Accessibility wish list

The AbleGamers Foundation reviews mainstream videogames with a focus on accessibility. Here is their annual shopping list of controllers, mounts and games; as recommended by the Foundation, providing “game accessibility for the gamer with disability”.

www.ablegamers.com/general-game-news/ablegamers-2011-holiday-shopping-list.html

What makes therapy work?

Defining the active ingredients of interactive computer play interventions for children with neuromotor impairments: A scoping review


Levac, D., Rivard, L. & Missiuna, C.
Research in Developmental Disabilities, 33 (2012) 214-223

Link to abstract: www.sciencedirect.com/science/article/pii/S089142221100343X

Objective:
Active ingredients are why a treatment is expected to be effective. Rehabilitation therapists might identify the dosage, intensity of treatments, or the therapist-client interaction, as active ingredients in usual or traditional treatments. The goal of this article is defining the active ingredients of interactive computer play.

New pediatric rehabilitation interventions like interactive computer play are often incorporated into clinical practice without a clear understanding of their active ingredients. Reviews of the literature, while positive, lack strong conclusions and urge more stringent designs.

Method: Scoping reviews can be applied to identify a field of research and interpret the findings of the studies that are reviewed. The purpose of this scoping review is to identify the potential active ingredients of video game and virtual reality interventions used to improve motor outcomes in children and youth with neuromotor impairments.

Findings:A number of studies were gathered and analyzed for themes revealing potential active ingredients either explicitly or implicitly referred to in the study.
Authors explicitly linked the following as possible active ingredients. They were characterized as belonging to a property of the game, an effect of the intervention on the user, or a role of the therapist.

Properties of the game include: duration, frequency or intensity of practice; task relevance to real-world activities, within-game parameters, feedback, and equal-opportunity play. Effects on the user included: neuroplastic changes, problem-solving and motivation. Support roles included one-to-one support, verbal feedback, and parental involvement and enthusiasm.

While little is currently known about the active ingredients in successful therapeutic interventions using virtual reality or video gaming, there is the opportunity to develop theoretical models that predict these ingredients.

Success & Motivation

Research paper

Hocine, Nadia and Gouaich, Abdelkader
"Therapeutic Games’ Difficulty Adaption: An Approach Based on Player’s Ability and Motivation", Published in the Proceedings of the 16th International Conference on Computer Games, pp. 257-261

Link to the abstract: ieeexplore.ieee.org/xpl/freeabs_all.jsp?arnumber=6000349

Objective: the authors set out to describe general principles for therapeutic video games, and to test how the success-to-failure ratio in game play affects motivation.
In traditional therapy, therapists improve the client’s functional skills such as movement using feedback to create a balance between the challenging activity and an reachable goal. Benefits of video games include their motivating and engaging nature: requirements of therapeutic games is that they have measureable outcomes and offer recovery-focused activities to meet rehabilitation goals. This study considers embedding difficulty adjustment into video games, including assessing the client’s ability, and providing variability to minimize boredom.

• Initial evaluation: Video games can provide an initial assessment by requiring the player to go through a series of movements that help create a profile and provide a game starting point and difficulty strategy.



• Variability: The game should be able to operate in a way that separates the therapeutic goals from game play so the therapeutic difficulties and accomplishments can be embedded in different levels of play and in different games.



• Motivation-based difficulty adjustment: This involves disrupting a player’s satisfaction from success at some level of game play. Called “constructive dissatisfaction”, the idea is that this disruption motivates the player to re-seek the satisfaction of successful accomplishment. The authors have created an algorithm that feeds back from motivation and success-to-failure rate to dynamically adjust the game parameters, to both meet the therapy goal of motor skills improvement, and to support the player’s motivation by manipulating the balance between success and failure.

Method: This pilot experiment compares random difficulty adjustment with motivation-based difficulty adjustment for two groups of four able-bodied adults. Hypotheses were i) there will be a difference across conditions for the balance of sucesses to failures and for perceived difficulty. Data included for analysis was the success-to-failure rate in the game session across conditions and the player’s perceived difficulty.

Findings: There is no evidence that motivation-based difficulty adjustment (operating by these authors’ algorithm) is different from randomly generated difficulty adjustment, by the measure of perceived difficulty. Both conditions may contribute to motivation.

