The Use of digital games to enhance the physical exercise activity of the elderly : a case of Finland

According to the World Health Organization (WHO), population ageing is a global phenomenon, which brings both challenges and opportunities for society. The current longer expected lifespan can create opportunities for the elderly to contribute in many ways to their families and communities. However, it greatly depends on their quality of life, which is affected by many factors, including physical and functional health, social well-being, and cognitive abilities. The WHO (2012) states that physical health is one of the indicators for the elderly’s quality of life, and it declines with increasing age. Participation in regular physical exercises can help the elderly improve their physical and mental health, and this has been aided by the use of modern technologies to promote the elderly’s physical and functional health. Of these latest technologies, digital games have shown promise to improve and enhance the elderly’s physical activities through fun and engaging gameplay. The literature highlights that some commercial games in the market (e.g. Microsoft Kinect- Sports and Nintendo Wii Sports games) have the potential to improve the elderly’s physical health such as gait, balance, and fall prevention. However, researchers argue that these commercial games are not designed specifically for the elderly and their physical exercise activities. They state that most commercial games are not user-friendly for the elderly whose functional and physical abilities are limited due to their advanced years. The literature points out that more studies need to be undertaken to understand the usability and usefulness of digital games for physical exercise activities so that game designers can create elderly-friendly digital games in the future. In Finland, the government has been focusing on promoting healthy ageing and increasing home care services for the elderly. In recent years, Finnish researchers have used digital games to promote older Finns’ healthy and active ageing. The existing literature, whilst showing the potential of digital games for elderly Finns’ physical health, also acknowledges further research is needed particularly in the context of Finland. Thus, in this study, we aimed at investigating digital games to specifically assess their applications for older Finns’ physical activities, focusing on the quality of users’ experiences, and their reported ease of use and perceived usefulness. We used the mixed methods approach, which applies both qualitative and quantitative research methods. The study design included four stages: requirements gathering, analysis and design, prototyping, and evaluation. Firstly, we conducted pre-studies to elicit users’ requirements. This was followed by the analysis of the resulting data to identify trends and patterns, which fuelled ideas in the brainstorming game design and development phases. The final product was a digital game-based physical exercise called the Skiing Game. We then evaluated the Skiing Game in Finland with 21 elderly Finns (M=7, F=14, Average Age =76). By using questionnaires, observation, and interviews, we investigated user experiences, focusing on the game’s usability, and usefulness for enhancing the physical activity and wellbeing of the elderly. We also conducted a comparative test of the Skiing Game in Japan with 24 elderly Japanese participants (M=12, F=12, Average Age = 72) to further understand non-Finnish elderly users’ experiences. The findings from the usability study of the Skiing Game in Finland demonstrated that elderly Finns had a positive experience in the gameplay, and their motivation was noticeably high. It also confirmed that elderly Finns have a genuine interest in digital game-based exercises and strong intentions to play digital games as a form of physical exercise in the future. Although prior to the study most of them had negative views and misconceptions about digital games, after the gameplay their attitudes were decidedly positive. They acknowledged that whilst playing digital games could be an alternative way of exercising for them their use would primarily be when they don’t have access to their usual non-digital physical exercise. The Japanese usability of the Skiing Game showed that the elderly Japanese people also had positive user experiences in playing digital games, and also intend to use them in the future. Similarly, after playing the game they reported that their attitudes towards digital games become positive, and indicated playing digital games could be an alternative way of exercising. Although the comparison of the two studies suggests that the elderly Finns had relatively more positive experiences whilst playing the Skiing Game, compared to their Japanese counterparts, in general, both groups had a positive experience in the gameplay and showed interest in digital games as an alternative exercise. Based on the usability lessons learned from these two studies, recommendations for practitioners and designers regarding improvements in game design and development are made in this report. Implementing these modifications into future designs and further development of digital games for the elderly will improve their commercial viability and user uptake. The findings from this study can provide valuable insights, particularly for Finnish policymakers and healthcare practitioners who are keen to introduce digital games into the aged-care sector in Finland. The studies have also provided valuable insights into the optimal methods for introducing Finnish digital games to international markets, in particular, digital games tailored specifically for the physical exercise needs and motivations of the elderly. By taking into consideration the limitations of the study, we provide our future studies and further improvements of the game to be conducted

Flexible Virtual Reality System for Neurorehabilitation and Quality of Life Improvement

