- 1. 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. Rachel Proffitt, OTD,
OTR/L Assistant Professor of Clinical Occupational Therapy Division
of Occupational Science and Occupational Therapy University of
Southern California ONE GAME, MANY USERS Inclusive Design of
Interactive Technologies for Rehabilitation
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. 4 Neuroplasticity Motor Learning/ Motor Control
Principles Traditional Therapy Wii-Fit Wii-Motion Plus EyeToy DDR
Wii-Hab 5. 5 What is the quality of movement we are asking our
clients to do? 6. 6 User Testing: Challenges with Off-Shelf-Devices
Level Difficulty Compensatory Movements Graphics Feedback Data
Management Dynamic Difficulty Adjustment 7. 7 Neuroplasticity Motor
Learning/ Motor Control Principles Traditional Therapy Game Design
Learning Theories Game Play mechanics Research and Development
Wii-hab Telemedicine Rehab Games Virtual Reality Game-Based Rehab
Stakeholders Needs Assessment Focus Groups Usability Testing
Testing Pilot Studies Case Controlled Trials Cohort Studies RCTs
Evidence 8. The process 9. 9 Initial Injury Family and Friends
Timing of Therapy Skillful Clinicians Successful Rehabilitation
Depends On: 10. 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
11. 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 users thoughts about the current games? How do they
interact with these games? What are the users thoughts about
aspects that could be added to the game? FOCUS GROUP: Users
thoughts on their impairment and associated therapy? Users
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. 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 users thoughts about the current
games? How do they interact with these games? What are the users
thoughts about aspects that could be added to the game? FOCUS
GROUP: Users thoughts on their impairment and associated therapy?
Users 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. 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 users thoughts about
the current games? How do they interact with these games? What are
the users thoughts about aspects that could be added to the game?
FOCUS GROUP: Users thoughts on their impairment and associated
therapy? Users 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. 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 users thoughts
about the current games? How do they interact with these games?
What are the users thoughts about aspects that could be added to
the game? FOCUS GROUP: Users thoughts on their impairment and
associated therapy? Users 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 15. 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 16. 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 users thoughts about the current
games? How do they interact with these games? What are the users
thoughts about aspects that could be added to the game? FOCUS
GROUP: Users thoughts on their impairment and associated therapy?
Users 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. 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 users thoughts about
the current games? How do they interact with these games? What are
the users thoughts about aspects that could be added to the game?
FOCUS GROUP: Users thoughts on their impairment and associated
therapy? Users 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 18. 18 Demographics Common
Data Element Structured Interview Game Play Overall perception of
the game Overall perception of the technology Instructions Game
elements Comparison to current exercise program Game Ideas Future
use of game User Testing Protocol 19. 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 users thoughts about
the current games? How do they interact with these games? What are
the users thoughts about aspects that could be added to the game?
FOCUS GROUP: Users thoughts on their impairment and associated
therapy? Users 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. 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 users thoughts
about the current games? How do they interact with these games?
What are the users thoughts about aspects that could be added to
the game? FOCUS GROUP: Users thoughts on their impairment and
associated therapy? Users 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. 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 users thoughts about the current games? How do they
interact with these games? What are the users thoughts about
aspects that could be added to the game? FOCUS GROUP: Users
thoughts on their impairment and associated therapy? Users
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 22. 22 Tracking Wheelchair Users 23. 23
Tracking User when Clinician is Present 24. 24 User Feedback in the
Clinic Iterative User Group Feedback during Design Process 25. 25
Collaborative Partners and Test Sites 26. The Game 27. 27 Microsoft
Kinect Sensor Field-of-view: 58 degrees horizontal and 45 degrees
vertical Resolution: 640x480 at 30 frames per second. 28. 28
Microsoft Kinect Skeletal Tracking 29. 34 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 30. 35
Calibration 31. 36 Performance Results 32. 38 Jewel Mine: Stepwise
menus 33. 39 Jewel Mine: Avatar Representation 34. 40 Jewel Mine:
Game Options 35. 41 Jewel Mine: Game Options 36. 43 37. 44 38. 45
39. Evaluation 40. 47 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 patients 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 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 Monitor Kinect Sensor Laptop
Wireless Mouse 42. 49 Real World Comparison: Community Dwelling
Older Adults 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) Sample of 30 older adults Age: 75.28.6yrs (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) 43. The future 44. 51 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
