1. The development and evaluation of an electric scooter simulation program Michiel JA Jannink (PhD)*, V. Erren (PT), A.C. de Kort (MD), Ir. H. vd Kooij (Phd), Ir. C. Haarmeijer * Roessingh Research and Development, Enschede, the Netherlands

2. Rehabilitation Centre ‘Het Roessingh’

3. University of Twente

4. VR facilities

5. Motivation VR Steady increase in age in western society; –2006 > estimation: 20.7% of the people are over 60 y –2020 > estimation: 25.9% of the people are over 60 Y –Substantial pressure on health care resources; Physical Medicine and Rehabilitaion new technologies like VR??

6. Electric Scooter Simulation Program (ScoMoSi)

7. ScoMoSi:

8. Background ScoMoSi project: Electric mobility scooters are provided by local authorities 183.000 users in the Netherlands (1998) Per year 15.000 new users 8 to 17 km/h (on pavement, but also on road/lanes) However Not every person receives a training period; If training, safety patient and health care professional can be a problem; no objective protocols.

10. Goal ScoMoSi project: To explore if it is possible to train the driving skills of future users of electric mobility scooters by means of an electric scooter simulation program in addition to conventional electric scooter training Question (a priori): Is Scomosi training at least as effective as conventional training

11. Methods: Literature search; Expert interviews; Scenario Development; Explorative RCT

12. Literature Search: Literature search: (1975- July 2005) -Medline -Embase -CIRRIE -Cochrane controlled Trials database

13. Selection of literature Goal Pronk et al. 1980Driving skills2D Cooper et al. 1995Exercise training2D Hasdai et al. 1997Driving skills2D O’conner et al. 2000Exercise training2D Webster et al. 2001Driving skills2D Harrison et al. 2002Driving skills2D Cooper et al. 2002Driving skills2D Weiss et al. 2003Leisure activity3D

14. Literature conclusions: The results of the studies indicate that VR might be a useful application to train powered wheelchair users. A positive training effect (in a simulator) resulted in an improved performance on real-life driving skills. The number of collisions decreased and the time needed to complete the course improved

15. User requirements based on scenario development Story line John suffered from a hemiplegics stroke 6 months ago. As a result he has ambulatory problems. To compensate this he will receive an electric scooter. To drive safely in different traffic situations, he will be trained by means of an electric scooter simulation program. Training session duration = half an hour. His performance will be stored on the computer. User requirements System requirements Full immersive VE to train future users of electric scooters. Acquire relevant date regarding driving skills - HMD/screens - Interface electric scooter - VE - Training protocols - Understand performance - Storage and processing unit - Interpretation of collisions - Free driving context/maps

16. 3 training levels: Level 1

17. Level 2

18. Level 3

19. ScoMoSi set-up 3 PC’s

22. Subjective questionnaire* Screens vs HMD Fun; Difficulty; Realistic; Dizziness; Sickness; Based on following items: Fatigue; Comfort; Control; Safety; Distraction. * Based on Cooper et al. 1995; Harrison et al. 2002

23. Results: No difference between screens and HMD with regard to: difficulty, realism, fatigue, control, safety and distraction. HMD: more fun, less dizziness and sickness, better comfort

24. Explorative RCT Clinical evaluation SCOMOSI –10 stroke patients –RCT design Experimental group (n=5) Control group (n=5) –Driving skills measured on T0 and T1 according to Functional Evaluating Rating Scale (Hasdai et al. 1997) –Subjective experiences measured on T1

25. Results: groupSubjectFERS PreFERS PostFERS pre-postProgress (%) experimentalPP04 18.0016.002.00 5.6 PP0621.0018.003.008.3 PP0714.0013.001.002.8 PP1019.0014.005.0013.9 PP1116.0014.002.005.6 Mean17.6015.002.607.2 controlPP0117.0014.003.008.3 PP0217.00.000.0 PP0318.00--- PP0521.0018.003.008.3 PP0816.0012.004.0011.1 Mean17.8015.252.506.9

26. Subjects SORT (max. 56) Content (max. 12) Performance (max. 16) Safety (max. 12) Comfort (max. 16) ExpPP0451.011.013.011.016.0 PP0650.511.513.511.014.5 PP0753.010.015.511.516.0 PP1051.09.014.012.016.0 PP1151.010.013.012.016.0 Total51.310.313.811.515.7 ControlPP0151.311.014.010.715.7 PP0253.012.016.010.515.5 PP0356.012.016.012.016.0 PP0551.011.014.011.015.0 PP0852.012.015.011.014.0 Total52.711.615.011.015.2

27. Current SCOMOSI environment

28. Conclusion The electric scooter simulation program is potentially useful an safe for training patients in handling electric powered scooters; Standardized assessment and training protocols need to be developed; Usability evaluation

29. Thank you for your attention