This pilot project, which builds on the Objects of Escape initiated during Tangible Memories, explores the therapeutic potential of cutting-edge technologies, to bring nature and natural environments into healthcare settings to enhance well-being.
Using sound and image archives from the BBC Natural History Unit, we are exploring multi-sensory and immersive experiences, such as Virtual Reality, tactile ‘Mutual Instruments’ and a rocking chair that transports the sitter to the natural world through evocative soundscapes.
This collaborative project is working alongside healthcare practitioners, families, and teenage and young adult patients at the Bristol Oncology Centre, and older people living with dementia, and their families and carers at Brunelcare’s Deerhurst home.
Helen Manchester (Social Scientist)
Kirsten Cater (Computer Scientist)
Heidi Hinder (Artist, Designer, Maker)
Steve Symons (Creative technologist and sculptor)
Esther Ingram (Archives Manager, BBC Natural History Unit)
Ailish Heneberry (Commercial and Business Manager, BBC Natural History Unit)
Sam Hume (Producer, BBC Natural History Unit)
Joe Hope (Researcher, BBC Natural History Unit)
Lesley Hobbs (Manager, Deerhurst care home)
Jamie Cargill (Lead Nurse, Teenage Cancer Trust, Teenager and Young Adults cancer service South West)
Fran Hardman (Well-being co-ordinator, Teenage Cancer Trust)
Hannah Lind (Youth Support Co-ordinator, Teenage Cancer Trust)
There has been a great sense of expectation on the Teenage and Young Adult cancer ward at the Bristol Oncology Centre, surrounding the start of our Virtual Reality trials in partnership with the BBC Natural History Unit. We have been working with Esther Ingram, Archives Project Manager, to share some of the BBC’s phenomenal natural history programming in this new context, with a new audience. Together, we are keen to find out if bringing nature into the TYA cancer ward through technology such as Virtual Reality (VR) can help to improve patients’ and supporters’ well-being during long-term hospital stays.
A group of 30 patients, relatives, friends and staff gathered over a two day period, to take part and try out the 360° immersive virtual reality experiences, often for the first time, or simply to watch these sessions in action.
There were a variety of technologies and films on offer, including the HTC Vive headset with bluetooth sensors and hand controllers for a more physically active VR experience. This was set up in the social space of the Chat Room to give people the chance to move and walk around in their virtual worlds.
Once this tech was rigged up, which takes about an hour, the VR experiences were ready to play. Patients could choose whether they wanted to immerse themselves underwater and visit a coral reef or a shipwreck, watch a Blue Whale swim past, or try and touch virtual jellyfish. These particular VR films are freely available online (cost-effective for charities like the Teenage Cancer Trust, should they wish to access them in future), and have been produced using computer generated imagery. Our teams are interested in the difference between people’s perception of ‘real’ nature (as filmed by the BBC) and digitally mediated nature through these CGI animations (produced by WEVR). Which is more effective in this context?Does it make any difference?
As we compared and contrasted versions of nature and VR, and interviewed participants about their experiences, all the volunteers became fully immersed in their virtual landscapes:
Alongside the more complex, expensive and physical HTC Vive VR kit, the BBC team set up an alternative using the Samsung Gear. This has the advantage of being completely portable, requiring only the virtual reality headset, headphones and a smart phone. As a result, we were able to share these VR experiences with patients who were unable to join in the communal Chat Room session while they were currently bed-bound and isolated in their bedrooms.
