Analysis of Virtual Reality Therapy Game Prototype for Persons Living

with Dementia in the Philippines

Veeda Michelle M. Anlacan

1,2,3,∗ a

, Roland Dominic G. Jamora

1,2,∗ b

Angelo Cedric F. Panganiban

1,4,∗ c

, Isabel Teresa O. Salido

1 d

, Romuel Aloizeus Z. Apuya

1 e

Bryan Andrei C. Galecio

1 f

, Michael L. Tee

1,5 g

, Maria Eliza R. Aguila

1,6 h

Cherica A. Tee

1,7 i

and Jaime D. L. Caro

1,4 j

Augmented Experience Ehealth Laboratory, University of the Philippines Manila, Manila, Philippines

Department of Neurosciences, College of Medicine - Philippine General Hospital, University of the Philippines Manila,

Manila, Philippines

Center for Memory and Cognition, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines

Department of Computer Science, College of Engineering, University of the Philippines Diliman, Quezon City, Philippines

Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines

Department of Physical Therapy, College of Allied Medical Professions, University of the Philippines Manila, Manila,

Philippines

Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila, Philippines

Keywords:

Virtual Reality (VR), Persons Living with Dementia (PLWDs), Behavioral and Psychological Symptoms of

Dementia (BPSD), Gamiﬁcation, Personalization, Virtual Environment Design.

Abstract:

Immersive technologies such as virtual reality (VR) had rapidly gained interest as part of the technological

revolution in healthcare. Because of its inspirational affectation, VR had been considered a potential interven-

tion for individuals with impaired memory such as dementia. This paper had two goals that were achieved in

collaboration with healthcare professionals and scientists from the Philippines: (a) to create an improved VR

therapy game for persons with behavioral and psychological symptoms of dementia (BPSD), and (b) to acquire

professional insights and recommendations about the game. With this, a VR game prototype was developed

and tested among ﬁve health and four game design professionals. A focus group discussion (FGD) was then

held to discuss the participants’ experience with the game. The results of the FGD provided an in-depth anal-

ysis regarding the game’s architecture and overall design for the use of persons with BPSD in the Philippines.

Critical points discussed in this paper may be adopted in future VR studies for general healthcare applications

personalized for a speciﬁc demographic.

https://orcid.org/0000-0002-1241-8805

https://orcid.org/0000-0001-5317-7369

https://orcid.org/0000-0001-9327-3339

https://orcid.org/0000-0002-9314-0891

https://orcid.org/0000-0001-8777-4356

https://orcid.org/0000-0003-4943-3504

https://orcid.org/0000-0003-0113-8290

https://orcid.org/0000-0002-4034-4655

https://orcid.org/0000-0002-0766-0189

https://orcid.org/0000-0003-1447-594X

∗

These authors contributed equally to this work

1 INTRODUCTION

As of 2015, Alzheimer’s Disease International has

documented an estimated 900 million senior citizens

around the globe, and with no upper limit in sight,

global life expectancy continues to increase (Prince

et al., 2015). With rising life expectancy, there is

an increased prevalence of chronic and progressive

diseases like dementia (World-Health-Organization,

2022; Prince et al., 2015). Dementia is a disor-

der characterized by an unusual progressive decline

in cognitive function (World-Health-Organization,

2022). Persons living with dementia (PLWDs) of-

144

Anlacan, V., Jamora, R., Panganiban, A., Salido, I., Apuya, R., Galecio, B., Tee, M., Aguila, M., Tee, C. and Caro, J.

Analysis of Virtual Reality Therapy Game Prototype for Persons Living with Dementia in the Philippines.

DOI: 10.5220/0011686900003414

In Proceedings of the 16th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2023) - Volume 5: HEALTHINF, pages 144-154

ISBN: 978-989-758-631-6; ISSN: 2184-4305

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

ten experience changes in mood, behavior, emo-

tional control or motivation that are collectively called

behavioral and psychological symptoms of demen-

tia (BPSD). BPSD tends to worsen and ﬂuctuate as

dementia progresses, and these symptoms are also

costly to manage (World-Health-Organization, 2022).

