Rachel Proffitt - One Game, Many Users

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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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  • Graphics – childish, too complex, red and green color blindness
    for systematic delivery and control of stimuli

    to vary intensity level in a flexible and dynamic way

    to precisely capture motor response in real time

    to motivate adherence of therapy process

    to provide face-to-face therapy sessions
  • To construct a depth map, the sensor uses a proprietary algorithm to resolve the pattern produced by projecting coded infrared light onto the scene geometry. This system has a field-of-view of 58 degrees horizontal and 45 degrees vertical, and generated depth maps with a resolution of 640x480 at 30 frames per second.
  • The software components of the sensing package are the OpenNI and NITE frameworks, which provide user identification, scene segmentation, and skeleton tracking. To create the game, we used the Unity3 game engine along with an OpenNI wrapper developed by PrimeSense to integrate these frameworks with the game engine. The engine provides a C# API and flexible editor which allows for rapid development of games. This rapid development cycle enables faster iteration of game mechanics and ultimately results in more specificity for tailoring games to address patient’s individual disabilities
  • Rachel Proffitt - One Game, Many Users

    1. 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. 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. 3. Game-Based Rehabilitation
    4. 4. 4 • Neuroplasticity • Motor Learning/ Motor Control Principles Traditional Therapy • Wii-Fit • Wii-Motion Plus • EyeToy • DDR Wii-Hab
    5. 5. 5 What is the quality of movement we are asking our clients to do?
    6. 6. 6 User Testing: Challenges with Off-Shelf-Devices Level Difficulty Compensatory Movements Graphics Feedback Data Management Dynamic Difficulty Adjustment
    7. 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. 8. The process
    9. 9. 9 Initial Injury Family and Friends Timing of Therapy Skillful Clinicians Successful Rehabilitation Depends On:
    10. 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. 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
    12. 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 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. 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 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. 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 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
    15. 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. 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
    17. 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 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
    18. 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. 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
    20. 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 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. 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 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
    22. 22. 22 Tracking Wheelchair Users
    23. 23. 23 Tracking User when Clinician is Present
    24. 24. 24 User Feedback in the Clinic Iterative User Group Feedback during Design Process
    25. 25. 25 Collaborative Partners and Test Sites
    26. 26. The Game
    27. 27. 27 Microsoft Kinect Sensor Field-of-view: 58 degrees horizontal and 45 degrees vertical Resolution: 640x480 at 30 frames per second.
    28. 28. 28 Microsoft Kinect Skeletal Tracking
    29. 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. 30. 35 Calibration
    31. 31. 36 Performance Results
    32. 32. 38 Jewel Mine: Stepwise menus
    33. 33. 39 Jewel Mine: Avatar Representation
    34. 34. 40 Jewel Mine: Game Options
    35. 35. 41 Jewel Mine: Game Options
    36. 36. 43
    37. 37. 44
    38. 38. 45
    39. 39. Evaluation
    40. 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 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
    41. 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. 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: 75.2±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)
    43. 43. The future
    44. 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

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