The document discusses requirements for designing computer games for users with learning disabilities (LD). It outlines several key challenges, including that LD users are highly sensitive and vulnerable, may struggle physically and lack motivation. Standard requirements elicitation approaches are challenging for this group. The study examined the game "Somability" designed to motivate physical exercise for LD users. Findings showed that using theatrical techniques like method acting helped designers understand users. However, even sensitive approaches are not enough and LD games require characteristics like repetition and safety over competition. The study concluded that LD game design requires empathic understanding of users' needs.

1. Dr Patrick Stacey
Senior Lecturer
Loughborough University
Requirements by Proxy – Designing Games
for Users with Learning Disabilities

2. There are 1.4 million people with learning disability (LD) in the UK
and 75% of GPs do not know how to treat them. This user group is
highly vulnerable and deserve special attention and help from all
segments of society and industry, including computer game
design. Computer games offer promise in motivating people with
LD to carry out the basics in life, such as physical exercise. We
conducted a mixed-method study of one such game called
Somability by Cariad Interactive. The findings have implications
not only for game design for LD users but challenge the well-
established notion that requirements should faithfully be elicited
from users; particularly in the case of LD, this is not possible. The
talk is based on a paper presented at HICSS in 2017.

4. 1. LD

6. Mild LD
• This form refers to slight sensory or motor deficits
• Most of the people in this group are never diagnosed and are
able to live independently
• They might need help with employment and housing or when
under unusual stress
(Bouras et al., 1995)

7. Moderate LD
This form refers to people who can talk and care for themselves but
under supervision
Adults can undertake simple work
6% of adults with LD are in paid work
(Bouras et al., 1995; Vercida.com)

8. Severe LD
• People with severe LD have a slow pace of learning
• They may be able to communicate in a simple way
• They can perform easy tasks and engage in limited social interactions
• Often need help with daily activities and need to live under close supervision
(Bouras et al., 1995; Hardie and Tilly, 2012)

9. Profound LD
• A person with profound LD usually has a number of disabilities which could include impairments
to hearing, movement and vision.
• This can also include conditions such as epilepsy and autism.
• need help with daily activities.
• Their behaviors could be challenging for others
• They find it very difficult to communicate with others
• Tend to be neglected and excluded from society and there is need to increase meaningful social
interactions
(Ware, 2004; Kieron and Nind, 2005; Hardie and Tilly, 2012)

10. Generally, people with LD:
• Struggle with physical movement and have low fitness performance in terms of strength,
endurance, and motor coordination
• => associated with level of LD, limited motor development, sedentary lifestyle, mental impairments, short attention
span, lack of motivation
•
• Struggle with mental health
• are often withdrawn, engage in obsessive or compulsive behaviors that would stop them from
participating in everyday activities, and have low self-esteem.
(Halle et al., 1999; Guidetti et al., 2010; Golubović, and Maksimović, 2012; Lacey, and Oyvry, 2013)

11. LD Induced by:
• Maternal accident or illness while pregnant…
• Genes
• Lac of oxygen during childbirth, has trauma to
the head, or is born too early.
• early childhood illnesses, accidents and seizures.
(Mencap)

12. ‘Disability’
• “People with disabilities continue to suffer
from discrimination in jobs, education, and
housing, and are deprived of capabilities as
basic as the freedom to move about. Even
in aspects of life such as friendships,
disabled people, especially if they are
cognitively disabled, find themselves
excluded (Reinders, 2008). Disability is in
search of an ethics that will both articulate
the harms faced by people with
disabilities—discrimination that threatens
dignity as well as well‐being—and offer
moral resources for redress.” (Kittay, 2011)

14. LD User Requirement
Challenges
• Highly sensitive and vulnerable
• Socially uncomfortable, withdrawn
• Struggle physically
• Lack motivation
• Mental health issues
• Need support on a daily basis
• May not be able to communicate at all.
• Can be ‘distressing’ for a designer/engineer to interview them
So, how do you capture the requirements?

15. 2. Requirements

16. Thou Shalt Gather
Requirements
• Requirements Engineering is massive, well-established
• User engagement maxim
• Without user requirements, always risk usability failure, etc.

