ID Tech: A Virtual Reality Simulator Training for Teenagers with Intellectual Disabilities

Round 1

Reviewer 1 Report

The article addresses a relevant topic in the field of intervention and support in the field of intellectual disability, since it directly involves people and uses technology as support in learning new skills.

A theoretical argument must be incorporated that justifies the relevance for intellectual disability, it does not mention anything about the current paradigm from the aaidd or support systems, or something that allows to argue why it generates benefits in people with ID.

It is important to describe the choice of the learning-by-doing approach, since it is only mentioned, but does not delve into the use of this approach applied in VR

The description of the simulator is clear and it is seen that it is relevant to the designed scenarios.

Regarding the method, it would be interesting if the workshops and the protocols that were used were described in greater detail, this would be a contribution to be able to replicate the research

A more detailed description of the participants and their characteristics is necessary, inclusion and exclusion criteria, for example, as well as some of the personal characteristics that could be intervening in the success of the intervention.

It is not clear what the real impact is on the life of the users beyond measurements on autonomy (which may be biased and not respond solely to the participation in the experiment).

Regarding the results, they are interesting, I think it is necessary to describe them according to the characteristics of the sample, so it is essential to have greater detail than this, in addition to incorporating sociodemographic variables since we worked with different schools and ages for example.

The limitations of the study and the contributions of the work are determined, highlighting the work carried out with the educators, in addition, the support that is the RV in the learning of people with DID is highlighted.

Author Response

All the authors would like to thank you for your time and your reviews.

More references have been added for the background.

Details are added to describe the protocol and a sequence example has been added in annex.

A more detailed description of the participants , inclusion and exclusion criteria, have been added.

Reviewer 2 Report

why the time between testing is 2 weeks?

what is the using of gaze?

Comments for author File: Comments.pdf

Author Response

The authors would like to thank you for your review.
Both of your comments have been clarified in the revised version:

• The gaze is used as feedback to check whether the students were looking at the vehicles and not just turning their heads mechanically before crossing, for example.
• This choice of two weeks was made for two reasons. First, from an organizational point of view with the institutions.  Secondly, it is necessary to consider the fact that each new sequence of exercises was prepared progressively in order to adapt to the personal learning objectives of each student. Although different basic scenarios were prepared, it was sometimes necessary to combine several of them. 

Reviewer 3 Report

Need to address the Technology novelty factor in the introduction part. Please enhance the relationship between this manuscript and the topic of this special issue in the introduction section.

Overall need to improve references in terms of both quality and quantity.

Consider the following papers for directions.

·        "User experience design in virtual reality medical training application"

·        "Motivating medical students using virtual reality based education"

The methodology is ok. A lot of work has already been done in the following domains

1.      Virtual Reality Simulator Training

2.      Virtual Reality Training Teenagers 2

3.      Virtual Reality with Intellectual Disabilities

Please explore more and cite them as well.

Author Response

All the authors would like to thank you for your reviews.
Concerning the background, we focused on both virtual reality, mobility and ID. More references has been added in introduction and background sections.

Reviewer 4 Report

Thank you for the opportunity to review the manuscript titled, “ID Tech: a Virtual Reality Simulator Training for Teenagers with Intellectual Disabilities”. The paper is interesting but needs some corrections, explanations, and additions. There are some serious issues that the authors need to address before the manuscript can be considered for publication. I have a few recommendations for the authors.

My comments are as follows:

General comments:

1.      Please state whether or not your research was conducted in accordance with the declaration of Helsinki and with the approval of the Bioethics Committee. The consent of the bioethics committee is required- this is research on people with disabilities.

2.      The entire Method: protocol and evaluation section requires completion and additional explanation.

3.      The figures presented in the manuscript are incomprehensible to the reader, as they have not been translated into English.

4.      The references should be improved (only 10 items). French entries should be translated into English in brackets.

5.      From the editorial point of view, the manuscript requires many corrections- among others pay special attention to template remnants, e.g. 206-207, 403-412, 423-425, 441.

