Showing papers by "Albert Rizzo published in 2014"

SimSensei kiosk: a virtual human interviewer for healthcare decision support

Abstract: We present SimSensei Kiosk, an implemented virtual human interviewer designed to create an engaging face-to-face interaction where the user feels comfortable talking and sharing information. SimSensei Kiosk is also designed to create interactional situations favorable to the automatic assessment of distress indicators, defined as verbal and nonverbal behaviors correlated with depression, anxiety or post-traumatic stress disorder (PTSD). In this paper, we summarize the design methodology, performed over the past two years, which is based on three main development cycles: (1) analysis of face-to-face human interactions to identify potential distress indicators, dialogue policies and virtual human gestures, (2) development and analysis of a Wizard-of-Oz prototype system where two human operators were deciding the spoken and gestural responses, and (3) development of a fully automatic virtual interviewer able to engage users in 15-25 minute interactions. We show the potential of our fully automatic virtual human interviewer in a user study, and situate its performance in relation to the Wizard-of-Oz prototype.

The Distress Analysis Interview Corpus of human and computer interviews

Abstract: The Distress Analysis Interview Corpus (DAIC) contains clinical interviews designed to support the diagnosis of psychological distress conditions such as anxiety, depression, and post traumatic stress disorder. The interviews are conducted by humans, human controlled agents and autonomous agents, and the participants include both distressed and non-distressed individuals. Data collected include audio and video recordings and extensive questionnaire responses; parts of the corpus have been transcribed and annotated for a variety of verbal and non-verbal features. The corpus has been used to support the creation of an automated interviewer agent, and for research on the automatic identification of psychological distress.

Virtual Reality Exposure Therapy for Combat-Related Posttraumatic Stress Disorder

Abstract: Virtual reality (VR) technology is rapidly evolving to support prolonged exposure (PE) therapy, a proven treatment for combat-related posttraumatic stress disorder. Building on the successful 2007 Virtual Iraq/Afghanistan VRET system, a team of behavioral scientists, software engineers, and virtual artists has created Bravemind, a flexible VR system that offers significantly enhanced PE treatment possibilities. The first Web extra at http://youtu.be/EiYg-kMNMtQ is a video demonstration of an original early virtual reality exposure therapy (VRET) prototype that shows a small section of an Iraqi city with a landing helicopter (2004). The second Web extra at http://youtu.be/_cS-ynWZmeQ is a video demonstration of VRET that simulates driving a Humvee in a rural part of Iraq, showcasing several encounters, including IED and road-side attacks (2007). The third Web extra at http://youtu.be/78QXX_F4mc8 is a video demonstration of VRET that simulates an overview of several Iraqi city areas (2007). The fourth Web extra at http://youtu.be/_AnixslkVLU is a video demonstration of VRET that simulates a patrol entering interior buildings in Iraq (2007). The fifth Web extra at http://youtu.be/S22aQ-DqKKU is a video demonstration of an original VRET tablet interface that allows the clinician to change virtual reality settings and trigger encounters (2007). The sixth Web extra at http://youtu.be/C-fspuLo4vw is a video demonstration of the Bravemind VRET prototype showing a variety of driving and dismounted scenarios with encounters in Iraq and Afghanistan (2013). The sixth Web extra at http://youtu.be/HSPDomDAigg is a video collection of Iraqi and Afghanistan VRET scenarios within the Bravemind prototype (2013).

Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military.

