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Home > RNJ > 2010 > November/December > Opportunities for People with Disabilities in the Virtual World of Second Life

Opportunities for People with Disabilities in the Virtual World of Second Life
Stephanie Stewart, PhD RN Terri S. Hansen, MSN RN Timothy A. Carey, BA

The virtual world of Second Life® (SL) offers people with disabilities a chance to explore new worlds without being limited by their disabilities. Many people with disabilities use SL for information, support, and entertainment. SL is a computer-based simulated environment in which participants are represented by a human-like avatar. The avatar can move through the environment, manipulate objects, and participate in day-to-day activities that most people take for granted, such as walking, dancing, and communicating. In this article, the authors focus on the benefits that information, socialization, and community membership can offer people with disabilities and some of the resources that are available for them in SL. SL communities, groups, and activities also help increase self-worth and empower people with disabilities. Participating in a virtual world enriches the overall quality of life of people with disabilities and may enhance their physical, emotional, and social adjustment.

In the digital world of Second Life® (SL), people with disabilities have a chance to experience life beyond the limitations of their disabilities. In virtual worlds, computer-simulated environments host avatars, which are digital representations of a specific person. The avatar can manipulate objects and participate in day-to-day activities that most people take for granted, such as walking, dancing, and communicating. SL provides benefits to people with disabilities such as information, socialization, and community membership. SL communities, groups, and activities help increase feelings of self-worth and empowerment. Nurses caring for patients in a rehabilitation setting can use SL as an enrichment tool to help disabled, chronically ill, and convalescing patients improve their overall quality of life and enhance their physical, emotional, and social adjustment.

What Is Second Life?

Virtual worlds like SL have 3-dimensional (3-D) layouts in which multiple users can interact and communicate with one another. SL is a free online, computer-simulated environment where millions of real people are represented by avatars. A person is free to create an avatar that is similar in appearance and personality to himself or herself or one that is entirely different. People with disabilities can choose whether to have their avatars exhibit their disabilities. The individual user chooses a unique name for his or her avatar and can individualize hair color and length, eye color, body shape, height, and clothing. Personalization can be accomplished by using free features or Linden dollars (SL official unit of trade) to purchase more realistic skin and hair or designer clothing and furniture from virtual shops.

Avatars can walk, fly, or teleport (instantly appear in another location on command) to thousands of exciting locations and communicate with other real people from around the world through instant messaging or voice conversations. According to the SL website (www.secondlife.com), this 3-D virtual world is imagined, created, and owned by its residents.

Linden Lab, the privately owned company founded in 1999 that created SL, has established a code of conduct, but residents are responsible for maintaining their own safety by using intuition and discretion to determine the extent or accuracy of their communication and level of interactions with others. If an avatar is accosted or injured by another, an abuse report may be filed and Linden Lab will investigate and resolve the situation.

SL's popularity has grown dramatically, with millions of users from all over the globe occupying a virtual land area of more than four times the size of New York City. SL is a tool for innovation, attracting artists and musicians, nonprofit organizations and entrepreneurs, universities and scholars, large commercial brands, and government agencies seeing the potential for collaboration, education, communication, business, and organizational development. For example, the University of Wisconsin–Oshkosh College of Nursing used SL to enhance its second-degree, accelerated online Bachelor of Science in Nursing program. This nursing school purchased land in SL and developed a virtual campus where faculty have established office hours in tree-house offices and conduct real-time class discussions with students who live all over the country. Faculty members and students have customized avatars and stay connected using built-in voice conferencing, text chat, and group messaging systems. Students learn by watching demonstrations and attending virtual meetings. Faculty members have created avatars with specific illnesses and scripted responses so students can participate in safe simulations by interacting and caring for these patients, practicing skills, and role playing. In addition to the campus, this nursing college built a virtual public health office so students could gain experience in public safety and other aspects of public health. A disaster scenario at an industrial plant allows students to practice disaster preparedness, triage, and protocols.

Benefits of SL for People with Disabilities

Although many find it difficult to think of SL as more than an online gaming experience, SL is something very different for people with disabilities. In SL, people with disabilities are not limited by their disabilities. They can seek and build relationships and attend group therapy and rehabilitation services. Many people with disabilities feel as though they have escaped the confines of their disabilities in SL.

One of the coauthors (Figure 1), Timothy Carey (Tim), has Duchenne Muscular Dystrophy (DMD), which is caused by a genetic mutation resulting in the absence of dystrophin, a protein critical for the maintenance of muscle cells. DMD primarily affects young men and has progressive symptoms, such as muscles forming scar tissue and turning into fat. Loss of muscle mass results in muscle weakness of the legs and pelvis, which can spread to the arms, neck, and other areas. Reduced endurance, enlarged calf muscles, and difficulty standing may be early symptoms. As the condition progresses, muscle tissue wastes and leads to paralysis with increased sensitivity to touch. The heart and muscles of the lungs also become weaker, and eventually the affected individual will require a ventilator and possibly heart medication.