Therapists Creating Rehabilitation Games

Qualitative Research

Kelleher, C., Tam, S., May, M., Profitt, R. & Engsberg, J.
Towards a Therapist-Centered Programming Environment for Creating Rehabilitation Games Proceedings of the 16th International Conference on Computer Games pp. 240 – 247.

Link to abstract: ieeexplore.ieee.org/xpl/freeabs_all.jsp?arnumber=6000346

Objective: to discover the ways therapists describe video games in order to help create therapist-programmed video games for clients and rehabilitation goals. Characterizing the language therapists use to talk about video game-based therapies can help programmers, and may lead to games that can be programmed by therapists to suit the specific therapy goals of their patients.

This study comprises two parts:

1. a language study to elicit therapists’ descriptions of the relationship between players and the game environment.
   
2. have therapists build games using simple programming to suggest guidelines for supporting therapists to program games.

The first study introduced ten occupational therapists to seven video samples showing both the player and the player’s related action in the video game. Therapists were asked to describe in words or drawings “how the computer should perform the actions depicted in the clip”. This information was categorized into six properties describing various motions, the relationship between the player and game motion, and the relationship between the sensors and body parts.

The second study had eight rehabilitation occupational therapy graduate students do programming of a rehabilitation game using a simple program, Looking Glass. These subjects identified a target motion, then designed a game around that motion.

Outcomes:
Some of the guidelines that might help a therapist-friendly programming environment include:

• creating an avatar or player object for therapists to manipulate to see how the game responds,
  
• relating movements to player body parts rather than what the sensor does or detects,
  
• describing movements and distance relationships in the game in therapist-centric language
  
• providing a model of game development
  
• avoiding calling attention to the hardware
  
• improving the efficiency of game creation

Wii Balance Board vs. Force Plate

Research paper: Validity and Reliability of the Nintendo Wii Balance Board for assessment of standing posture

Clark, R. A., Bryant, A. L., Pua, Y., McCrory, P., Bennell, K. & Hunt, M. (2010). Published in:
Gait & Posture 31 pp.307-310

Link to abstract: ncbi.nlm.nih.gov/pubmed/20005112

Objective: The Nintendo Wii Balance Board has the ability to inexpensively measure standing balance. In clinical settings where the Wii is used as a rehabilitation tool, measuring improvement in standing balance becomes an asset to the therapist for tracking rehabilitation gains.

This paper demonstrates the Balance Board’s equivalence to the ‘gold standard’ of a force plate to assess standing balance. Thirty able-bodied subjects with an average age of 23.7 years, stood on both devices with one or two legs and eyes open or closed. Subjects were tested on these four conditions twice; at least one day and not more than 14 days apart. Testing device and order of balance tasks was randomly assigned. The outcome measure used in this study is the length of the center of pressure (COP) path, known to be a valid and reliable measure of standing balance.

Findings: Comparison of COP path lengths across the Balance Board and the force plate for the four test conditions show good to excellent reliability within and across the two devices, and the Balance Board “possesses concurrent validity with a laboratory-grade force plate.”

Less expensive than force plates, the Wii is now often found in clinical settings. In addition to being popular with therapists and children, providing a way to measure change and give therapists quantitative data gives the Wii extra value.

Wiihabilitation Games Blog

Rebecca is a physiotherapist based in Cheltenham, Gloucestershire, England. She has created a blog on the use of Nintendo Wii for therapy, “based on experience... as a physiotherapist working with young disabled adults with a variety of conditions.” Her website is aimed at therapists who are using or will use the (Wii) console in rehabilitation. wiihabilitationgames.blogspot.com/

The blog organizes information about Wii by diagnosis including assessment and recording and by therapy type indicating what body system is being targeted for physiotherapy. The equipment section includes wii adaptations, and ways to calibrate the wii balance board for use with upper extremities and in sitting. This and the game reviews she has prepared wiihabilitation.co.uk/games.shtml can be of great benefit to therapists.

Virtual reality in Autism: Subject review

Bellani, M., Fornasari, L., Chittaro, L., Brambilla, P.
"Virtual reality in autism: state of the art", Epidemiology and Psychiatric Sciences, 20(3): 235-238.

Link to the pre-print article
hcilab.uniud.it/publications/2011-03/VRInAutismEPS.pdf

Objective: This short article reviews eight “behavioural studies investigating VR in patients with Autism disorders and healthy subjects.”

