Music meets robotics: a prospective randomized study on motivation during robot aided therapy.

BACKGROUND: Robots have been successfully applied in motor training during neurorehabilitation. As music is known to improve motor function and motivation in neurorehabilitation training, we aimed at integrating music creation into robotic-assisted motor therapy. We developed a virtual game-like environment with music for the arm therapy robot ARMin, containing four different motion training conditions: a condition promoting creativity (C+) and one not promoting creativity (C-), each in a condition with (V+) and without (V-) a visual display (i.e., a monitor). The visual display was presenting the game workspace but not contributing to the creative process itself. In all four conditions the therapy robot haptically displayed the game workspace. Our aim was to asses the effects of creativity and visual display on motivation. METHODS: In a prospective randomized single-center study, healthy participants were randomly assigned to play two of the four training conditions, either with (V+) or without visual display (V-). In the third round, the participants played a repetition of the preferred condition of the two first rounds, this time with a new V condition (i.e., with or without visual display). For each of the three rounds, motivation was measured with the Intrinsic Motivation Inventory (IMI) in the subscales interest/enjoyment, perceived choice, value/usefulness, and man-machine-relation. We recorded the actual training time, the time of free movement, and the velocity profile and administered a questionnaire to measure perceived training time and perceived effort. All measures were analysed using linear mixed models. Furthermore, we asked if the participants would like to receive the created music piece. RESULTS: Sixteen healthy subjects (ten males, six females, mean age: 27.2 years, standard deviation: 4.1 years) with no known motor or cognitive deficit participated. Promotion of creativity (i.e., C+ instead of C-) significantly increased the IMI-item interest/enjoyment (p=0.001) and the IMI-item perceived choice (p=0.010). We found no significant effects in the IMI-items man-machine relation and value/usefulness. Conditions promoting creativity (with or without visual display) were preferred compared to the ones not promoting creativity. An interaction effect of promotion of creativity and omission of visual display was present for training time (p=0.013) and training intensity (p<0.001). No differences in relative perceived training time, perceived effort, and perceived value among the four training conditions were found. CONCLUSIONS: Promoting creativity in a visuo-audio-haptic or audio-haptic environment increases motivation in robot-assisted therapy. We demonstrated the feasibility of performing an audio-haptic music creation task and recommend to try the system on patients with neuromuscular disorders. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02720341. Registered 25 March 2016, https://clinicaltrials.gov/ct2/show/NCT02720341.

High User Control in Game Design Elements Increases Compliance and In-game Performance in a Memory Training Game.

Computer games are increasingly being used for training cognitive functions like working memory and attention among the growing population of older adults. While cognitive training games often include elements like difficulty adaptation, rewards, and visual themes to make the games more enjoyable and effective, the effect of different degrees of afforded user control in manipulating these elements has not been systematically studied. To address this issue, two distinct implementations of the three aforementioned game elements were tested among healthy older adults (N = 21, 69.9 ± 6.4 years old) playing a game-like version of the n-back task on a tablet at home for 3 weeks. Two modes were considered, differentiated by the afforded degree of user control of the three elements: user control of difficulty vs. automatic difficulty adaptation, difficulty-dependent rewards vs. automatic feedback messages, and user choice of visual theme vs. no choice. The two modes ("USER-CONTROL" and "AUTO") were compared for frequency of play, duration of play, and in-game performance. Participants were free to play the game whenever and for however long they wished. Participants in USER-CONTROL exhibited significantly higher frequency of playing, total play duration, and in-game performance than participants in AUTO. The results of the present study demonstrate the efficacy of providing user control in the three game elements, while validating a home-based study design in which participants were not bound by any training regimen, and could play the game whenever they wished. The results have implications for designing cognitive training games that elicit higher compliance and better in-game performance, with an emphasis on home-based training.

O efeito de diferentes adaptações de dificuldade em estratégias de diversão e performance em serious games para trieno de memória / The effect of different difficulty adaptation strategies on enjoyment and performance in a serious game for memory training / El efecto de diferentes adaptaciones de dificultades en estrategias de diversion y performance en seriousgames para entrenamiento de memoria

The goal of this study was to evaluate two kinds of difficulty adaptation techniques in terms of enjoyment and performance in a simple memory training game: one based on difficulty-performance matching (?task-guided?) and the other based on providing a high degree of control/choice (?user-guided?). Methods: Performance and enjoyment are both critical in making serious games effective. Therefore the adaptations were based on two different approaches that are used to sustain performance and enjoyment in serious games: 1) adapting task difficulty to match user performance by leveraging the theories of zone of proximal development and flow, thus maximizing performance that can then lead to increased enjoyment and 2) providing a high degree of control and choice by using constructs from self-determination theory, which maximizes enjoyment, that can potentially increase performance. 24 participants played a simple memory training serious game in a fully randomized, repeated measures design. The primary outcome measures were enjoyment and performance. Results: Enjoyment was significantly greater in user-guided (p < 0.05), whereas performance was significantly greater in task-guided (p < 0.05). Conclusion: The results suggest that a trade-off between maximizing performance and maximizing enjoyment could be achieved by combining the two approaches into a ?hybrid? adaptation mode that gives users a high degree of control in setting difficulty, but also advises them about optimizing performance...

