AN INVESTIGATION INTO UTILISING
A THERAPEUTIC EXERGAME TO
IMPROVE THE REHABILITATION
PROCESS
Sarah O'Neill M.Sc. – sloneill@wit.ie
Dr. Patrick Felicia – pfelicia@wit.ie
Outline
1. Limitations
2. Games Applicability to Physiotherapy
3. Game Development Technologies
4. Game Design Approach
5. The Game Developed
6. Preliminary Study & Results
2
Background
 Serious need to improve rehabilitation process for
physiotherapy
 Challenges impacting negatively on success rates and
recovery times
 Low Adherence



Detected – Modify Programme
Success – Dependent upon adherence
Adherence falters – Recovery could take longer or be
unsuccessful
3
Background
 Monitoring




Exercise Sheets
Common practice
Essential Intervention
Difficult to understand
 Exercise Technique


Crucial exercise is accurate
Further Injury = Prolonged recovery time
4
Games Applicability to Physiotherapy
 Gesture-based games
 Natural Interaction
 New realm – players are not sedentary
 Feedback is more appropriate
 Gaming is ubiquitous!
 Gesture based consoles
 Generational Acceptance
 Opportunities for Serious Games
5
Games Applicability to Physiotherapy
 Learning is more engaging
 Innovative and playful  Increase motivation
 Multi-sensory environments  Learning styles
 Multimedia Elements
 Exercise demonstrations
 Correct technique
6
Games Applicability to Physiotherapy
 Distraction
 Pain management
 Remove the idea of exercise or treatment
 Drill and Practice
 Skill and competence through repetition
 Achieved easily through game elements
7
Game Development - Technologies
Unity3D
OpenNi
 3D & fast code execution
 Open- Source Software
Development Kit (SDK)
 C++, C# & JavaScript
 Integration with Unity3D
 Open Source
 Platform Independence
 Graphical User Interface
 Tracking System
 ZigFu
8
Game Design Approach
User Centered Design
 Analysis Phase
 Exercises to be incorporated
 Exercise Repetitions
 Design, Evaluation and Implementation Phases
 Game Content
 Storyboarding
 Prototyping
 Deployment
9
The Game Developed
10
Preliminary Study
 Single Session Study
 Physiotherapy clinic in Waterford
 Ten Participants
 20 – 55yrs old
 Self-Determination Theory (SDT)
 Study of human motivation and personality
 Different types of motivation inspire human behaviour
& exist on a continuum
11
Preliminary Study
 Self-Determination Theory (SDT)
 Intrinsic Motivation

Performing an activity for its own sake
 Extrinsic Motivation


External Regulation
 Positive incentives/Avoid negative consequences
Identified Regulation
 Valuable / Chosen by oneself
12
Preliminary Study
 Self-Determination Theory (SDT)
 Amotivation

