MIST: A Multi-sensory Immersive Stimulation Therapy Sandbox Room

Bruno Ferreira

1,2,† a

, Gustavo Assunc¸

1,2,† b

and Paulo Menezes

1,2 c

Institute of Systems and Robotics, University of Coimbra, Coimbra, Portugal

Department of Electrical and Computer Engineering, University of Coimbra, Coimbra, Portugal

Keywords:

Immersive, Virtual Reality, Sensory Stimulation, Interactive Therapies.

Abstract:

Multi-Sensory Stimulation Environments are a form a therapy in which a patient is exposed to a set of con-

trolled stimuli on various sensory modalities, including visual and auditory, in order to induce some desired

physical or mental state. Despite their success, these environments are still not widely known or available

to everyone today. However, through the use of virtual reality, that can be made possible and even have its

effects boosted thanks to the observed beneﬁts of VR usage in conventional therapy. Thus in this work we

propose a virtual reality implementation of an immersive controlled stimulation environment, customizable

and adaptive to a user’s response to stimulus, which can be used as a simple mobile app added to a phone

VR headset. Initial experimentation with the platform has been very positive making it highly promising for a

future validation of its therapeutic use.

1 INTRODUCTION

Due to the accelerated lifestyle humans have been

progressively exposed to in our evolving society,

stress has become a recurrent obstacle for healthy liv-

ing (AIS, 2019). In addition, the growth of life ex-

pectancy and consequential development of therapy-

requiring illnesses as well as the deﬁnition of devel-

opmental disorders, such as autism, places additional

pressure onto an already unstable environment. Re-

latedly, time has become a scarce resource and the in-

ability to balance physical/mental wellness and stress

inadvertently leads to a depressive state or other spi-

raling issues (Beiter et al., 2015), (Menard et al.,

2017). Yet, the development of readily available ther-

apeutic tools which can both address these problems

and be executed on the go has received little to no fo-

cus from the research community.

Snoezelen



, a Dutch word originating from its

homologous terms snuggle and snooze, refers to a

type of therapy which aims to provide controlled stim-

uli to a set of sensory modalities in order to induce a

sense of equilibrium and relaxation during a session.

The concept, known also as multi-sensory stimulation

environment (MSE), ultimately attempts to reinforce

https://orcid.org/0000-0001-7792-412X

https://orcid.org/0000-0003-4015-4111

https://orcid.org/0000-0002-4903-3554

†Both authors contributed equally to this work.

executive functioning and ease communication in sce-

narios where such tasks are difﬁcult to accomplish,

or with people inherently dysfunctional (mentally or

physically) and behaviorally impaired. In these en-

vironments, sensory stimulation may range from vi-

sual to proprioceptive and vestibular depending on the

objective of the session as well as the patient’s goal.

MSE’s claim of success rests on the observed effect of

stress reduction (both physical and emotional) which

leads to enhanced concentration (Ashby et al., 1995),

(Hodgins and Adair, 2010), (Moore and Malinowski,

2009). Moreover, MSE may serve as an introduc-

tory means to develop cognitive cues for progressive

relaxation, following the observations of (Scheufele,

2000). Overall the concept has been physically im-

plemented for leisurely meditation settings as well as

speciﬁcally for the personalized treatment of autistic

patients. The observed results were generally positive

as shown in (Manuel, 2000) and (Baranek, 2002).

In addition to the growing recurrence of stress pat-

terns in human life, technology has also become a fre-

quent cohort of our daily activities. Though they may

be argued as a cause of stress and anxiety, tech appli-

ances may also be used to combat and reduce these

factors. Considering the observed success of Snoeze-

len



therapy, its implementation as an immersive vir-

tual reality (VR) exercise evidently appears to be a a

path worthwhile exploring. Consequently, its bene-

ﬁts would be boosted by those related with the use of

160

Ferreira, B., Assunção, G. and Menezes, P.

MIST: A Multi-sensory Immersive Stimulation Therapy Sandbox Room.