On the second day of our VR trial, the Samsung Gear headset was on offer again to the wider group and included a selection of quieter, more therapeutic nature films in VR. There was a sub-aqua diving experience in the tropical waters of Costa Rica, a jungle documentary, a 360° woodland dawn chorus and an immersive guided tour of a pre-historic dinosaur presented by David Attenborough, each lasting about five minutes. Although it’s not possible to experience virtual reality without the appropriate technology, here’s a hint of what people were watching:
Here is some of the patients’ and supporters’ feedback from their first experiences of Virtual Reality:
‘I can see [VR] being something that if you’re stressed or anxious, just pop this on and get away, to feel like you’re somewhere else – that would be when I would use it. I think that would be quite a good thing to do’. (Holly, patient)
‘I didn’t really know what to expect, then when I put it on, I was like, whoa! I’m under the sea!’ (Laura, patient)
‘You do lose yourself. You definitely lose yourself. Which is important being on this ward, and going through what the kids have got to go through. … To be honest, it just enables you to get away from this clinical environment which is paramount.’ (Suzie, parent)
‘I could just zone out completely and watch [VR] for a good hour or two or something like that. It’s so good, it’s amazing. … I’m well into it! I am ridiculously stressed out and anxious, so this has been really helpful. … This has real helped today. I’ve been mad stressed all day … so this has been real good to come and just chill out for a bit. So yeah, thank you.’ (Matt, patient)
After such positive responses, we look forward to continuing our valuable collaboration with the Teenage and Young Adult cancer service, the Teenage Cancer Trust, and the BBC Natural History Unit, for the well-being and benefit of those in long-term hospital care.
During the second day of our rocking chair trial at Deerhurst, we were also testing out a new handheld prototype, developed by creative technologist and sculptor Steve Symons. This wooden prototype plays nature sounds and music when it is picked up, tapped, shaken, smoothed and generally explored through touch. The top surface is embedded with pebbles and pieces of wood and conceals the network of electronics and programming that is hidden inside. Underneath, on the base of the prototype is a discreet speaker.
One of the first participants to visit us in the Garden Room this morning was a resident who is new to Deerhurst and just settling in. Betty was a very jovial character who really enjoyed shaking the handheld prototype and touching the different textures of embedded stone and wood. On contact with her hands and triggered by the movement, the sound of seagulls started squawking at Betty. She laughed and joked that the birds must be hungry ‘because we were mean and had forgotten to feed them!’
When Betty tried out the rocking chair for the first time, she put her head back, closed her eyes and started singing along to one of the songs that she recognized. She reminisced about her parents as she listened to the poems and nature sounds, and described her experience in the rocking chair as ‘lovely, very moving’ and commented that she ‘could stay here all day’.
Joyce was the only repeat resident who had tried out the rocking chair on my previous visit. On the first test day, Joyce had been upset and in tears before sitting in the chair, but after listening to the audio and rocking, she became very calm and left smiling, and generally seeming much happier. Today she closed her eyes and nodded off to sleep for most of the session.
Joyce’s goddaughter Beverly was visiting today and suggested that it would be good to have the option of an automated rocking feature on future versions of the chair, as she felt that Joyce’s condition and stage of dementia would mean that Joyce would forget to rock. Beverly also tried out the chair, finding it very comfortable and when asked about her preferred audio content, she said that she would choose to listen to poetry and short stories.
During the course of this short pilot study, thirteen different people have tested the rocking chair at Deerhurst, including care staff and family, as well as residents. We hope to secure further funding next year, in order to develop these prototypes and explore, in greater depth, the benefits of nature on well-being in dementia care.
For the first time today, we are testing out the soundscape interactive rocking chair at Deerhurst, following our successful trials at Westbury Fields during the Tangible Memories project. We have six residents, relatives and staff who are all looking forward to sitting, rocking, listening and imagining, for a half hour relaxation session in the Garden Room.
As a recap, to summarise this tech-embedded piece of furniture, here is our poster from the recent Computer-Human Interaction conference in San Jose:
Designed for older people living with the advanced stages of dementia, the rocking chair plays sounds from the natural world, nature-themed poetry and music through speakers embedded in the headrest. The audio is triggered by the rocking motion of the chair, so the sitter doesn’t have to learn or remember an interaction. If the chair stops rocking, then the poems, music or nature sounds gradually fade away to quiet. The sound content plays at random, removing the onus of choice from the individual, and the associated anxiety and frustration of sometimes not being able to recall personal preferences.
