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GETTING SERIOUS
about serious

VR

GamesForDementia

Background
BACKGROUND

Environmental Scan
of VR apps designed to date

There is increasing evidence of the effectiveness of game-based dementia treatments, with a growing investment in Virtual Reality (VR). VR-games are immersive, interactive, and imaginative, providing exciting and life-like multisensory (visual, auditory, and tactile) experiences.

 

Despite its promise, it is currently unknown how many VR apps have been created for people with dementia or how to best design for this unique population.

If we are serious about designing effective serious VR games for people with dementia, these are things that we need to know.

To help fill this knowledge gap and lay the groundwork for developing a set of design guidelines, we conducted a systematic environmental scan to identify and describe currently available VR applications and their design features. 

Our
Methods

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Prisma
Framework
Search conducted: December 6-8, 2022

We included only apps designed to be used in a VR HMD, by people with dementia. 

 

255 apps were initially extracted from popular VR game-engines (Oculus, Steam, iOS, Google Store), peer-reviewed and grey literature (Google and Google Scholar). After screening by three reviewers, 12 apps were included in the analysis.

Thematic
Analysis

In-depth thematic charting (by three reviewers) included documenting available information on:

  • App purpose and design

  • Design features specific to PwD
    (e.g., accessibility, safety, user instructions, interaction requirements)

  • Evidence of therapeutic benefits

  • Indications for medical use

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HMD
Testing
2 apps were tested in an Oculus Go & Meta Quest 2 

Two apps - “Seas the Day” and “The Wayback”  - were commercially available to download and were tested in a Meta Quest 2 VR HMD. 

Of the remaining apps, four were available for businesses and six were only described in the literature.

12 Apps that
Made the Cut

2001
diagnosis application
LEGEND

Direct to Consumer

Business to Business

Described in the Literature

icon exercise.png
icon cognition.png
diagnosis application

Exercise

Social and Psychological Well-Being

Improve Cognition

Diagnosis

2015
icon cognition.png
icon exercise.png
2016
2017
2019
icon exercise.png
2020
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2021
icon cognition.png
icon exercise.png
2022

Visuals

8 Used Computer Graphics
6 Used 360-degree video
2 Used static 360-degree images
(e.g. Google Maps)

Movement

Interaction

8%

None (stationary only)

42%

First-person

motion

25%

Leap-motion

25%

Not described

8%

None (head movement only)

8%

Hand movement

8%

Not described

25%

Caregiver control through

a secondary device

(e.g. tablet, smartphone)

50%

Hand-held

controllers

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Social &
Co-Operative
Experiences

3 apps allowed users to meet with another individual in VR. 

For example, the RendeverLiveTM program offers daily live programs and live interaction with a virtual program host.

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Dementia-Specific Considerations

8 apps described dementia-specific design features.

7 apps described having dementia-specific user instructions.

COGNITIVE

  • Clear, specific tasks

  • Incorporating task-focused activities that do not rely on memory (e.g., Montessori approach)

  • Verbal and visual cues

  • No-fail conditions

  • Simple, recognizable visuals to prevent overwhelm

  • Intuitive and realistic game mechanics (e.g., rowing a boat)

icon cognition_edited.png

PHYSICAL

  • Based on prescribed movements for people with dementia

  • Incorporation of natural movements (e.g., reach over head to lift box of apples)

  • Simple interaction with virtual objects (larger boundary around an object so that it can be easily grabbed)

  • Designed to be used seated

  • 5-minute exercise time limit to minimize fatigue

  • Lightweight VR headset

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SOCIAL

  • Familiar content and music to foster positive emotion and trigger memories

  • Group use: TV casting and networking to synchronize multiple headsets

  • Design to meet psychological needs of people with dementia (e.g., quiet environment, positive words, remaining occupied)

  • Person-centered approach: choice of exercise duration, feedback on behaviour and self-monitoring (e.g., distance cycled)

  • Experience personalization: music choice, photograph

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Methods
Findings

Evidence

Theory/

Expert Opinion

Lived Experience/

User Testing

Peer Reviewed

Article

Peer Reviewed

Article Evaluating

Effectiveness

100%

75%

75%

0%

While all apps were described as based on theory and/or expert opinion and many had peer-reviewed publications describing the design or user testing, evidence to support effectiveness was scarce.
 

Future

Where in the world are the apps developed?

FUTURE DIRECTIONS

Overall, the few VR-games created for PwD, and frail older adults in general, do not meet their complex needs. Our findings highlight opportunities for designing more engaging, effective, and appropriate VR-based interventions for people living with dementia.

To increase the chance of meaningful and long-term use in this unique population, we recommend developing ways to interact with and move within the virtual world that accommodate a range of physical and cognitive abilities, are safe, and facilitate social connection. Rigorous studies that incorporate feedback from people with lived experience (people with dementia and their caregivers) will be necessary to demonstrate the effectiveness of VR-based applications.

Did we miss your app? Contact us here to let us know!

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