Impact of Serious Games on Health and Well-being of Elderly: A Systematic Review

Besides their entertainment value, serious games can have beneficial therapeutic effects for elderly people that improve their health and well-being. Games are likely to be accepted by elderly persons who have enjoyed games their lives, and because there are more and more of such elderly, it is important to investigate games as a therapeutic device. This research reviewed the literature focusing on the effects of games on elderly persons in three main types of effects: physical, cognitive, and social effects. The majority of reviewed papers focused on physical and cognitive effects, and were published in recent years, which emphasizes the relative novelty of this topic and suggests that future research will need to address social impact as well. In addition, while many papers claimed positive impacts as a result of using games, our review found that more attention should be given to research designs

A Person-Centric Design Framework for At-Home Motor Learning in Serious Games

abstract: In motor learning, real-time multi-modal feedback is a critical element in guided training. Serious games have been introduced as a platform for at-home motor training due to their highly interactive and multi-modal nature. This dissertation explores the design of a multimodal environment for at-home training in which an autonomous system observes and guides the user in the place of a live trainer, providing real-time assessment, feedback and difficulty adaptation as the subject masters a motor skill. After an in-depth review of the latest solutions in this field, this dissertation proposes a person-centric approach to the design of this environment, in contrast to the standard techniques implemented in related work, to address many of the limitations of these approaches. The unique advantages and restrictions of this approach are presented in the form of a case study in which a system entitled the "Autonomous Training Assistant" consisting of both hardware and software for guided at-home motor learning is designed and adapted for a specific individual and trainer. In this work, the design of an autonomous motor learning environment is approached from three areas: motor assessment, multimodal feedback, and serious game design. For motor assessment, a 3-dimensional assessment framework is proposed which comprises of 2 spatial (posture, progression) and 1 temporal (pacing) domains of real-time motor assessment. For multimodal feedback, a rod-shaped device called the "Intelligent Stick" is combined with an audio-visual interface to provide feedback to the subject in three domains (audio, visual, haptic). Feedback domains are mapped to modalities and feedback is provided whenever the user's performance deviates from the ideal performance level by an adaptive threshold. Approaches for multi-modal integration and feedback fading are discussed. Finally, a novel approach for stealth adaptation in serious game design is presented. This approach allows serious games to incorporate motor tasks in a more natural way, facilitating self-assessment by the subject. An evaluation of three different stealth adaptation approaches are presented and evaluated using the flow-state ratio metric. The dissertation concludes with directions for future work in the integration of stealth adaptation techniques across the field of exergames.Dissertation/ThesisDoctoral Dissertation Computer Science 201

Immersive Virtual Environments and Wearable Haptic Devices in rehabilitation of children with neuromotor impairments: a single-blind randomized controlled crossover pilot study

Background: The past decade has seen the emergence of rehabilitation treatments using virtual reality. One of the advantages in using this technology is the potential to create positive motivation, by means of engaging environments and tasks shaped in the form of serious games. The aim of this study is to determine the efficacy of immersive Virtual Environments and weaRable hAptic devices (VERA) for rehabilitation of upper limb in children with Cerebral Palsy (CP) and Developmental Dyspraxia (DD). Methods: A two period cross-over design was adopted for determining the differences between the proposed therapy and a conventional treatment. Eight children were randomized into two groups: one group received the VERA treatment in the first period and the manual therapy in the second period, and viceversa for the other group. Children were assessed at the beginning and the end of each period through both the Nine Hole Peg Test (9-HPT, primary outcome) and Kinesiological Measurements obtained during the performing of similar tasks in a real setting scenario (secondary outcomes). Results: All subjects, not depending from which group they come from, significantly improved in both the performance of the 9-HPT and in the parameters of the kinesiological measurements (movement error and smoothness). No statistically significant differences have been found between the two groups. Conclusions: These findings suggest that immersive VE and wearable haptic devices is a viable alternative to conventional therapy for improving upper extremity function in children with neuromotor impairments. Trial registration ClinicalTrials, NCT03353623. Registered 27 November 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03353623

Motion-Based Video Games for Stroke Rehabilitation with Reduced Compensatory Motions

Stroke is the leading cause of long-term disability among adults in industrialized nations, with 80% of people who survive strokes experiencing motor disabilities. Recovery requires daily exercise with a high number of repetitions, often without therapist supervision. Motion-based video games can help motivate people with stroke to perform the necessary exercises to recover. We explore the design space of video games for stroke rehabilitation using Wii remotes and webcams as input devices, and share the lessons we learned about what makes games therapeutically useful. We demonstrate the feasibility of using games for home-based stroke therapy with a six-week case study. We show that exercise with games can help recovery even 17 years after the stroke, and share the lessons that we learned for game systems to be used at home as a part of outpatient therapy. As a major issue with home-based therapy, we identify that unsupervised exercises lead to compensatory motions that can impede recovery and create new health issues. We reliably detect torso compensation in shoulder exercises using a custom harness, and develop a game that meaningfully uses both exercise and compensation as inputs. We provide in-game feedback that reduces compensation in a number of ways. We evaluate alternative ways for reducing compensation in controlled experiments and show that using techniques from operant conditioning are effective in significantly reducing compensatory behavior compared to existing approaches

ReHabgame: A non-immersive virtual reality rehabilitation system with applications in neuroscience