Lack of intention to act
 Situational Motivation
 Motivation at a given point in time
 SItuational Motivation Scale (SIMS)
 16 Item adaptable self report questionnaire
13
Overall Motivation - SDI Scores
SDI formula: (2 * IM + 1 * IR) – (1 * ER + 2 * A)
14
Different Types of Motivation
15
Exercise Technique
 8 Participants – Accurate
 2 Participants – Inaccurate
 2 Participants had used the Microsoft Kinect before
 Game Scores - Successfully completed games with high
scores
16
Thank you for listening
I will be happy to answer any questions
you may have
17
References
Baranowski, T., Baranowski, J., Cullen, K.W. (2003) ‘ Squire’s Quest! dietary outcome
evaluation of a multimedia game’. Am J Prev Med. 24(1), pp. 52-61.
Baranowski, T., Buday, R., Thompson, D.I., Baranowski, J. (2008) ‘Playing for Real Video Games and Stories for Health-Related
Behavior Change’. Am J Prev Med. 34(1) pp. 74–82.
Baranowski T, Lin LS, Wetter DW, Resnicow K, Hearn MD. Theory as mediating variables: Why aren’t community interventions
working as desired? Annals of Epidemiology 1997;S7:S89–S95.
Bee, H. and Boyd, D. (2006) The Developing Child. Pearson, Boston.
Birch, A., Malim, T. (1998) Introductory Psychology. Palgrave, Hampshie.
Burdea, G. C., Tamar Weiss, P. L., Thalmann, D. (2007) ‘Guest Editorial Special Theme on Virtual Rehabilitation’, Neural Systems and
Rehabilitation Engineering, IEEE Transactions on , 15(1), pp. 1. Institute of Electrical and Electronics Engineers [Online] Available
at: http://ieeexplore.ieee.org.ezproxy.wit.ie:2048/stamp/stamp.jsp?tp=&arnumber=4126534&isnumber=4126524 (Accessed 21
December 2011).
Codori A-M, Nannis E D and Pack A D (1992): The development of a clinical measure of compliance with hand rehabilitation.
Journal of Hand Therapy 5: 29-33.
Csikszentmihalyi M. (1990) Flow: The Psychology of Optimal Experience. New York: Harper & Row.
de Freitas, S., Levene, M. (2004) ‘An investigation of the use of simulations and video gaming for supporting exploratory learning
and developing higher-order cognitive skills’ IADIS International Conference in Cognition and Exploratory Learning in the Digital
Age. Lisbon: Portugal.
de Freitas, S., Jarvis, S. (2007) 'Serious games - engaging training solutions: A research and development project for supporting
training needs’. British Journal of Educational Technology. 38(3), pp. 523-525.
Deci, E. L., & Ryan, R. M. (1985). Intrinsic motivation and self-determination in human behavior.New York: Plenum.
Deci, E. L., & Ryan, R. M. (1991). A motivational approach to self: Integration in personality. In R. Dienstbier (Ed.), Nebraska
Symposium on motivation: vol. 38. Perspectives on motivation. (p. 237–288). Lincoln: University of Nebraska press.
Doyle, J., Kelly, D., Caulfield, B. (2011) ‘Design considerations in therapeutic exergaming’. Pervasive Computing Technologies for
Healthcare (PervasiveHealth), 2011 5th International Conference on. pp. 389-393 Institute of Electrical and Electronics Engineers
[Online] Available at:
http://ieeexplore.ieee.org.ezproxy.wit.ie:2048/stamp/stamp.jsp?tp=&arnumber=6038836&isnumber=6038756 (Accessed: 14
December 2011).
Doyle, J., Kelly, D., Patterson, M., Caulfield, B. (2011) ‘The effects of visual feedback in therapeutic exergaming on motor task
accuracy’ Virtual Rehabilitation (ICVR), 2011 International Conference on. pp. 1-5. Institute of Electrical and Electronics Engineers
[Online] Available at:
http://ieeexplore.ieee.org.ezproxy.wit.ie:2048/stamp/stamp.jsp?tp=&arnumber=5971821&isnumber=5971805 (Accessed: 14
December 2011).
18
References
Encarnação, M 2010, 'Beauty and the Beast -- Serious Games in Healthcare', International Journal Of Computer Science In Sport, 9, 2,
pp. 27-39, SPORTDiscus with Full Text, EBSCOhost, viewed 21 December 2011.
Gee, J. (2003). What video games have to teach us about learning and literacy. New York: Palgrave-Macmillan.
Guay, F., Vallerand, R. J., Blanchard, C.. (2000). ‘On the Assessment of Situational Intrinsic and Extrinsic Motivation: The Situational
Motivation Scale’, Motivation and Emotion. 24 (3), p. 175 - 210.
Hofstetter, F. (1995) Multimedia literacy. New York: McGraw- Hill
Johnson, L., Smith, R.., Willis, H., Levine, A., and Haywood, K., (2011). The 2011 Horizon Report Austin, Texas: The New Media
Consortium.
Jones, D.C. (2006) ‘Scavenger Hunt Enhances Students' Utilization of Blackboard’ MERLOT Journal of Online Learning and Teaching.
2(2), pp. 86-99.