While pharmacological interventions are available,

the effects of these medications are modest and are

limited by side effects. Furthermore, inadequate man-

agement may cause poor health outcomes for both

the patient and their caregivers (Kales et al., 2015).

Thus, it is necessary to develop alternative, non-

pharmacological strategies for managing BPSD (Ap-

pel et al., 2021).

In recent years, Immersive technologies have

rapidly gained interest as one of the tools aiding

the technological revolution in healthcare (Andringa

et al., 2019). Virtual reality (VR) in particular has

been studied as an intervention for clinical conditions

such as pain and anxiety (Eijlers et al., 2019; Pour-

mand et al., 2018; Wittkopf et al., 2020), burns (Czech

et al., 2022), phobias (Wechsler et al., 2019), and neu-

rocognitive diseases (Moreno et al., 2019). More-

over, the inspirational affectation brought about by

VR (Huntsman, 2014) has led researchers to consider

it for use among individuals with impaired memory

such as PLWDs. VR can be used for cognitive and

motor stimulation (Garcia et al., 2012); for early de-

tection and diagnosis of dementia (Elvey, 2016); or

for recreating the experience of dementia for carers to

better understand the detrimental effects of the disor-

der on the lives of PLWDs (Grifﬁths, 2016).

This research is part of an ongoing program to

develop an immersive technology system for manag-

ing BPSD among PLWDs. The researchers collabo-

rated with Philippine healthcare professionals and sci-

entists representing the ﬁelds of neurology, internal

medicine, physiatry, nursing, anthropology, graphic

design, game design, and software engineering to

achieve the following goals: (a) to create an improved

VR therapy game speciﬁc for persons with BPSD re-

siding in the Philippines; and (b) to acquire valuable

insights and recommendations on the architecture and

overall design of the developed VR game prototype

for the target population.

This paper will discuss different studies that have

inﬂuenced the architecture and overall design of the

developed VR game prototype for the target popu-

lation; the clinical setup and the components of the

game prototype. The results and discussion of the fo-

cus group discussion about the participants’ experi-

ence using the prototype will be presented, followed

by the summary.

2 REVIEW OF RELATED

LITERATURE

Several early attempts had been made to utilize VR

for dementia care. A study (Flynn et al., 2003)

showed that using virtual environments (VEs) was

feasible among patients with dementia. They noted

that during the VR sessions, patients had little difﬁ-

culty in navigating and performing simple life activi-

ties in a VE, had no signiﬁcant increase in simulator

sickness-related symptoms, and had no experiences

that negatively affected their psychological and physi-

cal well-being. To some extent, patients felt present in

the VE, perceived that objects appeared realistic and

moved naturally, and generally felt in control of the

interaction.

A study (Panganiban et al., 2023) on the feasi-

bility of detecting mild cognitive impairment (MCI)

through long-term cognitive monitoring or repeated

assessment also noted several considerations from the

literature for the design of such applications. These

considerations included (a) the physical and cogni-

tive limitations of the target users; (b) the cultural

aspect of the virtual environment; (c) the cognitive

assessment aspect; (d) the utilization of the three-

dimensional aspect of VR; and (e) the repeatability

aspect of the VR application. Designing an applica-

tion with these considerations in mind might allow a

VR application to be personalized and gamiﬁed for a

speciﬁc demographic for healthcare, particularly for

cognitive monitoring.

Previous research had attempted to create tools to

aid in the design of VEs based on real-world loca-

tions. One such tool was the BENOGO Place Probe

(Benyon et al., 2006), which aims to capture the sense

of place from a speciﬁc location in a form that is

useful for VE designers. The Place Probe elicits in-

formation on three areas of insight: general impres-

sions, key features, and the feelings of presence while

being in a particular place. Results from (Benyon

et al., 2006) suggested that similar experiences be-

tween the actual and simulated environments were

achieved with the help of the Place Probe. The Place

Probe was able to identify features common to both

virtual and real-world environments, and the features

in the VE that deviated from the experience of its real-

world counterpart. This made the Place Probe a useful

method of exploring virtual and actual environments

that may contribute insights into designing VEs.

