A Survey on Serious Games for Rehabilitation

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1 A Survey on Serious Games for Rehabilitation Paula Rego 1,2, Pedro Moreira 1, Luís Paulo Reis 2 1 Instituto Politécnico de Viana do Castelo 2 Faculdade de Engenharia da Universidade do Porto 28th - 29th January, 2010 Doctoral Symposium :: FEUP in DSIE 10 Informatics :: Paula Engineering Rego:: 1

2 Agenda A Survey on Serious Games For Rehabilitation Overview Serious Games Serious Games for Rehabilitation Proposed Classification Criteria Comparison RehaCom A Case Study Conclusions and Future Work :: FEUP DSIE 10 :: Paula Rego:: 2

3 Overview Motivation Rehabilitation results in high social costs Effective rehabilitation must be early, intensive and repetitive It is difficult to maintain patient motivation and interest High rehabilitation costs at hospitals/clinics Approach Computer assisted Rehabilitation Use of Game Design and Technologies can be effective in augmenting motivation Our Research Focus on rehabilitation Identify features relevant to design more effective rehabilitation games Develop a classification framework :: FEUP DSIE 10 :: Paula Rego:: 3

4 Serious Games Serious Games (SG) : definitions Zyda (2005): a mental contest, played with a computer in accordance with specific rules, which uses entertainment to further government or corporate training, education, health, public policy, and strategic communication objectives. Michael and Chen (2006): games that do not have entertainment, enjoyment or fun as their primary purpose Our definition: games that engage the user, and contribute to the achievement of a defined purpose other than pure entertainment (whether or not the user is consciously aware of it) :: FEUP DSIE 10 :: Paula Rego:: 4

5 Serious Games SG: A Recent and Active Research Topic In 2002 was formed the Serious Games Initiative In 2009 was organized the first Conference specialized in SG: VS- GAMES 09 First IEEE Int. Conf. in Games and Virtual Worlds for Serious Applications Recent Advances in game platforms High availability of new forms of interaction :: FEUP DSIE 10 :: Paula Rego:: 5

6 Serious Games SG: Surveys Zyda (2005): SG technology can be applied to domains as diverse as healthcare, public policy, strategic communication, defense, training, and education Michael and Chen (2006): SG can have a number of markets: military games, government games, educational games, corporate games, healthcare games, and political, religious and art games Sawyer and Smith (2008) introduced a Serious Games taxonomy Start point to further contributions :: FEUP DSIE 10 :: Paula Rego:: 6

7 SG for Rehabilitation SG for Rehabilitation: Problems Impairments: attention and concentration deficiencies, balance loss, pain, weakness and paralysis Tasks often repetitive and boring Can cause depression and fatigue Rehabilitation can require patients to travel to specialised units High healthcare costs Early and intensive practice of functional tasks in an enriched environment show more positive outcomes for motor and cognitive rehabilitation :: FEUP DSIE 10 :: Paula Rego:: 7

8 SG for Rehabilitation SG for Rehabilitation: Related Works Classifications: Flores et al. (2008): classification for elderly rehabilitation - Criteria: entertainment for elderly + stroke rehabilitation - Subjective comparison Burke et al.(2009): classification for upper limb stroke rehabilitation - Game design principles: meaningful play and challenge - Developed games based on the criteria - Evaluation using questionnaires - Small number of participants Applications: Balance rehabilitation Upper limb stroke rehabilitation Behavioral and addictive disorders Traumatic brain injury (TBI) :: FEUP DSIE 10 :: Paula Rego:: 8

9 Proposed Classification Criteria Application Area Two main areas: Cognitive Rehabilitation and Motor Rehabilitation Cognitive Rehabilitation Goal: to achieve most independent/highest level of functioning How: individualized goals according to strengths and weaknesses Examples: brain injury, cognitive impairments from chronically illness Motor Rehabilitation Stroke rehabilitation Balance training Acquired brain injury Wheelchair mobility Parkinson s disease Orthopaedic rehabilitation Functional activities of daily living training Telerehabilitation :: FEUP DSIE 10 :: Paula Rego:: 9

10 Proposed Classification Criteria Interaction Technology Body Weight Movement WiiMote and Wii Balance Board Motion Tracking HMD Speech + Touch + Motion Tracking + Biosensors Special Keyboard Joystick Web cam :: FEUP DSIE 10 :: Paula Rego:: 10

