Digitization of Landmark Training for Topographical Disorientation:

Opportunities of Smart Devices and Augmented Reality

Tom Lorenz

1 a

, Mirco Baseniak

1 b

, Linda M

unch

2 c

, Ina Schiering

1 d

and Sandra Verena M

uller

2 e

Faculty of Computer Science, Ostfalia University of Applied Sciences, Wolfenb

uttel, Germany

Faculty of Social Work, Ostfalia University of Applied Sciences, Wolfenb

uttel, Germany

Keywords:

mHealth, Landmark, Augmented Reality, Smart Devices, Usability, Privacy, Topological Disorientation.

Abstract:

Navigational abilities and wayﬁnding are important skills for participation in society. Landmark-based naviga-

tion is considered as an important basic wayﬁnding strategy. This strategy is used as the underlying concept for

a rehabilitation training for people with topological disorientation. A digitization of this approach is proposed

based on a smartphone application employing Augmented Realty concepts. This application allows to describe

routes based on landmarks and a training of the deﬁned routes. It is developed in an agile, interdisciplinary

research process taking especially usability and privacy aspects into account.

1 INTRODUCTION AND

BACKGROUND

Navigational ability is typically an individual-related,

developed skill, affected by multiple factors like age,

sex, level of education and even emotional states.

Daily problems that might occur during wayﬁnding

are often solved intuitively by continuing to walk un-

til a familiar or characteristic place has been recog-

nized. During the process of navigation spatial in-

formation is perceived from multiple types of sensors

(e.g. visual, vestibular, proprioceptive). Further many

cognitive functions contribute to wayﬁnding like vi-

sual perception, short- and long-term memory, men-

tal images, attention, awareness and executive func-

tions. Two perspectives are important during this pro-

cess: The egocentric perspective describes if objects

are perceived from a personal and local point of view,

while the allocentric perspective considers relations

between objects (e.g. the school is north of the li-

brary). These perspectives do not exclude each other

but have complementary roles that interact with each

other (Claessen, 2017).

https://orcid.org/0000-0001-9594-7683

https://orcid.org/0000-0003-2599-864X

https://orcid.org/0000-0002-7711-7421

https://orcid.org/0000-0002-7864-5437

https://orcid.org/0000-0003-4450-9936

Further strategies for wayﬁnding, based on dif-

fering knowledge, are ranging from basic landmark

based navigation to route knowledge, up to a survey-

level navigation (Gupta et al., 2020).

Navigational problems are often caused by exter-

nal factors. Moreover primarily people with cogni-

tive impairments have difﬁculties in orientation and

wayﬁnding due to problems with, or lack of spatial

skills. Often less intuitive problem solving strategies

are used when a person gets lost, e.g. no alternation of

the current route, or not taking alternative routes into

consideration at all (Delgrange et al., 2020). Since

wayﬁnding relies on many different cognitive abili-

ties, research has been very complex and not well-

advanced (Sohlberg et al., 2007; Gyselinck et al.,

2009). Difﬁculties can result from limited concen-

tration abilities, changes in context (e.g. construction

works) or discomfort of being lost resulting in a pas-

sive attitude. Additionally, map-like perspectives re-

quire a substantial mental transfer. Consequences are

anxieties resulting in avoidance of moving indepen-

dently and developing even more dependencies for

being accompanied (Gupta et al., 2020).

Different types of impairments concerning

wayﬁnding exist and were classiﬁed by (Claessen,

2017) to their underlying category. Landmark-based

navigation impairment includes difﬁculties with

processing landmarks, or environmental sceneries.

Further location-based navigation impairments exist,

Lorenz, T., Baseniak, M., Münch, L., Schiering, I. and Müller, S.

Digitization of Landmark Training for Topographical Disorientation: Opportunities of Smart Devices and Augmented Reality.

DOI: 10.5220/0010980500003123

In Proceedings of the 15th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2022) - Volume 5: HEALTHINF, pages 727-734

ISBN: 978-989-758-552-4; ISSN: 2184-4305

727

(a) Bad landmark due to similarity and

short lifespan.

(b) Good landmark due to cultural her-

itage and longevity.

