C- Hg: A COLLABORATIVE HAPTIGRIPPER VIRTUAL REALITY SYSTEM
6.2 Introduction
Impairments in executive function skills (EF), which include domains such as working memory, flexible thinking, and inhibition of impulses, are commonly reported among individuals with ASD [1-3]. Executive function skills are crucial for effective coordination and completion of tasks, with deficits associated with poor adaptive, academic, and employment outcomes [4, 5] These skills are especially important to multitasking, or the ability to plan, coordinate and complete multiple tasks within a given time period not in a sequential fashion but rather by interweaving task performance by switching back and forth between them [6].
Because of the relevance of EF to so many academic, adaptive, and employment tasks, several recent studies have investigated EF in ASD by using multitasking paradigms [7-9]. Multitasking involves many aspects of EF that may be hard for someone with ASD, such as switching attention between components and practicing flexible thinking. Mackinlay et al. [7] investigated multitasking in 14 children with high- functioning ASD (HF-ASD) and 16 typically developing (TD) controls using a novel task called the Battersea Multitask Paradigm (BMP). The BMP consists of three interwoven tasks (bead sorting, counter sorting and caterpillar) which should be completed within 3 minutes. The authors assessed the cognitive processes underlying multitasking by using a six-stage invariant sequence, proposed by [10], which were Rule learn, Plan, Perform, Plan follow, Monitor and Rule memory. Results indicated that the ASD group generated significantly fewer strategic plans, attempted fewer tasks, and less flexibility in switching between tasks, and that they broke rules more frequently than the TD controls. Rajendran et al. [8] used a modified version of the Virtual Errands Task (VET) [11] to investigate EF and multitasking in 18 adolescents with HF-ASD and 18 TD controls. In VET, participants were required to role-play a lecturer running a set of errands in a university building within 8 minutes. Participants were awarded points for task completion and had points subtracted for breaking rules. Results indicated that the ASD group completed fewer tasks, broke more rules and more rigidly followed the task list in the original order of presentation.
Therefore, the authors concluded that inflexible planning, low inhibition, as well as difficulties with prospective memory (remembering to carry out intentions) may underlie multitasking difficulties in ASD.
Finally, Hutchison et al. [12] examined EF in relation to basic functional communication (FC) and more complex verbal conversation (VC) skills among 92 children with ASD and 94 TD controls. They reported that metacognition (or “thinking about thinking”) was a strong predictor of FC, while the domains of behavioral regulation and inhibition were predictive of VC skills. Therefore, they suggested that targeting EF domains specifically might improve FC and VC skills in children with ASD.
The impact of EF on multitasking and its impact on individuals with ASD becomes more salient when one considers that multitasking is a ubiquitous requirement of everyday activities, including social interactions. Each interaction draws upon not only the need to inhibit impulses, pay attention to cues, remember what has just happened, and plan for what happens next; many also involve motor skills, another common area of deficits for many people on the autism spectrum [13]. Motor skill deficits (including gross motor, i.e., postural control and limb movements; and fine motor, i.e., object control, manual dexterity and visuomotor integration) are incredibly prevalent among children with ASD, estimated to occur in 90% of individuals with ASD across the lifespan [14-18]. Fine motor challenges in children with ASD include trouble with grasping and reaching [19], eye-hand coordination [20], and handwriting skills [21]. These basic tasks, which many people execute almost automatically, likely require extra effort, control, and mental attention from people with ASD.
When thinking about designing intervention paradigms for individuals with multiple areas warranting attention, it follows that focusing on a single area of deficit (e.g., conversation) rather than incorporating multiple integrated targets (e.g., conversation as part of game-playing) may hinder the generalizability of learnt skills to complex real-world activities. In particular, it will be problematic if additional real-word components create added levels of difficulty and complexity that could impact success. Existing literature suggests that teaching motor skills to children with ASD may help create a context for practicing social skills and lead to further social success [18]. For example, Chetcuti et al.[22] conducted a study with 35 children with ASD and 20 TD children to examine the role of social motivation and motor execution factors in object-directed imitation difficulties in ASD. They found that difficulties in object-directed imitation in ASD might be the result of motor execution difficulties, and not reduced social motivation. Srinivasan et al. [23] evaluated the impacts of rhythm, robotic and standard-of-care interventions, on 36 children with ASD (5-12 years of age). They found that socially embedded movement-based contexts are valuable in promoting imitation/praxis, interpersonal synchrony and motor performance. Fulceri et al. [24] applied Artificial Neural Networks (ANNs) to reveal the entire spectrum of the relationship between motor skills and clinical variables. Their findings suggested that poor motor skills were a common clinical feature of preschoolers with ASD, relating both to the high level of repetitive behaviors and to the low level of expressive language. Collectively, these findings suggest that in order to benefit from social skills training, some individuals might also require training in other, related functional domains, like motor skills.
Compared to extensive research focusing on the social deficits of ASD, motor deficits of children with ASD and the influence of motor skills on social skills of children with ASD are relatively underexplored, especially within the context of technological intervention. To address this issue, a training system that can provide social skills practice as well as the fine motor skill practice is needed. In Chapter 2, we have developed a Collaborative Virtual Environment (CVE) to provide social skill training for children with ASD. The CVE system preserves the benefits of virtual reality (VR) systems but also offers the opportunities for flexible and convenient interactions over Internet between remote users. In Chapter 4, we have developed a Haptic-Gripper VR system (Hg) to provide fine motor skill training for children with ASD. Hg took advantages of the haptic device to increase immersion and quality of task performance and thus had the possibility of enhancing the training outcomes. Combining these two systems, we present a collaborative haptic-gripper virtual reality system, called C-Hg, to simultaneously practice social skills (communication and collaboration skills) and fine motor skills (hand movement and grip control skills), and to investigate the impact of fine motor skill improvement on social skill trajectory.
In this chapter, we introduce a collaborative haptic-gripper fine motor skill training system (C-Hg) that can provide carefully designed fine motor skill training tasks in both individual mode and collaborative mode. In the collaborative mode, a Collaborative Haptic Virtual Environment (CHVE) is built to allow
remote users to perform haptic interaction through haptic devices. Social communication and collaboration skills are required to successfully implement the fine motor skill training tasks in the collaborative mode.
We also present a usability study to explore the usefulness of this system on improving the fine motor skills through individual fine motor tasks, and also to investigate if improved fine motor skills would improve the social communication and collaboration skills of the users.
The rest of the chapter is organized as follows. Section 6.3 presents the system design, which is followed by the usability study in Section 6.4. The results and discussions of the study are presented in Section 6.5.
Finally, we summarize the contributions of the work and discuss its limitations in Section 6.6.