A review study (Martinho et al., 2020) tackling the

current state of gamiﬁcation and related techniques

observed that applications designed for elderly pop-

ulations utilized similar gamiﬁcation techniques and

game design elements. Combining the elements of

Analysis of Virtual Reality Therapy Game Prototype for Persons Living with Dementia in the Philippines

145

feedback, progression, time constraints, and score

game design provided an effective and real-time in-

dicator of performance. This was common among

applications designed for training purposes to moti-

vate and encourage a user to participate. Alterna-

tively, the combination of feedback, progression, re-

ward, and social interaction was used by applications

designed to enhance relaxed gameplay. Rather than

using time constraints or a score track that might en-

courage competitiveness, entertaining features using

the latter combination are used to improve both indi-

vidual and collective gameplay.

Considerations relevant to the Philippine setting

were noted in a previous study (Anlacan et al., 2023)

on a VR prototype application to address BPSD in

Filipino patients with dementia. The prototype re-

volved around a user’s experience of visiting a fa-

miliar place and engaging in recreational activities

while being accompanied and guided by a virtual

companion throughout the experience. Its gameplay

followed a smooth progression with well-structured

storytelling. The results of this study suggested that

it is feasible and that there is potential for the use

of VR therapy for elderly patients with BPSD in the

Philippines. The authors pointed out design consid-

erations that should be incorporated into the applica-

tion’s overall design for future VR studies, such as

easy-to-use instruments, a user-friendly interface, and

captivating gameplay with respect to the target popu-

lation’s familiarity, comfort, and safety while in the

simulated environment.

3 METHODOLOGY

This section discusses the architecture and overall de-

sign of the developed VR game and its game ﬂow and

setup for application testing.

3.1 Participants and Focus Group

Discussion

A sample (n = 9) of healthcare workers with experi-

ence with PLWD, game designers, and game devel-

opers were recruited to experience the VR game pro-

totype (see Table 1). The participants had a mean age

of 35.11 (16.96) years, and most were female (66.7%)

and were licensed healthcare professionals (55.56%).

Each participant experienced the VR prototype at

least once. A focus group discussion (FGD) was then

conducted following the prototype testing. The goals

of the FGD were (a) to describe the participants’ ex-

perience using the VR prototype, (b) to discuss how

Table 1: Participant characteristics during the application

testing session (n = 9).

Variable n = 9 (%)

Age (in years), M (SD) 35.11 (16.96%)

Sex

Male 3 (33.33%)

Female 6 (66.67%)

Field

Healthcare or rehabilitation 5 (55.56%)

Computer science or game

development 4 (44.44%)

the application may help PLWDs, and (c) to make rec-

ommendations to improve the virtual experience.

3.2 VR Therapy Game

The VR game prototype described in this paper con-

tained improvements from the VR game developed

and discussed in a previous publication (Anlacan

et al., 2023). The target population of this application

are the older persons with mild to moderate demen-

tia. The experience in this improved prototype still

revolved around visiting a familiar or historical place

to relax and to invoke pleasant memories about the

simulated environment and activities.

3.2.1 Features

Virtual Companion and Observation/Control Module.

The virtual companion was designed with the appear-

ance/form of a child, and was piloted and voiced

in real time by a trained therapist. The compan-

ion guided the participant throughout the experience

by communicating directions, making spontaneous

conversations, and moving in a predeﬁned anima-

tion by pointing and cheering) through the observa-

tion/control module. These features were intended to

give the companion a more human-like interaction to

make the experience more natural and sociable. Other

features on the observation module included the guide

for the ﬂow of the session, a companion animation

wheel, a timer, a view of the participant in real time,

and the participant’s view of the VE. The interface

of the Observation/Control Module as viewed by the

therapist is shown in ﬁgure 1.