17. Standard Approaches
• Sommerville and Sawyer (1997): requirements elicitation methods
include interviews, team meetings, focus groups, prototyping…
• In Agile, user stories are elicited and inscribed onto story cards
(Abrahamsson et al., 2002)
• In game development, highly emergent – play-testing approach, e.g.
Boomerang model (Stacey and Nandhakumar, 2008)
• GUIs: “I can’t tell you in advance, but I’ll know it when I see it (IKIWISI).
In such a case, it is a high risk to try to document the GUI in advance”
(Ågerfalk and Fitzgerald, 2006:p31)
• Always some unpredictability! Need to be adaptive (Sawyer, Bencomo et
al).

18. Sensitive User Approaches
• Popular sensitive user group is the elderly
• Popular technology research case is the mobile phone
de Urturi Breton et al (2012):
• Mismatch between LD users and design mental models
• “The specific set of requirements needed can be found by involving intellectually
challenged users in the design process starting at the requirement stage and ideally
throughout the entire development phase as well.”

19. Sensitive User Approaches ii
Nicol, Lumsden et al., (2015) take this further:
• “In the absence of a complete methodology for working with older users,
researchers and designers are often left to improvise their own methods.”
• “Antona et al. surveyed 12 design techniques and evaluated their usefulness for
use with older adults. Only 5 were deemed appropriate without modification:
direct observation; activity diaries & cultural probes; scenarios & personas;
prototyping; and art-based approaches.”
• “Is it more difficult to run ethnographic studies with older adults given the more
socially intimate nature of the activities being observed -i.e. in the home or other
social space compared with much ethnography, which is workplace-focused?”

20. LD Sensitive Users
Cheverst et al’s (2011) response to Nicol et al (2015) is “Yes it is”:
• Design ethnography impractical:
• “…the highly personal character of such settings presents conventional observational techniques,
such as ethnography, with obdurate problems that make direct observation intrusive, disruptive
and inappropriate on occasion. ”
• You don’t gather direct LD user requirements

21. So what’s left? Design in the dark ?
(Nandhakumar and Jones, 1997)

22. 3. Our Case Findings

23. The Case of
‘Somability’
• Somability is a fitness game by Cardiff
Metropolitan University in partnership with
Cariad Interactive.
• It contains three games: Reach, Balance and
Flow.
• Reach - users reach high with their reflections
to touch the shapes on the screen.
• Balance - users open their arms and to balance
as many digital balls as possible.
• Flow - a task-free game where users perform
any movements they like.

24. Data Collection
• Qualitative (Interviews and Observations)
• Survey
• 10 people involved in game development interviewed:
• programmers, graphic designers, managers, researchers,
dancers, facilitators and care givers.
• Natural observations:
• (a) of game designers developing the game. (b) of beta
testing by designers and users from a day care center -
we observed 26 people.

25. Qualitative Study
Findings:
• We conducted observations, interviews with experts: game
designers’ user analysis based on role-playing, method
acting (e.g. Rain man), rehearsal and performance with LD
experts
• > Less intrusive (Cheverest et al 2011), creative
(Maiden et al., 2004), empathic (Stacey and Tether,
2015)
• Observations of users: they appeared to enjoy the
game, felt in control, became more interactive with
others, everyone wanted to have a go in front of ‘the
machine,’ often promoting healthy competition.
• Side benefit is that it takes the strain off the carers
• Somability deemed a success by all involved

26. Contributions of Qual Study:
Theatrical
techniques were
successful
LD Software
developers could
adopt the technique
more widely
Role-playing is used
in mainstream game
and software design,
but the motivation
for using it different
However, this
approach is not
enough for an LD
game;
empathic design
principles and
characteristics
required

27. Quantitative
Follow-on Study
• Survey of experts in healthcare and
game design
• 245 responses with a response rate
of 41.8% (245/586):
• 114 game designers and 131
from healthcare professionals
• Five-point Likert scale
Sub-hypotheses / design characteristics Sources
Fitness games should:
H1a: promote physical exercise
H1b: encourage social connections
Qualitative findings
H1c: develop users’ self-esteem
H1d: decrease users’ anxiety
Lotan et al (2009)
Hutzler & Korsensky (2010)
Fitness games could be simplified through:
H2a: allowing mistakes
Qualitative findings
H2b: allowing repetitive play
H2c: a clear interface
H2d: tactile features
H2e: non-tactile features
Coles et al (2007)
Werbach & Hunter (2012)
Nicolle and Abascal (2001)
During game play, users should:
H3a: start to play with others
H3b: become more independent
Qualitative findings
H3c: compete with each other
H3d: feel happier
Vansteenkiste & Deci (2003)
Yalon-Chamovitz & Weiss
(2008)

