Inertial Measurement Unit and Heart Rate Monitoring to Assess Cardiovascular Fitness of Manual Wheelchair Users during the Six-Minute Push Test.

Manual wheelchair users (MWUs) are prone to a sedentary life that can negatively affect their physical and cardiovascular health, making regular assessment important to identify appropriate interventions and lifestyle modifications. One mean of assessing MWUs' physical health is the 6 min push test (6MPT), where the user propels themselves as far as they can in six minutes. However, reliance on observer input introduces subjectivity, while limited quantitative data inhibit comprehensive assessment. Incorporating sensors into the 6MPT can address these limitations. Here, ten MWUs performed the 6MPT with additional sensors: two inertial measurement units (IMUs)-one on the wheelchair and one on the wrist together with a heart rate wristwatch. The conventional measurements of distance and laps were recorded by the observer, and the IMU data were used to calculate laps, distance, speed, and cadence. The results demonstrated that the IMU can provide the metrics of the traditional 6MPT with strong significant correlations between calculated laps and observer lap counts (r = 0.947, p < 0.001) and distances (r = 0.970, p < 0.001). Moreover, heart rate during the final minute was significantly correlated with calculated distance (r = 0.762, p = 0.017). Enhanced 6MPT assessment can provide objective, quantitative, and comprehensive data for clinicians to effectively inform interventions in rehabilitation.

Load Position and Weight Classification during Carrying Gait Using Wearable Inertial and Electromyographic Sensors.

Lifting and carrying heavy objects is a major aspect of physically intensive jobs. Wearable sensors have previously been used to classify different ways of picking up an object, but have seen only limited use for automatic classification of load position and weight while a person is walking and carrying an object. In this proof-of-concept study, we thus used wearable inertial and electromyographic sensors for offline classification of different load positions (frontal vs. unilateral vs. bilateral side loads) and weights during gait. Ten participants performed 19 different carrying trials each while wearing the sensors, and data from these trials were used to train and evaluate classification algorithms based on supervised machine learning. The algorithms differentiated between frontal and other loads (side/none) with an accuracy of 100%, between frontal vs. unilateral side load vs. bilateral side load with an accuracy of 96.1%, and between different load asymmetry levels with accuracies of 75-79%. While the study is limited by a lack of electromyographic sensors on the arms and a limited number of load positions/weights, it shows that wearable sensors can differentiate between different load positions and weights during gait with high accuracy. In the future, such approaches could be used to control assistive devices or for long-term worker monitoring in physically demanding occupations.

Competitive and cooperative arm rehabilitation games played by a patient and unimpaired person: effects on motivation and exercise intensity.

BACKGROUND: People with chronic arm impairment should exercise intensely to regain their abilities, but frequently lack motivation, leading to poor rehabilitation outcome. One promising way to increase motivation is through interpersonal rehabilitation games, which allow patients to compete or cooperate together with other people. However, such games have mainly been evaluated with unimpaired subjects, and little is known about how they affect motivation and exercise intensity in people with chronic arm impairment. METHODS: We designed four different arm rehabilitation games that are played by a person with arm impairment and their unimpaired friend, relative or occupational therapist. One is a competitive game (both people compete against each other), two are cooperative games (both people work together against the computer) and one is a single-player game (played only by the impaired person against the computer). The games were played by 29 participants with chronic arm impairment, of which 19 were accompanied by their friend or relative and 10 were accompanied by their occupational therapist. Each participant played all four games within a single session. Participants' subjective experience was quantified using the Intrinsic Motivation Inventory questionnaire after each game, as well as a final questionnaire about game preferences. Their exercise intensity was quantified using wearable inertial sensors that measured hand velocity in each game. RESULTS: Of the 29 impaired participants, 12 chose the competitive game as their favorite, 12 chose a cooperative game, and 5 preferred to exercise alone. Participants who chose the competitive game as their favorite showed increased motivation and exercise intensity in that game compared to other games. Participants who chose a cooperative game as their favorite also showed increased motivation in cooperative games, but not increased exercise intensity. CONCLUSIONS: Since both motivation and intensity are positively correlated with rehabilitation outcome, competitive games have high potential to lead to functional improvement and increased quality of life for patients compared to conventional rehabilitation exercises. Cooperative games do not increase exercise intensity, but could still increase motivation of patients who do not enjoy competition. However, such games need to be tested in longer, multisession studies to determine whether the observed increases in motivation and exercise intensity persist over a longer period of time and whether they positively affect rehabilitation outcome. TRIAL REGISTRATION: The study is not a clinical trial. While human subjects are involved, they participate in a single-session evaluation of a rehabilitation game rather than a full rehabilitation intervention, and no health outcomes are examined.

