MIST: A Multi-sensory Immersive Stimulation Therapy Sandbox Room
Bruno Ferreira
1,2, a
, Gustavo Assunc¸
˜
ao
1,2, b
and Paulo Menezes
1,2 c
1
Institute of Systems and Robotics, University of Coimbra, Coimbra, Portugal
2
Department of Electrical and Computer Engineering, University of Coimbra, Coimbra, Portugal
Keywords:
Immersive, Virtual Reality, Sensory Stimulation, Interactive Therapies.
Abstract:
Multi-Sensory Stimulation Environments are a form a therapy in which a patient is exposed to a set of con-
trolled stimuli on various sensory modalities, including visual and auditory, in order to induce some desired
physical or mental state. Despite their success, these environments are still not widely known or available
to everyone today. However, through the use of virtual reality, that can be made possible and even have its
effects boosted thanks to the observed benefits of VR usage in conventional therapy. Thus in this work we
propose a virtual reality implementation of an immersive controlled stimulation environment, customizable
and adaptive to a user’s response to stimulus, which can be used as a simple mobile app added to a phone
VR headset. Initial experimentation with the platform has been very positive making it highly promising for a
future validation of its therapeutic use.
1 INTRODUCTION
Due to the accelerated lifestyle humans have been
progressively exposed to in our evolving society,
stress has become a recurrent obstacle for healthy liv-
ing (AIS, 2019). In addition, the growth of life ex-
pectancy and consequential development of therapy-
requiring illnesses as well as the definition of devel-
opmental disorders, such as autism, places additional
pressure onto an already unstable environment. Re-
latedly, time has become a scarce resource and the in-
ability to balance physical/mental wellness and stress
inadvertently leads to a depressive state or other spi-
raling issues (Beiter et al., 2015), (Menard et al.,
2017). Yet, the development of readily available ther-
apeutic tools which can both address these problems
and be executed on the go has received little to no fo-
cus from the research community.
Snoezelen
R
, a Dutch word originating from its
homologous terms snuggle and snooze, refers to a
type of therapy which aims to provide controlled stim-
uli to a set of sensory modalities in order to induce a
sense of equilibrium and relaxation during a session.
The concept, known also as multi-sensory stimulation
environment (MSE), ultimately attempts to reinforce
a
https://orcid.org/0000-0001-7792-412X
b
https://orcid.org/0000-0003-4015-4111
c
https://orcid.org/0000-0002-4903-3554
†Both authors contributed equally to this work.
executive functioning and ease communication in sce-
narios where such tasks are difficult to accomplish,
or with people inherently dysfunctional (mentally or
physically) and behaviorally impaired. In these en-
vironments, sensory stimulation may range from vi-
sual to proprioceptive and vestibular depending on the
objective of the session as well as the patient’s goal.
MSE’s claim of success rests on the observed effect of
stress reduction (both physical and emotional) which
leads to enhanced concentration (Ashby et al., 1995),
(Hodgins and Adair, 2010), (Moore and Malinowski,
2009). Moreover, MSE may serve as an introduc-
tory means to develop cognitive cues for progressive
relaxation, following the observations of (Scheufele,
2000). Overall the concept has been physically im-
plemented for leisurely meditation settings as well as
specifically for the personalized treatment of autistic
patients. The observed results were generally positive
as shown in (Manuel, 2000) and (Baranek, 2002).
In addition to the growing recurrence of stress pat-
terns in human life, technology has also become a fre-
quent cohort of our daily activities. Though they may
be argued as a cause of stress and anxiety, tech appli-
ances may also be used to combat and reduce these
factors. Considering the observed success of Snoeze-
len
R
therapy, its implementation as an immersive vir-
tual reality (VR) exercise evidently appears to be a a
path worthwhile exploring. Consequently, its bene-
fits would be boosted by those related with the use of
160
Ferreira, B., Assunção, G. and Menezes, P.
MIST: A Multi-sensory Immersive Stimulation Therapy Sandbox Room.