Figure 1

Tim was diagnosed with DMD at the age of 3 after his mother noticed he had trouble getting up from the floor toward the end of the day. He was aware that he was challenged because he could not run like the other children. Many children did not understand why he had trouble standing up or running. Until he needed a wheelchair at age 8, he avoided calling attention to his disability. As he got older, he grew fond of fast-flying airplanes and wanted to be a pilot. As the disease progressed and his physical ability declined, his future ambitions changed from pilot to air traffic controller, to architect, to landscaper, to solid-state electronics, and finally to computer programmer. He eventually earned a 2-year degree in computer programming from a local technical college and a 4-year degree in mathematics and computer science from a local university. In 1999 he started a website development business based out of his home.

Even though there are recreational activities available in SL, he does not consider SL a game. His avatar (Figure 2), Timm Short, is a pilot, builder and architect, inventor and innovator, programmer, and a man of charity who attends church. As a pilot, he provides free tours of SL in his airplane or helicopter (Figure 3). As an SL builder and architect, he designed his dream home and airport in the sky. Others were so impressed with his work that they enlisted him to help build their dreams as well. He uses his programming skills to help people with disabilities participate more easily in SL. For example, he is creating an SL object that allows an avatar to assist another avatar. This invention will allow a friend or a healthcare provider to help a person with a disability when he or she becomes fatigued and unable to use a mouse. Another SL device Tim is developing will help people who are hearing impaired communicate by enabling an avatar to use sign language.

Figure 2Figure 3

At 36 years old, Tim's disease has progressed to the point where he can only slightly move his fingers. He rarely leaves his home to socialize unless he is going to a doctor's appointment or meeting with his parents or a healthcare provider. When he first logged on to SL, he had two thoughts: as a professional computer programmer and Web developer, he thought SL was the future of the Internet, and as a person with a disability, he was amazed at how liberating it felt to have his avatar walk, fly, and socialize.

For many people with disabilities, SL is an extension of their lives. Because people with disabilities have similar access to everything in SL that people without disabilities have, their disabilities are not readily apparent unless they choose to make them obvious. When a user discloses that he or she has a disability, others do not seem to react as they would in the real world because the disability does not exist in SL. SL provides opportunities for Tim to socialize, including taking field trips with friends, dancing, horseback riding, and windsurfing at the beach, and other activities (Figures 4–6). Tim is in charge of the dance and party committee for the Hope Village, which will soon be the nonprofit oganization Bright Hope Community. He also participates in educational activities in SL that include furthering his knowledge of SL programming, transcribing books to be read in SL, and learning more about landscaping and cooking. Tim participates in these activities in SL for the same reasons others do in the real world; they enrich and add meaning to his life and give him the opportunity to meet people.

Figure 4Figure 5

Figure 6

In 2008 Tim received a grant to create a website advocating for people with disabilities called DisabilityVoice (www.DisabilityVoice.us). The website helps inform people with disabilities about SL and the advantages of joining that community. The site offers original articles about people with disabilities and offers free advocacy pages to people who help people with disabilities socially, politically, or for public change.

Research Support for the Potential Benefits of SL

Research suggests that SL is beneficial for people with disabilities because it improves their quality of life and sense of self-importance. Just as Tim experienced, Kizelshteyn (2008) found that SL made it possible for people with disabilities to participate in day-to-day activities most people take for granted. They are able to walk, dance, and communicate with others in cafés, nightclubs, and other gathering places. Kizelshteyn's ethnographic qualitative study involved 15 formal interviews and 50 informal conversations with SL residents about the socialization and support they received in the virtual world. Kizelshteyn concluded that the multitude of social and recreational activities available in the virtual world improved the quality of life for disabled, convalescent, and chronically ill people.

Antle (2004) identified social support from friends to be a significant factor associated with self-worth in 85 people with spinal cord injuries ages 8–23 years. The study also identified friendships as contributing to self-worth. In addition, Wilson, Washington, Engel, Ciol, and Jensen (2006) found that emotional support provided to youths with disabilities had a positive impact on their level of functioning. Wilson and colleagues examined the relationship between perceived social support, psychological adjustment, and functional ability in youths with physical disabilities. To obtain demographic and disability-related information, 37 youths with neuromuscular diseases and 33 with spina bifida completed a Child Health Questionnaire, Functional Disability Inventory, and Multidimensional Scale of Perceived Social Support. In the study, social support appeared to play an important role in the psychological adjustment and functional ability of this population. The relationship between social support, function, and adjustment may be moderated, to some extent, by age and gross motor functioning. SL offers people with disabilities countless opportunities to socialize, obtain support, and develop friendships that help improve their emotional well-being and functional ability.