DOI: 10.5220/0009118401600168

In Proceedings of the 15th International Joint Conference on Computer Vision, Imaging and Computer Graphics Theory and Applications (VISIGRAPP 2020) - Volume 1: GRAPP, pages

160-168

ISBN: 978-989-758-402-2; ISSN: 2184-4321

VR technology for therapeutic purposes (Sucar et al.,

2014), (Bartolom

e et al., 2011). In this study we de-

veloped and validated a readily available pocket VR

MSE platform, customizable on the ﬂy to patient re-

quirements and which can be used with the aid of a

phone and corresponding VR headset.

The presented work reﬂects the following struc-

ture. First, Section II presents an overview of previous

research on similar approaches and immersive ther-

apeutic environments, in order to contextualize the

reader on the proposed system. The platform itself

is described in Section III after a summary examina-

tion of its requirements and speciﬁcations. Section

IV then describes how the environment has been ex-

perimentally tested and empirically validated. An as-

sessment and discussion of the outcome of the exper-

iments is provided in Section V. Finally, the paper is

concluded in Section VI.

2 RELATED WORK

This overview of previous works is divided in the fol-

lowing two subsections. To start, recent approaches to

the development and use of controlled multi-sensory

environments are examined in order to contextualize

our system. Following that, we analyze immersive

VR therapy as an alternative to conventional therapy

and how its technological edge may generally provide

greater beneﬁts to patients.

2.1 Multi-sensory Environments

A simulation of a Portuguese traditional game was

adapted as a MSE that focused on playfulness,

while being expanded by interactive fantasy ele-

ments (Castelhano and Roque, 2015). The authors

deﬁned a set of guidelines for the design of the game

that comprise the same principles of a MSE with the

purpose of mediating a therapeutic intervention be-

tween an Occupational Therapist and a Child with in-

tellectual disability.

SnoezelenCAVE, as the name suggests, is a vir-

tual reality CAVE Snoezelen



that intends to provide

therapy for Autism Spectrum Disorder (ASD), which

are known to have issues on social skills, speech, self-

care or job skills (Perhakaran et al., 2015). Although

mental health therapies, medication or special educa-

tion are the most common approaches to deal with

ASD, rehabilitation centers and hospitals have been

using MSEs, such as Snoezelen



rooms, to create

a soothing and stimulating environment that under-

take intellectual disabilities (Hogg et al., 2001; Ka-

plan et al., 2006; Barton et al., 2015; Anderson et al.,

2011). In this way, the authors proposed a therapeutic

tool that is expected to solve the immersion character-

istics of the traditional Snoezelen



, while following

the standardized procedures for this type of treatment.

A multi-sensory stimulation virtual environment

(MSVE) for relaxation was created as a part of an ex-

ploratory case study in (Diaconu et al., 2018). The

idea behind this virtual environment is that the user

should explore the existing scenes while actively in-

teracting with some of the present objects. Some of

these objects are passive (non-interactable) with the

principal purpose of being aesthetically pleasing, as to

enhance the feeling of calmness. The authors tested

their MSVE with ten individuals of a residence and

development center for the disabled to provide guide-

lines for the future design of therapeutic tools that fol-

low the same purpose. Extra attention should be paid

off into making the controls and the environment as

simple as possible, as well as being understandable

and suitable for different needs of the target group.

2.2 Virtual Reality for Therapies

Virtual Reality refers to the capability of transfer-

ring individuals to ”new realities” and support expe-

riences through sensory stimulation. Over time it has

been successfully applied to a vast panoply of areas,

such as military training (Baumann, 1993; Bhagat

et al., 2016), social science and psychology (Bailen-

son et al., 2008; Wilson and Soranzo, 2015), educa-

tion (Freina and Ott, 2015), or healthcare and clinical

rehabilitation therapies (Chirico et al., 2016; Weiss

and Katz, 2004).

Focusing on clinical rehabilitation, VR brings sev-

eral advantages to the conventional therapies for pa-

tients ranging from musculo-skeletal problems, to

stroke-induced paralysis, or even cognitive deﬁcits. In

fact, there are several documented advantages that en-

dorse VR-based rehabilitation, as stated below (Sucar

et al., 2014; Lafond et al., 2010; Burdea, 2003):

• Signiﬁcant improvement in patients motivation

and engagement with their recovery plan;

• Increased frequency and more repetitions during

exercises;

• Enhanced motor (re)learning by visual stimuli;

• Possibility to provide tele-rehabilitation and re-

quire low clinical supervision (easing home use);

• Ability to track the patient’s recovery progress

over time;

MIST: A Multi-sensory Immersive Stimulation Therapy Sandbox Room

161

3 METHODOLOGY

This section overviews the steps taken during the de-

velopment of our VR MSE room, encompassing re-

quirement deﬁnition, designing and usage of room

components and their actual implementation.