DOI: 10.5220/0009118401600168
In Proceedings of the 15th International Joint Conference on Computer Vision, Imaging and Computer Graphics Theory and Applications (VISIGRAPP 2020) - Volume 1: GRAPP, pages
160-168
ISBN: 978-989-758-402-2; ISSN: 2184-4321
Copyright
c
2022 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
VR technology for therapeutic purposes (Sucar et al.,
2014), (Bartolom
´
e et al., 2011). In this study we de-
veloped and validated a readily available pocket VR
MSE platform, customizable on the fly to patient re-
quirements and which can be used with the aid of a
phone and corresponding VR headset.
The presented work reflects the following struc-
ture. First, Section II presents an overview of previous
research on similar approaches and immersive ther-
apeutic environments, in order to contextualize the
reader on the proposed system. The platform itself
is described in Section III after a summary examina-
tion of its requirements and specifications. Section
IV then describes how the environment has been ex-
perimentally tested and empirically validated. An as-
sessment and discussion of the outcome of the exper-
iments is provided in Section V. Finally, the paper is
concluded in Section VI.
2 RELATED WORK
This overview of previous works is divided in the fol-
lowing two subsections. To start, recent approaches to
the development and use of controlled multi-sensory
environments are examined in order to contextualize
our system. Following that, we analyze immersive
VR therapy as an alternative to conventional therapy
and how its technological edge may generally provide
greater benefits to patients.
2.1 Multi-sensory Environments
A simulation of a Portuguese traditional game was
adapted as a MSE that focused on playfulness,
while being expanded by interactive fantasy ele-
ments (Castelhano and Roque, 2015). The authors
defined a set of guidelines for the design of the game
that comprise the same principles of a MSE with the
purpose of mediating a therapeutic intervention be-
tween an Occupational Therapist and a Child with in-
tellectual disability.
SnoezelenCAVE, as the name suggests, is a vir-
tual reality CAVE Snoezelen
R
that intends to provide
therapy for Autism Spectrum Disorder (ASD), which
are known to have issues on social skills, speech, self-
care or job skills (Perhakaran et al., 2015). Although
mental health therapies, medication or special educa-
tion are the most common approaches to deal with
ASD, rehabilitation centers and hospitals have been
using MSEs, such as Snoezelen
R
rooms, to create
a soothing and stimulating environment that under-
take intellectual disabilities (Hogg et al., 2001; Ka-
plan et al., 2006; Barton et al., 2015; Anderson et al.,
2011). In this way, the authors proposed a therapeutic
tool that is expected to solve the immersion character-
istics of the traditional Snoezelen
R
, while following
the standardized procedures for this type of treatment.
A multi-sensory stimulation virtual environment
(MSVE) for relaxation was created as a part of an ex-
ploratory case study in (Diaconu et al., 2018). The
idea behind this virtual environment is that the user
should explore the existing scenes while actively in-
teracting with some of the present objects. Some of
these objects are passive (non-interactable) with the
principal purpose of being aesthetically pleasing, as to
enhance the feeling of calmness. The authors tested
their MSVE with ten individuals of a residence and
development center for the disabled to provide guide-
lines for the future design of therapeutic tools that fol-
low the same purpose. Extra attention should be paid
off into making the controls and the environment as
simple as possible, as well as being understandable
and suitable for different needs of the target group.
2.2 Virtual Reality for Therapies
Virtual Reality refers to the capability of transfer-
ring individuals to ”new realities” and support expe-
riences through sensory stimulation. Over time it has
been successfully applied to a vast panoply of areas,
such as military training (Baumann, 1993; Bhagat
et al., 2016), social science and psychology (Bailen-
son et al., 2008; Wilson and Soranzo, 2015), educa-
tion (Freina and Ott, 2015), or healthcare and clinical
rehabilitation therapies (Chirico et al., 2016; Weiss
and Katz, 2004).
Focusing on clinical rehabilitation, VR brings sev-
eral advantages to the conventional therapies for pa-
tients ranging from musculo-skeletal problems, to
stroke-induced paralysis, or even cognitive deficits. In
fact, there are several documented advantages that en-
dorse VR-based rehabilitation, as stated below (Sucar
et al., 2014; Lafond et al., 2010; Burdea, 2003):
Significant improvement in patients motivation
and engagement with their recovery plan;
Increased frequency and more repetitions during
exercises;
Enhanced motor (re)learning by visual stimuli;
Possibility to provide tele-rehabilitation and re-
quire low clinical supervision (easing home use);
Ability to track the patient’s recovery progress
over time;
MIST: A Multi-sensory Immersive Stimulation Therapy Sandbox Room
161
3 METHODOLOGY
This section overviews the steps taken during the de-
velopment of our VR MSE room, encompassing re-
quirement definition, designing and usage of room
components and their actual implementation.
