AIMS of the NEUROTIV (FIRB) Project:

Immersive virtual telepresence managed care for the assessment and rehabilitation in neuro-psychology and clinical psychology 

Italian Context

The general background

The goals

Italian Context

According to the recent “ISTAG SCENARIOS FOR AMBIENT INTELLIGENCE 2010” (European Commission, February 2001) the evolutionary technology scenarios in support of the Knowledge Society of the years 2000’s will be rooted into three dominant trends:

- Pervasive diffusion of intelligence in the space around us, through the development of network technologies towards the objective of the so-called “Ambient Intelligence” (AmI);

- Increasingly relevant role of mobility, through the develpoment of mobile communications, from the UMTS towards the so-called “Fourth Generation” (4G);

- Increase of reachness and completeness of communications, through the development of multimedia technologies, towards the “Immersive Virtual Telepresence” (TIV), including an increased attention to the aspects of human perception and of person-machine interaction.

The TIV perspective is reached through the complete development of multimedia technologies, generating far away the sense of presence through the integrated availability of sound, vision, smell, touch-and-feel (haptics) signals.
Typically, the sense of presence is accomplished through multisensor stimuli by means of which actual reality is either hidden and substituted with a virtual reality, i.e. fully synthetic, or is virtualized, i.e. made virtual through audio and 3-D video analysis and modeling procedures.

The convergence of AmI, 4G and TIV technologies manifests itself as the next frontier of ICT (Information and Communication Technology). This convergence will determine the advent of ubiquitous 3-D telecommunications and the built-up of intelligent environments for health care in which complex multimedia contents integrate and enrich the real space. The most ambitious objective is to integrate the computer interfaces in the real environment (Mixed Reality) so that the user can take advantage of the clinical care in the most natural and intuitive way.

However in Italy, the research on TIV technologies in the health care sector is still insufficient and fragmented as compared with the other industrialized Countries.

This unsatisfactory framework depends on scarce national funding, as well as on absence of an organization to direct the researches with decision. There is the serious risk to be unprepared, both at cultural level and at industrial level, to face the evolution that foreign Countries will impose to the vast ICT sector. In this situation, the exigency of a national coordination exists, able to push and lead the development of the research in the application of TIV technologies to health care and in particular to neuropsychology and clinical psychology, so to allow Italy avoiding a condition of cultural and technology dependency difficult to overcome.
The aim of this project is to promote an action coordinated at national level, also harmonized with the foreseen developments for the 4G technologies and current/future European research project in the area of neuropsychology and clinical psychology.

The Project aims at improving the know-how level, at generating new development and application opportunities, at organizing and finalizing multidisciplinary skills, and at developing system and component prototypes for the use of TIV technologies in a managed care system for neuropsychology and clinical psychology.

Main tool for this goal will be the creation of the "NEUROTIV" research network joining the main Italian research labs in this area (source: “STUDIO DI FATTIBILITÀ DI UN PROGRAMMA QUADRO NAZIONALE SU TECNOLOGIE DI TELEPRESENZA PER LE COMUNICAZIONI DI QUARTA GENERAZIONE”, Italian Communication Ministry, 2001).

The general background

“Managed care” indicates an health care system that uses organizational and management controls to offer patients appropriate care in cost-effective treatment settings. Today, the managed care environment is beginning to focus its attention on new technologies especially in the areas of organization and clinical data management. However, the most recent researches underline the possibility that distributed communication media could become a significant enabler of consumer health initiatives. In fact, in comparison to traditional communication technologies, shared media offer greater interactivity and better tailoring of information to individual needs. In other words, e-health can be considered a process and not a technology, including different complementing areas: health care information provision, administrative and clinical data collection, therapy and assessment provision.

This trend is also influencing neuro-psychology and clinical psychology. As noted by Jerome and Zailor in the Professional Psychology: Research and Practice Journal (31, 5, 478-483, 2000): “emerging technology will perpetually alter the health care environment, continuously changing the tools and options that are available to therapists. It is thus important to study the impact of these changes as they occur, and it is imperative that new technological competencies be developed as clinicians integrate these technologies into their research and practice” (p. 478).
In fact, even many clinicians have the naive assumption that couches and conversation are the best used therapeutic tools in mental health care. But tools for neuro-psychological rehabilitation and psychotherapy are evolving in a much more complex environment than a designer's made chaise longue. In particular Immersive Virtual Telepresence (TIV) technology, such as wireless devices and shared virtual reality (VR), have the potential for appearing soon in many consulting rooms.

