Aug 03, 2014
Detecting awareness in patients with disorders of consciousness using a hybrid brain-computer interface
Detecting awareness in patients with disorders of consciousness using a hybrid brain-computer interface.
J Neural Eng. 2014 Aug 1;11(5):056007
Authors: Pan J, Xie Q, He Y, Wang F, Di H, Laureys S, Yu R, Li Y
Abstract. Objective. The bedside detection of potential awareness in patients with disorders of consciousness (DOC) currently relies only on behavioral observations and tests; however, the misdiagnosis rates in this patient group are historically relatively high. In this study, we proposed a visual hybrid brain-computer interface (BCI) combining P300 and steady-state evoked potential (SSVEP) responses to detect awareness in severely brain injured patients. Approach. Four healthy subjects, seven DOC patients who were in a vegetative state (VS, n = 4) or minimally conscious state (MCS, n = 3), and one locked-in syndrome (LIS) patient attempted a command-following experiment. In each experimental trial, two photos were presented to each patient; one was the patient's own photo, and the other photo was unfamiliar. The patients were instructed to focus on their own or the unfamiliar photos. The BCI system determined which photo the patient focused on with both P300 and SSVEP detections. Main results. Four healthy subjects, one of the 4 VS, one of the 3 MCS, and the LIS patient were able to selectively attend to their own or the unfamiliar photos (classification accuracy, 66-100%). Two additional patients (one VS and one MCS) failed to attend the unfamiliar photo (50-52%) but achieved significant accuracies for their own photo (64-68%). All other patients failed to show any significant response to commands (46-55%). Significance. Through the hybrid BCI system, command following was detected in four healthy subjects, two of 7 DOC patients, and one LIS patient. We suggest that the hybrid BCI system could be used as a supportive bedside tool to detect awareness in patients with DOC.
Jul 30, 2014
A virtual rehabilitation program after amputation: a phenomenological exploration.
Disabil Rehabil Assist Technol. 2013 Nov;8(6):511-5
Authors: Moraal M, Slatman J, Pieters T, Mert A, Widdershoven G
Abstract. PURPOSE: This study provides an analysis of bodily experiences of a man with a lower leg amputation who used a virtual rehabilitation program. METHOD: The study reports data from semi-structured interviews with a 32-year veteran who used a virtual environment during rehabilitation. The interviews were analyzed using interpretative phenomenological analysis (IPA). RESULTS: During this rehabilitation program, he initially experienced his body as an object, which he had to handle carefully. As he went along with the training sessions, however, he was more stimulated to react directly without being aware of the body's position. In order to allow himself to react spontaneously, he needed to gain trust in the device. This was fostered by his narrative, in which he stressed how the device mechanically interacts with his movements. CONCLUSION: The use of a virtual environment facilitated the process of re-inserting one's body into the flow of one's experience in two opposite, but complementary ways: (1) it invited this person to move automatically without taking into account his body; (2) it invited him to take an instrumental or rational view on his body. Both processes fostered his trust in the device, and ultimately in his body. IMPLICATIONS FOR REHABILITATION: Providing (more) technological explanation of the technological device (i.e. the virtual environment), may facilitate a rehabilitation process. Providing (more) explicit technological feedback, during training sessions in a virtual environment, may facilitate a rehabilitation process.
Characteristics of Successful Technological Interventions in Mental Resilience Training.
J Med Syst. 2014 Sep;38(9):113
Authors: Vakili V, Brinkman WP, Morina N, Neerincx MA
Abstract. In the last two decades, several effective virtual reality-based interventions for anxiety disorders have been developed. Virtual reality interventions can also be used to build resilience to psychopathology for populations at risk of exposure to traumatic experiences and developing mental disorders as a result, such as for people working in vulnerable professions. Despite the interest among mental health professionals and researchers in applying new technology-supported interventions for pre-trauma mental resilience training, there is a lack of recommendations about what constitutes potentially effective technology-supported resilience training. This article analyses the role of technology in the field of stress-resilience training. It presents lessons learned from technology developers currently working in the area, and it identifies some key clinical requirements for the supported resilience interventions. Two processes made up this research: 1) developers of technology-assisted resilience programs were interviewed regarding human-computer interaction and system development; 2) discussions with clinicians were prompted using technology-centered concept storyboards to elicit feedback, and to refine, validate and extend the initial concepts. A qualitative analysis of the interviews produced a set of development guidelines that engineers should follow and a list of intervention requirements that the technology should fulfill. These recommendations can help bridge the gap between engineers and clinicians when generating novel resilience interventions for people in vulnerable professions.