Figure 1: Differences between good and bad landmarks.

where difﬁculties occur in processing landmark

locations and the relations between them, while being

able to visually identify these landmarks. Patients

struggling with connecting locations to another show

a path-based navigation impairment. Problems recall-

ing paths in new, as well as in familiar environments

are prominent. Furthermore patients rely only on

spatial information resulting in distorted maps and

inaccurate description of routes similar to patients

with location-based navigation impairments. Lastly

navigation impairment might occur due to other

conditions e.g. spatial disorders, neglect, deﬁcits

in visuospatial perception, spatial disorientation,

memory impairment, etc.

As already mentioned, research about people with

cognitive impairments is limited as well as research

regarding rehabilitation. Missing knowledge is re-

sulting in a lack of effective rehabilitation training,

that meets spatial demands (Sohlberg et al., 2007;

Gyselinck et al., 2009). Since many cognitive func-

tions are used during navigation, probably not all ar-

eas are affected by impairments and could be used and

trained for compensation. Present approaches rely

on investigating deﬁned routes instead of focusing on

conveying universal wayﬁnding strategies (Claessen

et al., 2016).

Landmarks are an important basic concept for

wayﬁnding and provide a great potential for naviga-

tion services (Amirian and Basiri, 2016). Some tar-

get groups, like people with intellectual disabilities

(Gupta et al., 2020), have in addition problems in

identifying reliable landmarks.

In the following sections we will concentrate on

landmark based navigation as a central basis for

wayﬁnding.

Good landmarks are long-living, preferably with a

high visibility and have a distinctive appearance (see

Figure 1(b)). On the other hand bad landmarks are

characterized by high interchangeability and a short

life span while being often very eye-catchy or not be-

ing distinguishable at all (see Figure 1(a)). The qual-

ity of environmental elements qualifying as good or

bad landmarks has already been discussed in (Lorenz

et al., 2021).

Classical approaches for landmark training rely

on people using printed and laminated pages with

step by step instructions. Usually these instructions

were written in simple language containing pictures

of buildings close by and arrows to indicate direc-

tions. Slight changes in appearance or differences

in positions are already problematic due to posi-

tional changes, different lighting conditions or sea-

sonal changes. If uncertainties arise, a supporting per-

son will be called because of the anxiety of being lost

triggered by e.g. a building painted in a different color

or similar changes while other identifying features re-

mained unchanged.

Nakamura and Ooie (Nakamura and Ooie, 2017)

tested the improvement of supporting public transport

via pictures of the surrounding area via smartphone,

providing additional feedback to reduce nervousness.

Smartphones are already widely used and their in-

ﬂuence is growing. In addition smartphones are also

common among people with intellectual disabilities

HEALTHINF 2022 - 15th International Conference on Health Informatics

728

(Morris et al., 2017) and offer a wide variety of sen-

sors as well as functions, eliminating the need of spe-

cialized hardware, e.g. smartglasses as the Hololens.

Therefore a huge potential exists to use these al-

ready existing devices to support wayﬁnding and cre-

ate training applications.

In this context we are focusing on people with

intellectual disabilities as they often suffer from ex-

ecutive dysfunctions, struggle with attentiveness and

are easily overwhelmed. An approach for a landmark

training using mobile devices (smartphones) is pro-

posed. Augmented Reality (AR) will be used to re-

duce mental barriers. In this paper the prototype of

such an application is described including the creation

of routes and the following training mainly based on

landmarks.

2 RELATED WORK

Nowadays smartphones are the foundation for sev-

eral navigational applications, e.g. Google Maps,

Apple Maps, OpenStreetMap, etc. Typical parts of

such turn-by-turn navigational systems can be cate-

gorized as positioning, planning and communication.

While communication mostly relies on map views

and instructions including information concerning the

distance to the next turn, adapted approaches using

Augmented Reality (AR) already exist (Rehrl et al.,

2012). People with disabilities are often not able to

use these classical approaches and further problems

with maps and the mental transfer between places,

corners and the real world arise (Delgrange et al.,

2020). Additionally ﬁrst approaches based on land-

marks as central elements are proposed by Gupta et.

al. (Gupta et al., 2020). Navigational systems for peo-

ple with disabilities exist as well, but are mainly fo-

cused on visual impairments resulting in audible feed-

back (Rivest et al., 2018; Davies et al., 2010). One

approach features Global Navigation Satellite System

(GNSS), e.g. GPS based on audible and visual feed-

back supporting people with intellectual disabilities

going by bus, further showing current environmental

features to reduce insecurities and emphasize on the

correct bus stop (Davies et al., 2010). Augmented re-

ality brings new potential to navigational systems em-

ploying high quality tracking due to the use of visual

odometry (Yoon et al., 2019). Additionally to ease the

complexity of mainly relying on visual odometry for

localization, markers (Fusco and Coughlan, 2018; El-

gendy et al., 2019) as well as beacons (Delnevo et al.,

2018) can be used typically indoors, while GNSS can

be employed outdoors.

