Impact of game mode in multi-user serious games for upper limb rehabilitation: a within-person randomized trial on engagement and social involvement

Abstract

Background Serious games have been increasingly used for motor rehabilitation. However, it is not well known how different game features can be used to impact specific skills properly. Here, we study how the mode (competitive, co-active, collaborative) in which a multi-user game is presented impacts engagement and social involvement. Methods We collected data from 20 pairs of community-dwelling older adults (71.5 ± 8.7 years) in a study following a within-persons design. The participants performed a two-player upper limb rehabilitation game with three conditions (Competitive, Co-active, and Collaborative modes). Engagement and social involvement were assessed through the Core Module and Social Presence Module, respectively, from the Game Experience Questionnaire. To infer the impact of personality and cognitive function, users answered the International Personality Item Pool (short version) and the Montreal Cognitive Assessment, respectively. Results Results show that the Collaborative game mode promotes more social involvement when compared to Competitive and Co-active modes. This result is mostly explained by those participants with higher cognitive skills, and those that are more extrovert. Extrovert participants feel more empathy and are behaviorally more involved when playing the Collaborative mode. Also, the Collaborative mode is shown to be appropriate to promote interaction with participants that previously had a distant relationship, while the Competitive mode seems to be more beneficial to promote empathy between players with a closer relationship. Conclusions The Collaborative game mode elicited significantly higher social involvement in terms of Empathy, Positive Affect, and Behavioral Involvement. Hence, this game mode seems to be the most adequate choice to be used in multiplayer rehabilitation settings, where social interaction is intended.

A Multisession Evaluation of a Collaborative Virtual Environment for Arm Rehabilitation

“…At the end of each session, participants filled out the Intrinsic Motivation Inventory (IMI) which measures four aspects of motivation: enjoyment/interest, effort/importance, perceived competence, and pressure/tension. The IMI is a standard questionnaire commonly used with rehabilitation VEs (Colombo et al, 2007;Mihelj et al, 2012;Nijenhuis et al, 2015;Pereira et al, 2019) and has been extensively validated in other settings (McAuley, Duncan, & Tammen, 1989). The specific IMI version used was the same 8-item version used in our previous study (Goršič, Cikajlo, Goljar, & Novak, 2017), with two 7-point Likert items for each aspect of motivation.…”

“…Unlike previous work on competition and cooperation, collaborative rehabilitation VEs remain largely unexplored. They do, however, have potential: a recent single-session study found higher motivation during collaboration than during competition or co-activity, though only in unimpaired older adults (rather than patients) and only over single 8-minute sessions (Pereira et al, 2019). Thus, the goal of the present study was to compare a collaborative and single-player VE with regard to stroke survivors' motivation and exercise intensity (defined as the amount of movement) over multiple sessions.…”

“…However, the same studies have shown that competition is not suitable for everyone. For example, our previous work showed that a subset of patients does not enjoy competition and would prefer to work together instead Novak et al, 2014); another recent study observed overall higher motivation when patients worked together than when they competed (Pereira et al, 2019). Thus, multiplayer VEs that allow people to work together have the potential to improve patient motivation, especially in noncompetitive patients.…”

“…Such multiplayer VEs can be classified into four main types: competition, co-activity, cooperation, and collaboration (Jarrasse, Charalambous, & Burdet, 2012). Competition, where players compete against each other, has been extensively studied for rehabilitation; both single-session (Ballester, Bermúdez i Badia, & Verschure, 2012;Novak, Nagle, Keller, & Riener, 2014;Pereira, Bermúdez i Badia, Ornelas, & Cameirão, 2019) and multisession (Goršič, Cikajlo, Goljar, & Novak, 2017;Maier, Ballester, Duarte, Duff, & Verschure, 2014) studies have shown that competition can increase exercise intensity and motivation compared to exercising alone. However, the same studies have shown that competition is not suitable for everyone.…”

“…In co-activity, two people perform a task together, but each person simply does his or her own subtask and does not interact with the other person. For example, two people may play Pong on parallel fields without being able to affect the other player's field Novak et al, 2014); alternatively, two people may collect objects together, with one person's performance having no effect on the other person (Pereira et al, 2019). In both collaboration and cooperation, on the other hand, each player must take the other player's behavior into account.…”