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.
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!
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.
Although the official timeline and AHRC funding for Tangible Memories has now drawn to a close, many of the team are still busy working with our Story Creator app in care homes, sharing our research through conferences and publications, and applying for funding to progress our work with older people, well-being and technology.
We are thrilled to share news that we have been awarded funding from University of Bristol’s Brigstow Institute to develop the Soundscape rocking chair and explore the use of technology in bringing the benefits of nature into healthcare settings.
Some of the research questions that we will be asking include: Can technology and/or nature enhance well-being while a person, relative or carer is in hospital, visiting hospital, or in long-term care? If so, how? What are the differences between experience of real world nature and a digitally mediated experience of nature? Which is more beneficial in a healthcare setting? What sound would you miss, if you could no longer hear it?
Following on from our pop-up exhibition of audio stories, produced from our winter visit to the MShed (see Memories and Museums) we have been developing another auditory experience using chairs, and inspiration drawn from venturing outdoors. Here I introduce the concept of a therapeutic rocking chair for older people with dementia.
Early on in the Tangible Memories project, we recognised that access to the outdoors, and specifically to the natural world, was very limited for many care home residents, often due to a decline in their physical mobility, or particularly if they were suffering from the more advanced stages of dementia. Equally, when we asked ourselves as a team, ‘what would we want in a care home of the future?’, we identified the simple routine of being able to go outside and experience the elements as something that would be of great importance to us all.
So throughout the project, we have been seeking different ways to incorporate aspects of life outside the care home environment into our technologies and prototypes, for those who are not able to venture out independently, or as often as they might like.
To begin with, we explored virtual travel using the Oculus Rift VR headset (see Virtual Reality Storytelling), with 360˚ stitched photographs of local places and museums:
We also offered VR experiences using moving imagery, sending residents to a virtual Tuscan villa, up in a hot air balloon, and even into the solar system on an animated space journey. Closer to home, we had previously recorded a kind of video postcard that reflects on the beauty of springtime in the countryside:
In this short film, as we focused on the many calming and uplifting effects of nature, such as birdsong or the sound of a river, we felt that adopting such a therapeutic approach would be particularly beneficial to residents living in the specialist dementia care home. Anxiety, agitation and memory loss are recurring symptoms of advanced dementia, so rather than placing the onus on an individual to remember past realities, we wondered whether it would prove more positive to provide an evocative soundscape of the natural world, without visual stimuli, where a person’s imagination could wander freely, and enjoy fact or fiction, in a peaceful listening experience.
With this in mind, the concept of a therapeutic rocking chair evolved, and was partly in response to Pete Bennett’s brilliant Resonant Bits harmonic user interface. This app triggers sound content on an iPhone or an iPad using a kind of rocking movement from simple subtle gestures and a slow meditative motion response. In his research, Pete asks:
How can interfaces support slow and meditative interaction in a fast paced world? How would it feel to be able to ‘tune in’ and interact directly with digital ‘bits’ of data?
Thinking about the meditative field recordings that I had already captured from nature, and wanting to combine these with Pete’s app to create a calming user experience and interaction, the traditional rocking chair seemed like an appropriate medium for a therapeutic listening experience, simply by embedding some speakers in the headrests. Rocking chairs can be a familiar item of furniture for many older people, the type of chair which provides an opportunity to dwell, ponder and relax, with its motion considered to be very comforting. (Perhaps why babies and young children are typically rocked to sleep).
In essence, this therapeutic rocking chair would play calming, comforting sound content triggered by the rocking motion. The soundscapes of nature, poetry or music would fade away and change track as the rocking motion stops and starts again, making the interaction as simple and intuitive as possible. (The chair would be silent when it was not moving). Here’s a quick demo, using just the app on an iPhone:
The rocking chair would offer this spontaneous and relaxing listening experience through hidden stereo speakers in the headrests, connected to the Harmonic User Interface app on an iPhone.
Alongside this concept development, what a bonus it was to discover a medical study published in the American Journal of Alzheimer’s Disease and other dementias which cites the psychosocial and physical benefits for dementia patients who regularly rock in a platform rocking chair:
The US study used traditional platform rocking chairs and their rocking motion alone as a form of therapy, which researchers found could improve balance, muscle tone, emotional well-being, and resulted in a reduction in the number of requests for medication to treat aches and pains in the majority of older people they tested.
If such results could be achieved with support and persistence, using a traditional piece of furniture, what more might we be able to offer residents by embedding therapeutic sounds triggered by the rocking motion? One of our key aims on the Tangible Memories project is to develop assistive technologies that enhance the social, personal and emotional well-being of older people, in addition to addressing their physical needs.
So I set to work, hacking an existing platform rocking chair in order to integrate stereo speakers into the headrests and create a quick iteration of our initial prototype so we could test the idea and get it working:
The next step required uploading an adapted version of Pete’s Harmonic User Interface app (currently called ‘SoundChair’) to my iPhone and then adding the sound content via iTunes.
The app can play any m4a, mp3 or aac file which is triggered by the rocking movement.
In addition to the sounds of nature, I’ve added other content known to be beneficial for dementia patients, which includes the rhythmic repetition of poetry, as well as classical music. Here are a few examples to give a flavour:
‘Sailing By’, Radio 4 shipping forecast theme:
The sound of waves on the seashore:
‘The Daffodils’ by William Wordsworth:
Next, the speakers were crudely connected to a battery power pack and my iPhone….
We played around with using the Oculus Rift today as a means for creating a virtual space for storytelling. Our first two testers M & B both enjoyed the experience. We firstly tried out stepping into a 3D snapshot of the Bristol Museum Foyer, and then took a trip up Cabot Tower. M had a look around a virtual Tuscan Villa whilst B opted for a whistle-stop tour of the Solar System. The next step is to customise the virtual scenes and introduce the possibility of handling objects relevant to the scene during the experience. An interesting finding was that binaural audio recordings played at the same time proved to be a distraction from the visual material.