Our first participant today was assisted into the rocking chair from a wheelchair, with the help of care staff and a hoist. As she listened to sounds of the dawn chorus and waves on the seashore, she asked me what was causing the rocking movement of the chair. When I told her that it was her legs, pushing herself back and forth in the chair, she was surprised but very pleased – she told me that she can’t walk. While we have largely focused on the emotional and well-being effects of the rocking chair, it seems we have underestimated the potential physical benefits as well!
There were two other highlight responses from today as well as this significant start. A lady called Thelma had felt very agitated and anxious before she joined us in the Garden Room to try out the rocking chair. By the time she left to go to lunch, she was smiling and happy, and seemed very uplifted by her experience.
Thelma said she loved the music the most (more than the poetry or nature sounds), and she rocked in time with the rhythm of the music that she was listening to. She told me that she didn’t want the music to finish and at the end, repeatedly commented on how ‘that was so lovely’ and thanked me so much for the experience. She was moved to tears, telling me ‘oh, I could cry, that was just lovely’. Bidding goodbye, Thelma shook my hands in both of hers and kissed the back of my hand as she thanked me again.
Another instance that seemed to illustrate the uplifting effects of the chair, was demonstrated by a lady called Joyce who joined us in the Garden Room in tears and was very sad and upset at the start. After sitting in the rocking chair, listening to birdsong, and to Vivaldi’s Four Seasons, Joyce began to relax and started chatting to me (about music, her father, and how she liked instruments). She recognized Wordworth’s Daffodils poem and quoted some lines from it as she was listening. She was able to sing along with several lines of ‘Let There Be Love’. She left the session seeming much happier than she was at the beginning.
Here at Deerhurst, like at the Oncology Centre, I also shared a selection of natural objects with the residents, to see which items they were drawn to pick up and handle for the different tactile qualities.
This feedback will contribute to artist Steve Symons’ decision-making with regards to which materials he will use to design and produce a handheld interactive prototype for residents to pick up and play.
From this box of objects, Joyce chose the rubber, the bamboo spoon and the silver birch birdcall whistle. With the spoon and the birch-whistle in hand, Joyce enjoyed tapping these two pieces of wood together, in time to the music she was listening to while rocking in the chair.
As well as the many positive and encouraging responses from today’s participants, it was equally useful to observe aspects of the chair and app design that will need to improve in future developments of this initial prototype. For example, Thelma found it difficult to hear many of the softer nature sounds such as the cat purring, the sound of waves on the seashore or the crickets singing. It might be that this range of sounds is too subtle for those who are hard of hearing and, in future, we could reduce the number of these types of tracks – although some people do find them relaxing and calming, as these particular sounds have a similar effect to white noise, and they seem to help people fall asleep. Volume is also an issue. Residents have very different levels of hearing and the volume needs to be adjusted for each individual, then sometimes adjusted again within each track as a piece of music will suddenly get louder or dwindle away to a volume where people think it has stopped, if they can no longer hear it.
Overall, this first day of testing the rocking chair at Deerhurst was a very valuable experience. Each of the participants seemed to gain something positive from sitting in the chair, ranging from a restful sleep to a noticeable transition from agitation to calm, from sadness to happiness.
We look forward to returning to Deerhurst again next month and hope that we will once more see residents enjoying a sense of well-being provided by the rocking chair.
Today we facilitated a session called ‘Co-design and cake’ on the Teenage and Young Adult ward at the Bristol Oncology Centre.
With the support of the Teenage Cancer Trust’s Well-being Co-ordinator and Youth Support Co-ordinator, we gathered together as a group of patients, relatives and friends, in the bright environment of the ward’s Chat Room to enjoy afternoon tea. This was a chance for me to introduce myself and the project, and find out what the participants might think would benefit them during their hospital treatment, and what they would like to try out over the course of this pilot.
