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Purpose The purpose of this paper is to identify the main reasons for low uptake of robots in special education (SE), obtained from an analysis of previous studies that used robots in the area, and from interviewing SE teachers about the topic. Design/methodology/approach An analysis of 18 studies that used robots in SE was performed, and the conclusions were complemented and compared with the feedback from interviewing 13 SE teachers from Spain and the UK about the reasons they believed caused the low uptake of robots in SE classrooms. Findings Five main reasons why SE schools do not normally use robots in their classrooms were identified: the inability to acquire the system due to its price or availability; its difficulty of use; the low range of activities offered; the limited ways of interaction offered; and the inability to use different robots with the same software. Originality/value Previous studies focussed on exploring the advantages of using robots to help children with autism spectrum conditions and learning disabilities. This study takes a step further and looks into the reasons why, despite the benefits shown, robots are rarely used in real-life settings after the relevant study ends. The authors also present a potential solution to the issues found: involving end users in the design and development of new systems using a user-centred design approach for all the components, including methods of interaction, learning activities and the most suitable type of robots.

Many hearing aid (HA) users are dissatisfied with HA performance in social situations. One way to improve HA outcomes is training the users to understand how HAs work. Play&Tune was designed to provide this training and to foster autonomy in hearing rehabilitation. We carried out two prototype evaluations and a prerelease evaluation of Play&Tune with 71 HA users, using an interview or online survey. Users gave detailed feedback on their experiences with the app. Most participants enjoyed learning about HAs and expressed a desire for autonomy over their HA settings. Our case study reinforces the importance of user feedback during app development.

BACKGROUND: Aircraft passengers’ physical activity levels are often limited during flight for extended periods of time, which can have serious impact on health, comfort, and passenger experience. However, several factors, such as limited personal space and social factors, can make movement difficult. OBJECTIVE: The study aimed to identify participant behaviour and postures during medium to long-haul flights and their effect on location and severity of physical discomfort. This work investigated how aircraft passengers’ comfort ratings changed over time and explored the association between postures and comfort ratings during flight. The study also explored the association between performing in-flight exercises and factors limiting participants’ abilities to complete these exercises. METHOD: Twenty-nine participants sat in an aircraft simulated cabin for 180 minutes and periodically performed in-seat exercises. They also completed a questionnaire providing data on demographic information, self-reported discomfort scores for multiple areas of the body, which types of exercises participants performed, and qualitative comments about discomfort. Self-reported comfort ratings were measured at 20-min intervals and posture identification was conducted by analysing the video recordings. RESULTS: Six postures were identified, and it was observed that individual participants changed posture at least once and up to nine times during the three-hour period. Body part areas with the highest reported scores of discomfort ratings were: back of the neck, back-left shoulder, back-right shoulder, back-left buttock, and lower back. Participants reported that they had difficulty in performing recommended in-flight exercises due to limited space. CONCLUSIONS: Limited space in aircraft seating restricts passenger movement. Some body areas are more prone to discomfort.

The study aimed to determine the prevalence of Work-related Musculoskeletal Symptoms (WRMS) and associated work system factors impacting laparoscopic surgery in Peruvian Hospitals. Methods: An online survey with 17 questions was sent to 320 laparoscopic surgeons in different hospitals in Peru. The survey was distributed by email and paper format and consisted of six sections: informed consent, demographic data, physical symptoms, working conditions, impact on surgeons and others. Descriptive data were presented in tables and figures while associations were established using chi-square and fisher´s exact tests with a significance of 0.05. Results: 140 surgeons responded to the survey. Most surgeons worked more than 5 years (57%) and belong to the age group 30–60 years (87%). The prevalence rate of WRMS in survey respondents was 89%, with targeted WRMS identified in the following body regions: shoulders (59%), neck (51%), hand/wrist (41%) and upper back (43%). Duration and complexity of surgeries (nature of tasks) and inadequate table height (technology) were considered as highly contributing factors to WRMS by more than 50% of surgeons surveyed. 40% of surgeons considered the lack of suitable equipment and inadequate training as a highly contributed factor to WRMS. Conclusion: The study determined a high rate of WRMS, especially in the upper body region. These WRMS were associated with several work factors mainly related to inadequate operating table height, duration and complexity of surgeries, lack of suitable equipment and training.

