Using movement sonification to alter body perception and promote physical activity in physically inactive people

Mención Internacional en el título de doctorWorldwide, one out of four adults are not physically active enough. Supporting people to be physically active through technology remains thus an important challenge in the field of Human-Computer Interaction (HCI). Some technologies have tried to tackle this challenge of increasing physical activity (PA) by using sensing devices for monitoring the amount and quality of PA and providing motivational feedback on it. However, such technologies provide very limited support to physically inactive users: while users are aware of their physical inactivity level, they are frequently incapable of acting on these problems by themselves. Among the reasons for it are negative perceptions about one’s body (e.g., feelings of body tiredness or weakness in self-esteem) which may act as psychological barriers to PA. This research project aims to address this limitation by employing an approach that, through movement sonification (i.e., real-time auditory feedback on body movement), exploits bottom-up multisensory mechanisms related to BPs to ultimately support PA. This thesis presents the design, development, and evaluation of SoniShoes and SoniBand, two wearable technological devices with a gesture-sound palette that allows for a range of body movement sonifications aimed to alter BPs. These prototypes aim at changing BPs, and in turn emotional state and movement behavior, to address psychological barriers related to the perception of one’s body, and ultimately impact positively on people’s adherence to PA. First, this work proposes to organize knowledge through a taxonomy of the barriers to PA related to body perception (BP), which follows a process of four steps to inform the design of the movement-sound palette: (1) Identification, (2) Extraction and clustering of attributes, (3) Definition of instructions or considerations, and (4) Strategies. The first two steps allowed the identification and grouping of barriers to PA that are related to BPs, with inputs from a literature review, a survey, and a focus group with HCI experts. The third and fourth steps allowed defining the body features and dimensions to act upon, to finally propose movement sonification strategies that have the potential to tackle the barriers. Second, several movement-sound mappings, based on metaphors, are presented. Movements were selected from exercises included in guidelines for becoming more physically active (e.g., walking). The mappings of these movements into sounds were implemented in SoniShoes and SoniBand prototypes. They were evaluated through an iterative process, starting with an exploratory study that tested for the first time the potential of the proposed mappings to change BPs. In this first study, participants were asked to think aloud about their experiences using the first prototype of SoniShoes (from MagicShoes project), by describing their body sensations and sound characteristics during the exercise. Results suggested the potential of movement sonification to alter BP through movement sonification and informed the design of the subsequent studies and prototypes. This exploratory study was followed by quantitative and qualitative studies aimed to understand how to design movement sonifications and wearable devices integrating them to facilitate PA by tackling barriers related to BP. The quantitative studies were controlled laboratory studies, in which different versions of SoniShoes and SoniBand prototypes were evaluated, and which results led to further iterations of the prototypes. The results of these quantitative evaluations revealed movement-sound mappings that can lead to changes in feelings about the body (e.g., feeling lighter or less tired), feelings about the movement (e.g., having more movement control over the movement), and emotional feelings (e.g., having more comfort, motivation to complete the exercise, or feeling happier) during PA. Results also showed effects of sound on movement behavior, such as effects in movement deceleration/acceleration and stance time, and proprioceptive awareness. Furthermore, two qualitative studies were carried out, which involved using the SoniBand prototype for several days and in two different contexts of use, laboratory and home. The aim of these studies was two-fold. First, elucidating the effects that particular metaphorical sonifications’ qualities and characteristics have on people’s perception of their own body and their PA. Second, understanding how the observed effects may be specific to physically inactive (vs. active) populations. The results revealed specific connections between properties of the movement sonifications (e.g., gradual or frequency changes) on the one hand, and particular body feelings (e.g., feeling strong) and aspects of PA (e.g., repetitions) on the other hand, but effects seem to vary according to the PA-level of the populations. Finally, the findings, contributions, and principles for the design of movement sonifications and wearable technology to promote PA through acting upon BP are discussed, finishing by considering implications for potential interventions and applications supporting PA, as well as opportunities opened for future research.En todo el mundo, uno de cada cuatro adultos no es lo suficientemente activo físicamente. Por ello, ayudar a las personas a ser físicamente activas a través de la tecnología sigue siendo un reto importante en el campo de “Human-Computer Interaction” (HCI). Algunas tecnologías han tratado de abordar el reto de aumentar la actividad física (PA) mediante el uso de dispositivos de detección para controlar la cantidad y la calidad de la PA y proporcionar retroalimentación motivacional al respecto. Sin embargo, estas tecnologías proporcionan una ayuda muy limitada a los