Recent Advances in Technologies for Inclusive Well-Being

Despite the growing popularity and widespread use of serious games, the development of effective serious games is difficult, requiring an appropriate balance between game design and instructional design. Although there are fundamental differences between games developed purely for entertainment compared to those developed for “serious” purposes, there are currently no standard development tools specifically intended for serious game design and development available that encourage developers to follow a set of best practices. Rather, developers of serious games often rely on existing game engines and frameworks that are specific to entertainment-based game development. Given the availability of a large number of game engines and frameworks, deciding on which one to use to develop a serious game may be difficult, yet the choice of engine or framework can play a significant role in the development process. In this paper we present the results of a literature review that examined the frameworks and game engines that are used to develop serious games. We provide a list of the most commonly used frameworks and game engines and summarize their features. Knowledge of the frameworks and game engines that are most popular and details regarding why they are popular may prove to be useful to serious games developers seeking such tools. The chapter ends with a brief discussion regarding a framework that is currently being developed specifically for the development of serious games. Through consultation with the potential users of the framework (serious games developers), the framework aims to strike a balance between ease of use and functionality, while providing the user with the necessary options and tools to ideally develop effective serious games.

Stroke and other acquired brain injuries leave a staggering number of people worldwide with impaired motor abilities. Repetitive motion exercises can, thanks to brain plasticity, allow a degree of recovery, help adaptation and ultimately improve quality of life for survivors. The motivation for survivors to complete these exercises typically wanes over time as boredom sets in. To ease the effect of boredom for patients, research efforts have tied the rehabilitation exercises to computer games. Review of recent works found through Google scholar and Carleton’s summon service which indexes most of Carleton’s aggregate collection, using the key terms: stroke, acquired brain injury and video/computer games revealed a number of research efforts aimed primarily at proving the viability of these systems. There were two main results; (1) A classification scheme for computer neurological motor rehabilitation systems (CNMRS) was created based on the researched systems. (2) The systems reviewed all reported some degree of positive results—small sample sizes, large range of neuro-impairments, varied motion recording technology and different game designs make it problematic to formally quantify results, beyond a general net positive trend. The taxonomy presented here can be used to classify further works, to form the basis for meta-studies or larger long term longitudinal study and by neurological rehabilitation practitioners to help select and deploy systems to match client specific needs.

Brain injury can cause a variety of physical effects and cognitive deficits. Although it has not yet been systematically adopted in clinical settings, virtual reality promises to be an excellent therapeutic tool for regaining both locomotor and neurological capacities. This work presents the design and implementation of VR\(^2\) (Virtual Reality Rehabilitation), a customizable rehabilitation framework intended to enable the creation of motivating rehabilitation scenarios based on an ecologically valid semi-immersive system. Following the implementation phase, a study to test the acceptability of VR\(^2\) in a group of subjects with cerebral lesions was conducted to investigate the usability of the framework. The group consisted of 11 people from 22 to 70 years of age, who were divided into two groups depending on the chronicity of disorder. The adequacy of the interface between patient and system was verified through questionnaires containing subjective questions, which revealed good overall acceptance and enjoyment of the tool. Moreover, to obtain early results useful for tuning the overall system in preparation for rigorous clinical trials, a set of preliminary cognitive tests concerning the rehabilitation protocol was conducted within the same group. Although the preliminary findings are promising and reveal a positive trend in neurocognitive investigations, the system should undergo clinical trials before being used in real clinical settings.

People with neuromuscular disorders often suffer for gait and balance problems. Most of them are unable to stand up. Recent technologies do not specifically address these problems but offer an excellent tool for expanding possibilities and accelerate rehabilitation process. In this chapter we present virtual reality supported balance training, a haptic floor as an add-on for enhanced balance training and a postural response assessment and progressing from sit-to-stand with controlled active support. Experimental studies have been carried out with our developed novelties in healthy and neurologically impaired persons in order to demonstrate the feasibility of the approach. The haptic floor causes postural strategy changes when adding visual feedback, while the virtual reality balance training appeared to be also clinically effective in the small scale study. On the other hand the sit-to-stand trainer enables adjustable training conditions and facilitates the subject’s voluntary activity. The device can also mimic the natural like standing up. All technological novelties have been tested in the preliminary case and proof-of-concept studies in the clinical environment.

