THE THERAPY TRAIL
THE PROBLEM
Rehabilitation is a very long, drawn-out process, and can be a huge burden on one's mental health. Recovery from substance misuse and strokes are especially difficult as they both have long-lasting physical and psychological effects.
TIMELINE
12 Weeks
March–May 2020
TEAM
I worked with a partner, Bella Bergam, for this project as part of a class called 'VR For Palliative Care.'
KEY GOAL
Investigate how VR can have a positive effect on those recovering from substance addiction or strokes.
UNDERSTANDING THE USER
The research process for both halves of the project began as a whole class with talks from a doctor who works with patients recovering from substance use disorders, a recovering substance addict, and a doctor of physical therapy, as well as scientific readings and lectures.
Substance Addiction
In addition to reading some literature on the psychological aspects of substance addiction, and attending a lecture on the neuroscience of addiction, we participated in a Q and A with a young adult who had been clean for 7 years. They gave us some background information about their struggles with drugs, alcohol, and mental health, as well as their stints in rehab before we asked questions about what kinds of VR experiences they felt might be useful as part of rehabilitation and therapy.
Their ideas/input included:
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Active problem-solving, accomplishing a goal
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Escapism
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Music can be triggering - would have to be neutral/atmospheric music, as songs can remind people of certain bad times
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Human connection
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Nostalgia
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Nature
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Choose your own destiny, autonomy
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Navigating through social situations while sober
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Self-reflection
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Triggers
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Violence
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Yelling
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Stigmatizing addiction
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Coping Strategies
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Sleep
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Healthy eating
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Meditation
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Gratitude
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Physical Therapy
In addition to reading some literature on stroke recovery and physical therapy, we attended a lecture and Q and A with a physical therapist. We learned about the ins and outs of stroked and loss of mobility as well as gaining insight into the various exercises that patients are given.
We found that while in some cases a stroke can cause permanent paralysis, there are a lot of cases in whch the part of the brain controlling a limb simply needs to be re-stimulated through a combination of movement and visual feedback, which VR can provide. Another benefit of using VR in this situation would be engaging patients with their prescribed exercises and providing them with motivation and a sense of achievement.
BREAKING DOWN THE PROCESS
We began the ideation process by synthesizing our research and coming up with two sets of hypotheses and sketches - one for each medical scenario.
Design Hypothesis: Substance Addiction
The main takeaways from the Q and A and readings that we focused on were nature, accomplishing a goal, escapism, and self-reflection.
Project Goals/Intended Results:
By presenting the user with the power to grow a garden despite uncontrollable difficulties, the game hopes to help the user develop a healthy internal dialog.
Target User/Patient Profile:
Michael is a young man in his twenties recovering from a substance use disorder and is under clinical care. While he is managing to refrain from using hard substances,
he continues to struggle with the negative internal dialog/core beliefs that led him to start using in the first place and is still coping in other unhealthy ways.
Design Specifics:
The user would be walking through a garden scene with brightly colored flowers and plants, which will periodically be affected by things in the environment, e.g. bad weather. By forming a positive affirmation using an in-game menu and saying it out loud at the same time, the user can revive the plants. Occasionally, weeds will also grow, which users will have to chop down using their controllers.
A selection of our initial sketches can be found below.
*click images to enlarge*
Design Hypothesis: Physical Therapy
The main takeaways from the Q and A and readings that we focused on were providing visual feedback and incorporating the exercises into an experience that keeps the user engaged, motivated, and in a positive headspace.
Project Goals:
To gradually restore, or at least improve, the functionality of a patient who has limited arm mobility due to stroke, surgery, or other injuries.
Target User/Patient Profile:
Laura is a middle-aged woman recovering from a stroke with limited mobility in her left arm. She currently visits her physical therapist twice a week for assistance with exercise. She used to be very athletic and particularly enjoyed climbing.
The game would also ideally be enjoyable for others, for example, it could still be used by those recovering from substance use disorders to symbolize endurance and overcoming a struggle.
Design Specifics:
The user will gradually attempt to climb a mountain, on the other side of which is a waterfall. They will be guided up the mountain using various commands, which will get them to make certain movements, which are in line with some of the ‘Thrower’s Ten’ exercises but will also facilitate the simulation of climbing. Over time, the user will ideally regain strength and functionality in the affected arm.
This will be situated in the same setting as Project 2 and will continue to have a relaxing garden aesthetic. We may also incorporate some of these physical therapy exercises into the weed pulling aspect of Project 2 so that the two mini-games overlap.
Intended Design Outcome/Effect:
The user should climb a mountain through completing exercises. Some form of visual guide will appear on the rock face to inform the user of how to complete the movement. By developing a visually interesting landscape the patient will be encouraged and informed as to how to climb along with being motivated to see from a better point of view. Audio and visual cues will increase motivation to continue. The design will combine techniques of both rock climbing and traditional physical therapy to execute a realistic and effective way of coordinating the body while building mental and physical endurance, and experiencing an affirming and relaxing environment.
Our initial storyboard can be found below.
*click image to enlarge*
FINAL DELIVERABLES
We ultimately ended up combining the two ideas into one experience, leaving room to extend it and add more 'minigames' in the future.
Final Product Descriptions
The substance use recovery scene involves the user following the trail down the 'Gardening' path, before being teleported onto a bridge, upon which there is a sign instructing them to pull the weeds down below and place them into the basket. Once they do so, they find themself in a beautiful, luscious garden and, upon exiting back to the trail, read a positive affirmation indicating that fighting through the struggle will yield good results, a metaphor for overcoming addiction.
The physical therapy scene involves the user following the train down the 'Climbing' path towards a waterfall. Once they walk into the waterfall, they are teleported to the base of a fantasy-like mountain, which they must climb by raising and lowering both arms, as in line with their physical therapy exercises. Once they reach the summit, they are teleported to a relaxing garden, which they can relax in until they decide to exit back onto the trail. The physical therapist we spoke to ended up giving us a specific patient profile to work from. The patient in question is only able to move their arm up and down very slightly, and so we decided to provide a wide range of grabbing points so that the patient would move upwards regardless of their progress, but as their mobility improved, they could reach more interesting items as they wished.
The main reason that we combined the experiences is that we feel that they could both be used for either purpose. The weed pulling can be incorporated into physical therapy sessions, and the climbing can be used as a metaphor for overcoming a struggle, with the relaxing garden at the end acting as a space for self-reflection.
Final Prototype
NB: There are some drops in video quality due to file size and connectivity issues; we are currently working on producing a higher-quality 360° walkthrough. However, the build (optimized for the HTC Vive and Windows) can be found and downloaded at this link.
KEY TAKEAWAYS & FUTURE GOALS
For this project, I spearheaded the scripting, in addition to contributing to the scene building, visual design, and overall UX. As part of the process, I taught myself C# from scratch. Although I was familiar with JavaScript, which has a lot of structural similarities, this was still a fairly steep learning curve in terms of syntax, especially in regards to interfacing with Unity.
In terms of future goals, we are hoping to test out this application with the patients we consulted with throughout the process; we were unable to do this due to the pandemic. We also hope to incorporate an element of arm span tracking and recording, so that physical therapists can also use this application to follow their patients' progress.