This paper proposes the use of a non-immersive virtual reality rehabilitation system ”ReHabgame” developed using Microsoft KinectT M and the ThalmicT M Labs Myo gesture control armband. The ReHabgame was developed based on two third-person video games that provide a feasible possibility of assessing postural control and functional reach tests. It accurately quantifies specific postural control mechanisms including timed standing balance, functional reach tests using real-time anatomical landmark orientation, joint velocity, and acceleration while end trajectories were calculated using an inverse kinematics algorithm. The game was designed to help patients with neurological impairment to be subjected to physiotherapy activity and practice postures of daily activities. The subjective experience of the ReHabgame was studied through the development of an Engagement Questionnaire (EQ) for qualitative, quantitative and Rasch model. The Monte-Carlo Tree Search (MCTS) and Random object (ROG) generator algorithms were used to adapt the physical and gameplay intensity in the ReHabgame based on the Motor Assessment Scale (MAS) and Hierarchical Scoring System (HSS). Rasch analysis was conducted to assess the psychometric characteristics of the ReHabgame and to identify if these are any misfitting items in the game. Rasch rating scale model (RSM) was used to assess the engagement of players in the ReHabgame and evaluate the effectiveness and attractiveness of the game. The results showed that the scales assessing the rehabilitation process met Rasch expectations of reliability, and unidimensionality. Infit and outfit mean squares values are in the range of (0.68 − 1.52) for all considered 16 items. The Root Mean Square Residual (RMSR) and the person separation reliability were acceptable. The item/person map showed that the persons and items were clustered symmetrically

Safety and Feasibility of a First-Person View, Full-Body Interaction Game for Telerehabilitation Post-Stroke

This study explored the feasibility and safety of pairing the Microsoft Kinect® sensor with the Oculus Rift® Head Mounted Display (HMD) as a telerehabilitation technology platform for persons post-stroke. To test initial safety, fourteen participants without disabilities (age 30 ± 8.8 years) engaged in a game-based task using the Microsoft Kinect® with a first-person view using the Oculus Rift®. These tasks were repeated for five participants post-stroke (age 56 ± 3.0 years). No significant adverse events occurred in either study population. When using the Oculus Rift® HMD, three participants without disabilities reported dizziness and nausea. All of the participants post-stroke required hands-on assistance for balance and fall prevention. The intensive nature of physical support necessary for this type of interaction limits the application as a telerehabilitation intervention.  Given the increasing availability of HMDs for commercial use, it is crucial that the safety of immersive games and technologies for telerehabilitation is fully explored

State of Evidence for Everyday Technology Use in Upper Extremity Motor Recovery Post-Stroke

The research team, in consultation with collaborating clinician Sarah Bicker, an OTR/L at Harborview Medical Center, researched everyday technology applications. The team conducted a systematic review considering what evidence exists about the effectiveness of commercially available everyday technology (ET) for improving upper extremity motor control and/or motivation to participate in therapy in clients post-stroke. The evidence was promising in support of the use of ET as indicated by improved upper extremity motor control outcomes and client and clinician reports of satisfaction, motivation, and engagement in post-stroke rehabilitation. Clinicians should consider the benefits of implementing ET for upper extremity motor recovery for clients post-stroke. Due to the changing nature of ET, the research team chose to minimize recommendations of specific applications. Instead, the team created a decision chart to help therapists identify what elements to consider when choosing a technology application to address the upper extremity motor control conditions/impairments with clients post-stroke. The decision tree considers performance skills according to the Occupational Therapy Practice Framework (OTPF), and includes current applications as examples. The research findings and decision chart were presented as an in-service to occupational therapy (OT) practitioners at Harborview Medical Center. Feedback from the in-service indicated that practitioners were positively receptive to the information provided and were more likely to incorporate ET into rehabilitation with their clients as a result of learning the research findings. Reviewing the literature indicates the need for more research regarding technology use for rehabilitation of individuals post-stroke

Games used with serious purposes: a systematic review of interventions in patients with cerebral palsy

The purpose of the present systematic review was to examine extant research regarding the role of games used seriously in interventions with individuals with cerebral palsy. Therefore, PubMed, PsyINFO, Web of Science, Scopus, and IEEE databases were used. Search terms included: "serious games" OR "online games" OR "video games" OR "videogame" OR "game based" OR "game" AND "intervention" AND "cerebral palsy." After the full reading and quality assessment of the papers, 16 studies met the inclusion criteria. The majority of the studies reported high levels of compliance, motivation, and engagement with game-based interventions both at home and at the clinical setting intervention. Regarding the effectiveness of the use of games, the results of the studies show both positive and negative results regarding their effectiveness. The efficacy was reported to motor function (i.e., improvements in the arm function, hand coordination, functional mobility, balance and gait function, postural control, upper-limbs function) and physical activity. Findings of this review suggest that games are used as a complement to conventional therapies and not as a substitute. Practitioners often struggle to get their patients to complete the assigned homework tasks, as patients display low motivation to engage in prescribed exercises. Data of this review indicates the use of games as tools suited to promote patients' engagement in the therapy and potentiate therapeutic gains.This study was conducted at Psychology Research Centre (UID/PSI/01662/2013), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). SL and AP were supported by a Ph.D. fellowship from the Portuguese Foundation for Science and Technology (FCT). PM was supported by a Post-Doctoral fellowship from the Psychology Research Centre (CIPsi), University of Minho. JM was supported by a research scholarship from the Psychology Research Centre (CIPsi), University of Minho