A multisession evaluation of an adaptive competitive arm rehabilitation game.

BACKGROUND: People with neurological injuries such as stroke should exercise frequently and intensely to regain their motor abilities, but are generally hindered by lack of motivation. One way to increase motivation in rehabilitation is through competitive exercises, but such exercises have only been tested in single brief sessions and usually did not adapt difficulty to the patient's abilities. METHODS: We designed a competitive arm rehabilitation game for two players that dynamically adapts its difficulty to both players' abilities. This game was evaluated by two participant groups: 15 participants with chronic arm impairment who exercised at home with an unimpaired friend or relative, and 20 participants in the acute or subacute phase of stroke who exercised in pairs (10 pairs) at a rehabilitation clinic. All participants first played the game against their human opponent for 3 sessions, then played alone (against a computer opponent) in the final, fourth session. In all sessions, participants' subjective experiences were assessed with the Intrinsic Motivation Inventory questionnaire while exercise intensity was measured using inertial sensors built into the rehabilitation device. After the fourth session, a final brief questionnaire was used to compare competition and exercising alone. RESULTS: Participants who played against an unimpaired friend or relative at home tended to prefer competition (only 1 preferred exercising alone), and exhibited higher enjoyment and exercise intensity when competing (first three sessions) than when exercising alone (last session). Participants who played against each other in the clinic, however, did not exhibit significant differences between competition and exercising alone. For both groups, there was no difference in enjoyment or exercise intensity between the first three sessions, indicating no negative effects of habituation or novelty. CONCLUSIONS: Competitive exercises have high potential for unsupervised home rehabilitation, as they improve enjoyment and exercise intensity compared to exercising alone. Such exercises could thus improve rehabilitation outcome, but this needs to be tested in long-term clinical trials. It is not clear why participants who competed against each other at the clinic did not exhibit any advantages of competition, and further studies are needed to determine how different factors (environment, nature of opponent etc.) influence patients' experiences with competitive exercises. TRIAL REGISTRATION: The study is not a clinical trial. While human subjects are involved, they do not participate in a full rehabilitation intervention, and no health outcomes are examined.

Toward real-time automated detection of turns during gait using wearable inertial measurement units.

Previous studies have presented algorithms for detection of turns during gait using wearable sensors, but those algorithms were not built for real-time use. This paper therefore investigates the optimal approach for real-time detection of planned turns during gait using wearable inertial measurement units. Several different sensor positions (head, back and legs) and three different detection criteria (orientation, angular velocity and both) are compared with regard to their ability to correctly detect turn onset. Furthermore, the different sensor positions are compared with regard to their ability to predict the turn direction and amplitude. The evaluation was performed on ten healthy subjects who performed left/right turns at three amplitudes (22, 45 and 90 degrees). Results showed that turn onset can be most accurately detected with sensors on the back and using a combination of orientation and angular velocity. The same setup also gives the best prediction of turn direction and amplitude. Preliminary measurements with a single amputee were also performed and highlighted important differences such as slower turning that need to be taken into account.

Online phase detection using wearable sensors for walking with a robotic prosthesis.

This paper presents a gait phase detection algorithm for providing feedback in walking with a robotic prosthesis. The algorithm utilizes the output signals of a wearable wireless sensory system incorporating sensorized shoe insoles and inertial measurement units attached to body segments. The principle of detecting transitions between gait phases is based on heuristic threshold rules, dividing a steady-state walking stride into four phases. For the evaluation of the algorithm, experiments with three amputees, walking with the robotic prosthesis and wearable sensors, were performed. Results show a high rate of successful detection for all four phases (the average success rate across all subjects >90%). A comparison of the proposed method to an off-line trained algorithm using hidden Markov models reveals a similar performance achieved without the need for learning dataset acquisition and previous model training.

Effects of the Auxivo CarrySuit occupational exoskeleton when carrying front and side loads on a treadmill.

