Posts Tagged Serious games

[ARTICLE] Music meets robotics: a prospective randomized study on motivation during robot aided therapy – Full Text

Abstract

Background

Robots have been successfully applied in motor training during neurorehabilitation. As music is known to improve motor function and motivation in neurorehabilitation training, we aimed at integrating music creation into robotic-assisted motor therapy. We developed a virtual game-like environment with music for the arm therapy robot ARMin, containing four different motion training conditions: a condition promoting creativity (C+) and one not promoting creativity (C–), each in a condition with (V+) and without (V–) a visual display (i.e., a monitor). The visual display was presenting the game workspace but not contributing to the creative process itself. In all four conditions the therapy robot haptically displayed the game workspace. Our aim was to asses the effects of creativity and visual display on motivation.

Methods

In a prospective randomized single-center study, healthy participants were randomly assigned to play two of the four training conditions, either with (V+) or without visual display (V–). In the third round, the participants played a repetition of the preferred condition of the two first rounds, this time with a new V condition (i.e., with or without visual display). For each of the three rounds, motivation was measured with the Intrinsic Motivation Inventory (IMI) in the subscales interest/enjoyment, perceived choice, value/usefulness, and man-machine-relation. We recorded the actual training time, the time of free movement, and the velocity profile and administered a questionnaire to measure perceived training time and perceived effort. All measures were analysed using linear mixed models. Furthermore, we asked if the participants would like to receive the created music piece.

Results

Sixteen healthy subjects (ten males, six females, mean age: 27.2 years, standard deviation: 4.1 years) with no known motor or cognitive deficit participated. Promotion of creativity (i.e., C+ instead of C–) significantly increased the IMI-item interest/enjoyment (p=0.001) and the IMI-item perceived choice (p=0.010). We found no significant effects in the IMI-items man-machine relation and value/usefulness. Conditions promoting creativity (with or without visual display) were preferred compared to the ones not promoting creativity. An interaction effect of promotion of creativity and omission of visual display was present for training time (p=0.013) and training intensity (p<0.001). No differences in relative perceived training time, perceived effort, and perceived value among the four training conditions were found.

Conclusions

Promoting creativity in a visuo-audio-haptic or audio-haptic environment increases motivation in robot-assisted therapy. We demonstrated the feasibility of performing an audio-haptic music creation task and recommend to try the system on patients with neuromuscular disorders.

 

Background

Following a stroke, 80-90% of patients suffer from arm paresis, which remains chronic in about 30-40% of all cases [123]. Task-oriented, intensive, and motivational training is important to increase arm function post-stroke [245678].

Intensity is recognized as a key feature of successful rehabilitation therapy [9]. Robots in neurorehabilitation allow for highly-intensive, task-oriented training and have the potential to be superior to conventional therapies (i.e., physical or occupational therapy) in improving motor function post-stroke [10]. Robotic therapy may embed functional training tasks into computer games to facilitate motor learning and to stimulate motivation [11].

Autonomy, competence, and relatedness can be regarded as the main components of intrinsic motivation [1213]. While extrinsic motivation can be described as a goal-directed drive towards an externally provided reward (e.g., a score in a game), intrinsic motivation is a process oriented and internally provided reward due to a satisfying, interesting, meaningful or enjoyable activity [1415]. The knowledge regarding the meaningfulness of an activity is a positive determinant of patient motivation [7]. Thus, for patients, an activity should not only be enjoyable, but also lead to a rehabilitation progress. Furthermore, patient engagement is related to the expected reduction of impairment during game-based therapy in stroke [16].

Activities with a close relation to intrinsic motivation are frequently associated with activities promoting creativity [171819]. This might be because activities promoting creativity involve one’s own accord, active decision making, and a resulting product, thus satisfying the need of autonomy, competence, and relatedness [12202122].

In addition to encouraging creativity, music is a promising stimulator for intrinsic motivation in the context of rehabilitation [2324]. Music effectively promotes post-stroke recovery in motor and cognitive functions, and furthermore in emotional and social domains [25262728293031]. Studies that compared conventional therapy forms to therapy tasks embedded in active music making revealed that music-associated training increases the level of motivation significantly [2432].