Abstract

1.      Line 18: Could authors explain what mean the 3 stars “***”?

Introduction

1.      Could the authors explain why they do not refer to any other studies in this introduction? For example, the ID characteristic is not a definition written by the authors. It seems to me that this should be supported by scientific evidence.

2.      Could Authors specify what is new in this research please?

3.      The aim of the project is not consistent with the methods described.

Aims: The goal of this project is to allow young people (12-20 years old) with ID to learn with a "learning by doing" approach to move in public space in safe conditions by using Virtual Reality (VR).

Therefore, methods should start with Participants (young people with ID and possibly teachers), and be focused on the assessment of the degree of learning. The VR hardware and software itself should be described as equipment.

As an example, the authors can see the article below. Although the article concerns older people, a similar problem is considered there in a similar way.

·         Stephen Uzor and Lynne Baillie. 2019. Recov-R: Evaluation of a Home-Based Tailored Exergame System to Reduce Fall Risk in Seniors. ACM Trans. Comput. Hum. Interact. 26, 4, https://doi.org/10.1145/3325280

4.      Could authors add information that the aim of this study was also analyzing the user experience from the point of view of teachers and educators to use this system?

State of the Art

1.      For a more comprehensive overview, please also add or at least discuss the disadvantages of VR technologies. There are numerous studies showing that often the benefits of virtual reality are surpassed by the limitations due to cyber sickness. Knowing the limitations of a new technology solution shows a deeper understanding of its overall usefulness. Due to the lack of the “other side” of the story, the Introduction comes out somewhat biased.

Conception

Simulator design

1.     Line 109: HTC Vive Pro Eye was used in the research. Could the authors explain why they decided to use this virtual reality headset? Does it have any specific specs? Would it be possible to use another virtual reality headset for this game? Could the authors clarify these issues and include an explanation in the manuscript?

2.     Line 112-114: Figure 1. Texts in gray frames are not readable. Please correct it.

3.     Line 115: Is it possible to translate the parameters shown in figure 2 into English?  It would be clearer to the reader.

Training scenarios

1.      The possible variants of each scenario in the three tables included in Appendix A are completely illegible. Could the authors improve the quality of the tables or change their resolution? Appendix A is a very important element of this study.

Materials and Methods

1.      Could the authors include characteristics of the research group in the methods section? The description should include both groups of young people with intellectual disabilities as well as teachers and educators who commented on the user experience of this system.

Material

1.      Perhaps it would be worthwhile to present the experiment graphically for better understanding.

Method: protocol and evaluation

1.      What were the participation criteria for the study? Perhaps it would be good to give a clear inclusion and exclusion criteria? Please clarify it in the manuscript.

2.      Line 175: Please add the abbreviation of the Single Case Protocol that you use later in the manuscript.

3.      Lines 175-176: Could the actors give an example of one of the sequences and include it in the manuscript as well?

4.      Line 176: “These protocols are based on 10 learning sequences, each consisting of 3 exercises…” Does this mean that during each meeting, which takes place every 2 weeks, the participant performed 3 or 30 exercises?

5.      Lines 180-181: The authors wrote “Each learning sequence lasted between half an hour and an hour took place once every two weeks from November to May.” 

- First, could the authors explain a difference in time? Did it depend on the type of exercise or on the speed at which the participant completed the tasks? If one participant did the exercises in 30 minutes and another participant in 60 minutes, in this case, he needed double time for the same exercise, this could have affected the results.

Could you please clarify this in the manuscript?

- Second, could the authors explain why they decided to do one learning sequence every two weeks? Other studies suggest learning sequences at least once a week. This point should also be justified in the manuscript.

Results

1.      Line 228: Abbreviations used in figure 6 should be explained

2.      Line 268: please change it to 5.3.4 instead 3.4

3.      Line 285: please change it to 5.3.5 instead 3.5

4.      Line 294-296: Due to the fact that figure 8 has not been translated into English, the presented results are completely not clear to the reader. Please correct it.

