AIMS of the NEUROTIV (FIRB) Project:
Immersive virtual telepresence managed care for the assessment and rehabilitation in neuro-psychology and clinical psychology
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).
“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.