Communities in SL

There is a large community for people with disabilities in SL. Virtual communities provide a sense of connectedness (Antle, 2004) and empower people with disabilities (Mactavish & Iwasaki, 2005). A community was created in SL for people with disabilities and their caregivers. Elfline (2008) quotes the group's cofounder, Kat Klata: "Here, I've developed close friendships, and I feel connected to the world... If I didn't have SL, I would be staring at the wall or the TV" (p. 51). Elfline notes that people can explore personal identities in SL. For example, a person can be a different race, gender, or another slight variation of him or herself through the creation of an avatar. This concept is especially attractive to people with mobility issues because anyone can walk, fly, or teleport in SL. Another member of Klata's support group, Maladrera Reymour, stated, "I couldn't even walk to the end of my street, but SL brought the world to my door" (Elfine, p. 51).

One acquaintance of Tim's, Huntress Catteneo (avatar name), shares how she feels about community life for people with disabilities in SL:

In real life we struggle to meet people, never mind actually make friends. We can't walk, see, hear, or speak without swearing or stuttering, and few people can understand our dark moods, odd behaviors, or phobias. We are all around, yet often go unnoticed, ignored, or shunned… It is hard to reach out to the 'normals' around us; we see their looks, hear the comments whispered as we pass, and we feel isolated and alone.

But it is different now; we have found something interesting that gives us a new lease on life, a better life, a 'second life.' I can fly here, high into the clouds, even up into space, and, even though I fear heights, I can handle it here. Flying here has even lessened my anxiety when riding those horrible glass elevators in the real world.

I have found groups of real people with problems just like mine who[m] I can talk to openly and honestly, and through our experiences we can help each other. We have a voice here even if we have none outside of this place. The small communities here join with all the wonderful individuals and become one very big community that spans our little blue planet.

It is easy to make friends here. People see me now. Even though my form changes, they no longer see my illness, my scars, my deformity, my disability—they just see me. I have a sense of humor, an eye for beauty, a caring heart, and a brightly burning intelligence that just loves to be tested. There is so much I can do here that others appreciate and encourage. I can give back to the community that has inspired me and in return I grow, emerge, bit by bit, from my shell and realize I never need to be alone again.

I am real here in this unreal world, and I notice that, after talking to many others here, the community we have lost in our 'normal' lives is starting to return. I am not quite so invisible now. I am not the feared leper you think will infect you. I am your neighbor, your work colleague, and the person who travels on the same bus as you every day. I am no longer hidden. I am part of a community, and I love it.

Virtual Ability Community

Virtual Ability is one community in SL that helps people with disabilities move beyond the barriers that separate them from being a part of society (http://virtualability.org/default.aspx). Virtual Ability is an orientation site that integrates people with a wide range of disabilities into SL society and offers a place for support and mentorship. Members learn how to walk, shop, play, and have fun. Residents are offered information, encouragement, training, companionship, referrals to SL resources and groups, and ways to contribute to the community. In some circumstances, the group helps newcomers by referring them to sources for assistive hardware and software or offering individualized attention with training and orientation.

In February 2009, Virtual Ability had more than 200 members and a reputation for being the leader in helping people with disabilities in SL. People with disabilities learn about the benefits of virtual world communities through the Virtual Ability group's Virtual Ability Island (VAI; Figure 7). Avatars can stay at Cape Able and find entertainment at the VAI Sanctuary. Virtual Ability, with the help of the SecondAbility Mentors group, is completing outreach work to inform people with disabilities, their doctors, and their caregivers of the benefits of virtual worlds. Virtual Ability maintains ties with a group called the VirtualGuidedog project (http://world.secondlife.com/group/b2debe82-5156-9dd2-2d27-5b9600b4e9a6), founded by Charles Mountain. He is working to perfect a guide-dog script that can help the blind, print-impaired, or those who are unable to use the standard interface in SL by telling them who or what is around them.