Nature is already well represented on the ward, and patients are provided with options for a range of activities when they’re feeling well enough. The Chat Room, where we were meeting, is a large, open plan communal space, with a kitchen area, table football, sofas, board games, pool table and a jukebox:
As shown in the photo above, along the main wall of The Chat Room there is a beautiful woodland frieze. These outdoor scenes also create a peaceful backdrop to the reception area, the seclusion of The Snug (for reading and quiet solitude), and the Games Room (complete with Smart TV, Xbox consoles, and a film library of DVDs):
Elsewhere on the ward, there is a well-being room with mood lighting and a therapies couch for reflexology. The ward staff had previously highlighted to our project team, the well-being needs of visiting families and supporters, alongside the needs of patients themselves. Staff had talked about ‘occupational loss’ – referring to how parents, relatives and supporters would normally be spending their time, if they weren’t at the hospital. This occupational loss could quite literally be a loss of work, but also missed time with other children and family members, or the loss of holidays and so forth.
So the key research questions from staff on the TYA ward for our exploratory pilot study include these points:
Will the outcome be something that supporters could use, as well as patients? (For example, a recent reflexology trial, set up by the Teenage Cancer Trust, was found to benefit carers and family members almost more than the patients).
Can the project outcomes improve people’s experience during treatment?
The Well-being Co-ordinator recognised that it is difficult for patients to spend time out of their bedrooms for lots of reasons, but she felt there was a need to offer patients something else to do, other than to sit (or lie down) in the seclusion of their bedrooms, and in addition to the variety of activities already available. With this in mind, we decided that portability was an essential feature for any prototypes, alongside careful consideration and medical guidance regarding infection control.
Back with the group of patients and their supporters in The Chat Room, I introduced a series of questions to initiate our discussions around nature and technology, assisted by a collection of natural objects and materials, and a large selection of nature-themed images to serve as conversational prompts. Here is just a small selection of the objects and images shared today:
Interestingly, almost as soon as the group began to talk about nature, they also started referring to the smells, sounds and other sensory aspects of being outdoors. Nearly all of the participants said that they experience nature most frequently through some kind of activity, such as walking, swimming, kayaking, sailing or sightseeing.
When asked the question, ‘Which natural world environment would you transport yourself to, if you could go anywhere?’ these were some of the group’s responses:
Desert – for the warmth (feeling relaxed in the heat)
Beach – going swimming, walking barefoot on the sand and paddling in the shallows (which was forbidden during treatment for one of the patients)
Woods – ideally a combination of forests, hills, meadows and freshwater lakes
Waterfalls and running rivers – a Canadian mountain landscape
Norway – snow, water, fjords, green landscape, peaceful, spellbinding environments with a chance to see the Northern Lights
With such a variety of choices for contrasting terrain, one of the patient’s fathers suggested that whatever nature and technology experiences we offer, these must be bespoke and personalised, as people’s opinions and preferences are always so individual.
The concept of nature as a means of ‘getting away from it all’ and as a form of escapism appealed to the whole group. One patient described how ‘the one thing you want when you are stressed and intimidated by all the hospital treatments and procedures, is to take your mind away from the present, so the escapism of Virtual Reality sounds very appealing’.
In discussing potential technologies, everyone in the group had said they were excited about the idea of experiencing Virtual Reality, while no one had yet had the chance to try it before…
So compelled by this really useful session, we look forward to returning to the ward in a couple of weeks time, when we will be able to offer the participants some immersive digital experiences of nature, and find out what they think of VR – in reality!
We are delighted to be working with Brunelcare, renowned South West regional care provider for older people, and today we had the pleasure of our first visit to Deerhurst in Bristol to meet with the manager and have a tour of the home.
As the photos below illustrate, this is a vibrant place to live, offering lots of stimulation for those living with advanced dementia, and a busy programme of activities including gardening, swimming, singing, music – and even the occasional ‘Deerhurst’s got talent’ contest!
The manager recommended the quiet Garden Room as the best place to install the Soundscape rocking chair, and had even arranged for some astroturf to be fitted instead of carpet, to help evoke the sense of being outside:
It makes such a difference to be collaborating with such enthusiastic partners and we look forward to working towards a satisfying outcome for all.
As this pilot research phase begins, we will be building on some of the therapeutic prototypes that we developed under the AHRC-funded Tangible Memories project, and are looking forward to exploring ways of ‘bringing the outside in’ for people who have limited access to nature for protracted periods of time.