3.1 Design Requirements
Given the necessity of MSE rooms to induce or boost
a desired state in a user while also preserving com-
fort and engagement, these environments must flu-
idly adhere to a set of rules aimed at presenting the
various sensory stimuli in a controlled and adaptive
fashion. As examined by (Collier and Truman, 2008),
a MSE session must consider a patient’s capabilities
and limitations related with attention and executive
functioning in addition to reducing agitation and anx-
iety. In terms of virtual reality, the latter can be ad-
dressed by means of shaping the environment to have
a cozy mind-blanking appearance, contrastingly re-
taining the ability to sustain attention by means of the
stimuli stemming from its components. Envisioning
this, the following design guidelines were considered:
Rounded configuration with lack of sharp edges;
Smooth transitions between textures;
Dim lighting;
User adaptive surrounds;
These characteristics facilitate isolation of the im-
mersed user from the typical barrage of real world
stimuli humans are continuously exposed to. Subse-
quently, a patient can be progressively presented with
controlled stimuli corresponding to their level of en-
gagement, and their response measured to improve
system adaptability. The general goal is to match in-
dividual needs with the selected MSE demands by ad-
justing perceived complexity.
Of course virtual reality relies heavily on the ex-
posure of stimulus to the visual modality given how
incorporating other sensory factors, such as tactile or
olfactory, would require more complex and indepen-
dent mechanisms. However, auditory stimulation is
also a highly functional option which considerably
enhances the immersive VR experience, besides be-
ing a major element of MSEs. Hence, integrated mu-
sical themes should as well follow some specifica-
tions:
No abrupt or sudden variations;
Melodic tones with little noise;
Ideally correlate with the visual factor;
Another important aspect to consider is the need
for both active and passive interactions to be possi-
ble within the MSE, enabling its use by individuals
who struggle with initiating/maintaining them. Over-
all and considering the defined scenario, the tuning
of specific components and VR artifacts then stems
from the desired goals of each session. These can be
many and varied, such as stimulating a patient’s fo-
cus to be on a specific artifact so as to assist them
in countering an attention deficit disorder, for exam-
ple. Or relatedly, provide joint audio-visual stimuli
to help patients link multimodal elements which they
are usually unable to given some neurological condi-
tion. The world of potential applications and corre-
sponding benefits of an MSE extends far beyond their
sensory exploration leisurely use.
3.2 Component Overview
Based on the aforementioned requirements, the pro-
posed virtual environment dynamically modifies it-
self by adapting a series of intervening components
and concepts. Depending on this modification pro-
cess, the system may incorporate a subset of all po-
tential components, out of which the most recurring
ones are:
Shimmering Effect - Shimmering colors, chang-
ing lights and fibre optics which stimulate and
hold attention. It becomes ideal for individuals
with visual disabilities, as their main purpose is to
break through their own personal perceptual bar-
riers.
Sense of Flow - The soft flow of artifacts in the
room is expected to ease the relaxation process.
While observing their slow chaotic flow through
the wall and around the room, users undergo stim-
ulation of their tracking capabilities. This is es-
sential for people of all ages, specially the ones
with visual processing problems.
Bubbles/Lava - A highly common component of
MSEs. In relation to the sense of flow, these pro-
vide a multi-sensory feedback and improve the
ability to track motion. Applying constant ef-
fects of color change, rotation, shape morphing
and movement enables perception and cognitive
stimulation.
Animated Panels - Capable of displaying a
panoply of effects, ranging from infinity to com-
mon physiological illusions to simple perpetual
motion. Accompanied by a relaxing soundtrack,
these provide a leisurely and pleasant sensory ac-
tivity which encourages introspection besides ex-
ploration of the effect.