Abstract: Objective Subthreshold posttraumatic stress disorder (PTSD) has garnered recent attention because of the significant distress and functional impairment associated with the symptoms as well as the increased risk of progression to full PTSD. However, the clinical presentation of subthreshold PTSD can vary widely and therefore is not clearly defined, nor is there an evidence-based treatment approach. Thus, we aim to further the understanding of subthreshold PTSD symptoms by reporting the use of a virtual combat environment in eliciting distinctive psychophysiological responses associated with PTSD symptoms in a sample of subthreshold recently deployed US service members. Methods Heart rate, skin conductance, electromyography (startle), respiratory rate, and blood pressure were monitored during three unique combat-related virtual reality scenarios as a novel procedure to assess subthreshold symptoms in a sample of 78 service members. The Clinician-Administered PTSD Scale was administered, and linear regression analyses were used to investigate the relationship between symptom clusters and physiological variables. Results Among the range of psychophysiological measures that were studied, regression analysis revealed heart rate as most strongly associated with Clinician-Administered PTSD Scale-based measures hyperarousal (R = 0.11, p = .035,) reexperiencing (R = 0.24, p = .001), and global PTSD symptoms (R = 0.17, p = .003). Conclusions Our findings support the use of a virtual reality environment in eliciting physiological responses associated with subthreshold PTSD symptoms.

Compelling evidence that exposure therapy for PTSD normalizes brain function

Abstract: Functional magnetic resonance imaging (fMRI) is helping us better understand the neurologic pathways involved in posttraumatic stress disorder (PTSD). We previously reported that military service members with PTSD after deployment to Iraq or Afghanistan demonstrated significant improvement, or normalization, in the fMRI-measured activation of the amygdala, prefrontal cortex and anterior cingulate gyrus following exposure therapy for PTSD. However, our original study design did not include repeat scans of control participants, rendering it difficult to discern how much of the observed normalization in brain activity is attributable to treatment, rather than merely a practice effect. Using the same Affective Stroop task paradigm, we now report on a larger sample of PTSD-positive combat veterans that we treated with exposure therapy, as well as a combat-exposed control group of service members who completed repeat scans at 3-4 month intervals. Findings from the treatment group are similar to our prior report. Combat controls showed no significant change on repeat scanning, indicating that the observed differences in the intervention group were in fact due to treatment. We continue to scan additional study participants, in order to determine whether virtual reality exposure therapy has a different impact on regional brain activation than other therapies for PTSD.

A Pilot Study of the VirtuSphere as a Virtual Reality Enhancement

Abstract: This pilot study assessed the utility and acceptability of the VirtuSphere, a cutting edge navigation platform designed to enhance presence in virtual environments. The VirtuSphere includes a 12-ft hollow sphere within which the user stands, and it rolls within a wheeled platform, in any direction, according to the user's steps. The pilot was a within-subject crossover design comparing the VirtuSphere to standard game controller navigation. The comparison was based on locomotion in Virtual Iraq, a virtual world resembling Iraqi war zones. Participants were 10 active duty soldiers not suffering from posttraumatic stress disorder. Results indicated that there were negligible differences in sense of presence, simulator sickness, and satisfaction across the two navigation systems. Although the VirtuSphere may provide entertainment value, these results do not provide initial support for the use of the VirtuSphere to improve constructs thought to be important to behavioral health applications of virtual reality...

Intelligent Frozen Shoulder Rehabilitation

Abstract: Frozen shoulder, or adhesive capsulitis, which reportedly affects 2â5 percent of the general population, is a shoulder condition characterized by painful and limited active and passive range of motion. The main treatment involves applying proper shoulder exercises and joint mobilization to break up adhesions at the joint capsules and improve joint mobility and functions. However, due to a lack of persistence, not all patients complete rehabilitation. To address this concern, this study focused on providing interactive treatments to encourage patients to participate in regular rehabilitation. Patients can inquire freely about their rehabilitation progress with real-time sensing and game-based feedback. In addition, six progressive and hierarchical training tasks make each training step adjustable based on the patient's physical condition. The authors used standard randomized clinical trial criterion to recruit 40 patients for a sequence of trials over a four-week period. The evaluation of the study group revealed that shoulder joint mobility and muscle strength of the patients significantly improved compared to that achieved by the traditional rehabilitation method.

