Development of a VR Head-mounted Display Strap Modification for Use by Individuals with a Cochlear Implant

Abstract

Virtual reality (VR) continues to revolutionize how people work, play, and socialize. Even with new VR systems released regularly, VR hardware can still be inaccessible to many, especially people with disabilities. While researching VR accessibility barriers for older adults, we discovered that the Meta Quest 2 VR head-mounted display (HMD) does not allow for a person with a cochlear implant to wear both simultaneously. This inaccessibility is due to the cochlear implant being surgically implanted along the path of the HMD strap. To increase VR accessibility for individuals with a cochlear implant, we designed, developed, and tested a 3D-printed HMD strap modification that supports wearing both a VR HMD and a cochlear implant. This work illustrates that small, simple modifications can significantly increase the accessibility of VR system hardware for people with disabilities.

Keywords

Virtual Reality Accessibility Head-mounted Display Cochlear Implant

Introduction

Virtual reality (VR) has transformed how individuals work and play. While modern VR could still be considered an emerging technology (Mott et al., 2019), we argue that the upsurge of usage in the workplace (PwC, 2019) demonstrates that VR is increasingly becoming more mainstream. However, VR technology still has an accessibility problem (Phillips, 2020). While multiple researchers are investigating VR accessibility (Gluck et al., 2021; Mirzaei et al., 2020; Mott et al., 2020; Zhao et al., 2019), there is still a long way to go before VR can claim it is accessible for everyone.

In a recent VR study for older adults, we found that the Meta Quest 2 HMD (Meta, 2023) cannot be worn simultaneously with an implanted cochlear hearing device. The path of the HMD strap goes directly across the cochlear’s implantation site. Therefore, without modifying the VR hardware, a person with a cochlear implant cannot wear their hearing device while wearing the HMD.

This paper discusses designing, developing, and testing a 3D-printed HMD strap modification that redirects the HMD strap to allow for a cochlear implant and a commercial-off-the-shelf (COTS) HMD to be worn simultaneously, thus increasing VR hardware accessibility.

Related Work

Cochlear Implant

Cochlear implants are an assistive technology designed to replace the function of the inner ear hair cells with electrical signals to allow people who are deaf or hard of hearing to hear via the implanted device (Lenarz, 2017; Rauterkus et al., 2022). Surgeons use a transmastoid procedure to insert the cochlear implant electrode from the middle ear to the inner ear. This placement stimulates hearing nerves, differentiating sound signals when transmitted to the neurons (Lenarz, 2017). While cochlear implant technology continues to evolve, placement is essential to how they work and will most likely not be changed (O’Connell et al., 2016).

Cochlear implants were first approved for human implantation in 1984 (Rauterkus et al., 2022). At the start of 2020, nearly 750,000 cochlear implants have been implanted worldwide, with approximately 185,000 implants done in the United States (Megerian et al., 2022). Over the last four decades, the technology has improved and evolved to restore the hearing preferences of the hard-of-hearing community (Hainarosie et al., 2014; Rauterkus et al., 2022). Studies have found increased academic performance and literacy in children who are deaf before learning languages (Sarant et al., 2015). The intervention of this technology early on is changing how the hard-of-hearing community grows into adulthood. Additionally, the cochlear implant assistive technology can increase the quality of life for adults (Rauterkus et al., 2022).

Accessible VR Hardware

COTS VR systems have been produced by various manufacturers and have gone through multiple iterations since the release of the Oculus Rift in 2016 (Hamad & Jia, 2022; VR Space, LLC, 2022). While many individuals with disabilities believe they will never access or experience VR (Andrade et al., 2019; Mott et al., 2020), there have been some positive accessibility trends for VR hardware. Many COTS HMDs allow users to set the interpupillary distance via adjustable lenses and include spacers for wearing glasses with the HMD (Mott et al., 2019).