Keen, P. (1997) Business Multimedia Explained: A managers guide to key terms and concepts. America: Harvard Business School Press.
Koster, R. (2004) A Theory of Fun for Game Design. United States: Paraglyph Press
Laikari, A. (2009) ‘Exergaming - Gaming for health: A bridge between real world and virtual communities’, Consumer Electronics,
IEEE 13th International Symposium. pp. 665-668. Institute of Electrical and Electronics Engineers [Online] Available at:
http://ieeexplore.ieee.org.ezproxy.wit.ie:2048/stamp/stamp.jsp?tp=&arnumber=5157004&isnumber=5156791 (Accessed: 14
December 2011).
Ley P, Bradshaw PW, Eaves DE, Walker, CM 1973 A method for increasing patients’ recall of information presented by doctors.
Psychological Medicine 3: 217-220.
Lieberman, D. (1997). Interactive Video Games for Health Promotion: Effects on Knowledge, Self-Efficacy, Social Support and
Health. In R. L. Street, W. R. Gold, & T. R. Manning (Eds.), Health promotion and interactive technology (pp. 103-119). Mahwah,
NJ: Lawrence Erlbaum Associates.
Mitchell, A., Savill-Smith, C. (2001) ‘The Use of Computer and Video Games for Learning’. A Review of the Literature, Learning and
Skills Development Agency.
O'Huiginn, B., Smyth, B., Coughlan, G., Fitzgerald, D., Caulfield, B. (2009) ‘Therapeutic Exergaming’ Wearable and Implantable Body
Sensor Networks, 2009. BSN 2009. Sixth International Workshop on. pp.273-277. Institute of Electrical and Electronics Engineers
[Online] Available at:
http://ieeexplore.ieee.org.ezproxy.wit.ie:2048/stamp/stamp.jsp?tp=&arnumber=5226878&isnumber=5226857 (Accessed: 14
December 2011).
Park, D.C., Willis, S.L., Morrow, D., Diehl, M., Gaines, CL. (1994) ‘Cognitive function and medication usage in older adults’. Journal
of Applied Gerontology. 13, pp. 39-57.
Prensky, M. (2001). Digital-game-based learning. New York and London: McGraw Hill.
19
References
Rastall, M., Brooks, B., Klarneta, M., Moylan, N., McCloud, W., Tracey, S. (1999) ‘An investigation into younger and older adults’
memory for physiotherapy exercises’. Physiotherapy. 85, pp. 122-128.
Ryan R, Rigby C, Przybylski A. (2006) ‘The motivational pull of videogames: a self-determination theory approach’. Motivation and
Emotion. pp. 347–63.
Shaffer, D.W., Squire, K.D., Halverson, R. and Gee, J.P. (2005) ‘Video Games and the Future of Learning’. Phi Delta Kappan. 87(2), pp.
104-111.
Smith, E. Nolen-Hoeksema, S. Fredrickson, B and Loftus, G. (2003) Atkinson & Hilgard’s Introduction to Psychology. 14th Edition.
Wadsworth, Belmont.
Smith, J, Lewis, J, & Prichard, D 2005, 'Physiotherapy exercise programmes: Are instructional exercise sheets effective?',
Physiotherapy Theory & Practice, 21, 2, pp. 93-102, Academic Search Complete, EBSCOhost, viewed 18 December 2011.
Tang, S., Hanneghan, M. (2010) ‘A Model-Driven Framework to Support Development of Serious Games for Game-based Learning’.
Developments in E-systems Engineering (DESE). pp.95-100. Institute of Electrical and Electronics Engineers [Online] Available at:
http://ieeexplore.ieee.org.ezproxy.wit.ie:2048/stamp/stamp.jsp?tp=&arnumber=5633373&isnumber=5629955 (Accessed: 20
November 2011).
Taylor, N.F., Dodd, K.J., Shields, N., Bruder, A. (2007) ‘Therapeutic exercise in physiotherapy is beneficial: a summary of systematic
reviews 2002- 2005’ Australian Journal of Physiotherapy. 53, pp. 7-16.
Thompson, D. Baranowski, T., Buday, R., Baranowski, J., Thompson, V., Jago, R., Griffith, M.J. (2010) ‘Serious Video Games for
Health: How Behavioral Science Guided the Development of a Serious Video Game’ Simulation & Gaming. 41(4), pp. 587–606.
Vallerand, R. J. (1997). Toward a hierarchical model of intrinsic and extrinsic motivation. In M. P. Zanna (Ed.), Advances in
experimental social psychology (pp. 271–360). New York: Academic Press.
Vredenburg, K., Isensee, S. and Righi, C. (2002) User-Centered Design – An Integrated Approach. New Jersey: Prentice Hall.
Web Accessibility Initiative. (1994-2006) Notes on User Centered Design Process (UCD). [Online] Available at:
http://www.w3.org/WAI/redesign/ucd (Accessed 14 January 2012).
Yusoff, A., Crowder, R., Gilbert, L., Wills, G. (2009) ‘A Conceptual Framework for Serious Games’ Advanced Learning Technologies,
2009. ICALT 2009. Ninth IEEE International Conference on. pp. 21-23. Institute of Electrical and Electronics Engineers [Online]
Available at: http://ieeexplore.ieee.org.ezproxy.wit.ie:2048/stamp/stamp.jsp?tp=&arnumber=5194153&isnumber=5194138
(Acessed: 14 December 2011).
20