GAME-BASED MOBILITY TRAINING AND MOTIVATION OF SENIOR CITIZENS
GameUp project is cofunded by the AAL Joint Programme (AAL-2011-4-090)
GAME-BASED MOBILITY TRAINING AND MOTIVATION OF SENIOR CITIZENS
PARTNERSCOFUNDING

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
User Forum and workshop for
exergames in AAL
AAL Forum 2014
Palace of the Parliament
Bucharest, Romania

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Agenda
• Overview GAMEUP Project
– Antonio Remartinez (Ibernex)
• Mobility and fall prevention Apps
– Viviane Hasselmann (K. Valens)
• User-centric design
– Ellen Brox (Norut)
• Rehabilitation Games
– Luis Luque (Norut/USE)
• Panel discussion

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Overview GAMEUP Project:
Exergames for enhanced
mobility
Antonio Remartinez

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
GameUp Main Objective
The main objective is to sustain mobility of senior citizens, prolonging
the time they can live autonomously in their home environment and
consequently enhance quality of life
Done by:
Developing an ecosystem of personalized social and motivational
exercise games to reduce physical and motivational barriers of elderly
people’s mobility
General Overview
User Interface Coaching Portal
TV with SetTopBox
PC with
keyboard
Indoor motion sensor
Outdoor motion
sensor/
pedometer
personalized exergames
with motivational and
social elements
User is the
controller

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Example Games
• Strength games
• Balance games
• Walking games
• Flexibility games
• Games with several levels
• Levels in each game depending
on abilities
• Personal safety while playing is considered important
General Overview

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Exercises
• Chosen exercises are recognized as important for mobility of elderly,
focusing on leg strength and balance.
• Research shows that Long-lasting and high-intensive
multicomponent exercise programs have a positive effect on
Activities of Daily Living.
• A coach portal will enable instructors to follow progress
General Overview

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Technologies
• Will use Kinect sensor for detecting movement
• Will use Fitbit pedometer for outdoor walking
• Must be very easy to use with
as little buttons and remotes
as possible
• Price is important
• Will use TV and Small PC
connected to internet
General Overview

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Mobility and Fall Prevention Apps:
the role of rehabilitation clinics
Viviane Hasselmann, MAS PT

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Context
Percentage of the
population over 65 in
Europe in 2010
Based on data from the CIA World Factbook.

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum Bucarest September 2014
Age structure of patients in Valens
Clinics (2013)
-14
20-24
30-34
40-44
50-54
60-64
70-74
80-84
90+
150 100 50 n Patients 50 100 150
FemaleMale

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
WHO Recommendations
• Adults aged over 65 should practice aerobic physical activity
for at least 150 minutes of moderate intensity or 75 minutes
of high intensity per week (WHO, 2010).
• elderly people should perform strengthening exercises
minimum twice a week and balance exercises minimum
thrice a week (NIH, 2013).
• Sitting and lying should be reduced at maximum (WHO, 2010).

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Rehabilitation programs for elderlies
• Rehabilitation programs are highly effective for geriatric
patients (Daniels et al., 2008; Seematter-Bagnoud et al.,2013).
• Specific inpatient rehabilitative programs increase physical
abilities of elderlies and thus reduce institutional placement
and mortality (Bachmann et al., 2010).
→ Unsufficient available data to properly define all the features
of the most successful and efficient rehabilitation program.

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum Bucarest September 2014
Therapies offered in Valens Clinics
1. Chest physiotherapy 2. Exercises
3. Hydrotherapy 4. Gait training and ADL

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum Bucarest September 2014
Therapies -2
5. Outdoor activities 6. Armeo® robotic
rehabilitation
7. Wii® game console

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Self-training to improve mobility
• Self-training programs improve significantly physical
capacities, likewise therapist-assisted sessions
(Olney, Nymark et al., 2006).
 serves as a proven efficient and cost-effective mean for
inpatient rehabilitation settings.However, the compliance of elderly people to
execute self-exercise programs varies
considerably. These programs are often
prematurely stopped.
(Phillips, Schneider et al., 2004; Burdea, 2002; Robertson et al., 2010; Rego et al., 2010).