A virtual reality system integrated with robot-assisted haptics to simulate pinch-grip task: Motor ingredients for the assessment in chronic stroke

Abstract: BACKGROUND Among numerous studies on virtual reality (VR) technology for motor rehabilitation, the majorities have only used it as a motor training system and did not use the kinematic or kinetic information obtained as the basis for therapeutic effect assessment OBJECTIVE Incorporating the kinematic and kinetic information acquired through a robot-assisted VR system on pinch-grip training, this study intends to propose novel motor ingredients represented as indices for the interpretation of motor behaviors and verify the efficacy of them for the assessment in chronic stroke METHODS Clinical trials were conducted on eight stroke patients and clinical assessments were made as the objective standard Non-parametric test and correlation analysis were performed on results of motor indices and clinical assessments RESULTS Non-parametric test indicated that 50% of the motor indices significantly improved while the others showed a trend of improvement, consisting with the findings in clinical assessments Correlation analysis showed that the three clinical assessment items were correlated to items in the motor ingredients CONCLUSIONS The proposed motor ingredients gathered from the robot-assisted VR training system were able to contribute to the assessment of therapeutic effect in chronic stroke and were capable for the interpretation of behavior phases

Adolescent suicidal risk assessment in clinician-patient interaction: A study of verbal and acoustic behaviors

Abstract: Suicide among adolescents is a major public health problem: it is the third leading cause of death in the US for ages 13-18. Up to now, there is no objective ways to assess the suicidal risk, i.e. whether a patient is non-suicidal, suicidal re-attempter (i.e. repeater) or suicidal non-repeater (i.e. individuals with one suicide attempt or showing signs of suicidal gestures or ideation). Therefore, features of the conversation including verbal information and nonverbal acoustic information were investigated from 60 audio-recorded interviews of 30 suicidal (13 repeaters and 17 non-repeaters) and 30 non-suicidal adolescents interviewed by a social worker. The interaction between clinician and patients was statistically analyzed to reveal differences between suicidal vs. non-suicidal adolescents and to investigate suicidal repeaters' behaviors in comparison to suicidal non-repeaters. By using a hierarchical ensemble classifier we were able to successfully discriminate non-suicidal patients, suicidal repeaters and suicidal non-repeaters.

Motion controllers for learners to manipulate and interact with 3D objects for mental rotation training

Abstract: Mental rotation is an important spatial processing ability and an important element in intelligence tests. However, the majority of past attempts at training mental rotation have used paper-and-pencil tests or digital images. This study proposes an innovative mental rotation training approach using magnetic motion controllers to allow learners to manipulate and interact with three-dimensional ( 3D) objects. Stereovision allows learners to perceive the spatial geometric form of a 3D object. This approach allows learners to perceive 3D objects in space through stereovision and make mental rotation visible from each intrinsic and invisible mental rotation step using motion-interaction methods. This study examines the effects of user training performance and perceptions. The results indicate that the proposed approach can improve user mental rotation ability effectively. Learners expressed high degrees of concentration toward the mechanism that included direct control and immediate feedback. The results also suggest that female testers perceive greater degrees of playfulness toward the mechanism and improve more through training than male testers. [ABSTRACT FROM AUTHOR]

Virtual Reality Exposure Therapy for Combat-Related Posttraumatic Stress Disorder

Abstract: Virtual reality (VR) technology is rapidly evolving to support prolonged exposure (PE) therapy, a proven treatment for combat-related posttraumatic stress disorder. Building on the successful 2007 Virtual Iraq/Afghanistan VRET system, a team of behavioral scientists, software engineers, and virtual artists has created Bravemind, a flexible VR system that offers significantly enhanced PE treatment possibilities. The first Web extra at http://youtu.be/EiYg-kMNMtQ is a video demonstration of an original early virtual reality exposure therapy (VRET) prototype that shows a small section of an Iraqi city with a landing helicopter (2004). The second Web extra at http://youtu.be/_cS-ynWZmeQ is a video demonstration of VRET that simulates driving a Humvee in a rural part of Iraq, showcasing several encounters, including IED and road-side attacks (2007). The third Web extra at http://youtu.be/78QXX_F4mc8 is a video demonstration of VRET that simulates an overview of several Iraqi city areas (2007). The fourth Web extra at http://youtu.be/_AnixslkVLU is a video demonstration of VRET that simulates a patrol entering interior buildings in Iraq (2007). The fifth Web extra at http://youtu.be/S22aQ-DqKKU is a video demonstration of an original VRET tablet interface that allows the clinician to change virtual reality settings and trigger encounters (2007). The sixth Web extra at http://youtu.be/C-fspuLo4vw is a video demonstration of the Bravemind VRET prototype showing a variety of driving and dismounted scenarios with encounters in Iraq and Afghanistan (2013). The sixth Web extra at http://youtu.be/HSPDomDAigg is a video collection of Iraqi and Afghanistan VRET scenarios within the Bravemind prototype (2013).