Due to the nature of AR enriching the view with

additional elements, navigational approaches using

AR outperform classical approaches in comprehen-

sibility for people with (intellectual) disabilities re-

sulting in less assistance required (McMahon et al.,

2015). With the help of AR barriers can be low-

ered, as well as new possibilities for interventions are

provided, fostering autonomy especially for people

with intellectual disabilities (McMahon et al., 2015;

Smith et al., 2017; Bridges et al., 2020). Additionally

AR has positive effects on learning outcomes (Bower

et al., 2014) and encourages self-regulation as well as

self-determination (Cihak et al., 2016; Smith et al.,

2017). Nonetheless even with AR most approaches

focus on visual impairment (Yoon et al., 2019; Ko

and Kim, 2017; Al-Khalifa and Al-Razgan, 2016; El-

gendy et al., 2019) . In addition, marker are used

for indoor localization (Fusco and Coughlan, 2018;

Elgendy et al., 2019), and also for speciﬁc instruc-

tions (Ko and Kim, 2017; Al-Khalifa and Al-Razgan,

2016). Furthermore it was shown, that AR as a tech-

nology provides great potential regarding wayﬁnding

and orientation (Ko and Kim, 2017). User feedback

is in general very positive (Yoon et al., 2019). Smart

glasses as e.g. the Hololens offer a handsfree AR ex-

perience but are signiﬁcantly more expensive, often

limited by built in sensor technology (e.g. lack of

GPS sensors) or have to be used in combination with

smartphones. Nonetheless navigational approaches

using smart glasses utilizing tactile, audible and vi-

sual assistance exist, but mainly focus on people with

visual impairments as well (Zhao et al., 2020).

In general landmark based navigation outperforms

turn-by-turn navigation if used by pedestrians. Ap-

proaches using local landmarks, that are only visi-

ble from the current location, are great for new envi-

ronments, e.g. used by tourists (Amirian and Basiri,

2016) but often require object detection, therefore in-

creasing complexity (Wakamiya et al., 2016). Global

landmarks on the other hand are visible from far away

and outperform classical navigation systems as well,

while only showing a general direction, or being vis-

ible itself. The effects of showing a general direc-

tion were investigated by Wenig et. al. (Wenig et al.,

2017) utilizing a smartwatch. Further global land-

marks increase the capability of creating a mental

map while being unmodiﬁed and signiﬁcant.

Lastly the usability for people with disabilities is

considered important. While they are highly moti-

vated to interact with the digital world (Rocha et al.,

2017), usability is essential and dependent on the

quality of the application as well.

Since digitized trainings in the area of landmarks

and wayﬁnding are promising but were mainly inves-

tigated for people with visual impairments, a train-

Digitization of Landmark Training for Topographical Disorientation: Opportunities of Smart Devices and Augmented Reality

729

ing for people with intellectual disabilities provides a

huge potential.

3 CONCEPT OF

LANDMARK-TRAINING

APPLICATION

Participants tend to rely on poor landmarks, uncer-

tainty, or getting lost. In the following a concept and

prototype for a landmark-based navigational training

is proposed to support autonomous wayﬁnding. The

application encompasses two central parts: The cre-

ation of routes and the following training of routes.

These two stages are integrated in a mobile applica-

tion. Before participants can train routes, these routes

have to be deﬁned and created in a previous setup-

stage typically in collaboration with a supporting per-

son. A central focus of the work presented here is the

usability from the point of view of people with intel-

lectual disabilities.