Low-cost exoskeletons can effectively support workers in physically demanding jobs, but most such exoskeletons have been developed to support repetitive lifting or uncomfortable static postures. Very few low-cost exoskeletons have been designed to support walking while carrying heavy objects, which would be beneficial for jobs such as moving furniture and warehouse work. This paper thus presents a single-session lab evaluation of the Auxivo CarrySuit, a low-cost upper-body exoskeleton designed for carrying objects that would normally be held with the arms. Twenty participants carried four loads (box or two bags, 20 or 40 lb total weight) for 2 min each on a treadmill with and without the CarrySuit. Across all loads, the CarrySuit significantly reduced the mean electromyogram of the middle trapezius (partial eta-squared = 0.74 - from 16.1% to 8.8% of maximum voluntary contraction value) and anterior deltoid (partial eta-squared = 0.26 - from 3.0% to 1.1% of maximum voluntary contraction value) with no corresponding increase in lower back muscle activation. Furthermore, maximum heart rate and Ratings of Perceived Exertion were also reduced by the CarrySuit, and discomfort was shifted from the upper body to the legs. While arm EMG was not measured, it is likely that it was also reduced due to the unloading of the arms. The CarrySuit can thus be considered beneficial in the short term, though longer-term evaluations with actual workers are needed to determine practical benefits.

Effects of a Passive Back Support Exoskeleton when Lifting and Carrying Lumber Boards.

Passive back support exoskeletons, which support the human trunk using elements like springs and elastic bands, have demonstrated positive results in laboratory-based studies, but have seen significantly less field testing. As an intermediate step between generic lab evaluations and field tests, we conducted a single-session lab evaluation of the HeroWear Apex exoskeleton with mockup construction tasks: 20 adult men (without extensive construction experience) lifted, carried and raised lumber boards (265 cm length, up to 18 kg total load). The exoskeleton significantly reduced mean erector spinae electromyograms, with effect sizes (Cohen's d) ranging from -0.2 to -0.55 - corresponding to reductions of 5-25% relative to noexoskeleton electromyogram values. In asymmetric carrying tasks, the exoskeleton provided more assistance to the more heavily loaded erector spinae muscle. Additionally, in lifting tasks, the exoskeleton decreased trunk/hip flexion/extension range of motion and increased knee range of motion, indicating changes in lifting strategy. These results indicate potential exoskeleton benefits for lumber board carrying and will serve as the basis for further evaluations with workers in the field.Clinical Relevance- This study establishes that a passive back exoskeleton reduces erector spinae electromyograms by 525% when lifting and carrying lumber boards used in construction work.

Community mobility and participation assessment of manual wheelchair users: a review of current techniques and challenges.

According to the World Health Organization, hundreds of individuals commence wheelchair use daily, often due to an injury such as spinal cord injury or through a condition such as a stroke. However, manual wheelchair users typically experience reductions in individual community mobility and participation. In this review, articles from 2017 to 2023 were reviewed to identify means of measuring community mobility and participation of manual wheelchair users, factors that can impact these aspects, and current rehabilitation techniques for improving them. The selected articles document current best practices utilizing self-surveys, in-clinic assessments, and remote tracking through GPS and accelerometer data, which rehabilitation specialists can apply to track their patients' community mobility and participation accurately. Furthermore, rehabilitation methods such as wheelchair training programs, brain-computer interface triggered functional electric stimulation therapy, and community-based rehabilitation programs show potential to improve the community mobility and participation of manual wheelchair users. Recommendations were made to highlight potential avenues for future research.

Automated Classification of Dyadic Conversation Scenarios using Autonomic Nervous System Responses.

Two people's physiological responses become more similar as those people talk or cooperate, a phenomenon called physiological synchrony. The degree of synchrony correlates with conversation engagement and cooperation quality, and could thus be used to characterize interpersonal interaction. In this study, we used a combination of physiological synchrony metrics and pattern recognition algorithms to automatically classify four different dyadic conversation scenarios: two-sided positive conversation, two-sided negative conversation, and two one-sided scenarios. Heart rate, skin conductance, respiration and peripheral skin temperature were measured from 16 dyads in all four scenarios, and individual as well as synchrony features were extracted from them. A two-stage classifier based on stepwise feature selection and linear discriminant analysis achieved a four-class classification accuracy of 75.0% in leave-dyad-out crossvalidation. Removing synchrony features reduced accuracy to 65.6%, indicating that synchrony is informative. In the future, such classification algorithms may be used to, e.g., provide real-time feedback about conversation mood to participants, with applications in areas such as mental health counseling and education. The approach may also generalize to group scenarios and adjacent areas such as cooperation and competition.

