The use of embedded context-sensitive attractors for clinical walking test guidance in virtual reality

Virtual reality is increasingly used in rehabilitation and can provide additional motivation when working towards therapeutic goals. However, a particular problem for patients regards their ability to plan routes in unfamiliar environments. Therefore, the aim of this study was to explore how visual cues, namely embedded context-sensitive attractors, can guide attention and walking direction in VR, for clinical walking interventions. This study was designed using a butterfly as the embedded context-sensitive attractor, to guide participant locomotion around the clinical figure of eight walk test, to limit the use of verbal instructions. We investigated the effect of varying the number of attractors for figure of eight path following, and whether there are any negative impacts on perceived autonomy or workload. A total of 24 participants took part in the study and completed six attractor conditions in a counterbalanced order. They also experienced a control VE (no attractors) at the beginning and end of the protocol. Each VE condition lasted a duration of 1 minute and manipulated the number of attractors to either singular or multiple alongside, the placement of turning markers (virtual trees) used to represent the cones used in clinical settings for the figure of eight walk test. Results suggested that embedded context-sensitive attractors can be used to guide walking direction, following a figure of eight in VR without impacting perceived autonomy, and workload. However, there appears to be a saturation point, with regards to effectiveness of attractors. Too few objects in a VE may reduce feelings of intrinsic motivation, and too many objects in a VE may reduce the effectiveness of attractors for guiding individuals along a figure of eight path. We conclude by indicating future research directions, for attractors and their use as a guide for walking direction.