Exercise is often encouraged, preferably under physician supervision, to help overcome the various musculoskeletal disorders that can often hinder the execution of daily personal and work-related tasks. However, ones motivation to exercise typically decreases after a short period of time, particularly when considering repetitive exercise routines. Furthermore, assessing ones performance within an exercise program is important, particularly when considering rehabilitation-based exercise routines, yet assessment can be problematic as it consists of qualitative measures only (observation, questionnaires, and self-reporting). Obtaining quantitative information has traditionally required cost prohibitive specialized measuring equipment, scenario that is changing with current immersive technologies (virtual reality and gaming). Exergaming couples video games and exercise whereby playing a video game becomes a form of physical activity. Exergaming takes advantage of the engaging, interactive, and fun inherent in video games to promote physical activity and engagement applicable to physical training or rehabilitation. Furthermore, recent technological advances have led to a variety of consumer-level motion tracking devices that provide opportunities for novel interaction techniques for virtual environments and games and the ability to generate quantitative data (feedback) dynamically. In this chapter, we outline our experience in dynamic design, development, and testing of two independently developed exergames that have been specifically developed for shoulder rehabilitation. Shoulder injuries are very common, particularly with the college-aged population.

Work-related health afflictions are a major concern as they may affect the ability for one to carry out daily activities and negatively affecting the quality of life. Possible causes have been associated with sedentary, repetitive movements, bad postures, and lack of occupational health exercises. Aside from the health consequences, there is also concern about the loss of productivity and its associated costs, in addition to the treatment costs (which in some cases may require attending to specialized facilities). The standard approach to minimize such risks involves preventive exercises at the workplace and annual medical examinations. Typically, employees are provided with printed or multimedia guides to educate them regarding work-related afflictions and preventive steps that can be taken to prevent them. However, such educational material generally does little to motivate employees to start and maintain a preventive exercise program. Exergaming (that is video games that incorporate exercise), are capable of motivating users into starting and maintaining an exercise program. In this book chapter, we present the development of an exergaming prototype suite to address common work-related preventive exercises associated with the lower-limb, upper-limb, hands, and eyes. By using a gaming scenario we are capable of providing the player with compelling interactions and game play experiences that allow increasing motivation to exercise, while tracking the player’s movements and using that information as part of a medical assessment.

Strokes are the most widely recognized reason of long-term disability of adults in developed countries. Continuous participation in rehabilitation can alleviate some of its consequences and support recovery of stroke patients. However, physical rehabilitation requires commitment to tedious exercise routines over lengthy periods of time, which often causes patients to drop out of therapy routines. In this context, game-based stroke rehabilitation has the opportunity to address two important barriers: accessibility of rehabilitation, and patient motivation. This chapter provides a comprehensive analysis on the advances in human-computer interaction (HCI) and development of games to support stroke rehabilitation. There are existing cases in the field of game-based stroke rehabilitation studied, for example the development of motion-based video games particularly addressing rehabilitation among stroke patients. This chapter discusses the effectiveness of design efforts in HCI and games research to support stroke rehabilitation by integrating findings from medical research that consider health outcomes of game based stroke rehabilitation. Based on these findings, challenges and opportunities in game based stroke rehabilitation are discussed. Critical components that influence the effectiveness of Tele-rehabilitation are identified and further design opportunities in the field of game-based stroke rehabilitation are explored as an important step toward the creation of games that are accessible, motivating and enjoyable for stroke patients. Finally, the chapter presents the challenges and opportunities in game-based stroke rehabilitation.

Multi-sensory environments can improve and maximize the well-being of individuals with multiple disabilities, that is, individuals who have more than one significant disability (one of which is a cognitive impairment). In this chapter we present a multi-sensory environmental stimulation system that combines different technologies such as computer vision and tactile cues in the form of vibrations. The system offers users control over the environmental stimulation by responding to their body movements. A vision-based interface detects the user’s hand position and activates meaningful and motivational outcomes when the hand is positioned over specific regions. Further, we extended the system by including a wearable vibrotactile interface that encourages users to move their arms by using vibrations that exploit the saltation perceptual illusion known for inducing movement.

