Design and Evaluation of Virtual Reality Exergames for People Living with Dementia

Dementias such as Alzheimer’s disease are a progressive neurodegenerative disorder with consequences such as cognitive impairment and memory problems. While exercise is important to improve physical health and quality of life for people living with dementia (PWD), symptom-induced challenges, such as language processing and physical limitations, can make it more difficult for PWD to engage in exercise. In this study, exercise games (exergames) to promote exercise for PWD were designed in two virtual environments: a farm and a gym. To design the activities and interfaces of the games, a participatory design approach was followed with exercise therapists, kinesiologists, and PWD from Schlegel Villages long-term care facility. Five upper-body motions were selected and five corresponding activities developed for each game. The games were built for the Oculus Rift CV1 head mounted display virtual reality (HMD-VR) as this platform uses a fully immersive three-dimensional display with high frame rate display. The touch controllers of Oculus were used to provide hand-motion interactions in virtual reality (VR). A three-week evaluation experiment was conducted with six PWD to evaluate the designed exercise games. A mixed-methods approach was used to qualitatively and quantitatively investigate the impact of using designed HMD-VR exergames in engaging PWD in exercise. Questionnaires for participants recorded participants’ feelings of enjoyment, engagement, interest, easiness, comfort, and level of effort. Clinical measurements of fitness parameters and recorded motion parameters from sensors in Oculus Rift provided quantifiable metrics such as range of motion (ROM), distance traversed, speed, grip strength, and shoulder circumduction for evaluation. All the participants successfully completed the exercise using the exergames, demonstrating the promising potential of using HMD-VR for PWD. The analysis of the participants’ answers to the questionnaires shows subjective metrics for human-guided exercise is comparable to VR games conditions, which is a noteworthy result considering the novelty of using VR for PWD. Overall, the analysis of motion parameters showed no differences between environments, which indicates the participants’ level of movment in VR environments was as good as with human-lead exercise. This thesis research demonstrates the potential of HMD-VR as an engaging way to support exercise of PWD

Empowering vulnerable people with serious games and gamification

Although many people will associate games with entertainment and leisure, games can also aim more serious purposes, such as training or education. Games with such goals are called serious games. In addition, gamification means that a (serious) task is enhanced with game elements. Examples of serious games and gamification can be seen in many aspects of daily life. Loyalty programs of stores, educational games in schools, fitness wearables and their gamified applications, rehabilitation games, and so on. In this dissertation, the focus is on a specific domain in which serious games and gamification can create societal benefit, namely by using them to empower vulnerable target groups. In the first part of this dissertation, a literature review is performed to understand the domain of serious games and gamification for vulnerable target groups. Based on this review, research gaps can be identified. Moreover, the review resulted in a taxonomy that is used throughout the dissertation to classify different games and applications. In the following parts of the dissertation, projects addressing two different target groups and in total three vulnerabilities are discussed. The first target group is older adults, who are vulnerable in different ways. In this dissertation, safety risks for doorstep scams and health risks through malnutrition are addressed. The first vulnerability is addressed by a serious game using interactive scenarios of doorstep scams. A diet tracking system that was used to support participants in a diet trial addressed the latter vulnerability. The second target group is young adults, which is an age group with a vulnerable mental well-being. The last part of this dissertation aims to study how gamification can be used to enhance self-compassion among young adults via an online 6-weeks training program, to increase their resilience in the face of mental well-being difficulties. Artificial Intelligence (AI) technologies can be used to personalize and adapt the experience of a game to users. Tone of voice analysis was used to influence the progression in scenarios of the serious game about doorstep scams, and it gave players the possibility to assess the assertiveness of their voice. Machine learning algorithms were used to create personalized meal recommendations that can be used to improve the user experience of the diet tracking system for older adults. These algorithms base their recommendations on information about the historical intake of users to suggest meals and to additional items during meal editing. This makes the process of registering a meal less time-consuming. Sentiment analysis is used to adapt responses of the system in an exercise from the self-compassion training program. In addition, a topic detection algorithm was designed to assign one topic from a predefined set of topics to a note by a user of the training program. With this information, users can choose different types of situations to use in the exercises: frequently or rarely discussed topics. Aside from those techniques, knowledge representation is used in all projects, which is important for serious games/gamified applications since they are often based on expert and/or domain knowledge. This dissertation contributes to understanding the domain of serious games and gamification to empower vulnerable groups. The work also contributes to the research on the development of applications within that domain. On top of that, it contributes to understanding how AI techniques can be used to offer (personalized) features that enrich serious games or gamified applications. Finally, for each of the project centered parts, the results that are found in those parts contribute to the research in those specific fields