Jul 29, 2014
Ekso is an exoskeleton bionic suit or a "wearable robot" designed to enable individuals with lower extremity paralysis to stand up and walk over ground with a weight bearing, four point reciprocal gait. Walking is achieved by the user’s forward lateral weight shift to initiate a step. Battery-powered motors drive the legs and replace neuromuscular function.
Ekso Bionics http://eksobionics.com/
Jul 09, 2014
Experiential Virtual Scenarios With Real-Time Monitoring (Interreality) for the Management of Psychological Stress: A Block Randomized Controlled Trial
The recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress. Objective: Our goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) using advanced technologies (virtual worlds, wearable biosensors, and smartphones).
Full text paper available at: http://www.jmir.org/2014/7/e167/
Apr 29, 2014
Actually, according to my experience, citizens and public stakeholders are not well-informed or educated about mHealth. For example, to many people the idea of using phones to deliver mental health programs still sounds weird.
Yet the number of mental health apps is rapidly growing: a recent survey identified 200 unique mobile tools specifically associated with behavioral health.
These applications now cover a wide array of clinical areas including developmental disorders, cognitive disorders, substance-related disorders, as well as psychotic and mood disorders.
I think that the increasing "applification" of mental health is explained by three potential benefits of this approach:
- First, mobile apps can be integrated in different stages of treatment: from promoting awareness of disease, to increasing treatment compliance, to preventing relapse.
- Furthermore, mobile tools can be used to monitor behavioural and psychological symptoms in everyday life: self-reported data can be complemented with readings from inbuilt or wearable sensors to fine-tune treatment according to the individual patient’s needs.
- Last - but not least - mobile applications can help patients to stay on top of current research, facilitating access to evidence-based care. For example, in the EC-funded INTERSTRESS project, we investigated these potentials in the assessment and management of psychological stress, by developing different mobile applications (including the award-winning Positive Technology app) for helping people to monitor stress levels “on the go” and learn new relaxation skills.
In short, I believe that mental mHealth has the potential to provide the right care, at the right time, at the right place. However, from my personal experience I have identified three key challenges that must be faced in order to realize the potential of this approach.
I call them the three "nEEEds" of mental mHealth: evidence, engagement, enactment.
- Evidence refers to the need of clinical proof of efficacy or effectiveness to be provided using randomised trials.
- Engagement is related to the need of ensuring usability and accessibility for mobile interfaces: this goes beyond reducing use errors that may generate risks of psychological discomfort for the patient, to include the creation of a compelling and engaging user experience.
- Finally, enactment concerns the need that appropriate regulations enacted by competent authorities catch up with mHealth technology development.
Being myself a beneficiary of EC-funded grants, I can recognize that R&D investments on mHealth made by EC across FP6 and FP7 have contributed to position Europe at the forefront of this revolution. And the return of this investment could be strong: it has been predicted that full exploitation of mHealth solutions could lead to nearly 100 billion EUR savings in total annual EU healthcare spend in 2017.
I believe that a progressively larger portion of these savings may be generated by the adoption of mobile solutions in the mental health sector: actually, in the WHO European Region, mental ill health accounts for almost 20% of the burden of disease.
For this prediction to be fulfilled, however, many barriers must be overcome: thethree "nEEEds" of mental mHealth are probably only the start of the list. Hopefully, the Green Paper consultation will help to identify further opportunities and concerns that may be facing mental mHealth, in order to ensure a successful implementation of this approach.