In this study we investigate the experience for participants while wearing a vibrotactile vest that interacts with a vibroacoustic architecture The Humming Wall, set in an urban space. This public large scale artefact is built to exchange vibrotactile and physiological interactions with a vibrotactile wearable vest. The heart beats and breath rates of the vest wearers are vibroacoustically displayed at The Humming Wall. In addition, participants can swipe and knock on The Humming Wall and the vest wearer is effectively swiped and knocked upon. We work with overlapping vibrotactile outputs in order that the wearers experience a flow of sensations similar to a touch gesture. The communication advantaged vibroacoustic and vibrotactile as the primary interaction modalities for both vest wearers as well as for a passing public. The participants found the experience favourable and analysis reveals some patterns on the vest and zones at the wall impact relaxation in the form of calming and feel-good sensations, (even therapeutic) as well as activation and warning on the vest. We contribute to this research field by adding a large scale public object and visibly responsive interactive wall that was positively received as the partner responder for the wearers of a vibrotactile vest set in an urban environment. Participants reported calming, therapeutic, feel good sensations in response to the patterns.

This chapter provides a brief review of how virtual reality technologies (VRTs) have been used within research-contexts to support people on the autism spectrum. One area of innovation and research that has evolved since the mid-1990s to aid people with an ASD is that of the use of virtual reality technology (VRT). Research has focused on helping develop personal, social, functional, and pre- vocational/vocational skills. This chapter will provide a review of literature in this field in addition to distilling the key affordances, issues and challenges identified in this evolving area of research. This review will focus on the potentially useful application of VRTs to train and support people with an ASD in developing life-skills (i.e., social skills, job skills, independent living skills) and where there has been successful implementation in applied contexts. The chapter will then describe a project the authors undertook, that sought to ask questions surrounding the role of head-mounted displays and the impact these might have for this population. As more affordable and accessible wearable devices (e.g., Oculus Rift™) are commercially available, we suggest that questions surrounding the acceptability and practicality quickly need to be addressed if we are to develop a sustainable line of inquiry surrounding HMDs and VRTs for this specific population. Therefore this chapter will report, in a rich, descriptive and illustrative manner, the process we engaged to work with a range of participants with ASD (here range refers to low-high functioning ASD with a wide range of IQ) to assess and measure the acceptability of, and experiences within, HMD VRTs (immersion, presence, ecological validity, and any negative effects). We will discuss, in some detail, the ethical approaches the research team took in using HMDs with this population (as this is sometimes a neglected aspect of this type of research), and suggest some guidance for future scholars/practitioners working in this field. Finally, based on our preliminary study, this chapter will conclude with how we think HMDs and VRTs might be used in the future to help enable ASD populations address some of the challenges faced on a daily basis. Here we are primarily concerned with the challenges, but also the contexts in which this technology can be applied, with specific focus on moving research from labs to real-life (and potentially beneficial) contexts.

Residents at nursing homes need to exercise to retain self-efficacy. But all the while, many do not seem to want to prioritize exercise routines over leisure activities. The first part of this chapter analyzes the potential reasons for this lack of exercise commitment at a nursing home in Copenhagen, Denmark, and show a solution to overcome such obstacles, by augmenting the exercise routine with the accompagnement of recreational virtual environments. The second part of the chapter shares insights from the experiences from spending 3 years with the unique challenges and complex conditions that researchers face, when operating and navigating the specific field of nursing homes, due to the inherent characteristics of its context and users.

This contribution posits a supposition on the topic of ‘ethical’ consideration when advanced, engaging, and playful ICT, i.e. beyond that available to the public, is researched. In focus are participants without communicative competence—especially young children diagnosed with Profound and Multiple Learning Disabilities (PMLD)—who are unable to express their desire for continued access/use/play. The position results from a mature body of empirical work that began in 1985 that, through specific case studies, stresses the need to contemplate affect on participants, thus promoting funding applications to include post-research access to content for participants as well to support staff intervention training to optimize content use.

This contribution is timely as it addresses accessibility in regards system hardware and software aligned with introduction of the Twenty-First Century Communications and Video Accessibility Act (CVAA) and adjoined game industry waiver that comes into force January 2017. This is an act created by the USA Federal Communications Commission (FCC) to increase the access of persons with disabilities to modern communications, and for other purposes. The act impacts advanced communications services and products including text messaging; e-mail; instant messaging; video communications; browsers; game platforms; and games software. However, the CVAA has no legal status in the EU. This text succinctly introduces and questions implications, impact, and wider adoption. By presenting the full CVAA and game industry waiver the text targets to motivate discussions and further publications on the subject that could significantly impact industries targeted by this volume (In citing the CVAA the author does not posit himself as a specific expert in the act or field—reference is made to awaken discussions to the important issues surrounding accessibility and inclusion.).