5.      Line 298: Is it possible to translate the parameters shown in figure 2 into English?  It would be clearer to the reader.

6.      Line 301: please change it to 5.3.6 instead 3.6

7.      Line 304-307: “The test was conducted with 11 adult participants (three men, eight women) with an average age of 36.43 years (±11.84).” This information suggests that another group of participants also took part in the study. Why was this not included in the methods? This information should be completed in the methods section.

8.      The presentation of the data in this form does not make it easy to determine if there were any practical differences in the results. It is suggested that graphs are added. If there are practical results to be highlighted, it may make the results more clear.

Discussion

1.      Definitely, the discussion should be reconstructed. The discussion section should focus on the interpretation of the results and their application in science or real world applications.  The Authors should highlight findings that differ from findings in previous publications and unexpected findings. Are your results consistent with what other investigators have reported? Or are there any differences? Why?

2.      A very large number of limitations may indicate weak evidence from these studies.

Conclusion

1.       Line 387-389: “The aim of this study was to evaluate the students' learning (single-case protocols), the impact of the exercises (self-evaluation), the confidence index of the entourage as well as the user experience from the point of view of teachers and educators to use this system.” This information should be moved to the introduction section and added to the aims. There is no information in the introduction that the study will also take into account the experiences of users from the point of view of teachers and tutors in using this system.

 

2.       Conclusions are not meaningful, the authors do not show quantitative results. The conclusions should answer the aims of the study.

Author Response

All authors thank you for your review. The state of the art part is completed in the revised version.

 

• General: All images have been translated into the revised version and Appendix A is more readable.
• Introduction: the ID definition (with reference) has been added. Additional information is present for the user experience.
• State of the art: This section has been completed
• Design: all remarks have been taken into account
• Material and method: the characteristics of the participants have been clarified. A sample sequence has been added in the appendix. A justification for the two-week period has been added.
• Results: numbering errors have been corrected. The confidence sub-section has been has been removed for consistency with the methodology described.
• Discussion and conclusion: have been revised. The results are mainly interpreted in the Results section.

Reviewer 5 Report

The study is well planned. The base is adequate, the successful methodological design. The conclusions respond to the objectives set and with current references. Its publication is recommended given the aforementioned conditions and the interest of the subject. For all the above, I consider that this work can be published.

Author Response

All authors thank you for your review. The state of the art part is completed in the revised version.

Round 2

Reviewer 1 Report

The article has incorporated the suggestions made. Research is an important contribution to the field of intellectual disability, incorporating technology is an issue that promotes autonomy and fundamental support for people with intellectual disabilities.

If it is necessary to resume in the introduction the support model proposed by the AAIDD, since it is relevant to understand the and offer spaces and opportunities to people with intellectual disabilities.

Author Response

Thank you for your remark, the following description has been adding in the introduction :
"In this article, we discuss intellectual disabilities using the AAIDD model. The person's level of functioning depends on the intensity of the support received in five areas: intellectual abilities, adaptive behavior, participation, health and context. We postulate that virtual reality (VR) can support the youth in the areas of cognitive abilities, adaptive behavior and participation. The other two dimensions of the model are also involved: the use of VR can have an impact on health, and it depends on the opportunities offered by the context. These aspects will be discussed later."

Reviewer 4 Report

Dear Authors,

Thank you for completing and updating your manuscript. Unfortunately is still do not see if your research was conducted in accordance with the declaration of Helsinki and with the approval of the Bioethics Committee. It is necessary that the respective ethical committees granted ethical approvals for this study- this is research on people with disabilities. The document is required. Could the authors provide it?

Author Response

The project has been submitted to the Cantonal Commission for Ethics in Human Research and that each youth and each legal representative has signed a consent form. This cantonal commission adheres to the Helsinki Declaration. 

Do you want us to add an example of consent form in the appendix ?

Round 3

Reviewer 4 Report

Dear Autors,

Thank you for clarifying this matter. It is important to mention this information in the manuscript. I would like to congratulate the authors of an interesting scientific article.