Expansion of a VR Exposure Therapy System for Combat-Related PTSD to Medics/Corpsman and Persons Following Military Sexual Trauma.

Abstract: The stressful experiences that have been characteristic of the combat environments in Iraq and Afghanistan have produced significant numbers of returning service members at risk for developing posttraumatic stress disorder and other psychosocial/behavioral health conditions. This paper describes a set of projects that are expanding the content for inclusion in a newly updated "Virtual Iraq/Afghanistan" Virtual Reality system for the delivery of exposure therapy (VRET) for PTSD with Service Members and Veterans. In addition to the complete rebuilding of this VRET system using the latest version of the Unity Game Engine, the system's content and functionality has been expanded to now support the use of VRET with combat medics/corpsmen and persons who have experienced military sexual trauma (MST). The focus of this paper is to present the rationale and general overview of the progress on these projects that will provide new relevant and customizable options for conducting VRET with a wider range of trauma experiences.

Self-Reported Differences in Personality, Emotion Control, and Presence Between Pre-Military and Non-Military Groups in a Pilot Study Using the Stress Resilience in Virtual Environments (STRIVE) System.

Abstract: Mental health disorders are the signature wounds of war resulting from extended U.S. Military conflicts in the Middle East [1]. In an effort to abate the number of Service Members that develop mental health disorders in these conflicts, USC-ICT has created the Stress Resilience in Virtual Environments (STRIVE) project, a set of highly realistic virtual reality combat scenarios and resilience-building sessions designed for pre-deployed military personnel. This short-paper looks at self-reported differences in personality, emotion control, and presence between two different groups, pre-military and non-military, of pilot subjects that tested a prototype of the first four modules of STRIVE.

Using Virtual Reality as Part of an Intensive Treatment Program for PTSD

Abstract: Up to 18.5% of veterans returning from OIF/OEF are diagnosed with posttraumatic stress disorder (PTSD). In addition to symptoms of anxiety (intrusive thoughts, re-experiencing, hyperarousal, and avoidance), PTSD can result in social maladjustment, poor quality of life, and medical problems. Other emotional problems include guilt, anger, and unemployment, impulsive or violent behavior, and family discord. Many veterans seeking treatment for PTSD also seek disability compensation for debilitating occupational impairment. There are few administrative or research data to indicate veterans are recovering from PTSD. Exposure therapy, a form of behavior therapy, alleviates anxiety symptoms, but may not address the anger, depression and social impairment that accompanies this disorder. In this presentation, we will discuss an intensive treatment program, known as Trauma Management Therapy (TMT), which combines individual virtual reality (VR) assisted exposure therapy with group social and emotional rehabilitation skills training, delivered in a 3 week format. The presentation will demonstrate the VR environment (Virtual Iraq), will discuss how often/successfully various VR elements are integrated into a comprehensive treatment program, and the adaptability of the program for active duty military personnel, as well as veterans. We will discuss the format of the intensive program as well as factors such as compliance and drop-out rates, comparing these important clinical variables to more traditional outpatient treatment programs. Additionally, we will address common clinical concerns regarding the use of VR exposure therapy for individuals suffering from PTSD.