For some of the groups we will be working with, this lack of opportunity to experience the natural environment or simply go outside, will be a symptom of low immunity during cancer treatment and long-term hospital stays, with patients sometimes needing to remain in isolation for six weeks at a time.
For others, an age-related deterioration in mobility and cognition, and the disorientating effects of advanced dementia will restrict experiences of the natural world.
Nature is widely acknowledged to have restorative and therapeutic effects, so how then might it be incorporated into these healthcare settings to benefit and improve well-being, for those who can’t physically access or enjoy the reality of it?
This is just one of the many questions that our multi-disciplinary team will be researching over the next six months, as we collaborate with the Teenage and Young Adult ward at the Bristol Oncology Centre, the Teenage Cancer Trust and a Brunelcare home for older people in east Bristol.
We will be exploring the potential of virtual reality for the teenage and young adult cancer patients at the Oncology Centre, offering 360°immersive experiences of nature through specially produced film and sound content.
At the residential care home, we will mainly develop the use of the Soundscape rocking chair, which can transport the individual to a natural environment by evoking the imagination, using atmospheric sounds and audio. The rocking motion of the chair triggers sound recordings from nature, such as the dawn chorus, waves on the seashore, or walking on snow, and plays these soundtracks through stereo speakers embedded in the chair’s headrest. Other nature-themed content which the rocking chair plays at random, includes poetry like Wordworth’s Daffodils, and classical music such as The Lark Ascending by Vaughan Williams.
In both settings, we will experiment with natural materials and digital technologies to develop multi-sensory sound-emitting objects.
So where better to find nature in all its multifarious forms, other than outdoors? Surely very few representations of nature can surpass the sound, film and image archives of one of our project partners, in the BBC Natural History Unit. As a starting point for our research, I had the great pleasure of exploring some of these awe-inspiring collections, and meeting some of the archive and digital production teams for the first time, to progress some ideas about how best to begin.
I was given an exhilarating taster of some of the virtual reality films available, using both the HTC Vive headset and the more portable Samsung Gear VR. With the help of some sophisticated 360°film-making, I took a virtual trip to the Kashmiri mountains and enjoyed an underwater dive off the coast of Costa Rica. Here’s me getting very involved in one of these immersive experiences!
Afterwards I was introduced to the BBC’s digital sound library, and was struck by the sheer volume and diversity of these audio archives. In this extensive and absorbing sound store, any generic searches quickly proved pointless. For example, I needed to specify whether the sound of a storm that I was looking for, was specifically a sandstorm, snowstorm, thunderstorm, tropical storm, monsoon, hurricane or other kind of environmental maelstrom. Type ‘dawn chorus’ into the online search box, and initially, most people would expect birdsong. But dawn chorus in the rainforest includes gibbons, frogs, insects and the sound of dripping water. Dawn chorus on Talan Island however, on the Sea of Okhotsk in Russia, sounded a deafening mass colony of crested auklets.
As well as the atmospheric audio, the brief descriptions of these sound recordings conjured up equally vivid scenes:
‘Whistling wind in the harbour, with some rattling of ships rigging’ ‘Large flock of Greater Snow Geese flying overhead on the Delmarva Peninsula, Virginia’ .
These poetic snippets and their accompanying sound files gave me ideas about curating an aural story or journey for the rocking chair.
But what about unsettling and disturbing nature sounds? What about ‘European Wolves howling, ravens picking at carcass; growling, snarling, chewing and crunching bones’? Or presumably, the irritation caused by listening to a ‘High pitched whine from a swarm of brine flies’?
The BBC Archives Manager and I had an interesting conversation about our objectives for the project. In a healthcare setting, where we are seeking to improve patients’ and residents’ sense of well-being, should we only include nature content that would be considered relaxing and therapeutic? Inevitably, what is defined as relaxing and therapeutic, is also highly subjective, even cultural.
Thanks to the benefits of working in collaboration, we will be better able to address some of these questions once we start working alongside the staff and young people at the Oncology Centre, and the carers and older people at Deerhurst, in order to co-design some prototypes and experiences that they want to use and enjoy.