Developing Serious Games Specifically Adapted to People Suffering from Alzheimer

Review of Navigation Assistive Tools and Technologies for the Visually Impaired

The visually impaired suffer greatly while moving from one place to another. They face challenges in going outdoors and in protecting themselves from moving and stationary objects, and they also lack confidence due to restricted mobility. Due to the recent rapid rise in the number of visually impaired persons, the development of assistive devices has emerged as a significant research field. This review study introduces several techniques to help the visually impaired with their mobility and presents the state-of-the-art of recent assistive technologies that facilitate their everyday life. It also analyses comprehensive multiple mobility assistive technologies for indoor and outdoor environments and describes the different location and feedback methods for the visually impaired using assistive tools based on recent technologies. The navigation tools used for the visually impaired are discussed in detail in subsequent sections. Finally, a detailed analysis of various methods is also carried out, with future recommendations.

Serious Gaming for Behaviour Change: A Systematic Review

Over the years, there has been a significant increase in the adoption of game-based interventions for behaviour change associated with many fields such as health, education, and psychology. This is due to the significance of the players’ intrinsic motivation that is naturally generated to play games and the substantial impact they can have on players. Many review papers measure the effectiveness of the use of gaming on changing behaviours; however, these studies neglect the game features involved in the game design process, which have an impact of stimulating behaviour change. Therefore, this paper aimed to identify game design mechanics and features that are reported to commonly influence behaviour change during and/or after the interventions. This paper identified key theories of behaviour change that inform the game design process, providing insights that can be adopted by game designers for informing considerations on the use of game features for moderating behaviour in their own games.

User Experience of Interactive Technologies for People With Dementia: Comparative Observational Study

Background

Serious games (SGs) are used as complementary approaches to stimulate patients with dementia. However, many of the SGs use out-of-the-shelf technologies that may not always be suitable for such populations, as they can lead to negative behaviors, such as anxiety, fatigue, and even cybersickness.

Objective

This study aims to evaluate how patients with dementia interact and accept 5 out-of-the-shelf technologies while completing 10 virtual reality tasks.

Methods

A total of 12 participants diagnosed with dementia (mean age 75.08 [SD 8.07] years, mean Mini-Mental State Examination score 17.33 [SD 5.79], and mean schooling 5.55 [SD 3.30]) at a health care center in Portugal were invited to participate in this study. A within-subject experimental design was used to allow all participants to interact with all technologies, such as HTC VIVE, head-mounted display (HMD), tablet, mouse, augmented reality (AR), leap motion (LM), and a combination of HMD with LM. Participants’ performance was quantified through behavioral and verbal responses, which were captured through video recordings and written notes.

Results

The findings of this study revealed that the user experience using technology was dependent on the patient profile; the patients had a better user experience when they use technologies with direct interaction configuration as opposed to indirect interaction configuration in terms of assistance required (P=.01) and comprehension (P=.01); the participants did not trigger any emotional responses when using any of the technologies; the participants’ performance was task-dependent; the most cost-effective technology was the mouse, whereas the least cost-effective was AR; and all the technologies, except for one (HMD with LM), were not exposed to external hazards.

Conclusions

Most participants were able to perform tasks using out-of-the-shelf technologies. However, there is no perfect technology, as they are not explicitly designed to address the needs and skills of people with dementia. Here, we propose a set of guidelines that aim to help health professionals and engineers maximize user experience when using such technologies for the population with dementia.

Considerations on Effective Feedback in Computerized Speech Training for Dysarthric Speakers

Introduction: In this article, we consider the role of feedback in computerized speech training for patients with dysarthric speech due to acquired neurological disorders such as Parkinson's disease and stroke. Methods: Based on literature from different fields, we review several issues that play a role when designing feedback for computerized speech training, including serious games. Results: Which speech dimensions (e.g., articulation, loudness) to target in computerized speech feedback, and at what level of detail to provide the feedback, depend on the focus of the specific speech therapy and the technical feasibility of providing reliable speech feedback. Furthermore, feedback that provides knowledge of results generally appears equally effective as knowledge of performance feedback, and is more easily provided in computerized speech training systems. Implicit feedback can be more motivating than explicit feedback (e.g., in serious games), but may be harder to understand. Multimodal feedback is preferred over unimodal feedback to ensure that the feedback message is optimally perceived. Mild negative task-oriented feedback can enhance effort but should be balanced with positive feedback, such as feedback referring to patients' progress. Finally, a balance should be found between the motivational advantages of high-frequency immediate feedback (e.g., in serious games) and the advantages of low-frequency and delayed feedback in preventing patients from becoming dependent on augmented feedback. Conclusions: Several aspects play a role in designing feedback for computerized speech training for dysarthric speakers. Decisions on these aspects should be made carefully, accounting for the specific characteristics of the patient group that is targeted, the focus of the specific speech therapy, and the technological possibilities that are available.