This study examined the role design plays in infection prevention and control within an existing neonatal intensive care unit. Methods from human-centred design such as planning, stakeholder meetings and naturalistic observation were used to obtain infection prevention information related to the existing unit design, interactions with products and the environment, and perspectives of front-line staff on design. Thematic analysis was used to categorize and structure the issues that were identified. The analysis revealed that the design of products and the environment may be undermining best practice in infection prevention. Health care workers experience a variety of difficulties in maintaining the recommended barriers to infection transmission, difficulties which stem from deficiencies in products and the environment. Various aspects of the neonatal care design lack the feedback or supports needed to help health care workers differentiate or work between infection transmission zones making the design challenging to use or maintain in a manner that supports best practice in infection prevention. Identifying issues in the design of products and the environment related to infection prevention practice led to the development of a ‘Design Exploration Guide’. The guide outlines issues and strategies for remediation based on feasibility within the project constraints.

Introduction It is notoriously difficult to obtain a perfect fitting of hearing aids (HAs) for children as they often struggle to understand their hearing loss well enough to discuss the fitting adequately with their audiologist. Dartanan is an ‘edutainment’ game developed to help children understand the functions of their HA in different sound contexts. Dartanan also has elements of a leisure game for all children, in order to create an inclusive activity. Methods Game prototypes were evaluated during two formative evaluations and a summative evaluation. In total 106 children with and without hearing loss in Italy, Spain and the UK played Dartanan. A built-in virtual HA enabled children with hearing loss to use headphones to play. Results and conclusions: During the formative stages, feedback was discussed during focus groups on factors such as the audiological aspects, the extent to which children learned about HA functions, accessibility and usability, and this feedback was presented to the developers. After redevelopment, a summative evaluation was performed using an online survey. It was concluded that the game had met the goals of helping children understand their HA functionalities and providing an inclusive activity. User-evaluations were crucial in the development of the app into a useful and useable service.

© 2018 Taylor & Francis Group, LLC. Involvement of children with autism spectrum conditions (ASC) in the design of new educational technology is becoming more prevalent. Despite potential barriers due to communication and ideation difficulties for children with ASC, adapted participatory design methods can successfully facilitate their direct involvement. Nonetheless, methods requiring face-to-face communication can still be difficult for children with ASC and research suggests that technology mediation could facilitate their contribution. This study explores the use of collaborative virtual environments (CVEs) as a medium through which students evaluated existing computer games and offered suggestions for game development. CVEs in which the users were represented by (a) avatars and (b) video-pods were compared to a face-to-face condition. Twelve typically developing (aged 8–9years), 12 higher ability ASC (12–14) and 4 lower ability ASC children (12–14) participated. All student groups preferred the video-pod CVE and students with ASC were generally better able to contribute effectively through this medium than face-to-face.

Qualitative data collection methods drawn from the early stages of human-centred design frameworks combined with thematic analysis were used to develop an understanding of infection prevention practice within an existing neonatal intensive care unit. Findings were used to generate a framework of understanding which in turn helped inform a baseline approach for future research and design development. The study revealed that a lack of clarity between infection transmission zones and a lack of design attributes needed to uphold infection prevention measures may be undermining healthcare workers' understanding and application of good practice. The issue may be further complicated by well-intentioned behavioural attitudes to meeting work objectives; undue influences from spatial constraints; the influence of inadvertent and excessive touch-based interactions; physical and/or cognitive exertion to maintain transmission barriers; and the impact of expanding job design and increased workload to supplement for lack of effective barriers. Practitioner Summary: Despite high hand hygiene compliance within a neonatal intensive care unit, healthcare workers expressed concerns about the unit design and infection prevention practice. Early inquiry methods from human-centred design and thematic analysis helped develop a framework to understand how design can be used to aid infection prevention.

A computer-based interactive binocular treatment system (I-BiT) for amblyopia has been developed, which utilises commercially available 3D ‘shutter glasses’. The purpose of this pilot study was to report the effect of treatment on visual acuity (VA) in children with amblyopia. Thirty minutes of I-BiT treatment was given once weekly for 6 weeks. Treatment sessions consisted of playing a computer game and watching a DVD through the I-BiT system. VA was assessed at baseline, mid-treatment, at the end of treatment, and at 4 weeks post treatment. Standard summary statistics and an exploratory one-way analysis of variance (ANOVA) were performed. Ten patients were enrolled with strabismic, anisometropic, or mixed amblyopia. The mean age was 5.4 years. Nine patients (90%) completed the full course of I-BiT treatment with a mean improvement of 0.18 (SD=0.143). Six out of nine patients (67%) who completed the treatment showed a clinically significant improvement of 0.125 LogMAR units or more at follow-up. The exploratory one-way ANOVA showed an overall effect over time (F=7.95, P=0.01). No adverse effects were reported. This small, uncontrolled study has shown VA gains with 3 hours of I-BiT treatment. Although it is recognised that this pilot study had significant limitations—it was unblinded, uncontrolled, and too small to permit formal statistical analysis—these results suggest that further investigation of I-BiT treatment is worthwhile.