3.1 Design Requirements

Given the necessity of MSE rooms to induce or boost

a desired state in a user while also preserving com-

fort and engagement, these environments must ﬂu-

idly adhere to a set of rules aimed at presenting the

various sensory stimuli in a controlled and adaptive

fashion. As examined by (Collier and Truman, 2008),

a MSE session must consider a patient’s capabilities

and limitations related with attention and executive

functioning in addition to reducing agitation and anx-

iety. In terms of virtual reality, the latter can be ad-

dressed by means of shaping the environment to have

a cozy mind-blanking appearance, contrastingly re-

taining the ability to sustain attention by means of the

stimuli stemming from its components. Envisioning

this, the following design guidelines were considered:

• Rounded conﬁguration with lack of sharp edges;

• Smooth transitions between textures;

• Dim lighting;

• User adaptive surrounds;

These characteristics facilitate isolation of the im-

mersed user from the typical barrage of real world

stimuli humans are continuously exposed to. Subse-

quently, a patient can be progressively presented with

controlled stimuli corresponding to their level of en-

gagement, and their response measured to improve

system adaptability. The general goal is to match in-

dividual needs with the selected MSE demands by ad-

justing perceived complexity.

Of course virtual reality relies heavily on the ex-

posure of stimulus to the visual modality given how

incorporating other sensory factors, such as tactile or

olfactory, would require more complex and indepen-

dent mechanisms. However, auditory stimulation is

also a highly functional option which considerably

enhances the immersive VR experience, besides be-

ing a major element of MSEs. Hence, integrated mu-

sical themes should as well follow some speciﬁca-

tions:

• No abrupt or sudden variations;

• Melodic tones with little noise;

• Ideally correlate with the visual factor;

Another important aspect to consider is the need

for both active and passive interactions to be possi-

ble within the MSE, enabling its use by individuals

who struggle with initiating/maintaining them. Over-

all and considering the deﬁned scenario, the tuning

of speciﬁc components and VR artifacts then stems

from the desired goals of each session. These can be

many and varied, such as stimulating a patient’s fo-

cus to be on a speciﬁc artifact so as to assist them

in countering an attention deﬁcit disorder, for exam-

ple. Or relatedly, provide joint audio-visual stimuli

to help patients link multimodal elements which they

are usually unable to given some neurological condi-

tion. The world of potential applications and corre-

sponding beneﬁts of an MSE extends far beyond their

sensory exploration leisurely use.

3.2 Component Overview

Based on the aforementioned requirements, the pro-

posed virtual environment dynamically modiﬁes it-

self by adapting a series of intervening components

and concepts. Depending on this modiﬁcation pro-

cess, the system may incorporate a subset of all po-

tential components, out of which the most recurring

ones are:

• Shimmering Effect - Shimmering colors, chang-

ing lights and ﬁbre optics which stimulate and

hold attention. It becomes ideal for individuals

with visual disabilities, as their main purpose is to

break through their own personal perceptual bar-

riers.

• Sense of Flow - The soft ﬂow of artifacts in the

room is expected to ease the relaxation process.

While observing their slow chaotic ﬂow through

the wall and around the room, users undergo stim-

ulation of their tracking capabilities. This is es-

sential for people of all ages, specially the ones

with visual processing problems.

• Bubbles/Lava - A highly common component of

MSEs. In relation to the sense of ﬂow, these pro-

vide a multi-sensory feedback and improve the

ability to track motion. Applying constant ef-

fects of color change, rotation, shape morphing

and movement enables perception and cognitive

stimulation.

• Animated Panels - Capable of displaying a

panoply of effects, ranging from inﬁnity to com-

mon physiological illusions to simple perpetual

motion. Accompanied by a relaxing soundtrack,

these provide a leisurely and pleasant sensory ac-

tivity which encourages introspection besides ex-

ploration of the effect.