Short-term effects of the Auxivo LiftSuit during lifting and static leaning.

Back support exosuits can support workers in physically demanding jobs by reducing muscle load, which could reduce risk of work-related musculoskeletal disorders. This paper presents a two-session evaluation of a commercial exosuit, the Auxivo LiftSuit 1.1. In session 1, 17 participants performed single repetitions of lifting and static leaning tasks with and without the LiftSuit. In session 2, 10 participants performed 50 box lifting repetitions with and without the LiftSuit. In session 1, the exosuit was considered mildly to moderately helpful, and reduced erector spinae and middle trapezius electromyograms. In session 2, the exosuit was not considered helpful, but reduced the middle trapezius electromyogram and trunk and thigh ranges of motion. These effects are likely due to placement of elastic elements and excessive stiffness at the hips. Overall, the LiftSuit appears suboptimal for long-term use, though elastic elements on the upper back may reduce muscle activation in future exosuit designs.

Evaluation of the HeroWear Apex back-assist exosuit during multiple brief tasks.

Trunk exoskeletons are wearable devices that support humans during physically demanding tasks by reducing biomechanical loads on the back. While most trunk exoskeletons are rigid devices, more lightweight soft exoskeletons (exosuits) have recently been developed. One such exosuit is the HeroWear Apex, which achieved promising results in the developers' own work but has not been independently evaluated. This paper thus presents an evaluation of the Apex with 20 adult participants during multiple brief tasks: standing up from a stool with a symmetric or asymmetric load, lifting a unilateral or bilateral load from the floor to waist level, lifting the same bilateral load with a 90-degree turn to the right, lowering a bilateral load from waist level to floor, and walking while carrying a bilateral load. The tasks were performed in an ABA-style protocol: first with exosuit assistance disengaged, then with it engaged, then disengaged again. Four measurement types were taken: electromyography (of the erector spinae, rectus abdominis, and middle trapezius), trunk kinematics, self-report ratings, and heart rate. The exosuit decreased the erector spinae electromyogram by about 15% during object lifting and lowering tasks; furthermore, participants found the exosuit mildly to moderately helpful. No adverse effects on other muscles or during non-lifting tasks were noted, and a decrease in middle trapezius electromyogram was observed for one task. This confirms that the HeroWear Apex could reduce muscle demand and fatigue. The results may transfer to other exoskeletons with similar design principles, and may inform researchers working with other wearable devices.

Automatic Estimation of Interpersonal Engagement During Naturalistic Conversation Using Dyadic Physiological Measurements.

Physiological responses of two interacting individuals contain a wealth of information about the dyad: for example, the degree of engagement or trust. However, nearly all studies on dyadic physiological responses have targeted group-level analysis: e.g., correlating physiology and engagement in a large sample. Conversely, this paper presents a study where physiological measurements are combined with machine learning algorithms to dynamically estimate the engagement of individual dyads. Sixteen dyads completed 15-min naturalistic conversations and self-reported their engagement on a visual analog scale every 60 s. Four physiological signals (electrocardiography, skin conductance, respiration, skin temperature) were recorded, and both individual physiological features (e.g., each participant's heart rate) and synchrony features (indicating degree of physiological similarity between two participants) were extracted. Multiple regression algorithms were used to estimate self-reported engagement based on physiological features using either leave-interval-out crossvalidation (training on 14 60-s intervals from a dyad and testing on the 15th interval from the same dyad) or leave-dyad-out crossvalidation (training on 15 dyads and testing on the 16th). In leave-interval-out crossvalidation, the regression algorithms achieved accuracy similar to a 'baseline' estimator that simply took the median engagement of the other 14 intervals. In leave-dyad-out crossvalidation, machine learning achieved a slightly higher accuracy than the baseline estimator and higher accuracy than an independent human observer. Secondary analyses showed that removing synchrony features and personality characteristics from the input dataset negatively impacted estimation accuracy and that engagement estimation error was correlated with personality traits. Results demonstrate the feasibility of dynamically estimating interpersonal engagement during naturalistic conversation using physiological measurements, which has potential applications in both conversation monitoring and conversation enhancement. However, as many of our estimation errors are difficult to contextualize, further work is needed to determine acceptable estimation accuracies.

