CODY (Co-design for You): An Immersive Technology Tool for Experiencing and Assessing Home Alterations
CODY (Co-design for You): An Immersive Technology Tool for Experiencing and Assessing Home Alterations
CODY (co-design for you) is a Virtual Reality (VR) tool and Application Programming Interface
 (API) which uses an immersive, interactive environment for using, experiencing and
 co-designing home alterations. The aim of this research is to assess the efficacy of using
 CODY to aid and enhance the ability of adults with Parkinson's disease (PD) to experience and
 choose appropriate home modifications.
Accessible housing is a widespread need in this country. This is particularly true among
 those persons with mobility impairments and movement disorders. While design and construction
 guidebooks exist for modifying homes for people with disabilities, there are also many
 documented instances where a standard, "by-the-book" alteration or assistive technology did
 not support the need or condition of the particular individual it was intended for. Just as
 occupational therapists recognize that a critical component of successful rehabilitation
 assistance is a person-centered plan that facilitates individualized solutions, likewise
 diverse design (or home alterations/modification, referred here as HM) approaches which
 approximate a person-centered plan also provide a more effective fit for persons with
 disabilities. A "one-size-fits-all" approach is not comprehensive for the diverse disability
 community.

 This research entails the design and development of CODY (co-design for you), a Virtual
 Reality (VR) tool and Application Programming Interface (API), which uses an immersive,
 interactive environment for using, experiencing and co-designing home alterations. The
 'co-design' nature of CODY denotes that persons with movement disorders, such as Parkinson's
 disease can: virtually interact with and experience a home alteration/modification (HM) in a
 virtual, simulated environment; have multiple variations of a HM that the user can choose
 from; and is able to assess and manipulate the HM for appropriateness to one's need and
 circumstances before actually installing devices or making modifications to one's own home.
 As such, CODY is a new assistive technology that aids and enhances the ability of individuals
 with disabilities to live in adapted homes that supports their needs.

 This study focuses on movement disorders faced by persons with Parkinson's disease (PD) to
 demonstrate how effective CODY may be for those with major movement challenges, characterized
 by tremor, bradykinesia, postural instability, and freezing of gait (FoG). Collectively,
 these symptoms increase fall risk, fear of falling and impact the quality of life when
 compared to other age-matched non-PD adults. While clinical observations suggest that
 attributes of the physical interior environment may make daily activities easier or harder
 for persons with PD, few studies have actually examined the impact of specific changes in
 interior design on an individual's performance. One research study revealed that FoG, one of
 the major contributors to falls, was induced by doorways. Another study similarly revealed a
 significant increase in doorway-provoked FoG indicators by decreasing doorway width.

 The aims of this research are: (1) To develop the Virtual Reality-based CODY tool and
 corresponding API; and (2) To assess the efficacy of using CODY to aid and enhance the
 ability of persons with PD to experience and choose appropriate home modifications. The
 underlying purpose of CODY is to provide opportunities for the growing population of persons
 with movement disabilities and disorders to actively engage in decisions affecting their
 living environment. Although VR games have been used for rehabilitation and therapy purposes,
 no research studies exist that demonstrate the use or effectiveness of integrated VT
 simulations in allowing persons with disabilities to interactively design residential
 alterations. The study team's expectation is that CODY will not only be successful in this
 short-term pilot study, but will lead to further refinement, development and, potentially, a
 commercial product. The investigators envision CODY's integrated, immersive, and interactive
 simulation will be used by neurologists, rehabilitation specialists, and occupational
 therapists for working with consumers to assess and determine optimal home modifications for
 those with ambulatory and other movement impairments.
Inclusion Criteria: Parkinson's Disease participants

 -  Patients with a mild-to-moderate diagnosis of PD, evaluated using the Unified
 Parkinson's Disease Rating Scale (UPDRS) and the Modified Hoehn and Yahr stages I-III,
 by a fellowship trained neurologist, arriving at the diagnosis by applying strict UK
 Brain Bank criteria

 -  Disease duration is less than 5 years

 -  With phone area code of 352; 904

 -  Currently on their medications Inclusion Criteria: Healthy participants

 -  Individuals who indicated they would like to be contacted for future research
 opportunities.

 -  Age-matched (+ or - 5 years) healthy participants without PD

 -  No history of neurological or orthopedic problems that could impair walking function
 or upper extremity mobility

 Exclusion Criteria:

 -  Individuals with atypical features of PD, peripheral neuropathy, vestibular
 dysfunction, and medications affecting balance or alertness/ attention

 -  Individuals with the presence of active unstable medical, diabetes, or any orthopedic
 conditions

 -  Individuals who have previously undergone any brain surgeries

 -  Individuals who take any anti-psychotic medications

 -  Individuals with dementia as reflected by performance on the Mini-Mental State
 Examination (MMSE) (score < 24)

 -  Individuals with elevated scores on the Beck Depression Inventory-II (I.E., ≥20), the
 recommended cut-off for depressive symptoms in PD by the task force for the Movement
 Disorders Society or history of severe pre-existing psychiatric difficulties (i.e.,
 schizophrenia)