As noted recently by a well know expert in the field there are basically two reasons why these technologies are used: either because there is no alternative, or because they are in some sense better than traditional methods. Providing healthcare services via telemedicine offers many advantages. It can make specialty care more accessible to underserved rural and urban populations. Moreover, remote consultations from the patient home to a specialist can reduce prohibitive travel and associated costs for patients.
Also the use of Virtual Reality (VR) offers many new possibilities to therapists. Applications of VR for health care have been developed in many clinical areas ranging from surgical procedures to the visualization of medical databases. However, there is a growing recognition that VR can play an important role in neuro-psychology and clinical psychology, too. Virtual reality offers a blend of attractive attributes for cognitive psychologists. The most basic of these is its ability to create a 3D simulation of reality that can be explored by patients. In many virtual environments, the graphic renderings of people and objects are quite simple, but they are still able to give the visitor a strong sense of presence-the illusion of being in a real place.
In conventional therapy, psychologists treat simple phobias by asking patients to imagine their fears or by taking them into real situations that frighten them. Each approach has its strengths: The first requires no special staging and can take place in the privacy of a clinician's office, while gradual exposure to a real source of fear more viscerally arouses the typical patient's emotions. Virtual reality simulations provide the advantages of both approaches-patients can go into vivid computer-generated worlds that they perceive as real, yet they do so in safety and privacy. In a recent report, the US National Advisory Mental Health Council suggested that "Research is needed to understand both the positive and the negative effects [of VEs]... on children's' and adult's perceptual and cognitive skills... and to exploit the enormous clinical potential of this technology" (1995, p.51).

To reach this goal in 1999 different US government institutions (i.e. Office of Naval Research, National Science Foundation, and Defence Advanced Research Projects Agency) funded the research in this area to the amount of 22 million US$ (Source: DARPA bullettin, 1999). In the same year the European institutions funded research in this field with less that 1 million Euros (estimated from CORDIS database, 1999): less than 1/20 of the US effort.

Up to now, Europe has matched the reduced funds with the creativity of its researchers. In fact, the main applications of VEs in psychological assessment and rehabilitation come from Italian, Spanish, and English institutions. In 1997, European researchers authored 72% of all the published papers in this area on peer-reviewed journals. This percentage slipped to 56% in 1998 and to 51% in 1999 (Sources: MedLine, Science Citation Index, PsycLit, Sept. 2001).
In this sense this project, headed by the researcher in the world with the highest number of published papers in the area of clinical applications of VR on peer reviewed journals, (Sources: MedLine, PsycLit, Sept. 2001, under the keyword “virtual reality”) aims at creating a sufficient critical mass to make the Italian-based research and companies more competitive in the field of Immersive Virtual Telepresence for health care. In fact the project includes the four main research labs in this area (source: “STUDIO DI FATTIBILITÀ DI UN PROGRAMMA QUADRO NAZIONALE SU TECNOLOGIE DI TELEPRESENZA PER LE COMUNICAZIONI DI QUARTA GENERAZIONE”, Italian Communication Ministry, 1 Sept. 2001).

The goals

More in detail, the project aims at:

- joining in the NEUROTIV research network the major Italian players in the field, aims at creating a sufficient critical mass to make the Italian-based research in this area more competitive.
- proving the technical and clinical viability of integrating TIV systems in a managed care platform for neuro-psychology assessment and rehabilitation
- designing/tuning and developing managed care tools to be used in the prevention, planning provision and follow-up of the required treatment. The developed modules will be optimised to meet the demands of the emerging 2,5G/GPRS and 3G/UMTS wireless networks and terminals.
- Defining new treatment protocols for the use of the clinical tools in assessment, therapy and follow up.
- Verify the clinical economic/organizative efficacy of the managed care system by using controlled clinical trials.
- Disseminating the obtained results through scientific papers and conference presentations.