Auditory displays have already been determined to be effective for navigation within complex systems [33]. Accordingly, sound is an audible source for navigation through the execution of a task in virtual scenarios without the need for a visual display unit, the advantage being that the visual focus can be on the trained limb rather than a graphical display, thus promoting visuo-motor control [3435].

We developed tasks for robot-assisted training of the arm that aim to increase intrinsic motivation with a focussed stimulation of the two aspects: creativity and music. To investigate whether a music condition promoting creativity influences motivation differently than a music condition not promoting creativity, we compared motivational effects of both versions. We investigated the effect of the presence or absence of a visual display for both conditions regarding promotion of creativity. As the training goal of the presented gamified task is to induce high intensity during exercise, the game is operated by repetitive horizontal movements.

For this current study, we designed audio-haptic tasks in a way that they can be performed either with visual display (i.e., a monitor presenting the game workspace) as an audio-visuo-haptic environment or without a visual display as an audio-haptic environment only. To reduce the cognitive load of the participants and have more cognitive resources for creation and decision making processes, we designed the visual display and the haptic environment such that they both presented the same game workspace [36]. Accordingly, the visuals were not essential to complete the audio-haptic task.

Given these related works, the primary hypothesis was that a gamified task promoting creativity embedded in a task for motor therapy increases intrinsic motivation more than a gamified task not promoting creativity. Our second hypothesis was that a gamified task in motor therapy without visual display increases intrinsic motivation more than a gamified task with visual display. Moreover, we hypothesized that promoting creativity and omitting a visual display would increase total training time, free movement time and perceived product value. We further hypothesized that promoting creativity and omitting a visual display would reduce energy expenditure, relative perceived training time and perceived effort.[…]

 

Fig. 1

Fig. 1ARMin arm rehabilitation robot. Additionally for this study, a keyboard was placed close to the participant’s left hand so that the space bar could be used as input device

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[Review] Gamified In-Home Rehabilitation for Stroke Survivors: Analytical Review – Full Text DOC file

Abstract

A stroke is a life-changing event that may end up as a disability, with repercussions on the patient’s quality of life. Stroke rehabilitation therapies are helpful to regain some of the patient’s lost functionality. However, in practice stroke patients may suffer from a gradual loss of motivation. Gamified systems are used to increase user motivation, hence, gamified elements have been implemented into stroke rehabilitation therapies in order to improve patients’ engagement and adherence. This review work focuses on selecting and analyzing developed and validated gamified stroke rehabilitation systems published between 2009 and 2017 to identify the most important features of these systems. After extensive research, 32 articles have met the selection criteria, resulting in a total of 28 unique works. The works were analyzed and a total of 20 features were identified. The features are explained, making emphasis on the works that implement them extensively. Finally, a classification of features based on objectives is proposed, which was used to identify the relationships between features and implementation gaps. It was found that there is a tendency to develop low-cost solutions as in-home therapy systems; to include automated features; provide a diversity of games and use of simple interaction devices. This review allowed the definition of the opportunities for future research direction such as systems addressing the three rehabilitation areas; data analytics to make decisions; motivational content identification based on automatic engagement detection and emotion recognition; and alert systems for patient´s safety.

  1. Introduction

Brain stroke is a life-changing disease that can have fatal consequences. Stroke survivors may end up with long-term disabilities. These disabilities will depend on the damaged part of the brain and the body functions related to it. Older adults are the population with the highest risk of suffering a stroke and ending up with a disability. This makes of stroke the leading cause of adult disability worldwide [1-4].

Stroke rehabilitation therapy has proven to be useful in helping the patient to regain some of his lost functionality [5-8]. In traditional rehabilitation programs, when the rehabilitation in the hospital is completed, the patients return to their homes, where they should continue with more rehabilitation activities. However, the patient’s adherence is reduced at home. The two main causes for this are: the lack of available resources and tools to sustain training for longer periods; and, a diminishing motivation as repetitive exercises are perceived as tedious and boring [9-12]. Gamified rehabilitation systems have proven to be useful to improve motor and cognitive function and additionally as a tool to motivate patients to adhere to the therapy programme [13-22].