GRAPP 2020 - 15th International Conference on Computer Graphics Theory and Applications
162
Adaptive Wall - The whole room envelops a pleas-
ing experience with a focus on the most dominant
theme adequate for the user. This will induce a
sense of isolation and security in the user, so as to
maximize comfort and confidence in the session
and ease handling of sensorial stimulation. For
instance, manipulating the user’s perception to be
just above or surrounded by water, where they can
observe ripple and wave-like effects.
3.3 System Construction
Given how a MSE is composed by many distinct el-
ements, the Blender software was used in order to
fasten the process of 3D modeling most artifacts in-
cluded in the room, following the guidelines pre-
sented above. The final model, containing all devel-
oped components as well as the configuration specifi-
cations, is loaded into the Unity game engine. Here,
the adaptive process is implemented so as to perform
the real-time modifications which follow the men-
tioned requirements and suit the MSE session.
The characteristic of being dynamic and able to re-
spond to the user’s needs comes from the app’s inner
flow, presented in Figure 1. By tracking and monitor-
ing the user’s head movements on a real-time scale,
adequate visual and sound stimuli are produced on
the regarding sensory inputs. Moreover, from this di-
agram, one can see that the main way for users to in-
teract with the MSE room is by rotating their head and
gazing something.
Figure 1: Overall view of the mobile application’s architec-
ture.
Considering the current computational capabilities of
mobile phones nowadays, one can use their own de-
vices as pocket personal VR platforms, able to sup-
port varied applications. The proposed portable ther-
apeutic tool can therefore be used anywhere by a com-
mon person to relax and undergo stimulation, as well
as in rehabilitation and therapy centers by healthcare
professionals to aid in patient treatment. Our de-
veloped mobile app is deployable for both the An-
droid and iOS operating systems, using phone sen-
sors, specifically the accelerometer and gyroscope, to
track the position and orientation of the user’s head.
Thus, any low-cost head-mounted display (HMD)
with a pair of lenses and cushioning is enough for
displaying the virtual environment according to the
user’s point of view. Considering how auditory stim-
ulation is likewise one of the crucial components of
MSE rooms, the system also expects the user to wear
some type of earphones to benefit from the audio
modality, ideally fully covering headphones. Plus,
this is a requirement if the user intends to enhance
their immersive experience during the usage of the
app.
Our brain defines reality and what it believes to
be real based on the collected information from our
senses and perception systems. If we replace those
sensory inputs with made-up information (e.g, by us-
ing an HMD and headphones), our perception of re-
ality would change, since we would be confronted
with a version of reality that isn’t really there, but it
would seem real. Therefore, once the users wear the
HMD, they start the transportation process to a new
world by acknowledging the surroundings of the dis-
played virtual scene. As shown in Figure 2, there is
a virtual model that is considered to be a temporary
representation of oneself inside the MSE room. It is
expected for the user to to experience the illusion of
body ownership, and consequently augment the feel-
ing of presence inside the virtual environment (Kilteni
et al., 2012).
Figure 2: Self representation in the virtual environment.
As previously mentioned, the developed MSE is
adaptive to the person’s response in relation with the
presented stimulation. Building on an initially small
feedback, the room aims to amplify a desired response
by means of controlled stimulation, being therefore
able to acquire different shapes and characteristics.
As a showcase of two different and somewhat oppos-
ing possible scenarios the room may manifest, Fig-
ure 3 shows an exemplary darker warm-feeling room
while Figure 4 demonstrates a possible cooling deep
dive room.
MIST: A Multi-sensory Immersive Stimulation Therapy Sandbox Room
163
Figure 3: A warm MSE room.
Figure 4: A cool MSE room.
4 EXPERIMENTAL RESULTS
In order to test and validate the developed MSE, it
was first necessary to define a standard in which users
could experience the room, for later comparison. In
the adopted setting, the user sits comfortably on an
armchair or sofa before launching the mobile applica-
tion, requiring only the mounting of three devices: an
Android or iOS smartphone, a low-cost HMD and a
set of headphones. The overall experimental appara-
tus can be observed in figure 5, for reference.
Figure 5: User experiencing the MSE room.