Researchers are also investigating VR add-on hardware for people with disabilities. For people with visual impairments, virtual white canes have been explored (Siu et al., 2020; Zhao et al., 2018). Additionally, for people with mobility impairments, motion platforms for wheelchairs have been studied (Brachtendorf et al., 2020; Richir et al., 2015).

While COTS VR systems have thus far implemented adjustable lenses and eyeglass spacers, these are hopefully the first of many VR accessibility feature implementations.

3D Printing for Accessibility

As 3D printers decrease in price and become easier to use, more individuals gain access to the technology (Petersen & Pearce, 2017). The increased access to 3D printers has led many to explore the creation of accessible technologies using 3D printing technology. In 2012, Ivan Owen and Richard Van As used a 3D printer to print the first 3D-printed prosthetic device (Manero et al., 2019). Since then, individuals and students have developed low-cost prosthetics using 3D printing technologies (Kellam et al., 2019; Zuniga et al., 2015) and donated to those in need. However, prosthetic devices are not the only use 3D printing technology for accessibility.

Among other things, 3D printing has provided an accessible technology for people who are blind to interact with artwork (Knochel et al., 2018; Shin et al., 2020), an easy way to attach items to a wheelchair (Syed, 2021), a way to create accessible learning aids (Buehler et al., 2014), and tactile maps (Auricchio et al., 2017; Shi et al., 2020). In 2019, emerging technology librarians at the University of Oklahoma investigated modifying VR controllers with 3D-printed modifications to provide access for people with limited mobility (Clark & Lischer, 2020). These studies demonstrate that the development of accessible technologies can be conducted through 3D printing technologies, benefiting people with disabilities and impairments.

Methodology

We conducted participatory design sessions with nine older adult participants to develop potential HMD strap modification solutions. The solutions were then 3D-printed and presented to an expert co-designer for final modification design and iteration. The final prototype was then tested for ease of installation by 13 older adult participants.

Participant Recruitment

The co-designer and all participants were recruited as part of a more extensive research study on VR accessibility for older adults. Initial recruitment was conducted via email through a third-party affiliate associated with a retirement community in upstate South Carolina. Those 65 years of age or older were invited to participate. The Institutional Review Board of the authors’ university approved these studies.

Participant Description

Nine older adult participants participated in the participatory design (PD) sessions (4 female, 5 male, mean age of 83.3 years, range = 70 to 92 years old). One older adult with a cochlear implant was recruited as a co-designer (male, 90 years old). Finally, 13 older adults participated in a single evaluation study (ES) session (3 female, 10 male, mean age of 83.5 years, range = 70 to 92 years old). Table 1 summarizes the participant demographic information.

Table 1.

Participant demographic information.

ID	Age	Gender	Self-reported Impairment(s)
PD1	84	M	Visual
PD2	92	F	Mobility
PD3	73	M
PD4	87	F
PD5	70	M	Auditory and Visual
PD6	84	F
PD7	87	M	Visual
PD8	90	M	Auditory
PD9	83	F
CD1	90	M	Auditory and Visual
ES1	71	M	Motor
ES2	88	M	Auditory
ES3	81	M
ES4	90	F	Auditory and Mobility
ES5	80	M	Auditory
ES6	92	M
ES7	84	M	Mobility
ES8	92	F	Mobility
ES9	73	M
ES10	87	F
ES11	70	M	Auditory and Visual
ES12	87	M	Visual
ES13	90	M	Auditory

Procedure

Participatory Design Sessions: Participants participated in multiple sessions to brainstorm, develop, and iterate on design solutions for an HMD strap modification.

Co-Designer: The co-designer participated in two sessions based on the Google “Start with One: Invent for Many” process (Google, 2022). For the first session, the four prototypes developed during the participatory design sessions were presented for review, selection, and iteration. During the second session, the co-designer installed the prototype strap modification on the HMD strap and evaluated the final design iteration for usability with a cochlear implant.