Variations in the domains of social interaction, communication and repetitive behaviour characterize Autism spectrum disorders (ASD). Virtual reality or the creation of virtual environments is potentially useful as a treatment medium for ASD. Stimuli can be managed to permit focus on selected activities; concept learning and activity practice can occur repeatedly. And hopefully the environments are realistic enough to prompt transfer to real world interactions.

Findings: Several studies found positive improvements in because safe, repeatable diversifiable tool for learning. The eight studies found that when children can limit off-task behaviour, complete the tasks, they may improve performance. Two studies found that newly gained skills generalized outside the virtual environment.

Augmented Reality & Mobility

OutRun video game vehicle
This project leads the way for other augmented-reality mobility platforms.

Garnet Hertz, a research scientist at the Centre for Computer Games and Virtual Worlds, ics.uci.edu turns the 1980’s driving arcade game Sega Outrun into an electric vehicle. Operating on streets while using the video game monitor provides an augmented forward view that may help people with visual impairments.

Youtube video youtube.com/UCIBrenICS#p/u/4/zd-t7WoshS4

Garnet Hertz - research scientist in informatics
“The project started with thinking what would it be like if this driving arcade game could actually drive. ... A number of pieces of software that run here that look in front of the car, try to interpret what the features there are in front of the car. In this case it looks specifically for roads, and then it draws that road shape in the style of the original video game. So this software that is running looks like the old video game but its actually an augmented reality type of system that tries to make the real world look like a video game from the 1980’s.”

Walt Scacchi - Research Director at the Centre for computer games and virtual worlds at the University of California at Irvine
“...one of the things that is starting to arise from it is whole new ways of thinking about how game-based virtual worlds can be embodied into physical devices in order to create new experiences. One of the things that may come from the outrun project are new ways of associating game-based therapies for people who might be limited to electric chair assisted mobility, kids who have limited mobility ...may be able to take advantage of this technology if we can get it embodied in, rather than the form of an arcade machine, also in the form of a powered wheelchair.”

Garnet Hertz' website conceptlab.com

Video game highlights accessibility features

The Spanish group the game kitchen have created a simple puzzle game that showcases accessibility features. The game has no time limit and no death as the player goes through the levels. Controls permit variable game speed, interaction by mouse, keyboard or voice control, a high contrast feature and the ability to manage distractions by turning off sound effects and music.

To watch the accessibility options on Youtube youtube.com/watch?v=hxdMsaTxm-0

To play Attractor thegamekitchen.com/attractor

Download Attractor thegamekitchen.com/attractor/attractor-redis01.zip
http://www.thegamekitchen.com/attractor/attractor-redis01.zip
Download the game

Choosing between games for rehab: the prequel

Subject Review: Facilitating clinical decision-making about the use of virtual reality within paediatric motor rehabilitation: Describing and classifying virtual reality systems
Galvin, J., & Levac, D.
Developmental Rehabilitation,, April 2011; 14(2): 112-122

Link to abstract: informahealthcare.com/doi/abs/10.3109/17518423.2010.535805

Objective: to describe and categorize VR game systems using characteristics relevant to paediatric rehabilitation.

Method: Literature search followed by paper review. Descriptive process to develop classification framework. Based on articles on seven virtual reality game systems: Dance Dance Revolution, EyeToy, IREX by Gesturetek, Pediatric Intensive Therapy System (PITS), PlayStation 3 sensor glove and WiiFit.

Findings: All VR systems possessed three features: they require the player to move in space, they offer an exactly reproduced environment for repeated practice and provide augmented feedback.

A descriptive table is provided to identify the characteristics of each game. The classification system identifies five game characteristics and two variables in user ability that the games should accommodate.

• Game should have properties that are relevant to therapists and that can be both manipulated and measured.
  
  
• Games should target various body movements; it’s best if these can be assessed for quality of movement.
  
  
• Motor demands of the games should change independently from cognitive demands.
  
  
• Users should be able to play without fine motor control, and VR games accommodate both sitting or standing positions.

Experimenting with Kinect

This Peter Wayner article from the New York Times of July 20th details how the hacker-friendly Kinect is being adapted for artistic uses and as a unique home amusement. Kinect’s cameras collect body movements in three dimensions. This could create an opportunity for adapted game playing. Various software helps non-programmers easily create visual or sound feedback environments operated by gestures and movements. It is also possible to do keyboard activities using gestures instead.

