Exergaming for balance training in elderly: User requirements Mike van Diest, Claudine JC Lamoth, Jan Stegenga, Sabine Wildevuur, Miriam Reitenbach, Klaas Postema, Bart Verkerke
Background 1/3 of people aged 65+ falls at least once per year Emergency Department: 72.000 Requiring hospitalization: 24.000 Hip fractures: 15.000 20% dies within 3 months 50% never regains previous level of functioning Costs due to falls in NL: 675 M / year 65+ population: 2.4 million (2008) 4.5 million (2040) Major cause: Impaired postural control and muscle strenght 2 Delbaere 2010, Hartholt 2012, Yardley 2006, CBS
Balance training Fall rate can be decreased through training Recent review studies showed that effective training programs include: Strength, balance, flexibility, endurance High dose (>50 hr) However, therapy adherence is low. Gillespie 2009, Howe 2007 3
Exergames for balance training Why Exergames? Home situation Monitoring performance Wii Fit Wobble board External focus of attention Personalized: train what you need Smith 2011 Training both motor control and cognitive function Hebi Hebi Motivation and social interaction So do they work? Gil-Gómez 2011 Xbox Kinect 4
Exergames for balance training in elderly Growing number of studies show that exergame training programs have the potential to improve balance in elderly Positive effect on balance ability Participants are more motivated to exercise Enjoyable, Challenging, Attractive However Current exergames are not developed specifically with and for elderly Complex controls Hard to navigate through system No independent use Complex game mechanics Design of Visual style too distracting exergames not Game scores/feedback User-driven Agmon 2011, Betker 2005, Gerling 2011, Lamoth 2011, Lamoth 2012, Williams 2010 5
Exergames for balance training in elderly Goal: Develop an exergame tool that enables elderly to train balance at home Monitor the user s changes in balance ability (short and long timescales) Motivating à high therapy adherence Approach Knowledge motor control, learning theories Game design Sensor technology / data fusion à User driven ß 6
Exergames for balance training in elderly Serious Game Training Aspects Parameters Balance Quantification Sensor System 7 Tognetti 2006, Novel
User Requirements Methodical Design Process User as Designers Verkerke 2008, Waag Society 2011 8
User Requirements If I had asked people what they wanted, they would have said faster horses. Henry Ford Users as designers Interviews 1:1 What needs do elderly have? What are elderly prepared to invest? Wat kind of games would they like to play? What does their daily context and home environment look like? Study 1 10 elderly aged 75.1 ± 5.6 Semi-structured interviews Topics: Context and Game recommendations Study 2 4 elderly aged 73 ± 4.5 Xbox Kinect games 30 min/week over 7 weeks Group interview 9
Methods: Users as designers Context mapping 10
Results: User Context Social context Family Friends Neighbors/Committee/Sports club 33% 11% 56% Multiplayer Singleplayer Both Single/multiplayer and with who? 53% 20% Peers Physical context Awareness of aging 27% Children Grandchildren I used to work in the garden for a full day, but cannot do that anymore Motivation for being physically active Health Fun I don t like being physically active, but I do it because it s healthy 11
Results: Exergame Recommendations Motivation for training/playing To stay healthy and as a social activity Not agree The game should be realistic Agree Content Ideas very similar to daily activities Focus on sports and puzzles Sensor technology Hard to come up with ideas 10 9 8 7 6 5 4 3 2 1 0 Realistic Unrealistic Competitive Cooperative Difficulty Visual Analog Scales 0=not agree, 10 = fully agree (n=9) If I go bowling I always have to put on other shoes 12
Results: Exergame Recommendations Kinect group : Observations fit literature Fun! Games were appealing But also difficult and distracting System is difficult to operate In-game instructions went too fast, text too small and in English à confusion Recommendations: User friendly installation, controls and navigation We already have too many remote controls at home Text in Dutch, simple/clear visual style, instructions should be clear The game should motivate to exercise Sports/adventure/puzzle games Useful, but heavily influenced by their game experience 13
Conclusions Current Exergames for training balance are not suitable for elderly Complex navigation/controls Gameplay too fast No independent use Visual style too distracting Game scores/feedback not geared towards elderly Observations regarding: Social network and weekly activities Game preferences Motivation for exergaming Future Work Develop persona and scenarios for exergames Present work in progress to a focus group Keep the target group involved in all stages Develop an exergame tool that enables elderly to train balance at home 14
Thank you Exergaming for balance training in elderly mikevandiest@incas3.eu 15