Initiator. An area called the “Initiator” was de-

signed to familiarize the participants with the virtual

world and its interface. It functioned as an introduc-

tion to the VR user interface. And served as a tu-

torial: a venue to practice hand gestures and object

interaction before the actual VR game. The initiator

had minimal visual and auditory triggers in its struc-

tural design to help the participants adapt to the VE. A

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Figure 1: Observation Module (as viewed by the therapist). (A) Guide for the ﬂow of the session, (B) companion animation

wheel, (C) timer, (D) view of the participant in real-time, (E) participant’s view of the VE without the module interface A to

D, and (F) the boy in white is the virtual companion.

demonstration of the design and activities in the Ini-

tiator is shown in ﬁgure 2.

Figure 2: (A) The location of the initiator. (B) Participant

matching objects at the initiator. (C) Teleportation tutorial

at the initiator.

Hand Tracking and Gestures. Utilizing the Ocu-

lus Quest 2 features, the game adopted hand tracking,

which is the real-time tracking of a user’s hand and

projecting its movements to the virtual world. Hand

tracking enabled the participants to interact with ob-

jects using their physical hands. This feature freed the

participant’s hands from contraptions/ trackers which

PLWD might perceive as cumbersome or uncomfort-

able. Moreover, hand tracking also enabled the use

of hand gestures to prompt the system or trigger an

event. Through hand gestures, the user might move

from one place to another by pointing their index ﬁn-

ger, and trigger events using a thumb-up hand gesture.

These gestures were taught to the participant in the

initiator and were utilized throughout the experience.

A demonstration of hand tracking is shown in ﬁgure

3.2.2 Places in the Virtual Environment

Waiting Room. The waiting room was where the par-

ticipants were teleported after the initiator. It was de-

picted as an enclosed space with black walls and a

ﬂoating television screen in front of the participants.

The virtual companion was introduced in this room,

and an introductory video about the VE was shown on

the ﬂoating screen. Once the video ﬁnishes playing,

the surrounding black walls dissolve, revealing the

Rizal Park VE. The participants returned to this room

after completing all the activities in the VE, signiﬁed

by the build-up of the black walls. A demonstration of

the design and activity in the Waiting Room is shown

in ﬁgure 4.

Rizal Park VE. The Rizal Park VE was the main

setting where the participants could move around to

explore or perform recreational activities. It utilized

a 360° image of Rizal Park as the background while

Analysis of Virtual Reality Therapy Game Prototype for Persons Living with Dementia in the Philippines

147

Figure 3: (A) (A) Participant’s virtual hand as viewed by

the participant in the virtual environment. (B) Participant

in the real life as viewed by the therapist in the Observa-

tion/Control Module.

Figure 4: (A) The virtual companion in the Waiting Room.

(B) Introductory Video in the waiting room.

some of the landmarks and structures were added as

generated virtual objects. The Place Probe (Benyon

et al., 2006) was utilized to capture the essence of

the park and create a more convincing VE. The re-

sulting VE was depicted as an open space with visual

and auditory triggers consistent with the ambiance of

its real-world counterpart in Manila, Philippines. A

demonstration of the design of the Rizal Park VE and

its real-world counterpart is shown in ﬁgure 5.

This location was chosen due to its signiﬁcance

and popularity among Filipinos. The park was named

after the Philippine national hero, Dr. Jos

e Rizal,

who was executed in the exact location. His execu-

tion fanned the ﬂames of national independence from

Spain.

Figure 5: (A) Rizal Park at Manila, Phillipines. (B) Rizal

Park Virtual Environment.

Avatar Room. The avatar room was the ﬁrst of

three booths depicted in the Rizal Park VE. This was

where the participants selected what their avatar wore

throughout the experience. The room was an enclosed

structure with Filipino-inspired architectural design.

This provided security and comfort for the partic-

ipant while performing the sensitive activity. The

clothes selection was also inspired by traditional Fil-

ipino dresses and accessories. A demonstration of the

design and activity in the Avatar Room is shown in

ﬁgure 6.

Painting Booth.The painting booth was the second

of three booths depicted in the Rizal Park VE, and the

ﬁrst booth that offered a recreational activity. In this

booth, the participants engaged in a painting activity

where they were tasked to add color to the white ﬂow-

ers presented in the middle of the room using a virtual

paintbrush. The vase containing the ﬂowers could be

rotated by tapping one of its four handles. This booth

was designed as a roofed open space with Filipino-

inspired architectural design surrounded by a garden

of ﬂowers and ﬂying butterﬂies. A demonstration of

the design and activity in the Painting Booth is shown

in ﬁgure 7.

