Tag Archives: virtual reality

Do you see what I see?

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VR

Over time, I’ve learnt that you can do a lot more harm than good in being critical over other people’s initiatives in dementia. I really do believe it’s essential to be supportive, and to give recognition to other people’s efforts and hard work. The ‘virtual reality centre’ is of course no exception to this for me.

This news article will give you a good introduction to the innovation (as well as the video above).

“Aged care workers can now experience what it feels like to live with dementia at an Australian-first dementia learning centre that uses light, sound, colour, visual content and serious gaming technology to create a virtual reality.

The Perc Walkley Dementia Learning Centre is a key feature of Alzheimer’s Australia Vic’s new facility in Parkville, Melbourne, which was opened by Alzheimer’s Australia National President Ita Buttrose on Wednesday.

The training centre features doughnut shaped mood lighting, a 10 metre by two metre projection wall, an interactive touch screen and gesture-sensor technology.

It allows students to be immersed in the virtual world of someone with dementia and experience the cognitive and perceptual difficulties they might face in their daily life that can make ordinary tasks challenging or dangerous.”

There is much to laud here. How persons living with dementia and carers, very often family members including spouses, deal with risk in the community is of huge interest worldwide. Take for example the brilliant work of the Cognitive Decline Partnership Centre based at Sydney which has this as one of its research goals.

The description of course seems perfectly plausible.

“Aged care workers can now experience what it feels like to live with dementia at an Australian-first dementia learning centre that uses light, sound, colour, visual content and serious gaming technology to create a virtual reality.

The Perc Walkley Dementia Learning Centre is a key feature of Alzheimer’s Australia Vic’s new facility in Parkville, Melbourne, which was opened by Alzheimer’s Australia National President Ita Buttrose on Wednesday.”

But sorry to be the first to rain on this parade but we currently have a very scant knowledge of the perception of objects in dementia.

There’s no doubt that cognitive neurologists have not given due regard to sensory perceptual effects of living with dementia. Agnes Houston and Donna Houston have been educating others about how dementia can affect the senses, in remarkable work which the Life Changes Trust have supported. The feedback from other people living with dementia has shown that many people have experienced sensory phenomena, with the medical profession barely batting an eyelid. Sensory phenomena can indeed be marked phenomena of some young onset dementias, though I am not one to define any person by their medical label. For example, in diffuse lewy Body dementia, sensory hallucinations can be common. In the posterior cortical atrophy, there can be some marked differences in the perception of space. I feel, in common with many others, what we call the posterior cortical atrophy is one common presentation of the dementia of Alzheimer type in an earlier age group (typically 55-60).

But likewise, not everyone living with dementia experiences marked sensory changes early one. It would be very unlikely for somebody with the behavioural variant frontotemporal dementia, known for changes in personality and behaviour, and relatively normal cognition otherwise, to experience marked perceptual changes. In my own Brain paper from 1999, indeed, I found no evidence for sensory disturbances. This would be entirely expected, as this type of dementia affects early on the very front of the brain, very far from the parts of the brain further back which process vision and other senses.

So the sentiments expressed in these paragraphs came somewhat as a surprise to me:

“Aged care workers can now experience what it feels like to live with dementia at an Australian-first dementia learning centre that uses light, sound, colour, visual content and serious gaming technology to create a virtual reality.

The Perc Walkley Dementia Learning Centre is a key feature of Alzheimer’s Australia Vic’s new facility in Parkville, Melbourne, which was opened by Alzheimer’s Australia National President Ita Buttrose on Wednesday.””

The project sits uneasily with the conflation of dementia and ageing. Not everyone with dementia is old, and yet it is an altogether different thing to say someone has visual problems due to cataracts (common causes being age, diabetes and smoking). This can cause fogging of the image and colour changes, as Monet himself noticed. It’s unlikely for somebody just to be living with dementia; for example, somebody might be living with dementia as well as with a previous stroke, and the stroke might cause visual problems of their own such as field defects.

I do not deny the value of public-private partnerships, but I feel I have to raise the scrutiny with which scarce resources for dementia care are allocated into projects such as these with questionable scientific and clinical merit. The initiative raises concerns for me with the due diligence with which other professionals are involved. I feel any reasonable cognitive neurologist would have come to the same conclusions as me. I am more concerned about the ‘engagement’ (suboptimal term) of people actually living with dementia. Sure, it’s not possible to consult all 47 million people living with dementia around the world, but people living with dementia have different ‘faces’, depending on how much a cause of dementia has affected the brain; and there are at least 120 different causes of dementia, medically, depending on how you count them,

So unfortunately this project for me, and freedom of expression is important, raises the grim reality of ‘the wrong type of awareness of dementia’.

But I do agree with the write-up that this is fun, and – ironically – this is the bit of the pitch which has the most scientific validity for me.

“While conventional video games are made to entertain, serious games use traditional gaming technology and techniques to create tools for education or a particular purpose, said Norman Wang, the founder of Opaque MultiMedia, which is developing the virtual dementia experience (VDE).

“Normally people can understand dementia at an intellectual level. We are using immersive virtual reality so people can understand it at a visceral level,” Mr Wang said.”

There’s indeed a lot in ‘gamification‘ to recommend.

The issue here is we are much better at learning stuff if it engages neural circuitry involved in arousal, emotion and motivation (this is simply because it engages different parts of the brain which help to consolidate memories).

And it’s important not to throw the baby out with the bathwater in this case. For any innovation to take off, you need to see what real adoption is like. For all I know, this innovation will be really helpful to carers.

I have noticed that people living with dementia, of whatever background, can have real issues with features in the environment, such as ‘garish’ carpets. This is utterly genuine, and explains the rationale of the global approach of ‘dementia friendly communities’.

This makes sense to me.

““We can create special effects, such as have surfaces that ripple or change colour,” Mr Wang said.”

But above all this innovation does not get round the somewhat philosophical problem of ‘Do you see what I see?’ This problem, often articulated as ‘Will you hear an apple dropping in a forest the same way as me?’, is a very difficult question of philosophy of mind, a favourite of undergraduate finalists in philosophy exams all around the world. We should be very wary of attributing perceptions to people with dementia, in the same way we attribute other functions of the brain, on the one hand. On the other hand, identifying what may be ‘deficits’ in the thinking of others may help us best to retrofit ‘reasonable adjustments’ entirely consistent with the attitude (and legal fact) of dementia as a disability.

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