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.

Goals Software Construction Process

Generalized hyper competitiveness in the world markets has determined the need to offer better products to potential and actual clients in order to mark an advantagefrom other competitors. To ensure the production of an adequate product, enterprises need to work on the efficiency and efficacy of their business processes (BPs) by means of the construction of Interactive Information Systems (IISs, including Interactive Multimedia Documents) so that they are processed more fluidly and correctly.The construction of the correct IIS is a major task that can only be successful if the needs from every intervenient are taken into account. Their requirements must bedefined with precision, extensively analyzed and consequently the system must be accurately designed in order to minimize implementation problems so that the IIS isproduced on schedule and with the fewer mistakes as possible. The main contribution of this thesis is the proposal of Goals, a software (engineering) construction process which aims at defining the tasks to be carried out in order to develop software. This process defines the stakeholders, the artifacts, and the techniques that should be applied to achieve correctness of the IIS. Complementarily, this process suggests two methodologies to be applied in the initial phases of the lifecycle of the Software Engineering process: Process Use Cases for the phase of requirements, and; MultiGoals for the phases of analysis and design. Process Use Cases is a UML-based (Unified Modeling Language), goal-driven and use case oriented methodology for the definition of functional requirements. It uses an information oriented strategy in order to identify BPs while constructing the enterprise’s information structure, and finalizes with the identification of use cases within the design of these BPs. This approach provides a useful tool for both activities of Business Process Management and Software Engineering. MultiGoals is a UML-based, use case-driven and architectural centric methodology for the analysis and design of IISs with support for Multimedia. It proposes the analysis of user tasks as the basis of the design of the: (i) user interface; (ii) the system behaviour that is modeled by means of patterns which can combine Multimedia and standard information, and; (iii) the database and media contents. This thesis makes the theoretic presentation of these approaches accompanied with examples from a real project which provide the necessary support for the understanding of the used techniques.