- freely available
Sensors 2018, 18(7), 2343; https://doi.org/10.3390/s18072343
1.1. The Problem of Frailty
1.2. The Potential of Virtual Reality to Counteract Frailty
2. Positive Bike
2.1. System Architecture
2.2. Virtual Environments
- Game type: the therapist can set the target typology—and thus define the exercise type—by choosing between animals or street furniture.
- Characteristic of the target to select: for animals, the first letter of the animals’ names (C/G/T/S); for street furniture, distinct colors are available (orange/blue /yellow/violet).
- Level: two levels of difficulty are available; in level 1, targets appear on the route each 15 s, in level 2, each 10 s.
- Cycle-ergometer workload: the operator can set the bike workload selecting among 20/30/40/50 Watt, depending on the patient’s physical condition.
- Time: the duration of the exercise, the therapist can select 15 or 20 min.
3. Usability Study
- Effectiveness: the possibility for the users to achieve goals;
- Efficiency: the effort made by the user to reach the goal;
- Satisfaction: what users think about the interaction with the system.
- SUS is a “quick and easy to use” questionnaire composed by ten items and created by Brooke in the 1996 . The final score can range from 0, lack of usability, to 100, best usability (for an interpretation of SUS scores, see ). This is a standard scale for the assessment of usability of technological systems and it is easy to use and to understand for the patients.
- The short flow state scale  assesses nine key flow dimensions: (1) challenge–skill balance: “I feel I am competent enough to meet the high demands of the situation”; (2) action–awareness merging: “I do things spontaneously and automatically without having to think”; (3) clear goals: “I have a strong sense of what I want to do”; (4) unambiguous feedback: “I have a good idea while I am performing about how well I am doing”; (5) concentration on the task at hand: “I am completely focused on the task at hand”; (6) sense of control: “I have a feeling of total control over what I am doing”; (7) transformation of time: “The way time passes seems to be different from normal”; (8) loss of self-consciousness: “I was not worried about what others may have been thinking of me”; (9) and autotelic experience: “The experience is extremely rewarding”. These characteristics were constructed using the conceptual flow model [68,69]. Subjects have to rate the flow experience on a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).
- Utilization (effectiveness),
- Learning (efficiency),
- Pleasantness (satisfaction).
- Sense of presence:
- Spatial presence,
6. Conclusions and Future Works
Conflicts of Interest
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|Usability||Utilization||What difficulties did you encounter in carrying out the task?|
Was it difficult to use the instrument?
There were technical issues during the session?
|Learning||Did you have to ask for help to understand how to use the system?|
Did it take a long time to figure out how the instrument works?
Was exercise complicated?
|Pleasantness||Did you like the virtual environment?|
Some parts of the system were uncomfortable?
Did you have any trouble riding a stationary bike with 3D glasses?
|Sense of Presence||Spatial presence||Did you feel part of the environment?|
Do you feel you have control over the environment?
|Engagement||Were you happy that the exercise was over?|
What do you think about the duration of the experience?
Did you easily get distracted during exercise?
|Realism||How did you find the environment, realistic or too artificial?|
|Cyber Sickness||Physical side-effects||Did you feel bad during exercise?|
Did you have nausea, dizziness or other physical symptoms during exercise?
|Expectations||Would you like to use this system to do exercise?|
Do you think this system can be useful for other types of patients?
|Q6||Sense of control||4.4||0.80|
|Q7||Loss of self-consciousness||5||0.00|
|Q8||Transformation of time||3.8||1.60|
|Measure of agreement||Kappa||0.850||0.102|
|No. of valid cases||27|
|Usability||Utilization||“Both the motor and cognitive tasks were easy.”|
|Learning||“There was no problem in learning the use of the system.”|
|Pleasantness||“The 3D glass was not uncomfortable.”|
“The environment was beautiful.”
“The cycle-ergometer was manageable.”
|Sense of Presence||Spatial Presence||“The feeling was to be in the real park.”|
“I had the feeling of being suspended.”
“The environment was relaxing.”
|Engagement||“I was focused on the task.”|
“I think I’ve been pedaling for 5 min.”
“I forget you (the examiners) were here too.”
|Realism||“The environment was realistic.”|
|Cyber Sickness||Physical side-effects||None present side effect like cyber-sickness or nausea|
|Expectations||“This system could be useful for several types of patients.”|
“I think it’s easier to train with this tool.”
|Usability||Utilization||“It’s difficult to recognize small animals.”|
“It’s not easy to identify animals placed backward.”
“Some similar animals were confused (zebra–horse and turkey–swan).”
|Learning||The sound of the bike might be confused with the sound that give a feedback about speed.|
“When frequency increases the exercise becomes more difficult.”
|Pleasantness||“Animals are repetitive.”|
|Sense of Presence||Spatial Presence||“I had the feeling that animals bumped me.”|
|Engagement||“I felt passive and not active in the environment.”|
|Realism||“The environment was nice but did not look very real.”|
“Some animals are ‘out of context’.”
|Cyber Sickness||Physical side-effects||One patient was tired before the end of the task.|
|Expectations||There is no difference between this type of treatment and another.|
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