Figure 7

Gimpgirl Community

Jennifer Cole (SL username JennyLin Arashi) and other women with disabilities who felt the need for a community that understood women and their needs started another supportive community, Gimpgirl, in 1998. The Gimpgirl Community is a safe place where people with disabilities can express who they are and discuss important topics such as abuse, violence, sexuality, parenting, intolerance, health, and politics in a healthy and pressure-free environment. Women of all ages and sexual orientations with disabilities can find support at Gimpgirl, which welcomes partners of women with disabilities, researchers with written permission, and anyone who supports women with disabilities academically, personally, or politically. The community has weekly support group meetings for participants comfortable with discussing their issues from a personal perspective. The Gimpgirl Community also lists resources on their website, www.gimpgirl.com. The Gimpgirl Community hosts mailing lists, sponsors, and polls, and is active on Facebook, Flickr, MySpace, Eventful Calendars, Twitter, Livejournal, and LinkedIn.

A variety of activities (Figure 8) are available in the Gimpgirl community, including a skybox where weekly support meetings are held, a first-floor lounge, and a roof for dancing and hanging out by the pool. There is also a 60-avatar auditorium for large events, a main house with an art gallery, and an Affiliates Pavilion where other communities for people with disabilities can have a presence.

Figure 8

Dreams Community

SL also offers sites to promote health for people with disabilities. One of the goals of these health-promotion programs is to provide an opportunity for leisure and enjoyment and enhance the overall quality of life by reducing barriers to good health. Dreams (Figure 9), an interactive health-related community, has an area for teaching and holding discussions and events. Dreams supports two main groups, ShockProof and Brigadoon Explorers. ShockProof offers support to stroke survivors and their loved ones and those afflicted with transient ischemic attacks. Members learn from each other and are educated about the warning signs of a stroke, vascular disease, and the recovery process. Brigadoon Explorers was started in July 2004 by John Lester (SL username Pathfinder Linden) and is a place for individuals with Asperger syndrome and autism (to congregate as a supportive community and for parents, teachers, and others to learn).

Figure 9

The Path of Support is located on VAI and has various billboards displaying words such as fibromyalgia, diabetes, multiple sclerosis, spina bifida, cystic fibrosis, dementia, cancer, and Alzheimer's. The Path of Support was created by Drangea Lyndhurst (avatar name), a Virtual Ability member, as a place for people to find out about therapeutic peer support. Knoh Oh (avatar name), an informatics specialist, now manages the Path of Support, which would not exist without Virtual Ability support groups or SL communities like Gimpgirl Community and Dreams.

Conclusion

In addition to people with disabilities, nurses dealing with patients requiring physical, psychological, and cognitive rehabilitation or those who are chronically ill, convalescing, or homebound may find SL an inexpensive and useful therapeutic tool. SL accounts are free, and orientation to the virtual world takes approximately 2 hours. Those new to the virtual world immediately experience a sense of community. There are numerous mentors who help newcomers traverse the virtual world and introduce them to social and therapeutic opportunities.

SL could become part of a rehabilitation plan for people with disabilities, enabling patients to learn more about their own conditions, health and well-being, and resources available to enhance their quality of life. Participation in support groups and communities of people who understand what they are going through improves their sense of self-worth and augments their adjustment and functional ability by providing opportunities for socialization, encouragement, friendships, and fun. In addition, people with disbilities who are unable to work in the real world may be able to find work or volunteer in SL. SL offers people with disabilities a chance to explore new worlds without the limitations of their disabilities, offering them hope and promoting a higher level of emotional functioning. There are unlimited possibilities for how SL can be used in the rehabilitation of patients.

About the Authors

Stephanie Stewart, PhD RN, is a professor of nursing and director of nursing innovation at the College of Nursing, University of Wisconsin–Oshkosh, in Oshkosh, WI.

Timothy A. Carey, BA, is the owner of Golden Fire Computer Productions in Appleton, WI.

Terri S. Hansen, MSN RN, is an academic staff member at the College of Nursing, University of Wisconsin–Oshkosh, in Oshkosh, WI. Address correspondence to her at hansent@uwosh.edu.

References

Antle, B. J. (2004) Factors associated with self-worth in young people with physical disabilities. Health and Social Work, 29(3), 167–175.

Elfine, J. (2008). Exploring a Second Life. Momentum, 1(4), 51.

Kizelshteyn, M. (2008). Therapy and the metaverse: Second Life and the changing conditions of therapy for convalescent and chronically ill users. Washington University Undergraduate Research Digest, 4(1), 17–26.

Mactavish, J. (2005). Exploring perspectives of individuals with disabilities on stress-coping. Journal of Rehabilitation, 71(1), 20–31.

Wilson, S., Washington, L. A., Engel, J. M, Ciol, M. A., & Jensen, M. P. (2006). Perceived social support, psychological adjustment, and functional ability in youths with physical disabilities. Rehabilitation Psychology, 51(4), 322–330.