System Development Guidelines From a Review of Motion-Based Technology for People With Dementia or MCI

As the population ages and the number of people living with dementia or mild cognitive impairment (MCI) continues to increase, it is critical to identify creative and innovative ways to support and improve their quality of life. Motion-based technology has shown significant potential for people living with dementia or MCI by providing opportunities for cognitive stimulation, physical activity and participation in meaningful leisure activities, while simultaneously functioning as a useful tool for research and development of interventions. However, many of the current systems created using motion-based technology have not been designed specifically for people with dementia or MCI. Additionally, the usability and accessibility of these systems for these populations has not been thoroughly considered. This paper presents a set of system development guidelines derived from a review of the state of the art of motion-based technologies for people with dementia or MCI. These guidelines highlight three overarching domains of consideration for systems targeting people with dementia or MCI: (i) cognitive, (ii) physical, and (iii) social. We present the guidelines in terms of relevant design and use considerations within these domains and the emergent design themes within each domain. Our hope is that these guidelines will aid in designing motion-based software to meet the needs of people with dementia or MCI such that the potential of these technologies can be realized.

Recommendations for the Use of Serious Games in Neurodegenerative Disorders: 2016 Delphi Panel

The use of Serious Games (SG) in the health domain is expanding. In the field of neurodegenerative disorders (ND) such as Alzheimer’s disease, SG are currently employed both to support and improve the assessment of different functional and cognitive abilities, and to provide alternative solutions for patients’ treatment, stimulation, and rehabilitation. As the field is quite young, recommendations on the use of SG in people with ND are still rare. In 2014 we proposed some initial recommendations (Robert et al., 2014). The aim of the present work was to update them, thanks to opinions gathered by experts in the field during an expert Delphi panel. Results confirmed that SG are adapted to elderly people with mild cognitive impairment (MCI) and dementia, and can be employed for several purposes, including assessment, stimulation, and improving wellbeing, with some differences depending on the population (e.g., physical stimulation may be better suited for people with MCI). SG are more adapted for use with trained caregivers (both at home and in clinical settings), with a frequency ranging from 2 to 4 times a week. Importantly, the target of SG, their frequency of use and the context in which they are played depend on the SG typology (e.g., Exergame, cognitive game), and should be personalized with the help of a clinician.

Intelligent Biohazard Training Based on Real-Time Task Recognition

Virtual environments offer an ideal setting to develop intelligent training applications. Yet, their ability to support complex procedures depends on the appropriate integration of knowledge-based techniques and natural interaction. In this article, we describe the implementation of an intelligent rehearsal system for biohazard laboratory procedures, based on the real-time instantiation of task models from the trainee’s actions. A virtual biohazard laboratory has been recreated using the Unity3D engine, in which users interact with laboratory objects using keyboard/mouse input or hand gestures through a Kinect device. Realistic behavior for objects is supported by the implementation of a relevant subset of common sense and physics knowledge. User interaction with objects leads to the recognition of specific actions, which are used to progressively instantiate a task-based representation of biohazard procedures. The dynamics of this instantiation process supports trainee evaluation as well as real-time assistance. This system is designed primarily as a rehearsal system providing real-time advice and supporting user performance evaluation. We provide detailed examples illustrating error detection and recovery, and results from on-site testing with students from the Faculty of Medical Sciences at Kyushu University. In the study, we investigate the usability aspect by comparing interaction with mouse and Kinect devices and the effect of real-time task recognition on recovery time after user mistakes.

Study of the usability of spaced retrieval exercise using mobile devices for Alzheimer's disease rehabilitation

Background

Alzheimer's disease (AD) is an irreversible brain disease that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest daily tasks. Recent studies showed that people with AD might actually benefit from physical exercises and rehabilitation processes. Studies show that rehabilitation would also add value in making the day for an individual with AD a little less foggy, frustrating, isolated, and stressful for as long as possible.

Objective

The focus of our work was to explore the use of modern mobile technology to enable people with AD to improve their abilities to perform activities of daily living, and hence to promote independence and participation in social activities. Our work also aimed at reducing the burden on caregivers by increasing the AD patients’ sense of competence and ability to handle behavior problems.

Methods

We developed ADcope, an integrated app that includes several modules that targeted individuals with AD, using mobile devices. We have developed two different user interfaces: text-based and graphic-based. To evaluate the usability of the app, 10 participants with early stages of AD were asked to run the two user interfaces of the spaced retrieval memory exercise using a tablet mobile device.

Results

We selected 10 participants with early stages of AD (average age: 75 years; 6/10, 60% males, 4/10, 40% females). The average elapsed time per question between the text-based task (14.04 seconds) and the graphic-based task (12.89 seconds) was significantly different (P=.047). There was also a significant difference (P<.001) between the average correct answer score between the text-based task (7.60/10) and the graphic-based task (8.30/10), and between the text-based task (31.50/100) and the graphic-based task (27.20/100; P<.001). Correlation analysis for the graphic-based task showed that the average elapsed time per question and the workload score were negatively correlated (−.93, and −.79, respectively) to the participants’ performance (P<.001 and P=.006, respectively).

Conclusions

We found that people with early stages of AD used mobile devices successfully without any prior experience in using such devices. Participants’ measured workload scores were low and posttask satisfaction in fulfilling the required task was conceivable. Results indicate better performance, less workload, and better response time for the graphic-based task compared with the text-based task.