Apr 15, 2014
A post-stroke rehabilitation system integrating robotics, VR and high-resolution EEG imaging.
IEEE Trans Neural Syst Rehabil Eng. 2013 Sep;21(5):849-59
Authors: Steinisch M, Tana MG, Comani S
We propose a system for the neuro-motor rehabilitation of upper limbs in stroke survivors. The system is composed of a passive robotic device (Trackhold) for kinematic tracking and gravity compensation, five dedicated virtual reality (VR) applications for training of distinct movement patterns, and high-resolution EEG for synchronous monitoring of cortical activity. In contrast to active devices, the Trackhold omits actuators for increased patient safety and acceptance levels, and for reduced complexity and costs. VR applications present all relevant information for task execution as easy-to-understand graphics that do not need any written or verbal instructions. High-resolution electroencephalography (HR-EEG) is synchronized with kinematic data acquisition, allowing for the epoching of EEG signals on the basis of movement-related temporal events. Two healthy volunteers participated in a feasibility study and performed a protocol suggested for the rehabilitation of post-stroke patients. Kinematic data were analyzed by means of in-house code. Open source packages (EEGLAB, SPM, and GMAC) and in-house code were used to process the neurological data. Results from kinematic and EEG data analysis are in line with knowledge from currently available literature and theoretical predictions, and demonstrate the feasibility and potential usefulness of the proposed rehabilitation system to monitor neuro-motor recovery.
Apr 06, 2014
The effects of augmented visual feedback during balance training in Parkinson's disease - trial protocol
The effects of augmented visual feedback during balance training in Parkinson's disease: study design of a randomized clinical trial.
BMC Neurol. 2013;13:137
Authors: van den Heuvel MR, van Wegen EE, de Goede CJ, Burgers-Bots IA, Beek PJ, Daffertshofer A, Kwakkel G
Abstract. BACKGROUND: Patients with Parkinson's disease often suffer from reduced mobility due to impaired postural control. Balance exercises form an integral part of rehabilitative therapy but the effectiveness of existing interventions is limited. Recent technological advances allow for providing enhanced visual feedback in the context of computer games, which provide an attractive alternative to conventional therapy. The objective of this randomized clinical trial is to investigate whether a training program capitalizing on virtual-reality-based visual feedback is more effective than an equally-dosed conventional training in improving standing balance performance in patients with Parkinson's disease.
METHODS/DESIGN: Patients with idiopathic Parkinson's disease will participate in a five-week balance training program comprising ten treatment sessions of 60 minutes each. Participants will be randomly allocated to (1) an experimental group that will receive balance training using augmented visual feedback, or (2) a control group that will receive balance training in accordance with current physical therapy guidelines for Parkinson's disease patients. Training sessions consist of task-specific exercises that are organized as a series of workstations. Assessments will take place before training, at six weeks, and at twelve weeks follow-up. The functional reach test will serve as the primary outcome measure supplemented by comprehensive assessments of functional balance, posturography, and electroencephalography. DISCUSSION: We hypothesize that balance training based on visual feedback will show greater improvements on standing balance performance than conventional balance training. In addition, we expect that learning new control strategies will be visible in the co-registered posturographic recordings but also through changes in functional connectivity.
Mar 03, 2014
Virtual reality for the assessment of frontotemporal dementia, a feasibility study.
