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Playful Tray: Adopting Ubicomp and Persuasive Techniques into Play-based Occupational Therapy for Reducing Poor Eating Behavior in Young ChildrenUBICOMP 2007Dori Lin, Hao Chu, Arthur Chen, Jane Hsu, Polly HuangGraduate Institute of Networking and MultimediaNational Taiwan UniversityJin-Ling Lo, His-Chin ChouNational Taiwan University Hospital
Child Behavior Training • Child behavior training as important but challenging parental responsibility • Potty training, tooth brushing, self-dressing, cleaning room, slow eating (focus of this work) • The most common form of parental persuasion is verbal persuasion. • “if you don’t finish your food, you are going to sit here for the rest of your life”. • Effective and Why not? • Verbal persuasion alone lacks proper incentive to motivate child
A Case Study: Child Mealtime Behavior • Target child long mealtime problem (over 30 minutes) • Affect the participation of daily activities • Negative parent-child interaction • Dinner time supposed to be valuable family time together • Common scenario: A child refuses to eat -> Mother upset -> Mother force feed -> Child upset
Play-based Occupational Therapy • Pediatric occupational therapy (O.T.) • Leverage the desire of children to play to induce their behavior change willingly. • A child may not like to sit & eat dinner, but likes to play. • Add playfulness (game) into the eating activity • Effective – full of toys in pediatric O.T. clinic.
Play-Based O.T. Limitations (1) Children treated in clinics during regular office hours (NTU Hospital) • Many child behavior problems not observable to therapists • Eating (dinner time), sleeping (night time), etc. • Effective treatment is difficult. (2) Train general performance skill rather than specific functional skill • Hand scoping skill vs. eating skill • Improvement in general performance skills may not translate into specific functional skills
UBICOMP Opportunities • Embed digital technology into a child naturalistic living environment • Sensing to observe child behavior anytime, anywhere • Game playing to influence child behavior anytime, anywhere • Occupational therapist perspective: • From treatment clinic • To the child actual living environment (functional behaviors) • UBICOMP perspective: • From sense and track behaviors • To engage children to change behaviors • Also called Persuasive technology (by Fogg and others)
Playful Tray Prototype 1: Coloring Game • Sensing • Weight sensors underneath tray detect child eating actions • Eating actions are game input • Playing • An interactive game of coloring a cartoon character • To fully color the cartoon character, a child is motivated to eat. • Is this design successful?
Why not? Show prototype #1 to our pediatric O.T. partners, their feedbacks are two questions: • Do you think the child would pay attention to playing the game or eating (enjoying) food? • What would happen if parents take away the tray after a while? • Intervention (Effective) – Post (Ineffective) Guess their opinions from their questions …
Play-based Occupational Therapy Model • Treatment program is about designing a play activity (three elements). Volition Performance Habituation Bring enough enjoyment to attract a child to participate in the target activity. Ensure a child will have a successful experience. Set appropriate level of difficulty. Apply reinforcement to reward good performance, so increase change of repeating desirable behavior. Enough times to become a habit.
Design Consideration • Attention (Child) • Split between playing and eating • Game playing (secondary) not overtaking eating (primary, target) • Enjoyment (Game) • Bring just enough fun to attract children to eating • Engagement (Game) • Simple (Not all young children can learn to operate complex devices) • Use natural eating actions as game inputs • Child must eat to continue playing (eating becomes self-inforced)
Prototype 1: Problems • Disengagement • Grabbed too much attention & distract children from proper eating. • Gobbling • Impatient children ate too quickly (to color cartoon character). • Single weight cell is sufficient • Food is served in one bowl to a young child (at home or school).