This paper outlines the participatory design processes adopted within the COSPATIAL project which is developing interactive, collaborative technologies for children and young people on the autism spectrum to support collaboration and social conversation skills. The project has involved a ‘core design team’ of teachers in a series of design workshops from the start. Groups of typically developing children and those on the autism spectrum have also been regularly involved in design and feedback activities to inform the development of our technology prototypes. Initial impressions from pilot testing suggest that children have enjoyed using the prototypes and teachers have found them useful; we suggest that our participatory design methods have strongly contributed to this positive response.

Background and purpose: We describe our attempts to evaluate the effectiveness of a virtual environment developed to rehabilitate stroke patients in the task of making a hot drink. Methods: Single case studies were performed in 13/138 (9%) stroke patients undergoing rehabilitation in a UK stroke unit. Participants in AB/BA (n = 5) and ABA (n = 2) design studies received 5 one-hour sessions of attention control training (A phase) and 5 one-hour sessions of virtual environment training (B phase). An AB design with random duration of A and B phases (minimum duration of A and B phases 3 and 5 days respectively, with total duration of 3 weeks) was used in 6 participants. Results: Visual inspection of scores across all cases showed a trend towards improvement over time in both real and virtual hot drink making ability in both control and intervention phases. There was no significant difference (Wilcoxon, p > 0.05) in the improvements in real and virtual hot drink making ability during all control and intervention phases in the 13 cases. Ceiling effects limited the evaluation of effectiveness in 5 of the 8 cases in which daily performance measures were used. Conclusions: Few people in this setting were suitable for this intervention. The case studies showed no evidence of a strong effect of this intervention, but we had great difficulty in performing single case studies. We conclude that more testing and development of this system is required before it is subjected to rigorous testing of clinical effectiveness.

Flashlight torches are cheap, robust, familiar and fun and so make interesting devices upon which to base interaction technologies. Computer vision software has been developed that can recognise and distinguish between different flashlight beams and these can be used to activate digital media including audio, video or special effects. The technology appears to ’magically bring to life’ objects and areas of the environment merely by shining a torch on them and has been used successfully to enhance visitor attractions such as museum exhibits and displays. This paper considers the potential for using this technology in special needs education, providing a means for children to explore their immediate environment and discover something new. Potential applications for supporting learning are proposed and a feasibility study is presented. Three case examples were conducted to assess the practicalities of configuring interactive learning experiences within the school environment and pupil’s responses to the technology.

We have developed a novel application of adapted virtual reality (VR) technology, for the binocular treatment of amblyopia. We describe the use of the system in six children. Subjects consisted of three conventional treatment ‘failures’ and three conventional treatment ‘refusers’, with a mean age of 6.25 years (5.42–7.75 years). Treatment consisted of watching video clips and playing interactive games with specifically designed software to allow streamed binocular image presentation. Initial vision in the amblyopic eye ranged from 6/12 to 6/120 and post-treatment 6/7.5 to 6/24-1. Total treatment time was a mean of 4.4 h. Five out of six children have shown an improvement in their vision (average increase of 10 letters), including those who had previously failed to comply with conventional occlusion. Improvements in vision were demonstrable within a short period of time, in some children after 1 h of treatment. This system is an exciting and promising application of VR technology as a new treatment for amblyopia.

house, a supermarket, a café and a transport system. Evaluation of the project was concerned as much with the design of the virtual learning environments (VLEs), issues of usability and access as with monitoring skill learning and transfer to the real world. For three of the VLEs, Supermarket, Café and Transport, a test-retest experimental design method was used. This compared user performance in real world tasks with the same tasks presented in the VLE. Expert assessment was used to evaluate the Virtual House, looking at usability and appropriateness of the learning scenarios. It was found that VLEs can provide interesting, motivating learning environments, which are accessible to users with special needs. Individuals differed in the amount of support required to use the input devices and achieve task objectives in the VLE. Expert and user review methods indicated that the VLEs are seen to be representative of real world tasks and that users are able to learn some basic skills. However, it would be unrealistic to expect transfer of skill over a short experimental time. Further testing is needed to establish the longitudinal learning effects and to develop more reliable techniques to allow users to express their own opinions. Within this project the value of a user centred approach has been demonstrated. The groups involved have provided informed input at each stage of VE development. This has been enhanced by contributions from experts in the field of learning disabilities. The Virtual City has been developed in response to the needs of people with learning disabilities, not in response to their assumed needs.

