Health Ninjas: A Personalized Biofeedback Game to Teach Children Deep Breathing and Nutrition Knowledge

Children’s wellbeing has been regarded as one of the primary focus of public health. Among all of the factors which have huge impacts on children’s wellbeing, stress has been given a primary priority and is the one which has lifelong effects. Deep breathing is an established and evidence-based strategy for reducing stress and it has been integrated with biofeedback techniques to help adults regulate their stress. While all these biofeedback games are effective to teach adults self-regulation skills while emerged in a stressful environment, however, they are not likely to be applicable to children. Thus more could be gained if a biofeedback game typically designed for children could take consideration of child’s characteristics and capability, and meanwhile provide necessary guidance and instructions. We developed a personalized biofeedback game – Health Ninjas as a game-like intervention to teach children deep breathing and nutrition knowledge in an effective and fun way. To the best of knowledge, Health Ninjas is the first game that integrates self-regulation training with nutrition education. Health Ninjas incorporates calibration function which calculates “personalized” target breathing rate within the child’s capability, and more importantly, provides intuitive visualization of desired breathing patterns for the child to follow. Additionally, Health Ninjas incorporates nutrition education to help children better discriminate between healthy and junk food. Health Ninjas includes three game scenarios: Direct Biofeedback mode, Indirect Biofeedback mode and Control mode. We conducted two comparative studies: one study aims at testing whether children are able to follow subtle biofeedback cues or need a more explicit feedback; the other study aims to test whether playing our nutrition education game changes children’s perception of healthy vs. junk foods. Our results indicated that children need a more explicit and intuitive biofeedback strategy to better perform the desired behaviors

Health Ninjas: A Personalized Biofeedback Game to Teach Children Deep Breathing and Nutrition Knowledge

Children’s wellbeing has been regarded as one of the primary focus of public health. Among all of the factors which have huge impacts on children’s wellbeing, stress has been given a primary priority and is the one which has lifelong effects. Deep breathing is an established and evidence-based strategy for reducing stress and it has been integrated with biofeedback techniques to help adults regulate their stress. While all these biofeedback games are effective to teach adults self-regulation skills while emerged in a stressful environment, however, they are not likely to be applicable to children. Thus more could be gained if a biofeedback game typically designed for children could take consideration of child’s characteristics and capability, and meanwhile provide necessary guidance and instructions. We developed a personalized biofeedback game – Health Ninjas as a game-like intervention to teach children deep breathing and nutrition knowledge in an effective and fun way. To the best of knowledge, Health Ninjas is the first game that integrates self-regulation training with nutrition education. Health Ninjas incorporates calibration function which calculates “personalized” target breathing rate within the child’s capability, and more importantly, provides intuitive visualization of desired breathing patterns for the child to follow. Additionally, Health Ninjas incorporates nutrition education to help children better discriminate between healthy and junk food. Health Ninjas includes three game scenarios: Direct Biofeedback mode, Indirect Biofeedback mode and Control mode. We conducted two comparative studies: one study aims at testing whether children are able to follow subtle biofeedback cues or need a more explicit feedback; the other study aims to test whether playing our nutrition education game changes children’s perception of healthy vs. junk foods. Our results indicated that children need a more explicit and intuitive biofeedback strategy to better perform the desired behaviors

Nature vs. Stress: Investigating the Use of Biophilia in Non-Violent Exploration Games to Reduce Stress

Games hold the potential to help many address health-related issues such as chronic stress. We investigated the use of biophilia, an affective response to nature grounded in the psychology literature, as indirect physiological input for biofeedback games. We designed and developed a non-violent exploration game, and conducted an empirical study that examined affective and physiological responses to gameplay in virtual nature and urban settings. Our results did not identify a difference in stress levels experienced by players between these two settings, but point to improved attention when playing in nature settings. We discuss implications of these findings, and discuss both difficulties in and potential future strategies for applying biophilia to the design of biofeedback games

Live Biofeedback as a User Interface Design Element: A Review of the Literature

With the advances in sensor technology and real-time processing of neurophysiological data, a growing body of academic literature has begun to explore how live biofeedback can be integrated into information systems for everyday use. While researchers have traditionally studied live biofeedback in the clinical domain, the proliferation of affordable mobile sensor technology enables researchers and practitioners to consider live biofeedback as a user interface element in contexts such as decision support, education, and gaming. In order to establish the current state of research on live biofeedback, we conducted a literature review on studies that examine self and foreign live biofeedback based on neurophysiological data for healthy subjects in an information systems context. By integrating a body of highly fragmented work from computer science, engineering and technology, information systems, medical science, and psychology, this paper synthesizes results from existing research, identifies knowledge gaps, and suggests directions for future research. In this vein, this review can serve as a reference guide for researchers and practitioners on how to integrate self and foreign live biofeedback into information systems for everyday use