Disabil Rehabil Assist Technol. 2014 Feb 14;
Authors: Mendez MF, Joshi A, Jimenez E
Abstract Purpose: Behavioral variant frontotemporal dementia (bvFTD) is a non-Alzheimer dementia characterized by difficulty in documenting social-emotional changes. Few investigations have used virtual reality (VR) for documentation and rehabilitation of non-Alzheimer dementias. Methods: Five bvFTD patients underwent insight interviews while immersed in a virtual environment. They were interviewed by avatars, their answers were recorded, and their heart rates were monitored. They were asked to give ratings of their stress immediately at the beginning and at the end of the session. Results: The patients tolerated the head-mounted display and VR without nausea or disorientation, heart rate changes, or worsening stress ratings. Their insight responses were comparable to real world interviews. All bvFTD patients showed their presence in the VR environment as they moved their heads to face and respond to each avatar's questions. The bvFTD patients tended to greater verbal elaboration of answers with larger mean length of utterances compared to their real world interviews. Conclusions: VR is feasible and well-tolerated in bvFTD. These patients may have VR responses comparable to real world performance and they may display a presence in the virtual environment which could even facilitate assessment. Further research can explore the promise of VR for the evaluation and rehabilitation of dementias beyond Alzheimer's disease. Implications for Rehabilitation Clinicians need effective evaluation and rehabilitation strategies for dementia, a neurological syndrome of epidemic proportions and a leading cause of disability. Memory and cognitive deficits are the major disabilities and targets for rehabilitation in Alzheimer's disease, the most common dementia. In contrast, social and emotional disturbances are the major disabilities and targets for rehabilitation in behavioral variant frontotemporal dementia (bvFTD), an incompletely understood non-Alzheimer dementia. Virtual reality is a technology that holds great promise for the evaluation and rehabilitation of patients with bvFTD and other non-Alzheimer dementias, and preliminary evidence suggests that this technology is feasible in patients with bvFTD.
Evaluation of a virtual reality prospective memory task for use with individuals with severe traumatic brain injury
Evaluation of a virtual reality prospective memory task for use with individuals with severe traumatic brain injury.
Neuropsychol Rehabil. 2014 Feb 24;
Authors: Canty AL, Fleming J, Patterson F, Green HJ, Man D, Shum DH
The current study aimed to evaluate the sensitivity, convergent validity and ecological validity of a newly developed virtual reality prospective memory (PM) task (i.e., the Virtual Reality Shopping Task; VRST) for use with individuals with traumatic brain injury (TBI). Thirty individuals with severe TBI and 24 uninjured adults matched on age, gender and education level were administered the VRST, a lexical decision PM task (LDPMT), an index of task-friendliness and a cognitive assessment battery. Significant others rated disruptions in the TBI participants' occupational activities, interpersonal relationships and independent living skills. The performance of the TBI group was significantly poorer than that of controls on event-based PM as measured by the LDPMT, and on time- and event-based PM as measured by the VRST. Performance on the VRST significantly predicted significant others' ratings of patients' occupational activities and independent living skills. The VRST was rated as significantly more reflective of an everyday activity, interesting and was afforded a higher recommendation than the LDPMT. For the TBI group, event and total PM performance on the VRST significantly correlated with performance on measures of mental flexibility and verbal fluency, and total PM performance correlated with verbal memory. These results provide preliminary but promising evidence of the sensitivity, as well as the convergent and ecological validity of the VRST.
Virtual Reality for Sensorimotor Rehabilitation Post-Stroke: The Promise and Current State of the Field.
Curr Phys Med Rehabil Reports. 2013 Mar;1(1):9-20
Authors: Fluet GG, Deutsch JE
Developments over the past 2 years in virtual reality (VR) augmented sensorimotor rehabilitation of upper limb use and gait post-stroke were reviewed. Studies were included if they evaluated comparative efficacy between VR and standard of care, and or differences in VR delivery methods; and were CEBM (center for evidence based medicine) level 2 or higher. Eight upper limb and two gait studies were included and described using the following categories hardware (input and output), software (virtual task and feedback and presentation) intervention (progression and dose), and outcomes. Trends in the field were commented on, gaps in knowledge identified, and areas of future research and translation of VR to practice were suggested.
Mar 02, 2014
Reblogged from Medgadget
People unfortunate enough to lose an arm or a leg often feel pain in their missing limb, an unexplained condition known as phantom limb pain. Researchers at Chalmers University of Technology in Sweden decided to test whether they can fool the brain into believing the limb is still there and maybe stop the pain.
They attached electrodes to the skin of the remaining arm of an amputee to read the myoelectric signals from the muscles below. Additionally, the arm was tracked in 3D using a marker so that the data could be integrated into a moving generated avatar as well as computer games. The amputee moves the arm of the avatar like he would if his own still existed, while the brain becomes reacquainted with its presence. After repeated use, and playing video games that were controlled using the same myoelectric interface, the person in the study had significant pain reduction after decades of phantom limb pain.
