Since many years, Professor Giuseppe Riva is actively involved in the research on Virtual Reality Environments for psycho-neuro-physiological assessment and rehabilitation. The useful experience gained in the VREPAR projects, funded by the European Commission, has led to a profound insight in the communicative potential of Virtual Reality, especially when applied in a therapeutic context for the patient's sake and benefit. During the Seventh Conference of Medicine Meets Virtual Reality that was held last January in San Francisco, the scientific work of Dr. Riva and his colleague, Dr. Mantovani, faced the audience with some remarkable results, relating to the impact of telepresence on human interaction in a virtual environment.
Virtual Environments allow the patient to navigate and interact with computer-generated 3D animation in real time, empowering the control of complex stimulus presentations. The head-mounted display and a pair of data gloves featured with a series of position trackers are considered to serve as essential accessories. In fact, there is a whole lot more to Virtual Reality (VR) than mere technical toy manipulation. Indeed, the patient experiences the sensation of full immersion into a virtual world, functioning as a medium of communication. The VR system can be set up for one single user in which case the environment plays the restricted role of communication interface. If the configuration is conceived for multiple users, the system transforms into a real communication medium.
In the single-user VR system, there are two possible ways of approaching the interface as a vivid interaction with the sensorimotor channels of the patient. The relationship with the representational space can be thought of as based on the concepts of either metaphor or illusion. Professor Riva prefers the 3D interface to be designed in such a way as to make the patient believe in the truth and reality of the actions being performed. As a result, the designer has to guide the patient in his quest for the truth whereas in the case of the metaphor, it is the patient who has to realize the analogy between icon and reality. Only in the former option, the perceptual illusion of nonmediation as the prime condition for successful communication is being fulfilled.
The patient thus is able to reach a level of experience in which all awareness of possible mediation, in the form of a virtual environment or VR system, has disappeared. This kind of knowledge is of vital importance for the creation of clinically useful simulation environments. Not necessarily do they only have to depend on the faithful reproduction of the physical aspects in the external reality, but also on the interactive capacities of the virtual environment. This is where the patient's functional freedom of movement comes in that enables the acquisition of all necessary information and control authority. Instead of aiming at graphic perfection, VR system designers should pay more attention to the actions of actors in the virtual environment.
This brings us to the multi-user VR applications, described by Dr. Mantovani as a special form of computer-mediated communication (CMC). Two crucial concepts which define interpersonal contact are situation and social context. With regard to their use in virtual environments, Dr. Mantovani relies on two innovative socio-cognitive approaches. The Situated Action Theory considers action as adaptation to context in which communication is being defined as the shared interpretation of situations the various actors are involved in. In the case of virtual immersion, the meaning is clarified by means of multiple face creation as a medium for non-verbal expression to optimize the context comprehension.
In turn, the Positioning Theory deals with the issue of how the various actors in the VR environment have to relate to each other in the dynamic process of communication. The patient's self depends on the changing situations in the virtual conversation of the CMC. The problem in VR is that personal identity is far less tangible than physical appearance. In order to achieve some form of shared understanding of actions and situations, the subject has no other choice than to construct a false identity built out of stereotypical attitudes or behaviour. That is why several VR system designers try to integrate a sense of community when generating simulated environments so that the mutual exchange of information can serve as the carrier to both express self-concept and elicit emotional support.
Patients especially are sensitive to this evoked sense of community in virtual reality for clinical use, since this method of facilitated interaction can create an important stimulation for rehabilitation. The multi-user VR system thus invites the patient to co-operate with the physician and possibly with other patients or to even act as a contradictor towards other parties involved in the therapy process. Much more than the richness of the simulated content, it is the authentic sensation of telepresence in a virtual environment, which is full of interactivity, that attracts the patient. Please, consult the home page of the VREPAR projects to learn more about virtual reality applied to medicine.