usuarios físicamente inactivos: aunque los usuarios son conscientes de su nivel de inactividad física, a menudo son incapaces de actuar por sí mismos sobre estos problemas. Entre las razones están las percepciones negativas sobre el propio cuerpo (por ejemplo, la sensación de cansancio corporal o el no sentirse capaces) que pueden actuar como barreras psicológicas para la PA. Este proyecto de investigación pretende abordar esta limitación empleando un enfoque que, a través de la sonificación del movimiento (es decir, la retroalimentación auditiva en tiempo real sobre el movimiento del cuerpo), explota los mecanismos “bottom-up” multisensoriales relacionados con las percepciones del cuerpo (BPs) para apoyar la PA. Esta tesis presenta el diseño, el desarrollo y la evaluación de “SoniShoes” y “SoniBand”, dos dispositivos tecnológicos vestibles con una paleta de gestos y sonidos que permiten una serie de sonificaciones del movimiento corporal destinadas a modificar las BPs. Estos prototipos tienen como objetivo cambiar las BPs, y a su vez el estado emocional y el comportamiento de movimiento, para abordar las barreras psicológicas relacionadas con la BP, y en última instancia impactar positivamente en la adherencia de las personas a la PA. En primer lugar, este trabajo propone organizar el conocimiento a través de una taxonomía de las barreras a la PA relacionadas con la BP, que sigue un proceso de cuatro pasos para informar el diseño de la paleta de movimiento-sonido: (1) Identificación, (2) Extracción y agrupación de atributos, (3) Definición de instrucciones o consideraciones, y (4) Estrategias. Los dos primeros pasos permitieron identificar y agrupar las barreras a la PA relacionadas con los BP, con aportaciones de una revisión bibliográfica, una encuesta y un grupo de discusión con expertos en HCI. El tercero y cuarto paso permitió definir las características y dimensiones corporales sobre las que actuar, para finalmente proponer estrategias de sonificación del movimiento que tienen el potencial de abordar las barreras. En segundo lugar, se presentan varios mapeos de movimiento-sonido, basados en metáforas. Los movimientos se seleccionaron a partir de ejercicios incluidos en las guías para ser más activos físicamente (por ejemplo, caminar). Los mapeos de estos movimientos en sonidos se implementaron en los prototipos “SoniShoes” y “SoniBand”. Se evaluaron a través de un proceso iterativo, comenzando con un estudio exploratorio que probó por primera vez el potencial de los mapeos propuestos para cambiar los BP. En este primer estudio, se pidió a los participantes que pensaran en voz alta sobre sus experiencias utilizando el primer prototipo de “SoniShoes” (llamado “MagicShoes”), describiendo sus sensaciones corporales y las características del sonido durante el ejercicio. Los resultados mostraron el potencial de la sonificación del movimiento para alterar la BP a través de la sonificación del movimiento e informaron el diseño de los estudios y prototipos posteriores. A este estudio exploratorio le siguieron estudios cuantitativos y cualitativos destinados a comprender cómo diseñar sonificaciones del movimiento y dispositivos vestibles que las integren para facilitar la PA abordando las barreras relacionadas con la BP. Los estudios cuantitativos fueron estudios de laboratorio controlados, en los que se evaluaron diferentes versiones de los prototipos “SoniShoes” y “SoniBand”, y cuyos resultados condujeron a nuevas iteraciones de los prototipos. Los resultados de estas evaluaciones cuantitativas mostraron que existen mapeos de movimiento-sonido que pueden provocar cambios en las sensaciones sobre el cuerpo (por ejemplo, sentirse más ligero o menos cansado), en las sensaciones sobre el movimiento (por ejemplo, tener más control sobre el movimiento) y en las sensaciones emocionales (por ejemplo, tener más comodidad, motivación para completar el ejercicio o sentirse más feliz) durante la PA. Los resultados también mostraron los efectos del sonido en el comportamiento del movimiento, como los efectos en la desaceleración/aceleración del movimiento y el tiempo de postura, y la conciencia propioceptiva. Además, se llevaron a cabo dos estudios cualitativos, en los que se utilizó el prototipo “SoniBand” durante varios días y en dos contextos de uso diferentes, el laboratorio y el hogar. El objetivo de estos estudios era doble. En primer lugar, dilucidar los efectos que determinadas cualidades y características de las sonificaciones con metáforas tienen en la percepción que las personas tienen de su propio cuerpo y de su PA. En segundo lugar, comprender cómo los efectos observados pueden ser específicos de las poblaciones físicamente inactivas (vs. las activas). Los resultados revelaron conexiones específicas entre las propiedades de las sonificaciones de movimiento (por ejemplo, los cambios graduales o de frecuencia) por un lado, y las sensaciones corporales particulares (por ejemplo, sentirse fuerte) y los aspectos de la PA (por ejemplo, las repeticiones) por otro lado, pero los efectos parecen variar según el nivel de PA de las poblaciones. Por último, se discuten los hallazgos, las contribuciones y las guías de diseño de sonificación de movimiento y tecnología vestible para promover la PA a través de la actuación sobre la BP, para finalmente considerar las implicaciones para las posibles intervenciones y aplicaciones de apoyo a la PA, así como las oportunidades abiertas para futuras investigaciones.I owe thanks to “MAGIC SHOES” (PSI2016-79004-R and BES-2017-080471) and “CROSS-COLAB” (PGC2018-101884-B-I00) projects that funded my research. Thanks to “MAGIC OUTFIT” (PID2019-105579RB-I00) for letting me be part of the team and project.Programa de Doctorado en Ciencia y Tecnología Informática por la Universidad Carlos III de MadridPresidente: Paloma Martínez Fernández.- Secretario: Domna Banakou.- Vocal: Mar González Franc