Installation Evaluation: The final HMD strap modification prototype was evaluated through a performance assessment task in which participants first watched a video demonstrating the installation process. Participants were tasked to install the modification onto the Meta Quest 2 HMD (Meta, 2023) strap, then provide feedback via a questionnaire.

Results

Participatory Design Sessions

During the first participatory design session, participants brainstormed solutions to simultaneously support wearing the HMD and cochlear implant. Participants developed a list of seven potential solutions.

An object with a solid top, foam bottom, and adjustable sides to cover the implant

Attach the HMD to a hat

Move the HMD strap up or out to make space

Attach the HMD to a helmet, then cut the sides out of the helmet to make room for the cochlear implant

A foam protector to put around the implant that the strap would go over

Convert the HMD to be worn like glasses

Decrease the HMD strap height

These ideas were then used to develop four 3D-printed prototypes that could modify a COTS Meta Quest 2 HMD (Meta, 2023). These prototypes were presented to participants for review and iteration (Figure 1). Participants were first asked to use the prototype modifications with the HMD strap to make space for a cochlear implant and rate comfort, ease of use, and preference for each option (Table 2). Finally, we asked participants what changes could be made to the presented modifications to increase the usability and comfort of the prototypes. However, no suggestions were offered.

Figure 1.

A, B, C, D: 3D-printed HMD strap modification prototypes. A) Modification #1 pulls the HMD strap up by connecting it to the top strap. B) Modification #2 uses two 3D-printed modifications on the HMD strap, one on either side of the cochlear implant. C) Modification #3 attaches perpendicularly to the HMD strap and pulls the strap over the cochlear implant. D) Modification #4 pulls the strap over the cochlear implant but runs in line with the HMD strap.

Table 2.

Participatory design session review results.

	PD1	PD2	PD3	PD4	PD8	PD9	Mean
Modification #1 (Figure 1A)							2.44
Comfort	5	1	1	1	1	5	2.33
Ease of Use	4	1	1	1	na	5	2.40
Preference	5	1	1	1	na	5	2.60
Modification #2 (Figure 1B)							1.70
Comfort	3	1	1	1	1	3	1.67
Ease of Use	4	1	1	1	1	3	1.83
Preference	3	1	1	1	na	2	1.60
Modification #3 (Figure 1C)							2.67
Comfort	3	1	2	3	3	4	2.67
Ease of Use	4	1	2	2	3	4	2.67
Preference	3	1	2	3	3	4	2.67
Modification #4 (Figure 1D)							2.36
Comfort	3	2	1	2	5	4	2.83
Ease of Use	3	1	1	1	1	4	1.83
Preference	3	3	1	1	na	4	2.40

na = no answer provided.

Since no recommendations were offered to improve the four 3D-printed HMD strap modifications and because the mean score for comfort, ease of use, preference, and overall rating for each modification was less than three, resulting in a below-average rating, all potential HMD strap modification solutions were presented to the co-designer.

Co-Designer Session

The co-designer with a cochlear implant was presented with the four 3D-printed prototype solutions developed during the participatory design sessions (Figure 1). After trying each HMD strap modification prototype, the co-designer stated he preferred Modification #3 (Figure 1C) for three reasons, 1) it was the least complicated, 2) it was the most comfortable, and 3) it only needed to be installed once on the HMD strap (Figure 2). However, the co-designer stated that the modification required three changes to be usable. First, the modification needed to be taller for the cochlear implant to avoid device feedback. Second, the modification needed to be longer to fit the cochlear implant within the modification. Third, it needed a wider upper slot for easier installation.

Figure 2.

HMD strap modification installed on the Meta Quest 2 (Meta, 2023).

The required changes were made, and a final version of the HMD strap modification prototype (Figure 3) was 3D-printed and presented to the co-designer for final testing.

Figure 3.

Final HMD strap modification prototype.

The final iteration met the co-designer’s stated needs, so he could use the Meta Quest 2 VR system (Meta, 2023) while simultaneously wearing his cochlear implant (Figure 4).