Here’s a video showing off the experimental setup:
Feb 09, 2014
A high-fidelity virtual environment for the study of paranoia.
Schizophr Res Treatment. 2013;2013:538185
Authors: Broome MR, Zányi E, Hamborg T, Selmanovic E, Czanner S, Birchwood M, Chalmers A, Singh SP
Abstract. Psychotic disorders carry social and economic costs for sufferers and society. Recent evidence highlights the risk posed by urban upbringing and social deprivation in the genesis of paranoia and psychosis. Evidence based psychological interventions are often not offered because of a lack of therapists. Virtual reality (VR) environments have been used to treat mental health problems. VR may be a way of understanding the aetiological processes in psychosis and increasing psychotherapeutic resources for its treatment. We developed a high-fidelity virtual reality scenario of an urban street scene to test the hypothesis that virtual urban exposure is able to generate paranoia to a comparable or greater extent than scenarios using indoor scenes. Participants (n = 32) entered the VR scenario for four minutes, after which time their degree of paranoid ideation was assessed. We demonstrated that the virtual reality scenario was able to elicit paranoia in a nonclinical, healthy group and that an urban scene was more likely to lead to higher levels of paranoia than a virtual indoor environment. We suggest that this study offers evidence to support the role of exposure to factors in the urban environment in the genesis and maintenance of psychotic experiences and symptoms. The realistic high-fidelity street scene scenario may offer a useful tool for therapists.
Effects of the addition of transcranial direct current stimulation to virtual reality therapy after stroke: A pilot randomized controlled trial
Effects of the addition of transcranial direct current stimulation to virtual reality therapy after stroke: A pilot randomized controlled trial.
NeuroRehabilitation. 2014 Jan 28;
Authors: Viana RT, Laurentino GE, Souza RJ, Fonseca JB, Silva Filho EM, Dias SN, Teixeira-Salmela LF, Monte-Silva KK
Abstract. BACKGROUND: Upper limb (UL) impairment is the most common disabling deficit following a stroke. Previous studies have suggested that transcranial direct current stimulation (tDCS) enhances the effect of conventional therapies.
OBJECTIVE: This pilot double-blind randomized control trial aimed to determine whether or not tDCS, combined with Wii virtual reality therapy (VRT), would be superior to Wii therapy alone in improving upper limb function and quality of life in chronic stroke individuals.
METHODS: Twenty participants were randomly assigned either to an experimental group that received VRT and tDCS, or a control group that received VRT and sham tDCS. The therapy was delivered over 15 sessions with 13 minutes of active or sham anodal tDCS, and one hour of virtual reality therapy. The outcomes included were determined using the Fugl-Meyer scale, the Wolf motor function test, the modified Ashworth scale (MAS), grip strength, and the stroke specific quality of life scale (SSQOL). Minimal clinically important differences (MCID) were observed when assessing outcome data.
RESULTS: Both groups demonstrated gains in all evaluated areas, except for the SSQOL-UL domain. Differences between groups were only observed in wrist spasticity levels in the experimental group, where more than 50% of the participants achieved the MCID.
CONCLUSIONS: These findings support that tDCS, combined with VRT therapy, should be investigated and clarified further.
Dec 21, 2013
Effectiveness and feasibility of virtual reality and gaming system use at home by older adults for enabling physical activity to improve health-related domains: a systematic review.
