Coaching or gaming? Implications of strategy choice for home based stroke rehabilitation

Background: The enduring aging of the world population and prospective increase of age-related chronic diseases urge the implementation of new models for healthcare delivery. One strategy relies on ICT (Information and Communications Technology) home-based solutions allowing clients to pursue their treatments without institutionalization. Stroke survivors are a particular population that could strongly benefit from such solutions, but is not yet clear what the best approach is for bringing forth an adequate and sustainable usage of home-based rehabilitation systems. Here we explore two possible approaches: coaching and gaming. Methods: We performed trials with 20 healthy participants and 5 chronic stroke survivors to study and compare execution of an elbow flexion and extension task when performed within a coaching mode that provides encouragement or within a gaming mode. For each mode we analyzed compliance, arm movement kinematics and task scores. In addition, we assessed the usability and acceptance of the proposed modes through a customized self-report questionnaire. Results: In the healthy participants sample, 13/20 preferred the gaming mode and rated it as being significantly more fun (p < .05), but the feedback delivered by the coaching mode was subjectively perceived as being more useful (p < .01). In addition, the activity level (number of repetitions and total movement of the end effector) was significantly higher (p <.001) during coaching. However, the quality of movements was superior in gaming with a trend towards shorter movement duration (p=.074), significantly shorter travel distance (p <.001), higher movement efficiency (p <.001) and higher performance scores (p <.001). Stroke survivors also showed a trend towards higher activity levels in coaching, but with more movement quality during gaming. Finally, both training modes showed overall high acceptance. Conclusions: Gaming led to higher enjoyment and increased quality in movement execution in healthy participants. However, we observed that game mechanics strongly determined user behavior and limited activity levels. In contrast, coaching generated higher activity levels. Hence, the purpose of treatment and profile of end-users has to be considered when deciding on the most adequate approach for home based stroke rehabilitation.

A virtual agent to sustaining children's engagement in language learning

In this thesis we aimed to explore the potential of gamification - defined as “the use of game elements in non-game contexts” [30] - in increasing children's (aged 5 to 6) engagement with the task. This is mainly due to the fact that our world is living a technological era, and videogames are an example of this engagement by being able to maintain children’s (and adults) engagement for hours straight. For the purpose of limiting complexity, we only addressed the feedback element by introducing it with an anthropomorphic virtual agent (human-like aspect), because research shows that virtual agents (VA’s) can influence behavioural change [17], or even induce emotions on humans both through the use of feedback provided and their facial expressions, which can interpreted in the same way as of humans’ [2]. By pairing the VA with the gamification concept, we wanted to 1) create a VA that is likely to be well-received by children (appearance and behaviour), and 2) have the immediate feedback that games have, so we can give children an assessment of their actions in real-time, as opposed to waiting for feedback from someone (traditional teaching), and with this give students more chances to succeed [32, 43]. Our final system consisted on a virtual environment, where children formed words that corresponded to a given image. In order to measure the impact that the VA had on engagement, the system was developed in two versions: one version of the system was limited to provide a simple feedback environment, where the VA provided feedback, by responding with simple phrases (i.e. “correct” or “incorrect”); for the second version, the VA had a more complex approach where it tried to encourage children to complete the word – a motivational feedback - even when they weren’t succeeding. Lastly we conducted a field study with two groups of children, where one group tested the version with the simple feedback, and the other group tested the ‘motivational’ version of the system. We used a quantitative approach to analyze the collected data that measured the engagement, based on the number of tasks (words) completed and time spent with system. The results of the evaluation showed that the use of motivational feedback may carry a positive effect on engaging children.