This study focuses on gamified systems dedicated for stroke patients’ upper limb rehabilitation for in-home use. The objectives of this study are: 1) provide a literature review of the developed and tested gamified systems for in-home stroke rehabilitation, between 2009 and 2017; 2) identify and explain the most used features of these systems; 3) provide a simple way to classify the features, in order to identify the relationships between them and the gaps of their implementations. A total of 32 articles have met the selection criteria, which resulted in a total of 28 unique works. From analysis of these studies, a total of 20 features were identified. The remaining of this paper is structured as follows. Section 2 describes the methodology used to find the reviewed works and the database to be used, as well as the selection criteria applied to select research works. Section 3 presents the results of the analysis, with the emphasis on the importance of each feature and the works that implemented them to higher extents. An analytical point of view is discussed in Section 4, where an objective-based classification is proposed, the relationships between the features are presented and additionally, the gaps in the current systems are identified. Finally, Section 5 is dedicated for the conclusion and the future research perspectives.[…]

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[Abstract] Application of Commercial Games for Home-Based Rehabilitation for People with Hemiparesis: Challenges and Lessons Learned

Objective: To identify the factors that influence the use of an at-home virtual rehabilitation gaming system from the perspective of therapists, engineers, and adults and adolescents with hemiparesis secondary to stroke, brain injury, and cerebral palsy.

Materials and Methods: This study reports on qualitative findings from a study, involving seven adults (two female; mean age: 65 ± 8 years) and three adolescents (one female; mean age: 15 ± 2 years) with hemiparesis, evaluating the feasibility and clinical effectiveness of a home-based custom-designed virtual rehabilitation system over 2 months. Thematic analysis was used to analyze qualitative data from therapists’ weekly telephone interview notes, research team documentation regarding issues raised during technical support interactions, and the transcript of a poststudy debriefing session involving research team members and collaborators.

Results: Qualitative themes that emerged suggested that system use was associated with three key factors as follows: (1) the technology itself (e.g., characteristics of the games and their clinical implications, system accessibility, and hardware and software design); (2) communication processes (e.g., preferences and effectiveness of methods used during the study); and (3) knowledge and training of participants and therapists on the technology’s use (e.g., familiarity with Facebook, time required to gain competence with the system, and need for clinical observations during remote therapy). Strategies to address these factors are proposed.

Conclusion: Lessons learned from this study can inform future clinical and implementation research using commercial videogames and social media platforms. The capacity to track compensatory movements, clinical considerations in game selection, the provision of kinematic and treatment progress reports to participants, and effective communication and training for therapists and participants may enhance research success, system usability, and adoption.

 

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[Proceeding] Mobile, Exercise-agnostic, Sensor-based Serious Games for Physical Rehabilitation at Home – Full Text PDF

Serious games can improve the physical rehabilitation of patients with different conditions. By monitoring exercises and offering feedback, serious games promote the correct execution of exercises outside the clinic. Nevertheless, existing serious games are limited to specific exercises, which reduces their practical impact. This paper describes the design of three exercise-agnostic games, that can be used for a multitude of rehabilitation scenarios. The developed games are displayed on a smartphone and are controlled by a wearable device, containing inertial and electromyography sensors. Results from a preliminary evaluation with 10 users are discussed, together with plans for future work.

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[Abstract+References] A Serious Games Platform for Cognitive Rehabilitation with Preliminary Evaluation

Abstract

In recent years Serious Games have evolved substantially, solving problems in diverse areas. In particular, in Cognitive Rehabilitation, Serious Games assume a relevant role. Traditional cognitive therapies are often considered repetitive and discouraging for patients and Serious Games can be used to create more dynamic rehabilitation processes, holding patients’ attention throughout the process and motivating them during their road to recovery. This paper reviews Serious Games and user interfaces in rehabilitation area and details a Serious Games platform for Cognitive Rehabilitation that includes a set of features such as: natural and multimodal user interfaces and social features (competition, collaboration, and handicapping) which can contribute to augment the motivation of patients during the rehabilitation process. The web platform was tested with healthy subjects. Results of this preliminary evaluation show the motivation and the interest of the participants by playing the games.