The virtual environment and its effectiveness with real
users was analyzed by conducting an initial study with
21 participants, the majority being personnel from the
Department of Electrical and Computer Engineering
at the University of Coimbra. The total amount was
composed of 15 male and 6 female participants, rang-
ing between 11 and 47 years of age. The participant
distribution is shown in Figure 6. These participants
had no previous knowledge concerning the developed
work, simply being willing to volunteer for the ex-
perience and provide feedback on it. In order to as-
sess the environment’s effectiveness as a MSE and
obtain insight on the overall immersive system, vali-
dated and adapted versions of the Positive and Neg-
ative Affect Schedule (PANAS) scales, by (Watson
et al., 1988), and the Igroup Presence Questionnaire
(IPQ), described in (Schubert et al., 2001), were ap-
plied. The PANAS survey was applied twice, for
comparison, whilst the IPQ was given to the partic-
ipants only once.
Figure 6: Distribution os participants in the experiment.
The Positive and Negative Affect Schedule (PANAS)
scales was developed as a self-report questionnaire
with the main purpose of providing an estimation of
the individual’s affective experience regarding a cer-
tain time frame. Hence, it measures two primary di-
mensions of mood, Positive Affect (PA) and Nega-
tive Affect (NA), based on ten internally consistent
items for different time scales (e.g, ”At the moment”
or ”This day”). PA refers to a state where the individ-
ual feels enthusiastic, active or determined, meaning
that lower PA is closely associated with sadness and
lethargy. On the other hand NA reflects subjective
distress, being commonly correlated with feelings of
anger, disgust, fear or nervousness. Thus, low NA is
linked with states of calmness and serenity. The Por-
tuguese short-version of PANAS is presented in (Gal-
inha et al., 2014) and was employed as a mean for as-
sessing the emotional state of the participants before
and after the experience.
The Igroup Presence Questionnaire (IPQ) intends
to measure the sense of presence experienced by the
user in a virtual environment. Its current version
aims to subjectively determine three sub-scales (spa-
tial presence, involvement and realness), as well as to
infer a second-order factor (general presence). Spatial
presence refers to the sense of deeply being present in
GRAPP 2020 - 15th International Conference on Computer Graphics Theory and Applications
164
the VE, as if the user was there physically, while in-
volvement measures the attention that the user paid
to it and how embroiled they were during the ex-
perience. Experienced realism or realness aims to
classify how realistic the VE is, while measuring the
corresponding subjective experience. General pres-
ence can be referred to as a global analysis of the
”sense of being there”, and has deep loading on all
the three sub-scales. An adapted and validated Por-
tuguese version of this presence questionnaire, pre-
sented in (Vasconcelos-Raposo et al., 2016), was em-
ployed at the end of the participant’s experience.
The procedure followed during the conduction of
this initial study is described by the steps:
1. Briefly introduce the participant to what he/she is
about to experience and take part of, as well as the
involved technology.
2. Kindly request the participant to answer the Por-
tuguese short-version of PANAS that intends to
assess his/her current emotional state.
3. Aid the participant to place both the HMD and
headphones properly, and let him/her experience
the developed VR MSE room for five minutes.
4. After this time, the participant is expected to have
been driven to a new emotional state and thus re-
quired to respond the PANAS questionnaire again.
5. In the end, to evaluate the feeling of presence, the
participant is asked to answer the Portuguese val-
idated version of the IPQ questionnaire.
4.1 Sensation Analysis
In order to extract valuable information and assess the
results obtained from the first and second PANAS sur-
veys, the SPSS software (IBMCorp, 2017) was em-
ployed. The two iterations were parallelly compared
so as to draw conclusions on the effects of the pro-
posed MSE. The majority of participants reported an
increase in interest and enthusiasm, added to height-
ened inspiration. Concurrently, a decrease in nervous-
ness as well as in determination and activeness was
noted. Some participants mentioned a small degree
of scaredness related with the ocean-like environment
they were placed in (one participant suffers from Tha-
lassophobia
1
). All in all, participants felt more mo-
tivated and encouraged after performing the experi-
ment, while also becoming more relaxed and com-
fortable. It should be restated that each partaker in the
1
From Wikipedia Thalassophobia: An intense and per-
sistent fear of the sea. May include fear of being in large
bodies of water, vast emptiness of the sea, sea waves and/or
distance from land.
experiment was asked to assess a before and after es-
timation of their own levels of each PANAS item sen-
sation, ranging from low (1) to high (5). The PANAS
result progression is presented in Figure 7, where the
initial positive and negative affects are placed next to
their final counterparts. As can be observed, there was
an increase in both affects after the experiment.