Link to this article: nytimes.com/2011/07/21/technology/personaltech/kinect-hacking-finds-a-wider-crowd.html?_r=1&ref=technology

Related New York Times article:
nytimes.com/2010/11/22/technology/22hack.html

Kinect hacks
kinecthacks.net
kinecthacks.com
hackaday.com

Blog
kinecteducation.com/

Minigames offer adapted ‘slow fun’

Digital games for physical therapy: fulfilling the need for calibration and adaptation

Guerts, L., Vanden Abeele, V., Husson, J., Windey, F., Van Overveldt, M., Annema, J-H. & Desmet, S. Proceedings of the fifth international conference on Tangible, embedded, and embodied interaction, 117-124 doi>10.1145/1935701.1935725

Link to abstract and references portal.acm.org/citation.cfm?id=1935725

There has been a move from joystick game controllers to a variety of controllers; from fine motor control to whole body movements, creating an opportunity for people with limited fine motor control to play video games. This paper looks at mapping controllers (calibration) and altering game settings (adaptation) to make games available to people with spasticity. Video games used as therapy tools should be adaptable to the capabilities (and potential) of the player and responsive to the goals defined by the therapist. The authors define calibration: “the fit of the game to the patient”, and adaptability: “game mechanics such as speed and accuracy should be easily adjustable and designed to accommodate [for] a wide range skills”.

After evaluating currently available video games, they discover that the relationship between game actions and ‘correct’ therapy movements (mapping) is insufficient to accommodate their test sample of game players with spasticity.

The authors develop four minigames that offer ‘slow fun’ for people with limited motor control to maintain range, increase strength, and increase coordination. The games variably use arm movement, standing balance, head movements and seated weight shifting to activate webcam, Wii remote, and balance board controllers. The sensitivity of the input devices were sufficient both for these players and for these applications. “It is important however that the game parameters can be adjusted to the players skills and development goals”.

Link to conference TEI '11

Advances in Game Accessibility

Paper review: Advances in Game Accessibility from 2005 to 2010
Westin, T., Bierre, K., Grammenos, D. & Hinn, M.

Published in: C. Stephanidis (Ed.): Universal Access in HCI, Part II, HCII 2011, LNCS 6766, pp. 400–409, 2011. © Springer-Verlag Berlin Heidelberg 2011

Link to abstract: www.springerlink.com/content/v5231nn67304275m/

The references in the text below can be found at www.citeulike.org/group/8459

This document summarizes published research literature between 2005 and 2010 on game accessibility. The review organizes accessibility research by the type of disability and alternate feedback modality.

Reduced vision is accommodated using auditory or tactile (haptic) inputs (Savadis et al., 2007; Atkinson et al., 2006; Archambault & Olivier, 2005; White et al., 2008; Gutschmidt et al., 2010; Sepchat et al., 2006; Archambault, Guady & Meisenberger, (nd); Roden & Parberry, 2005; Sanchez & Saenz, 2005; Morelli et al., 2010; Oren et al., 2008; Sanchez & Elias, 2007; Folmer et al., 2009; Pascale et al., 2008; Glinert & Wyse, 2007; Miller et al., 2007; Allman et al., 2009; Yuan & Folmer, 2008; Sanchez et al., 2009).

Impaired hearing receives feedback through haptics (Brashear et al., 2006).

Motor disabilities feedback comes through adapted controls (Lepicard et al., 2007), speech (Sporka et al., 2006), or both modalities (Norte & Lobo, 2008).

The authors highlight game interaction models: (Archambault et al., 2008; Grammenos et al., 2007; Grammenos et al., 2009; Ossmann et al., 2008; Yuan et al., 2010; Torrente et al., 2009).

Game accessibility guidelines are identified: (Archambault et al., 2008; Ossmann et al., 2008; Tollefsen & Flyen, 2006).

Results of selected user surveys (Trewin et al., 2008; Trewin et al., 2008) are included.

Virtual table tennis – alternate access

‘Hyper Ping-Pong’ is a virtual table tennis game, played with a bat containing motion sensors and a speaker. The game provides sound feedback to the motion of swinging at the ball to guide game play. A player hears the other (virtual) player hit the ball, and responds to sustain a rhythm, or to keep the rally going.

The game was developed by Happinet, a Japanese game company, and demonstrated at the International Tokyo Toy Show, June 16 – 19, 2011. It will not be available till October of this year and is estimated to cost $25.