GRAPP 2020 - 15th International Conference on Computer Graphics Theory and Applications

162

• Adaptive Wall - The whole room envelops a pleas-

ing experience with a focus on the most dominant

theme adequate for the user. This will induce a

sense of isolation and security in the user, so as to

maximize comfort and conﬁdence in the session

and ease handling of sensorial stimulation. For

instance, manipulating the user’s perception to be

just above or surrounded by water, where they can

observe ripple and wave-like effects.

3.3 System Construction

Given how a MSE is composed by many distinct el-

ements, the Blender software was used in order to

fasten the process of 3D modeling most artifacts in-

cluded in the room, following the guidelines pre-

sented above. The ﬁnal model, containing all devel-

oped components as well as the conﬁguration speciﬁ-

cations, is loaded into the Unity game engine. Here,

the adaptive process is implemented so as to perform

the real-time modiﬁcations which follow the men-

tioned requirements and suit the MSE session.

The characteristic of being dynamic and able to re-

spond to the user’s needs comes from the app’s inner

ﬂow, presented in Figure 1. By tracking and monitor-

ing the user’s head movements on a real-time scale,

adequate visual and sound stimuli are produced on

the regarding sensory inputs. Moreover, from this di-

agram, one can see that the main way for users to in-

teract with the MSE room is by rotating their head and

gazing something.

Figure 1: Overall view of the mobile application’s architec-

ture.

Considering the current computational capabilities of

mobile phones nowadays, one can use their own de-

vices as pocket personal VR platforms, able to sup-

port varied applications. The proposed portable ther-

apeutic tool can therefore be used anywhere by a com-

mon person to relax and undergo stimulation, as well

as in rehabilitation and therapy centers by healthcare

professionals to aid in patient treatment. Our de-

veloped mobile app is deployable for both the An-

droid and iOS operating systems, using phone sen-

sors, speciﬁcally the accelerometer and gyroscope, to

track the position and orientation of the user’s head.

Thus, any low-cost head-mounted display (HMD)

with a pair of lenses and cushioning is enough for

displaying the virtual environment according to the

user’s point of view. Considering how auditory stim-

ulation is likewise one of the crucial components of

MSE rooms, the system also expects the user to wear

some type of earphones to beneﬁt from the audio

modality, ideally fully covering headphones. Plus,

this is a requirement if the user intends to enhance

their immersive experience during the usage of the

app.

Our brain deﬁnes reality and what it believes to

be real based on the collected information from our

senses and perception systems. If we replace those

sensory inputs with made-up information (e.g, by us-

ing an HMD and headphones), our perception of re-

ality would change, since we would be confronted

with a version of reality that isn’t really there, but it

would seem real. Therefore, once the users wear the

HMD, they start the transportation process to a new

world by acknowledging the surroundings of the dis-

played virtual scene. As shown in Figure 2, there is

a virtual model that is considered to be a temporary

representation of oneself inside the MSE room. It is

expected for the user to to experience the illusion of

body ownership, and consequently augment the feel-

ing of presence inside the virtual environment (Kilteni

et al., 2012).

Figure 2: Self representation in the virtual environment.

As previously mentioned, the developed MSE is

adaptive to the person’s response in relation with the

presented stimulation. Building on an initially small

feedback, the room aims to amplify a desired response

by means of controlled stimulation, being therefore

able to acquire different shapes and characteristics.

As a showcase of two different and somewhat oppos-

ing possible scenarios the room may manifest, Fig-

ure 3 shows an exemplary darker warm-feeling room

while Figure 4 demonstrates a possible cooling deep

dive room.

MIST: A Multi-sensory Immersive Stimulation Therapy Sandbox Room

163

Figure 3: A warm MSE room.

Figure 4: A cool MSE room.

4 EXPERIMENTAL RESULTS

In order to test and validate the developed MSE, it

was ﬁrst necessary to deﬁne a standard in which users

could experience the room, for later comparison. In

the adopted setting, the user sits comfortably on an

armchair or sofa before launching the mobile applica-

tion, requiring only the mounting of three devices: an

Android or iOS smartphone, a low-cost HMD and a

set of headphones. The overall experimental appara-

tus can be observed in ﬁgure 5, for reference.

Figure 5: User experiencing the MSE room.