Figure 7: Panas results in terms of affective progression,
according to Positive Affect (PA) and Negative Affect (NA)
comparisons before and after participant immersion.
4.2 Feeling of Presence
In terms of the results stemming from the IPQ eval-
uation, which were obtained by resorting to SPSS as
well as Excel (Microsoft, 2018), positive conclusions
can be drawn such as the following. In general, par-
ticipants reported being able to prescind themselves
from their real world surroundings, feeling immersed
within and enveloped by the virtual environment. In
addition, the environment was also noted to be ap-
pealing to the participants, differing from common
everyday experiences people are accustomed to. On
the whole, the demonstrated room was perceived as
clearly virtual and easily distinguishable from the real
world, despite presence results being positive. It is
important to reiterate that each participant was asked
to specify their level of agreement with each of the
14 IPQ questionnaire items, ranging from 1 (strongly
disagree) to 5 (strongly agree), via a Likert scale (Lik-
ert, 1932). The IPQ results are visually displayed
in Figure 8, in the form of spatial presence (being
physically present in VR), involvement (user attention
level), realness (VR realism level) and general pres-
ence (overall immersion), as previously described.
In addition to the surveys, partakers were also
asked to answer 4 short questions regarding their
experience. From these it was observed that, even
though 5 of the participants had never before been in
a VR environment, all would appreciate doing one or
more MSE sessions with the presented system. Fur-
MIST: A Multi-sensory Immersive Stimulation Therapy Sandbox Room
165
ther, no volunteer reported any sort of nausea or dis-
orientation from being immersed in the VR room.
Figure 8: IPQ results in terms of Spatial Presence (SP), In-
volvement (I), Experience Realism (ER) and Presence (P).
Cronbach’s Alpha (Cronbach, 1951), a common mea-
sure of result reliability which widely applied in psy-
chometric testing, was also computed for the evalu-
ated questionnaires by means of the SPSS software.
Bearing in mind even higher values may be achieved
by increasing the sample size of test participants, the
computed values were still very acceptable, being in
the 0.7 to 0.8 range. Furthermore, despite the major-
ity of participants being male, no significant disparity
was observed between male and female results in both
the pre-test and post-test.
5 DISCUSSION
Considering the experimental results obtained by
comparison of the initial and final iterations of the
PANAS survey, it can be inferred that participants
were indeed stimulated, having become more moti-
vated to complete some assigned task thanks to under-
going a short session in the VR MSE room. Moreover
the raised senses of relaxation and peacefulness while
maintaining engagement, observed in the participants
after the experiment, can in fact justify the application
of the proposed MSE as a mental preparatory stage of
therapy as proposed. Plus, it can be concluded that the
developed system is adequate and provides the same
benefits for both men and women. Thus the VR stim-
ulation room’s effect was validated by the obtained
positive results.
Evidently there was a small increase of worry or
apprehension for a group of participants. However,
this group was almost solely made up of young par-
ticipants within the 18-27 age range. When ques-
tioned about the scaredness increase, it was highly
clear how a previous type of experiences related to
thriller video games and ”jump scare” scenarios was
common to all and the culprit of such uneasiness. The
involved participants all stated they felt a sense of
false security and expected something to appear un-
expectedly at some point. This, of course, may be
related with the previously mentioned overstimulat-
ing and stressful society humans live in today which
is causing younger generations to maintain a constant
state of alert. This could also explain the observed
raise in Negative Affect, given the 18-27 age range
contained most of the experiment participants. Nev-
ertheless, we believe better informing the participants
on multi-sensory environments and performing fur-
ther sessions could heavily attenuate this negative fac-
tor for the people who experienced it. Another related
and curious serendipity was caused by one of the par-
ticipants suffering from Thalassophobia, something
which the authors were unaware of before starting the
experiment. Given how the room was majorly a deep
ocean-like environment, the user felt anxious and in-
creasingly worried. Still, the participant finished the
entire session without stopping and felt entertained by
observing artifacts in the room. This is highly valu-
able as it shows how even patients with some degree
of trauma may benefit from being immersed in a per-
sonally triggering MSE.