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[BOOK] Serious Games in Physical Rehabilitation: From Theory to Practice – Google Books

Front Cover
SpringerOct 30, 2017 – Medical – 146 pages

Marketing text: This innovative book explores how games can be serious, even though most people generally associate them with entertainment and fun. It demonstrates how videogames can be a valuable tool in clinics and demonstrates how clinicians can use them in physical rehabilitation for various pathologies. It also describes step by step their integration in rehabilitation, from the (gaming) technology used to its application in clinics. Further, drawing on an extensive literature review, it discusses the pros and cons of videogames and how they can help overcome certain obstacles to rehabilitation.

The last part of the book examines the main challenges and barriers that still need to be addressed to increase and improve the use and efficacy of this new technology for patients. The book is intended for physiotherapists and clinicians alike, providing a useful tool for all those seeking a comprehensive overview of the field of serious games and considering adding it to conventional rehabilitation treatment.

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[BOOK] Chapter 4: The Design Process and Usability Assessment of an Exergame System to Facilitate Strength for Task Training for Lower Limb Stroke Rehabilitation

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Abstract

Successful stroke rehabilitation relies on early, long-term, repetitive and intensive treatment, which is rarely adhered to by patients. Exergames can increase patients’ engagement with their therapy. Marketed exergaming systems for lower limb rehabilitation are hard to find and, none yet, facilitate Strength for Task Training (STT), a novel physiotherapeutic method for stroke rehabilitation. STT involves performing brief but intensive strength training (priming) prior to task-specific training to promote neural plasticity and maximize the gains in locomotor ability. This research investigates how the design of an exergame system (game and game controller) for lower limb stroke rehabilitation can facilitate unsupervised STT and therefore allow stroke patients to care for their own health. The findings suggest that specific elements of STT can be incorporated in an exergame system. Barriers to use can be reduced through considering the diverse physiological and cognitive abilities of patients and aesthetic consideration can help create a meaningful system than promotes its use in the home. The semantics of form and movement play an essential role for stroke patients to be able to carry out their exercises.

1. Background

With over 15 million cases worldwide every year [1], strokes are a leading cause of serious long-term disability [23]. Up to 75% of people affected by stroke have lower limb mobility limitations [34], including hemiplegia (muscle paralysis) or hemiparesis (muscle weakness) down one side of the body [5]. The World Health Organization (WHO) has highlighted the need for home health care that calls for rehabilitative devices, self-monitoring tools and self-management skills [6].

Success for stroke rehabilitation relies on early, intensive, long term repetitive treatment to regain motor control [57] by learning to use existing redundant neural pathways [8]. However, although abundantly prescribed by clinicians, as little as 31% of patients perform these exercises correctly and consistently, often due to their monotonous nature [9].

Recent studies show that systems of rehabilitative devices with incorporated digital games for exercising (exergames) improve patient engagement with their home-based therapies. This has promoted beneficial patient outcomes for different long-term conditions, including upper limb stroke rehabilitation [51011], and more effective recovery [12]. While there exist systems designed for upper-limb stroke rehabilitation [51314] and for improving gait and balance [1517], only one was found targeted specifically towards lower limb stroke rehabilitation [18].[…]

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[Thesis] Serious Games for Health Rehabilitation

FACULDADE DE ENGENHARIA DA UNIVERSIDADE DO PORTO
Serious Games for Health Rehabilitation
Paula Alexandra Carvalho de Sousa Rego

Abstract
Serious Games are growing into a significant area spurred by the growth in the use of video games and of new methods for their development. They have important applications in several distinct areas such as: military, health, government, and education. As such, their purpose is to be used for other purposes than pure entertainment, which is normally associated with the concept of game. The interest for Serious Games arises from the fact that games have a set of features that makes them very effective to engage users and keep their motivation at higher levels.