Altering body perception and emotion in physically inactive people through movement sonification

Reino Unido. Cambridge (3-6 Septiembre 2019)Physical inactivity is an increasing problem. It has been linked to psychological and emotional barriers related to the perception of one's body, such as physical capabilities. It remains a challenge to design technologies to increase physical activity in inactive people. We propose the use of a sound interactive system where inputs from movement sensors integrated in shoes are transformed into sounds that evoke body sensations at a metaphorical level. Our user study investigates the effects of various gesture-sound mappings on the perception of one's body and its movement qualities (e.g. being flexible or agile), the related emotional state and movement patterns, when people performed two exercises, walking and thigh stretch. The results confirm the effect of the "metaphor" conditions vs. the control conditions in feelings of body weight; feeling less tired and more in control; or being more comfortable, motivated, and happier. These changes linked to changes in affective state and body movement. We discuss the results in terms of how acting upon body perception and affective states through sensory feedback may in turn enhance physical activity, and the opportunities opened by our findings for the design of wearable technologies and interventions in inactive populations.The work is supported by Ministerio de Economía, Industria y Competitividad of Spain Grants RYC-2014–15421 and PSI2016-79004-R (“MAGIC SHOES”; AEI/FEDER, UE) and doctoral training grant BES-2017-080471. FB was supported by the ELEMENT project (ANR-18-CE33-0002)

Effects of pitch and musical sounds on body-representations when moving with sound