Prototype 2: Racing Game Tray Palm-top PC with touch screen For placing the bowl Weight sensing surface
The Racing Game • No reward for eating too fast
Racing Game Tray: Feedbacks • Tray was too thick (3 cm) • Inconvenience for young children with short arms • Playing the same game boring • Download new games • Expensive • Difficult to wash
Prototype 3: Mobile Penguin Fishing Tray Bluetooth mobile phone accessory Placemate skin Weight sensing module Mobile Phone Download new games Only buy the skin & weight sensing model Light, foldable, washable, changeable 50% Thinner (1.5 cm)
Game start Child selects a penguin to compete in a fishing game.
Game start Each bite causes one penguin to get a fish The penguin getting more fish at the end wins Child is motivate to help in order to help penguin to win.
Pilot User Study on Prototype #2 • Conducted by our pediatric O.T. team • Subjects: four young children with reported long mealtime problems (30 min to over 1 hr)
User Study Procedure • Child’s Mealtime Behavior Checklist • Interview - to clarify behavioral details • Record eating activities without the tray • Record eating activities with the tray within 1 week
Measurement method • Code behaviors of both children & parents from taped videos • Our eating coding behavior table was modified from Moore. • Self-feeding (Positive, Negative) • Child active feeding or related behaviors • Interaction (Positive, Negative) • Actively initiated behaviors and synchronous responsive behaviors of the feeding partners • Social • Toward a feeding partner but unrelated to feeding • Positive (promote self-feeding); Negative (interrupt self-feeding)
Measurements (with vs. without the tray) • Mealtime duration • Child on-task / off-task behavior ratio • Parent on-task / off-task behavior ratio • Parent positive / negative behavior ratio
Result: Mealtime Duration • (A:23, B:40, C:41, D:25) -> (23, 25, 29, 9) • Except for Child A, children B, C, D all had reduced mealtime from 29% ~ 64%.
Measurements (with vs. without the tray) • Mealtime duration • Child on-task / off-task behavior ratio • On-task behaviors: positive behaviors • Off-task behaviors: negative + social behaviors • High ratio is good. • Parent on-task / off-task behavior ratio • Parent positive / negative (P/N) behavior ratio
Child On-task/Off-task Behavior Ratio • Improvement in all children • Children were more focused on self-feeding with the playful tray 0.8~1.6 2.3~5.9
Measurements: with vs. without the tray • Mealtime duration • Child on-task / off-task behavior ratio • Parent on-task / off-task behavior ratio • On-task behaviors: positive behaviors • Off-task behaviors: negative + social behaviors • High ratio means good improvement. • Parent positive / negative behavior ratio
Parent On-task/Off-task Behavior Ratio • Improvement of all parents • Parents were also more focused on the feeding task with the playful tray. 0.5~1.1 0.8~2.3
Measurements: with vs. without the tray • Mealtime duration • Child on-task / off-task behavior ratio • Parent on-task / off-task behavior ratio • Parent positive / negative behavior ratio
Result: Parent P/N Ratio • Less negative & more positive interaction between parent-child. • A positive interaction cycle of parent giving encouragement and children responding with positive self-feeding behaviors • Mealtime experience can be good. 0.79~4.00 4.30~30.00
Limitation • Pilot user study results were encouraging but not conclusive • Lack long-term user studies involving more children • Lack post-intervention study • What happened when taking away the tray? • For O.T., success = improvement from posttest to pretest.
Conclusion • This work demonstrates a case study of adopting UBICOMP technology in play-based occupational therapy for children • Pilot user study results were encouraging
Ongoing & Future Work (Children have lots of behavior problems) • Playful toothbrush • Tooth brushing behavior • Sensing: camera vision to recognize brushing motions • Playing: an game of cleaning dirty teeth • Mug-Tree • Regular water drinking habit • Sensing: tilt sensor to detect drinking actions. • Playing: watering a virtual tree
Many Thanks • Reviewers for their insightful comments • Our shepherd Sunny Consolvo • Keng-hao Chang on helping to create the first prototype
Thanks Q & A
Result: Child P/N Ratio • Child negative behaviors decreased 0.80~13.33 6.95~19.00 different food types (rice/ dumpling→easy to eat → less self-feeding actions) ↑