Differing but equally interesting interpretations of
the room were described by the participants. Though
the ocean/aquarium theme was common to most, with
an observed ripple effect and floating/flowing objects,
one compared the presented MSE to a sensory de-
privation room while other felt he was floating in
heaven. Another participant felt hypnotized by the
room, having lost track of time, while yet a different
one acknowledged to initially feel some nose discom-
fort (stemming from the VR glasses weight) which he
forgot about as his session progressed. Some users
even mentioned feeling the whole room to be rotat-
ing around them, despite this never actually happen-
ing. Lastly, all agreed sound to be a key compo-
nent in their sense of immersiveness, in addition to
the person avatar being present and visible. Consider-
ing these statements and how no interpretation of the
room is particularly correct or incorrect, we can suc-
cessfully assert its effectiveness as a MSE. A feel of
stimulation was blatant in nearly all participants, fol-
lowing exactly what was initially intended to happen.
Undoubtedly the testing carried out is limited. Due
to the fact that the developed MSE was applied on
volunteers only, it would be senseless to extrapolate
the obtained results to patients with diverse mental
pathologies as their reactions might differ from those
of a healthy person. Nevertheless, the results are still
positive and more than sufficient to warrant a second
GRAPP 2020 - 15th International Conference on Computer Graphics Theory and Applications
166
testing phase with actual patients and further improve
the MSE. As such, preparations for such a phase are
underway, ideally aiming for a clinical trial soon.
Finally, after providing valuable insight and eval-
uations during the development phase of the system,
a final iteration of this system was presented to and
validated by a clinical psychologist who considered it
to be adequate for its objective, respecting the stated
requirements and being safe and suitable for testing
with people.
6 CONCLUSION
In this paper, we examined the requirements and spec-
ifications of multi-sensory stimulation environments
(MSEs) in order to use these as an alternative to con-
ventional therapy. A virtual reality implementation of
a MSE was produced, able to run on both Android
and iOS, as a platform which can be used without
the need of expensive material and by anyone, includ-
ing healthcare specialists for patient therapy. Follow-
ing its development, the app was made available to
a set of beta testers so as to have its usage and ben-
efits be validated. Based on the analysis of the ob-
tained responses, we were able to demonstrate how
the proposed environment can in fact be beneficial for
leisurely uses, engagement stimulation, and in ther-
apy, in terms of mental preparation for treatments and
by adaptive stimulation of necessary factors. In ad-
dition, insight on the platform was obtained from a
therapist so as to further corroborate its use and im-
prove it later on.
In the future, we aim to introduce the collection
of biometric markers so as to more meticulously ver-
ify patient improvement, and also test the developed
system on real patients ideally through clinical trials.
We further intend to explore the possibility of inte-
grating other modalities besides the visual and au-
ditory. Specifically tactile factors can be introduced
by incorporating a set of gloves in the system which
can provide haptic feedback for feeling and picking
up objects in VR. Some prototypes of this technology
are already being developed. such as the ones intro-
duced in (Hinchet et al., 2018) and (Perret and Van-
der Poorten, 2018), or the 3D printed Sense Glove de-
veloped by a Dutch company of the same name. Ulti-
mately the goal would be to also provide the user with
textural stimulation, besides the haptical holding feel.
Integration of other modalities such as olfactory and
gustatory are other potential paths of further research.
ACKNOWLEDGEMENTS
The authors would like to thank clinical psycholo-
gist Prof. Dr. Ana Xavier of Oporto Global Uni-
versity (UPT) for guiding the development process
of this implementation with valuable insight and for
validating the obtained results. In addition, our grat-
itude is extended to all participants for their avail-
ability and willingness to partake in our experiment.
This work has been partially supported by OE - Na-
tional funds of FCT/MCTES (PIDDAC) under project
UID/EEA/00048/2019.
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