Physiological Self Regulation with Biofeedback Games

Mental stress is a global epidemic that can have serious health consequences including cardiovascular diseases and diabetes. Several techniques are available to teach stress self-regulation skills including therapy, meditation, deep breathing, and biofeedback. While effective, these methods suffer from high drop-outs due to the monotonic nature of the exercises and are generally practiced in quiet relaxed environment, which may not transfer to real-world scenarios. To address these issues, this dissertation presents a novel intervention for stress training using games and wearable sensors. The approach consists of monitoring the user’s physiological signals during gameplay, mapping them into estimates of stress levels, and adapting the game in a way that promotes states of low arousal. This approach offers two key advantages. First, it allows users to focus on the gameplay rather than on monitoring their physiological signals, which makes the training far more engaging. More importantly, it teaches users to self-regulate their stress response, while performing a task designed to increase arousal. Within this broad framework, this dissertation studies three specific problems. First, the dissertation evaluates three physiological signals (breathing rate, heart rate variability, and electrodermal activity) that span across the dimensions of degrees of selectivity in measuring arousal and voluntary control in their effectiveness in lowering arousal. This will identify the signal appropriate for game based stress training and the associated bio-signal processing techniques for real-time arousal estimation. Second, this dissertation investigates different methods of biofeedback presentation e.g. visual feedback and game adaptation during gameplay. Selection of appropriate biofeedback mechanism is critical since it provides the necessary information to improve the perception of visceral states (e.g. stress) to the user. Furthermore, these modalities facilitate skill acquisition in distinct ways (i.e., top-down and bottom-up learning) and influence retention of skills. Third, this dissertation studies reinforcement scheduling in a game and its effect on skill learning and retention. A reinforcement schedule determines which occurrences of the target response are reinforced. This study focuses on continuous and partial reinforcement schedules in GBF and their effect on resistance to extinction (i.e. ability to retain learned skills) after the biofeedback is removed. The main contribution of this dissertation is in demonstrating that stress self-regulation training can be embedded in videogames and help individuals develop more adaptive responses to reduce physiological stress encountered both at home and work

A Design Exploration of Affective Gaming

Physiological sensing has been a prominent fixture in games user research (GUR) since the late 1990s, when researchers began to explore its potential to enhance and understand experience within digital game play. Since these early days, it has been widely argued that “affective gaming”—in which gameplay is influenced by a player’s emotional state—can enhance player experience by integrating physiological sensors into play. In this thesis, I conduct a design exploration of the field of affective gaming by first, systematically exploring the field and creating a framework (the affective game loop) to classify existing literature; and second by presenting two design probes, to probe and explore the design space of affective games contextualized within the affective game loop: In the Same Boat and Commons Sense. The systematic review explored this unique design space of affective gaming, opening up future avenues for exploration. The affective game loop was created as a way to classify the physiological signals and sensors most commonly used in prior literature within the context of how they are mapped into the gameplay itself. Findings suggest that the physiological input mappings can be more action-based (e.g., affecting mechanics in the game such as the movement of the character) or more context-based (e.g., affecting things like environmental or difficulty variables in the game). Findings also suggested that while the field has been around for decades, there is still yet to be any commercial successes, so does physiological interaction really heighten player experience? This question instigated the design of the two probes, exploring ways to implement these mappings and effectively heighten player experience. In the Same Boat (Design Probe One) is an embodied mirroring game designed to promote an intimate interaction, using players’ breathing rate and facial expressions to control movement of a canoe down a river. Findings suggest that playing In the Same Boat fostered the development of affiliation between the players, and that while embodied controls were less intuitive, people enjoyed them more, indicating the potential of embodied controls to foster social closeness in synchronized play over a distance. Commons Sense (Design Probe Two) is a communication modality intended to heighten audience engagement and effectively capture and communicate the audience experience, using a webcam-based heart rate detection software that takes an average of each spectator’s heart rate as input to affect in-game variables such as lighting and sound design, and game difficulty. Findings suggest that Commons Sense successfully facilitated the communication of audience response in an online entertainment context—where these social cues and signals are inherently diminished. In addition, Commons Sense is a communication modality that can both enhance a play experience while offering a novel way to communicate. Overall, findings from this design exploration shows that affective games offer a novel way to deliver a rich gameplay experience for the player