3.1 Route Elements

Generally a route consists of a start and a goal with

multiple landmarks in between. While in principle

start and end point could be interchangeable, some

buildings might not be visible from afar or due to

differences in perspectives. Since the application ex-

pects straight lines between points, additional way-

points are introduced, to ensure a better navigation for

e.g. curved roads. Waypoints provide additional in-

formation making the distance between the user and

the designated path more precise. Further it should

be considered whether waypoints could also provide

visible hints for users. Experiences showed that par-

ticipants tend to feel lost when the next landmark is

not directly visible. Therefore using additional land-

marks on curved or even long roads should be consid-

ered, preferably one landmark should always be visi-

ble. All these points are intended to be visualized via

AR markers.

Additionally assistance points are introduced to

mark locations and give hints for safety reasons. As-

sistance points can be reinforced with a short message

that will be displayed if the location is reached. We

emphasize the conciseness of the information with a

strict character limit to ensure conciseness and under-

standability. Furthermore the AR sight of the app will

be disabled and only the message will be displayed

until the area is left. Furthermore a conﬁrmation but-

ton to close the dialog might be needed if no gen-

eral direction is present afterwards. An overview of

speciﬁc points and their necessary parameters is pre-

sented in Table 1.

3.2 Route Creation

During the setup-phase preferably a guiding person

walks the route together with a participant. Some ex-

perience with the route might be gained already and

fear could be slightly reduced. Moreover the guid-

ing person should actively involve the participant in

choosing relevant routes and deﬁne route elements in

a collaborative manner.

At ﬁrst a start point has to be deﬁned consisting of

the current location with an associated name. While

walking the designated path, appropriate local land-

marks can be selected and documented in the applica-

tion by pressing the corresponding button (see Figure

2(a)). In addition to a name and positional informa-

tion (via GNSS), a picture of the landmark is required.

Adequate positions might be hard to reach, therefore

not optimally placed points can be altered or reﬁned

via a map view (see Figure 2(b)).

Further along the route landmarks can be iden-

tiﬁed and deﬁned via the mobile app by the guid-

ing person in collaboration with the disabled person

while passing by. Also the need of additional way-

points should be directly considered in conjunction

with the participant. Another beneﬁt of having to ac-

tually walk the route together with participants is the

identiﬁcation of potentially critical trafﬁc situations.

Assistance points could be placed there to give partic-

ipants safety guidance. Lastly upon reaching the des-

tination, a route is completed with a goal marking the

end point of a route. Routes including names, posi-

tions, and additional data as pictures can be altered at

any time. Also the order of points can be changed and

points can be deleted or added to adapt to changes or

to address manual fading-out strategies in the training

process.

All steps of route creation can be prepared in ad-

vance (e.g. taking pictures and checking for sufﬁcient

landmarks) and realized completely in a workspace

environment using a computer, however undergoing

this experience together with participants might lead

to important additional details resulting in a huge ben-

eﬁt during training if routes are created on location.

3.3 Route Training

While supporting and encouraging autonomy in gen-

eral during navigation, we primarily focus on the im-

provement of wayﬁnding abilities of participants as

well as training of the general concept of landmark-

based navigation and the identiﬁcation of valid and

HEALTHINF 2022 - 15th International Conference on Health Informatics

730

Table 1: Different available points per route and their parameters.

Type of point Icon Description Parameters

Start Start point of a designated route Name, Position

Goal End point of a route Name, Position

Landmark Position of a good local landmark used for navigation Name, Position, Photo

Waypoint Technical, not visible point, that is used by the app

for better route extrapolation (e.g. curved roads)

Position

Assistance Critical point along the route that might need additional

assistance and caution (e.g. crosswalks, crossroads, etc.)

Name, Position,

short message

(a) Selection for different

point types.

(b) Precise adjustment via a

map is possible.

saved routes.

Figure 2: Different views for route creation landmark-training.

feasible landmarks. To reinforce immersion, land-

marks are embedded into the environment via AR

markers (see Figure 3(b)). This view contains 2 mark-

ers, one for the current landmark and another one for

the end point resp. the next landmark. As soon as

a landmark or the goal of the route is reached, au-

diovisual feedback will notify participants (see Figure

3(c)). The focus of participants should be directed to

long-lasting features and away from eye-catching as-

pects like advertisement.