Age Ageing. 2013 Dec 17; Authors: Miller KJ, Adair BS, Pearce AJ, Said CM, Ozanne E, Morris MM
BACKGROUND: use of virtual reality and commercial gaming systems (VR/gaming) at home by older adults is receiving attention as a means of enabling physical activity. OBJECTIVE: to summarise evidence for the effectiveness and feasibility of VR/gaming system utilisation by older adults at home for enabling physical activity to improve impairments, activity limitations or participation. METHODS: a systematic review searching 12 electronic databases from 1 January 2000-10 July 2012 using key search terms. Two independent reviewers screened yield articles using pre-determined selection criteria, extracted data using customised forms and applied the Cochrane Collaboration Risk of Bias Tool and the Downs and Black Checklist to rate study quality. RESULTS: fourteen studies investigating the effects of VR/gaming system use by healthy older adults and people with neurological conditions on activity limitations, body functions and physical impairments and cognitive and emotional well-being met the selection criteria. Study quality ratings were low and, therefore, evidence was not strong enough to conclude that interventions were effective. Feasibility was inconsistently reported in studies. Where feasibility was discussed, strong retention (≥70%) and adherence (≥64%) was reported. Initial assistance to use the technologies, and the need for monitoring exertion, aggravation of musculoskeletal symptoms and falls risk were reported. CONCLUSIONS: existing evidence to support the feasibility and effectiveness VR/gaming systems use by older adults at home to enable physical activity to address impairments, activity limitations and participation is weak with a high risk of bias. The findings of this review may inform future, more rigorous research.
Nov 20, 2013
inFORM is a Dynamic Shape Display developed by MIT Tangible Media Group that can render 3D content physically, so users can interact with digital information in a tangible way.
inFORM can also interact with the physical world around it, for example moving objects on the table’s surface.
Remote participants in a video conference can be displayed physically, allowing for a strong sense of presence and the ability to interact physically at a distance.
Nov 16, 2013
Neurofeedback training aimed to improve focused attention and alertness in children with ADHD: a study of relative power of EEG rhythms using custom-made software application.
Clin EEG Neurosci. 2013 Jul;44(3):193-202
Authors: Hillard B, El-Baz AS, Sears L, Tasman A, Sokhadze EM
Abstract. Neurofeedback is a nonpharmacological treatment for attention-deficit hyperactivity disorder (ADHD). We propose that operant conditioning of electroencephalogram (EEG) in neurofeedback training aimed to mitigate inattention and low arousal in ADHD, will be accompanied by changes in EEG bands' relative power. Patients were 18 children diagnosed with ADHD. The neurofeedback protocol ("Focus/Alertness" by Peak Achievement Trainer) has a focused attention and alertness training mode. The neurofeedback protocol provides one for Focus and one for Alertness. This does not allow for collecting information regarding changes in specific EEG bands (delta, theta, alpha, low and high beta, and gamma) power within the 2 to 45 Hz range. Quantitative EEG analysis was completed on each of twelve 25-minute-long sessions using a custom-made MatLab application to determine the relative power of each of the aforementioned EEG bands throughout each session, and from the first session to the last session. Additional statistical analysis determined significant changes in relative power within sessions (from minute 1 to minute 25) and between sessions (from session 1 to session 12). Analysis was of relative power of theta, alpha, low and high beta, theta/alpha, theta/beta, and theta/low beta and theta/high beta ratios. Additional secondary measures of patients' post-neurofeedback outcomes were assessed, using an audiovisual selective attention test (IVA + Plus) and behavioral evaluation scores from the Aberrant Behavior Checklist. Analysis of data computed in the MatLab application, determined that theta/low beta and theta/alpha ratios decreased significantly from session 1 to session 12, and from minute 1 to minute 25 within sessions. The findings regarding EEG changes resulting from brain wave self-regulation training, along with behavioral evaluations, will help elucidate neural mechanisms of neurofeedback aimed to improve focused attention and alertness in ADHD.
Aug 07, 2013
Using avatars to model weight loss behaviors: participant attitudes and technology development.
