Design and Development of One-Switch Video Games for Children with Severe Motor Disabilities

Video games are not just played for fun; they have become a handy instrument for the cognitive, emotional, and social development of children. However, several barriers prevent many children with disabilities from playing action-oriented video games, alone or with their peers. In particular, children with severe motor disabilities, who rely on one-switch interaction for accessing electronic devices, find fast-paced games that require rapid decision-making and timely responses, completely unplayable. This article contributes to lowering such barriers by presenting GNomon (Gaming NOMON), a software framework based on the NOMON mode of interaction that allows the creation of action-oriented single-switch video games. The article reports the results of two studies that evaluate the playability and rehabilitation suitability of GNomon-based video games. The playability of GNomon-based games is evaluated by assessing their learnability, effectiveness, errors, satisfaction, memorability, and enjoyability with a group of eight children with severe motor disabilities. The suitability for pediatric rehabilitation is determined by means of a focus group with a team of speech therapists, physiotherapists, and psychologists from a Local Health Agency in Turin, Italy. The results of the playability study are positive: All children had fun playing GNomon-based video games, and seven of eight were able to interact and play autonomously. The results of the rehabilitation-suitability study also entail that GNomon-based games can be exploited in training hand-eye coordination and maintenance of selective attention over time. The article finally offers critical hindsight and reflections and shows possible new future game concepts

Designing a Smartphone Exergame for Children with Cerebral Palsy in the Home Environment

Children with cerebral palsy must perform daily exercise which is a tedious and energy consuming task. Exergames can make this routine more engaging, which can increase the compliance of the patient. This research explores the feasibility of an exergame device called the Squid Monster. The device is the result of a research through design process, and it is designed to be played on smartphones in the home environment. It operates on the smartphone's integrated sensors and two external squeeze sensors, making it accessible and cost-effective. We conceptualize how the design can be supported using a machine learning adaptive difficulty system, aiming to increase flow and therapeutic adherence of the device. Ultimately, guidelines are provided to designers for future work in this field

Serious Games for Physical Rehabilitation: Aesthetic discrepancies between custom-made serious games and commercial titles used for healthcare

Serious games are videogames that are used with purposes that go beyond the mere entertainment of the player. Among their many applications, healthcare is one of the most prominent ones, as serious games can have a wide range of uses within this field, namely physical rehabilitation of patients. For this purpose, both custom-made serious games and commercial entertainment titles, such as those for Nintendo Wii, can be used. However, while custom-made serious games appear to be more clinically effective, patients seem to prefer the gaming experience of playing a commercial title. This paper aims to compare the game goals and the aesthetics of Wii Sports (a commercial title used in the context of physical rehabilitation) with custom-made serious games that have obtained clinically significant results in upper limb rehabilitation, in order to try and understand what can be done to bridge the gap between these two approaches

From AAL to ambient assisted rehabilitation: a research pilot protocol based on smart objects and biofeedback

AbstractThe progressive miniaturization of electronic devices and their exponential increase in processing, storage and transmission capabilities, represent key factors of the current digital transformation, also sustaining the great development of Ambient Assisted Living (AAL) and the Internet of Things. Although most of the investigations in the recent years focused on remote monitoring and diagnostics, rehabilitation too could be positively affected by the widespread integrated use of these devices. Smart Objects in particular may be among the enablers to new quantitative approaches. In this paper, we present a proof-of-concept and some preliminary results of an innovative pediatric rehabilitation protocol based on Smart Objects and biofeedback, which we administered to a sample of children with unilateral cerebral palsy. The novelty of the approach mainly consists in placing the sensing device into a common toy (a ball in our protocol) and using the information measured by the device to administer multimedia-enriched type of exercises, more engaging if compared to the usual rehabilitation activities used in clinical settings. We also introduce a couple of performance indexes, which could be helpful for a quantitative continuous evaluation of movements during the exercises. Even if the number of children involved and sessions performed are not suitable to assess any change in the subjects' abilities, nor to derive solid statistical inferences, the novel approach resulted very engaging and enjoyable by all the children participating in the study. Moreover, given the almost non-existent literature on the use of Smart Objects in pediatric rehabilitation, the few qualitative/quantitative results here reported may promote the scientific and clinical discussion regarding AAL solutions in a "Computer Assisted Rehabilitation" perspective, towards what can be defined "Pediatric Rehabilitation 2.0"

Towards ai-based interactive game intervention to monitor concentration levels in children with attention deficit