The virtual environment and its effectiveness with real

users was analyzed by conducting an initial study with

21 participants, the majority being personnel from the

Department of Electrical and Computer Engineering

at the University of Coimbra. The total amount was

composed of 15 male and 6 female participants, rang-

ing between 11 and 47 years of age. The participant

distribution is shown in Figure 6. These participants

had no previous knowledge concerning the developed

work, simply being willing to volunteer for the ex-

perience and provide feedback on it. In order to as-

sess the environment’s effectiveness as a MSE and

obtain insight on the overall immersive system, vali-

dated and adapted versions of the Positive and Neg-

ative Affect Schedule (PANAS) scales, by (Watson

et al., 1988), and the Igroup Presence Questionnaire

(IPQ), described in (Schubert et al., 2001), were ap-

plied. The PANAS survey was applied twice, for

comparison, whilst the IPQ was given to the partic-

ipants only once.

Figure 6: Distribution os participants in the experiment.

The Positive and Negative Affect Schedule (PANAS)

scales was developed as a self-report questionnaire

with the main purpose of providing an estimation of

the individual’s affective experience regarding a cer-

tain time frame. Hence, it measures two primary di-

mensions of mood, Positive Affect (PA) and Nega-

tive Affect (NA), based on ten internally consistent

items for different time scales (e.g, ”At the moment”

or ”This day”). PA refers to a state where the individ-

ual feels enthusiastic, active or determined, meaning

that lower PA is closely associated with sadness and

lethargy. On the other hand NA reﬂects subjective

distress, being commonly correlated with feelings of

anger, disgust, fear or nervousness. Thus, low NA is

linked with states of calmness and serenity. The Por-

tuguese short-version of PANAS is presented in (Gal-

inha et al., 2014) and was employed as a mean for as-

sessing the emotional state of the participants before

and after the experience.

The Igroup Presence Questionnaire (IPQ) intends

to measure the sense of presence experienced by the

user in a virtual environment. Its current version

aims to subjectively determine three sub-scales (spa-

tial presence, involvement and realness), as well as to

infer a second-order factor (general presence). Spatial

presence refers to the sense of deeply being present in

GRAPP 2020 - 15th International Conference on Computer Graphics Theory and Applications

164

the VE, as if the user was there physically, while in-

volvement measures the attention that the user paid

to it and how embroiled they were during the ex-

perience. Experienced realism or realness aims to

classify how realistic the VE is, while measuring the

corresponding subjective experience. General pres-

ence can be referred to as a global analysis of the

”sense of being there”, and has deep loading on all

the three sub-scales. An adapted and validated Por-

tuguese version of this presence questionnaire, pre-

sented in (Vasconcelos-Raposo et al., 2016), was em-

ployed at the end of the participant’s experience.

The procedure followed during the conduction of

this initial study is described by the steps:

1. Brieﬂy introduce the participant to what he/she is

about to experience and take part of, as well as the

involved technology.

2. Kindly request the participant to answer the Por-

tuguese short-version of PANAS that intends to

assess his/her current emotional state.

3. Aid the participant to place both the HMD and

headphones properly, and let him/her experience

the developed VR MSE room for ﬁve minutes.

4. After this time, the participant is expected to have

been driven to a new emotional state and thus re-

quired to respond the PANAS questionnaire again.

5. In the end, to evaluate the feeling of presence, the

participant is asked to answer the Portuguese val-

idated version of the IPQ questionnaire.

4.1 Sensation Analysis

In order to extract valuable information and assess the

results obtained from the ﬁrst and second PANAS sur-

veys, the SPSS software (IBMCorp, 2017) was em-

ployed. The two iterations were parallelly compared

so as to draw conclusions on the effects of the pro-

posed MSE. The majority of participants reported an

increase in interest and enthusiasm, added to height-

ened inspiration. Concurrently, a decrease in nervous-

ness as well as in determination and activeness was

noted. Some participants mentioned a small degree

of scaredness related with the ocean-like environment

they were placed in (one participant suffers from Tha-

lassophobia

). All in all, participants felt more mo-

tivated and encouraged after performing the experi-

ment, while also becoming more relaxed and com-

fortable. It should be restated that each partaker in the

From Wikipedia – Thalassophobia: An intense and per-

sistent fear of the sea. May include fear of being in large

bodies of water, vast emptiness of the sea, sea waves and/or

distance from land.

experiment was asked to assess a before and after es-

timation of their own levels of each PANAS item sen-

sation, ranging from low (1) to high (5). The PANAS

result progression is presented in Figure 7, where the

initial positive and negative affects are placed next to

their ﬁnal counterparts. As can be observed, there was

an increase in both affects after the experiment.