As life expectancy is mostly increasing, the incidence of many neurological disorders is also constantly growing. For improving the physical functions affected by a neurological disorder, rehabilitation procedures are mandatory, and they must be performed regularly. Unfortunately, neurorehabilitation procedures have disadvantages in terms of costs, accessibility and a lack of therapists. This paper presents Immersive Neurorehabilitation Exercises Using Virtual Reality (INREX-VR), our innovative immersive neurorehabilitation system using virtual reality. The system is based on a thorough research methodology and is able to capture real-time user movements and evaluate joint mobility for both upper and lower limbs, record training sessions and save electromyography data. The use of the first-person perspective increases immersion, and the joint range of motion is calculated with the help of both the HTC Vive system and inverse kinematics principles applied on skeleton rigs. Tutorial exercises are demonstrated by a virtual therapist, as they were recorded with real-life physicians, and sessions can be monitored and configured through tele-medicine. Complex movements are practiced in gamified settings, encouraging self-improvement and competition. Finally, we proposed a training plan and preliminary tests which show promising results in terms of accuracy and user feedback. As future developments, we plan to improve the system's accuracy and investigate a wireless alternative based on neural networks.Comment: 47 pages, 20 figures, 17 tables (including annexes), part of the MDPI Sesnsors "Special Issue Smart Sensors and Measurements Methods for Quality of Life and Ambient Assisted Living

Applied Games for smart phenotypic data acquisition - challenges of a web platform with digital gamified testing instruments for online-based large scale phenotyping

Since more than five decades, the replication crisis taints the field of psychological science. Small sample sizes and low statistical power are the identified issues, resulting in a staggering amount of results from studies that can not be replicated. Combating this crisis requires new and scalable approaches that enable innovative testing instruments. Gamification and Applied Games offer those crucial and innovative new ways to assess cognition in an online setting. On the basis of two original research objects, this thesis highlights the challenges, obstacles and benefits from utilizing gamification and applied games for large-scale phenotypic measurements on the basis of an online platform called COSMOS. First, we applied this concept in the form of our established platform COSMOS which we presented in a published paper. In this paper, we purposed a digital psychometric toolkit in the guise of applied games that enables automatized psychometric data collection while measuring a broad range of cognitive functions. Second, we conducted a pilot study that assessed the feasibility and acceptance of a gamified test of the N-back task called HoNk-Back. We showed that participants like the HoNk-Back more than the non-gamified N-back and are more likely to replay the HoNk-Back again. Both the paper and the pilot study point out the benefits of using gamification and applied games for large-scale neurocognitive phenotype cohort screenings for genetic and imaging studies. The challenges and hurdles for future studies regarding data protection, data security and ethics in the online acquisition of personal data are identified and discussed

A RGBD-Based interactive system for gaming-driven rehabilitation of upper limbs

Current physiotherapy services may not be effective or suitable for certain patients due to lack of motivation, poor adherence to exercises, insufficient supervision and feedback or, in the worst case, refusal to continue with the rehabilitation plan. This paper introduces a novel approach for rehabilitation of upper limbs through KineActiv, a platform based on Microsoft Kinect v2 and developed in Unity Engine. KineActiv proposes exergames to encourage patients to perform rehabilitation exercises prescribed by a specialist, controls the patient's performance, and corrects execution errors on the fly. KineActiv comprises a web platform where the physiotherapist can review session results, monitor patient health, and adjust rehabilitation routines. We recruited 10 patients for assessing the system usability as well as the system performance. Results show that KineActiv is a usable, enjoyable and reliable system, that does not cause any negative feelings

A comparison between expert and beginner learning for motor skill development in a virtual reality serious game

