Virtual Reality Design for Stroke Rehabilitation.

Stroke is a leading cause of disability, and with the stroke survivor population rising in most countries it is increasingly difficult to provide optimal treatment to patients once they return home. Assistive technology solutions can potentially contribute to meeting demand, and also be cost effective. In this chapter, we consider the design and development of engaging serious virtual reality (VR) games for upper arm stroke rehabilitation. Fundamental design principles are summarised and related to our experience of creating game-based VR rehabilitation. The application of ideas from psychology, particularly behavioural change and flow theory are discussed, as well as related learning and gamification principles. We address how to manage differences between people through design, user profiling, and intelligent dynamic system behaviour, and we also explore how to account for variation in stroke survivor capability and personality. The idea of a hero's journey as a metaphor for stroke recovery is introduced and we discuss how this metaphor may guide system design, its relationship to game design principles, and how patient narratives and embedded stories might support engagement with treatment. An overview of our previous work is summarised and we discuss how our experience and increased knowledge and capability has informed improved approaches to development processes. Finally, our approach is illustrated with reference to a recent EU project.

Gaming for Health: Systematic Review and Meta-analysis of the Physical and Cognitive Effects of Active Computer Gaming in Older Adults.

BACKGROUND: Active computer gaming (ACG) is a method of facilitating physical activity in older people to improve health outcomes. PURPOSE: The purpose of this study was to update and extend a systematic review of the evidence for ACG to determine its effects on physical and cognitive health in older adults. DATA SOURCES: MEDLINE, EMBASE, CENTRAL in the Cochrane Library, and PsycINFO databases were searched from the date of the previous review (2011) to May 2016. STUDY SELECTION: Eligible articles were randomized controlled trials (RCTs) investigating the effect of ACG in adults aged 65 and older. DATA EXTRACTION: Thirty-five studies were eligible for inclusion. Two review authors independently conducted data extraction, risk-of-bias assessment, and coding of behavior change techniques. Outcomes of interest were analyzed as continuous data and pooled as standardized mean differences (SMD) and 95% confidence intervals (CI). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to determine the quality of the evidence. DATA SYNTHESIS: Behavior change techniques (N = 106) were coded in the included studies (mean = 3.02). Data were pooled for 5 main outcomes of interest. Significant moderate effects in favor of ACG were observed for balance (SMD = 0.52, 95% CI = 0.24 to 0.79; 17 studies; 743 participants), for functional exercise capacity when intervention delivery was >120 minutes per week (SMD = 0.53, 95% CI = 0.15 to 0.90; 5 studies; 116 participants), and for cognitive function (SMD = -0.48, 95% CI = -0.80 to 0.17; 8 studies; 459 participants). There was no significant effect observed for functional mobility or fear of falling. LIMITATIONS: The quality of the evidence for all comparisons was graded low or very low. CONCLUSIONS: At present there is very little confidence that ACG improves physical and cognitive outcomes in older adults.

Gaming for health: a systematic review of the physical and cognitive effects of interactive computer games in older adults.

This systematic review examined the physical and cognitive effects of physically based interactive computer games (ICGs) in older adults. Literature searching was carried out from January 2000 to June 2011. Eligible studies were trials involving older adults (>65 years) describing the effects of ICGs with a physical component (aerobic, strength, balance, flexibility) on physical or cognitive outcomes. Secondary outcomes included adverse effects, compliance, and enjoyment. Twelve trials met the inclusion criteria. ICG interventions varied in terms of software, game type, and nature of the computer interaction. Although there was preliminary evidence that ICG is a safe and effective exercise intervention for older adults, the dearth of high-quality evidence limits this finding. No major adverse effects were reported and two studies reported minor events. ICG could be improved further by tailoring interventions for older adults; in particular, they should aim to optimize participant safety, motivation, and enjoyment for this population.