Figure 7: Panas results in terms of affective progression,

according to Positive Affect (PA) and Negative Affect (NA)

comparisons before and after participant immersion.

4.2 Feeling of Presence

In terms of the results stemming from the IPQ eval-

uation, which were obtained by resorting to SPSS as

well as Excel (Microsoft, 2018), positive conclusions

can be drawn such as the following. In general, par-

ticipants reported being able to prescind themselves

from their real world surroundings, feeling immersed

within and enveloped by the virtual environment. In

addition, the environment was also noted to be ap-

pealing to the participants, differing from common

everyday experiences people are accustomed to. On

the whole, the demonstrated room was perceived as

clearly virtual and easily distinguishable from the real

world, despite presence results being positive. It is

important to reiterate that each participant was asked

to specify their level of agreement with each of the

14 IPQ questionnaire items, ranging from 1 (strongly

disagree) to 5 (strongly agree), via a Likert scale (Lik-

ert, 1932). The IPQ results are visually displayed

in Figure 8, in the form of spatial presence (being

physically present in VR), involvement (user attention

level), realness (VR realism level) and general pres-

ence (overall immersion), as previously described.

In addition to the surveys, partakers were also

asked to answer 4 short questions regarding their

experience. From these it was observed that, even

though 5 of the participants had never before been in

a VR environment, all would appreciate doing one or

more MSE sessions with the presented system. Fur-

MIST: A Multi-sensory Immersive Stimulation Therapy Sandbox Room

165

ther, no volunteer reported any sort of nausea or dis-

orientation from being immersed in the VR room.

Figure 8: IPQ results in terms of Spatial Presence (SP), In-

volvement (I), Experience Realism (ER) and Presence (P).

Cronbach’s Alpha (Cronbach, 1951), a common mea-

sure of result reliability which widely applied in psy-

chometric testing, was also computed for the evalu-

ated questionnaires by means of the SPSS software.

Bearing in mind even higher values may be achieved

by increasing the sample size of test participants, the

computed values were still very acceptable, being in

the 0.7 to 0.8 range. Furthermore, despite the major-

ity of participants being male, no signiﬁcant disparity

was observed between male and female results in both

the pre-test and post-test.

5 DISCUSSION

Considering the experimental results obtained by

comparison of the initial and ﬁnal iterations of the

PANAS survey, it can be inferred that participants

were indeed stimulated, having become more moti-

vated to complete some assigned task thanks to under-

going a short session in the VR MSE room. Moreover

the raised senses of relaxation and peacefulness while

maintaining engagement, observed in the participants

after the experiment, can in fact justify the application

of the proposed MSE as a mental preparatory stage of

therapy as proposed. Plus, it can be concluded that the

developed system is adequate and provides the same

beneﬁts for both men and women. Thus the VR stim-

ulation room’s effect was validated by the obtained

positive results.

Evidently there was a small increase of worry or

apprehension for a group of participants. However,

this group was almost solely made up of young par-

ticipants within the 18-27 age range. When ques-

tioned about the scaredness increase, it was highly

clear how a previous type of experiences related to

thriller video games and ”jump scare” scenarios was

common to all and the culprit of such uneasiness. The

involved participants all stated they felt a sense of

false security and expected something to appear un-

expectedly at some point. This, of course, may be

related with the previously mentioned overstimulat-

ing and stressful society humans live in today which

is causing younger generations to maintain a constant

state of alert. This could also explain the observed

raise in Negative Affect, given the 18-27 age range

contained most of the experiment participants. Nev-

ertheless, we believe better informing the participants

on multi-sensory environments and performing fur-

ther sessions could heavily attenuate this negative fac-

tor for the people who experienced it. Another related

and curious serendipity was caused by one of the par-

ticipants suffering from Thalassophobia, something

which the authors were unaware of before starting the

experiment. Given how the room was majorly a deep

ocean-like environment, the user felt anxious and in-

creasingly worried. Still, the participant ﬁnished the

entire session without stopping and felt entertained by

observing artifacts in the room. This is highly valu-

able as it shows how even patients with some degree

of trauma may beneﬁt from being immersed in a per-

sonally triggering MSE.