Design and Pilot Evaluation of a Prototype Sensorized Trunk Exoskeleton.

Trunk exoskeletons are wearable devices that support wearers during physically demanding tasks by reducing biomechanical loads and increasing stability. In this paper, we present a prototype sensorized passive trunk exoskeleton, which includes five motion processing units (3-axis accelerometers and gyroscopes with onboard digital processing), four one-axis flex sensors along the exoskeletal spinal column, and two one-axis force sensors for measuring the interaction force between the wearer and exoskeleton. A pilot evaluation of the exoskeleton was conducted with two wearers, who performed multiple everyday tasks (sitting on a chair and standing up, walking in a straight line, picking up a box with a straight back, picking up a box with a bent back, bending forward while standing, bending laterally while standing) while wearing the exoskeleton. Illustrative examples of the results are presented as graphs. Finally, potential applications of the sensorized exoskeleton as the basis for a semi-active exoskeleton design or for audio/haptic feedback to guide the wearer are discussed.

Simultaneously varying back stiffness and trunk compression in a passive trunk exoskeleton during different activities: A pilot study.

Passive trunk exoskeletons support the human body with mechanical elements like springs and trunk compression, allowing them to guide motion and relieve the load on the spine. However, to provide appropriate support, elements of the exoskeleton (e.g., degree of compression) should be intelligently adapted to the current task. As it is not currently clear how adjusting different exoskeleton elements affects the wearer, this study preliminarily examines the effects of simultaneously adjusting both exoskeletal spinal column stiffness and trunk compression in a passive trunk exoskeleton. Six participants performed four dynamic tasks (walking, sit-to-stand, lifting a 20-lb box, lifting a 40-lb box) and experienced unexpected perturbations both without the exoskeleton and in six exoskeleton configurations corresponding to two compression levels and three stiffness levels. While results are preliminary due to the small sample size and relatively small increases in stiffness, they indicate that both compression and stiffness may affect kinematics and electromyography, that the effects may differ between activities, and that there may be interaction effects between stiffness and compression. As the next step, we will conduct a larger study with the same protocol more participants and larger stiffness increases to systematically evaluate the effects of different exoskeleton characteristics on the wearer.Clinical Relevance- Trunk exoskeletons can support wearers during a variety of different tasks, but their configuration may need to be intelligently adjusted to provide appropriate support. This pilot study provides information about the effects of exoskeleton back stiffness and trunk compression on the wearer, which can be used as a basis for more effective device design and usage.

Effects of Different Opponent Types on Motivation and Exercise Intensity in a Competitive Arm Exercise Game.

Objective: Competitive exercise games are popular in areas like rehabilitation and weight loss due to their positive effects on motivation. However, it is unclear whether a human opponent is necessary, as the same benefits may be achievable with a "human-like" computer-controlled opponent or a human who talks to the player without playing the game. Our objective was to compare four opponent types in a competitive exercise game: a simple computer opponent, "human-like" computer opponent, human opponent, and a simple computer opponent accompanied by a player-selected human who chats with the player. Materials and Methods: Sixteen participants (3 women, 24.4 ± 7.7 years old) played a competitive arm exercise game in the above four conditions. Exercise intensity was measured with inertial sensors, and four motivation scales were measured with the Intrinsic Motivation Inventory. After playing, participants answered several questions regarding their preferences. Results: The human opponent was the favorite for 14 of 16 participants and resulted in the highest interest/enjoyment and exercise intensity. All participants preferred the human opponent over the computer opponent accompanied by a human companion. Finally, 12 of 16 participants preferred the "human-like" computer opponent over the simple one. Conclusion: Our results have two implications for competitive exercise games. First, they indicate that developing computer-controlled opponents with more human-like behavior is worthwhile, but that the best results are achieved with human opponents. Second, social interaction without in-game interaction does not provide an enjoyable, intense experience. However, our results should be verified with different target populations for exercise games.

Corrections to "A Pilot Study of Varying Thoracic and Abdominal Compression in a Reconfigurable Trunk Exoskeleton During Different Activities" [Jun 20 1585-1594].

Presents a corrected version of Table A-II in the above named paper.

A Pilot Study of Varying Thoracic and Abdominal Compression in a Reconfigurable Trunk Exoskeleton During Different Activities.

