Playfulness and New Technologies in Hand Therapy for Children With Cerebral Palsy: Scoping Review.

BACKGROUND: Innovative technologies such as game consoles and smart toys used with games or playful approaches have proven to be successful and attractive in providing effective and motivating hand therapy for children with cerebral palsy (CP). Thus, there is an increased interest in designing and implementing interventions that can improve the well-being of these children. However, to understand how and why these interventions are motivating children, we need a better understanding of the playful elements of technology-supported hand therapy. OBJECTIVE: This scoping review aims to identify the playful elements and the innovative technologies currently used in hand therapy for children with CP. METHODS: We included studies that design or evaluate interventions for children with CP that use innovative technologies with game or play strategies. Data were extracted and analyzed based on the type of technology, description of the system, and playful elements according to the Lenses of Play, a play design toolkit. A total of 31 studies were included in the analysis. RESULTS: Overall, 54 papers were included in the analysis. The results showed high use of consumer technologies in hand therapy for children with CP. Although several studies have used a combination of consumer technologies with therapeutic-specific technologies, only a few studies focused on the exclusive use of therapeutic-specific technologies. To analyze the playfulness of these interventions that make use of innovative technologies, we focused our review on 3 lenses of play: Open-ended Play, where it was found that the characteristics of ludus, such as a structured form of play and defined goals and rules, were the most common, whereas strategies that relate to paidia were less common. The most commonly used Forms of Play were physical or active form and games with rules. Finally, the most popular Playful experiences were control, challenge, and competition. CONCLUSIONS: The inventory and analysis of innovative technology and playful elements provided in this study can be a starting point for new developments of fun and engaging tools to assist hand therapy for children with CP.

Assessing Children's Fine Motor Skills With Sensor-Augmented Toys: Machine Learning Approach.

BACKGROUND: Approximately 5%-10% of elementary school children show delayed development of fine motor skills. To address these problems, detection is required. Current assessment tools are time-consuming, require a trained supervisor, and are not motivating for children. Sensor-augmented toys and machine learning have been presented as possible solutions to address this problem. OBJECTIVE: This study examines whether sensor-augmented toys can be used to assess children's fine motor skills. The objectives were to (1) predict the outcome of the fine motor skill part of the Movement Assessment Battery for Children Second Edition (fine MABC-2) and (2) study the influence of the classification model, game, type of data, and level of difficulty of the game on the prediction. METHODS: Children in elementary school (n=95, age 7.8 [SD 0.7] years) performed the fine MABC-2 and played 2 games with a sensor-augmented toy called "Futuro Cube." The game "roadrunner" focused on speed while the game "maze" focused on precision. Each game had several levels of difficulty. While playing, both sensor and game data were collected. Four supervised machine learning classifiers were trained with these data to predict the fine MABC-2 outcome: k-nearest neighbor (KNN), logistic regression (LR), decision tree (DT), and support vector machine (SVM). First, we compared the performances of the games and classifiers. Subsequently, we compared the levels of difficulty and types of data for the classifier and game that performed best on accuracy and F1 score. For all statistical tests, we used α=.05. RESULTS: The highest achieved mean accuracy (0.76) was achieved with the DT classifier that was trained on both sensor and game data obtained from playing the easiest and the hardest level of the roadrunner game. Significant differences in performance were found in the accuracy scores between data obtained from the roadrunner and maze games (DT, P=.03; KNN, P=.01; LR, P=.02; SVM, P=.04). No significant differences in performance were found in the accuracy scores between the best performing classifier and the other 3 classifiers for both the roadrunner game (DT vs KNN, P=.42; DT vs LR, P=.35; DT vs SVM, P=.08) and the maze game (DT vs KNN, P=.15; DT vs LR, P=.62; DT vs SVM, P=.26). The accuracy of only the best performing level of difficulty (combination of the easiest and hardest level) achieved with the DT classifier trained with sensor and game data obtained from the roadrunner game was significantly better than the combination of the easiest and middle level (P=.046). CONCLUSIONS: The results of our study show that sensor-augmented toys can efficiently predict the fine MABC-2 scores for children in elementary school. Selecting the game type (focusing on speed or precision) and data type (sensor or game data) is more important for determining the performance than selecting the machine learning classifier or level of difficulty.

