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Title: Usability of a virtual reality environment simulating an automated teller machine for assessing and training persons with acquired brain injury
Authors: Fong, NKK 
Chow, KYY
Chan, BCH
Lam, KCK
Lee, JCK
Yan, EWH
Wong, ATY
Keywords: Brain injuries
Reaction time
Sensitivity and specificity
User-computer interface
Issue Date: 30-Apr-2010
Publisher: BioMed Central Ltd.
Source: Journal of neuroEngineering and rehabilitation, 30 Apr. 2010, 7, 19, p.1-9 How to cite?
Journal: Journal of neuroEngineering and rehabilitation 
Abstract: Objective: This study aimed to examine the usability of a newly designed virtual reality (VR) environment simulating the operation of an automated teller machine (ATM) for assessment and training.
Design: Part I involved evaluation of the sensitivity and specificity of a non-immersive VR program simulating an ATM (VR-ATM). Part II consisted of a clinical trial providing baseline and post-intervention outcome assessments.
Setting: A rehabilitation hospital and university-based teaching facilities were used as the setting.
Participants: A total of 24 persons in the community with acquired brain injury (ABI) - 14 in Part I and 10 in Part II - made up the participants in the study.
Interventions: In Part I, participants were randomized to receive instruction in either an "early" or a "late" VR-ATM program and were assessed using both the VR program and a real ATM. In Part II, participants were assigned in matched pairs to either VR training or computer-assisted instruction (CAI) teaching programs for six 1-hour sessions over a three-week period.
Outcome Measures: Two behavioral checklists based on activity analysis of cash withdrawals and money transfers using a real ATM were used to measure average reaction time, percentage of incorrect responses, level of cues required, and time spent as generated by the VR system; also used was the Neurobehavioral Cognitive Status Examination.
Results: The sensitivity of the VR-ATM was 100% for cash withdrawals and 83.3% for money transfers, and the specificity was 83% and 75%, respectively. For cash withdrawals, the average reaction time of the VR group was significantly shorter than that of the CAI group (p = 0.021). We found no significant differences in average reaction time or accuracy between groups for money transfers, although we did note positive improvement for the VR-ATM group.
Conclusion: We found the VR-ATM to be usable as a valid assessment and training tool for relearning the use of ATMs prior to real-life practice in persons with ABI.
ISSN: 1743-0003
DOI: 10.1186/1743-0003-7-19
Rights: © 2010 Fong et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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