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