A Functional Analysis Of An Assistive Device Information Database in Flanders: A Qualitative Study.

Since 1989-1990, Vlibank is the Flemish AT information database managed by the Flemish government and aims to have a complete overview of AT devices in Flanders. The growing AT market increases the need for unbiased information on AT. However, maintaining and keeping a database up-to-date is a very challenging task. Because of recent changes in policy, the Flemish government needs to be able to reimburse a bigger group of AT devices, but also the changing needs of a larger group of people, regardless of their age. Because the crucial role of an AT information database in the selection of AT devices and the effectiveness of the service delivery, a functional analysis of an online information database is made. This paper describes the qualitative part of the study, in particular the focus groups that were held to gather views of three groups of stakeholders. Preliminary results indicate that there is consensus on the information needs next to product information and on the use of generic questions as a selection tool for AT devices. The biggest issue raised is the difficulty of keeping an information database up-to-date, especially for individualized devices. All participants, except one, are very wary of the use of user ratings and reviews.

Perceiving the direction of articulatory motion in point-light actions.

Human observers are able to perceive the motion direction of actions (either forward or backward) on the basis of the articulatory, relative motion of the limbs, even when the actions are shown under point-light conditions. However, most studies have focused on the action of walking. The primary purpose of the present study is to further investigate the perception of articulatory motion in different point-light actions (walking, crawling, hand walking, and rowing). On each trial, participants were presented with a forward or backward moving person and they had to decide on the direction of articulatory motion of the person. We analyzed sensitivity (d') as well as response bias (c). In addition to the type of action, the diagnosticity of the available information was manipulated by varying the visibility of the body parts (full body, only upper limbs, or only lower limbs) and the viewpoint from which the action was seen (from frontal view to sagittal view). We observe that, depending on the specific action, perception of direction of motion is driven by different body parts. Implications for the possible existence of a life detector, i.e., an evolutionarily old and innate visual filter that is tuned to quickly and automatically detect the presence of a moving living organism and direct attention to it, are discussed.

An anxiety-induced bias in the perception of a bistable point-light walker.

Human sensitivity for social cues is exquisite, as illustrated by the ease with which simplified point-light movements invoke social and emotional responses. Compared to faces, these biological motion stimuli only recently started to be used to explore questions regarding social cognition and anxiety. We presented human point-light walkers that could be perceived as facing towards or facing away from the observer, and tested whether participants with high social anxiety would perceive these bistable stimuli differently, because this type of stimuli has particular relevance for them. The results showed that observers with high social anxiety tended to see walkers as facing away more frequently than those with low social anxiety. This may mean that high socially anxious observers are biased towards the more positive perceptual alternative because they are motivated to protect themselves against threatening social experiences, but we also explore alternative explanations. The findings are in line with the evidence for a positivity bias in perception, also called wishful seeing, but in contrast with the attentional negativity bias often found in social anxiety. We discuss reasons for this divergence and possible limitations of the current study.

Further explorations of the facing bias in biological motion perception: perspective cues, observer sex, and response times.

The human visual system has evolved to be highly sensitive to visual information about other persons and their movements as is illustrated by the effortless perception of point-light figures or 'biological motion'. When presented orthographically, a point-light walker is interpreted in two anatomically plausible ways: As 'facing the viewer' or as 'facing away' from the viewer. However, human observers show a 'facing bias': They perceive such a point-light walker as facing towards them in about 70-80% of the cases. In studies exploring the role of social and biological relevance as a possible account for the facing bias, we found a 'figure gender effect': Male point-light figures elicit a stronger facing bias than female point-light figures. Moreover, we also found an 'observer gender effect': The 'figure gender effect' was stronger for male than for female observers. In the present study we presented to 11 males and 11 females point-light walkers of which, very subtly, the perspective information was manipulated by modifying the earlier reported 'perspective technique'. Proportions of 'facing the viewer' responses and reaction times were recorded. Results show that human observers, even in the absence of local shape or size cues, easily pick up on perspective cues, confirming recent demonstrations of high visual sensitivity to cues on whether another person is potentially approaching. We also found a consistent difference in how male and female observers respond to stimulus variations (figure gender or perspective cues) that cause variations in the perceived in-depth orientation of a point-light walker. Thus, the 'figure gender effect' is possibly caused by changes in the relative locations and motions of the dots that the perceptual system tends to interpret as perspective cues. Third, reaction time measures confirmed the existence of the facing bias and recent research showing faster detection of approaching than receding biological motion.