J Diabetes Sci Technol. 2013;7(4):1057-65
Authors: Napolitano MA, Hayes S, Russo G, Muresu D, Giordano A, Foster GD
BACKGROUND: Virtual reality and other avatar-based technologies are potential methods for demonstrating and modeling weight loss behaviors. This study examined avatar-based technology as a tool for modeling weight loss behaviors. METHODS: This study consisted of two phases: (1) an online survey to obtain feedback about using avatars for modeling weight loss behaviors and (2) technology development and usability testing to create an avatar-based technology program for modeling weight loss behaviors. RESULTS: Results of phase 1 (n = 128) revealed that interest was high, with 88.3% stating that they would participate in a program that used an avatar to help practice weight loss skills in a virtual environment. In phase 2, avatars and modules to model weight loss skills were developed. Eight women were recruited to participate in a 4-week usability test, with 100% reporting they would recommend the program and that it influenced their diet/exercise behavior. Most women (87.5%) indicated that the virtual models were helpful. After 4 weeks, average weight loss was 1.6 kg (standard deviation = 1.7). CONCLUSIONS: This investigation revealed a high level of interest in an avatar-based program, with formative work indicating promise. Given the high costs associated with in vivo exposure and practice, this study demonstrates the potential use of avatar-based technology as a tool for modeling weight loss behaviors.Abstract
May 06, 2013
With the rapid adoption of mobile technologies and the proliferation of smartphones, new opportunities are emerging for the delivery of mental health services. And indeed, psychologists are starting to realize this potential: a recent survey by Luxton and coll. (2011) identified over 200 smartphone apps focused on behavioral health, covering a wide range of disorders, including developmental disorders, cognitive disorders, substance-related disorders as well as psychotic and mood disorders. These applications are used in behavioral health for several purposes, the most common of which are health education, assessment, homework and monitoring progress of treatment.
For example, T2 MoodTracker is an application that allows users to self-monitor, track and reference their emotional experience over a period of days, weeks and months using a visual analogue rating scale. Using this application, patients can self-monitor emotional experiences associated with common deployment-related behavioral health issues like post-traumatic stress, brain injury, life stress, depression and anxiety. Self-monitoring results can be used as self-help tool or they shared with a therapist or health care professional, providing a record of the patient’s emotional experience over a selected time frame.
Measuring objective correlatives of subjectively-reported emotional states is an important concern in research and clinical applications. Physiological and physical activity information provide mental health professionals with integrative measures, which can be used to improve understanding of patients’ self-reported feelings and emotions.
The combined use of wearable biosensors and smart phones offers unprecedented opportunities to collect, elaborate and transmit real-time body signals to the remote therapist. This approach is also useful to allow the patient collecting real-time information related to his/her health conditions and identifying specific trends. Insights gained by means of this feedback can empower the user to self-engage and manage his/her own health status, minimizing any interaction with other health care actors. One such tool is MyExperience, an open-source mobile platform that allows the combination of sensing and self-report to collect both quantitative and qualitative data on user experience and activity.
Other applications are designed to empower users with information for making better decisions, preventing life-style related conditions and preserving/enhancing cognitive performance. For example, BeWell monitors different user activities (sleep, physical activity, social interaction) and provides feedback to promote healthier lifestyle decisions.
Besides applications in mental health and wellbeing, smartphones are increasingly used in psychological research. The potential of this approach has been recently discussed by Geoffrey Miller in a review entitled “The Smartphone Psychology Manifesto”. According to Miller, smartphones can be effectively used to collect large quantities of ecologically valid data, in a easier and quicker way than other available research methodologies. Since the smartphone is becoming one of the most pervasive devices in our lives, it provides access to domains of behavioral data not previously available without either constant observation or reliance on self-reports only.
For example, the INTERSTRESS project, which I am coordinating, developed PsychLog, a psycho-physiological mobile data collection platform for mental health research. This free, open source experience sampling platform for Windows mobile allows collecting self-reported psychological data as well as ECG data via a bluetooth ECG sensor unit worn by the user. Althought PsychLog provides less features with respect to more advanced experience sampling platform, it can be easily configured also by researchers with no programming skills.
In summary, the use of smartphones can have a significant impact on both psychological research and practice. However, there is still limited evidence of the effectiveness of this approach. As for other mHealth applications, few controlled trials have tested the potential of mobile technology interventions in improving mental health care delivery processes. Therefore, further research is needed in order to determine the real cost-effectiveness of mobile cybertherapy applications.