The effects of music on bodily movement and feelings, such as when people are dancing or engaged in physical activity, are well-documented¿people may move in response to the sound cues, feel powerful, less tired. How sounds and bodily movements relate to create such effects? Here we deconstruct the problem and investigate how different auditory features affect people's body-representation and feelings even when paired with the same movement. In three experiments, participants executed a simple arm raise synchronised with changing pitch in simple tones (Experiment 1), rich musical sounds (Experiment 2) and within different frequency ranges (Experiment 3), while we recorded indirect and direct measures on their movement, body-representations and feelings. Changes in pitch influenced people's general emotional state as well as the various bodily dimensions investigated¿movement, proprioceptive awareness and feelings about one's body and movement. Adding harmonic content amplified the differences between ascending and descending sounds, while shifting the absolute frequency range had a general effect on movement amplitude, bodily feelings and emotional state. These results provide new insights in the role of auditory and musical features in dance and exercise, and have implications for the design of sound-based applications supporting movement expression, physical activity, or rehabilitation.We acknowledge funding by the Spanish Agencia Estatal de Investigación (PID2019-105579RB-I00/AEI/10.13039/501100011033) and the European Research Council Grant (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No 101002711). JL is funded by the Ministry of Economy, Industry and Competitivity of Spain (doctoral training Grant BES-2017-080471). OD is funded by the Volkswagen Foundation (Co-Sense grant). FB is partially funded by the ELEMENT project (ANR-18-CE33-0002)

Interactive sonification to assist children with autism during motor therapeutic interventions

Interactive sonification is an effective tool used to guide individuals when practicing movements. Little research has shown the use of interactive sonification in supporting motor therapeutic interventions for children with autism who exhibit motor impairments. The goal of this research is to study if children with autism understand the use of interactive sonification during motor therapeutic interventions, its potential impact of interactive sonification in the development of motor skills in children with autism, and the feasibility of using it in specialized schools for children with autism. We conducted two deployment studies in Mexico using Go-with-the-Flow, a framework to sonify movements previously developed for chronic pain rehabilitation. In the first study, six children with autism were asked to perform the forward reach and lateral upper-limb exercises while listening to three different sound structures (i.e., one discrete and two continuous sounds). Results showed that children with autism exhibit awareness about the sonification of their movements and engage with the sonification. We then adapted the sonifications based on the results of the first study, for motor therapy of children with autism. In the next study, nine children with autism were asked to perform upper-limb lateral, cross-lateral, and push movements while listening to five different sound structures (i.e., three discrete and two continues) designed to sonify the movements. Results showed that discrete sound structures engage the children in the performance of upper-limb movements and increase their ability to perform the movements correctly. We finally propose design considerations that could guide the design of projects related to interactive sonification

Body x Materials: A workshop exploring the role of material-enabled body-based multisensory experiences

Over the last 15 years, HCI and Interaction Design have experienced a “material turn” characterized by a growing interest in the materiality of technology and computation, and in methods that support exploring, envisioning, and crafting with and through materials. The community has experienced a similar turn focused on the body, on how to best design for and from a first-person, lived experience, and the moving and sensual body. In this workshop, we focus on the intersection of these two turns. The emerging developments in multimodal interfaces open opportunities to bring in materiality to the digital world as well as to transform the materiality of objects and bodies in the real-world, including the materiality of our own body. The different sensory qualities of (touchable and untouchable, physical and digital) objects and bodies, including our own, can be brought into the design of digital technologies to enrich, augment, and transform embodied experiences. In this “materials revolution” [15], what are the current theories, approaches, methods, and tools that emphasize the critical role of materiality to body-based interactions with technology? To explore this, in this workshop we will focus on five related themes: material enabling expression, material as a catalyst for human action, material enabling reflection and awareness, material enabling transformation and material supporting the design process for the re-creation of the existing and the yet-to-exist. This workshop with technology presentations, panel sessions with experts, and multidisciplinary discussions will: (i) bring together researchers who work on (re)creating sensory properties of materials through technology with those who investigate experiential effects of materials and materialenabled interactions, (ii) discuss methods, opportunities, difficulties in designing materiality and material-enabled interactions, and (iii) form a multidisciplinary community to build synergies and collaborations

