Clinical Rehabilitation Experience Utilizing Serious Games

Physical activity is a major part of the user’s context for wearable computing applications. When using body-worn sensors, one can acquire the user’s physical activities. In recent years, wearable and pervasive computing were the basis of many research projects in industrial and healthcare environments. As such, projects used wearable computing technology to help people with chronic diseases like chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and Parkinson disease (PD). However, the needs of the target groups cannot be satisfied just by technical solutions alone. Motivation plays a major role in really helping people. Serious Games or exergames promise a positive effect on motivation and activity. In this chapter, we will explain the basic technology concepts of wearable and pervasive computing and motivation using Serious Games based on the personal experience of the authors and their co-workers in topic-related research projects over the last twelve years.

In this book chapter, we describe a Reference Rehabilitation Platform (RRP) for Serious Games as developed in the three years EC funded eHealth project Rehab@Home. We refer to our experiences with its implementation and continuous evaluation and improvement. The RRP allows therapists, patients and caregivers to configure and monitor a sometimes – after a stroke or in case of chronic diseases like Multiple Sclerosis (MS) and Parkinson – a long-lasting rehabilitation process using Serious Games in the patient’s home. The RRP supports both individual configuration to the patient’s needs by the therapist and communication with the therapist and caregiver. We implemented the system in a cyclic user-centred design approach with three pilots and strong stakeholder involvement. Designed for the rehabilitation of the upper extremities, the RRP can be extended not only to the whole body and fine hand movements but also cognitive and aphasia training. Its modularity based on sensor integration enables this.

The purpose of this book chapter is to show how to solve the problem of selection of an appropriate hardware and software. This is a challenge for any non-standardized application domain and a problem any research project has when looking for a general purpose solution for a specific problem. Here we target the evaluation of a Reference Rehabilitation Platform (RRP) for Serious Games. One constraint in such a case is that all components should be commercial off-the-shelf during the runtime of the project. Components should be well tested, provide sufficient firmware and documentation for integration and have the potential of becoming a kind of standard in the market. This is essential, as the focus of any such project is the problem solution and its evaluation of the hardware and software. We propose a platform where different Serious Games can be deployed and input devices as bio sensors can be plugged in easily. We developed a solution where these components can be replaced by new components easily without changing the whole architecture. This book chapter addresses technical issues and provides an idea how to integrate Serious Games for rehabilitation purposes as described in the chapter four.

In this book chapter, we describe a set of Serious Games suitable for therapeutic purposes in Neuro Rehabilitation. This set of games was developed using the Reference Rehabilitation Platform (RRP) for Serious Games as described in book chapter two. The design and development of these games follows a user centred design approach. This book chapter provides an insight into the development cycles, including the results from evaluations with patients and stakeholders of rehabilitation clinics. The games are designed for the rehabilitation of the upper extremities although the RRP allows extensions towards the whole body, fine hand movements, as well as cognitive and aphasia training; the modularity of the RRP concerning the sensor integration enables this. Although the games described here mainly used the Kinect as input device, the context framework approach described in book chapter three allows an extension towards other input devices using the eHealth platform described there.

The collection of data for therapeutic purposes when using Serious Games in a home environment is essential to help therapists and medical doctors deliver better therapy. It is necessary to use different sensors for collecting such data. This requires using standards as HL7 as much as possible to provide a general purpose approach. On the other hand, the collected data needs an extensive evaluation and interpretation and tools are required to provide the therapist and medical doctor with meaningful information. In this chapter we offer a closer look to standards and propose tools for the analysis of collected data for later use by therapists and medical doctors as a result of the Rehab@Home project.

Modern societies are facing two major trends: widespread population ageing and rapid development of new technologies. Since old age is usually also a time of reduced and diminished abilities and health, it is very important to recognize the potential of technological advances to enhance health, abilities and relationships. However, the abilities, needs, aspirations and contextual environments of older people vary greatly. This chapter gives an overview of the characteristics and circumstances of the older adults that are perceived to have potential influence on the acceptability of assistive and rehabilitation technology systems and devices. We explore the concept of ‘Media Ecology’ and its impact on the adoption success of assistive and rehabilitation technology systems and devices by elderly population.

In this book chapter, we will reflect on our experiences gained in the context of testing solutions like those of the SafeMove project. The project aimed to increase the mobility of the elderly, both near their home and on journeys. Currently, elderly people often avoid leaving their home because they feel insecure outdoors. They might have different health problems, sometimes depression and cognitive disorders. As a consequence, their reduced presence in normal daily life results in social isolation. The design of the SafeMove system is intended to encourage self-confidence in peoples’ own abilities by providing home-based physical and cognitive training as well as location-based aids during outdoor life activities. The actual use of technology seemed appropriate as a potential support for this purpose. Conversely, the question arises; does the target group accept those devices and what results in an optimal user experience? Thus, it is not only about interaction but in this case about intuitive interaction. However, what makes an interaction intuitive? Interaction is intuitive when we intuitively (in advance) know how the interaction works. This is especially important when we assume people experience neurocognitive disorders at an early stage.

Neurological disorders, such as post stroke or multiple sclerosis (MS), are among the most common causes of long-term disability in the general population. Limitations in mobility of persons post stroke or with multiple sclerosis (MS) frequently present with limitations in reaching and grasping and consequently impact their independence and health related quality of life [1]. Neurorehabilitation is aimed at reducing the limitations resulting from the neurological deficit. However, not all patients have access to continuous rehabilitation. That leads to non-optimal recovery and functionality. To address this lacuna in the offering of necessary rehabilitation, Rehab@Home a European 7th Framework funded project was carried out. The project group came from five different countries and from several diverse disciplines, both technical and clinical, in order to implement solutions aimed at improving use of the arms of persons with neurological disorders. The project aim was to provide a motivational technological solution for rehabilitation of the arms through the creation of Serious Games with the final aim of increasing participation in life situations and quality of life of the persons. The aim of this book chapter is to give an overview of how gaming has been applied to rehabilitation, the innovative solution of Rehab@Home and how the gaming platform developed has been applied to persons with neurological disorders in two different rehabilitation centres. Evaluation and treating- protocols, as well as results of the pilot efficacy study will be presented.

Recognizing emotional states is becoming a major part of user context for wearable computing applications. The approach presented here starts from the research hypothesis that a wearable system can acquire a user’s emotional state by using physiological sensors. The purpose is to develop a personal emotional states recognition system that is practical, reliable, and can be used for health-care related applications. We use, as book chapter three described, the eHealth platform [1] which is a ready-made, light weight, small and easy to use device. The intension is to recognize emotional states like ‘Sad’, ‘Dislike’, ‘Joy’, ‘Stress’, ‘Normal’, ‘No-Idea’, ‘Positive’ and ‘Negative’ using a decision tree classifier. In this chapter, we present an approach that exhibits this property and provides evidence based on data for eight different emotional states collected from 24 different subjects. Our results indicate that the system has an accuracy rate of approximately 98%.