Read more: www.dailymail.co.uk/sciencetech/article-2007785/Ping-pong-partner--ball-Japanese-develop-table-tennis-game-play-ear.html#ixzz1QalvnkAF

View: www.youtube.com/watch?v=H5xdj3s7uXc

Choosing Between Games for Rehab

Subject Review:
Facilitating clinical decision-making about the use of virtual reality within paediatric motor rehabilitation: Application of a classification framework

Levac, D. C. & Galvin, J., Developmental Rehabilitation, June 2011; 14(3): 177-184. Link to the abstract: www.ncbi.nlm.nih.gov/pubmed/21410403

The authors create a clinical tool to enable therapists to choose when they would use different virtual reality game systems. Game systems covered include: Nintendo Wii, Sony EyeToy, Dance Dance Revolution (DDR), GestureTek IREX, Pediatric Intensive Therapy System (PITS) glove and Sony PlayStation 3 (PS3) glove. The decision tool is applied to three case studies of children with motor impairments.

Levac and Galvin identify (but don’t define) their therapist-friendly criteria for sorting out the video games. The criteria include the following. Is it possible to manipulate game levels to grade activity difficulty, or track the variables to evaluate activity performance? Can the therapist choose games that focus separately on upper extremity or lower extremity activities? Are the cognitive requirements to follow the game separate from increasing motor demands as the game progresses? What is the type of motor input and user capabilities, such as fine motor control, required to operate the game? And what seated or standing position is required to play the various games? These criteria are assembled into a table that sorts the game systems.

Then, by way of example, the criteria are applied to three case studies to choose game systems. The authors also provide a comparison of game systems, based on the criteria. This has value in clinical settings where only one system can be purchased. Generally, commercial systems (Wii, EyeToy, DDR) are seen to have fewer motor rehabilitation qualities than the game systems specifically developed for rehabilitation (IREX, PITS, PS3 glove).

The classification system is continuing to be studied to establish validity and clinical utility.

Alternate Access: Speech used as a form of input to mediate video games

Prototype development paper

Audition, the Game: Assessing the possibilities of speech as a non-trivial gameplay element in video games, Lavender, T. J., (2011)

Contact Terry Lavender: tjl.sfu@gmail.com

Link to the article: www.terrylavender.ca/wordpress/wp-content/uploads/2010/06/lavender_finalprojectIAT881.pdf

Speech as a motor-free way of driving video games is not common yet, but Terry Lavender at Simon Fraser University’s School of Interactive Arts and Technology has developed a prototype game that uses speech to change the outcome of a game. The game requires the player to say a certain speech in a given amount of time in order to advance the game.

Players in this prototype game are also hooked up to sensors which make a physiological measure of galvanic skin response (GSR) or hand sweatiness. This is a common way to detect stress or emotion, and may also be a way to indirectly measure speech difficulty. Currently, there is little evidence of the link between speech difficulty and stress. As a possible connection is explored, there could be opportunity to develop therapeutic applications. Physiological measures like GSR, heart rate or temperature are expected to be available in commercial hand held game controllers in the future as effective ways to mediate game play.

Further in the future, speech-mediated qualities like verbal memory and vocal clarity could be more direct game controllers and make motor-free game play a realistic avenue for participation of children with motor difficulties or a way to engage children in speech rehabilitation.

CONSORT Statement for Ehealth randomized controlled trials

www.consort-statement.org/ CONSORT stands for Consolidated Standards of Reporting Trials. The group exists to encourage good reporting of randomized controlled trials (RCTs) by offering recommendations on a standard way to report findings.

CONSORT has recently created a checklist for reporting Ehealth trials as a draft version. www.jmir.org/ojs/public/journals/1/CONSORT-EHEALTH-v1-5.pdf

The opportunity exists to comment on the CONSORT items as this document evolves.
tinyurl.com/consort-ehealth-v1-5

CONSORT seeks “to improve the reporting of different types of health research, and indeed, to improve the quality of research used in decision-making in healthcare”.

Does Virtual Reality improve Upper Extremity Function: Systematic Review

Galvin, J., McDonald, R., Catroppa, C. & Anderson, V. (2011). Brain Injury, 1-8, Early Online

Objective: One randomized control trial (RCT) and four case studies were found that fit the criteria of the literature search; research articles that “specifically refer to upper limb interventions and outcomes of the use of virtual reality (VR) with children who had neurological impairment.”