Puzzle Booth. The puzzle booth was the last booth

depicted in the Rizal Park VE, and the second booth

that offered a recreational activity. Participants were

tasked to assemble a car by grabbing a car part and

matching the piece to its correct placement on the car,

a task analogous with assembling a puzzle. The booth

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Figure 6: (A) Exterior design of the Avatar Room. (B) User

changing clothes inside the Avatar Room. (C) Outﬁt selec-

tion (left of the participant) and (D) hat selection (right of

the participant).

was also designed to be a roofed open space, depict-

ing car parts and tools similar to a typical auto repair

shop in the Philippines. A demonstration of the de-

sign and activity in the Puzzle Booth is shown in ﬁg-

ure 8.

Figure 7: Painting Booth in the Rizal Park VE.

Figure 8: Puzzle Booth in the Rizal Park VE.

3.3 VR Testing Setup and Flow

A small testing setup was built at the University of

the Philippines Manila - College of Allied Medical

Professions (UPM-CAMP) and at the University of

the Philippines Diliman - Alumni Engineers Centen-

nial Hall. This setup consisted of a 9m

(3m × 3m)

“play area” for the participant and a workstation for

a therapist who was trained to administer the VR ex-

perience and a researcher who observed the testing

Analysis of Virtual Reality Therapy Game Prototype for Persons Living with Dementia in the Philippines

149

sessions. The therapist supervised the session using

a laptop computer with an observation/control mod-

ule. Through this module, the therapist managed the

application parameters, oversaw the therapy from the

participant’s point of view, and guided the partici-

pant throughout the experience. Figure 9 shows an

overview of the clinic setup.

Figure 9: Application Testing Clinic Setup.

The VR head-mounted display (VR HMD) (Ocu-

lus Quest 2, 128 GB storage), which was tethered

to a laptop (Nitro AN515-45, AMD Ryzen 7 5800H,

16GB RAM, Windows 11 g4-bit) was used by the par-

ticipant to view and interact with the VE. Before the

experiment, researchers orientated the participants on

the VR HMD and the proper use and handling of the

device. The participant was then seated on a stable

swivel chair and was asked to remain seated through-

out the experiment. The experiment started after the

user successfully put on the VR HMD and earphones

with the assistance of the researchers, and ended upon

the participant’s completion of all activities and the

removal of the HMD. An overview of the ﬂow of ac-

tivities in the VR Game prototype is shown in ﬁgure

10.

4 RESULTS AND DISCUSSION

This section discusses the insights and recommenda-

tions of health and game design professionals during

the FGD regarding the architecture and overall design

of the developed VR game prototype for the target

population.

4.1 User Interface

A common feature that the participants appreciated

was the use of hand gestures instead of handheld

controllers to interact with the VE. A participant ex-

plained that patients with dementia may have difﬁ-

culty in using handheld controllers, especially if they

are not familiar with the technology. Another partic-

ipant appreciated that, instead of all the instructions

being given before the session, instructions on the

hand gestures were simultaneously given throughout

the experience at the Initiator. Despite these positive

comments, the hand gestures still required improve-

ment. Participants still encountered difﬁculties in ac-

curately using it for teleporting and interacting with

objects within the VE. This was a hardware limitation

and gesture ﬂaw that will be improved in future VR

HMDs.

Another characteristic that the participants appre-

ciated was the light weight of the headset. Only one

participant expressed discomfort while wearing the

headset, but noted that it was the only source of dis-

comfort throughout the VR experience.

Lastly, the participant who served as the therapist

administering the VR experience praised the obser-

vation/control module for its user-friendly interface,

stating that it was easy to learn regardless of one’s

level of familiarity with technology. However, they

hoped that more interactions between the virtual com-

panion and the patient could be added.