Consiste em avaliar dois tipos de adaptação de dificuldades em termos de ludicidade e desempenho num jogo simples de treino de memória: um dos métodos é baseado no relacionamento entre desempenho e dificuldade (guiado a tarefas) e o outro é baseado em prover um alto grau de controle e escolha (guiado a usuário). Método: Desempenho e ludicidade são ambos críticos ao fazer jogos sérios serem eficientes. Assim sendo, a adaptação foi baseada em dois aspectos diferentes que são usados para sustentar tanto o desempenho como a ludicidade: 1) adaptar as dificuldades das tarefas para corresponder o desempenho do usuário através de nivelamento das teorias da zona proximal, maximizando o desempenho que podem levar ao acréscimo do fator lúdico e 2) prover um alto grau de controle e escolha usando construtores da teoria da autodeterminação, que maximiza o lúdico e potencializa o aumento do desempenho. Foram selecionados 24 participantes para utilizar o jogo de treino da memória de uma forma totalmente aleatória. Os primeiros resultados medidos foram ludicidade e desempenho. Resultados: A ludicidade foi significativamente maior na abordagem guiada a usuário (p<0.05), enquanto o desempenho foi significativamente maior no modelo guiado a tarefas (p<0.05). Conclusão: Os resultados sugerem que haja uma combinação entre maximização de desempenho e maximização de ludicidade, criando um modelo adaptado híbrido, capaz de dar ao usuário um alto grau de controle na escolha da dificuldade, mas também sugerindo otimizações de desempenho...

Estudio consiste en valuar dos tipos de adaptación de dificultades en respecto al lúdico y performance en un juego simple de entretenimiento para memoria: uno de los métodos es basado en el relacionamiento entre performance y dificultad (guiado a tareas) y el otro es basado en fornecer un alto grado de controle y elección (guiado a usuario). Metodos: Performance y lúdico son ambos críticos al hacer que juegos serios sean eficientes. Esto dicho, la adaptación fue basada en dos aspectos distintos que son usados para sostener tanto la performance como el lúdico: 1) adaptar las dificultades de las tareas para corresponder a la performance del usuario por el uso de las teorías de zona proximal, maximizando e la performance que pueden llevar al aumento del factor lúdico y 2) proveer un alto grado de control y elección usando constructores de la teoría de la autodeterminación, que maximiza el lúdico y potencializa el aumento de performance. Fueran seleccionados 24 participantes para utilizar el juego de manera totalmente aleatoria. Los primeros resultados medidos fueron el factor lúdico y performance. Resultados: El lúdico fue significativamente mayor en la abordaje guiada a usuario (p<0.05), mientras la performance fue significativamente mayor en el modelo guiado a tareas (p<0.05). Conclusión: Los resultados sugieren que haya una combinación entre maximización de performance y maximización del factor lúdico, creando un modelo adaptado hibrido, capaz de dar al usuario un alto grado de control en la elección de la dificultad, pero también sugiriendo optimizaciones de performance...

Increasing motivation in robot-aided arm rehabilitation with competitive and cooperative gameplay.

BACKGROUND: Several strategies have been proposed to improve patient motivation and exercise intensity during robot-aided stroke rehabilitation. One relatively unexplored possibility is two-player gameplay, allowing subjects to compete or cooperate with each other to achieve a common goal. In order to explore the potential of such games, we designed a two-player game played using two ARMin arm rehabilitation robots. METHODS: The game was an air-hockey task displayed on a computer monitor and controlled using shoulder movements in the ARMin robot. Three game modes were tested: single-player (competing against computer), competitive (competing against human), and cooperative (cooperating with human against computer). All modes were played by 30 unimpaired subjects and 8 impaired chronic stroke subjects. The subjects filled out the Intrinsic Motivation Inventory questionnaire after each game mode, as well as a final questionnaire about game preferences and their personality. RESULTS: Nearly all unimpaired subjects preferred playing the two-player game modes to the single-player one, as they enjoyed talking and interacting with another person. However, there were two distinct player groups: one liked the competitive mode but not the cooperative mode while the other liked the cooperative but not the competitive mode. Unimpaired subjects who liked the competitive mode also put significantly more effort into it than into the other modes. Results from impaired subjects were similar, with even impaired subjects over 60 years old enjoying competitive gameplay. The subjects' personalities roughly predicted which mode they would prefer, which was especially evident in a poorly-matched impaired pair that preferred the single-player mode. CONCLUSIONS: Results indicate great potential for two-player rehabilitation games, in the form of greater enjoyment as well as potentially more intensive exercise compared to single-player games. However, the right game type needs to be chosen for each subject depending on skill and personality, along with selecting an appropriate co-player. Further studies with patients that are currently enrolled in rehabilitation programs are recommended, and the subjective measures used in our study should be augmented with objective measures such as electromyography.

Virtual reality aided training of combined arm and leg movements of children with CP.

Cerebral palsy (CP) occurs in over 2 out of 1000 live births and can impair motor control and cognition. Our goal was to create a robotic rehabilitation environment that mimics real-life situations by allowing simultaneous exercise of upper and lower limbs. We chose to use the Lokomat as a gait robot and added a novel removable arm robot, called PASCAL (pediatric arm support robot for combined arm and leg training), that was integrated into the Lokomat environment. We also added a virtual reality (VR) environment that enables the subject to perform motivating game-like scenarios incorporating combined arm and leg movements. In this paper we summarize the design of PASCAL and present the novel virtual environment including first experimental results. The next step will be to test whether a combined application of the virtual environment and the two simultaneously working robots is feasible in healthy participants, and finally to clinically evaluate the entire system on children with CP.