Defining Reality in Dementia VR: Stakeholder Perspectives on Ecological Validity for Functional Activity Training

Paper Title

Defining Reality in Dementia VR: Stakeholder Perspectives on Ecological Validity for Functional Activity Training

Publication Info

• Topic area: Virtual reality design for dementia care, focusing on ecological validity in functional activity training.
• Keywords: Virtual reality, dementia care, ecological validity, IADLs, functional fidelity, caregiver collaboration, rehabilitation, verisimilitude, adaptive systems, person-centered design.

Background and Problem

• Problem / challenge: Existing VR systems for dementia often emphasize visual fidelity and immersion but lack alignment with the functional and cognitive demands of real-world instrumental activities of daily living (IADLs). Ecological validity is inconsistently defined and operationalized, limiting the systems' practical relevance.
• Significance: Supporting IADL practice in PwD can enhance independence, quality of life, and rehabilitation outcomes. VR offers a safe and controlled environment for repeated practice, but its design must reflect the lived realities of PwD and their caregiving ecosystems.
• Motivation and related work: Prior VR systems for PwD focus on recreation or cognitive stimulation rather than functional activities. Rehabilitation-oriented systems often lack stakeholder input and fail to address the relational and adaptive nature of caregiving. Ecological validity has been inconsistently applied, conflating visual fidelity with functional relevance. This paper seeks to clarify and operationalize ecological validity for IADL-based VR.

Solution

• Proposed approach: A stakeholder-informed framework for designing IADL-based VR systems that emphasize functional fidelity, adaptability, and collaborative caregiving dynamics.
• Novelty:
  1. Reframes ecological validity as grounded in functional fidelity and caregiving contexts rather than visual fidelity or immersion.
  2. Highlights the relational and collaborative nature of IADLs in dementia care, integrating caregiver and therapist roles into VR design.
  3. Proposes adaptive VR systems that respond dynamically to PwD’s fluctuating abilities and personal aspirations.
  4. Introduces design implications for culturally and personally meaningful VR experiences.
• Procedure and key techniques:
  • Conducted semi-structured interviews with 11 PwD, 9 caregivers, and 8 occupational therapists (OTs).
  • Used visual probes (sketches and storyboards) to ground discussions in concrete IADL contexts.
  • Applied inductive thematic analysis to identify themes related to realism, usefulness, and ecological validity in VR.

Results

• Concrete findings:
  • Functional fidelity (task sequencing, executive function demands) is more critical than visual fidelity for ecological validity.
  • Meaningful engagement is driven by personal, cultural, and gendered relevance of tasks.
  • Collaborative caregiving dynamics shape IADL participation and must be reflected in VR design.
  • Adaptive VR systems are essential to accommodate fluctuating abilities and support aspirational goals.
• Advantage over baselines: Moves beyond traditional VR systems that prioritize visual replication or cognitive assessment by centering lived routines, caregiving ecosystems, and adaptive functionality.
• Experiments / evaluation:
  • Two-stage interviews with stakeholders using visual probes to explore perceptions of realism and usefulness.
  • Themes identified through thematic analysis, supported by participant quotes and examples.
• Limitations and future work:
  • Lack of a functional VR prototype limits insights into embodied interaction and real-time feedback.
  • Focused on home-dwelling PwD with family caregivers, limiting generalizability to institutional settings or diverse cultural contexts.
  • Predominantly White sample; future work should explore cultural and gendered variations in IADL relevance.
  • Longitudinal studies and co-design processes are needed to refine adaptive features and ecological validity.

Summary

This study investigates how VR can support IADL practice for PwD by emphasizing functional fidelity, meaningful engagement, and caregiving collaboration. It reframes ecological validity as grounded in real-world cognitive and functional demands rather than visual fidelity. Findings highlight the importance of culturally and personally relevant tasks, adaptive systems that respond to fluctuating abilities, and caregiver involvement in VR design. The proposed design implications aim to create VR systems that enhance independence, safety, and quality of life for PwD, while supporting caregivers and therapists in collaborative dementia care.