—Preliminary results to a new approach for neurocognitive training on academic engagement and monitoring of attention levels in children with learning difficulties is presented. Machine Learning (ML) techniques and a Brain-Computer Interface (BCI) are used to develop an interactive AI-based game for educational therapy to monitor the progress of children’s concentration levels during specific cognitive tasks. Our approach resorts to data acquisition of brainwaves of children using electroencephalography (EEG) to classify concentration levels through model calibration. The real-time brainwave patterns are inputs to our game interface to monitor concentration levels. When the concentration drops, the educational game can personalize to the user by changing the challenge of the training or providing some new visual or auditory stimuli to the user in order to reduce the attention loss. To understand concentration level patterns, we collected brainwave data from children at various primary schools in Brazil who have intellectual disabilities e.g. autism spectrum disorder and attention deficit hyperactivity disorder. Preliminary results show that we successfully benchmarked (96%) the brainwave patterns acquired by using various classical ML techniques. The result obtained through the automatic classification of brainwaves will be fundamental to further develop our full approach. Positive feedback from questionnaires was obtained for both, the AI-based game and the engagement and motivation during the training sessions

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Socio-digital experiences

The experiences emerging from interacting with digital technology need to be understood, designed and engineered. This is quintessential for ensuring that related systems and services have a purpose and value for their users, helping them achieve their aspirations and desires. Rooted in this human-experience centered perspective, we explore ambient intelligence technologies, where computation and communication are embedded in our physical and social environment, adapting to users and their context. The overarching motivation is to create novel socio-digital experiences that address societal needs, like staying connected with dear ones, children’s outdoor play, achieving desirable behavior change, supporting independent living, and rehabilitation. Looking to the future, two grand challenges concern us. First is to design technologies that people can shape to meet idiosyncratic and dynamically emerging requirements, known as meta-design. Second is endowing ambient intelligence technologies with aspects of social intelligence

Studying Serious Games for the Therapy of Children with Disabilities following a Co-Design Process

Therapy can be a long and tedious process where progress is usually not immediately visible. This slow process can discourage younger patients, especially children who do not understand exactly what they are doing. Serious Games can help in these situations since they are games designed for a primary purpose other than pure entertainment. These games can be helpful as therapy tools because they promote engagement on the side of the patients, which in turn will make them feel more motivated to follow the therapeutic programme. In order to develop a game with a meaningful experience for users, beyond the fun of playing it, which helps them in their therapy, experts in the area need to be involved through close collaboration throughout the whole research process. Therefore, we de- veloped a game suite for the therapy of children with disabilities following a co-design process that included Cresce com Amor as the partner clinic. Cresce com Amor provided therapy expertise to the research team, collaborating in several phases of the process. Furthermore, by developing a classification system for serious games, based on the International Classification of Functioning, Disability and Health (ICF), which matches each game with body functions and therapy areas, we intend to support the classification of serious games in order to make them more suitable for their ultimate purpose. An in-house developed platform, called PLAY, supports the games by acting as a repository for the data collected and giving the therapists an interface to interact with and adjust the game parameters. The games use different interaction methods, other than the usual keyboard and mouse, to allow patients to seamlessly perform exercises that simulate the ones done in current traditional therapy sessions. By using off-the-shelf controllers, such as the balance board and dance mat, we can translate real-life movements more naturally into character movements in the virtual space.A terapia pode ser um processo longo e tedioso onde o progresso geralmente não é imedi- atamente visível. Este processo lento pode desencorajar os pacientes mais jovens, especi- almente as crianças que não entendem exatamente o que estão a fazer. Jogos Sérios podem ajudar nestas situações, uma vez que são jogos concebidos com um propósito principal que não seja apenas entretenimento. Estes jogos podem ser úteis como ferramentas te- rapêuticas porque promovem o envolvimento do lado dos pacientes, o que, por sua vez, fará com que se sintam mais motivados para seguir o programa terapêutico. Para desenvolver um jogo com uma experiência significativa para os utilizadores, para além da diversão de jogar, que os ajude na sua terapia, os especialistas na área precisam de estar envolvidos através de uma estreita colaboração ao longo de todo o processo de investigação. Assim, desenvolvemos uma suite de jogos para a terapia de crianças com incapacidades seguindo um processo de co-criação que incluiu a Cresce com Amor como clínica parceira. A Cresce com Amor adicionou conhecimentos terapêuticos à equipa de investigação, colaborando em várias fases do processo. Além disso, ao desenvolver um sistema de classificação para jogos sérios, baseado na Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), que combina cada jogo com funções corporais e áreas de terapia, pretendemos apoiar a classificação de jogos sérios, a fim de torná-los mais adequados ao seu propósito final. Uma plataforma desenvolvida internamente, chamada PLAY, suporta os jogos, agindo como um repositório para os dados coletados e dando aos terapeutas uma interface para interagir e ajustar os parâmetros do jogo. Os jogos utilizam diferentes métodos de interação, além do habitual teclado e rato, para permitir que os pacientes realizem exercícios que simulam os que são feitos nas sessões de terapia tradicional atuais. Usando controladores comerciais, "prontos para uso", como a balance board e o dance mat, podemos traduzir de forma mais natural movimentos da vida real em movimentos de personagens no espaço virtual