Time will show: real time predictions during interpersonal action perception.

Predictive processes are crucial not only for interpreting the actions of individual agents, but also to predict how, in the context of a social interaction between two agents, the actions of one agent relate to the actions of a second agent. In the present study we investigated whether, in the context of a communicative interaction between two agents, observers can use the actions of one agent to predict when the action of a second agent will take place. Participants observed point-light displays of two agents (A and B) performing separate actions. In the communicative condition, the action performed by agent B responded to a communicative gesture performed by agent A. In the individual condition, agent A's communicative action was substituted with a non-communicative action. For each condition, we manipulated the temporal coupling of the actions of the two agents, by varying the onset of agent A's action. Using a simultaneous masking detection task, we demonstrated that the timing manipulation had a critical effect on the communicative condition, with the visual discrimination of agent B increasing linearly while approaching the original interaction timing. No effect of the timing manipulation was found for the individual condition. Our finding complements and extends previous evidence for interpersonal predictive coding, suggesting that the communicative gestures of one agent can serve not only to predict what the second agent will do, but also when his/her action will take place.

Are you approaching me? Motor execution influences perceived action orientation.

Human observers are especially sensitive to the actions of conspecifics that match their own actions. This has been proposed to be critical for social interaction, providing the basis for empathy and joint action. However, the precise relation between observed and executed actions is still poorly understood. Do ongoing actions change the way observers perceive others' actions? To pursue this question, we exploited the bistability of depth-ambiguous point-light walkers, which can be perceived as facing towards the viewer or as facing away from the viewer. We demonstrate that point-light walkers are perceived more often as facing the viewer when the observer is walking on a treadmill compared to when the observer is performing an action that does not match the observed behavior (e.g., cycling). These findings suggest that motor processes influence the perceived orientation of observed actions: Acting observers tend to perceive similar actions by conspecifics as oriented towards themselves. We discuss these results in light of the possible mechanisms subtending action-induced modulation of perception.

The effect of looming and receding sounds on the perceived in-depth orientation of depth-ambiguous biological motion figures.

BACKGROUND: The focus in the research on biological motion perception traditionally has been restricted to the visual modality. Recent neurophysiological and behavioural evidence, however, supports the idea that actions are not represented merely visually but rather audiovisually. The goal of the present study was to test whether the perceived in-depth orientation of depth-ambiguous point-light walkers (plws) is affected by the presentation of looming or receding sounds synchronized with the footsteps. METHODOLOGY/PRINCIPAL FINDINGS: In Experiment 1 orthographic frontal/back projections of plws were presented either without sound or with sounds of which the intensity level was rising (looming), falling (receding) or stationary. Despite instructions to ignore the sounds and to only report the visually perceived in-depth orientation, plws accompanied with looming sounds were more often judged to be facing the viewer whereas plws paired with receding sounds were more often judged to be facing away from the viewer. To test whether the effects observed in Experiment 1 act at a perceptual level rather than at the decisional level, in Experiment 2 observers perceptually compared orthographic plws without sound or paired with either looming or receding sounds to plws without sound but with perspective cues making them objectively either facing towards or facing away from the viewer. Judging whether either an orthographic plw or a plw with looming (receding) perspective cues is visually most looming becomes harder (easier) when the orthographic plw is paired with looming sounds. CONCLUSIONS/SIGNIFICANCE: The present results suggest that looming and receding sounds alter the judgements of the in-depth orientation of depth-ambiguous point-light walkers. While looming sounds are demonstrated to act at a perceptual level and make plws look more looming, it remains a challenge for future research to clarify at what level in the processing hierarchy receding sounds affect how observers judge the in-depth perception of plws.

Communicative interactions improve visual detection of biological motion.

