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Rachel Proffitt - One Game, Many Users

Developing games for rehabilitation and the medical field requires input from a variety of sources and stakeholders. A game for rehabilitation can have multiple potential end users, all of whom can have different requirements for the game. Rehabilitation also occurs in a variety of settings all of which have different demands on the player and the game/system. It is a challenge to incorporate the needs of multiple end users and requirements of multiple treatment settings into a single game for rehabilitation. This talk will discuss the challenges of creating a rehabilitation game for multiple end users and the methods used to overcome the challenges. A prototype game for rehabilitation, Mystic Isle, will be used as an example to highlight specific methods, including the user centered design cycle, multiple iterations, and stakeholder engagement through user testing and focus groups.

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Rachel Proffitt - One Game, Many Users

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  1. ONE GAME, MANY USERS Inclusive Design of Interactive Technologies for Rehabilitation Rachel Proffitt, OTD, OTR/L Assistant Professor of Clinical Occupational Therapy Division of Occupational Science and Occupational Therapy University of Southern California The work depicted here was sponsored by the U.S. Army. Statements and opinions expressed do not necessarily reflect the position or the policy of the United States Government, and no official endorsement should be inferred.

  2. Acknowledgments  U.S. Army Research Lab SFC Paul Ray Smith, Simulation and Training Technology Center (STTC), the Telemedicine and Advanced Technology Research Center (TATRC) at the US Army Medical Research and Materiel Command (USAMRMC) (W911NF- 04-D-0005) (PI: Lange)  National Institute on Disability and Rehabilitation Research (NIDRR) grant: Optimizing Participation Through Technology: Rehabilitation Engineering Research Center (OPTT:RERC) (PI: Winstein) (H133E080024)  NIH T32 Institutional Postdoctoral Training Grant- TREET: Training in Rehabilitation Efficacy and Effectiveness Trials (5T32HD064578- 02) (PI: Clark)  Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California

  3. Game-Based Rehabilitation

  4. Traditional Therapy • Neuroplasticity • Motor Learning/ Motor Control Principles • Wii-Fit • Wii-Motion Plus • EyeToy • DDR Wii-Hab 4

  5. What is the quality of movement we are asking our clients to do? 5

  6. User Testing: Challenges with Off-Shelf-Devices Compensatory Movements Level Difficulty Graphics Dynamic Difficulty Adjustment Data Management Feedback 6

  7. •Stakeholders •Needs Assessment •Focus Groups •Usability Testing Research and Development • Wii-hab • Telemedicine • Rehab Games • Virtual Reality • Neuroplasticity • Motor Learning/ Motor Control Principles •Pilot Studies •Case Controlled Trials •Cohort Studies •RCTs Testing • Game Design • Learning Theories • Game Play mechanics Traditional Therapy Evidence Game-Based Rehab 7

  8. The process

  9. Successful Rehabilitation Depends On: Skillful Clinicians Initial Injury Timing of Therapy Family and Friends 9

  10. Key Stakeholders & User Centered Design  Patients  Clinicians  Occupational Therapists  Physical Therapists  Speech Therapists  Psychiatrist/Neuropsychiatrists  Physicians/PM&R/Physiatry  Caregivers  Family  Friends  Paid/unpaid 10

  11. Functional tasks (motor, sensory, cognitive) that need to be included in the game Is there something that already exists? (off the shelf or developed in our lab: what technologies (hardware) is available and what games are available?) Yes No FOCUS GROUP: What are the user’s thoughts about the current games? How do they interact with these games? What are the user’s thoughts about aspects that could be added to the game? FOCUS GROUP: User’s thoughts on their impairment and associated therapy? User’s suggestions for game play characteristics, mechanics and goals? GAME DESIGN and HARDWARE DESIGN: Depending on user feedback and requirements, hardware is designed and games are designed. These games are designed using the Iterative design process (outlined by Fullerton et al 2004). This iterative design process involves input from user groups throughout the process. USABILITY STUDIES: Users provide feedback about all aspects of the hardware and games. REVISIONS: Games and hardware revised based on user feedback. CLINIC BASED ASSESSMENT 11

  12. Functional tasks (motor, sensory, cognitive) that need to be included in the game Is there something that already exists? (off the shelf or developed in our lab: what technologies (hardware) is available and what games are available?) Yes No FOCUS GROUP: What are the user’s thoughts about the current games? How do they interact with these games? What are the user’s thoughts about aspects that could be added to the game? FOCUS GROUP: User’s thoughts on their impairment and associated therapy? User’s suggestions for game play characteristics, mechanics and goals? GAME DESIGN and HARDWARE DESIGN: Depending on user feedback and requirements, hardware is designed and games are designed. These games are designed using the Iterative design process (outlined by Fullerton et al 2004). This iterative design process involves input from user groups throughout the process. USABILITY STUDIES: Users provide feedback about all aspects of the hardware and games. REVISIONS: Games and hardware revised based on user feedback. CLINIC BASED ASSESSMENT 12