Differing but equally interesting interpretations of

the room were described by the participants. Though

the ocean/aquarium theme was common to most, with

an observed ripple effect and ﬂoating/ﬂowing objects,

one compared the presented MSE to a sensory de-

privation room while other felt he was ﬂoating in

heaven. Another participant felt hypnotized by the

room, having lost track of time, while yet a different

one acknowledged to initially feel some nose discom-

fort (stemming from the VR glasses weight) which he

forgot about as his session progressed. Some users

even mentioned feeling the whole room to be rotat-

ing around them, despite this never actually happen-

ing. Lastly, all agreed sound to be a key compo-

nent in their sense of immersiveness, in addition to

the person avatar being present and visible. Consider-

ing these statements and how no interpretation of the

room is particularly correct or incorrect, we can suc-

cessfully assert its effectiveness as a MSE. A feel of

stimulation was blatant in nearly all participants, fol-

lowing exactly what was initially intended to happen.

Undoubtedly the testing carried out is limited. Due

to the fact that the developed MSE was applied on

volunteers only, it would be senseless to extrapolate

the obtained results to patients with diverse mental

pathologies as their reactions might differ from those

of a healthy person. Nevertheless, the results are still

positive and more than sufﬁcient to warrant a second

GRAPP 2020 - 15th International Conference on Computer Graphics Theory and Applications

166

testing phase with actual patients and further improve

the MSE. As such, preparations for such a phase are

underway, ideally aiming for a clinical trial soon.

Finally, after providing valuable insight and eval-

uations during the development phase of the system,

a ﬁnal iteration of this system was presented to and

validated by a clinical psychologist who considered it

to be adequate for its objective, respecting the stated

requirements and being safe and suitable for testing

with people.

6 CONCLUSION

In this paper, we examined the requirements and spec-

iﬁcations of multi-sensory stimulation environments

(MSEs) in order to use these as an alternative to con-

ventional therapy. A virtual reality implementation of

a MSE was produced, able to run on both Android

and iOS, as a platform which can be used without

the need of expensive material and by anyone, includ-

ing healthcare specialists for patient therapy. Follow-

ing its development, the app was made available to

a set of beta testers so as to have its usage and ben-

eﬁts be validated. Based on the analysis of the ob-

tained responses, we were able to demonstrate how

the proposed environment can in fact be beneﬁcial for

leisurely uses, engagement stimulation, and in ther-

apy, in terms of mental preparation for treatments and

by adaptive stimulation of necessary factors. In ad-

dition, insight on the platform was obtained from a

therapist so as to further corroborate its use and im-

prove it later on.

In the future, we aim to introduce the collection

of biometric markers so as to more meticulously ver-

ify patient improvement, and also test the developed

system on real patients ideally through clinical trials.

We further intend to explore the possibility of inte-

grating other modalities besides the visual and au-

ditory. Speciﬁcally tactile factors can be introduced

by incorporating a set of gloves in the system which

can provide haptic feedback for feeling and picking

up objects in VR. Some prototypes of this technology

are already being developed. such as the ones intro-

duced in (Hinchet et al., 2018) and (Perret and Van-

der Poorten, 2018), or the 3D printed Sense Glove de-

veloped by a Dutch company of the same name. Ulti-

mately the goal would be to also provide the user with

textural stimulation, besides the haptical holding feel.

Integration of other modalities such as olfactory and

gustatory are other potential paths of further research.

ACKNOWLEDGEMENTS

The authors would like to thank clinical psycholo-

gist Prof. Dr. Ana Xavier of Oporto Global Uni-

versity (UPT) for guiding the development process

of this implementation with valuable insight and for

validating the obtained results. In addition, our grat-

itude is extended to all participants for their avail-

ability and willingness to partake in our experiment.

This work has been partially supported by OE - Na-

tional funds of FCT/MCTES (PIDDAC) under project

UID/EEA/00048/2019.

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