Physiological Self Regulation with Biofeedback Games

Mental stress is a global epidemic that can have serious health consequences including cardiovascular diseases and diabetes. Several techniques are available to teach stress self-regulation skills including therapy, meditation, deep breathing, and biofeedback. While effective, these methods suffer from high drop-outs due to the monotonic nature of the exercises and are generally practiced in quiet relaxed environment, which may not transfer to real-world scenarios. To address these issues, this dissertation presents a novel intervention for stress training using games and wearable sensors. The approach consists of monitoring the user’s physiological signals during gameplay, mapping them into estimates of stress levels, and adapting the game in a way that promotes states of low arousal. This approach offers two key advantages. First, it allows users to focus on the gameplay rather than on monitoring their physiological signals, which makes the training far more engaging. More importantly, it teaches users to self-regulate their stress response, while performing a task designed to increase arousal. Within this broad framework, this dissertation studies three specific problems. First, the dissertation evaluates three physiological signals (breathing rate, heart rate variability, and electrodermal activity) that span across the dimensions of degrees of selectivity in measuring arousal and voluntary control in their effectiveness in lowering arousal. This will identify the signal appropriate for game based stress training and the associated bio-signal processing techniques for real-time arousal estimation. Second, this dissertation investigates different methods of biofeedback presentation e.g. visual feedback and game adaptation during gameplay. Selection of appropriate biofeedback mechanism is critical since it provides the necessary information to improve the perception of visceral states (e.g. stress) to the user. Furthermore, these modalities facilitate skill acquisition in distinct ways (i.e., top-down and bottom-up learning) and influence retention of skills. Third, this dissertation studies reinforcement scheduling in a game and its effect on skill learning and retention. A reinforcement schedule determines which occurrences of the target response are reinforced. This study focuses on continuous and partial reinforcement schedules in GBF and their effect on resistance to extinction (i.e. ability to retain learned skills) after the biofeedback is removed. The main contribution of this dissertation is in demonstrating that stress self-regulation training can be embedded in videogames and help individuals develop more adaptive responses to reduce physiological stress encountered both at home and work

Understanding and Supporting Decision-Making in Electronic Auctions: A NeuroIS Approach

Making use of the potential of NeuroIS, I apply a NeuroIS approach in this thesis to further the understanding of decision-making and to analyze the opportunities for NeuroIS in decision-support, both in electronic auctions

Database of Video Games and Their Therapeutic Properties

There are reported to be 2.96 billion video game players in the world as of 2021 and this number is expected to grow to 3.32 billion by the year 2024. Of that total, 215.5 million video game players live in the United States with a reported average age of 33 years old. Thousands of commercial video games are released every year. There is evidence to support video game technology use as therapeutic media however it predominately utilizes outdated technology or technology designed for a specific purpose also called “serious games.” The problem is that OT practitioners are unaware of the potential therapeutic properties of video games they have not played, so are unable to integrate unfamiliar video games as therapeutic media in clinical practice. The purpose of this capstone project is to develop an online database of commercial video games, and their therapeutic properties, to facilitate their use as therapeutic media in OT practice. To address this problem a webpage was developed in partnership with the Family Gaming Database that cataloged 10 commercial video games from commercially available video game subscription services and the Nintendo Switch. The 10 games were subject to an activity analysis based on the AMPS to determine their therapeutic potential. The resulting webpage contains three main lists in which filters can be applied in order to display games that meet a specific desired criterion. Applicable filters include platform, age rating, difficulty, and specific accessibility features. Keywords: database, occupational therapy, video game, video game

