Abstract Background Visuospatial neglect (VSN) is a cognitive disorder after stroke in which patients fail to consciously process and interact with contralesional stimuli. Visual Scanning Training (VST) is the recommended treatment in clinical guidelines. At the moment, several mixed reality versions of Visual Scanning Training (VST) are being developed. The aim of this study was to explore the opinions of end-users (i.e., therapists) on the use of Virtual Reality (VR) and Augmented Reality (AR) in VSN treatment. Methods Therapists played one VR and two AR Serious Games, and subsequently flled out a questionnaire on User Experience, Usability, and Implementation. Results Sixteen therapists (psychologists, occupational, speech, and physiotherapists) played the games, thirteen of them evaluated the games. Therapists saw great potential in all three games, yet there was room for improvement on the level of usability, especially for tailoring the games to the patient’s needs. Therapists’ opinions were comparable between VR and AR Serious Games. For implementation, therapists stressed the urgency of clear guidelines and instructions. Discussion Even though VR/AR technology is promising for VSN treatment, there is no one-size-fts-all applicability. It may thus be crucial to move towards a plethora of training environments rather than a single standardized mixed reality neglect treatment. Conclusion As therapists see the potential value of mixed reality, it remains important to investigate the efcacy of AR and VR training tools.
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Introduction: Visuospatial neglect (VSN) is common after stroke and can seriously hamper everyday life. One of the most commonly used and highly recommended rehabilitation methods is Visual Scanning Training (VST) which requires a lot of repetition which makes the treatment intensive and less appealing for the patient. The use of eHealth in healthcare can increase options regarding improved treatment in the areas of patient satisfaction, treatment efficacy and effectiveness. One solution to motivational issues might be Augmented Reality (AR), which offers new opportunities for increasing natural interactions with the environment during treatment of VSN. Aim: The development of an AR-based scanning training program that will improve visuospatial search strategies in individuals affected by VSN. Method: We used a Design Research approach, which is characterized by the iterative and incremental use of prototypes as research instruments together with a strong human-centered focus. Several design thinking methods were used to explore which design elements the AR game should comply with. Seven patients with visuospatial neglect, eight occupational therapists, a game design professional and seven other healthcare professionals participated in this research by means of co-creation based on their own perspectives. Results: Fundamental design choices for an AR game for VSN patients included the factors extrinsic motivation, nostalgia, metaphors, direct feedback, independent movement, object contrast, search elements and competition. Designing for extrinsic motivation was considered the most important design choice, because due to less self-awareness the target group often does not fully understand and accept the consequences of VSN. Conclusion: This study produced a prototype AR game for people with VSN after stroke. The AR game and method used illustrate the promising role of AR tools in geriatric rehabilitation, specifically those aimed at increasing the independence of patients with VSN after stroke. 2020 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Purpose - This paper provides an overview on the technical and vocational education and training (TVET) program components/mechanisms and their overall effect on learning outcomes in a developing country context. Design/methodology/approach - Using secondary data, this descriptive case study integrates the realistic evaluation framework of Pawson and Tilley (1997) with Total Quality Management (TQM) frameworks. Findings - Ethiopia's TVET system adopts/adapts international best practices. Following the implementation of the 2008 TVET strategy, the proportion of formal TVET graduates who were recognized as competent by the assessment and certification system increased from 17.42 percent in 2009/2010 to 40.23 percent in 2011/2012. Nevertheless, there is regional variation. Research limitations/implications - Outcome-based TVET reforms that are based on TQM frameworks could improve learning outcome achievements in developing countries by enhancing awareness, coordination, integration, flexibility, participation, empowerment, accountability and a quality culture. Nevertheless, this research is limited by lack of longitudinal data on competency test results. There is also a need for further investigation into the practice of TQM and the sources of differences in internal effectiveness across TVET institutions. Practical implications - Our description of the Ethiopian reform experience, which is based on international best experience, could better inform policy makers and practitioners in TVETelsewhere in Africa. Originality/value - A realistic evaluation of TVET programs, the articulation of the mechanisms, especially based on TQM, that affect TVET effectiveness would add some insight into the literature. The evidence we have provided from the Ethiopian case is also fresh. Keywords TVET reform, TVET quality, Total quality management, Internal effectiveness, Realistic evaluation, Developing countries, Ethiopia
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