHOBI
A
COM
WWW I
NTER
ACTI
VEMEDI
AI
NST
IT
UTE
COM
subscribe to the Journal of
Cybertherapy & rehabilitation (JCr)
What is the JCr?
The JCR is a scientific, peer-reviewed journal that allows subscribers to take advantage of a growing quantity and quality of
research by academicians, researchers, and clinicians in the expanding field of virtual reality and advanced technologies in thera-
py, training, prevention, education, and rehabilitation. Our main focus includes, but is not limited to, psychiatry, psychology, phys-
ical medicine and rehabilitation, neurology, occupational therapy, physical therapy, cognitive rehabilitation, neurology, occupation-
al therapy, neurorehabilitation, oncology, obesity, eating disorders, and autism, among many others.
JCR is the official journal of the International Association of CyberPsychology, Training & Rehabilitation (iACToR). Its mission
is to explore the uses of advanced technologies for education, training, prevention, therapy, and rehabilitation.
Payment For:
one year two years
Individual Institution Individual Institution
europe: Euro 115 Euro 245 europe: Euro 210 Euro 465
International: Euro 145 Euro 295 International: Euro 270 Euro 575
online: Euro 60 Euro 100
*Subscriptions begin with the first issue of the current volume. No cancellations or refunds are available after the volume’s first issue is pub-
lished. Publisher is to be notified of cancellations six weeks before end of subscription. Members of the International Association of
CyberPsychology, Training & Rehabilitation receive a 20% discount.
Leading the Path to KNOWLEDGE
w w w.vrphobia.eu | office@vrphobia.eu