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.