Kessel Run: towards emotion adaptation in a BCI multiplayer game

Tese de mestrado integrado, Engenharia Biomédica e Biofísica (Sinais e Imagens Médicas) Universidade de Lisboa, Faculdade de Ciências, 2017O objetivo original de uma Interface Cerebro-Máquina (BCI, do inglês Brain-Computer Interface) é o restauro de função a portadores de deficiências motoras, com aplicações que abrangem desde o mover de um cursor de computador ou de uma cadeira de rodas, a dispositivos complexos de soletração que substituem a fala. No entanto, com o recente aparecimento no mercado de aparelhos de BCI portáteis e económicos, as aplicações de BCI têm vindo a migrar lentamente para áreas fora do âmbito da saúde, como é o caso do entretenimento. Em particular, o desenvolvimento de videojogos em que os modos de interação tradicionais (teclado ou botões, por exemplo) são substituídos por controlos BCI é uma aposta frequente em vários grupos de investigação em neurociências. O uso de paradigmas de BCI como controladores de jogos tem a capacidade de não só possibilitar novos meios de interação mais intuitivos (como é o caso de apenas pensar em mover a personagem do jogo, em vez de pressionar o botão que a move), mas também de criar novos mecanismos de jogo que não são possíveis com dispositivos tradicionais. Para a criação destes novos mecanismos a Computação Afetiva é de relativo interesse, já que esta é a área de investigação encarregue de encontrar relações entre o estado emocional de um sujeito, através de BCIs, por exemplo, e utilizá-las para melhorar a interação com um computador (ou um jogo). Apesar de beneficiarem de um ligação direta ao cérebro, poucos são os videojogos BCI que a utilizam para adaptar o conteúdo do jogo ao estado emocional do jogador, em parte porque são poucas as relações conhecidas entre o eletroencefalograma (EEG) e o estado emocional do indivíduo, especialmente em condições pouco controladas e em cenários realistas. De facto, a maioria dos estudos em Computação Afetiva feitos com o objetivo de procurar correlações entre o estado emocional do sujeito e o seu EEG pecam por serem realizados sob condições pouco realistas, e, em particular, nunca durante uma situação de jogo. Por outro lado, apesar da frequente aposta no desenvolvimento de novos videojogos controlados por um paradigma de BCI, poucos têm em consideração as regras de um bom desenho de jogos, resultando muitas vezes num jogo que mesmo sendo funcional, é aborrecido. Com as perspetivas da aplicação de BCI e Computação Afetiva aos videojogos em mente, esta dissertação tem como objetivo o desenvolvimento de um jogo multiplayer controlado por BCI, que ao seguir as regras de bom desenho de jogos, é capaz de desencadear uma sensação de divertimento nos seus jogadores. Para além disso, o jogo também deve ser capaz de evocar um conjunto diversificado de estados emocionais nos seus jogadores, de forma a poder estudar-se as correlações entre o EEG e o estado emocional de cada indivíduo no espectro da frequência. Desta forma, poder-se-á comparar as correlações obtidas num cenário realístico de jogo com o estado-da-arte, frequentemente realizado em situações controladas, e assim contribuir para o avanço da adaptação emocional em videojogos BCI. Para concretizar estes objetivos, o videojogo Kessel Run foi desenvolvido. Kessel Run é um jogo 3D de uma corrida espacial para dois jogadores, em que ambos devem cooperar um com o outro de forma a direcionar uma nave espacial para longe de asteróides e assim conseguir finalizar uma corrida de 2 minutos com o mínimo de danos possível. Neste jogo, as regras básicas de desenho de jogos (Teoria de Flow e o Paradoxo de Controlo) foram aplicadas de forma a criar uma sensação de divertimento e de controlo no jogador. A sensação de controlo por parte do jogador é particularmente importante na criação de um jogo BCI, uma vez que a sua falta poderá levar a perda de imersão no jogo e, consequentemente, à diminuição do divertimento. Assim, de forma a garantir o bom controlo do jogo o paradigma SSVEP (do inglês Steady-State Visually Evoked Potential) foi escolhido como modo de interação BCI. De forma a evocarem-se um conjunto diversificado de estados emocionais nos jogadores, várias estratégias de elicitação foram aplicadas no jogo. Em primeiro lugar, este dispõe de dois níveis de dificuldade (um fácil e um difícil). O primeiro nível desafia as capacidades dos jogadores sem contudo ser demasiado difícil, pelo que se espera que evoque emoções mais positivas. Já o segundo nível aumenta bastante a dificuldade do jogo, tornando-se muito difícil batê-lo. Para além da dificuldade acrescida, o nível difícil do jogo foi programado de forma a que o controlo BCI falhe com frequência sem o conhecimento do jogador. Espera-se por isso que o segundo nível evoque níveis de frustração maiores, e estados emocionais mais negativos e excitados. O jogo Kessel Run foi colocado em prática ao desenvolver-se um protocolo experimental onde 12 participantes jogaram os dois níveis de dificuldade do jogo. A cada participante