Games as Systems for Rehabilitation: A Design Strategy for Game-based Exercise Rehabilitation for Parkinson\u27s Disease

Games are of interest for health interventions including but not limited to physical activity and rehabilitation, behavior change, motor-cognitive training, and mood elevation. Despite increased interest in using games to produce positive health outcomes, the development or selection process of games, or their suitability for a target demographic in a context of health and rehabilitation, remains ad-hoc. As a result, game-based interventions lacking application specificity produce variable outcomes that obscure the true treatment effect of game-based therapies. To address this issue, we present a design strategy for game-based rehabilitation that uses a player-centric approach to develop/select games for specific contexts such as for improving functional deficits in patients with Parkinson’s disease. This strategy establishes a relationship between the exercise rehabilitation regimen and gameplay by incorporating the rehabilitation requirements, patient condition, and player affordances, into the game world. In addition, we present guiding questions to support the application of the design strategy for improving the effectiveness of game-based rehabilitations

The effect of video gaming on physical activity among nursing home residents

There are approximately 1.5 million residents living in nursing homes in the United States. For those living in this environment, opportunities to participate in health promoting behaviors, such as physical activity, have been limited (Kayser-Jones, 2009). The use of video game technology is now being used related to health and health benefits with older adults (Primack et al., 2012). Because there have been limited research studies conducted in long-term care environments related to physical activity and health promotion, current research is needed to further explore these phenomena. The purposes of this study were as follows: (1) to describe the use of video game technology, specifically the Nintendo Wii, with older adults living in long term care facilities; (2) to determine if there is a relationship among personal factors, perceived barriers, perceived benefits, perceived self-efficacy, and physical activity; and (3) to examine the effects of this video game technology perceived barriers, perceived benefits, and perceived self-efficacy for physical activity using a 6-week intervention with nursing home residents. Pender’s Promotion Model was used as a guiding framework for this study. Twenty-four participants, primarily Caucasian (n=20, 83.3%) women (n=16, 66.7%) were recruited from four nursing homes in and around central North Carolina. Prior to the start of the intervention, data were collected by face to face interviews on current self-reported level of physical activity and prior use of a technological device, as well as other pre-intervention measures. The majority of the sample reported being very physically active and had prior experience using a technological device. The intervention period lasted for 6 weeks, meeting twice per week for 45 minute sessions. The sessions included a 15 minute educational component followed by 30 minutes of Nintendo Wii game play. From the data gathered prior to the intervention, it was ascertained that the majority of the study participants reported currently engaging in physical activity (87.4%). Many of the participants (83.3%) reported prior use of a technological device, with the computer being the most commonly reported. Using the scores from the multiple regression analysis (F (6, 22) = 2.49, p =.07, R2 = .48, R2Adjusted = .29) revealed no significant predictors of physical activity at posttest. Paired t-tests revealed no significant change in key variables between before and after intervention. Although the study the findings were not statistically significant, the intervention provided some useful clinical information that can be used in the development of future physical activity programs for residents in long-term care facilities. The use of video games with older adults is a feasible, inexpensive method to assist them in physical activity maintenance. Initiating interventions that are tailored to older adults, focused on health promoting behaviors such as physical activity, within long-term care facilities can help reduce to maintain the functional ability of residents in long-term care

On the Persuasive Power of Videogame avatars on Health-related behaviours

Background: Avatars are representations of the self in a virtual environment. They have been used to influence behaviour and may represent a promising avenue for designing interventions to promote health-related behaviour change. Aim: To determine the extent to which a representation of the self in a videogame influences health-related behaviours. Method: In addressing the aim of the thesis, a mixed methods approach was adopted. This started with a systematic review investigating the effectiveness of various attempts at health persuasion using avatar appearance manipulation. Next, a qualitative study investigating gamers’ avatar design preferences and experiences of playing an exergame with an idealised, self-similar avatar was conducted. The quantitative phase of the thesis involved three quantitative studies investigating the existence, ambivalence, and variance of stereotypes associated with plus-sized and athletic physiques over three modalities (text, image, video); and a replication-extension of an exergame-based Proteus Effect study involving larger-bodied and ‘average’ avatars. In this latter study, a bespoke exergame was developed that used the stimuli developed in the previous studies as avatars. Results: The systematic review (Chapter 4) revealed that a small number of studies had investigated using avatars to promote health related behaviour, and a common finding was that using larger-bodied (compared with athletic) avatars in exergames resulted in reduced physical-activity. Since this was explained in terms of stereotypical behaviours, such as laziness, being assimilated into the players’ behaviour, the qualitative study (Chapter 5) explored participants’ accounts of being restricted to an athletic avatar and found that this was not always a positive experience. To explore this further, Chapter 6 investigated the stereotype structures of plus-sized and athletic bodies were both found to suggest ambivalence. Text descriptions of prototypical ‘athletic’ groups (Chapter 6), and images of virtual humans with athletic bodies (Chapter 7) were rated as more competent, more arrogant, and less friendly compared with larger-bodied examples. Negative stereotypes, such as laziness, were reflected in evaluations of larger bodied representations, but so was the potentially positive trait of affability. In Chapter 8, larger-bodied exemplars that were animated with counter-stereotypical information (running on the spot) were rated less negatively than those that were stationary. When the exemplars were used as avatars, there was no evidence for behaviour change as a function of avatar-physique in the experimental replication study (Chapter 9). Conclusion: By using methods derived from existing social psychological theories, it is possible to create representations of larger bodies that are evaluated more positively. Further, there may be negative consequences to relying on athletic-bodied avatars to encourage exercise. Although there was no strong evidence that participants behaviour was affected by the type of avatar used, an argument can be made for allowing users to explore a broader range of physiques and presenting larger-bodied characters positively as competent agents

DESIGNING AUGMENTED SPORTS: TEAM GAMES WITH A BALL

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