Process: Studies were rated for level of evidence using the Australian National Health and Medical Research Council scale (1) and for study quality using the Downs and Black Checklist (2). The Downs and Black scale assesses internal validity, generalizability, bias, confounders and power. The instruments used within the studies were the Quality of Upper Extremity Skills Test, the Melbourne Assessment, the Pediatric Motor Activity Log and the Canadian Occupational Performance Measure. Three of the studies used one item of one sub-test of the Bruininks-Oseretsky Test of Motor Proficiency.

Results: The RCT showed an evidence level of II (n = 34) and the remaining articles are all case studies (n =1-5) with an evidence level of IV. The studies scored from 9 to 22 of a possible 32 points on the Downs and Black scale, with only the RCT scoring more than 50% on each of the sub-scales. The case studies are weak in the areas of reporting and analysis which limits their external validity. Power is limited due to sample size.

Conclusion: “Small sample sizes and inconsistencies in outcome measures limit the ability to generalize findings.” There is a continuing need to establish evidence for the clinical utility of VR as a treatment medium.

Link to abstract: http://informahealthcare.com/doi/abs/10.3109/02699052.2011.558047

References: (1) NHMRC. (1999) A guide to the development, implementation and evaluation of clinical practice guidelines. In: Council NNHaMR, editor. Canberra: Australian Government. (2) Downs, S.H. & Black, N. (1998). The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. Journal of Epidemiology and Community Health, 52: 377- 384.

Systematic review: VR for children with motor impairment

Virtual reality in the assessment and treatment of children with motor impairment: a Systematic review
Laufer, Y. & Weiss, P.L. (2011) Journal of Physical Therapy Education, 25 (1), Winter 2011, 59-71.

The objective of this article is to present a systematic review of publications where virtual reality (VR) has been used to provide rehabilitation to children with sensorimotor deficits. Articles were chosen from research reported in English, peer-reviewed journals.

Process: 26 studies were first classified by study design to reveal strength of evidence. Of them, 20 had sufficient strength of evidence to be evaluated using the American Academy for Cerebral Palsy and Developmental Medicine conduct questions. Based on positive responses to 10 study characteristics (such as adequate description of randomization, exclusion criteria and power calculations); the studies ranged from 3-10 positive responses with an average score of 5.25.

Results: Most studies reported positive outcomes with fair to poor evidence quality. Research of a higher quality is necessary for stronger assessment of the claims of VR. As noted, evaluation is limited by poor research design and methodology, but also by the “diversity of research objectives, outcome measures and treatment intensity presented in the different studies.”

Link to abstract: www.library.nhs.uk/booksandjournals/details.aspx?t=*systematic+review&stfo=True&sc=bnj.ovi.amed,bnj.ovi.bnia,bnj.ebs.cinahl,bnj.ovi.emez,bnj.ebs.heh,bnj.ovi.hmic,bnj.pub.MED,bnj.ovi.psyh&p=1&sf=srt.publicationdate&sfld=fld.title&sr=bnj.ebs&did=2010897080&pc=2295&id=6

Videogames in Therapy: A Therapist's Perspective

Annema, J-H., Verstraete, M., Vanden Abeele, V., Desmet, S., & Geerts, D. (2010). Videogames in therapy: a therapist's perspective Proceedings of the 3rd International Conference on Fun and Games doi>10.1145/1823818.1823828

Motion sensing video games have a certain appeal to physical and occupational therapists, but could be configured to serve the therapist and client better. This paper explores the use of video games for theraputic purposes from the perspective of the therapist. Therapeutic video games should be quick to start, should pause to allow the therapist to accommodate the client and should support store performance data.

The methodology consisted of both contextual inquiry (observing therapists and clients during therapy to organise observations into focus points) and workshops (to elicit feedback from therapists) to identify game characteristics that could be improved. The therapists were 11 physical and seven occupational therapists; clients were from two clinics for children with cerebral palsy; a clinic for adults with multiple sclerosis, and a centre that organized leisure activities for people with mental and physical impairments.

Findings

• Starting and calibrating the game should be quick and as straightforward as possible.
• On-screen instructions should be able to be skipped.
• Player-specific settings should be stored in profiles and automatically retrieved.
• Pausing play without exiting the game should be available to change settings; to position, encourage or instruct the client.
• Games should store performance data.

