Virtual Reality Meets the Road in Kessler Research Project

Clinical Neuropsychologist Dr. Maria Schultheis has discovered an unexpected admiration for the video game industry. More specifically, she appreciates the technical skills of their engineers, especially their ability to create realistic, incredibly complex interactive environments. And while it’s unlikely that she’ll be hooked on Grand Theft Auto anytime soon, Schultheis doesn’t hesitate to acknowledge that the gaming industry has been the driving force behind the rapid growth and sophistication of “virtual reality” systems, which she and a team of researchers are putting to unique new uses at the Kessler Medical Rehabilitation Research and Education Corporation (KMRREC) in West Orange, New Jersey.

Schultheis is director of the Virtual Reality Research Laboratory at KMRREC. For the last several years, she’s been working on a method of helping patients who have suffered cognitive impairments from traumatic brain injuries (TBIs) or strokes, assessing their abilities and limitations and helping them get back behind the wheel of a car. With the latest project, which combines three flat-screen monitors and a steering wheel column fitted with hand controls typical of cars modified for wheelchair users, Schultheis and her team are nearing completion of what may be the only “Accessible Virtual Reality Driving Simulator” in the country.

Actual vs. Virtual

Patients recovering from neurological compromise such as TBI, strokes, or spinal cord injury (SCI) who hope to drive again typically schedule a test drive in the company of a rehabilitation specialist and their performance is evaluated under actual road conditions. The problems with this approach are obvious, foremost being the physical safety of the therapist and the patient.

Cognitive impairments as a result of injury or stroke frequently include decreased attention and visual perceptual skills, slowed information-processing speed, and various “executive” dysfunctions. High-speed traffic on a modern superhighway presents formidable challenges for healthy drivers; for the cognitively-impaired, the risks are multiplied. Additionally, such evaluations are limited by the lack of standardized guidelines and “ecologically valid” measures, nonstandardized protocols, and subjective interpretation of performance. In other words, what might be acceptable driving skills for one evaluator might be unacceptable for another. There is simply no one agreed-upon measure for determining when an individual may safely resume driving.

Test developer David Heard confers with research assistant LaNora Callahan as they work to tweak the program in preparation for research with various users. (Photo by Emile Wamsteker) Dr. Maria Schultheis is the driving force behind the development of a virtual reality program that gives drivers with SCI the chance to get familiar with hand controls before the rubber meets the road. Further complicating the issue, Schultheis explained, there are no clear-cut regulations in place at the various state departments of motor vehicles (DMVs) regarding when, or if, someone who suffers a TBI, stroke, or SCI should be required to re-take a driving test, or if such injuries automatically require forfeiture of one’s license. Technically, the physician treating such patients is expected to notify the patient’s local DMV, informing the agency of the patient’s injury. But Schultheis says that because of the workload that most doctors endure, this communication is usually not a priority and is frequently missed.

“In most cases,” Schultheis says, “the DMV never hears about it and only a small percentage of people with impairments find their way to driver rehabilitation specialists.” She’s hoping that, with further development, the innovative and low-cost system designed at KMRREC will find applications in rehabilitation hospitals around the country.

Schultheis’s research, which is funded by the State of New Jersey Commission on Spinal Cord Research, assumes that a realistic, virtual environment can overcome the shortcomings inherent in trying to assess driving skills under actual road conditions and the technology can provide a standardized set of measurements for evaluation that can be used across a broad spectrum of physical and cognitive impairments.

As any video game aficionado can attest, virtual reality technology immerses a user in a three-dimensional, computer-generated environment that creates convincing, “real life” situations requiring quick, logical responses. The difference between a video game and Schultheis’s system is that, while a game will only record a score, her simulator records all of the participant’s actions, providing a complete, second-by-second picture of the user’s behavior. This will more accurately show how a user responds to an almost limitless number of potential situations.

A Unique Application

Driving simulators that employ virtual reality systems, like aircraft simulators, are becoming widely accepted tools and the technology is also being used more often in the medical community for treating phobias, training surgeons, and providing patient education. Schultheis explained that, in the rehabilitation universe, virtual reality systems have been used to recreate a typical kitchen environment to help teach stroke victims how to navigate around appliances, and classroom environments have been created to study how children diagnosed with attention deficit/hyperactivity disorder (ADHD) react to a variety of stimuli to learn when and how they are distracted and how their attention breaks down.

What makes the Schultheis team’s simulator unique, however, is the interface between the mechanical adaptive driving controls of an actual modified automobile steering column and the software that creates the visuals—hence, creating an “accessible” simulator. “To our knowledge, no one else in the US has come up with such a system,” she said.

Further, she and her staff have focused on building the system from “off-the-shelf” computer components to keep costs down. All the hardware components (mostly Dell equipment) were configured by Schultheis’ in-house staff. Depending on the configuration, Schultheis estimates that the system can be built for about $12,000. “What is not commercially available is the software,” she said. For that, she turned to a Canadian firm that specializes in virtual reality systems, Digital MediaWorks, Inc.

Schultheis also found support for the project from several local merchants who donated equipment. The steering wheel and column was given by a Bridgewater salvage yard, Price AutoWreckers; the adaptive driving equipment was donated by Drive Master of Fairfield; and the mechanical design and installation labor was provided by Spadix Technologies, Inc., of Middlesex.

Schultheis’ research team at KMRREC consists of Dr. David Tulsky; Electrical Engineer Dr. Lisa Simone; Research Assistant LaNora Callahan; and Rehabilitation Driving Specialist Richard Nead.

Schultheis says that she and her team have the driving simulator about “90%” complete and they are in the process of writing up the development experience for submission to a professional rehabilitation journal. She’s also looking at fund-raising options for a follow-up study to validate the reliability of the system. Ideally, she’d like to get results from about 120 participants and to eventually undertake a multicenter study where several different rehabilitation hospitals around the country could each build a system at relatively low cost and demonstrate the efficacy of the simulator across a broader geographical base.

“The goal of rehabilitation is to get people back into their communities; to take the strategies they’ve learned in rehab and apply them at home,” Schultheis said. “Unfortunately, once patients go home we don’t have an opportunity to observe them in their natural environment. With a virtual reality simulator we can create many of those environments ahead of time and see how our rehab strategies work.”

Rob Ingraham is senior editor in Communications at United Spinal.