The aim of this experiment was to measure the effect of immersion in a virtual environment (VE) on postural stability and examine the relationship between postural stability and self-reported simulator sickness. Forty healthy subjects were exposed to 20 min of immersion in an interactive VE with restricted user movement. The VE was viewed on a head mounted display (HMD) and the subject remained standing throughout the immersion period. Two static postures, normal stance and tandem romberg, were recorded before immersion, immediately after immersion and again at 10 min postimmersion. Performance in each posture was simultaneously measured by recording time that the posture could be maintained and mm path length of body sway over a 30-s period. The results demonstrated differences in the sensitivity of postural stability measurement techniques and variations in inter- and intraindividual responses to measures. Sway magnetometry measured a significant increase in postural instability in normal stance after VE immersion. None of the other measures were sensitive to this change. Postimmersion reports of simulator sickness symptoms indicate that the VE stimulus was provocative and correlation was found between reports of simulator sickness and balance-related symptoms. However, no association between self-reported symptoms and performance measures of postural instability was found.

A key theme in the ArtAbilitation conferences is the relationship between 6 sound, movement, and art, and how these can be used for rehabilitation and/or 7 expression by individuals who may have limited access to conventional communi- 8 cation. The development of VR environments and interactive technology has led to 9 a variety of applications that might broadly be considered as telerehabilitation, 10 including the use of 3D space and interactive feedback for remote assistance of 11 users in the areas of navigation and home living. These technologies can provide 12 access to activities and communication for individuals for whom such affordances 13 are otherwise restricted, and can make the process of rehabilitation more engaging 14 and motivating.

Background: Amblyopia (lazy eye) affects the vision of approximately 2% of all children. Traditional treatment consists of wearing a patch over their ‘good’ eye for a number of hours daily, over several months. This treatment is unpopular and compliance is often low. Therefore results can be poor. A novel binocular treatment which uses 3D technology to present specially developed computer games and video footage (I-BiT™) has been studied in a small group of patients and has shown positive results over a short period of time. The system is therefore now being examined in a randomised clinical trial. Methods/design: Seventy-five patients aged between 4 and 8 years with a diagnosis of amblyopia will be randomised to one of three treatments with a ratio of 1:1:1 - I-BiT™ game, non-I-BiT™ game, and I-BiT™ DVD. They will be treated for 30 minutes once weekly for 6 weeks. Their visual acuity will be assessed independently at baseline, mid-treatment (week 3), at the end of treatment (week 6) and 4 weeks after completing treatment (week 10). The primary endpoint will be the change in visual acuity from baseline to the end of treatment. Secondary endpoints will be additional visual acuity measures, patient acceptability, compliance and the incidence of adverse events. Discussion: This is the first randomised controlled trial using the I-BiT™ system. The results will determine if the I-BiT™ system is effective in the treatment of amblyopia and will also determine the optimal treatment for future development. Trial registration: ClinicalTrials.gov identifier: NCT01702727 Keywords: Amblyopia, I-BiT™, Randomised clinical trial, Lazy eye, Child, Visual acuity, Binocular

The COSPATIAL (Communication and social participation: collaborative technologies for interaction and learning) project explores how we can develop effective and useful educational technologies in the form of shared active surfaces (SASs) and collaborative virtual environments (CVEs) to support the enhancement of social competence skills for children with autism spectrum conditions (ASC). This paper presents a description of the COSPATIAL suite of applications, comprising of two CVE programs and two SAS programs.

COSPATIAL is a 3-year collaborative, technology-focused project exploring the use of collaborative virtual environments (CVE) and shared active surfaces (SAS) for supporting social competence for children with autism spectrum conditions (ASC). The UK team are developing CVE technology through a user centered design approach to inform design decisions and review prototype development. Teachers are involved throughout the design process to ensure that the technology developed is useful and effective. Involving children with ASC is also an important aspect of our design process. However, there are few published methods and guidance to support this involvement. This paper presents a method for involving children with ASC in the design of CVE.

We present the results of two usability studies evaluating the use of collaborative technologies designed to facilitate children with Autism Spectrum Conditions (ASC) learning social competence skills through technology-delivered Cognitive-Behavioral Therapy (CBT). The first study examined a co-located games (Join-In Suite) run on a multi-user tabletop shared active surface (SAS). The second study collaborative virtual environment (CVE) designed to support understanding and practice of social conversation skills. Both prototypes were developed following a participatory design process that included focus groups of occupational therapists and teachers as well as children with ASC. Usability studies were then conducted where occupational therapists used the systems for social competence training during a single one hour session with pairs of children with high functioning ASC, aged 9–13 years. Outcome measures included two usability questionnaires, the Intrinsic Motivation Inventory and interviews with the children. Therapists' responses to the System Usability Scale were also recorded. Results for SAS and CVE prototypes showed great enjoyment of the games, preferences amongst them and proficient use of the technology. For both technologies, the collaborative nature of the activities appeared to be effective in leveraging the engaging power of computer games as well as capturing a level of ecological validity which is often not sufficiently present in computer games alone.