Link to article abstract
portal.acm.org/citation.cfm?id=1823828

Autism and video game engagement

Engagement with electronic screen media among students with autism spectrum disorders
Mineo, B. A., Zeigler, W., Gill, S. & Salkin, D. Journal of Autism and Developmental Disorders (2009) 39:172-187

doi>10.1007/s10803-008-0616-0

 “Studies comparing the relative appeal and impact of technology-enabled interventions are few.” This study is concerned with the relative strength of engagement of four types of video-based content presented to a heterogeneous population of 42 children with autism.

The engaging quality of video-based media, combined with the preference for children with autism spectrum disorder (ASD) for screen media, suggest its suitability for delivering instructional material. Movies, video games and virtual reality (VR) games all exist in popular culture and can thus non-stigmatizing. Benefits of video presentation in comparison to live instruction include consistently presented, infinitely repeatable content. Screen media make good use of limited resources and can communicate visually, with or without language. Virtual reality puts the person into the game as an avatar, or some closer rendition of themselves. VR scenarios can represent unreal situations – ones that simulate impractical or dangerous real life situations. Like other video games,  tasks presented in the virtual environment can be graded to accommodate the learners’ ability and feedback sculpted to be effective for that learner.

Design

To reflect the heterogeneous nature of ASD, baseline data were collected using a basket of five communication characteristics, reported in a binary fashion. Expressive language may be understood to be a predictor of functioning in the ASD population. The primary metric in selecting candidates was having an expressive lexicon of greater than 50 words and 38 of 42 participants “passed” this criteria.. Other scales included receptive lexicon, frequency of conventional yes/no use, frequency of conversation, and frequency of echolalia. Additionally, informants reported on the participants attention to and previous experience of screen media.

Individuals were sequentially assigned to one of three groups: seeing themselves doing a familiar activity ( self video), seeing a familiar other in a video game (other VR), or seeing themselves as they played a virtual reality game (self VR). Measures of engagement included gaze duration and vocalizations during a two-minute presentation of  the various media. All participants watched a video movie clip to establish a baseline response level. Reliability across two raters was established. (94% for vocalizations, 86% for gaze). Scores were adjusted for baseline score, expressive language score, and age.

Findings: Gaze was significantly higher in the “self VR” condition (p = .014) than the “other VR” condition, possibly related to the novelty of the VR game, seeing themselves or being able to interact with the game. Vocalizations were significantly higher in the “other VR” condition (p = .03) than “self VR” condition due either to seeing a familiar person on the screen, seeing the game or a combination of the two. There were no other significant differences between groups. Possibly participants high attention to movie clips during the baseline exposure to a movie clip created a ceiling effect that limited the ability to demonstrate a difference compared to other conditions.

“While the study did not yield definitive data about the relative engagement potential of media alternatives it does provide a foundation for future research including  guidance related to participant profiles stimulus characteristics and data coding challenges.”

Link to article: www.udel.edu/cds/downloads/Mineo_J.AutismDev.Disord_2009.pdf

Wii vs.Standard Occupational Therapy for Children with Down Syndrome

Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome

Article published in Research in Developmental Disabilities, No.32 (2011) pages 312-321, by Yee-Pay Wuang, Ching-Sui Chiang, Chwen-Yng Su and Chih-Chung Wang in 2011.

This well written paper asks the question: do children with Down syndrome using Nintendo Wii compared with standard sensory-motor training by occupational therapists show differences in sensorimotor functions?

Three groups were created of children with Down syndrome and without comorbidities to populate two treatment conditions and a control. Fifty of the160 children who agreed to participate but were subsequently unable to attend the treatment sessions were assigned to the control group. The interventions were randomly assigned to children who received either Wii or SOT for one-hour sessions twice weekly for 24 weeks. Wii gameplay was compared with standard occupational therapy (SOT) treatments utilizing sensory integrative therapy, neurodevelopment treatment and perceptual-motor approach. The three groups’ outcomes were measured using the Bruininks-Oseretsky test of motor proficiency-second edition (BOT-2), the test of sensory integration function (TSIF) and the developmental test of visual motor integration (VMI).

Video games played with Wii showed significantly improved sensorimotor functions; both intervention conditions showed significant improvement over the control group.The Wii group outperformed SOT on three of eight BOT-2 subtests, six of seven TSIF subtests and both the VMI subtest measures. Statistically significant differences showed between both intervention groups and the control group. A moderate to large effect size was seen across all measures (Wii group vs. control) and across all measures except the BOT-2 strength subtest (SOT group vs. control group). Pre- and post-intervention analysis within groups showed the largest effect size for the Wii group, (14 of 17 pooled subtests).