Figure 4.

A, B: Strap modification installed on HMD strap. A) Side view showing the modification to the path of the HMD strap. B) Front view showing cochlear implant protected by the 3D-printed modification.

Installation Evaluation

With a viable VR HMD strap modification prototype, we investigated the 3D-printed HMD strap modification installation by conducting a performance assessment task. The task was to install the modification on the Meta Quest 2 HMD (Meta, 2023) strap after watching a 30-second video demonstrating the process (Figure 5). The scoring rubric (Perlman, 2003) assigned participants two points if they could complete the task without additional help, one point if they completed it with one-on-one coaching, and zero points if they could not complete the task. Additionally, participants were given a post-study questionnaire with a question inquiring about the comfort of the HMD strap modification prototype. Results from the performance assessment task and questionnaire can be found in Table 3.

Figure 5.

Screen capture of the HMD strap modification installation video.

Table 3.

HMD strap modification evaluation results.

ID	Task	Comfort
ES1	2	4
ES2	2	4
ES3	2	5
ES4	0	5
ES5	2	3
ES6	1	5
ES7	2	3
ES8	0	3
ES9	2	na
ES10	2	3
ES11	2	na
ES12	2	3
ES13	1	4

na = no answer provided.

Most participants (69.2%) could complete the task by only watching the demonstration video. Additionally, in terms of comfort, the mean score was 3.82, resulting in fairly to moderately comfortable. These findings suggest that the majority of individuals needing to use the HMD strap modification can install it themselves and that they should find it comfortable to wear.

Discussion

Research into developing an accessible VR HMD strap modification to allow an individual with a cochlear implant began when the co-designer attempted to use VR for the first time. He reported that “… for me to be able to use it properly, I got to hear,” and to do that, “I got to be able to work around that hearing device.” When asked what he believed could help make it accessible, he replied that the HMD required a “different [strap] configuration.”

Through multiple studies exploring VR accessibility for older adults, we developed a 3D-printed VR HMD strap modification that can be installed on a Meta Quest 2 (Meta, 2023) and modified the path of the HMD strap allowing for a cochlear implant to be worn simultaneously. The co-designer evaluated the modification’s usability and found it encompassed all his stated needs and requirements. Additionally, other older adults found the modification installation process completable and that, overall, the modification was comfortable.

Finally, the development of the HMD strap modification prototype allows individuals with a cochlear implant who may have found COTS VR inaccessible to have the opportunity to experience VR that supports their needs and abilities.

Limitations

The results presented in this paper are part of a more extensive study on the accessibility of VR for older adults. Therefore, the design and evaluation of the HMD strap modification were based on older adults’ thoughts, opinions, and feedback. Having the modification evaluated by a wider age range would be beneficial. Additionally, we only worked with one person with a cochlear implant. Testing that the VR HMD strap modification works for various cochlear implants and implant locations is necessary.

Future Work

We plan to continue our work towards accessible VR HMD usage for people with cochlear implants. To accomplish this, we will conduct a second study with multiple individuals with cochlear implants to further explore the current design across a larger population of stakeholders.

Conclusion

The presented findings show that a simple, 3D-printed prototype can increase the accessibility of the COTS Meta Quest 2 VR system (Meta, 2023), allowing nearly three-quarters of a million individuals with a cochlear implant to wear their implanted hearing device while also wearing a VR HMD. This increase is significant for multiple reasons, including equal access to VR technology, adapting the technology to the individuals’ needs (Wobbrock et al., 2018), and demonstrating that the presence of people with disabilities is vital to a diverse VR environment. Every accessible VR hardware modification or accessibility feature moves us closer to VR accessibility for everyone.

Footnotes

Acknowledgements

We want to thank all the older adult participants who participated in this study, especially the co-designer. Additionally, we would like to thank the staff at Clemson Downs for their assistance throughout these studies.

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