  13. Functional tasks (motor, sensory, cognitive) that need to be included in the game Is there something that already exists? (off the shelf or developed in our lab: what technologies (hardware) is available and what games are available?) Yes No FOCUS GROUP: What are the user’s thoughts about the current games? How do they interact with these games? What are the user’s thoughts about aspects that could be added to the game? FOCUS GROUP: User’s thoughts on their impairment and associated therapy? User’s suggestions for game play characteristics, mechanics and goals? GAME DESIGN and HARDWARE DESIGN: Depending on user feedback and requirements, hardware is designed and games are designed. These games are designed using the Iterative design process (outlined by Fullerton et al 2004). This iterative design process involves input from user groups throughout the process. USABILITY STUDIES: Users provide feedback about all aspects of the hardware and games. REVISIONS: Games and hardware revised based on user feedback. CLINIC BASED ASSESSMENT 13

  14. Functional tasks (motor, sensory, cognitive) that need to be included in the game Is there something that already exists? (off the shelf or developed in our lab: what technologies (hardware) is available and what games are available?) Yes No FOCUS GROUP: What are the user’s thoughts about the current games? How do they interact with these games? What are the user’s thoughts about aspects that could be added to the game? FOCUS GROUP: User’s thoughts on their impairment and associated therapy? User’s suggestions for game play characteristics, mechanics and goals? GAME DESIGN and HARDWARE DESIGN: Depending on user feedback and requirements, hardware is designed and games are designed. These games are designed using the Iterative design process (outlined by Fullerton et al 2004). This iterative design process involves input from user groups throughout the process. USABILITY STUDIES: Users provide feedback about all aspects of the hardware and games. REVISIONS: Games and hardware revised based on user feedback. CLINIC BASED ASSESSMENT 14

  15. Focus Group Protocol Clinicians  Current patient populations  Current rehabilitation protocols  Use of technology with patients  Issues with current rehabilitation protocols  Feedback on game concepts  Ideas for tasks within game-based tool  Patient / Client and Caregiver groups  Current exercise protocols  Lifestyle and recreational activities  Social and community participation  Barriers to exercise and aging with/into disability  Thoughts on use of technology in the clinic/home  Feedback on game concepts  Ideas for maintaining motivation  15

  16. Functional tasks (motor, sensory, cognitive) that need to be included in the game Is there something that already exists? (off the shelf or developed in our lab: what technologies (hardware) is available and what games are available?) Yes No FOCUS GROUP: What are the user’s thoughts about the current games? How do they interact with these games? What are the user’s thoughts about aspects that could be added to the game? FOCUS GROUP: User’s thoughts on their impairment and associated therapy? User’s suggestions for game play characteristics, mechanics and goals? GAME DESIGN and HARDWARE DESIGN: Depending on user feedback and requirements, hardware is designed and games are designed. These games are designed using the Iterative design process (outlined by Fullerton et al 2004). This iterative design process involves input from user groups throughout the process. USABILITY STUDIES: Users provide feedback about all aspects of the hardware and games. REVISIONS: Games and hardware revised based on user feedback. CLINIC BASED ASSESSMENT 16

  17. Functional tasks (motor, sensory, cognitive) that need to be included in the game Is there something that already exists? (off the shelf or developed in our lab: what technologies (hardware) is available and what games are available?) Yes No FOCUS GROUP: What are the user’s thoughts about the current games? How do they interact with these games? What are the user’s thoughts about aspects that could be added to the game? FOCUS GROUP: User’s thoughts on their impairment and associated therapy? User’s suggestions for game play characteristics, mechanics and goals? GAME DESIGN and HARDWARE DESIGN: Depending on user feedback and requirements, hardware is designed and games are designed. These games are designed using the Iterative design process (outlined by Fullerton et al 2004). This iterative design process involves input from user groups throughout the process. USABILITY STUDIES: Users provide feedback about all aspects of the hardware and games. REVISIONS: Games and hardware revised based on user feedback. CLINIC BASED ASSESSMENT 17

  18. User Testing Protocol Overall perception of the game Overall perception of the technology Instructions Game elements Comparison to current exercise program Game Ideas Future use of game        Demographics Common Data Element Game Play Structured Interview 18

  19. Functional tasks (motor, sensory, cognitive) that need to be included in the game Is there something that already exists? (off the shelf or developed in our lab: what technologies (hardware) is available and what games are available?) Yes No FOCUS GROUP: What are the user’s thoughts about the current games? How do they interact with these games? What are the user’s thoughts about aspects that could be added to the game? FOCUS GROUP: User’s thoughts on their impairment and associated therapy? User’s suggestions for game play characteristics, mechanics and goals? GAME DESIGN and HARDWARE DESIGN: Depending on user feedback and requirements, hardware is designed and games are designed. These games are designed using the Iterative design process (outlined by Fullerton et al 2004). This iterative design process involves input from user groups throughout the process. USABILITY STUDIES: Users provide feedback about all aspects of the hardware and games. REVISIONS: Games and hardware revised based on user feedback. CLINIC BASED ASSESSMENT 19

