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