Aside from the negative experiences noted above,

a participant also raised a concern on the use of ear-

phones for elderly patients. They mentioned that

one of their elderly relatives was averse to using ear-

phones and that other elderly patients may react sim-

ilarly.

4.2 User Experience

The participants had positive experiences with one or

more components of the VE. Overall, the painting

activity was the most favored activity by the partic-

ipants, especially with respect to its use as a therapy

activity for patients with PLWD. Notable quotes from

the participants are displayed in table 2.

4.2.1 Initiator

The participants positively reacted to the addition of

a tutorial before the VR experience since it helped

in self-orientation within the VE. The activity was

simple, structured, and had deﬁnite correct answers,

which would be helpful for PLWD. The initiator also

encouraged (upper body) movement, which one of the

participants appreciated.

4.2.2 Waiting Room

Two participants selected the waiting room as their fa-

vorite part of the VR experience because it helped pre-

pare them for the main environment. They felt excited

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Figure 10: Flow of the activities in the VR Game prototype.

Analysis of Virtual Reality Therapy Game Prototype for Persons Living with Dementia in the Philippines

151

and nostalgic after watching the introductory video.

One participant likened the waiting room to feeling

like sitting in a movie theater or in a car traveling to a

destination because it was comfortable and relaxing.

4.2.3 Rizal Park Virtual Environment

Participants appreciated the choice of setting for the

main environment where the activities took place. As

one participant noted, it was a good choice if the goal

was reminiscence or cognitive stimulation; especially

if the patients were familiar with the place. Seeing a

familiar place may help make it easier to feel secure

in a virtual setting, especially for ﬁrst-time users.

4.2.4 Avatar Room

Participants mainly had good experiences with the

dress-up activity, and some also chose it as one of

their favorite activities. The activity was simple and

memorable. It was a pleasant experience to choose the

clothes that they wanted their avatar to wear. A partic-

ipant noted that being able to choose their own clothes

could make patients more interested in the experience.

Moreover, this could also be an opportunity for them

to have conversations about their feelings and past ex-

periences.

4.2.5 Painting Activity

Many participants enjoyed the painting activity, say-

ing that it was fun and they felt satisﬁed when they

completed it. The healthcare professionals in the

group particularly appreciated the painting activity for

the sense of accomplishment it could provide PLWD.

The design of the task would enable a patient to com-

plete the activity since it was simple, structured, and

had clear instructions. Many patients with dementia

ﬁnd it difﬁcult to do everyday tasks, so the easy and

straightforward nature of the activity could also help

with their self-esteem.

The activity was also praised for its physically

stimulating elements. Throughout this activity, target

patients could move their hands to reach for certain

objects. These movements could challenge balance

and would require extra physical effort to perform.

Aside from physical stimulation, target patients could

also be mentally stimulated by the activity. The activ-

ity might provide a sense of independence by giving

them opportunities to make choices, such as deciding

what colors to use or what colors to put next to each

other. This activity might also give the opportunity for

therapists to engage patients in natural conversations.

Participants felt that the painting activity was sim-

ilar to current non-pharmacological therapy activities

for PLWD. They felt that the virtual activity was able

to synchronize with coloring book activities that they

often do with patients.

Minor difﬁculties were encountered when the par-

ticipants performed the activity. For one participant,

the grip on the paintbrush felt unnatural since it was

not similar to how a paintbrush would be held in real

life. Many participants also found it challenging to

turn the vase, stating that patients may also feel frus-

trated. They suggested a more user-friendly interface

for moving the vase in future iterations.

4.2.6 Puzzle Activity

The participants viewed the puzzle activity as an ac-

tivity that could be particularly engaging for patients

with interest in cars. Although some participants ap-

preciated the activity, many felt that it still had room

for improvement, particularly in making the activity

feel familiar to patients without experience with or

interest in cars. One participant attributed their low

preference for the activity to technical aspects of the

experience, such as the interaction with the virtual ob-

jects and the lack of key sound effects.

4.3 Sensory Elements

4.3.1 Visual Elements

The majority of the visual elements identiﬁed were

from the main Rizal Park environment: the overall de-

sign, the background characters/objects, and the land-

marks depicted.