OBJECTIVE: Trunk exoskeletons are a new technology with great promise for human rehabilitation, assistance and augmentation. However, it is unclear how different exoskeleton features affect the wearer's body during different activities. This study thus examined how varying a trunk exoskeleton's thoracic and abdominal compression affects trunk kinematics and muscle demand during several activities. METHODS: We developed a trunk exoskeleton that allows thoracic and abdominal compression to be changed quickly and independently. To evaluate the effect of varying compression, 12 participants took part in a two-session study. In the first session, they performed three activities (walking, sit-to-stand, lifting a box). In the second session, they experienced unexpected perturbations while sitting. This was done both without the exoskeleton and in four exoskeleton configurations with different thoracic and abdominal compression levels. Trunk flexion angle, low back extension moment and the electromyogram of the erector spinae and rectus abdominis were measured in both sessions. RESULTS: Different exoskeleton compression levels resulted in significantly different peak trunk flexion angles and peak electromyograms of the erector spinae. However, the effects of compression differed significantly between activities. CONCLUSION: Our results indicate that a trunk exoskeleton's thoracic and abdominal compression affect the wearer's kinematics and muscle demand; furthermore, a single compression configuration is not appropriate for all activities. SIGNIFICANCE: The study suggests that future trunk exoskeletons should either be able to vary their compression levels to suit different activities or should have the compression designed for a specific activity in order to be beneficial to the wearer.

Biomechanical comparisons of back and front squats with a straight bar and four squats with a transformer bar.

The purpose was to quantify trunk and lower extremity biomechanics among back and front squats with a straight bar and four squats with different anterior-posterior load placements imposed by a transformer bar. Ten males and eight females performed six squat conditions: back and front squats with a straight bar, back and front squats with a transformer bar, and squats with more posteriorly or anteriorly placed loads with a transformer bar. A constant load of 70% of the participant's one-repetition maximum in the straight-bar front squat was used. Kinematic and kinetic data were collected to quantify joint biomechanics at an estimated parallel squat position in the descending and ascending phases. Squats with more anteriorly placed load significantly decreased trunk flexion and pelvis anterior tilt angles with large effect sizes but increased low-back extension moments with medium to large effect sizes. Hip, knee, and ankle extension moments were generally similar among most conditions. Participants adjusted their trunk and pelvis to mediate the effects of load placements on low-back and lower extremity moments. While lower extremity loading was similar among different squats, the different trunk and pelvis angles and low-back moments should be taken into consideration for people with low-back impairment.

A Brief Measure of Interpersonal Interaction for 2-Player Serious Games: Questionnaire Validation.

BACKGROUND: Competitive and cooperative serious games have become increasingly popular in areas such as rehabilitation and education and have several potential advantages over single-player games. However, they are not suitable for everyone, and the user experience in competitive and cooperative serious games depends on many factors. One important factor is the verbal interaction between players, but the effect of this factor has not been extensively studied because of the lack of a validated measurement tool. OBJECTIVE: This paper aimed to validate a brief questionnaire that measures the verbal interaction between 2 players of a serious game. The questionnaire consists of 8 questions pertaining to the amount of conversation, its valence (positive or negative emotion), and its game relatedness. METHODS: The questionnaire was validated with 30 pairs of participants who played a competitive serious game for 10 min while being recorded with cameras. The questionnaire was filled out by both participants, an in-person observer, and 2 members of our research group who watched the videos. Results from these raters were used to develop questionnaire instructions, and the finalized questionnaire was given to 2 additional raters who were trained on 5 videos and then rated the other 25 videos independently. RESULTS: The questionnaire's interrater reliability is excellent for the amount of conversation and its game relatedness (intraclass correlation coefficients [ICCs] above 0.9). Interrater reliability is fair to good for conversation valence (ICCs between 0.4 and 0.7). We believe that the lower interrater reliability for valence is primarily because of a limited spread of valence values in our sample. Furthermore, questionnaire ratings were significantly correlated with players' personality characteristics (eg, amount of conversation was correlated with extraversion) and pressure/tension experienced in the competitive game. CONCLUSIONS: The validated questionnaire has the potential to be a useful tool for studying user experience in competitive and cooperative serious games. Furthermore, it could be adapted for other applications such as entertainment games. However, it has only been validated with unimpaired university students in a 2-player competitive serious game and should next be validated with different target populations (eg, stroke survivors) and different game designs (eg, cooperative games).