With the beneﬁt of increased immersion and em-

bedding AR elements into the environment, markers

might be out of sight in the current viewport during

a turn, if a directional change has to be made, or

the smartphone is accidentally facing the wrong di-

rection. To provide further transparency and reduce

the need of searching the surrounding thoroughly if

a marker is not visible in the current view, arrows on

the side of the screen serve as rotational hint.

Although the existence of multiple markers at

a time might be useful, the need of searching for

the next one as well as the amount of information

displayed should be reduced to a bare minimum at

each time to avoid irritation. Nonetheless participants

might leave the designated path unintentionally. If a

certain distance away from the points of the route is

exceeded, a notiﬁcation will be shown and an arrow

will be pointing back to the route itself, where the

navigation to the next landmark continues. The dis-

tance to the route when sending notiﬁcations is crucial

and has to be chosen carefully. Additional waypoints

can support this information for more complex road

design.

Besides leaving the designated route, participants

might not be able to ﬁnd the route again based on

the guidancy of the application and continue the route

without assistance. To address given circumstances it

is useful to ask the participant if everything is all right

Digitization of Landmark Training for Topographical Disorientation: Opportunities of Smart Devices and Augmented Reality

731

(a) Participant holding smartphone. (b) AR Marker embedded

into environment showing

Landmark and Goal direction.

reached.

Figure 3: Views of the landmark-training application.

or help is needed, if no movement is detected. To this

end, the timing is crucial since participants might be

distracted and demotivated by frequent notiﬁcations

nor do we want to distract focus from trafﬁc lights or

walk ways. If a participant feels stuck, there will be

a possibility to contact a predeﬁned guiding person.

While a permanent visible help button might be eas-

ily accessible, we abandoned this idea due to potential

over usage or accidental usage.

Due to the intrusiveness of AR, safety is one of

our main priorities. Therefore the application should

be less intrusive and only show a bare minimum of

elements with minor transparency effects to not ob-

struct the vision of the user. Several approaches for

safety measures in AR navigation exist e.g. showing

a safety notiﬁcation at the beginning of the route, or

locking the whole application while the user is mov-

ing. We decided not to lock the app while participants

move, since stopping every time to assure oneself that

the next landmark is still in the right direction is to

disrupting. Instead we integrated assistance points

that display additional notiﬁcation that users should

pay attention to the environment right now to use e.g.

crosswalks or wait at trafﬁc lights.

4 DISCUSSION & CONCLUSION

The prototype described here is developed in an agile

approach within an interdisciplinary research group.

All elements in this ﬁrst prototyping phase were thor-

oughly discussed and conceptualized, but still have to

be evaluated with participants. Results of these evalu-

ations and additional ideas from participants are used

as a basis for further prototypes in the agile develop-

ment.

Another central focus of the research process is

the consideration of privacy for participants via a pri-

vacy by design approach. This is especially impor-

tant for AR technologies. Advanced AR features as

e.g. object detection are mainly realized by sending

the corresponding data to a cloud service where ma-

chine learning based classiﬁcation tasks are realized,

instead of performing these operations on the smart-

phone itself. Since to this end raw data as photos

or voice recordings are sent to a cloud service, this

raises signiﬁcant privacy concerns. For this reason an

AR framework that does not employ cloud services is

used. Also for the use of sensor data of smartphones

in general, as e.g. capturing location data or voice

data, privacy risks need to be analyzed and privacy

respecting solutions need to be conceptualized.

People with topological disorientation are often

not able to use classical navigational devices or maps.

Augmented Reality provides a promising alternative

by adding elements directly into the environment

while additionally still being aware of the surround-

ings. While the application can be used as a compen-

sational tool, the training approach has to be evaluated

as well, including fading-out strategies.

The prototype presented here is the basis of fur-

ther participatory research where especially usability

HEALTHINF 2022 - 15th International Conference on Health Informatics

732

and understandability are focused. Aspects for further

improvements might include customizable icons for

start and goal points for better understanding. More-

over based on the current location, routes with a start

point nearby could be ﬁltered beforehand, minimizing

the amount of available routes in the route selection

view signiﬁcantly. Another important aspect is to fos-

ter the motivation of participants. Here the integration

of gamiﬁcation elements in the training process will

be considered to be an important area of future work.

ACKNOWLEDGEMENTS

This work was supported by the Federal Ministry of

Education and Research (BMBF) as part of SmarteIn-

klusion (01PE18011C).

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