Detection and computational analysis of psychological signals using a virtual human interviewing agent

Abstract: It has long been recognized that facial expressions, body posture/gestures and vocal parameters play an important role in human communication and the implicit signalling of emotion. Recent advances in low cost computer vision and behavioral sensing technologies can now be applied to the process of making meaningful inferences as to user state when a person interacts with a computational device. Effective use of this additive information could serve to promote human interaction with virtual human (VH) agents that may enhance diagnostic assessment. The same technology could also be leveraged to improve engagement in teletherapy approaches between remote patients and care providers. This paper will focus on our current research in these areas within the DARPA-funded “Detection and Computational Analysis of Psychological Signals” project, with specific attention to the SimSensei application use case. SimSensei is a virtual human interaction platform that is able to sense and interpret real-time audiovisual behavioral signals from users interacting with the system. It is specifically designed for health care support and leverages years of virtual human research and development at USC-ICT. The platform enables an engaging face-to-face interaction where the virtual human automatically reacts to the state and inferred intent of the user through analysis of behavioral signals gleaned from facial expressions, body gestures and vocal parameters. Akin to how non-verbal behavioral signals have an impact on human to human interaction and communication, SimSensei aims to capture and infer from user non-verbal communication to improve engagement between a VH and a user. The system can also quantify and interpret sensed behavioral signals longitudinally that can be used to inform diagnostic assessment within a clinical context.

Development of a Virtual Reality-Based Pinch Task for Rehabilitation in Chronic Hemiparesis

Abstract: Impaired pinch performance affects dexterity function after stroke. Virtual reality-based training may be beneficial for improving dexterity function. This study aimed to develop a virtual reality-based pinch task and to investigate its feasibility for chronic hemiparesis. The pinch task in the virtual environment was accomplished by coordinating two PHANTOM devices that provide haptic feedback. Participants grasped and lifted a virtual cube with 30-sec time limit for 10 trials. Cube size, cube mass and lift height were systematically varied. The participant poststroke attempted an average of 38 trials per session with a 60 % success rate and without complaint of fatigue or pain. After the training, the participant poststroke decreased the total time. However, the peak pinch force did not change. The results suggest that the virtual reality-based pinch task was feasible for chronic hemiparesis. Further investigation is warranted to better understand the effect of pinch force regulation using hepatic feedback.

Haptic Virtual Reality Pinch Task for Chronic Hemiparesis

Abstract: Incorporating the virtual reality technology into stroke rehabilitation has been proved to be effective in improving upper extremity function for stroke survivors. However, without haptic feedback, the recovery of pinch skill will not be sufficient for daily activities. Pinch skill is an important component for hand manipulation. Impaired pinch skill affects dexterity function after stroke. This study aimed to develop a haptic virtual reality pinch task and to investigate its feasibility and effectiveness for chronic hemiparesis. The pinch task in the virtual environment was accomplished by coordinating two PHANTOM devices that provide haptic feedback. Participants grasped and lifted a virtual cube within 30 seconds for 10 trials. Cube size, cube mass and lift height were systematically varied. The participant poststroke attempted an average of 38 trials per session with a 60% success rate and without complaint of fatigue or pain. After training, the participant poststroke decreased the total time. However, the peak pinch force did not change. The results suggest that the haptic virtual reality pinch task was feasible for chronic hemiparesis. Further investigation is warranted to better understand the pinch force regulation using hepatic feedback.

Agile development of a virtual reality cognitive assessment

Abstract: In recent years user-centered design, participatory design and agile development have seen much popularity in the field of software development. More specifically, applying these methods to user groups with cognitive and motor disabilities has been the topic of numerous publications. However, neuropsychological assessment and training require special consideration to include therapists and brain-injured patients into the development cycle. Application goals, development tools and communication between all stakeholders are interdependent and outlined in a framework that promotes elements of agile development. The framework is introduced by example of a virtual reality cognitive assessment for patients with traumatic brain injuries. The assessment has seen a total of 20 iterations over the course of nine months including changes in task content, task difficulty, user interaction and data collection. The framework and development of the cognitive assessment are discussed.