The participants appreciated the overall design of

the environment. The structures and objects appeared

Filipino and old-fashioned, such as the choice of car

model for the car (puzzle) activity and the architecture

of the ﬂower shop (painting booth). For the ﬂower

shop, a participant said: “It had the same feeling for

me as visiting an ancestral home.” For the partici-

pants, these design choices were cohesive for the en-

tire environment and added an element of familiarity.

Participants also liked the addition of background

characters in the environment, such as the child ﬂying

a kite in the environment of the park. They felt that

this character added a human element to the environ-

ment and made it feel less lonely. One participant, in

particular, felt nostalgic and recalled their childhood

upon seeing the character. The majority of the par-

ticipants suggested the inclusion of more characters,

each with a different personality.

Landmarks, background objects (e.g., ﬂags, traf-

ﬁc), and even the lighting of the environment was also

noted by the participants. These elements made the

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Table 2: Notable quotes from participants for each location/activity in the VE.

Location/Activity Quote

Initiator Participant 8: “It’s one thing for someone to talk to you and to orient you (about

the VR game), but it’s another thing to actually experience it (while instructing

you).”

Rizal Park VE Participant 5: “It serves as your ﬁrst impression of the virtual environment.

Even though it’s new because it’s your ﬁrst time to enter a virtual environment,

the fact that it is Luneta Park would make it feel familiar and, at the same time,

I assume it would make it easier to feel secure in the new environment.”

Avatar Room Participant 1: “If we want it to be like reminiscence therapy, it could be a venue

for them to share their experiences and talk about their feelings. I think that

the ability to change how they look like, the designs of the clothes, and the

things that they wear could be really good conversation starter for them.”

Painting Activity Participant 7: “There’s an element of easy winnability to the activity. It’s a

feature that I sometimes use for some of my patients to raise their self-esteem.

A lot of activities of daily living, chores and other activities are already

difﬁcult for them, so it would be good for them to have a task that is winnable.”

Puzzle Activity Participant 3: “The car activity feels like it does the same job as the painting

of the ﬂowers. But I think the car activity does not feel as good as the ﬂower

activity because the latter is a better way of moving your hands around during an

activity.”

environment appear more realistic and recognizable

as Rizal Park.

4.3.2 Auditory Elements

The most common auditory element that the partici-

pants described was the therapist’s voice. The ther-

apist’s involvement as an instructor and guide would

also be helpful to patients. According to the partici-

pants, the therapist’s voice could make the experience

familiar, stimulating, and engaging. The real-time de-

livery of scripted instructions would allow the thera-

pist to adjust instructions or their approach to accom-

modate a patient’s level of understanding and cogni-

tion.

Participants had mostly positive comments on the

sound effects of the VE, particularly for the sound ef-

fects associated with the painting activity. However,

one participant reported that the ending sound effect

of the painting activity shocked them. They suggested

that the effect could be turned down. In contrast, they

noted that the puzzle activity could be improved by

adding more key sound effects.

4.4 Safety

A few positive comments were made regarding pa-

tient safety during the VR experience. One partici-

pant appreciated that patients would be seated while

interacting with the VE since it minimize the risk of

falling. Another participant, who declared easily hav-

ing motion sickness, commented that they did not ex-

perience any dizziness or nausea despite freely turn-

ing their head during the 15-20 minute VR session.

5 CONCLUSION

This study developed a personalized VR game proto-

type and provided an in-depth analysis regarding its

architecture and overall design for the use of PLWD

in the Philippines. The researchers acquired valuable

insights and recommendations regarding the user in-

terface, user experience, sensory elements, and safety

of the game for future development and possible im-

plementation. Critical points discussed in this paper

might be used or adopted for personalized VR appli-

cations in future studies for healthcare, particularly

for persons with chronic and progressive diseases like

dementia.

ACKNOWLEDGEMENTS

The authors of this paper would like to give acknowl-

edgement to the Republic of the Philippines Depart-

ment of Science and Technology (DOST) Philip-

pine Council for Health Research and Development

(PCHRD) for funding this research.

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153

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