In order to be used for skill development and skill maintenance, virtual environments require accurate simulation of the physical phenomena involved in the process of the task being trained. The accuracy needs to be conveyed in a multimodal fashion with varying parameterisations still being quantified, and these are a function of task, prior knowledge, sensory efficacy and human perception. Virtual reality (VR) has been integrated from a didactic perspective in many serious games and shown to be effective in the pedological process. This paper interrogates whether didactic processes introduced into a VR serious game, by taking advantage of augmented virtuality to modify game attributes, can be effective for both beginners and experts to a task. The task in question is subjective performance in a clay pigeon shooting simulation. The investigation covers whether modified game attributes influence skill and learning in a complex motor task and also investigates whether this process is applicable to experts as well as beginners to the task. VR offers designers and developers of serious games the ability to provide information in the virtual world in a fashion that is impossible in the real world. This introduces the question of whether this is effective and transfers skill adoption into the real world and also if a-priori knowledge influences the practical nature of this information in the pedagogic process. Analysis is conducted via a between-subjects repeated measure ANOVA using a 2 \backslashtimes 22×2factorial design to address these questions. The results show that the different training provided affects the performance in this task ($$N=57$$N=57). The skill improvement is still evidenced in repeated measures when information and guidance is removed. This effect does not exist under a control condition. Additionally, we separate by an expert and non-expert group to deduce if a-priori knowledge influences the effect of the presented information, it is shown that it does not

Mobile services for green living

A thesis submitted in partial fulfillment of the requirements for the degree of Doctor in Information Management, specialization in Geographic Information SystemsUrban cycling is a sustainable transport mode that many cities are promoting. However, few cities are taking advantage of geospatial technologies to represent and analyse behavioural patterns and barriers faced during cycling. This thesis is within the fields of geoinformatics and serious games, and the motivation came from our desire to help both citizens and cities to better understand cyclist behaviour and mobility patterns. We attempted to learn more about the impact of gamified strategies on engagement with cycling, the reasons for choosing between mobile cycling applications and the way such applications would provide commuting information. Furthermore, we explored the potential benefits of offering tools to build decision-making for mobility more transparent, to increase cycling data availability, and to analyse commuting patterns. In general, we found our research useful to enhance green living actions by increasing citizens’ willingness to commute by bicycle or communicating cycling conditions in cities. For urban cycling, data coming from mobile phones can provide a better assessment and enrich the analysis presented in traditional mobility plans. However, the diversity of current mobile applications targeting cyclists does not provide useful data for analysing commuter (inner-city, non-sporting) cycling. Just a few cyclists are adopting these applications as part of their commuting routine, while on the other hand cities are lacking a valuable source of constantly updated cycling information helpful to understand cycling patterns and the role of bicycles in urban transport. This thesis analyses how the incentives of location-based games or geo-games might increase urban cycling engagement and, through this engagement, crowdsource cycling data collection to allow cities to better comprehend cycling patterns. Consequently, the experiment followed a between-groups design to measure the impact of virtual rewards provided by the Cyclist Geo-c application on the levels of intention, satisfaction, and engagement with cycling. Then, to identify the frictions which potentially inhibit bicycle commuting, we analysed the bicycle trips crowdsourced with the geo-game. Our analysis relied on a hexagonal grid of 30-metre cell side to aggregate trip trajectories, calculate the friction intensity and locate the frictions. The thesis reports on the results of an experiment which involved a total of 57 participants in three European cities: M¨unster (Germany), Castell ´o (Spain), and Valletta (Malta). We found participants reported higher satisfaction and engagement with cycling during the experiment in the collaboration condition. However, we did not find a significant impact on the participants’ worldview when it comes to the intentions to start or increase cycling. The results support the use of collaboration-based rewards in the design of game-based applications to promote urban cycling. Furthermore, we validated a procedure to identify not only the cyclists’ preferred streets but also the frictions faced during cycling analysing the crowdsourced trips. We successfully identified 284 places potentially having frictions: 71 in M¨unster, Germany; 70 in Castell ´ o, Spain; and 143 in Valletta, Malta. At such places, participants recorded trip segments at speeds below 5 Km/h indicating a deviation from a hypothetical scenario with a constant cycling speed. This thesis encompasses the cyclist and city perspectives of offering virtual incentives in geo-games and crowdsourcing cycling data collection to better comprehend cycling conditions in cities. We also compiled a set of tools and recommendations for researchers, practitioners, mobile developers, urban planners and cyclist associations interested in fostering sustainable transport and the use of bicycles

Using brain-computer interaction and multimodal virtual-reality for augmenting stroke neurorehabilitation

Every year millions of people suffer from stroke resulting to initial paralysis, slow motor recovery and chronic conditions that require continuous reha bilitation and therapy. The increasing socio-economical and psychological impact of stroke makes it necessary to find new approaches to minimize its sequels, as well as novel tools for effective, low cost and personalized reha bilitation. The integration of current ICT approaches and Virtual Reality (VR) training (based on exercise therapies) has shown significant improve ments. Moreover, recent studies have shown that through mental practice and neurofeedback the task performance is improved. To date, detailed in formation on which neurofeedback strategies lead to successful functional recovery is not available while very little is known about how to optimally utilize neurofeedback paradigms in stroke rehabilitation. Based on the cur rent limitations, the target of this project is to investigate and develop a novel upper-limb rehabilitation system with the use of novel ICT technolo gies including Brain-Computer Interfaces (BCI’s), and VR systems. Here, through a set of studies, we illustrate the design of the RehabNet frame work and its focus on integrative motor and cognitive therapy based on VR scenarios. Moreover, we broadened the inclusion criteria for low mobility pa tients, through the development of neurofeedback tools with the utilization of Brain-Computer Interfaces while investigating the effects of a brain-to-VR interaction.Todos os anos, milho˜es de pessoas sofrem de AVC, resultando em paral isia inicial, recupera¸ca˜o motora lenta e condic¸˜oes cr´onicas que requerem re abilita¸ca˜o e terapia cont´ınuas. O impacto socioecon´omico e psicol´ogico do AVC torna premente encontrar novas abordagens para minimizar as seque las decorrentes, bem como desenvolver ferramentas de reabilita¸ca˜o, efetivas, de baixo custo e personalizadas. A integra¸c˜ao das atuais abordagens das Tecnologias da Informa¸ca˜o e da Comunica¸ca˜o (TIC) e treino com Realidade Virtual (RV), com base em terapias por exerc´ıcios, tem mostrado melhorias significativas. Estudos recentes mostram, ainda, que a performance nas tare fas ´e melhorada atrav´es da pra´tica mental e do neurofeedback. At´e a` data, na˜o existem informac¸˜oes detalhadas sobre quais as estrat´egias de neurofeed back que levam a uma recupera¸ca˜o funcional bem-sucedida. De igual modo, pouco se sabe acerca de como utilizar, de forma otimizada, o paradigma de neurofeedback na recupera¸c˜ao de AVC. Face a tal, o objetivo deste projeto ´e investigar e desenvolver um novo sistema de reabilita¸ca˜o de membros supe riores, recorrendo ao uso de novas TIC, incluindo sistemas como a Interface C´erebro-Computador (ICC) e RV. Atrav´es de um conjunto de estudos, ilus tramos o design do framework RehabNet e o seu foco numa terapia motora e cognitiva, integrativa, baseada em cen´arios de RV. Adicionalmente, ampli amos os crit´erios de inclus˜ao para pacientes com baixa mobilidade, atrav´es do desenvolvimento de ferramentas de neurofeedback com a utilizac¸˜ao de ICC, ao mesmo que investigando os efeitos de uma interac¸˜ao c´erebro-para-RV

Effective gamification of the stop-signal task: Two controlled laboratory experiments

BACKGROUND A lack of ability to inhibit prepotent responses, or more generally a lack of impulse control, is associated with several disorders such as attention-deficit/hyperactivity disorder and schizophrenia as well as general damage to the prefrontal cortex. A stop-signal task (SST) is a reliable and established measure of response inhibition. However, using the SST as an objective assessment in diagnostic or research-focused settings places significant stress on participants as the task itself requires concentration and cognitive effort and is not particularly engaging. This can lead to decreased motivation to follow task instructions and poor data quality, which can affect assessment efficacy and might increase drop-out rates. Gamification-the application of game-based elements in nongame settings-has shown to improve engaged attention to a cognitive task, thus increasing participant motivation and data quality. OBJECTIVE This study aims to design a gamified SST that improves participants' engagement and validate this gamified SST against a standard SST. METHODS We described the design of our gamified SST and reported on 2 separate studies that aim to validate the gamified SST relative to a standard SST. In study 1, a within-subject design was used to compare the performance of the SST and a stop-signal game (SSG). In study 2, we added eye tracking to the procedure to determine if overt attention was affected and aimed to replicate the findings from study 1 in a between-subjects design. Furthermore, in both studies, flow and motivational experiences were measured. RESULTS In contrast, the behavioral performance was comparable between the tasks (P<.87; BF01=2.87), and the experience of flow and intrinsic motivation were rated higher in the SSG group, although this difference was not significant. CONCLUSIONS Overall, our findings provide evidence that the gamification of SST is possible and that the SSG is enjoyed more. Thus, when participant engagement is critical, we recommend using the SSG instead of the SST