foi pedido a classificação do jogo em termos de experiência do utilizador, e de cada nível relativamente às emoções sentidas no decorrer do jogo, na forma de questionários. Foram também adquiridos os sinais de EEG de cada participante. De forma geral, o desempenho do paradigma BCI foi menor do o que esperado, conseguindo-se apenas um máximo de 79% classificações correctas. Este resultado deve-se essencialmente a dois factores: o grau deficiente de escuridão da sala laboratorial, responsável pela perda de desempenho na ordem dos 6%, e a deteção individual das frequências escolhidas para estímulo SSVEP (12 e 15 Hz). Neste último, os participantes tiveram maior facilidade em reconhecer o estímulo de 12 Hz, com um desempenho individual médio de 63%, face ao estímulo de 15 Hz com apenas 38%, o que comprometeu a performance geral do reconhecimento SSVEP. No entanto, apesar do desempenho fraco do paradigma, os participantes reportaram uma experiência bastante divertida (média de flow = 2:6 numa escala 0-5) e desafiante (média de challenge = 2:3 numa escala 0-5), com apenas um ligeiro aborrecimento (média de tension=annoyance = 1:1 numa escala 0-5), podendo-se concluir o sucesso do emprego das regras de bom desenho de jogos. As estratégias de elicitação de emoções foram apenas parcialmente bem sucedidas; não foram observadas diferenças significativas entre os níveis de dificuldade do jogo Kessel Run em termos de valência e excitação emocionais. No entanto conseguiu-se uma boa distribuição das avaliações emocionais dos participantes pelos quatro quadrantes das dimensões de valência e excitação, possibilitando o estudo de correlações entre o EEG dos participantes e as suas avaliações para cada nível de jogo em termos de oscilações no espectro da frequência e assimetrias na banda alfa. Encontraram-se correlações significativas na dimensão da valência que parecem contradizer a teoria da assimetria da banda alfa. Em particular, obteve-se uma correlação positiva significativa indicando uma relação de diminuição da activação hemisférica esquerda e consequente aumento da banda alfa. Esta contradição foi também confirmada pela obtenção de uma assimetria esquerda bastante significativa na banda alfa para o córtex frontal. Observou-se ainda uma diminuição da potência central da banda beta e um aumento occipital e temporal direito para a mesma banda relacionado com a dimensão da valência. Para a excitação encontrou-se uma correlação negativa significativa em regiões centrais e frontais na banda alfa, indicando uma activação destas regiões cerebrais aquando de estados mais excitados. Mais ainda, uma correlação significativa indicou uma assimetria direita na banda alfa para um par de eléctrodos fronto-centrais. Espera-se que este estudo possa contribuir para uma futura geração de videojogos com a capacidade de adaptação ao conteúdo emocional do seu jogador.Lately the field of (digital) game research is rapidly growing, with studies dedicated to capture game experience, adopting new technologies or exploring outside traditional input methods. Alongside, research in Brain-Computer Interfaces (BCI) has significantly increased in its applications for healthy users, such as games. BCIs benefit from access to brain activity which can bypass bodily mediation (e.g. controllers) and enable gamers to express themselves more naturally in a given game context. Moreover, BCI can provide significant insight into the user's emotional state. Recent research points to numerous correlates of emotion in brain signals. A complex challenge is to use BCI for access to the player's affective state in a real gaming context, improving and tailoring the user experience. The goal of this dissertation project is to introduce affective research to BCI games by creating a novel multiplayer Steady-State Visually Evoked Potential (SSVEP) BCI game, capable of providing a fun experience to its players and eliciting emotions for a study on EEG correlates of emotion. The multiplayer game Kessel Run was created, resulting in a space exploration game with a exible system that followed good game design rules with emotion elicitation strategies, controlled by the SSVEP paradigm. Twelve participants played Kessel Run using a 32-electrode EEG cap and rated the emotions felt during gameplay in a questionnaire. The SSVEP game performance achieved a maximum of 79% accuracy and an average of 55%. In addition, players reported that playing the game created a fun and immersive experience. A significant correlation with increased alpha power on the left hemisphere and positive valence led to the contradiction of the popular alpha asymmetry theory, which states that processing of positive information causes a decrease in alpha power on the left frontal hemisphere. Furthermore, correlates in the beta frequency range have been found for valence on right temporal and central sites. In the arousal dimension a significant central and frontal alpha power decrease was found, along with significant alpha asymmetry on fronto-central pairs for increased arousal