From the above discussion, the design of computer games can offer valuable contributions to develop effective games in the rehabilitation area. In rehabilitation programs, one of the major problems reported are related to the motivation and engagement of patients in the exercises training sessions using traditional therapy approaches. Patients rapidly lose their interest and get bored doing the, usually repetitive, rehabilitation tasks.

This thesis addresses Serious Games for Health Rehabilitation (SGHR), and provides an indepth study and survey of the existent games and features. With this study we were able to devise a taxonomy that enables researchers and practitioners to use a systematic approach to study, classify and compare SGHR. This taxonomy is validated by a set of experts in the interrelated domain of knowledge. The research led us to identify and propose several important features and guidelines to include in SGHR. As a result, we propose, discuss and describe a framework for the development of serious games. The framework integrates a set of features of natural and multimodal interaction, social interaction (collaboration and competitiveness) and progress monitoring, which can be used to increase the motivation of the patients during the rehabilitation process.

To validate the proposed framework and features, a set of serious games were developed. These games are intended to be used in rehabilitation sessions, and their main goal is to increase the users’ motivation during the rehabilitation process. The developed games were designed based on well established rehabilitation systems and rehabilitation tasks. We describe the design and implementation of the games with respect to our proposed framework. The resulting game platform includes a set of features, such as competitiveness, collaboration and handicap mechanisms, with the aim of promoting the engagement and motivation of the patients involved in the rehabilitation process. The resulting system is a Web platform that enables games to be played online, making it more accessible to all users, including patients in rehabilitation. Besides that, the web platform provides a low cost solution to patients training and enables home rehabilitation, in addition to traditional therapy.

Final experiments were performed in order to validate the proposed framework and provide scientific evidence that it is possible to use serious games for health rehabilitation to increase the motivation of users. Experiments were conducted with healthy people and elderly users. The scores achieved in all the tests used were quite good with emphasis for the very good SUS and IMI scores achieved.

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[Abstract] Virtual Reality and Serious Games in Neurorehabilitation of Children and Adults: Prevention, Plasticity, and Participation

Use of virtual reality (VR) and serious games (SGs) interventions within rehabilitation as motivating tools for task specific training for individuals with neurological conditions are fast-developing. Within this perspective paper we use the framework of the IV STEP conference to summarize the literature on VR and SG for children and adults by three topics: Prevention; Outcomes: Body-Function-Structure, Activity and Participation; and Plasticity. Overall the literature in this area offers support for use of VR and SGs to improve body functions and to some extent activity domain outcomes. Critical analysis of clients’ goals and selective evaluation of VR and SGs are necessary to appropriately take advantage of these tools within intervention. Further research on prevention, participation, and plasticity is warranted. We offer suggestions for bridging the gap between research and practice integrating VR and SGs into physical therapist education and practice.

Source: Virtual Reality and Serious Games in Neurorehabilitation of… : Pediatric Physical Therapy

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[Abstract+References] A Serious Games Platform for Cognitive Rehabilitation with Preliminary Evaluation

Abstract

In recent years Serious Games have evolved substantially, solving problems in diverse areas. In particular, in Cognitive Rehabilitation, Serious Games assume a relevant role. Traditional cognitive therapies are often considered repetitive and discouraging for patients and Serious Games can be used to create more dynamic rehabilitation processes, holding patients’ attention throughout the process and motivating them during their road to recovery. This paper reviews Serious Games and user interfaces in rehabilitation area and details a Serious Games platform for Cognitive Rehabilitation that includes a set of features such as: natural and multimodal user interfaces and social features (competition, collaboration, and handicapping) which can contribute to augment the motivation of patients during the rehabilitation process. The web platform was tested with healthy subjects. Results of this preliminary evaluation show the motivation and the interest of the participants by playing the games.

Source: A Serious Games Platform for Cognitive Rehabilitation with Preliminary Evaluation | SpringerLink

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