Design and pilot evaluation of competitive and cooperative exercise games for arm rehabilitation at home

Abstract

People with chronic arm impairment should exercise intensely at home after completing their clinical rehabilitation program, but frequently lack motivation. To address this issue, we present a home rehabilitation system that motivates patients by allowing them to perform arm exercises together with friends or relatives in competitive and cooperative games. Inertial sensors are used to track the patient’s arm and control the game. The system was tested with seven adults with arm impairment as well as their friends or spouses. They tested four exercise games (single-player, competitive and two different cooperative games) for 3 minutes each. Of the 7 participants, 4 preferred the competitive game, 2 preferred a cooperative game, and 1 preferred to exercise alone. Competition also increased exercise intensity (measured using inertial sensors) compared to exercising alone. Though preliminary, these results indicate that competitive exercise games could improve arm rehabilitation at home for survivors of neurological and orthopedic injuries.

What is the impact of user affect on motor learning in virtual environments after stroke? A scoping review

“…Motivation was also described as a rationale for use of VR/AVG interventions for its potential to increase training intensity, influencing motor learning and neuroplasticity [20, 39, 41–45, 49, 60]. The ability to motivate clients in this way was identified as unique to this treatment method [40, 42, 45, 48]. Rationales presented for VR/AVG use included the potential to engage and motivate users by involving them in game selection [20] or individualization of game features [46], the ability to elicit multiplayer competition or cooperation [39, 44, 48] the provision of individualized challenge [21, 44, 48, 54, 57], and the delivery of feedback [43, 45, 50, 53, 61, 62, 73] or of a rewarding sense of achievement [45, 55].…”

“…Motivation, enjoyment and engagement were the only constructs described under this theme. Engagement and motivation were described as contributing to intervention success by promoting adherence and contributing to a higher training intensity [20, 41, 43, 47, 48, 52, 55, 58] as well as by distracting participants’from therapeutic intent [50, 60]. For example, Lewis et al [68] state that “the level of engagement and motivation in performing tasks is posited as factor in determining the success of rehabilitation interventions using VR” .…”

“…For example, Lewis et al [68] state that “the level of engagement and motivation in performing tasks is posited as factor in determining the success of rehabilitation interventions using VR” . Another example is Sampson et al [41] who describe that “ (…) perhaps the main benefit found in this study was that the VR system successfully motivated participants to practice using their affected arms and engage in and enjoy therapy for sustained periods of time.” Game design features such as individualized challenge levels [21, 42, 47, 48, 51–53, 57, 58, 61, 62], meaningful tasks [20, 52, 53, 57, 58], multiplayer platforms [39, 48], and feedback [42, 43, 46, 48, 49, 51, 52, 58, 61–63] were described as promoting motivation and influencing successful outcomes. For example, Friedmann et al [43] suggested that “... sensory-rich visual and auditory feedback motivated high effort levels” .…”

The Role of Social Interactions in Motor Performance: Feasibility Study Toward Enhanced Motivation in Telerehabilitation

“…Patients undergoing physical rehabilitation have shown a strong preference toward exercise embedded with citizen science and were more likely to repeat it at the cost of their time commitment [19]. Although social interactions hold potential to further increase patients’ engagement in rehabilitation [30,57], the modality in which they are framed could widely shape the outcomes of the treatment [84]. In this study, we attempted to elucidate the influence of computer-mediated cooperation on motor performance during a citizen science activity, mediated by a low-cost haptic device.…”

“…The mere interaction with inanimate socially assistive robots was demonstrated to increase patients’ engagement in therapy and alleviate their feelings of stress and depression [52-54]. Building on this evidence, interhuman social interactions were introduced between the patient and their practitioner [52,55,56] and subsequently extended to include interactions with relatives and friends, and even strangers [30,52,57-59]. In all cases, patients expressed a strong preference to perform exercise with another person rather than alone and with a human partner rather than a virtual one [30,57,60].…”