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

The Possibilities of Kinect as an Access Device for People with Cerebral Palsy A Preliminary Study

Cerebral palsy (CP) is a general term for a group of permanent, nonprogressive movement disorders that cause physical disability in development, mainly in the areas of body movement but it might also affect intellectual capabilities. Among all this diversity of profiles, we find that, for some of them, access to a computer application is almost impossible in spite of the great variety of commercial devices based of different technologies. Kinect might be a viable possibility in order to facilitate access to games and computer applications that help users improve their skills or communication

The use and effect of video game design theory in the creation of game-based systems for upper limb stroke rehabilitation

Upper limb exercise is often neglected during post-stroke rehabilitation. Video games have been shown to be useful in providing environments in which patients can practise repetitive, functionally meaningful movements, and in inducing neuroplasticity. The design of video games is often focused upon a number of fundamental principles, such as reward, goals, challenge and the concept of meaningful play, and these same principles are important in the design of games for rehabilitation. Further to this, there have been several attempts for the strengthening of the relationship between commercial game design and rehabilitative game design, the former providing insight into factors that can increase motivation and engagement with the latter. In this article, we present an overview of various game design principles and the theoretical grounding behind their presence, in addition to attempts made to utilise these principles in the creation of upper limb stroke rehabilitation systems and the outcomes of their use. We also present research aiming to move the collaborative efforts of designers and therapists towards a model for the structured design of these games and the various steps taken concerning the theoretical classification and mapping of game design concepts with intended cognitive and motor outcomes

Multisensory learning in adaptive interactive systems

The main purpose of my work is to investigate multisensory perceptual learning and sensory integration in the design and development of adaptive user interfaces for educational purposes. To this aim, starting from renewed understanding from neuroscience and cognitive science on multisensory perceptual learning and sensory integration, I developed a theoretical computational model for designing multimodal learning technologies that take into account these results. Main theoretical foundations of my research are multisensory perceptual learning theories and the research on sensory processing and integration, embodied cognition theories, computational models of non-verbal and emotion communication in full-body movement, and human-computer interaction models. Finally, a computational model was applied in two case studies, based on two EU ICT-H2020 Projects, "weDRAW" and "TELMI", on which I worked during the PhD

Motion-Based Video Games for Older Adults in Long-Term Care

Older adults in residential care often lead sedentary lifestyles despite physical and cognitive activities being crucial for their well-being. Care facilities face the challenge of encouraging their residents to participate in leisure activities, but as the impact of age-related changes grows, few activities remain accessible. Video games in general – and motion-based games in particular – hold the promise of providing mental, physical and social stimulation for older adults. However, the accessibility of commercially available games for older adults is not considered during the development process. Therefore, many older adults are unable to obtain any of the benefits. In my dissertation, this issue is addressed through the development of motion-based game controls that specifically address the needs of older adults. The first part of this thesis lays the foundation by providing an overview of motion-based game interaction for older adults. The second part demonstrates the general feasibility of motion-based game controls for older adults, develops full-body motion-based and wheelchair-based game controls, and provides guidelines for accessible motion-based game interaction for institutionalized older adults. The third part of this thesis builds on these results and presents two case studies. Motion-based controls are applied and further evaluated in game design projects addressing the special needs of older adults in long-term care, with the first case study focusing on long-term player engagement and the role of volunteers in care homes, and the second case study focusing on connecting older adults and caregivers through play. The results of this dissertation show that motion-based game controls can be designed to be accessible to institutionalized older adults. My work also shows that older adults enjoy engaging with motion-based games, and that such games have the potential of positively influencing them by providing a physically and mentally stimulating leisure activity. Furthermore, results from the case studies reveal the benefits and limitations of computer games in long-term care. Fostering inclusive efforts in game design and ensuring that motion-based video games are accessible to broad audiences is an important step toward allowing all players to obtain the full benefits of games, thereby contributing to the quality of life of diverse audiences

Advanced displays and natural user interfaces to support learning

[EN] Advanced displays and Natural User Interfaces (NUI) are a very suitable combination for developing systems to provide an enhanced and richer user experience. This combination can be appropriate in several fields and has not been extensively exploited. One of the fields that this combination is especially suitable for is education. Nowadays, children are growing up playing with computer games, using mobile devices, and other technological devices. New learning methods that use these new technologies can help in the learning process. In this paper, two new methods that use advanced displays and NUI for learning about a period of history are presented. One of the methods is an autostereoscopic system that lets children see themselves as a background in the game and renders the elements in 3D without the need for special glasses; the second method is a frontal projection system that projects the image on a table in 2D and works similarly to a touch table. The Microsoft Kinect© is used in both systems for the interaction. A comparative study to check different aspects was carried out. A total of 128 children from 7 to 11 years old participated in the study. From the results, we observed that the different characteristics of the systems did not influence the children s acquired knowledge, engagement, or satisfaction. There were statistically significant differences for depth perception and presence in which the autostereoscopic system was scored higher. However, of the two systems, the children considered the frontal projection to be easier to use. We would like to highlight that the scores for the two systems and for all the questions were very high. These results suggest that games of this kind (advanced displays and NUI) could be appropriate educational games and that autostereoscopy is a technology to exploit in their development.This work was funded by the Spanish Ministry of Science and Innovation through the APRENDRA project (TIN2009-14319-C02-01).Martín San José, JF.; Juan, M.; Mollá Vayá, RP.; Vivó Hernando, RA. (2017). Advanced displays and natural user interfaces to support learning. Interactive Learning Environments. https://doi.org/10.1080/10494820.2015.1090455

DESIGNING BETTER EXERGAMES: APPLICATION OF FLOW CONCEPTS AND THE FITT PRINCIPLE TO FULL BODY EXERTION VIDEO GAMES AND FLEXIBLE CHALLENGE SYSTEMS

Exercise video games have a recognized potential for widespread use as tools for effective exercise. Current exergames do not consistently strike a successful balance between the “fun gameplay” and “effective exercise” aspects of the ideal exergame. Our research into the design of better exergames applies existing gameflow research and established exercise guidelines, such as those published by the American College of Sports Medicine, to a collection of four custom exergames: Astrojumper, Washboard, Sweet Harvest and Legerdemain implement full-body motion mechanics that support different types of exercise, and vary in intended duration of play, game complexity, and level of physical challenge. Each game also implements a difficulty adjustment system that detects player performance from in-game data and dynamically adjusts game difficulty, in order to balance between a player’s fitness level and the physical challenge presented by the game. We have evaluated the games produced by our design approach through a series of user studies on players’ physiological and psychological responses to gameplay, finding that balance between challenge types (cognitive or physical) is an important consideration along with challenge-skill balance, and further, that game mechanics able to support creativity of movement are an effective means of bridging between gameplay and exercise in order to improve the player experience

The use of Analog and Digital Games for Autism Interventions

Many interventions that target improvements in social communication and other cognitive, learning, and physical issues have been developed to help autistic people. The gamification of interventions offers an alternative approach to fostering and assessing desired behaviors and cognitions in a more naturalistic and emergent setting. In this scoping review aimed at educators, practitioners, and parents of those with autism, we detail studies that have tested game-based approaches to improving the lives of autistic children, adolescents, and adults, focusing on how research into gamification and autism can both progress and can be progressed and implemented. We offer parents, professionals and academics resources to incorporate game-based psycho-educational programs into their current practice