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Exergames as an alternative to
increase patient’s motivation
• Valens Clinics had already positive experiences with the
use of exergames promoting mobility.
• Feasibility study demonstrated that stroke patients were
highly motivated to use Nintendo Wii® game console for
training balance exercises (Schurr and Oesch, 2012).

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Roles of rehabilitation clinics

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
1. Ensure users’ involvement in the
game design
• Group discussions
• Semi-structured interviews

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum Bucarest September 2014
2. Know users’ physical / medical
requirements
• Clinical observations
• Focus group discussion with
physiotherapits and
occupational therapists
• Development of adapted
exercises

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
3. Test prototypes: usability study
Clinics Valens (CH)
O+Berri (E)
Tromsøysund Menighet (N)

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
4. Pilot clinical trial: for evidence-
based recommendations

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
5. Ensure exploitation and
dissemination
• Health professionals (MD, PT, OT, sport therapists).
• Rehabilitation centers, clinics and hospitals.
• Interface between industry and community-dwelling
older population.

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Rehabilitation clinics‘ perspective
• provide insight into the effectiveness of exergames
promoting mobility within a inpatient rehabilitation.
• contribute to our understanding of the motivational potential
of exergames in elderly people.
→ Game technology can be of high importance to tackle the
low adherence of patients to self-training, so increasing the
effectiveness of rehabilitation programs.

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Thank you for your attention

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
User-centric design
experience in Tromsø
(Norway)
Ellen Brox

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
User involvement
• Users involved from the start
• A steady group
• Regular exercise gatherings
• Testing, discussing
– Games
– Colours
– Graphics
– Menus
– Step counter
– Etc.
User-centric design

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Recruiting
• Recruiting seniors is challenging
• Our group meets bi-weekly
• They always eat together
• Started with commercial Kinect games
User-centric design

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Basic user requirements
• From the literature
• From experience (playing commercial games)
– Wii and Kinect
– Playing Kinect over time
• Colours and contrast
• Speed
• Amount of information
• Want new things after a while
User-centric design

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Elderly vs young
It is amazing how difficult it is for a young
person to understand the limitations of age
• Speed
• Movements
• Information
• Small details
• Colours and fonts
• Sound
• Etc.
User-centric design

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Apple picking game
Some early changes:
• Lighter background
• Better contrast sky/tree
• Contrast apples / tree
• Apple signs visible
• Buckets lifted
• Head on stick man
• Moving cloud removed
• More blue, less green
User-centric design

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
More games
• Based on the apple picking we now
have FarmUp
User-centric design

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Small tests
Several small tests with interviews, questionnairs, discussions:
• Several iterations of the game – moving baskets, sounds,
changing colours etc.
• Reactions on the avatars,
colours of stars, sounds, texts,…
• Menu buttons: colours,
size, placement, etc
User-centric design

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Exit stategy
• The group has become important to some
• We keep telling where in the three year period the project is
• All the participants also belong to other groups in the
congregation
User-centric design

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Rehabilitation Games:
State of the Art and Business
Case
Luis Luque

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Game boom
Rehabilitation Games

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Ecosystem of Games for Rehab:
Gadgets
Rehabilitation Games

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Augmented Reality
http://www.burkazoid.com/

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Evidence

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Barriers for comercialization I
– There is no very sucessful
model for reimbursement of
home- rehabilitation
– Small clinics have problem to
cover the expenses, or have
trained professionals
http://www.creditcards.com/credit-
card-news/who-pays-expenses-
company-goes-bankrupt-1282.php

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Barriers for comercialization II
– User friendliness is not
common, and users are
still suffering
“technophobia”.
– Managers are concerned
of maitenance and
training costs

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Barriers for comercialization III
– Many new startups in
USA: very complex
legislation and ever
changing health system
– Market fragmentation in
Europe
– Emerging oportunities in
BRICS

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
How to overcome barriers
Business planning needs to be taken into
consideration at very early stage, and involve VCs,
investors, stakeholders, etc.

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GAME-BASED MOBILITY TRAINING AND MOTIVATION OF
SENIOR CITIZENS
Project Number: AAL-2011-4-090 AAL Forum 2014 9th September
Panel Discussion
Antonio Remartinez