28. Results

29. Interpretation / Contributions:
in addition to the
primary purpose,
motivating physical
exercise, games
should promote
social connections
and decrease
anxiety
LD users should be
allowed to make
mistakes and enjoy
repetitive play.
Simplified,
repetitive fitness LD
games should not
only make users
healthier but also
improve their
mental and social
conditions
Competition, has to
be handled
carefully and to be
kept in a safe level.
happiness,
independence and
social skills will
grow during play

30. SDT-esque Model

31. 4. Summative Implications

32. • Sensitive requirements-by-proxy
approach: merit in theatrical
techniques / method acting to
understand the LD user. Need
involvement of caregivers (cf Nicol,
Lumsden et al 2015)
• A way of Tuning-in
• cf. IDEO design ethos
• But even this sensitive approach is not
enough for LD

33. Similar Empathic Approach in Cancer Care
Facility Design
“We buffered the whole building with the birch
trees, so you get the wind in the birch trees, and
then there are these huge leaves in one of the
courtyard gardens, on the Tetrapanax [rice paper
plant], so when it rains you get this ‘patter’ on
the leaves. Then there is the perfume, so that
recurs again, again and again in the garden, and
then there is taste, so in all the gardens there are
edible things… So by stimulating people’s senses
you just very naturally get them to tune into a
place.” (Landscape designer)
(Stacey and Tether, 2015)

34. Predictable LD
Design
Requirements
Games for those with LD
requires specific, special game
characteristics:
repetition, safety, physical
movement, fun, socialization…
less of: scoring per se and
competition

35. Select Bibliography

36. Liu, L., Stacey, P. K., Tarafdar, M.,
& Kourentzes, N. (2017).
Simplifying Fitness Games for
Users with Learning Disabilities.
In 50th Hawaii International
Conference on Systems Sciences.
P. Stacey, and J. Nandhakumar.
"Opening up to agile games
development."
Communications of the ACM
51.12, 2008, pp. 143-146.
Stacey, P. K., & Tether, B. S.
(2015). Designing Emotion-
Centred Product Service
Systems: The Case of a Cancer
Care Facility. Design Studies, 40,
85-118.
N. Bouras, B. Murray, and T.
Joyce, eds. Mental Health in
Learning Disabilities: A Training
Pack for Staff Working with
People who Have a Dual
Diagnosis of Mental Health
Needs and Learning Disabilities.
E. Hardie, and L. Tilly. An
introduction to supporting
people with a learning
disability. Sage, 2012.
J. Ware, "Ascertaining the views
of people with profound and
multiple learning disabilities."
British Journal of Learning
Disabilities 32.4, 2004, pp. 175-
179.
Sheehy, Kieron, and Melanie
Nind. "Emotional well‐being for
all: mental health and people
with profound and multiple
learning disabilities." British
Journal of Learning Disabilities
33.1, 2005, pp. 34-38.
Š.Golubović, J. Maksimović, B.
Golubović, and N. Glumbić,
"Effects of exercise on physical
fitness in children with
intellectual disability." Research
in developmental disabilities
33.2, 2012, pp. 608-614.
J. W. Halle, D. Gabler-Halle, and
Y. B. Chung. "Effects of a peer-
mediated aerobic conditioning
program on fitness levels of
youth with mental retardation:
two systematic replications."
Mental retardation 37.6, 1999,
L. Guidetti, E. Franciosi, M.C.
Gallotta, G.P. Emerenziani, and
C. Baldari, "Could sport
specialization influence fitness
and health of adults with
mental retardation?." Research
in developmental disabilities
P. Lacey, and C. Oyvry. People
with Profound & Multiple
Learning Disabilities: A
Collaborative Approach to
Meeting. Routledge, 2013.