Link to the article abstract: linkinghub.elsevier.com/retrieve/pii/S0891422210002404

The Floor-Board for Wii

 floor-board.com/default.aspx

Image from: floor-board.com


"The Floor-Board when used with the Nintendo Wii gaming console, Wii games, and Wii Balance Board^TM allows wheelchair and able body players to participate in exercises and games associated with the system."

To use the Floor Board, "set up a Wii system with Wii Fit, Wii Fit Plus or any game compatible for use with the Nintendo balance board. Set the Floor-Board on top of your balance board, then roll or step onto the Floor-Board and begin play. There's no need to remove the Floor-Board when switching between wheelchair and able-bodied players".

The inventor, Dave Rountree, came to Pitt Meadows, British Columbia, Canada after a spinal cord injury. He was motivated to figure out how to use the Nintendo Balance Board as a way for people in wheelchairs to access Nintendo Wii games. Dave has created and tested several prototypes of his Floor Board with good results.

The Floor Board is now available for $125 plus tax and shipping.

To see videos of the Floor Board in action: floor-board.com/Video.aspx

Canadian Exergaming Research Centre

Image from: Canadian Exergaming
Research Centre

Exergaming leverages the video game environment familiar to children by adding an element of exercise. Exergames use video screen technologies that require physical participation in contrast to traditional sedentary video games.
“The Canadian Exergaming Research Centre (CERC) features games such as i-Dance (a wireless, multi-player system) Wii Fit and Exerboards. The Centre is a collaboration between the University of Calgary’s Faculty of Kinesiology, Mount Royal College and the Foundations for the Future school. An innovative research project is hoping to discover whether the new generation of ‘exergames’ can really impact on youth fitness, and perhaps help with the growing incidence of obesity among Canadian youth.”


www.ucalgary.ca/exergaming/

Health & Social Benefits of Virtual Exercise Games in Adolescents with CP

This study, called the CP Fit ‘n Fun Project, is being conducted at Holland Bloorview Kids Rehabilitation Hospital in Toronto with researchers there, at the University of Toronto and elsewhere.

The goal is to see if exercise video games (exergames) will help engage teenagers with CP to increase their fitness and help with socializing.

For more information, link to pdf: www.neurodevnet.ca/sites/default/files/neurodevnet/download/Fehlings-Graham_OppInit2010_WebInfo_1.pdf

Fun and Games: Virtual Reality Turns the Work of Rehab into Play

Image from: http://www.oandp.com/

By Miki Fairley
Published in the May 2010 issue of The OandP EDGE, Your Resource for Orthotics & Prosthetics Information
http://www.oandp.com/edge/
This article reports on researching the applications of video gaming as rehabilitation tools. Three examples are given: adults with stroke, children with cerebral palsy and amputees.
As with any physical or occupational therapy, video game playing can help to show progress by stimulating the brain's natural tendency to repair itself (plasticity), and by muscle strengthening. Video games, when not too frustrating for patients, typically hold the player’s attention longer than traditional therapies. These two factors together may contribute to better functional outcomes. The author reports on improvements in hand function, speed and grip strength. Evidence strength is not rated.

Ablegamers



Image from http://www.ablegamers.com/

 "The AbleGamers Foundation is dedicated to bring greater accessibility in the digital entertainment space so that people with disabilities can gain a greater quality of life, and develop a rich social life that gaming can bring."
This site is for gamers with disabilities: people who play popular games but need alternate access to control them.
www.ablegamers.com/

Just games

Up to now, this blog has been for pediatric therapists interested in virtual rehabilitation. Topics included Wii-hab, virtual reality and remote use of the videoconference for rehabilitation (telerehabilitation, teleassessment, telepractice).

From now on: News on clinical game-based rehabilitation.
The focus is narrowing to video games such as Nintendo, Kinect, Move and multi-touch surfaces that are based on virtual or augmented reality or alternate ways of access and used clinically by therapists for children in rehabilitation.

Information on telerehabilitation can be found at:
http://sh-elearn.atutor.ca/go.php/32/content.php/cid/752/
http://sh-elearn.atutor.ca/go.php/32/content.php/cid/753/