  20. Functional tasks (motor, sensory, cognitive) that need to be included in the game Is there something that already exists? (off the shelf or developed in our lab: what technologies (hardware) is available and what games are available?) Yes No FOCUS GROUP: What are the user’s thoughts about the current games? How do they interact with these games? What are the user’s thoughts about aspects that could be added to the game? FOCUS GROUP: User’s thoughts on their impairment and associated therapy? User’s suggestions for game play characteristics, mechanics and goals? GAME DESIGN and HARDWARE DESIGN: Depending on user feedback and requirements, hardware is designed and games are designed. These games are designed using the Iterative design process (outlined by Fullerton et al 2004). This iterative design process involves input from user groups throughout the process. USABILITY STUDIES: Users provide feedback about all aspects of the hardware and games. REVISIONS: Games and hardware revised based on user feedback. CLINIC BASED ASSESSMENT 20

  21. Functional tasks (motor, sensory, cognitive) that need to be included in the game Is there something that already exists? (off the shelf or developed in our lab: what technologies (hardware) is available and what games are available?) Yes No FOCUS GROUP: What are the user’s thoughts about the current games? How do they interact with these games? What are the user’s thoughts about aspects that could be added to the game? FOCUS GROUP: User’s thoughts on their impairment and associated therapy? User’s suggestions for game play characteristics, mechanics and goals? GAME DESIGN and HARDWARE DESIGN: Depending on user feedback and requirements, hardware is designed and games are designed. These games are designed using the Iterative design process (outlined by Fullerton et al 2004). This iterative design process involves input from user groups throughout the process. USABILITY STUDIES: Users provide feedback about all aspects of the hardware and games. REVISIONS: Games and hardware revised based on user feedback. CLINIC BASED ASSESSMENT 21

  22. Tracking Wheelchair Users 22

  23. Tracking User when Clinician is Present 23

  24. User Feedback in the Clinic Iterative User Group Feedback during Design Process 24

  25. Collaborative Partners and Test Sites 25

  26. The Game

  27. Microsoft Kinect Sensor Resolution: 640x480 at 30 frames per second. Field-of-view: 58 degrees horizontal and 45 degrees vertical 27

  28. Microsoft Kinect Skeletal Tracking 28

  29. Game-based rehabilitation tool  Tailored to individual level of ability  Option for individualized exercise prescription  Interchangeable graphics and environments  After action review and data management 34

  30. Calibration 35

  31. Performance Results 36

  32. Jewel Mine: Stepwise menus 38

  33. Jewel Mine: Avatar Representation 39

  34. Jewel Mine: Game Options 40

  35. Jewel Mine: Game Options 41

  36. 43

  37. 44

  38. 45

  39. Evaluation

  40. Case-study Clinical Setting  68 yo female with Parkinsonism (onset in 2009)  Intervention Dose: 8 x 1-hour sessions over 4 weeks  Customized JewelMine Intervention  Cross body and backwards reaching interventions  Dual tasking with Simon game  Calibration to patient’s limits of stability  Clinician programmed gem number/ sequence  Forward functional reach  Improved from 6 inches to 9.5 inches  Maintained at 4 week follow-up: 9.25 inch  Number of falls between Pre and Post testing  6 falls reported - None during reaching, turning or dual tasking 47

  41. Case Study & Case Series: Home Setting  55 year old Male, 39 months post-Stroke (left hemiparesis)  Intervention Dose: 30-90 minutes/day, 3-7 days/wk – Total 6 weeks  Customized JewelMine Intervention  Sitting, Sit to stand, Step up  Standing right and left, Standing right hand only  Standing with leg exercises Kinect Sensor Monitor Laptop Wireless Mouse

  42. Real World Comparison: Community Dwelling Older Adults Sample of 30 older adults Age: 75.2±8.6yrs (range = 59-92) Right hand dominant 2 x 2 cross-sectional design • 2 task conditions (virtual and real targets) • 2 postural demands (standing and stepping) • • • • Understood the importance of exercise in maintaining function and health • (Proffitt & Lange, 2013) Perceived virtual environments as more engaging than real environments for reaching tasks • (Proffitt et al., in press) Virtual environments required more attentional demand than real environments • (Chen et al., in submission) Used different reaching strategies in virtual environments compared to real environments • (Wade et al., in submission) 49

  43. The future

  44. Clinical Research – Clinic and Home Settings  Phase II Clinical Trial  Collaborations!  Provide feedback and assist with future development  Independent or collaborative studies with different clinical populations 51

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