Body x materials: A workshop exploring the role of material-enabled body-based multisensory experiences

Over the last 15 years, HCI and Interaction Design have experienced a “material turn” characterized by a growing interest in the materi- ality of technology and computation, and in methods that support exploring, envisioning, and crafting with and through materials. The community has experienced a similar turn focused on the body, on how to best design for and from a first-person, lived experience, and the moving and sensual body. In this workshop, we focus on the intersection of these two turns. The emerging developments in mul- timodal interfaces open opportunities to bring in materiality to the digital world as well as to transform the materiality of objects and bodies in the real-world, including the materiality of our own bod- ies. The different sensory qualities of (touchable and untouchable, physical and digital) objects and bodies, including our own, can be brought into the design of digital technologies to enrich, augment, and transform embodied experiences. In this “materials revolution” [15], what are the current theories, approaches, methods, and tools that emphasize the critical role of materiality to body-based interac- tions with technology? To explore this, in this workshop we will fo- cus on five related themes: material enabling expression, material as a catalyst for human action, material enabling reflection and aware- ness, material enabling transformation and material supporting the design process for the re-creation of the existing and the yet-to- exist. This workshop with technology presentations, panel sessions with experts, and multidisciplinary discussions will: (i) bring to- gether researchers who work on (re)creating sensory properties of materials through technology with those who investigate expe- riential effects of materials and material-enabled interactions, (ii)discuss methods, opportunities, difficulties in designing materiality and material-enabled interactions, and (iii) form a multidisciplinary community to build synergies and collaborations

Interactive Sonification to Assist Children with Autism During Motor Therapeutic Interventions

Interactive sonification is an effective tool used to guide individuals when practicing movements. Little research has shown the use of interactive sonification in supporting motor therapeutic interventions for children with autism who exhibit motor impairments. The goal of this research is to study if children with autism understand the use of interactive sonification during motor therapeutic interventions, its potential impact of interactive sonification in the development of motor skills in children with autism, and the feasibility of using it in specialized schools for children with autism. We conducted two deployment studies in Mexico using Go-with-the-Flow, a framework to sonify movements previously developed for chronic pain rehabilitation. In the first study, six children with autism were asked to perform the forward reach and lateral upper-limb exercises while listening to three different sound structures (i.e., one discrete and two continuous sounds). Results showed that children with autism exhibit awareness about the sonification of their movements and engage with the sonification. We then adapted the sonifications based on the results of the first study, for motor therapy of children with autism. In the next study, nine children with autism were asked to perform upper-limb lateral, cross-lateral, and push movements while listening to five different sound structures (i.e., three discrete and two continues) designed to sonify the movements. Results showed that discrete sound structures engage the children in the performance of upper-limb movements and increase their ability to perform the movements correctly. We finally propose design considerations that could guide the design of projects related to interactive sonificatio

Exploring the Design Space for Body Transformation Wearables to Support Physical Activity through Sensitizing and Bodystorming

We acknowledge funding by the Spanish Agencia Estatal de Investigación (PID2019-105579RBI00/AEI/10.13039/501100011033) and the European Research Council Grant (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No 101002711). JL is funded by the Ministry of Economy, Industry and Competitivity of Spain (doctoral training Grant BES-2017-080471). OV is funded by the Ministry of Science and Innovation of Spain (doctoral training Grant PRE2020-091790). EMS is funded by the Madrid Government (Comunidad de Madrid) under the Multiannual Agreement with UC3M in the line of "Research Funds for Beatriz Galindo Fellowships" (MovIntPlayLab-CM-UC3M), and in the context of the V PRICIT (Regional Programme of Research and Technological Innovation)

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit