1. CPLAY2 An HCI Game System for the Assessment and Intervention of
Children with Cerebral Palsy
Arun Gopinathan Manasa Nimmagadda
arun.gopinathan@mavs.uta.edu manasa.nimmagadda@mavs.uta.edu
Arth Vyas Papakostas Michalis Filia Makedon
arth.vyas@mavs.uta.edu michalis.papakostas@mavs.uta.edu makedon@uta.edu
Department of Computer Science and Technology
The University of Texas at Arlington
Arlington, TX 76010
ABSTRACT
Cerebral Palsy (CP) is group of permanent
movement disorders that appear in early childhood.
They include problems with sensation, vision,
hearing, swallowing and speaking. Difficulty of
ability to hearing or reasoning occurs in 1/3rd
of
total cases of Cerebral Palsy. Cerebral Palsy is
caused by abnormal damage to the parts of the brain
that control movement, balance and posture. About
2% of cases are believed to be due to an inherited
genetic cause while the remaining can be due to
brain damage occurring before/during or after birth.
Rehabilitative touch screen gaming promises to
assist in developing muscle tone and dexterity for
CP patients as well as help therapists keep track a
have developed a therapeutic game system (called
CPLAY 2) to assess attention deficit and tracks
game performance. The system generates reports on
CATEGORIES AND SUBJECT DISCRIPTORS
[Rehabilitation Issues] Assistive technology for
persons with disabilities.
KEYWORDS
Cerebral Palsy, therapeutic game, attention deficit,
Hand-Eye co-ordination, Bubble game.
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PETRA '16, June 29 - July 01, 2016, Corfu Island, Greece.
ACM 978-1-4503-4337-4/16/06.
http://dx.doi.org/10.1145/2910674.2935845
1. INTRODUCTION
The pervasiveness of CP range is from
approximately 2-2.5 cases for every 1000 persons.
People who are affected with cerebral palsy may
have paroxysm and intellectual impairments.
According to a survey, around 70 million people are
suffering from Cerebral Palsy. CP can vary in level of
severity, which can be classified by gross motor
function, manual ability and communication. The
problem mostly observed with cerebral palsy
affected children are hand tremors, muscle stiffness
and spasms, slow awkward jerky movements and
inability to identify and grasp objects by touch,
which we will be focusing mostly on.
The system is being developed at the University of
Texas at Arlington, heracleia lab. It is a touch
screen game which has different versions of
popping moving bubbles in random space. The
bubbles are randomly generated in the Unity game
engine platform and position of the falling bubbles
does not follow any pattern. Cerebral Palsy
patients will be able to play this game to increase
dexterity and muscle tone. The system maintains
and updates a web-based profile for each user
every time he/she will plays. This enables the
therapist to tra
and achieve targeted treatment.
1.1 PILOT STUDY
We have conducted a survey to base decisions on
objective information and evoke discussion. There
were 18 people who participated in our survey. We
have arrived on the following conclusion:
People like games that are adaptive
Users get more attracted to High-Definition
graphics and Gameplay
People adhere to a game activity when the

2. User Interface includes incentives to motivate
the interaction.
RELATED WORK
The heracleia lab at University of Texas at
Arlington has developed many games on variety of
platforms targeted for upper extremities
rehabilitation [5]. There are some important traits
each game should have, such as nice graphics and
sound effects so the user who is playing game is
motivated to play. It is important that therapist will
receive some feedback after each game as number
misses or hits and game completion speed. A survey
has been conducted to show the recent advances in
assistive technologies for foster rehabilitation and
improved quality of life of children who are
suffering from CP [4]. The survey focuses
specifically on robotics and interactive games used
in rehabilitation therapy. CP is one of the most
common causes of childhood physical disabilities
[6], though the effects differs from person to person
depending on severity. Apart from muscle control
disorders, Cerebral Palsy is closely associated with
ADHD (Attention Deficit/ Hyper Activity
Disorder). Few studies have proposed a higher 40%
rate of severe difficulties with emotional regulation,
behavior and concentration. In cases of Hemiplegia,
constraint induced movement therapy is one
common method of re habilitation. Recently, a
single investigation into the use of robots for upper
extremity rehabilitation for a child with CP was
presented by Fasoli et al [7].
THE CPLAY2 CEREBRAL PALSY SYSTEM
We have developed a bubble game therapy system for
CP, using the Unity game engine. The CPLAY2 has
some new features from the existing game (CPLAY)
like the statistics are shown to the therapist in
completely different web page where data like last
session score and overall longitudinal data are shown.
Bubbles fall from the virtual SKY (top of screen)
and the user has to pop the bubbles before it
actually falls off the screen. The Metrics used are:
noOfHits, noOfFailures and number of bubbles
escaped. The game has 3 different levels according
speed, size of bubbles and game complexity based on
combination of these two. If the user successfully
finishes level 1, the bubble size decreases and its
speed automatically increases while the user
advances to level 2 and so on. After each game, the
results are analyzed, visualized and stored or sent to
the therapist who may respond with a change in
treatment and record assessment. Figure 2 shows a
screenshot of the report that will be sent to the
therapist.
EXPERIMENTS
Four (4) healthy participants without any disabilities
were selected to play the game and we asked them
to play the game with intentionally given
disabilities like blind folded and fingers tied to each
other. In the later levels of game, we have
introduced a new variation of game in which
participant had to catch the bubbles in the hat and
not bombs which are falling from the top of the
screen, too. The main goal was to measure the focus
and motion ability of participants.
The scores were calculated using the following
formula:
Figure 1. Left shows the screenshot of the bubble
game developed using Unity Platform. Right:
shows a user playing it.
To calculate the score, total hits, failed attempts by
the user and total bubbles escaped were taken and
then they were put in the above formula to calculate
the final score. Because it was multiplied by 100 in
form and we have made rules according to the
scores of the user. With every increase of 500
points, user advances to next level.
RESULTS
After each session the final scores are stored in a
database specifically designed to facilitate user
profiling and user monitoring over time. Both
patient and therapist users can have access to
gaming results through a web service. The system

3. provides rich feedback to both users, which consists
of the total score of the user, the total number of
missed bubbles, the actual size of the bubbles that
escaped and the speed at which the mistakes were
made.
CONCLUSION
This study examines the implications in the
development of system paced gaming intended for
physical therapy. There is a scope of implementing
different techniques and variation in the existing
game and add other factors that avoid obscuring the
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