Computer simulations are gaining interest from researchers and therapists involved in stroke rehabilitation because they offer a means to monitor user activity and replicate tasks within safe and controlled environments. We developed a virtual environment (VE) to simulate the potentially hazardous task of making a hot drink. A three dimensional representation of a kitchen, including objects and utensils, was displayed on a computer screen and controlled through a touch screen interface. We also developed a user interface that employed real, physical kitchen objects, adapted in order to provide the computer with spatial and orientation data through a combination of motion sensors and a computer vision system. This tactile interface technology is known as a tangible user interface (TUI) and together with a VE comprises a mixed reality (MR) system. The MR system described here enabled users to perform naturalistic upper limb movements in order to interact with the task simulation. In this chapter we explain how the VE and MR systems were developed through a user-centred design process that involved the participation of consultants, clinicians and stroke survivors. Case examples of feasibility and evaluation studies using both the VE and MR systems are presented and discussed. Recommendations for the design and development of MR systems specifically for stroke rehabilitation are included.

Previous studies have examined the use of virtual environments (VEs) for stroke and similar rehabilitation. To be of real benefit it is essential that skills (re-)learned within a VE transfer to corresponding real-world situations. Many tasks have been developed in VEs, but few have shown effective transfer of training. We believe that, by softening the real/virtual divide, mixed reality technology has the potential to ease the transfer of rehabilitation activities into everyday life. We present two mixed reality systems, designed to support rehabilitation of activities of daily living and providing different mixtures of digital and physical information. Functional testing of these systems is described. System development and user evaluation continues, some of which is described in a sister paper (Edmans et al 2004) in this volume.

Background and Purpose— Virtual environments for use in stroke rehabilitation are in development, but there has been little evaluation of their suitability for this purpose. We evaluated a virtual environment developed for the rehabilitation of the task of making a hot drink. Methods— Fifty stroke patients undergoing rehabilitation in a UK hospital stroke unit were involved. The performance of stroke rehabilitation patients when making a hot drink had the neurological impairments associated with performance of this task, and the errors observed were compared for standardized task performance in the real world and in a virtual environment. Neurological impairments were measured using standardized assessments. Errors in task performance were assessed rating video recordings and classified into error types. Results— Real-world and virtual environment performance scores were not strongly associated (ρ=0.30; P Conclusions— Although this virtual environment was usable by stroke rehabilitation patients, it posed a different rehabilitation challenge from the task it was intended to simulate, and so it might not be as effective as intended as a rehabilitation tool. Other virtual environments for stroke rehabilitation in development require similar evaluation.

The papers presented in this issue provide a glimpse of the International Conference on Disability, Virtual Reality and Associated Technologies (ICDVRAT) research community, illustrating advances in virtual reality and associated technologies facilitating interaction in physical and digital environments for individuals and practitioners in disability and rehabilitation. We hope that you will find this issue of interest and recommend this journal and use it to communicate this research to a broader public.

Virtual Environments (VE's) offer the potential for users to explore social situations and 'try out' different behaviour responses for a variety of simulates social interactions. One of the challenges for the VE developer is how to construct the VE to allow freedom of exploration and flexibility in interactive behaviour, without the risk of users deliberately or inadvertently missing important learning goals. Scaffolding embedded within the VE software can aid the user's learning in different contexts, such as individual, tutored or group learning situations. This paper describes two single-user VE scenarios that have been developed within the AS interactive project and presents observation results from initial trials conducted at a user school.

The 3D Tune-In project aims to create an innovative toolkit based on 3D sound, visuals and gamification techniques to facilitate different target audiences in understanding and using the varied settings of their hearing aid to attain optimum performance in different social contexts. In the early stages of project development, hearing aid (HA) users participated in activities to identify user requirements regarding the difficulties and issues they face in everyday situations due to their hearing loss. The findings from questionnaire and interview studies and identification of current personas and scenarios of use indicate that the project can clearly and distinctly support the requirements of people with hearing loss as well as improve the general public's understanding of hearing loss. Five Future Scenarios of use have been derived to describe how the technologies and games to be developed by the 3D Tune-In project will address these requirements.