BACKGROUND: In the context of interacting activities requiring close-body contact such as fighting or dancing, the actions of one agent can be used to predict the actions of the second agent. In the present study, we investigated whether interpersonal predictive coding extends to interactive activities--such as communicative interactions--in which no physical contingency is implied between the movements of the interacting individuals. METHODOLOGY/PRINCIPAL FINDINGS: Participants observed point-light displays of two agents (A and B) performing separate actions. In the communicative condition, the action performed by agent B responded to a communicative gesture performed by agent A. In the individual condition, agent A's communicative action was substituted with a non-communicative action. Using a simultaneous masking detection task, we demonstrate that observing the communicative gesture performed by agent A enhanced visual discrimination of agent B. CONCLUSIONS/SIGNIFICANCE: Our finding complements and extends previous evidence for interpersonal predictive coding, suggesting that the communicative gestures of one agent can serve as a predictor for the expected actions of the respondent, even if no physical contact between agents is implied.

The facing bias in biological motion perception: structure, kinematics, and body parts.

Depth-ambiguous point-light walkers (PLWs) elicit a facing bias: Observers perceive a PLW as facing toward them more often than as facing away (Vanrie,Dekeyser, & Verfaillie, Perception, 33, 547-560, 2004). While the facing bias correlates with the PLW's perceived gender (Brooks et al., Current Biology, 18, R728-R729, 2008; Schouten, Troje, Brooks, van der Zwan, & Verfaillie, Attention, Perception, & Psychophysics, 72,1256-1260, 2010), it remains unclear whether the change in perceived in-depth orientation is caused by a change in perceived gender. In Experiment 1, we show that structural and kinematic stimulus properties that lead to the same changes in perceived gender elicit opposite changes in perceived in-depth orientation, indicating that the relation between perceived gender and in-depth orientation is not causal. The results of Experiments 2 and 3 further suggest that the perceived in-depth orientation of PLWs is strongly affected by locally acting stimulus properties. The facing bias seems to be induced by stimulus properties in the lower part of the PLW.

The facing bias in biological motion perception: Effects of stimulus gender and observer sex.

Under orthographic projection, biological motion point-light walkers offer no cues to the order of the dots in depth: Views from the front and from the back result in the very same stimulus. Yet observers show a bias toward seeing a walker facing the viewer (Vanrie, Dekeyser, & Verfaillie, 2004). Recently, we reported that this facing bias strongly depends on the gender of the walker (Brooks et al., 2008). The goal of the present study was, first, to examine the robustness of the effect by testing a much larger subject sample and, second, to investigate whether the effect depends on observer sex. Despite the fact that we found a significant effect of figure gender, we clearly failed to replicate the strong effect observed in the original study. We did, however, observe a significant interaction between figure gender and observer sex.

Determining the point of subjective ambiguity of ambiguous biological-motion figures with perspective cues.

Orthographic frontal/back projections of biological-motion figures are bistable: The point-light figure in principle can be perceived either as facing toward the viewer or as facing away from the viewer. Some point-light actions--for example, walking--elicit a strong "facing bias": Despite the absence of objective cues to depth, observers tend to interpret the figure as facing toward the viewer in most of the cases. In this article, we present and experimentally validate a technique that affords full experimental control of the perceived in-depth orientation of point-light figures. We demonstrate that by parametrically manipulating the amount of perspective information in the stimulus, it is possible to obtain any desired level of subjective ambiguity. Directions for future research, in which this technique can be fruitfully implemented, are suggested. Program code of a demo is provided that can be modified easily for program code of new experiments. The demo and QuickTime movie files illustrating our perspective manipulation technique may be downloaded from http://brm.psychonomic-journals.org/content/supplemental.

Inferring intentions from biological motion: a stimulus set of point-light communicative interactions.

We present the first database of communicative interactions reproduced through point-light displays (Communicative Interaction Database). The database contains 20 communicative interactions performed by male and by female couples. For each action, we provide movie files from four different viewpoints, as well as text files with the 3-D spatial coordinates of the point lights, allowing researchers to construct customized versions. By including various types of actions performed with different social motives, the database contains a diverse sample of nonconventional communicative gestures. Normative data collected to assess the recognizability of the stimuli suggest that, for most action stimuli, information in point-light displays is sufficient for clear recognition of the action as communicative, as well as for identification of the specific communicative gesture performed by the actor. The full set of stimuli may be downloaded from http://brm.psychonomic-journals.org/content/supplemental and from http://ppw.kuleuven.be/labexppsy/lepSite/resources/CID.rar.