11 Proposed Classification Criteria Game Genre :: FEUP DSIE 10 :: Paula Rego:: 11

12 Proposed Classification Criteria Game Interface 2D 3D :: FEUP DSIE 10 :: Paula Rego:: 12

13 Proposed Classification Criteria Adaptability Capacity to adapt dynamically game difficulty/ challenge according to patient performance and abilities Speed and position of game elements adjusted according to player s successive hits or misses Speed, position and size of game elements can set level of challenge Many games use levels to structure difficulty :: FEUP DSIE 10 :: Paula Rego:: 13

14 Proposed Classification Criteria Progress Monitoring Performance Feedback :: FEUP DSIE 10 :: Paula Rego:: 14

15 Proposed Classification Criteria Portability The capacity of the game to be played in a clinic or at home In a clinic it requires hardware that can not be used at home At home the therapist can analyse data remotely :: FEUP DSIE 10 :: Paula Rego:: 15

16 Proposed Classification Comparison Classification and Comparison of Rehabilitation Serious Games Application Area Interaction Tech.: Game Interface Betker et al.[24] Ma et Bechkoum [25] Conconi et al.[26] Caglio et al. [27] Motor Motor Cognitive Cognitive Body Weight Movement Motion Tracking + HMD Speech + Touch+ Motion Tracking + Biosensors Keyboard Cameirão et al.[28] Motor and Cognitive Motion Tracking Burke et al.[21] Ryan et al.[31] System RehaCom [32] Motor Motor Cognitive Motion Tracking WiiMote Wii Balance 2D 3D 3D 3D 3D 2D 2D 2D No. Players Single Single Single Single Single Single Competitive / Collaborative Game Genre Single/ Multi None None None None None None None None Memory + Simulation Special Keyboard + Joystick Single Simulation Strategy Simulation -- Simulation Maze Assorted Adaptability Yes Yes Yes No Yes Yes -- Yes Progress Monitoring Performance Feedback Yes Yes Yes No Yes Yes -- Yes Yes Yes Yes -- Yes Yes -- Yes Portability Home Clinic Clinic Clinic Clinic/Home Home -- Clinic :: FEUP DSIE 10 :: Paula Rego:: 16

17 RehaCom A Case Study RehaCom: Importance Modular computer system Widely used and tested in cognitive rehabilitation Installed in many clinics Effectiveness has been demonstrated in a number of studies all very well referenced It has many types of games :: FEUP DSIE 10 :: Paula Rego:: 17

18 RehaCom A Case Study Training Procedures of System RehaCom by Application Area Alertness Vigilance Visuo-spatial Attention Selective Attent. Attention Training - Acoustic Reactivity - Reaction Behavior - Vigilance - 2D - 3D - Attention & Concentration Divided Attention - Divided Attention Memory Training Topological Memory Physiognomic Memory Memory of Words Figural memory Verbal Memory Executive Functions Shopping Plan a Day Logical Reasoning Field of View Training Saccadic Training Exploration Visuomotor skills Visuomotor Coordination :: FEUP DSIE 10 :: Paula Rego:: 18

19 RehaCom A Case Study RehaCom: Game Examples Attention and Concentration Plan a Day :: FEUP DSIE 10 :: Paula Rego:: 19

20 Conclusions and Future Work Conclusions When compared to popular games: - Current therapeutic games lack qualities to be entertaining - Less motivating for patients Most applications are: - Prototypes - For a single-user player The evaluations made included a small number of participants - Effectiveness in rehabilitation is not well validated Most applications used only at clinics or hospitals Neither of the applications reviewed included the collaboration or competitiveness functionality :: FEUP DSIE 10 :: Paula Rego:: 20

21 Conclusions and Future Work Conclusions A review of the most important literature was made Relevant games characteristics were identified To distinguish different systems, a classification proposal was made The limitations and advantages of the systems were identified New opportunities for research were identified :: FEUP DSIE 10 :: Paula Rego:: 21

22 Conclusions and Future Work Future Research: Identify and measure the impact of more relevant aspects Explore automatic systems for monitoring patient performance Explore tele-rehabilitation Study the effectiveness of incorporating a social dimension: competitiveness or collaboration Competitiveness can be a positive feature Explore the use of artificial agents to simulate users presence In the later, study how we can put those agents in same level of abilities as real players and further problems :: FEUP DSIE 10 :: Paula Rego:: 22

23 Doctoral Symposium :: FEUP in DSIE 10 Informatics :: Paula Engineering Rego:: 23 A Survey on Serious Games for Rehabilitation Paula Rego 1,2, Pedro Moreira 1, Luís Paulo Reis 2 1 Instituto Politécnico de Viana do Castelo 2 Faculdade de Engenharia da Universidade do Porto Questions? Porto, 28th and 29th January 2010

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