A serious games platform for cognitive rehabilitation with preliminary evaluation

In recent years Serious Games have evolved substantially, solving problems in diverse areas. In particular, in Cognitive Rehabilitation, Serious Games assume a relevant role. Traditional cognitive therapies are often considered repetitive and discouraging for patients and Serious Games can be used to create more dynamic rehabilitation processes, holding patients' attention throughout the process and motivating them during their road to recovery. This paper reviews Serious Games and user interfaces in rehabilitation area and details a Serious Games platform for Cognitive Rehabilitation that includes a set of features such as: natural and multimodal user interfaces and social features (competition, collaboration, and handicapping) which can contribute to augment the motivation of patients during the rehabilitation process. The web platform was tested with healthy subjects. Results of this preliminary evaluation show the motivation and the interest of the participants by playing the games.- This work has been supported by FCT - Fundacao para a Ciencia e Tecnologia in the scope of the projects: PEst-UID/CEC/00319/2015 and PEst-UID/CEC/00027/2015. The authors would like to thank also all the volunteers that participated in the study

Evaluation of cervical posture improvement of children with cerebral palsy after physical therapy based on head movements and serious games

Background: This paper presents the preliminary results of a novel rehabilitation therapy for cervical and trunk control of children with cerebral palsy (CP) based on serious videogames and physical exercise. Materials: The therapy is based on the use of the ENLAZA Interface, a head mouse based on inertial technology that will be used to control a set of serious videogames with movements of the head. Methods: Ten users with CP participated in the study. Whereas the control group (n=5) followed traditional therapies, the experimental group (n=5) complemented these therapies with a series of ten sessions of gaming with ENLAZA to exercise cervical flexion-extensions, rotations and inclinations in a controlled, engaging environment. Results: The ten work sessions yielded improvements in head and trunk control that were higher in the experimental group for Visual Analogue Scale, Goal Attainment Scaling and Trunk Control Measurement Scale (TCMS). Significant differences (27% vs. 2% of percentage improvement) were found between the experimental and control groups for TCMS (p<0.05). The kinematic assessment shows that there were some improvements in the active and the passive range of motion. However, no significant differences were found pre- and post-intervention. Conclusions:Physical therapy that combines serious games with traditional rehabilitation could allow children with CP to achieve larger function improvements in the trunk and cervical regions. However, given the limited scope of this trial (n=10) additional studies are needed to corroborate this hypothesis

Custom-designed motion-based games for older adults: a review of literature in human-computer interaction

Many older adults, particularly persons living in senior residences and care homes, lead sedentary lifestyles, which reduces their life expectancy. Motion-based video games encourage physical activity and might be an opportunity for these adults to remain active and engaged; however, research efforts in the field have frequently focused on younger audiences and little is known about the requirements and benefits of motion-based games for elderly players. In this paper, we present an overview of motion-based video games and other interactive technologies for older adults. First, we summarize existing approaches towards the definition of motion-based video games – often referred to as exergames – and suggest a categorization of motion-based applications into active video games, exergames, and augmented sports. Second, we use this scheme to classify case studies addressing design efforts particularly directed towards older adults. Third, we analyze these case studies with a focus on potential target audiences, benefits, challenges in their deployment, and future design opportunities to investigate whether motion-based video games can be applied to encourage physical activity among older adults. In this context, special attention is paid to evaluation routines and their implications regarding the deployment of such games in the daily lives of older adults. The results show that many case studies examine isolated aspects of motion-based game design for older adults, and despite the broad range of issues in motion-based interaction for older adults covered by the sum of all research projects, there appears to be a disconnect between laboratory-based research and the deployment of motion-based video games in the daily lives of senior citizens. Our literature review suggests that despite research results suggesting various benefits of motion-based play for older adults, most work in the field of game design for senior citizens has focused on the implementation of accessible user interfaces, and that little is known about the long-term deployment of video games for this audience, which is a crucial step if these games are to be implemented in activity programs of senior residences, care homes, or in therapy

Visualization and Interaction Technologies in Serious and Exergames for Cognitive Assessment and Training: A Survey on Available Solutions and Their Validation

Exergames and serious games, based on standard personal computers, mobile devices and gaming consoles or on novel immersive Virtual and Augmented Reality techniques, have become popular in the last few years and are now applied in various research fields, among which cognitive assessment and training of heterogeneous target populations. Moreover, the adoption of Web based solutions together with the integration of Artificial Intelligence and Machine Learning algorithms could bring countless advantages, both for the patients and the clinical personnel, as allowing the early detection of some pathological conditions, improving the efficacy and adherence to rehabilitation processes, through the personalisation of training sessions, and optimizing the allocation of resources by the healthcare system. The current work proposes a systematic survey of existing solutions in the field of cognitive assessment and training. We evaluate the visualization and interaction technologies commonly adopted and the measures taken to fulfil the need of the pathological target populations. Moreover, we analyze how implemented solutions are validated, i.e. The chosen experimental designs, data collection and analysis. Finally, we consider the availability of the applications and raw data to the large community of researchers and medical professionals and the actual application of proposed solutions in the standard clinical practice. Despite the potential of these technologies, research is still at an early stage. Although the recent release of accessible immersive virtual reality headsets and the increasing interest on vision-based techniques for tracking body and hands movements, many studies still rely on non-immersive virtual reality (67.2%), mainly mobile and personal computers, and standard gaming tools for interactions (41.5%). Finally, we highlight that although the interest of research community in this field is increasingly higher, the sharing of dataset (10.6%) and implemented applications (3.8%) should be promoted and the number of healthcare structures which have successfully introduced the new technological approaches in the treatment of their host patients is limited (10.2%)

Enhancing Motivation in Physiotherapy for People with Parkinson’s Disease: An Exploration of Serious Games and Virtual Reality

Parkinson’s Disease (PD) is a degenerative disorder of the central nervous system that mainly affects the motor system. There is currently no cure for PD, although it is possible to slow down its progression and control its symptoms with medication, surgery and physiotherapy. Physical exercise is an essential component of the treatment, helping patients to stay active, maintain physical performance and stimulate cognitive function. One of the main problems is that patients are more vulnerable to apathy and lack of motivation, which affects their willingness to follow an exercises plan and maintain their quality of life. Therefore, the necessity to develop an effective tool that persuades and actively engages patients becomes evident. Persuasive Technology is defined as any interactive computing system designed to change a person’s attitudes or behaviors. Gamification has demonstrated successful results in healthcare by increasing physical activity levels. Moreover, treatment can take advantage of Serious Games by combining the physical exercise component with cognitive function stimulation. If well aligned with therapy these can be used as Persuasive Technology. Therefore, this dissertation aimed to tackle this challenge by studying a motivational approach to persuade People with PD to practice even more therapy exercises. The proposed solution is based on the exploration of Serious Games and Virtual Reality (VR), mainly to study and discover the best natural user interfaces that could be used. A collection of Serious Games was implemented under a preliminary study to determine which devices were more suited to use in the implementation of the motivational strategy. Afterwards, the solution was based on the development of two VR-based Serious Games, one using Kinect V2 and the other fully immersive with Oculus Quest 2. A human factors study was then designed, showing very positive results in the first evaluation phase before moving on to the final assessment with patients. The research produced conclusions about the devices to use, but also about the design process of these solutions, from non to fully immersive VR.A Doença de Parkinson é uma doença degenerativa do sistema nervoso central que afecta principalmente o sistema motor. Actualmente, não existe cura para a doença, embora seja possível abrandar a sua progressão e controlar os seus sintomas com medicação, cirurgia e fisioterapia. O exercício físico é um componente essencial do tratamento, que ajuda os doentes a manterem-se ativos, a manter o desempenho físico e a estimular a função cognitiva. Um dos principais problemas é que os doentes são mais vulneráveis à apatia e à falta de motivação, o que afeta a sua vontade de seguir um plano de exercícios e de manter a sua qualidade de vida. Por conseguinte, torna-se evidente a necessidade de desenvolver uma ferramenta eficaz que persuada e envolva ativamente os doentes. A Tecnologia Persuasiva é definida como qualquer sistema informático interativo concebido para alterar as atitudes ou os comportamentos de uma pessoa. A Gamificação demonstrou resultados de sucesso nos cuidados de saúde, aumentando os níveis de atividade física. Além disso, o tratamento pode tirar partido de Jogos Sérios, combinando a componente de exercício físico com a estimulação da função cognitiva. Se bem alinhados com a terapia, podem ser usados como Tecnologia Persuasiva. Assim, esta dissertação teve como objetivo enfrentar este desafio, estudando uma abordagem motivacional para persuadir as pessoas com a Doença de Parkinson a praticar ainda mais exercícios terapêuticos. A solução proposta baseia-se na exploração de Jogos Sérios e Realidade Virtual, principalmente para estudar e desenvolver as melhores interfaces de utilizador naturais que podem ser utilizadas. Foi implementada uma coleção de Jogos Sérios num estudo preliminar para determinar quais os dispositivos mais adequados para utilizar na implementação da estratégia motivacional. Posteriormente, a solução baseou-se no desenvolvimento de dois Jogos Sérios baseados em Realidade Virtual, um utilizando o Kinect V2 e o outro totalmente imersivo com o Oculus Quest 2. Foi então concebido um estudo de fatores humanos, com resultados muito positivos na primeira fase de avaliação, antes de passar à avaliação final com os pacientes. A investigação produziu conclusões sobre os dispositivos a utilizar, mas também sobre o processo de conceção destas soluções, desde a Realidade Virtual não imersiva até à totalmente imersiva

Development and implementation of technologies for physical telerehabilitation in Latin America:

La telerehabilitation ha surgido debido a la inclusión de tecnologías emergentes para la captura, transmisión, análisis y visualización de patrones de movimiento asociados a pacientes con trastornos músculo-esqueléticos. Esta estrategia permite llevar a cabo procesos de diagnóstico y tratamientos de rehabilitación a distancia. Este artículo presenta una revisión sistemática del desarrollo e implementación actual de las tecnologías de telerehabilitación en la región latinoamericana. El objetivo principal es explorar, a partir de la literatura científica reportada y fuentes divulgativas, si las tecnologías de telerehabilitación han logrado ser introducidas en esta región. Asimismo, este trabajo revela los prototipos actuales o sistemas que están en desarrollo o que ya están siendo usados. Se llevó a cabo una revisión sistemática, mediante dos búsquedas diferentes. La primera implicó una búsqueda bibliográfica rigurosa en los repositorios digitales científicos más relevantes en el área y la segunda incluyó proyectos y programas de telerehabilitación implementados en la región, encontrados a partir de una búsqueda avanzada en Google. Se encontró un total de 53 documentos de seis países (Colombia, Brasil, México, Ecuador, Chile y Argentina); la mayoría de ellos estaban enfocados en iniciativas académicas y de investigación para el desarrollo de prototipos tecnológicos para telerehabilitación de pacientes pediátricos y adultos mayores, afectados por deficiencias motoras o funcionales, parálisis cerebral, enfermedades neurocognitivas y accidente cerebrovascular. El análisis de estos documentos reveló la necesidad de un extenso enfoque integrado de salud y sistema social para aumentar la disponibilidad actual de iniciativas de telerehabilitación en la región latinoamericana.Telerehabilitation has arised by the inclusion of emerging technologies for capturing, transmitting, analyzing and visualizing movement patterns associated to musculoskeletal disorders. This therapeutic strategy enables to carry out diagnosis processes and provide rehabilitation treatments. This paper presents a systematic review of the current development and implementation of telerehabilitation technologies in Latin America. The main goal is to explore the scientific literature and dissemination sources to establish if such technologies have been introduced in this region. Likewise, this work highlights existing prototypes or systems that are to being used or that are still under development. A systematic search strategy was conducted by two different searches: the first one involves a rigorous literature search from the most relevant scientific digital repositories; the second one included telerehabilitation projects and programs retrieved by an advanced Google search. A total of 53 documents from six countries (Colombia, Brazil, Mexico, Ecuador, Chile and Argentina) were found. Most of them were focused on academic and research initiatives to develop in-home telerehabilitation technologies for pediatric and elderly populations affected by motor and functional impairment, cerebral palsy, neurocognitive disorders and stroke. The analysis of the findings revealed the need for a comprehensive approach that integrates health care and the social system to increase the current availability of telerehabilitation initiatives in Latin America

An interface to virtual environments for people who are blind using Wii technology - mental models and navigation

Accessible games, both for serious and for entertainment purposes, would allow inclusion and participation for those with disabilities. Research into the development of accessible games, and accessible virtual environments, is discussed. Research into accessible Virtual Environments has demonstrated great potential for allowing people who are blind to explore new spaces, reducing their reliance on guides, and aiding development of more efficient spatial maps and strategies. Importantly, Lahav and Mioduser (2005, 2008) have demonstrated that, when exploring virtual spaces, people who are blind use more and different strategies than when exploring real physical spaces, and develop relatively accurate spatial representations of them. The present paper describes the design, development and evaluation of a system in which a virtual environment may be explored by people who are blind using Nintendo Wii devices, with auditory and haptic feedback. The nature of the various types of feedback is considered, with the aim of creating an intuitive and usable system. Using Wii technology has many advantages, not least of which are that it is mainstream, readily available and cheap. The potential of the system for exploration and navigation is demonstrated. Results strongly support the possibilities of the system for facilitating and supporting the construction of cognitive maps and spatial strategies. Intelligent support is discussed. Systems such as the present one will facilitate the development of accessible games, and thus enable Universal Design and accessible interactive technology to become more accepted and widespread